Month: July 2017

2% have great med regimens

Are you part of the 2% with a perfect medication regimen? I hope so!

Posted on by Michelle Fritsch, Pharm.D.
2% have great med regimens
Are you in the 2% with a perfect med regimen or part of the 98% with room for improvement?

After thousands of patients and over 20 years of collecting data, I consistently find that 2% of the patients I see don’t need any medication change.   I hope you are in this esteemed 2%. It means your medication regimen is safe, effective, dosed correctly, and working just as expected for you. You have no unmet health needs. You are doing the things you want to do in your life with no limitations posed by medicine.

A full 2% understand their medications and take them correctly.

How do you know if you’re part of the other 98%?

A medication use specialist reviewing your health plan might uncover any of these things:

  • Your medication is causing a side effect that is impacting your day
  • There is another medication that could have the same benefit without the disruptive side effect
  • Your dose is too low to completely do what it is intended to do
  • Your dose is too high for what you need
  • Your kidneys or liver have changed, so your dose needs to change
  • A medication for one purpose is making another medical condition worse
  • You have a problem that could be treated and no treatment has been started
  • You are not taking the medication that has been prescribed and have not told your healthcare team (doctor)
  • The medication is so expensive you are having to make decisions about what to purchase each month
  • Your medication is not covered by your insurance; another safe and effective option is covered
  • You take your medicine at a time of day that will limit its effect
  • You take your medicine with other medicine or food that will change its effect
  • Your medication is making your dizzy or otherwise increasing your chance for falls
  • Your memory is changing because of your medication
  • The time of day you take your medication is limiting its effectiveness
  • You don’t remember which medication is for which indication
  • You have your medications confused
  • You pick and choose each day which medication to take (when maybe it only works if taken regularly)
  • You are taking a medicine that you no longer need
  • Medications, supplements, vitamins, over-the-counter items, and other things you take aren’t known by your healthcare team, are causing issues or are making you better such that you no longer need some of your prescriptions

What if you’re part of the 98%?

That’s why I do what I do!

The key elements of a Meds MASH health review:

  • Talk about your health goals and hopes
  • Review your health records
  • Review all of your medications exactly as you use them
  • Assess all of your supplements, herbals, over-the-counter medicines, vitamins, and the things you take just once in awhile
  • Evaluate your falls risk (helpful even if you are an athlete)
  • Evaluate your heart disease risk
  • Evaluate your memory
  • Assess your depression, anxiety, stress levels
  • Prepare you to get the most out of all healthcare visits with your doctor, therapist, or other providers
  • With your permission, share our findings and recommendations with your doctor and healthcare team
  • If you prefer, coach you to share our findings and recommendations with your doctor and healthcare team
  • Help your doctor with prioritizing items and medication titration (very gradually, carefully monitoring changes)

Contacting Meds MASH

A full 98% of people have room for improvement or education with their medications. Nearly ¾ need an actual medication or dose change. Even after I have worked with people for years, about ½ of the time, there is more work to be done. I never make changes all at once. Your health is too important.  Any changes, agreed to by you and your doctor, are made one at a time while we carefully monitor your response.

If you want to know if you are in the 98%, contact Meds MASH today at www.medsmash.com/contact or by calling 410-472-5078 or e-mailing michelle@medsmash.com.

BIBLICAL APPLICATION

This health blog was about the fact that most people have some room for improvement in their medication use.

Isn’t the same true in our life? I know I have a lot of room for improvement!

The sermon at my church today was about patience. I will readily admit that is not my strong suit. God has taught me a lot on this subject throughout my life so far. Like most of you, events have happened that absolutely stopped me in my tracks. All of my plans were out the window. The future was completely unclear. These are the times when we choose to shut down, take over our own planning, or give it all to God’s plan.

Solomon was the king blessed with great wisdom.  He was well aware of the value of waiting on God’s plan.

Proverbs 16:9 ESV

The heart of man plans his way, but the Lord establishes his steps.

Proverbs 19:21 ESV

Many are the plans in the mind of a man, but it is the purpose of the Lord that will stand.

As hard as we try to control these things ourselves, we can’t create, accumulate, or lead to the magnificent degree possible through Christ.

You are loved! God wants to guide you through your life according to HIS plan.

Throughout the Bible we have examples of God’s plan going beyond what we can even fathom. Even in terrible times, when people find themselves in dire situations, God has repeatedly demonstrated how He can turn things around.

Jeremiah 29:11-14 ESV

For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope. Then you will call upon me and come and pray to me, and I will hear you. You will seek me and find me, when you seek me with all your heart. I will be found by you, declares the Lord, and I will restore your fortunes and gather you from all the nations and all the places where I have driven you, declares the Lord, and I will bring you back to the place from which I sent you into exile.

Jesus addressed our tendency to stress out, worry, and try to assume control.

Matthew 6:25-34 ESV

“Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? And which of you by being anxious can add a single hour to his span of life? And why are you anxious about clothing? Consider the lilies of the field, how they grow: they neither toil nor spin, yet I tell you, even Solomon in all his glory was not arrayed like one of these. …

Ephesians 2:10 ESV

For we are his workmanship, created in Christ Jesus for good works, which God prepared beforehand, that we should walk in them.

How can you improve your life by turning it over more fully to God? He loves you! He has great plans for you! How can you be 100% committed to God and his plan in your life?

Blessings,

Michelle

 

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When the simple is complex

When Something so SIMPLE is NOT so simple – Tylenol®

Posted on by Michelle Fritsch, Pharm.D.
When the simple is complex
When simple pain meds aren’t so simple

How often have you reached for simple acetaminophen (brand name Tylenol®) in your life? It is the go-to remedy for so many symptoms. It will reduce a fever, help with a headache, and help with general aches and pains.

Note, acetaminophen is the generic name. The generic version works just the same as the brand Tylenol® version. It is sometimes abbreviated APAP. So, Tylenol® = acetaminophen = APAP.

#1 treatment of osteoarthritis

Do you have arthritis? I know I do. Most of us (about 90%) have osteoarthritis. This is a condition where the cartilage coating our joints has worn away. There is now pain where bone is rubbing against bone. Your main symptoms are usually pain when you use the joint, stiffness, weakness (from your tendency to use it less), and crackling sounds.

I know I can no longer sneak up on my teenagers when I climb the stairs. My gravely sound in my knees is easy to hear.

The American College of Rheumatology, the main group of specialist doctors who treat arthritis, recommends acetaminophen for osteoarthritis.

Safer than NSAIDs (ibuprofen = Motrin®, Advil®; naproxen = Aleve®, Naprosyn®)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain. They treat pain in a way just like acetaminophen, and they also help with inflammation.

There are three big risks associated with these that I want you to know about:

  1. They can be hard on your kidneys. Be sure your doctor and your pharmacist know that you take these, how much you take, and which ones you take. They will monitor your kidney function and likely ask you to stop taking them if your kidneys show signs of injury.
  2. They can be hard on your stomach. Your risk of stomach ulcer goes up when you take these. ALWAYS take them with FOOD. If you develop stomach pain, more indigestion, reflux, or burning, tell you doctor.
  3. They can raise your blood pressure. This in turn can increase the stress on your heart. If you have high blood pressure or a heart condition, talk with your doctor and pharmacist BEFORE choosing to take an NSAID.

Risks of acetaminophen – not so simple

Acetaminophen is safe, but not completely safe. It has some risks. The biggest risk is when we take too much. And taking too much, is VERY EASY to do.

Sometimes people don’t realize that Tylenol® and acetaminophen are the same thing. When in pain, they take both thinking they are different medicines.

Many opioid pain medicines contain acetaminophen (APAP). Here are some examples:

  • Percocet® (oxycodone and APAP)
  • Roxicet® (oxycodone and APAP)
  • Endocet® (oxycodone and APAP)
  • Norco® (hydrocodone and APAP)
  • Vicodin® (hydrocodone and APAP)
  • Lortab® (hydrocodone and APAP)
  • Lorcet® (hydrocodone and APAP)
  • Tylenol #3® (codeine and APAP)
  • Tylenol #4® (codeine and APAP)

Many cough/cold/flu medicines also contain APAP. Some examples are:

  • Contac Cold & Flu
  • Theraflu
  • Alka Selzer plus Cold
  • Vicks Sinex
  • Comtrex

Too much acetaminophen in a day can damage your liver. The most that should be taken in a day is 4,000 mg (8 Extra Strength 500mg tablets). A group of experts is supporting a change so people use 3,000 mg or less. This will decrease the chance of people taking too much if their combination medicines have some ‘hidden’ acetaminophen.

The other important factor is alcohol. It is best to not drink alcohol when taking acetaminophen. Both make the liver work hard. Each can damage the liver when the liver is overworked. It can hurt your kidneys, too. If drinking while taking acetaminophen, please not every day and not beyond 1-2 drinks.

For more information about best use of acetaminophen, contact us at www.medsmash.com/contact, 410-472-5078, or michelle@medsmash.com. We can assess all of your medication regimen to screen for hidden acetaminophen.

BIBLICAL APPLICATION

Oh my, isn’t this also true of our Christian walk? The rules are ‘simple’ – Love the Lord your God and your neighbor as yourself.

Love, love, love!

It is good for you, it is good for others, it’s so simple!

I can give a list of the people I have hurt, offended, taken for granted, or overlooked in the last day or two.   I get distracted, frustrated, caught up in work, or frazzled. There is no excuse. My intention is to spend each day expressing God’s love. And, each day, I fall short of my well-intentioned goal.

Paul describes his own struggle with this in Romans Chapter 7.

Romans 7:14-25 NIV (underline emphasis mine)

We know that the law is spiritual; but I am unspiritual, sold as a slave to sin. I do not understand what I do. For what I want to do I do not do, but what I hate I do. And if I do what I do not want to do, I agree that the law is good. As it is, it is no longer I myself who do it, but it is sin living in me.  For I know that good itself does not dwell in me, that is, in my sinful nature.[c] For I have the desire to do what is good, but I cannot carry it out. For I do not do the good I want to do, but the evil I do not want to do—this I keep on doing. Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it.

So I find this law at work: Although I want to do good, evil is right there with me. For in my inner being I delight in God’s law;  but I see another law at work in me, waging war against the law of my mind and making me a prisoner of the law of sin at work within me.  What a wretched man I am! Who will rescue me from this body that is subject to death?  Thanks be to God, who delivers me through Jesus Christ our Lord!

So then, I myself in my mind am a slave to God’s law, but in my sinful nature[d] a slave to the law of sin.

Why can’t we follow this simple rule of love?

Living in love means turning away from fear and selfishness*. We are so hardwired to think of ourselves first and foremost. It is a true choice (sometimes a very difficult choice) to put other people first. True love as demonstrated by Jesus is not selfish.

1 Corinthians 13:4-7 NIV

Love is patient, love is kind. It does not envy, it does not boast, it is not proud.  It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs.  Love does not delight in evil but rejoices with the truth.  It always protects, always trusts, always hopes, always perseveres.

Can you imagine our world if we all lived in perfect love, as we were designed to live? Can you imagine each person you see treating you with love and respect? Can you imagine a world without conflict?

It is coming!

Blessings,

Michelle

* This is a reminder of a book I have been recommending that addresses this conflict between fear/selfishness and love. The God-Shaped Brain by Timothy R. Jennings, MD.

Redwood forest serenity

Serenity- Exploring this component of your health

Posted on by Michelle Fritsch, Pharm.D.
Redwood forest serenity
Finding time for quiet serenity is key to good health.

Where do you find serenity? Webster defines

serenity as, ‘the state of being calm, peaceful, and untroubled’.

I have just returned from a trip of celebration with my Mom (70), me (50), and my daughters aged 18 and 16. We have been planning this trip for over a year. One of my favorite aspects was the serene places we found. While in the Redwood Forest it was awe inspiring and silent. Even though there were other people in the forest, somehow we couldn’t hear them if we weren’t beside them. To be in the midst of those giant trees and surrounded by giant ferns, it was so calm, awe-inspiring, and yes, serene.

The Redwoods were protected from excess logging by conservation efforts including the formation of the Redwood National Park in 1968. Then President Nixon dedicated a grove in the park to Lady Bird Johnson. Here is a quote on a plaque in that grove that struck me:

‘One of my most unforgettable memories of the past years is walking through the Redwoods last November – seeing the lovely shafts of light filtering through the trees so far above, feeling the majesty and silence of that forest, and watching a salmon rise in one of those swift streams – all our problems seemed to fall into perspective and I think every one of us walked out more serene and happier.’ Lady Bird Johnson, July 30, 1969

The part that grabbed my attention was, ‘all our problems seemed to fall into perspective…’

When was the last time you felt truly serene? How often do you slow down and allow yourself to just truly relax? What are the places or activities that bring you to that place of serenity?

Serenity and health

When you are calm, peaceful, and untroubled your whole body benefits. Your blood vessels relax, your blood pressure lowers, you breath more deeply, and your think more clearly. Your immune system is more active and you sleep more deeply.

I have been fascinated by the book, ‘The God-Shaped Brain’ by Dr. Timothy R. Jennings who is a psychiatrist and psycho-pharmacologist. He makes a compelling case that directly relates to serenity and health. He describes which part of your brain is working for you to think, reason, and plan. There is also a part that allows you to experience empathy, compassion, and love. When you are serene, these parts of your brain are fully operating.

When you are stressed, other parts of your brain take over. They put you in ‘fight or flight’ mode so that you are fully alert and ready to tackle the source of the stress. You were designed to have this stress alarm triggered only in rare truly life-threatening situations. However, in today’s society, so many of us are under constant stress. This system starts taking over our brain on a regular basis. As this stress system takes charge of your brain, your ability to think clearly, calmly, and to genuinely relate to others declines.

You have the power to give your stress signals a rest. As you do, and the more you do, the better your brain will function. You will be able to think through problems, plan, and prioritize. You will feel more connected to your own feelings, be able to manage them, and relate more to other people.

One of the best parts is that you will be free to think less about your own needs and more about the needs of others. That has been explored in previous blogs and will be explored again. There is a mountain of evidence that this is very good for your health!

The Role of Medications

There are many medications available to you that in some way target your mood, your anxiety, your depression, your anger, your emotions, and/or your reactions. These have a role. They cannot produce serenity. They cannot remove your stresses or your responses to them. They can help you cope. They are most effective when combined with therapy that can help you decrease the control of your stress response in your brain and let your thinking and loving parts of your brain resume control.

When medications are used, they should be used with great care and at the best doses. Your best medication and dose depend on several factors:

  • your kidneys and how they function
  • your liver and how it functions
  • side effects you might experience
  • your allergies
  • interactions with your other medications and your other medical conditions
  • evidence (studies that have been done to demonstrate what works best in a situation like yours)

The Role of Meds MASH

At Meds MASH a medication-use expert who is specialized in people over age 60 will help you and your doctor make sure the best, safest, most effective medication is used and only for the time period necessary. Meds MASH specialists can also help you find the counseling component you need to go with your medications.

Contact us today at 410-472-5078 or www.medsmash.com/contact or e-mail me at michelle@medsmash.com.

BIBLICAL APPLICATION

With each moment of our lives we have one basic decision to make. Will you make a choice for yourself or a choice for others? Jesus tells us our basic guiding principles are:

Luke 10:27 NIV

He answered, “‘Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind’; and, ‘Love your neighbor as yourself.’”

I mentioned the book I have been reading, ‘The God-Shaped Brain’. Dr. Jennings focused the book on how our brain functions when we are living according to God’s plan of love vs when we are not.

We get further and further from God’s plan the more we focus on ourself. Pride, envy, harbored resentment, anger, judgmental attitudes, and lust are just a few of the ways we turn our focus to ourself and our own needs.

Galatians 5:19-21 ESV

Now the works of the flesh are evident: sexual immorality, impurity, sensuality, idolatry, sorcery, enmity, strife, jealousy, fits of anger, rivalries, dissensions, divisions, envy, drunkenness, orgies, and things like these. I warn you, as I warned you before, that those who do such things will not inherit the kingdom of God.

1 Timothy 6:4 ESV

He is puffed up with conceit and understands nothing. He has an unhealthy craving for controversy and for quarrels about words, which produce envy, dissension, slander, evil suspicions,

1 Corinthians 3:3 ESV

For you are still of the flesh. For while there is jealousy and strife among you, are you not of the flesh and behaving only in a human way?

God’s plan is rooted in love and turns our focus outward. It also promotes the ‘best’ function of our brain, reduced stress, lower blood pressure, enhanced immune system function, and overall joy.

1 Corinthians 13:4 ESV

Love is patient and kind; love does not envy or boast; it is not arrogant

Galatians 5:22-23 NIV

But the fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness and self-control. Against such things there is no law.

It sounds so simple, but it is so hard to pursue and maintain. It is a daily, moment-by-moment decision to love and keep the focus turned outward. God is with you each of those moments ready to guide you and enable you to make those positive decisions.

Blessings,

Michelle

Safe meds and independence!

Independence – Live the Retirement of your Dreams

Posted on by Michelle Fritsch, Pharm.D.
Safe meds and independence!
Maintain your independence through safe medication use.

Happy Independence Day! On this day of immense gratitude for all who have served to preserve our freedom, I am also thinking about your freedom. My passion professionally is to help people live out their retirement dreams in good health avoiding physical limitations. It sounds so basic. No one thinks medication-related issues will apply to him or her – until they do.

I have talked with hundreds of people who found themselves suddenly limited. It happened ‘out of the blue’ in many instances. In others, it was a gradual approach that was more visible in hindsight.

Pay attention to maintain your independence

In many cases people noted a change but didn’t pay much attention to it. Often a medication had been changed, and their energy level or their clear thinking changed. Maybe they got dizzier or couldn’t exert themselves as much. These little changes led to new symptoms that led to more new medications. This can be a slow, barely noticeable cycle that leads to trouble.

Ask the right questions to maintain your independence

Before any new medication is started, fully understand why it is necessary, what other options were considered, and what you should expect. Read the information that comes with the prescription. Look at the common side effects and pay attention to whether you experience those. If they last more than a couple of days or they make you decrease your activity levels, call your doctor. Talk with your pharmacist.

Take active steps to maintain your independence

Always go to your medical visits prepared. Take a list of every medicine you take – including vitamins, supplements, over-the-counter medicine, and any other substance. Even include the ones you only take once in awhile.

Take two copies of any items you want to discuss. Give one to the medical assistant who takes you to the exam room. Ask that assistant to give it to your doctor. Keep the other copy for yourself. Take a pen or pencil to take notes for each item on your list.

Think about any new symptoms and how you could best describe those. Include any details such as what makes it better or worse, what you have already tried, and when you first noticed the symptoms. These details help your doctor discover the cause more quickly.

Medication is nearly always involved in someone’s loss of independence. So often that is completely avoidable. Don’t let it happen to you. Let us thoroughly review your medication regimen today. We can help you avoid the common pitfalls that lead to lost independence.

You can reach us at www.medsmash.com/contact, 410-472-5078, or michelle@medsmash.com.

BIBLICAL APPLICATION

This blog has been about maintaining your independence. It is about leading your life to the fullest with no avoidable decline in function.

On the flip side, we live our best life when we live in full dependence. Dependence on God, that is.

John 15:5 MSG

“I am the Vine, you are the branches. When you’re joined with me and I with you, the relation intimate and organic, the harvest is sure to be abundant. Separated, you can’t produce a thing.

Paul lived in complete dependence on God. He lived only to serve and do what was asked of him, even when he knew extreme hardship, flogging, and prison were waiting for him.

Galatians 2:20 ESV

I have been crucified with Christ. It is no longer I who live, but Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me.

2 Corinthians 1:8-9 ESV

For we do not want you to be ignorant, brothers, of the affliction we experienced in Asia. For we were so utterly burdened beyond our strength that we despaired of life itself. Indeed, we felt that we had received the sentence of death. But that was to make us rely not on ourselves but on God who raises the dead.

2 Corinthians 12:9-10 ESV

But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong.

I am praying you stay healthy, living independently in this lifetime so that you can do all God has called you to do. I am also praying you live in full dependence on the One who can guide your life through the amazing adventures He has planned just for you.

Blessings,

Michelle