Month: February 2017

Use reflective statements to enhance communication and decrease conflict

Communicate Your Way to Better Health

Posted on by Michelle Fritsch, Pharm.D.
Use reflective statements to enhance communication and decrease conflict
Communicate to decrease conflict and increase understanding using reflective statements

How do you handle conflict? For most of us the answer is, ‘not very well’. Conflict can raise your blood pressure, constrict your veins and arteries, and make your heart beat harder and faster.

Did you know that communication is NEARLY ALWAYS at the heart of conflict. As people, we miscommunicate on a regular basis. Part of what makes good communication so difficult is that it involves at least two people. Once is communicating and one is interpreting that communication. Let’s take a look at both important parts.

Communicate a consistent message

I was at a retreat this weekend where we played a game about consistent messaging. Think about a time when someone was talking with you and their message was not consistent. Their words said something that did not match their tone or their face or their body language. Imagine someone saying, ‘I love you’ with a grimace on their face and a mocking tone. Or picture someone saying, ‘So nice to meet you’ while glancing around the room looking for someone else. Has anyone ever tried to express anger with you then started laughing? It is hard to express anger while laughing. Someone was just telling me a story about a toddler rearranging a bunch of decorations and falling into a box headfirst with her feet sticking out of the top. The decoration was too heavy and pulled her over. This parent had to stifle giggles and get a picture before retrieving and correcting the toddler.

So, when you are communicating, carefully think about saying the same message with your words, your tone, your eye contact, your facial expression, and your body language. That will help avoid misinterpretation.

Check for understanding

When you are the one communicating, make sure the receiver actually understands what you are saying. It is ok to ask them to repeat it back. Or to ask what questions they have. If we assume the other person understood exactly what we were thinking and trying to communicate, we can often be disappointed. Think about the last time you thought someone understood and they did something completely different than what you asked.

If you are the listener, this is a critical step to assure you are understanding the message.

Reflective Statements

When you are the listener, one of the best techniques you can use is ‘reflective statements’. State back to the person communicating with you what you hear them saying. Put it in your own words. Here are some examples:

  • You are saying you are upset about _________ because _________.
  • You are asking me to _________________ and have it done by _________.
  • ___________ frustrates you when he/she ______________.
  • You want to ________________ before you agree to a hip surgery.
  • You heard that I ______________, and it has upset you.
  • Your son forgot to _______________, and not you don’t know what to do.

When you respond with a reflecting statement, you are making sure you understood the person’s message. It is a chance for them to clarify if you misunderstood. It is also a chance for them to feel heard and understood if you are correct.

Making sure you understand before taking any action, even before getting angry, and help avoid a lot of conflict.

If someone is upset or angry and respond also upset and angry, the situation escalates quickly. I have seen this happen where the two people don’t even realize they are saying the same thing. Neither is listening, they are just yelling. Now that will really get your blood pressure up!

I have found that FREQUENTLY, what I think I heard and what the person really intended were different. Especially when the topic is emotionally charged. It is our natural reaction to get defensive when someone comes at us angry. It is very hard to listen well in that state. So, a really deep breath and a calm reflecting statement can often help the situation calm back down. Sometimes when we are angry or frustrated we just want to vent. Once the venting is done, and the recipient reflects understanding, the situation doesn’t seem so bad.

Communicate with your Healthcare Team

These same techniques are very helpful when you communicate with your doctor. Sometimes the news we receive from our doctor can be upsetting. The words used in medicine are big and scary all by themselves. It can be hard to understand all of the technical information.

I highly encourage you to state back to your doctor what you just heard. Say it in your own words.   This will help the doctor know where to clarify. I have had many patients get upset by a medical term that was actually no big deal. It just sounded scary. My grandfather, after 40+ years of smoking, a heart attack, a stroke, and stomach ulcers quit smoking cold turkey. We had been trying to get him to quit for years. None of those scary medical issues made him quit. But, when he was diagnosed with hiatal hernia he quit on the spot. [Hiatal hernia is when the sphincter between the esophagus and the stomach can’t close all the way. This allows stomach acid to come back up giving you heartburn. For him, this was the mildest of his issues.] I ask him why. His answer, ‘That’s a really scary word.’ I was in pharmacy school at the time. I had all sorts of scary words I could have given him. Who knew that was all it would take to get him to quit.

So, I encourage use to be clear and consistent with your communication. And, ask clarifying questions and use reflective statements when you are receiving communication. Especially if it seems upsetting, make sure you really understand the message before you make any decisions. This could help you avoid a lot of conflict.

Your heart will thank you for managing conflict better and keeping your blood pressure down.

For more information about communication techniques for your health, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

When we react without first understanding, we often get ourselves into trouble. Throughout the Bible we see examples of people making bad assumptions followed by bad actions.

The people of Israel, after God had gotten them out of slavery and out of Egypt and led them through the desert supplying food and water and protection, still made bad assumptions. While Moses was on the mountain with God himself, they assumed he wasn’t coming back, so they made a golden calf to be their god.

Exodus 32:1 NIV

When the people saw that Moses was so long in coming down from the mountain, they gathered around Aaron and said, “Come, make us gods[a] who will go before us. As for this fellow Moses who brought us up out of Egypt, we don’t know what has happened to him.”

When Jesus was talking with his disciples about what was coming next for him, including his death, Peter jumped right in and disagreed.

Matthew 16:21-23 NIV

From that time on Jesus began to explain to his disciples that he must go to Jerusalem and suffer many things at the hands of the elders, the chief priests and the teachers of the law, and that he must be killed and on the third day be raised to life.

Peter took him aside and began to rebuke him. “Never, Lord!” he said. “This shall never happen to you!”

Jesus turned and said to Peter, “Get behind me, Satan! You are a stumbling block to me; you do not have in mind the concerns of God, but merely human concerns.”

In the bible we are also told to expect miscommunication in the future. There will be false prophets and all sorts of misinformation.

Matthew 7:15 ESV

“Beware of false prophets, who come to you in sheep’s clothing but inwardly are ravenous wolves.

1 John 4:1 ESV

Beloved, do not believe every spirit, but test the spirits to see whether they are from God, for many false prophets have gone out into the world.

We are called to be discerning. Ask questions. Get the full story. Make sure you understand and that what you hear matches the messages of the Bible.

I feel better when I read this passage. There will be no doubt when Jesus returns. Other people can claim what they want. I won’t believe it until it is this obvious:

Matthew 24:29-31 ESV

The Coming of the Son of Man

“Immediately after the tribulation of those days the sun will be darkened, and the moon will not give its light, and the stars will fall from heaven, and the powers of the heavens will be shaken. Then will appear in heaven the sign of the Son of Man, and then all the tribes of the earth will mourn, and they will see the Son of Man coming on the clouds of heaven with power and great glory. And he will send out his angels with a loud trumpet call, and they will gather his elect from the four winds, from one end of heaven to the other.

That doesn’t sound too subtle. So, until it is extremely obvious and visible to all of creation, let’s not fall for false messages.

Blessings,

Michelle

 

Advertisement
Newer diabetes options

Are You TOO Sweet? Newer Options for Diabetes

Posted on by Michelle Fritsch, Pharm.D.
Newer diabetes options
Newer diabetes medications to consider if you’re too sweet.

Do you remember when the treatment options for your type 2 diabetes were medicines that could make your blood sugar too low – oral medicine or insulin? The available options would also make you gain weight.

Those treatments are still available, and now there are improved versions of each. So, if you and your doctor and your healthcare team haven’t talked about options recently, now might be the time. The experts in the field, using the information from the latest studies, release guidelines. The latest guidelines from the American Diabetes Association have tables that provide comparisons between the options. These tables make a nice display to help you have a conversation with your doctor about which options might work best for you.

Those early medication options mentioned before would either help your pancreas release more insulin or would be an extra source of insulin.

Newer diabetes medication options

Here are ways other, newer medicines help control your diabetes:

  • control how your liver stores extra glucose (sugar) and when and how it lets it back out
  • control how your kidneys let your glucose out in your urine
  • impact how sugar is absorbed from the food you eat
  • mimic hormones that control how your body responds to sugar and insulin
  • slow down the rate food moves through your body keeping you feeling full longer
  • increasing how a cell responds to insulin

The body has many different steps in the way it handles the food you eat and how that food is turned from sugar into energy for your cells. Now, with these newer options, your diabetes can be treated with medicines that address more than one of those steps.

Combinations of medications can help control your diabetes more than one way at a time. Also, when you use combinations of medicines, you can usually use a lower dose. This helps cut down on side effects.

New insulin options

If a combination of medicines you take by mouth don’t help you reach your diabetes control goals, there are new insulins. The old insulins were dosed either around meals or twice a day. There are now basal insulins. These are dosed just once per day. They then provide some support to control your blood sugar all day and all night. Then, when you eat, your blood sugar does not climb as high.

Often, people who have been taking higher and higher doses of oral medicines find they can be on lower doses. The basal insulin helps decrease the need for so much oral medicine.

And, like we said before, using several different medicines helps you use lower doses of each. This is often easier to tolerate than high doses of one or two medicines.

NOTE, this information is all for type 2 diabetes. If you have type 1 you need insulin therapy only because your pancreas has quit working. The insulin is absolutely required. The oral medicines mentioned above won’t control your diabetes.

We have much more we can tell you about diabetes and treatment options. For more information, please contact us at www.medsmash.com/contact or call at 410-472-5078.

BIBLICAL APPLICATION

Diabetes (and other medical conditions) can be best treated with medication using different mechanisms. Treat different parts of the condition from all directions for the most comprehensive care.

I have been embarking on some new (to me) techniques for Bible study. Wow, there are so many ideas and methods out there! I am intrigued by all of the different ways we can approach the same scripture. And, as only God could do, I learn something different every time. Part of the reason I keep learning new things from the same scripture is that I am different every time I read it. The things happening in my life, the things that are exciting me, the things that are concerning me, the things happening with my friends and family are different. This changes my perspective. Also, my moods change. That can definitely impact how I approach anything I read or hear.

Then, there are all of these techniques and approaches I have been reading about. Some are obvious, and some, to me, seem really innovative. Here are some that I have been trying to incorporate:

  • When reading a small bit of scripture, read it over and over emphasizing a different word each time to see how that changes the meaning.
  • Research the history at the time it was written. Historical context helps to understand the culture and surrounding events.
  • Write down in a journal (or I write in the margins) insights, events, or ideas you get from that verse or chapter. (Date it so you can see it later. Often I find it strikes me a completely different way the next time I read it because I’m in a different frame of mind in different circumstances.)
  • Consider how the scripture you’re reading could be incorporated into your life today.
    • Sometimes this is an action, sometimes an new idea, sometimes a reflection on how great is our God, sometimes a prayer, sometimes a question to ponder.
  • Put yourself in the scripture. Try to imagine being there at that time. How did it probably look, sound, feel. How might you have gotten there? What are you probably wearing? Who else is there?
  • Read about the author of that chapter of the Bible. What do we know about that person? What was their perspective?
    • I like the Life Application Bible. It has information at the start of each chapter to start answering these questions. It has helped me dig a lot deeper and understand more concepts. There are application tidbits on each page.
  • Where else is this theme, story, or concept in the Bible?
  • Listen to the Bible being read to you. There are many online apps that include an audio version. Especially if you like to learn through hearing, this is a great method.
  • Read the same scripture as a friend and talk about it. Or better yet, talk about it in a Bible study group. I am always amazed at how we can read the very same thing and have completely different insights.

No doubt, there are many more.

God gave us his Word to be an integral part of our life.

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.

God’s Word can be a huge source of answers when you’re feeling lost, alone, hurt, confused.

Psalm 119:105 ESV

Your word is a lamp to my feet and a light to my path.

There’s not just one right way to study scripture. Like a combination of meds approach to diabetes, try a combination approach to reading your Bible.

Hebrews 4:12-13 MSG

 God means what he says. What he says goes. His powerful Word is sharp as a surgeon’s scalpel, cutting through everything, whether doubt or defense, laying us open to listen and obey. Nothing and no one is impervious to God’s Word. We can’t get away from it—no matter what.

My prayer is you’ll find it exciting and refreshing to try all sorts of new ways to get into your Bible. There is a never-ending amount of great information in there. It is always pertinent.

Blessings,

Michelle

Memory, Falls, and Function – Oh Meds!

Posted on by Michelle Fritsch, Pharm.D.
ID-10093880
Medications can make function difficult and lead to memory and falls issues.

If your memory is slipping, do you have dementia? If you fall are you just clumsy? If you need help doing some of your daily tasks, are you just lazy? Or, are these things just a normal part of aging?

I suggest that MANY TIMES, these memory and falls changes are because of medication. Medications can cause these types of issues in a few different ways:

  1. The dose is too high for you.
  2. Your body has trouble getting rid of that medication.
  3. You are on several medications with these types of effects.
  4. Your medications are interacting with each other.
  5. Your medications are interacting with your diet or your other medical conditions.

Medications and Memory and Falls

There are several types of medicines that can fog your thinking. They relax you, make you sleepy, and/or slow your thinking processes. Sometimes you use them for this effect. But know, in making you feel that way, they make it harder to think as quickly and clearly as you normally think.

And by slowing your thinking and response time, they increase your risk of falling, too.

It would be a very long blog to list them all. So, here are some of the more common culprits to impair memory and falls.

  • Anxiety/nerve medications
    • Benzodiazepines (e.g. alprazolam, lorazepam, diazepam)
    • Buspirone (Buspar)
  • Depression medications
    • Tricyclic antidepressants (e.g. amitriptyline, nortriptyline)
    • Selective serotonin reuptake inhibitors (SSRI’s) (e.g. escitalopram, sertraline, fluoxeting)
    • Wellbutrin
    • Buspirone
  • Sleep medications
    • Zolpidem (Ambien)
    • Ramelteon (Rozerem)
    • Eszopiclone (Lunesta)
    • Diphenhydramine (Benadryl, Tylenol PM, Aleve PM)
  • Pain medications
    • Oxycodone
    • Hydrocodone
    • Morphine
    • Hydromorphone
    • Tramadol
  • Anticholinergic medications
    • Incontinence
      • Oxybutynin
      • Darifenacin (Enablex)
      • Solfenacin (Vesicare)
      • Trospium (Sanctura)
      • Tolterodine (Detrol)
    • Parkinson’s Disease (e.g. benztropine, trihexyphenydil)
    • Allergy medications – sedating
      • Diphenhydramine (brand Benadryl)
      • Chlorpheniramine
      • Hydroxyzine
    • Antispasmodic agents (e.g. chlordiazepoxide, belladonna)
    • Diarrhea treatments
    • Muscle relaxants (e.g. cyclobenzaprine, orphenadrine)
    • Dizziness, sea sickness medication (e.g. meclizine, scopolamine)
    • Nausea/vomiting medication (e.g. prochlorperazine, promethazine)
    • Antipsychotic (e.g. thioridazine, chlorpromazine, clozapine, olanzapine)
  • Seizure medication
    • Carbamazepine
    • Valproic acid
    • Several others
  • Nerve pain medication
    • Gabapentin (Neurontin)
    • Pregabalin (Lyrica)

Medications and Function

I have worked with many people who were planning to move to assisted living. They just couldn’t do some of the daily tasks they had done before. These tasks might be cleaning, keeping up with finances, remembering to take medicines, or ability to cook healthy meals.

In many cases, some medication adjustments made a big difference. Assisted living could be delayed.

How do you decrease your risk?

Please NEVER change any medications without first checking with your doctor.

If you take medication that you think could be impacting your clear thinking or make you feel unsteady, talk with your doctor.

If the types of medications mentioned in the blog are going to be changed, make the changes one at a time gradually. Fast changes can be dangerous. Making too many changes at once can make it hard to determine which change works and which doesn’t. So, making these changes should be a slow, careful process.

If you want help –

  • talking with your doctors,
  • coordinating between your doctors, or
  • want to better understand this information

please call us at 410-472-5078 or e-mail at michelle@medsmash.com.

Our website is www.medsmash.com.

BIBLICAL APPLICATION

One of the key ways to prevent falls, medication-induced memory issues, and functional decline is to make sure your primary care physician knows exactly what medications you take and how you take them. Other physicians might contribute to your regimen, but your primary care physician is one who can analyze and control it all.

Similarly, Jesus is your primary spiritual care provider. You have a pastor, teachers, books, TV evangelists, friends, family, and more who contribute to your spiritual care. But, it is Jesus who is at the center.

The best-intentioned specialist medical provider can make a harmful decision because he/she is treating the specialty and less familiar with all of the other aspects of your care.

Similarly, the best-intentioned teacher/friend/colleague can distort the truth of Jesus. This is rarely done intentionally. We can all make mistakes, misinterpret, or be misled.

So, rather than take any teaching by a human at face value, compare it to the TRUTH of God’s Word, the Bible.

John recorded Jesus referring to God’s truth:

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.

Truth is not something we acquire passively. Just listening to your pastor on Sunday or listening to programs on the radio or TV won’t help you fully understand the truth. Your own reading and studying will give God a chance to talk to you directly. That private time in the Bible can help you recognize truths, understand information, and apply information in a very personal way.

Let your personal Primary Care Spiritual Physician, Jesus Christ, be your primary source of truth. Compare all other teaching to this truth.

2 Timothy 2:15 ESV

Do your best to present yourself to God as one approved, a worker who has no need to be ashamed, rightly handling the word of truth.

Blessings,

Michelle

Falls – Steps you can take now to prevent them

Posted on by Michelle Fritsch, Pharm.D.
fallenman
Be proactive to prevent falls that could change your future.

I have been talking with a lot of groups and individuals about ways to prevent falls. Falls come out of nowhere most of the time. You don’t even think about them until they happen.

According to data from the Centers for Disease Control, there are over 2.8 million older adults seen in the emergency department for falls every year! Yes, 2.8 million!!!   And these are not always the obvious people who can just look at and tell they could easily fall. Many would consider themselves health, active, and not at risk.

You CAN determine your risks and take action now to lower them.

So, how do you determine if you have this falls risk?

The Center for Disease Control tackled that question and developed the Stopping Elderly Accidents, Deaths, and Injuries. They created a toolkit with several resources. Some of the resources are for your doctor or other healthcare provider. Others are for YOU to help find and minimize your personal risks.

You can find access to these tools on our Meds MASH website. Or you can follow this link: https://www.cdc.gov/steadi/patient.html. You will find information about falls, how often they happen, and many of the risk factors. You will also find tools to help you assess yourself and your home.

I especially encourage you to complete the Check for Safety checklist. It has you walk room to room through your house looking for specific risk factors. It also has several tips to help you avoid falls.

Next, I encourage you to complete the Stay Independent checklist. This will ask you a series of 12 questions. You will answer each with a ‘Yes’ or a ‘No’. Then, take this list with you to your next doctor’s appointment. This will help you to have a very focused talk with your doctor about ways to minimize your falls risk.

Finally, read the What You Can Do to Prevent Falls brochure. This will give you even more tips to help you avoid a fall.

What can you do to lower your falls risk?

There are four different assessments in the toolkit that your doctor can use to better understand how to help you decrease your risks. One of these you can do yourself.

It is called a Chair Rise Exercise. It can help you gain strength in your thighs and buttocks. This will help you be more stable when you walk. Here are the instructions from the CDC STEADI guide:

How to do it: 

  1. Sit toward the front of a sturdy chair with your knees bent & feet flat on the floor, shoulder-width apart.
  2. Rest your hands lightly on the seat on either side of you, keeping your back & neck straight & chest slightly forward.
  3. Breathe in slowly. Lean forward & feel your weight on the front of your feet.
  4. Breathe out & slowly stand up, using your hands as little as possible.
  5. Pause for a full breath in & out.
  6. Breathe in as you slowly sit down. Do not let yourself collapse back down into the chair. Rather, control your lowering as much as possible.
  7. Breathe out.

What about medications?

There are so many medications that can increase your risk for falls. That’s one of our specialties at Meds MASH. We can take a thorough look at all of your prescribed medicines, your over-the-counter medicines, your vitamins, your herbal medicines, and any other substances. Even the doses you take, your kidney function, and your liver function will be assessed. We will also look at the timing of your medicines and your diet. All of these things work together to impact your falls risk.

For more information contact us at www.medsmash.com and 410-472-5078.

BIBLICAL APPLICATION

One of the best ways to avoid falls is to know your risks and take steps to minimize them. You need to do some work, and usually get some professional input, to fully analyze those risks. Then, it takes personal motivation to do the exercises, change the shoes, use the assistive device, or work with your healthcare team to make the medication changes to lower your risks.

What are your risks to fall off the path of Christ? I’m thinking of the parable of the seeds found in Matthew 13.

Matthew 13:8 NLT

Still other seeds fell on fertile soil, and they produced a crop that was thirty, sixty, and even a hundred times as much as had been planted!

How do we avoid the thorns, the rocks, the birds, the hot sun, and the shallow soil that kept the other seeds from growing?

Jesus explains the parable later in the chapter.

Matthew 13:23 NLT

The seed that fell on good soil represents those who truly hear and understand God’s word and produce a harvest of thirty, sixty, or even a hundred times as much as had been planted!

God’s Word and the value of our studying, understanding, and applying it are found throughout the Bible. It is throughout the Hebrew Bible, Proverbs, Psalms, and throughout the New Testament.

2 Timothy 3:16 ESV

All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness,

Proverbs 4:20-22 ESV

My son, be attentive to my words; incline your ear to my sayings. Let them not escape from your sight; keep them within your heart. For they are life to those who find them, and healing to all their flesh.

Isaiah 40:8 ESV

The grass withers, the flower fades, but the word of our God will stand forever.

Psalm 119:105 ESV

Your word is a lamp to my feet and a light to my path.

John 14:21 MSG

“The person who knows my commandments and keeps them, that’s who loves me. And the person who loves me will be loved by my Father, and I will love him and make myself plain to him.”

What is your grasp of the Word of God? If that is the key to ‘letting our seed grow’, what is your growing potential? I know I have rocks and thorns and birds that try to snatch my seeds away in my life.

It takes motivation and discipline to stay in God’s Word on a regular basis. It takes discussion and study with others to really understand it from varying perspectives. And, it takes talking about it with other people to apply it.

People, instructors, pastors, mature Christians can help you gain the self-insight needed to really determine where your stumbling blocks are. Sharing and accountability help us stay focused and commit to the spiritual exercise, assistive devices, and work required to maintain ‘fertile soil.’

Psalm 1:1-3 ESV

Blessed is the man

    who walks not in the counsel of the wicked,

nor stands in the way of sinners,

    nor sits in the seat of scoffers; 

but his delight is in the law of the Lord,

    and on his law he meditates day and night.

He is like a tree

    planted by streams of water

that yields its fruit in its season,

    and its leaf does not wither.

In all that he does, he prospers.

Blessings,

Michelle

Image source: National Library of Medicine, National Institutes of Health, United States Department of Health and Human Services