Month: December 2016

Serenity

Happy in 2017 – Let Go of Control to Find Health

Posted on by Michelle Fritsch, Pharm.D.
Serenity
Let go of control and let go of anxiety, depression, and pain

I’ve mentioned before, the three types of medications prescribed most commonly in the United States treat anxiety, depression, and pain. I propose CONTROL is in the midst of this frequent prescribing.

What happy, exciting things do you anticipate for 2017?

What fears, concerns, or dread do you have for 2017?

CONTROL

How much control do you have over the good things you anticipate?

How much control do you have over the things that concern you?

How well do you deal with the instances where you have no control?

I have had patients who rarely leave their house for fear of what could happen while out that they wouldn’t be able to control. Some fear injury or accident. Some fear having to interact with other people. Some fear having to make a decision for which they’re not prepared.

Other patients have had bad experiences they were unable to control. Someone they loved died, left, or now rejects them. In other cases, they were in an accident, hurt by someone, or had some other negative event they fear could repeat.

All of this worry directly impacts rates of anxiety, depression, and even pain. When worry doesn’t find an outlet, it can lead to pain, often chronic pain.

Letting go of control

Want to ease into 2017 with less burden and more lighthearted joy? Try letting go!

The Serenity Prayer that is prayed in 12-step programs is:

‘God grant me the serenity to accept the things I cannot change,

Courage to change the things I can,

and the Wisdom to know the difference.’

This is a powerful prayer. It acknowledges that there is so much beyond our control. Try as we might, we just cannot control or change some things.

For instance, I know a lot of people are incredibly tense about the implications of a new president in2017. They stew about the ‘what-ifs’. They worry about all of the things that could go wrong. They read each prediction, especially from the sources that don’t support the newly elected official. It’s all they think about, talk about, read about, watch on TV. They get more and more anxious as they continue on this circular path.

I know people who fear certain diagnoses such as cancer, heart disease, or Alzheimer’s Disease. They jump on any unusual symptom. Their frequent use of the medical system often leads to the prescribing of several medications. All of these medications interact causing problems of their own. As the person feels worse, the more they fall down this negative slippery slope.

Hope for 2017

Consider how the Serenity Prayer could be your mantra for 2017. Spend your energy, thoughts, and time on things that are positive. Do the things you enjoy. Spend time with those who love and support you. Reach out and help others.

For the many, many things in this world that could go wrong – Let It Go! If you can’t control it, admit that and let it go.

This change could actually mean less anxiety, less depression, and less pain.

For more information about the link between control and health, please contact us at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

Here is the full Serenity Prayer. I had never heard/read it until recently.

God, give me grace to accept with serenity

the things that cannot be changed,

Courage to change the things

which should be changed,

and the Wisdom to distinguish

the one from the other.

Living one day at a time,

Enjoying one moment at a time,

Accepting hardship as a pathway to peace,

Taking, as Jesus did,

This sinful world as it is,

Not as I would have it,

Trusting that You will make all things right,

If I surrender to Your will,

So that I may be reasonably happy in this life,

And supremely happy with You forever in the next.

Amen.

I love this! I plan to print it and keep it where I can read it frequently until I can memorize it. What a beautiful prayer for each and every day.

Let Go and Let God!

This is a prime example. Give up control and give it all to God who actually knows what to do with it all.

Peter and Paul very directly give us guidance on how to handle our anxieties.

Philippians 4:6-7 ESV

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

1 Peter 5:7 ESV

Casting all your anxieties on him, because he cares for you.

As hard as it is to let go of our very human desire to control, WOW, we will feel so much better when we truly give it all to God! (Please keep reminding me as I’ll keep reminding you. Satan DOES NOT want you to remember and apply this on a daily basis.)

Matthew 11:28-30 ESV

“Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.”

Blessings as you Let it Go,

Michelle

Image source: Winter Icon by Gwebwt.blogspot.com

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Peace

Peace, Joy, and Health – What is the Link?

Posted on by Michelle Fritsch, Pharm.D.
Peace
Peace and Joy can improve your health this holiday season

Merry Christmas! Happy Hanukkah! Happy Holidays! For many this is a season of wonder, excitement, friends, and family. It is a time of joy and celebration. The comforts of the season, and for many, the reasons for the season, are a source of peace.

Then, for others, this is a difficult season. It can be a reminder of loss, a lonely time, or a negative experience. I am regularly horrified at how people can hurt people. And hurt people tend to hurt people. It is a devastating trend.

Hurt and Health

The obvious connection between peace and health pertains to war. I am happy to see survivors finally being moved to safety away from Aleppo. War is definitely hazardous to health. Aleppo has been an example of how horrible things can get in the midst of war.

Conflict, abuse, hurtful words, neglect, oppression, and bullying are bad for your health, too. Anxiety, depression, and loss of hope are some common themes.

These cycles are hard to break. It can be challenging to find the hope.

I have seen in MANY patients that when this hurt is kept inside, it DOES come out. It can come out as depression, social anxiety, avoidance of people, and very often pain.

Peace and Health

Finding peace in life doesn’t only happen when things are perfect. Name the times in your life that absolutely everything was perfect. I’ll be surprised if you can find any at all. Rarely if ever are you in a place where there is absolutely no hurt, no mess, and all is good. So how do you ever find peace?

I have had the privilege of knowing many people, including many patients, who have found peace in spite of very turbulent events in their life.

Finding faith, meaning, and peace has been shown to improve quality of life in people with cancer. Some people bring these qualities into their cancer experience. Others find it in the midst of their cancer. I believe if this is true in cancer, it will be true with other chronic illnesses as well.

Another link is the association between giving to others and finding joy for yourself. Altruism and giving are linked with improved health. We often associate happiness with getting gifts. Now, it appears you will find even more joy if you focus on the giving of the season. Who could benefit from your giving today?

So, on this holiday weekend, seeking your source of peace and joy can actually improve your health. You physical, mental, emotional, and spiritual health will all benefit.

For more information about the health benefits of finding peace in the midst of life, contact us at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

I know a lot of Christians who struggle to find the peace and joy of Christmas. The busy-ness, stress, expectations, obligations, traffic, and events can be overwhelming.

None of that sounds like peace.

The birth of Jesus wasn’t surrounded by shopping, parties, pressure, or obligations. There might have been some traffic with the census.   🙂

The songs like ‘O, Holy Night’, ‘Silent Night’, and ‘It Came Upon a Midnight Clear’ paint a peaceful, serene event. The rich and famous were not present. The finest china and silver were not set in a well-decorated setting. No one compared value of gifts given and received.

Peace was mentioned to the very first people told about his birth.

Luke 2:14 ESV

“Glory to God in the highest, and on earth peace among those with whom he is pleased!”

Jesus had several messages about peace during his ministry.

John 16:33 ESV

I have said these things to you, that in me you may have peace. In the world you will have tribulation. But take heart; I have overcome the world.”

John 14:27 ESV

Peace I leave with you; my peace I give to you. Not as the world gives do I give to you. Let not your hearts be troubled, neither let them be afraid.

Jesus’ brother James understood the types of things that lead to our stress and frustration at Christmas.

James 4:2-3 ESV

You desire and do not have, so you murder. You covet and cannot obtain, so you fight and quarrel. You do not have, because you do not ask. You ask and do not receive, because you ask wrongly, to spend it on your passions.

Paul tells us what we should do instead.

Galatians 5:22 ESV

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness,

Jesus demonstrated this kind of life. Christmas is a time of love, joy, peace, patience, kindness, and goodness. How delightful if we can stay focused on these principles as we celebrate with our loved ones.

I pray Paul’s blessing for you and your family this blessed Christmas.

Romans 15:13 ESV

May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope.

Blessings,

Michelle

Perspective

Wrong Assumptions lead to Bad Medicine

Posted on by Michelle Fritsch, Pharm.D.
Perspective
Avoid wrong assumptions that lead to incorrect actions.

When was the last time you made and acted on wrong assumptions? It is so easy to do. You see something from your perspective and your mind fills in the details of the who, what, when, how, and why. It’s often long after you have acted that you are provided with a different perspective that makes the entire situation look different.

A quick, fun example is in this picture. Another proof that I am a geek. I get such a kick out of these pictures.  If I believed my eyes I might run in to help the poor guy being lifted into the air.

This happens in healthcare, too. Keep in mind, the provider that is making decisions in the emergency department or the hospital usually knows VERY LITTLE about you. Any information you or a loved one or friend can give is all they have at first.

One day, hopefully soon, these providers will be able to access your medical records and make much more informed decisions. Right now, your doctor has to be contacted then the information sent to the hospital. If it is the weekend or an evening, that can take hours to days. The information then needs to get to your hospital provider from the fax machine or the electronic messaging system. Even then, there might be important information about you that is not even in your doctor’s record.

This leaves those of us making decisions about your care to rely heavily on what we see right now.

I have seen SEVERAL examples in the last few weeks of an older adult reaching medical care confused. The quick wrong assumption has been that the person has dementia. When confused, behaviors often change. A confused person can yell, pull at catheters and IV’s, try to get out of bed, and generally not cooperate. Since the assumption has already been made that dementia is the cause, calming medications are given. These then assure further confusion (but calmer) and make it very hard for the person to get to a point of no confusion.

What can you do to prevent wrong assumptions?

  1. Carry in your wallet a list of your:
    1. Allergies
    2. Medications
    3. Diagnoses
    4. Emergency contact information – name, phone number(s)
  2. If you are accompanying someone to the hospital who is newly confused, explain this to the medical team. Help them understand what this person was like before this event. They need to know the ‘baseline’. If this person was living independently, driving, managing their finances the team needs to know that. If this person was unable to do those things and was getting frequently confused at home, the team needs to know that.
  3. Share any known history about the current event. If you have been feeling worse and worse for the past three days, make sure they know that. If you have been having pain, explain that including what it feels like, how often you feel it, what makes it better or worse.
  4. If you have been taking different medications for the past few days, make sure they know that. This often happens when we are in pain or have a cold. We take over-the-counter medications or left-over medications from prior prescriptions. These can cause confusion when mixed with our normal medication regimen.

Speak Up

Again, I have seen several instances in the past few weeks where assumptions are made when someone gets to the emergency department or hospital that make a situation worse.

  • In one instance the person’s confusion started as soon as a particular medicine was given. The family member noted that but didn’t speak up. Then medications were added to treat the confused behaviors. We are still trying to taper off of those medications and get this person independent again.
  • In another instance, the person had a urinary tract infection. These are famous for making older adults confused. But since no one was there to explain how odd this confusion was for this person, the team assumed this was normal and didn’t find the infection for a while.   By then, a couple of medications had been added to treat the confused behaviors. It will take us weeks to taper her back off of these medications.
  • In a third instance, the collection of pain medications given after a surgery left the person sleeping most of the day and unable to think clearly. The spouse was dutifully giving the prescribed medicines around the clock. The wrong assumption made here was that this very healthy person over 60 could handle these medications like someone in their 30’s.
  • One more instance involved using a medication to treat the side effect of another medication. The second medication (the one used to treat the side effect) is on a list of medicines to avoid in people over 60. Rather than treat the side effect, it made the person nearly unresponsive. In this case, as in several of the others, rather than treat the underlying issue, wrong assumptions were made and actions were taken to treat the symptoms without understanding the back story.

Why ‘Bad Medicine’

Just a side disclaimer. When I was contemplating this blog I saw it as a chance to use the terms, ‘Bad Medicine’. I am a big Bon Jovi fan. I am also a pharmacist. So, I have to admit I love the song, ‘Bad Medicine’.

For more information about how to protect yourself from wrong assumptions leading to bad medicine, contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

I can think of a lot of bad assumptions leading to bad decisions in the Bible. One of the first is Eve’s decision to eat the apple. The Israelites made bad assumptions continuously. A few that come to mind are thinking slavery would be better than ‘suffering’ in the desert; people in lands they were to conquer were too mighty to overcome; Moses was not going to return so a golden calf was needed. The list goes on.

So, how often do you make bad assumptions? I suggest we all do it every day. We don’t act on all of them. I don’t think we realize most of them.

I am consulting right now in a place that serves a highly diverse and unique population of people. Assumptions about gender, culture, religion, socioeconomic status, or just about anything will quickly lead you down an incorrect path. It has been an adventure of constant striving to avoid any assumptions.

These verses are good ones for me to remember each day:

Proverbs 18:2 ESV

A fool takes no pleasure in understanding, but only in expressing his opinion.

Matthew 7:1 ESV

“Judge not, that you be not judged.

Proverbs 25:8 ESV

Do not hastily bring into court, for what will you do in the end, when your neighbor puts you to shame?

Bad assumptions and temptations to act on them are one more test.

As I understand the Word, truth trumps all of the assumptions. Love trumps all of the wrong actions.

1 Corinthians 13:6 ESV

It (love) does not rejoice at wrongdoing, but rejoices with the truth.

1 Corinthians 13:7 ESV

Love bears all things, believes all things, hopes all things, endures all things.

The laws in Deuteronomy give us good advice even here in 2016.

Deuteronomy 17:13 ESV

And all the people shall hear and fear and not act presumptuously again.

I encourage you (and me) to guard against assumptions and focus on truth and love.

Blessings,

Michelle

Problem Medications sending people to the ER

Posted on by Michelle Fritsch, Pharm.D.
emergency
Don’t let problem medications send you to the emergency room

Problem medications are leading to an increasing number of emergency department visits. And more and more of those are ending up being admitted to the hospital. A study published in the Journal of the American Medical Association in November 2016 revealed these findings. The study was conducted by the Centers for Disease Control.

For every 1,000 emergency department visits, four are for people over the age of 65 with problem medications. In the last decade the number of people going to the emergency departments with problems with their medicines has gone up at least 10%.

The types of medications most often involved are opioid pain medicines, diabetes medicines that lower the blood sugar, blood thinners (anticoagulants), and antibiotics. There is still a significant use of medicines that have been long-recognized as a poor choice in people over 65. [I am still seeing that in my patients as well. Pain medication, anxiety and mood therapy, and anticholinergic (drying) medication use have been issues in nearly all of my referrals in the past 2 months.]

Why are there more medication-related emergency visits?

Part of the reason for this increase in emergencies could be the growing number of people over 65. But, that can’t be the only explanation.

Speed – Healthcare is moving and being provided at a very fast pace. The time your doctor gets to spend with you is very limited. Often the reason for your visit takes all of the time. This doesn’t allow for a thorough review of all of the rest of your health and your medicines.

Fragmentation – Your doctors, pharmacists, nurses, therapists don’t have enough time to talk to each other. When one doctor doesn’t know what the other one is doing, problem medications can be prescribed.

Incomplete information – Your doctors don’t often know what you REALLY do at home with your medicine. I have identified thousands of instances where medication is taken differently than prescribed. This can be for many reasons. Sometimes medications are stopped without telling the doctor. Sometimes extra doses are taken. Sometimes medications get confused such that each is taken incorrectly. Other times vitamins, herbal supplements, over-the-counter medications, and other substances are taken without the knowledge of the doctor or pharmacist. These are just a few of the examples of how medication can be different than what your doctor thinks it is.

Specialized knowledge – Only a small percentage of people aged 65 plus receives care from a specialist in healthcare for people in this age group. There are not nearly enough geriatricians and board certified geriatric pharmacists to oversee the prescribing for these adults.

Don’t let this statistic apply to you

What can you do to avoid being one of these people in the emergency department because of problem medications?

First, make sure your doctors (all of them) and your pharmacist know absolutely EVERY medication you take AND how you actually take them.

Second, ask your primary care doctor AND your pharmacist to carefully review all of those medications for:

  • Interactions
  • Lowest possible doses
  • Continued need for each medication
  • Safer options available
  • Removal/replacement of any medication known to be problem medications in people over 65
  • Assurance each is working as planned

Third, contact the board certified geriatric pharmacist at Meds MASH for a thorough medication review today. All findings will be shared with your healthcare providers so all can work together to keep your medication regimen safe. You can reach Michelle at www.medsmash.com/contact or by calling 410-472-5078.

Mistakes, oversights, misinformation, incomplete information, misunderstandings occur in all aspects of life. They certainly exist in healthcare. NO healthcare provider wants imperfect care, but it certainly happens. This is why a multi-check system where several people work together in your care is superior to independent practice. Different providers with varying backgrounds and perspectives can catch and fix issues before they ever reach you.

BIBLICAL APPLICATION

Is healthcare the only place where mistakes, oversights, misinformation, incomplete information, or misunderstandings happen? Of course not.

Can this happen in the church? Oh, yes! I’ll bet we could all share several stories.

Pastors, Sunday School teachers, small group leaders, professional speakers, authors, and media personalities are all fallible. We are all human. Jesus makes it very clear we are far from perfect. No matter how hard we try, we will never be perfect.

Romans 3:23 (ESV)

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

Does this mean you should consider all spiritual teaching as wrong? No!

It does mean you should check what you see, hear, and read and compare it with the absolute truth – the Bible.

2 Timothy 3:16-17 ESV

All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness, that the man of God may be competent, equipped for every good work.

Remember playing communication games in elementary school?   Games like telephone showed us how easily we can misconstrue information. Now, remember any class from your school days. Did you capture absolutely every word you teacher said? Did you ever miss important information because you weren’t paying attention – even for a second? Did you ever get an exam question wrong because you misunderstood the information?

I like this version from The Message:

Romans 3:23-24 (MSG)

God Has Set Things Right

But in our time something new has been added. What Moses and the prophets witnessed to all those years has happened. The God-setting-things-right that we read about has become Jesus-setting-things-right for us. And not only for us, but for everyone who believes in him. For there is no difference between us and them in this. 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.

These issues continue in healthcare and in spiritual teaching. Just like in healthcare, studying and learning from several spiritual sources will help you identify misinformation and reinforce the truths found in scripture.

John 8:32 ESV

And you will know the truth, and the truth will set you free.

John 16:13 ESV

When the Spirit of truth comes, he will guide you into all the truth, for he will not speak on his own authority, but whatever he hears he will speak, and he will declare to you the things that are to come.

John 17:17 ESV

Sanctify them in the truth; your word is truth.

The trust does exist, and you can find it.

John 14:6 ESV

Jesus said to him, “I am the way, and the truth, and the life.” (emphasis mine)

Blessings,

Michelle