Month: July 2016

Your Medical Insurance – perfect?

Posted on by Michelle Fritsch, Pharm.D.
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Does you medical insurance meet your needs? Is it a right?

You likely have medical insurance if you live in the United States. As of 2014, 90% of Americans did. When the 2015 data is released, that number is likely to go up a bit. It increased 2.9% from 2013 to 2014.

Does your insurance policy cover all that you want it to cover? Are all of the types of care you desire covered? Is your care ever delayed longer than anticipated due to insurance company authorization steps?

Our family just experienced this for the second time this year. It is very easy to get frustrated with insurance-related delays. Your doctor orders a test or procedure, and your insurance company takes time to authorize it.

There is a series of checks and balances between the healthcare system (doctors, clinics, hospitals, etc.), insurance companies, and lawyers. Sometimes it seems to tip, leaning more in one of these three directions, but each aspect is needed. Insurance provides you with coverage to maintain your health without losing all of your money due to an illness. It also provides checks and balances to assure cost-effective use of resources, such as procedures, surgeries, and devices. Lawyers help assure you have recourse if healthcare harms you rather than help you.

As a healthcare provider, I have seen numerous examples of excellent healthcare that has prevented or effectively treated a medical issue. I have seen unnecessary use of resources such as antibiotics or procedures. I have seen mistakes and the ramifications. I have seen heroic efforts by all involved to pull together, analyze mistakes, and create safety procedures to prevent such a mistake from happening again.

Is healthcare a right?

A question I annually ask students is whether healthcare is a right. It always leads to great discussion. If it is a right, then how should the system look that provides healthcare to the uninsured? Right now the emergency department (most cannot turn people away for lack of payment) is often the only source for uninsured people. That is a grotesquely expensive misuse of the specialized skills of emergency department personnel. But if you had no insurance, and your child was sick, what would you do? I know I would take my child to the emergency department if that were my only choice.

If it is not a right, then what should happen to uninsured people who are unable to access the healthcare system? Should we stand by and watch suffering and disease that could be treated? Could you walk down the street and just pass by someone suffering? (Do we already do that every day? If you live in Baltimore or another city of significant size, I know that you do.) It’s so easy to focus on ourselves and lose sight of those around us. I challenge you to get to know at least one uninsured person and hear his/her story. What should happen next time that person is injured in an accident or has trouble breathing due to asthma?

Is your medical insurance perfect?

I imaging your answer is ‘no.’ I know mine is far from perfect. But, I am so grateful to have insurance! I am grateful for the coverage I do have. Next week my daughter will get a sports physical to be sure she is healthy enough for her sport; my other daughter will be assessed for a nagging cough; my husband will see a surgeon to create a plan to treat his shoulder. All of these things are possible due to insurance. If all of that was out-of-pocket, my youngest would not play a sport, my middle child would continue to cough, and my husband would try to continue to function with one arm.

Perspective

Next weekend I leave on my first international medical mission trip. In the excellent materials I have been given to prepare, there is a statement that I will see more worms, scabies, and lice than I have seen in my entire career. Caring for the homeless of Baltimore, I have seen some of these things, but apparently not in the quantity I will see next week. How many times have you been treated for scabies, lice, or worms? Probably not many, if ever. We will also be caring for people with diabetes, hypertension, asthma, and the chronic conditions we treat in the affluent in the US. I am especially looking forward to analyzing the needs of a growing population over age 65.

I don’t claim to have the answers. But I do know there are several issues to be pondered. If you have ideas and opinions, please share them with me at www.medsmash.com/contact/.

BIBLICAL APPLICATION

There is no shortage of social issues that need to be addressed. Quality of insurance for the insured and what to do about the uninsured are certainly on that list.

Our pastoral team has been delivering a series based on Deuteronomy this summer. Here is a verse that very directly addresses these questions:

Deuteronomy 15:11 ESV

For there will never cease to be poor in the land. Therefore I command you, ‘You shall open wide your hand to your brother, to the needy and to the poor, in your land.’

This is from the Old Testament/Hebrew Bible, but wow, is it not as relevant today as it has ever been?

We are challenged in at least 60 verses to address these issues.

Proverbs 19:17 ESV

Whoever is generous to the poor lends to the Lord, and he will repay him for his deed.

1 John 3:17 ESV

But if anyone has the world’s goods and sees his brother in need, yet closes his heart against him, how does God’s love abide in him?

Luke 12:33 ESV

Sell your possessions, and give to the needy. Provide yourselves with moneybags that do not grow old, with a treasure in the heavens that does not fail, where no thief approaches and no moth destroys.

Proverbs 14:31 ESV

Whoever oppresses a poor man insults his Maker, but he who is generous to the needy honors him.

Proverbs 29:7 ESV

A righteous man knows the rights of the poor; a wicked man does not understand such knowledge.

I am not suggesting you go out and give everything you have right now. I am not suggesting you feel guilty about what you have.

I am suggesting you join me in contemplating these issues. They will certainly be in my face next week. So, I will be back to talk more about this as my own understanding and experience continue to grow.

Blessings,

Michelle

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Your Amazing Kidneys – what do they do exactly?

Posted on by Michelle Fritsch, Pharm.D.

Kidneys - NIH ADAM

Your kidneys clean the blood and manage water

Kidneys – most people have two. Their function is essential for life. If they stop working, then other types of filtration have to be used. We will talk about these back-up plans in a bit.

Think of your kidneys are filters, really good filters. They are about the size of your balled up fist. They are under your rib cage in the back.

Your kidneys have several functions

  • Filter waste and toxins from the blood
  • Remove extra water from the blood
  • Turn the waste, toxins, and extra water into urine
  • Urine removes all of those wastes and extra water from the body

Your kidneys have several parts

Nephrons in your kidneys are the filtering units. You have about a million of them – in each kidney! The nephrons have tubes that carry the urine. They also have small blood vessels that bring the blood past these tubes. The tubes can determine what to keep and put back in the blood and what to send on in the urine out of the body. They determine how much potassium, sodium, water and some other chemicals to keep or release. This is all regulated through a process called the renin-angiotensin-aldosterone system (RAAS).

Keeping and releasing the right amounts of these chemicals and fluids maintains balance in many other parts of your body. In particular, they have a big impact on your blood pressure. Your blood pressure is one important factor in how hard your heart has to work. When your heart has to work too hard for too long, damage can be done leading to heart disease.

The class of kidney-impacting medications that first comes to mind is diuretics. Many people call these ‘water pills’. They work directly in the tubes in the nephron that decide how much water to keep. The diuretics cause more water to be released into the urine and removed from the body. Lowering the total water in the blood lowers the blood pressure. [Note, this is NOT the same as changing the amount of water you drink. If you drink less you put yourself at risk of dehydration, and your kidneys will just hang on to the water it has causing you to urinate less rather than lower your blood pressure. So keep drinking plenty of water on these hot days even if you have high blood pressure. Your kidneys will take care of the rest.] There are a few different kinds of diuretics. Some are used primarily for blood pressure, some for heart failure, and some for edema or other conditions with large amounts of fluid retention.

Two other classes of medications that work through the RAAS system are angiotensin converting enzyme inhibitors (ACE Inhibitors) and Angiotensin II Receptor Blockers (sometimes called ARBs). Some examples of ACE Inhibitors are lisinopril, ramipril, enalapril. Note, the generic names of these medications end in ‘pril’. Some examples of ARBs are losartan and candesartan. Note, the generic names of these medications end in ‘sartan’. Both of these classes of medications have a direct impact on RAAS. This means they help control the amount of water that is excreted through the urine. They also impact the potassium (causing more to be kept in the blood) and have some other actions that lower blood pressure. They cause arteries and veins to open up more relieving pressure on the heart, kidneys, and other organs that have to work harder when these are squeezed tight. By opening them, the pressure slows down and the blood goes through these organs with less force. So these medications are used to treat high blood pressure, heart failure, kidney disease, and to protect the heart for people with diabetes.

When the kidneys just can’t work properly, then dialysis is used to provide the essential filtration. There are two main types of dialysis. One is hemodialysis that is performed in an infusion center. Someone requiring hemodialysis will go to the center about three times per week to be hooked to a machine which will filter the blood. This typically takes at least 2-4 hours. The other type is peritoneal dialysis that can be done at home. This requires an exchange of fluids through the abdominal area about four times per day. Each exchange takes about 30-40 minutes. You can learn a lot more about dialysis from the National Kidney Foundation at this link.

There is obviously a lot more detail needed to completely understand the function of the kidneys. The purpose of this article is to raise awareness of how very important those kidney-bean shaped organs are. It is well worth the effort to protect them. Some ways you can protect them are by keeping your blood pressure and diabetes controlled, staying well hydrated, and maintaining a healthy weight.

To learn more about your kidneys and medications that impact your kidneys, contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

The kidneys clean the blood. They remove waste, toxins, and extra water from the body.

We are called to be cleansed as Christians. How does that work?

First, what needs to be cleansed? Take an internal inventory on the following items to get started:

  • Judgmental thoughts
  • Angry words
  • Hurtful actions
  • Not helping when you could have helped
  • Selfish motives
  • Jealousy
  • Lustful thoughts

Whew, that list could go on forever, couldn’t it! Yep, you’re a sinner. So am I.

Romans 3:23 (NIV)

for all have sinned and fall short of the glory of God,

So, should you just give up and go home? Or, should you give up and just do what you want since you can’t get it right anyway?

Romans 3:21-24 (MSG)

Since we’ve compiled this long and sorry record as sinners (both us and them) and proved that we are utterly incapable of living the glorious lives God wills for us, God did it for us. Out of sheer generosity he put us in right standing with himself. A pure gift. He got us out of the mess we’re in and restored us to where he always wanted us to be. And he did it by means of Jesus Christ.

Jesus died to cleanse YOU of all of your sin.

1 John 1:9 ESV

If we confess our sins, he is faithful and just to forgive us our sins and to cleanse us from all unrighteousness.

1 John 1:7 ESV

But if we walk in the light, as he is in the light, we have fellowship with one another, and the blood of Jesus his Son cleanses us from all sin.

Titus 3:5 ESV

He saved us, not because of works done by us in righteousness, but according to his own mercy, by the washing of regeneration and renewal of the Holy Spirit,

2 Corinthians 7:1 ESV

Since we have these promises, beloved, let us cleanse ourselves from every defilement of body and spirit, bringing holiness to completion in the fear of God.

Romans 12:2 ESV

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

You can’t do it for yourself! Take all the baths you want. Do all of the good things you want for other people. Deny yourself all sorts of things. None of this will cleanse you.

But Jesus can. And He did! Just for you…

Blessings,

Michelle

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

Heart Collaterals – the alternate route

Posted on by Michelle Fritsch, Pharm.D.

Collaterals are your heart’s solution to blood flow problems. Not only does your heart pump essential blood to the body, it is also a vital muscle that needs its own blood flow. There are several arteries that provide blood to the heart muscle to keep it pumping efficiently.

Cholesterol or clots can block the blood flow in arteries. This can cause trouble anywhere in the body. It is especially troublesome in your heart. When a part of the heart muscle gets no blood or too little blood, that part of the heart muscle stops functioning, and with more time, can start to die. Any time the blood supply is cut off from any part of the body, that part of the body will stop functioning.

If your heart isn’t functioning, then the blood flow to all of the rest of the body can also suffer. So, there is an amazing solution built in.

How does the heart help itself?

When an artery providing blood to the heart muscle starts to fill up, the heart starts working on a back-up plan. Around the occluded artery smaller arteries start to form. These are called collateral blood vessels (collaterals).

As the main artery gradually narrows due to cholesterol, the small arteries (collaterals) are formed to give the blood another route to get to the muscle.

You aren’t born with these smaller collateral arteries. They are formed when a decrease in blood flow to part of the heart is detected. Then, in order to keep everything functioning normally, these much smaller arteries start to form as a bypass around the big artery. This gives the blood another path to the muscle.

I find it amazing that this back-up plan exists. I am also amazed that it starts before you even realize you have a problem. It is one of the ways that the body can actually heal itself.

How will I know if my arteries are filling up?

When you have cholesterol or plaque forming in your arteries gradually, symptoms are often feeling more tired when you exercise.   You might get short of breath doing activities that used to not bother you.

Or, you might not even know it. Some people don’t know their arteries are clogged until they get chest pain or have a heart attack. This is one reason why an annual check up with your doctor is so important. Catching these things early allows them to be addressed before anything like a heart attack happens.

If you would like to know more about how collateral arteries in your heart are formed, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Have you ever felt like you could no longer get to God? Or that God could no longer get to you? Have you felt like you’ve done so many bad things that there is no way God can even care about you any more? Does it feel like that path is blocked?

When we feel separated from God, we are told that simply whispering the name of Jesus can open that path. God is always there. There is nothing you can do keep God away from you or from loving you.

Romans 8:38-39 (NIV)

For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.

We can do nothing to earn God’s love. In fact, there is not way we can make ourselves do everything right without sin. We are all sinners. We ALL fall short of God’s glory. And He still loves us!

Titus 3:5 ESV / 3 helpful votes Helpful Not Helpful

He saved us, not because of works done by us in righteousness, but according to his own mercy, by the washing of regeneration and renewal of the Holy Spirit,

So, the heart makes alternate routes to feed the heart muscle when the main route is blocked. And God makes sure we have a CONSTANT connection available with Him. Nothing can block that path. His blood can wash over you with forgiveness; He can sustain you with peace and grace in ALL circumstances.

Blessings,

Michelle

Your amazing liver

Your Amazing Liver – what does it do exactly?

Posted on by Michelle Fritsch, Pharm.D.
Your amazing liver
Your liver breaks down medication and many other functions.

You have a liver. Do you have any idea what it does? I would venture a guess that most people don’t.

The liver sits in the upper right quadrant of your abdomen. When your doctor presses on your abdomen and puts fingers up under your ribs, that is what is being checked. Usually they won’t feel it or maybe just feel the very edge.

The liver has several functions:

  • Clotting factors in your blood are produced
  • Proteins in your blood are produced
  • Triglycerides and cholesterol are made
  • Stores vitamins
  • Removes toxins, such as ammonia, from the blood
  • Processes nutrients from our food
  • Regulates sugar in the blood
  • Metabolizes (breaks down) alcohol and medications

Of course it is the medication part that I am anxious to talk about.

What does the liver do to medication?

There are several types of enzymes in the liver.

These enzymes change the form of medications. They usually break medications down to a less active form. This also allows the medication to be processed and then to leave the body. If this slows down, then the medication stays in active form longer giving the medication a bigger effect and making it last longer.

Different medicines are broken down by different enzymes. Most of these enzymes are cytochrome P450 (CYP450)enzymes. There are several different CYP450 enzymes, each impacting different medications.

Some people have genetic differences that change those enzymes. For instance, a particular enzyme can be less active in some people based on their genes. This will make that medication more active, sometimes even toxic, for that person. It is becoming more common for people to be tested for any genetic changes that can help guide best medication use.

When there is more than one medication that is metabolized by the same enzyme that can change how those medications are broken down. This is where it really gets complicated. Some medications will induce the enzyme, or make it more effective. Others will inhibit the enzyme making it less effective. While others compete for the activity of the enzyme. These actions and interactions impact how well the medicine works and the amount of side effects it will have.

Even tobacco, some food, and herbs can impact the enzymes.

So, when your pharmacist is filling your prescription, there is SO MUCH more they are looking at than just getting the right number of tablets in to the bottle. The potential interactions need to be carefully screened each time any of your medicines are changed.

AND, this screening can only be complete if your pharmacist also knows what herbs, vitamins, over-the-counter, and other substances you take.

Pay attention to the extra instructions on your medicine label. These liver enzymes are often the reason for special instructions such as ‘avoid grapefruit’ or take at particular times of the day (to separate from other medications).

If you would like to know more about the liver and how liver enzymes impact medications, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Just as the liver has a very specific function within the body, each element of the armor of God has a specific function.

Ephesians 6:10-17 NIV

Finally, be strong in the Lord and in his mighty power.  Put on the full armor of God, so that you can take your stand against the devil’s schemes.  For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.  Therefore put on the full armor of God, so that when the day of evil comes, you may be able to stand your ground, and after you have done everything, to stand.  Stand firm then, with the belt of truth buckled around your waist, with the breastplate of righteousness in place, and with your feet fitted with the readiness that comes from the gospel of peace.  In addition to all this, take up the shield of faith, with which you can extinguish all the flaming arrows of the evil one.  Take the helmet of salvation and the sword of the Spirit, which is the word of God.

To take advantage of the full protection available to you, put on each piece of armor. Keep each functioning in its most complete and efficient form through prayer and reading the Bible.

If you’ve so much as glanced at the news in the last few weeks, you know that the ‘power of this dark world’ seems to be out in full force. People are hurting people all over the place.

Go out into this hurting world with your truth, righteousness, faith, assurance of salvation, and the Word securely in place.

Now is the time to have some scripture memorized or in your phone where you can reinforce your own understanding or reach out to others in an instant. That sword of the Spirit might be just what someone needs.

I’m praying for the hurt, the evil, the grief, the biases, the fear that separates us from each other and from turning to the love of God. May you be a light in this darkness.

Blessings,

Michelle

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

Gratitude

Gratitude – keeps you healthier

Posted on by Michelle Fritsch, Pharm.D.
Gratitude
Being thankful for what you have improves your health

Gratitude, grateful, thankful, thanksgiving, appreciation

What do these words mean to you? What role do they play in your everyday life?

Wow, I am amazed how much information is available on this important link between being thankful and health. Just search for these two terms and see what all you will find.

What is gratitude?

This is being aware of all of the good things in your life. And it is being thankful for those things. Have you considered being thankful for:

  • A safe place to sleep
  • Food to eat
  • Clothes to cover yourself
  • Having a friend to call
  • Your job – current or past
  • A beautiful day

This simple awareness of and being thankful for these ‘little’ things can boost your health.

Note, it doesn’t have to be the biggest house or the softest bed or the tastiest food or the latest fashion clothing to be grateful. Gratitude focuses on what you have – all of the good things – rather than what you don’t have.

Expressing gratitude can:

  • Boost your spirits and sense of well-being
  • Boost your immune system making you less likely to get sick
  • Decrease your chances of heart disease
  • Improve your performance (grades, work productivity, concentration)
  • Bust your stress

There are many ways you can make gratitude part of your life. Here are a few recommended in a Harvard Mental Health newsletter:

  • Write a thank-you note
  • Go up and thank someone
  • Keep a gratitude journal
  • Pray
  • Meditate
  • Keep a list of your thanks = count your blessings

See your day and your health improve by focusing on the positive.  Try starting your day with a list of things for which you are thankful.  On those nights you can’t sleep, name all of the good things in your life.  Let that override the worries and things you can’t control.

On this Independence Day weekend, as a country, we have much reason for gratitude!

For more information on gratitude and health, contact us at www.medsmash.com.

BIBLICAL APPLICATION

We have so many reasons to be grateful!

Have you ever been in a ‘funk’ having a bad day and then remembered to be grateful? I have done this so many times. When all looks dark and gloomy, make yourself think about all of the things that are good and right.

1 Thessalonians 5:18 ESV

Give thanks in all circumstances; for this is the will of God in Christ Jesus for you.

I’ll quickly admit I don’t always think to do this. I stay in that dark place far too long. Later, once I’m out I realize I had the ‘magic potion’ to leave that darkness behind. It was given to us by Christ when he died to erase our sins. It was given to us by God who maintained His love and focus on the good in the Jews through centuries of missteps (just as we live a series of missteps).

Lamentations 3:23 ESV

They are new every morning; great is your faithfulness.

I don’t even know where to begin selecting Bible verses to draw us closer to the benefits of gratitude. There are so many!!!

Psalm 118:24 ESV

This is the day that the Lord has made; let us rejoice and be glad in it.

Colossians 3:17 ESV

And whatever you do, in word or deed, do everything in the name of the Lord Jesus, giving thanks to God the Father through him.

Psalm 136:1 ESV

Give thanks to the Lord, for he is good, for his steadfast love endures forever.

Ephesians 1:16 ESV

I do not cease to give thanks for you, remembering you in my prayers,

James 1:17 ESV

Every good gift and every perfect gift is from above, coming down from the Father of lights with whom there is no variation or shadow due to change.

I feel energized, positive, and excited just reading these verses full of hope and promise! I am thankful for each person who takes the time to read this. May you be blessed by these assurances from God!

I pray you can stay focused on the many good things in your life this week and that can keep you out of the dark, gloomy places.

Blessings,

Michelle