Month: May 2016

No U-turn available

When a U-turn is not available – end-of-life care

Posted on by Michelle Fritsch, Pharm.D.
No U-turn available
Supportive options when it’s time for end-of-life care.

Now we turn to end-of-life care.  Last blog we talked about the U-turns available in your life and health. These can help you feel better and live healthier. We learned you can still make changes that have a positive impact on your overall health.

What about when a U-turn is not available?

What about when you get that diagnosis of:

The U-turn is not available.

We can’t stop it. We won’t be able to turn it around. There are a number of conditions that at this moment have no cure or way to get rid of them.

When we run out of options, then the end of life becomes our focus. This is peaceful for some. It is frightening and a huge struggle for others. It impacts not only the person diagnosed but also all of their friends and family. Each person involved deals with a number of feelings during this time. There can be guilt, fear, conflict, regret, and grief, among others.

The support of others, education about what is happening, and sources of comfort are critical.

Resources for end-of-life

Following are some resources for everyone involved in end-of-life care.

  • Support groups – There are support groups for most common diagnoses, for people with the diagnosis and for caregivers and family members, and for various stages of the condition.
  • Caregiver stress and burden – Caring for a loved one near the end of life can be emotionally and physically exhausting. There are many resources that provide assistance (such as in-home care agencies) or respite (short term stays while the caregiver takes a break).
  • Caregiver care – A caregiver can’t fully care for their loved one if they don’t also take care of themselves. Emotional, physical, and spiritual health need attention during this demanding time.
  • Resources – Your community will have various agencies available to provide numerous sources of help. These include direct healthcare, legal guidance, financial aid, spiritual support, placement options, and more. If the person nearing end-of-life is over age 65, your local Agency on Aging could be a valuable source of lists of the resources available in your area.
  • Palliative care – This is care that is focused on comfort and support to accomplish goals toward the end of life.
    • Hospice is one form of palliative care. Your hospice organization can support you, provide education about current and future changes, and help you with preparation for all involved.

When the end-of-life can be anticipated (vs suddenly taken), there is an opportunity to prepare and fully live those final months or days.

For more information about end-of-life options, contact us at www.medsmash.com.

BIBLICAL APPLICATION

What’s different about the people that find peace in the end of life?

Romans 6:23 ESV

For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord.

This tells us that death of this life is not he end. It is only the beginning of eternity. What does that mean to you? Is it really true?

John 3:16 ESV

“For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life.”

The hope we can take through those seasons of palliative care and hospice is the result of anticipating the end of this life and moving on to eternal life.

John 5:24 ESV

Truly, truly, I say to you, whoever hears my word and believes him who sent me has eternal life. He does not come into judgment, but has passed from death to life.

Ephesians 2:8-9 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast.

If this life is just the preamble to a life of eternity with Christ, then death loses its sting.

1 Corinthians 15:55-57 NIV

“Where, O death, is your victory?

    Where, O death, is your sting?”

The sting of death is sin, and the power of sin is the law.  But thanks be to God! He gives us the victory through our Lord Jesus Christ.

I pray you find hope and peace as you ponder this perspective of death.

Blessings,

Michelle

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U-Turn ahead – not too late to turn your health around

Posted on by Michelle Fritsch, Pharm.D.
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Turn your health around. Make changes to improve your health.

Is it too late to turn your health around? Although we were raised certain ways we can still make a U-turn, or at least navigate a big curve. I was raised with dessert every day, lots of processed foods, little to no access to seafood, and limited fresh vegetables beyond summer. Meals were built around meat and potatoes. As for exercise, anyone who knows me can attest to my utter lack of athletic ability. So, should we settle for life-long habits and figure it’s too late to make changes now?

Actually, there is a LOT of evidence that changes, at all stages of life, still help you. Below are just a few of the most common habits/choices that can be changed in a way that really makes you feel better.

Changes to turn your health around

  • Quit smoking –
    • Just 20 minutes after you quit your blood pressure and heart rate decrease.
    • Your risk of a heart attack starts to go down at 24 hours.
    • Taste and smell start to improve at 48 hours.
    • After 1-5 years your risk of heart disease is cut in half.
    • After 10 years your risk of lung cancer is almost as low as a lifelong nonsmoker.
  • Weight loss – short and long term
    • Small weight loss can have big advantages.
    • If you lose 5-10% of your body weight, your blood pressure, blood sugar, and cholesterol all improve.
    • Your risk of heart disease goes down.
    • It gets easier to breathe.
    • Sleep apnea can improve helping you sleep better and be less sleepy during the day.
    • Your sex drive
    • Joint pain
  • Diet changes –
    • Decreasing your daily calories by 500-1,000 per day will decrease weight 1-2 pounds per week. [Faster weight loss is not as healthy and hard to sustain.]
    • Gradually add more interesting fruits and vegetables to your diet.
      • Sudden, drastic changes are not necessary and are hard to do.
      • More variety in fruits and vegetables will increase the types of vitamins and nutrients you get.
    • Change up your fat
      • Exchange some of your red meat meals for fish (your grocery store meat section will likely have instructions on how to prepare whatever is on sale or available in the meat section).
      • Try nuts for snacks over sugary snacks.
    • Sugar
      • Drink more water or unsweetened beverages in place of sugary soda or fruit juice.
      • Eat smaller portions of your dessert, as a starting point to cut back.
  •  Exercise
    • Get moving – it helps with more than just weight control.
    • Decrease joint pain and strain, especially your lower back.
    • Get stronger and be more resilient against small strains and sprains.
    • Be more flexible.
    • Decrease your risk of a fall that could injure you.
    • Stay healthy and independent longer through fitness.
    • Have more energy and stamina.
    • Exercise doesn’t have to mean joining a gym or playing a sport.
      • Get up and move around during commercial breaks on TV.
      • Park farther from the front door.
      • Go for a walk with a friend.
      • Window shop in all of the stores at the mall before making a purchase.

U-turns are allowed in your life. No matter your age and for how long you have been doing things a certain way, make a change. Turn your health around. See how much better you can feel with very small changes starting today.

For more information about healthy choices and making a U-turn, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Are you drowning in your negative self-talk? Are you always striving to do better? Or, are you constantly making excuses and blaming others for your weaknesses?

These are such easy routes to take! They are such easy ruts to fall into.

Will you ever be at peace and feel that all is right in your world? What would that take?

My understanding of the Bible is that the peace and promise you’re seeking is available to you RIGHT NOW.

There is nothing you have done that God doesn’t already know about. You can’t hide. Rather than being terrified by that, realize you are loved. You are loved and accepted and forgivable. Absolutely nothing you have done could make God turn away from you.

1 John 4:18 ESV

There is no fear in love, but perfect love casts out fear. For fear has to do with punishment, and whoever fears has not been perfected in love.

Grace, mercy, and forgiveness are right here waiting for you.

Romans 5:8 ESV

But God shows his love for us in that while we were still sinners, Christ died for us.

You could absolutely never do anything so terrible that would exclude you from the love and grace of Jesus Christ.

It was this love that led to Jesus’ death – all for your sins and mine. And because of that sacrifice, you are saved.

Let’s look again at 1 John 4:17-18 from The Message:

God is love. When we take up permanent residence in a life of love, we live in God and God lives in us. This way, love has the run of the house, becomes at home and mature in us, so that we’re free of worry on Judgment Day—our standing in the world is identical with Christ’s. There is no room in love for fear. Well-formed love banishes fear. Since fear is crippling, a fearful life—fear of death, fear of judgment—is one not yet fully formed in love.

Not only can you take a U-turn in your daily physical health choices, you can take a U-turn in your spiritual health. Stop hiding. Stop beating yourself up. Embrace this love that is completely yours. You are forgiven as soon as you let go and give your all to God who loves you with no conditions.

Blessings,

Michelle

 

Are Your Medicines Improving Your Quality of Life?

Posted on by Michelle Fritsch, Pharm.D.
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Quality of life should be preserved and enhanced with your medication.

Medications have two main purposes.

  • One is to increase your QUALITY of life. They relieve or control the symptoms that make it hard to do our daily tasks. Quality of life is your ability to enjoy and engage in your life. It is your ability to do the things you want to do during the day.
  • The other is to increase your QUANTITY of life. They help control medical conditions so you can live longer.

ALL medications have potential side effects. Some of these side effects are a minor nuisance that goes away. Some of these side effects are so severe you are changed to a different medicine. Then there are some times when another medicine is started to treat the side effects of the first medicine. In most situations I highly discourage this practice. There are a few select exceptions.

Medications and Quality of Life

This blog is about the medications that are prescribed to help you live better. Using them is intended to improve your quality of life. But, they have side effects that keep you from functioning normally. Those side effects actually decrease your quality of life. Here are a few examples:

  • Pain medication for back pain makes you so sleepy you just lay around.
  • Blood pressure medicine makes your blood pressure so low you don’t have the energy to do regular daily tasks or you get really dizzy when you stand up or turn quickly.
  • Anxiety medicine keeps you so groggy you can’t function.
  • Sleep medicine keeps you sleepy all through the next morning.
  • Diabetes medicine makes your blood sugar so low you are weak, shaky, and dizzy.
  • Parkinson’s Disease medicine makes you so dizzy you can’t go out.
  • Incontinence medicines makes you so constipated you are miserable.

It doesn’t make sense for a medicine intended to help to actually cause just as many problems as the thing it was prescribed to treat. Talk to you doctor! Your doctor might not know unless you talk about it. Your relationship with your doctor should include conversations about your goals. Let your doctor know what daily events and tasks are important to you. Then, work together to reach those goals through medication, physical therapy, counseling, diet, or other means.

We are here to help, too! At Meds MASH we will carefully review all of your medicines to be sure you are getting the maximum benefit with the least side effects. Often a dose change or an alternate medication can make a huge difference. We work closely with your doctor to optimize your medicines. You don’t need to live with side effects that hold you down. Contact us at www.medsmash.com.

BIBLICAL APPLICATION

What is your purpose for being? I had a chance to ‘people watch’ for a while this week. It got me thinking about what drives people. We know that EVERYONE has insecurities. Everyone has struggles. God has a purpose for everyone. Society gives a lot of messages that don’t align with the Bible. A lot of people have never even heard about the God who loves them. People have so many reasons for the actions they take. As a whole, people are so confused.

Here are a few reasons for decisions that come to mind:

  • Some people elevate themselves by suppressing others.
  • Others spend all of their time growing their sphere of influence.
  • Some live to serve and please others (sometimes at risk to themselves).
  • Several spend their time protecting themselves.
  • And then some hide from other people and insulate themselves.

Our selfish actions can have unwanted side effects, just like the medications discussed above.

Are we to spend this life racking up points? No! That is exactly why Christ died and rose. He took the ‘rules’ and replaced them with grace and redemption. You don’t have to ‘earn’ your way to Him.

John 3:16-18 The Message

“This is how much God loved the world: He gave his Son, his one and only Son. And this is why: so that no one need be destroyed; by believing in him, anyone can have a whole and lasting life. God didn’t go to all the trouble of sending his Son merely to point an accusing finger, telling the world how bad it was. He came to help, to put the world right again. Anyone who trusts in him is acquitted; anyone who refuses to trust him has long since been under the death sentence without knowing it. And why? Because of that person’s failure to believe in the one-of-a-kind Son of God when introduced to him.

I’m hoping this makes you rethink your purpose for being the way it makes me rethink mine. As I make decisions each and every day, what is my underlying motivation?

I am called to believe, trust, and follow in faith. If I am walking closely with God, He will help me make decisions that make sense. He has this perspective that is so far beyond anything I could imagine.

Proverbs 3:5-6 ESV

Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths.

James 1:5 ESV

If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him.

So contrary to what society tells you and where your own flawed thinking might take you, your priority can be God’s plan for you. Staying focused on this can help you avoid decisions that hurt other people. It can help you take the focus off of yourself. It won’t rid you of problems, but it can increase your confidence that you’re not alone.

Just say ‘no’ to the side effects of selfish thinking!

Blessings,

Michelle

Sleep – To Medicate or Not to Medicate

Posted on by Michelle Fritsch, Pharm.D.
sleepingproblems
Regular sleep helps you think clearly and make better decisions

AAAhhhhh, there is nothing like a good night’s sleep. Don’t you feel refreshed and ready to conquer the world when you are well rested? How do you feel when you haven’t been sleeping well? Irritable, short-tempered, unfocused, …?

Feeling extra sleepy is linked to:

  • Motor vehicle accidents
  • Poor test performance
  • Poor decision making
  • Difficulty concentrating
  • Difficulty solving problems
  • Mood changes
  • Pain intolerance
  • Mistakes
  • Errors in judgment

So, it is not all in your head if you think you don’t have such a great day when you don’t sleep well.

The TV commercials tell you to grab one of the over-the-counter sleep medicines. I want to DISCOURAGE you from doing that. Most of the over-the-counter sleep options contain either diphenhydramine (Benadryl) or a sedating antihistamine like doxylamine. These medications are not recommended in people over 60. Not only do they make you really sleepy, they are very anticholinergic.

Anticholinergic

Anticholinergic medications are very drying. They cause dry mouth, dry eyes, constipation, and difficulty urinating. They also make your thought process fuzzy. Medications with anticholinergic side effects greatly increase risk of falls. There are MANY studies showing that people who take these sleep aids are more likely to fall.

Zzz sleep medications

There are some newer prescription sleep medications available. Three are referred to as the ‘zzz’ medications. They are zaleplon (Sonata), exzopiclone (Lunesta), and zolpidem (Ambien). Note the ‘z’ in each name. These are options when all good sleep habits have been tried and failed; or when insomnia occurs regularly or for a prolonged time. When they are used, the lowest possible dose for a short time is best. Each of these medications is linked to falls (especially if you get up during the night to go to the bathroom while sedated). Each is linked to car accidents if you drive while still under the effect of the medication. Each can cause odd behaviors in come people such as sleep driving or other tasks while asleep. I had a patient once who awoke to find Wal-Mart bags full of merchandise all over her living room floor. She had gone to Wal-Mart in her sleep and had a shopping spree. She brought it all home and into the house then went back to bed. She could remember none of it.

So use these medications only when necessary, at the lowest possible dose, for a short time under the careful guidance of a prescriber. Only take one when you are able to stay in bed and sleep for a full night (7-8 hours). These are NOT for a short sleep and get-up-and-go kind of night.

BEST sleep habits

Prior to considering adding medications, these habits can help you sleep better.

  • Keep your sleep schedule regular – Go to bed and get up at the same time each day.
  • Keep your bed for sleep and sex only.
  • Avoid daytime naps.
  • Avoid caffeine, chocolate, alcohol, or spicy food.
  • Avoid TV, reading your phone, using your computer right before bed. The light of the electronics triggers your brain to be active. There are several studies linking use of electronics before bed to poor sleep.
  • Get some exercise during the day so your body is tired as well as your brain.
  • Try deep breathing. Take slow, deep breaths in and slowly blow them out.
  • Try progressive muscle relaxation. Start at your toes. Squeeze your toes tightly then let them relax. Keep going with all of the muscles as you work up your body.
  • There are several other techniques available in the links on this page.

I highly encourage you to try all of the sleep techniques that don’t involve medications first. Then, if you do need medication, get a prescription from your doctor for a low dose. Use it only when truly needed for a very few days. Be sure you can dedicate a full night to sleep before taking a dose.

One other option when good sleep habits aren’t enough is melatonin. Melatonin is a natural product that improves sleep in some people. It takes up to a month to see the full effects. It can help you fall asleep quicker, sleep better, and sleep longer. Each dose won’t necessarily make you feel sleepy. The impact is more gradual over time. The starting dose is 2-3 mg at bedtime.

For more information on sleep options, contact us at www.medsmash.com.

BIBLICAL APPLICATION

It’s amazing how the eternal confidence of unconditional love can enhance sleep.

All of us have our overwhelming days, our painful nights, our frightening challenges.

We also have a source of hope and joy to see us through all circumstances. In Christ, you know who is ultimately in control. You know where you will be spending eternity.

So, on those bad, sleepless nights, give your burdens to the One who is asking you to give them over.

Proverbs 3:24 ESV

If you lie down, you will not be afraid; when you lie down, your sleep will be sweet.

Psalm 4:8 ESV

In peace I will both lie down and sleep; for you alone, O Lord, make me dwell in safety.

Psalm 121 CEV

The Lord Will Protect His People

I look to the hills!

    Where will I find help?

It will come from the Lord,

    who created the heavens

    and the earth.

The Lord is your protector,

    and he won’t go to sleep

    or let you stumble.

The protector of Israel

doesn’t doze

    or ever get drowsy.

The Lord is your protector,

there at your right side

    to shade you from the sun.

You won’t be harmed

by the sun during the day

    or by the moon[a] at night.

The Lord will protect you

    and keep you safe

    from all dangers.

The Lord will protect you

    now and always

    wherever you go.

 

Sweet dreams and blessings,

Michelle

Image source: Source:  National Library of Medicine; National Institutes of Health; U.S. Department of Health and Human Services

Narcotic Addiction – the epidemic and new strategies

Posted on by Michelle Fritsch, Pharm.D.
Meds bathroom
Prolonged use at higher than necessary doses can lead to opioid (narcotic) addiction

Narcotic addiction is now at epidemic proportions. Drug abuse has been with us for all of recorded time. The specifics of the drug(s) most commonly abused change over time. Sometimes the most abused drugs fall out of favor for a while and then reemerge. Common examples from the past few decades include LSD, cocaine, crack cocaine, and inhalants.

Right now, prescription opioid pain medicines (narcotics) are being abused at an alarming rate.

According to the Centers for Disease Control (CDC), 2 million people abused or were dependent on opioid analgesics in 2014.

Refer back to last week’s blog. Terms are very important here. Dependence is a physiologic response to these medications. Anyone who takes them over time will have some changes in how their body handles pain signals. The body’s normal response takes a backseat to the medication. In order for the body to take over again, the medication needs to be titrated off slowly. If you stop the medication all of a sudden, the body goes through withdrawal. It can’t take back over the pain control that quickly. It needs time to gear up. NOTE, this type of dependence and withdrawal is different than ADDICTION.

Addiction

Genetic, psychosocial, and environmental factors all play a role in the creation of an addiction.

Addiction usually occurs when the opioid medication is continued after the pain has gotten better. Sometimes people keep taking the medication for the effects beyond the pain relief. Some people feel a euphoria or high while others are very laid back.   If they keep continuing the medication for this purpose, then addiction can occur. Not only are the body’s receptors letting the medication handle pain it is seeking these other effects. Over time it takes a higher dose more frequently to get the same amount of desired effect. So, doses keep going up and desire to take the medication is very strong.

The FBI and the DEA created a documentary about this addiction. If you would like to know more, I highly encourage you to watch this video. You can find it at this link: https://www.fbi.gov/news/stories/2016/february/raising-awareness-of-opioid-addiction/video/chasing-the-dragon-the-life-of-an-opiate-addict.

In March of this year (2016), the CDC released new guidelines for prescribing of these medications. If you would like to read them, you can find it at this link: http://www.cdc.gov/drugoverdose/prescribing/guideline.html . These guidelines are emphasizing less use.  Use only for moderate to severe pain.  Use at the lowest possible dose for the shortest time possible. There are other, non-addictive options for lesser pain.

When people addicted to prescribed opioid pain medications can’t get more prescriptions, they often turn to heroin. This is another opioid substance that is illegal but sadly, easier to get ‘on the street’. This allows the addicted person to keep getting the effects they are seeking. Note, at this point, addicted people realize this is a miserable, horrifying state. But the demands for more drugs override common sense. Again, I highly recommend watching the video created by the FBI and DEA.

So overcoming this epidemic is being addressed from the prevention side by the new prescribing guidelines. It is also being addressed through new medications and techniques to help people escape the addiction. So, there is hope for the future with this addiction!

If you would like to know more about narcotic addiction, new steps to address it, or similar topics, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Temptation has been part of our world since Adam and Eve, the very first people. It did not take mankind long at all to prove how difficult resistance to temptation can be.

I first want to send a loud, clear message that love, compassion, forgiveness, and constant support are key elements of walking away from addiction. Rather than avoid, isolate, and punish those who find themselves addicted, we have a calling to reach out in love and be part of that crucial support network.

Proverbs 17:17 TLB

A true friend is always loyal, and a brother is born to help in time of need.

1 Peter 4:8 NIV

Above all, love each other deeply, because love covers over a multitude of sins.

I want to write about temptation and the fact that it is a fact of life. God knows all about the temptations in our path. He is also there to help us through. And when we are entangled in a temptation that we did not resist, He is there to bring us back away from it.

1 Corinthians 10:13 ESV

No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.

1 Peter 5:8 ESV

Be sober-minded; be watchful. Your adversary the devil prowls around like a roaring lion, seeking someone to devour.

James 1:12-15 ESV

Blessed is the man who remains steadfast under trial, for when he has stood the test he will receive the crown of life, which God has promised to those who love him. Let no one say when he is tempted, “I am being tempted by God,” for God cannot be tempted with evil, and he himself tempts no one. But each person is tempted when he is lured and enticed by his own desire. Then desire when it has conceived gives birth to sin, and sin when it is fully grown brings forth death.

1 John 2:16 ESV

For all that is in the world—the desires of the flesh and the desires of the eyes and pride in possessions—is not from the Father but is from the world.

I pray you are always aware of the temptation around you and the help available to you at all times from God. I also hope you find opportunities to reach out to those who have fallen into temptation and love them back out of that snare. That love might be tough love, but the Bible is full of examples of that too. Check out Luke 6:27-49.

Blessings,

Michelle