Who knows your WHOLE regimen of medicine?

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Let your doctors and pharmacist know your WHOLE regimen.

Which of your providers or pharmacists knows your WHOLE regimen of your medicines? When you go to your doctor you are likely asked about the medications you take. Some practices will ask you to include that information on a piece of paper on a clipboard in the waiting room. Some will hand you a computer with a list of questions that include your medicines. Still others will have the person checking you in ask you about your medications.

Do you take a list of all of your medications with you to the doctor?

Your doctor needs to know the names, the strength, the dose, and exactly how you take each medication.

Rather than try to memorize and remember all of this, make a list before you leave home.

  • Some people take pictures of each medication label and keep them in their phone.
  • Some people use the ‘Medical ID’ app on their smartphone.
  • Some people keep a list printed and in their wallet where it can be easily found by emergency personnel if needed.

Do you include all medicines prescribed by all doctors?

Many of the people I meet think their doctors talk to one another and coordinate their care. Although this is the desire of your doctors, it often does not happen. Your doctors and other providers find it hard to catch up with one another. Even if they work for the same health-system, important details and explanations are often not shared.

  • Include all medications coming from all of your doctors on your list.
  • Don’t assume one doctor explained the latest changes to the other doctors.

Do you include all of the medicines and other substances you take?

All of the substances you take have the potential to interact with each other. This means they can be dangerous when combined. If no one knows each substance you take, then those interactions cannot be checked.  It is important to have a thorough screen of your WHOLE regimen.

Include these items even if you only take them once in awhile.

I highly encourage you to include all of these on your written list.

  • Over-the-counter pain medicine (e.g. Tylenol, ibuprofen, Aleve, aspirin)
  • Stomach ache or acid reflux medicine
  • Headache medicine
  • Allergy medication
  • Eye drops
  • Nose sprays
  • Cold, flu, congestion medicines
  • Constipation or diarrhea medicines
  • Medicated creams or ointments
  • Vitamins
  • Supplements
  • Herbal therapies
  • Marijuana
  • Illicit drugs (at least tell your doctor about these)

I am finding that the people who make the decisions about your prescription medicines do not know all of these important facts. The over-the-counter, herbal, vitamin, and other substances can have side effects, cause problems, and interact just as prescription medications can.

Consider all of these to be MEDICATIONS! Let your doctors and pharmacist know your entire list – your whole regimen!

For more information about the importance of your complete medication list, or for a detailed review of your medication list, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

Just as there are a variety of medications that may be needed for overall health, there are a variety of things we need to include in our lives for our spiritual health. What are the components of your spiritual life?

In what ways do you acknowledge, praise, worship, study, talk with, share, enjoy, and spend time with God?

I liken the prescription medications from your primary doctor to Sunday worship and owning a Bible.

The specialist medications are like the Bible study, Sunday School, and other special short term studies.

What about the components that you choose for yourself from the smorgasbord of options? Do you include prayer, worship music, contemporary Christian music, daily devotions, meditation, accountability partners, online resources, or other choices?

Do you select a wide variety of options?

Do you stick to one or two?

Do you limit yourself to the Sunday morning selections?

Colossians 3:12-17 (MSG) gives several ideas about the many ways you can keep God active in your life.

So, chosen by God for this new life of love, dress in the wardrobe God picked out for you: compassion, kindness, humility, quiet strength, discipline. Be even-tempered, content with second place, quick to forgive an offense. Forgive as quickly and completely as the Master forgave you. And regardless of what else you put on, wear love. It’s your basic, all-purpose garment. Never be without it.

Let the peace of Christ keep you in tune with each other, in step with each other. None of this going off and doing your own thing. And cultivate thankfulness. Let the Word of Christ—the Message—have the run of the house. Give it plenty of room in your lives. Instruct and direct one another using good common sense. And sing, sing your hearts out to God! Let every detail in your lives—words, actions, whatever—be done in the name of the Master, Jesus, thanking God the Father every step of the way.

There are so many ways you can get to know God better. Even if you have been studying and worshipping for decades, there is more to learn and more love to experience.

Then there is prayer. There is real power in prayer.

James 5:13-16 (ESV)

Is anyone among you suffering? Let him pray. Is anyone cheerful? Let him sing praise. Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the one who is sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven. Therefore, confess your sins to one another and pray for one another, that you may be healed. The prayer of a righteous person has great power as it is working.

Prayer that acknowledges God and His will and timing can do great things. Never overlook the power of prayer.

It is my hope this has inspired you to add some more elements to your daily walk with God. The God who created the Universe and who loves you beyond measure looks forward to each and every remedy you select to stay close to Him and know Him better.

Blessings,

Michelle

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Aging effects

Aging – the good, the bad, the medication issues

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Changes come with aging – some impact best medication use.

You are aging. No matter your overall health, your lifestyle choice, your beliefs about the medical system, you are aging.

If you do EVERYTHING right when it comes to healthy living, will aging stop? No.

Here are some changes that occur in all of us with aging.

  • Kidney function starts a very gradual decline in your late 30’s or early 40’s.
  • Liver size and blood flow to your liver diminish. The number of cells shrinks. There is less activity of the enzymes that break down medications.
  • Food and medications move through the intestine more slowly.
  • The volume of urine that the bladder can hold decreases. Bladder muscles weaken.
  • For men, the prostate gland increases in size.
  • For women, the urethra shortens and becomes thinner. So, risk of urinary tract infection goes up.
  • Muscles weaken as growth hormone levels decline.
  • Aldosterone levels decrease, so risk of dehydration goes up.
  • The immune system slows down. So, risk of infection and cancer go up. Also, it can take longer to treat an infection.
  • Heart muscle and blood vessels get stiffer. This can increase risk of high blood pressure. Also, with exercise, the heart can’t pump as much blood or speed up as much as it did at younger ages. So, exercise capacity is lower.
  • The muscles involved in breathing weaken. There is a decline in the number of small sacs in the lungs where oxygen is passed to the blood.
  • The amount of water in the body goes down while the body fat goes up.

This is not intended to alarm or depress you. With aging also comes wisdom, experience, tolerance, and the benefits of many life lessons. So, celebrate the process with its good and challenging elements.

As a pharmacist, I want you to understand how and why medications should be prescribed differently at different ages. Any medical conditions; habits such as smoking or excess alcohol consumption; excess weight; and other factors can further impact how medication actions change over time.

The first step of a medication’s actions comes when it is presented to the body. Most often it is swallowed and then has to be absorbed. Absorption is not impacted very much by normal aging, but it is impacted by medications that lower stomach acid, change the rate of the gastrointestinal tract, or by stomach or intestine procedures.

The second step is distribution. The medication, once absorbed, is distributed throughout the body. Some medications prefer fat and other prefer water. As we age, we have more body fat and less body water. So, medications that love water are more concentrated in the overall smaller total amount of water. The medications that love fat are distributed to more places and can be harder to gather it all back together to get rid of it.

The third step is metabolism. This is how the medication is broken down in the body. Some medications have to be broken down in order to get rid of them. Others have to be broken down in order to reach their more active form. Metabolism happens in the liver. Over time, the liver becomes less active, so it takes longer to break down some medications.

The fourth step is elimination. This is how the medication leaves the body. Most medications are either eliminated through the urine or through the feces (stool). So, any decrease in kidney function will slow down the elimination through the urine. Any slowing, shortening, or other issues with the intestines and colon can impact the elimination through the feces.

The important point of mentioning all of this is to make you aware that medications act differently in your body as you age. The medication, the dose, the timing that was good for you 10 years ago might not be the best for you now. Your doctor shouldn’t prescribe medications in the same way for a 70 year old person as prescribed for a 30 year old person.

I encourage you to ask your doctor and your pharmacist to carefully review your medications to be sure all are correct for your age and your unique set of medical conditions.

We would also be happy to provide that very thorough assessment for you. You can contact us at www.medsmash.com.

BIBLICAL APPLICATION

A life of faith is a long pursuit. It often takes time to develop perseverance and character, hope and joy in all circumstances.

Romans 5:3-5 NIV

Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us.

Throughout the Psalms and Proverbs age is revered with dignity and honor.

Proverbs 16:31 ESV

Gray hair is a crown of glory; it is gained in a righteous life.

Psalm 71:18 ESV

So even to old age and gray hairs, O God, do not forsake me, until I proclaim your might to another generation, your power to all those to come.

Psalm 92:12-15 ESV

The righteous flourish like the palm tree and grow like a cedar in Lebanon. They are planted in the house of the Lord; they flourish in the courts of our God. They still bear fruit in old age; they are ever full of sap and green, to declare that the Lord is upright; he is my rock, and there is no unrighteousness in him.

Psalm 71:9 ESV

Do not cast me off in the time of old age; forsake me not when my strength is spent.

Proverbs 20:29 ESV

The glory of young men is their strength, but the splendor of old men is their gray hair.

At the end of this life we have the promise of a glorious eternity. It makes the aging and the waiting easier to dwell on what is to come!

2 Corinthians 4:16 ESV

So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day.

Blessings,

Michelle

Image source: National Institute of Aging; National Institutes of Health; US Department of Health and Human Services.

Sunscreen – Necessary protection or just a nuisance?

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Protect your skin with sunscreen this summer. Rest in the protection of the Son!

It is that sunburn time of year. Do you wear sunscreen? If you do, do you wear it every day? Do you just wear it when you are going to the beach?

I’ll start by admitting I have made nearly every sun protection mistake, so this blog comes from scientific research, reputable articles, and a little ‘school of hard knocks.’

Sunscreen for Babies

The American Academy of Pediatrics does not recommend sunscreen for infants under 6 months of age. Their skin functions are still developing. It is best to keep them out of the sun. But, if parts of them must be in the sun, a little bit of SPF 15 sunscreen is better than unprotected skin. Sun blocks are most protective. Look for ingredients of zinc oxide or titanium dioxide.

Sunscreen for everyone else

Suncreen is important to protect your skin.

Why?

Sunscreen can protect against skin cancer, age spots, and skin damage from the sun. It can also help prevent actinic keratoses, which are not cancer but are big brown spots. It can also protect against rashes and reactions to the sun (photosensitivity) that some people get.

How much? 

For an average size adult in a swimsuit, the proper amount is enough to fill a 1 ounce (30mL) shot glass.

When?

Chemical sunscreen products need to be applied 30 minutes before sun exposure because they need to be absorbed to protect your skin, but products containing zinc oxide or titanium dioxide protect right away. Reapply after each dip in the water and at least every 2 hours.

Which kind?

Interestingly, SPF 30 is NOT twice as good as SPF 15. When a proper amount is applied (see above), SPF 15 sunscreen absorbs 93% of UVB radiation. SPF 30 absorbs 97%, and SPF 50 absorbs 98%. Using SPF greater than 50 doesn’t really add any benefit.

So, if you put on the recommended amount and replace as recommended, SPF 15 is enough. If you put on a light layer or don’t repeat as often as you should, use SPF 30 or 50.

What if I have dark skin or already have a tan?

Studies have not found that this protects you. Skin protection is still important not only for sunburn but also for cancer and other skin damage. So, keep on wearing that sunscreen, even after you get tanned.

What else can cause me to burn?

There are several medications that cause you to be more sensitive to the sun. If you take these, your risk of sunburn is much greater. Some of the more common ones are:

  • Tetracycline or doxycycline (antibiotic – used for acne and Lyme’s disease and other infections)
  • Hydrochlorothiazide or furosemide (diuretic/water pill)
  • Sulfa antibiotics (SMX/TMZ, Bactrim, Septra)
  • Fluoroquinolone antibiotics (Cipro, Levaquin, and others)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – (piroxicam, ketoprofen, maybe ibuprofen or naproxen)
  • Phenothiazines – antipsychotic agents

Check with your pharmacist or look on the written information that comes with your prescription for the word ‘photosensitivity’ in the side effects.

Besides using sunscreen, keeping your skin covered with clothes, hats, or umbrellas can provide protection.

If you have a history of prolonged sun exposure, you have new brown or other colored spots on your skin, or you have spots that are changing, make an appointment with a dermatologist. Skin cancer screening is quick and can save your life. Don’t delay or wait to see with these skin changes.

For more information about sunscreen contact us at www.medsmash.com.

BIBLICAL APPLICATION

The sun is such a critical part of our existence. Yes it can harm us.

The Son is such a critical part of our existence. He can protect us.

What does that protection mean? Will you be without any trouble? If God is on your side, will no one be against you?

No, it doesn’t work like that. We are assured that trouble will come. We are assured we will be tempted,

2 Corinthians 4:8-9 TLB)

We are pressed on every side by troubles, but not crushed and broken. We are perplexed because we don’t know why things happen as they do, but we don’t give up and quit. We are hunted down, but God never abandons us. We get knocked down, but we get up again and keep going.

Knowing who is on our side and protecting us helps us through the trouble.

Psalm 121: 5-8 MSG

God’s your Guardian,

    right at your side to protect you—

Shielding you from sunstroke,

    sheltering you from moonstroke.

 

God guards you from every evil,

    he guards your very life.

He guards you when you leave and when you return,

    he guards you now, he guards you always.

So go on out into the sun relying on the protection of the Son in your life. Go where He leads with the assurance of His love and oversight.

Proverbs 3:5-6 MSG

Trust God from the bottom of your heart;

    don’t try to figure out everything on your own.

Listen for God’s voice in everything you do, everywhere you go;

    he’s the one who will keep you on track.

 

Enjoy these sunny days with confidence!

Blessings,

Michelle

Posttraumatic Stress Disorder (PTSD) – Is It Real?

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There are growing resources, help, and hope for those with PTSD.

Posttraumatic Stress Disorder (PTSD) is finally becoming a topic that is discussed – in public. It finally has ‘a voice’ and several avenues of treatment to address it.

I was fortunate to serve about seven years of my career in the Veterans Affairs system. I worked alongside some of the best, most caring providers and the most robust interprofessional teams. These teams consisted of physicians (geriatricians who focus on people over 65, in my case), nurses, pharmacists, dieticians, physical therapists, occupational therapists, social workers, psychologists, psychiatrists, and every level of trainee – students, residents, and fellows. Together we provided care to aging adults in the clinic, the acute care hospital, the intermediate unit, long-term-care (nursing home), and the domiciliary. The ‘dom’ was long term, independent housing for veterans who did not have a family to live with after the war.

I am thankful for every veteran that has served our country in one of the countless ways our uniformed services care for this country every day. The stories I heard during those years were enlightening, empowering, endearing, and sometimes gut wrenching. I have heard others say this: In my experience, those who talked the least about their service saw the most ‘action’ and devastation.

One day I was in clinic with a student. It was a very normal day. As the pharmacist, my visits mostly pertained to medications – why, how, when they are taken and the result. On this day, during a normal pharmacy clinic visit, one of our veterans told his story. It forever changed my life. Here is a paraphrase. I will leave out the specific war, because the story could fit any of them.

“I was assigned the night guard shift for my platoon. It was my duty to walk around the perimeter of the base to look for anyone (of the enemy) who might try to attack at night. It was typically uneventful. One night, as I rounded a corner, I was face-to-face with a man from the ‘other side.’ In a split second I thought about my family – my wife and children. I thought about how I just want to go home to them. I thought I don’t know this man. I don’t hate this man. He probably has a wife and children waiting for him at home, too. We might even be friends in other circumstances.’

We all sat and cried for a long time.

After this event, this man, this veteran had a mental breakdown. He was sent to an island where soldiers not able to function in combat were stationed during that war. While there he started trying to stop reliving the event through alcohol. When he finally got home to his wife and children, he was an alcoholic. He had posttraumatic stress disorder. But, it wasn’t recognized, diagnosed, and treated as it is now. I certainly don’t know all of the details, but he and his family were not able to reunite and stay together. It broke my heart to see what had happened. I wonder if his wife and children ever knew what happened? I wonder if knowing could have changed the outcome for their family. No doubt he would be forever changed after an experience like that.

Post Traumatic Stress Disorder (PTSD)

PTSD is a condition where there is stress and symptoms for more than three months after a trauma or highly stressful event (or series of events). The stress and symptoms disrupt regular daily activities and are distressing. PTSD can result from war (as in the example above), natural disasters, sexual or physical assault, horror, accidents, or other terrifying event. PTSD can present in about four different ways.

  1. Reliving the event – nightmares, flashbacks, triggers
  2. Avoiding any reminders of the event – driving if in a car crash; crowds if they cause insecurity; fireworks if associated with gunfire; movies related to the event
  3. Negative feelings or changes in feelings about the world and the future; suppressing or forgetting parts of the event
  4. Feeling keyed up (hyperarousal) – easily startled, trouble sleeping, difficulty concentrating

Treatment has multiple components. Understanding PTSD is an important step. Counseling and cognitive behavioral therapy can help. In cognitive behavioral therapy, people can become aware of thoughts and feelings, and that allows them to be processed and better understood. Then skills to face those feelings and make changes in a way that allows them to have less impact are developed. For each person, this process is different. There are highly trained, experienced therapists who will work with each personal individually.

For medication treatment, selective serotonin reuptake inhibitors (SSRIs) are most commonly used. These are medications that are also commonly used to treat depression and anxiety. They are unlikely to resolve symptoms alone. They are an important part of the multiple components of treatment.

Other components might be exposure therapy, group therapy, family therapy, and more.

A recommended site to learn more about PTSD is through the VA.

Again, there is a growing number of resources available to anyone who might be experiencing PTSD. If you or someone you know might have PTSD, please seek help right away. To suffer alone is not the answer. Alcohol, drugs, and suicide are not the answer. Help is available!

For more information about PTSD, contact us at www.medsmash.com.

BIBLICAL APPLICATION

PTSD is a real disorder. It is estimated about 3.5% of adults in the US have PTSD. Over 9% of people ages 50-65 have now or have experienced PTSD.

It can be hard to think rationally when suffering from PTSD. The terror, stress, and anxiety can keep the brain in ‘fight or flight’ mode. When in this mode, reflection, perspective, and problem-solving functions are very limited.

So, how can you support someone suffering from PTSD? Understanding the disorder and being a source of compassion and love are good places to start.

No platitude or Bible verse makes PTSD go away. Some Christian leaders have implied PTSD is something that can be chosen or can be avoided with a focus on God. I strongly disagree. Sinful people can hurt, traumatize, and destroy other people. Even people who know and love God can be traumatized.

But as people of God, we can support people who have suffered. If you have PTSD, know you are not alone. If you know someone who has (or you suspect may have) PTSD, approach with God’s unconditional love. Support through the many stages and steps of recovery and learning to cope. PTSD doesn’t just go away at some point; it might take a lifetime of coping and skill building to live in spite of past trauma.

There are many stories of violence, war, and crimes in the Bible.

These are followed by God’s restorative grace and mercy.

There are many verses about love, strength, deliverance, and rest for our soul.

In time, with treatment and a strong support network, these conversations can be had.

Until then, in the more acute phases when the brain is so busy with ‘fight or flight’ mode, prayer, presence, and unconditional love are ways you can start the story of grace.

Be on the lookout for people who may have PTSD who are not yet receiving treatment. Pray for the many people in our world who are PTSD victims. Love and care for those with PTSD in your life.

1 John 4:11-12 The Message (MSG)

My dear, dear friends, if God loved us like this, we certainly ought to love each other. No one has seen God, ever. But if we love one another, God dwells deeply within us, and his love becomes complete in us—perfect love!

Blessings,

Michelle