Your Doctor’s Advise – Misunderstanding can lead to BAD Decisions

Posted on March 21, 2019March 21, 2019 by Michelle Fritsch, Pharm.D.

Good communication with your doctor — Let us help you avoid misunderstanding with your doctor.

Have you ever experienced misunderstanding with someone? Did that lead you to make a bad decision? If you had understood the original message, would you have made a different decision?

I have had two client examples this week.

Misunderstanding what the doctor said

In one instance, the doctor had said something about the pain medicine and the stomach acid medicine should not be taken together. This person has had a long history of Barrett’s Esophagus – a severe inflammation of the esophagus cause by extreme gastroesophageal reflux disease (GERD). To break that down, this person’s stomach acid was going back up the esophagus – the tube from the mouth to the stomach. Normally there is a sphincter that closes to keep the acid safely in the stomach. In many of us, that sphincter can become loose or have a condition that keeps it from completely closing. When that happens, the acid can go back up the esophagus. Indigestion, burping, pain and/or burning in the mid chest area can result. The acid inflames the esophagus lining. When that inflammation becomes severe, the inflammation can lead to Barrett’s Esophagus. So the stomach acid medicine was VERY important!

This person’s other issue was low back pain due to a herniated (bulging) disk and sciatic pain. Sciatic pain results in pain and burning from the lower back and spreading through the buttocks and the leg. It is caused by irritation of the sciatic nerve, common with lower back issues.

When this person heard the doctor say the stomach acid medicine and the pain medicine shouldn’t be taken together, the person decided to STOP the stomach acid medicine. The sciatic pain was the ‘bigger issue’, so if both couldn’t be taken, the pain medicine took priority. The doctor was not told.

The client heard ’these medicines shouldn’t be taken together’. The more complete answer is, the pain medicine will make the stomach acid and esophagus irritation even worse. There are safer pain medicine options that won’t make the Barrett’s Esophagus worse. The person should DEFINITELY be on both a stomach acid medicine and a pain medicine. The pain medicine should just be changed to a safer option.

This was explained, and this person is now on a safer medication regimen for both conditions.

Another Misunderstanding Example

Another recent example was a man with severe vascular issues and lung cancer.

The lung and cancer doctors had together told him and his family there is no more they could do. They recommended hospice care. Hospice care was accepted.

The vascular issues caused very little blood flow to the feet. As a result, one foot and lower leg had been amputated a few months ago. The second leg and foot are now very infected. The foot infection is causing severe pain. Hospice is treating the pain with morphine. The morphine makes the patient’s stomach upset and dulls his thinking.

His wife understands that the hospice doctor is now his doctor rather than his specialists and primary doctor from before. The hospice nurses visits regularly, but the doctor has not. His wife is very upset that the doctor is doing nothing to heal the infection. She also feels he is very overmedicated since his memory and decision making are slowed due to the morphine.

When we discussed goals – quality vs quantity of life – they each indicated the specialists who recommended hospice had asked that. They chose quality. However, they didn’t understand that this would mean a rather rapid decline with the untreated lung cancer and foot infection. They thought he would be able to back to the things he loves like working on projects around the house and cooking. They see a decline in quality of life rather than the expected increase.

Now they want to go back to the specialists and change their minds. It has been six months of no curative treatment. There is most likely no way to alter the pending outcome.

Essential Clear Communication

Healthcare visits can feel fast and pressured. Any time there is bad news involved, it is hard to fully hear and process all that is being communicated. These and other communication issues lead to misunderstanding of healthcare information. This is NOT an uncommon problem.

Another contributing factor is difficulty reaching the doctor after getting home to request clarification. Most doctors are given schedules that make it difficult to squeeze in phone calls. So, it is always best to receive, process, and fully understand the information while you have the doctor’s full attention during an appointment.

At Meds MASH and Retirement Wellness Strategies, we are your advocate. You have guidance to prepare for medical visits by assuring you have your questions ready and the information your doctor needs organized and clear. We also attend the visit with you by video when you want that.

After the visit, we can provide a wealth of information to further explain any new conditions or medications. We can even contact your doctor(s) on your behalf to obtain any needed clarification.

Call today at 410-472-5078 and ask for Michelle Fritsch, Pharm.D. Or e-mail at michelle@medsmash.com. Check out more at www.medsmash.comor www.retirewellness.com.

BIBLICAL APPLICATION

Miscommunication and misunderstanding can lead to so many preventable problems. I often ask this question of students in the health professions. ‘Tell me about a time miscommunication led to a bad outcome.’ Usually the answers involve people going to different restaurants or friends having an argument. One time, while teaching active duty military healthcare providers, the example was of an international hunt for a notorious terrorist. The terrorist had been found and surrounded, but a delay in the order to detain him resulted in his escape. What an example!

The Bible has much instruction about good communication.

This Psalmist knows exactly how much trouble our words can cause:

Psalm 141:3 ESV

Set a guard, O Lord, over my mouth; keep watch over the door of my lips!

Our communication is instructed to build people up and turn them to Christ.

Ephesians 4:29 ESV

Let no corrupting talk come out of your mouths, but only such as is good for building up, as fits the occasion, that it may give grace to those who hear.

Colossians 4:6 ESV

Let your speech always be gracious, seasoned with salt, so that you may know how you ought to answer each person.

I know I have spoken in frustration and said words I regretted. I know I have neglected to speak up when my support could have been very helpful to someone else. I know I have said the wrong thing and caused more harm than good, usually out of complete ignorance or insensitivity.

Proverbs 15:2 ESV / 176 helpful votes

The tongue of the wise commends knowledge, but the mouths of fools pour out folly.

One of my frequent prayers in the morning is, ‘Lord please fill me up and pour me out today.’ I ask to be poured out with the Lord’s words and attitudes and sensitivities.

Psalm 19:14 ESV

Let the words of my mouth and the meditation of my heart be acceptable in your sight, O Lord, my rock and my redeemer.

I certainly can’t be trusted to do this on my own, but with the Lord’s guidance, excellent communication can make a huge positive difference in the lives we meet!

Blessings,

Michelle

The best laid plans… When retirement is unnecessarily too short

Posted on June 5, 2018June 5, 2018 by Michelle Fritsch, Pharm.D.

I am sad.

I am surprised.

I am mad.

So, I need to take action.

Retirement is often not the golden age of happiness that is dreamed.

Retirement is a MAJOR life transition – up there with marriage, having children, and moving.

I have been researching more and more about retirement. As a healthcare professional, I have seen TOO MANY people lying in a hospital bed with their future retirement plans dashed. And, TOO MANY times, this event that led to the hospital could have been prevented. If only things had gone differently hours, days, months, or years earlier, this hospital visit could have been avoided.

Role of Medication Use

Medication use plays a part in these avoidable events at least 80% of the time. There are many ways medication can be part of the problem:

Not taking a medication that is prescribed.
Taking too much of the medication.
Taking too little of the medication.
Taking a medication for one thing that makes another problem worse.
Taking medications that are not safe together.
Having a severe side effect from a medication.
Not seeking medical care for a problem that should be treated with medication.
Taking a medication when no medication is needed.

And then there are multiple variations of each of these issues.

Medications are not benign.

Medications are not all bad.

Medications can save lives.

Preparing for the future

Sometimes the preventable problem is related to lack of planning for retirement.

Most people think of MONEY when they think of retirement planning. There are many professionals who dedicate their career to helping people secure the finances for retirement. Others focus on insurance and protection of assets.

Few have made plans for the enormous lifestyle transition that is retirement. Those who especially struggle with the transition are:

people who are very busy at work with a lot of responsibility,
those who always have people lined up to talk with them,
those who are the decision makers, and
those who run the company.

Work Withdrawal

The withdrawal from the daily demands of work can be similar to any other withdrawal from an addiction. Symptoms the first few days can include:

sense of loss
restlessness
frustration
anger
palpitations
sense of loss

Later withdrawal symptoms can be:

depression
despondence
loneliness
feelings of inadequacy or irrelevance
anger
lack of concentration
irritability

Planning for Retirement

Finding the retirement years of your dreams takes planning. How will you prepare for the first day the phone no longer rings, people are no longer lined up outside your office, and the big decisions are made without your input?

We dream of retirement practically from the time we start working. The thought of a break from the pressure sounds wonderful. Then it happens…

I have talked to many men, most thinking they had planned well for retirement, who are then surprised and disappointed when the realities of the transition hit. Others plan to never retire to avoid going through this.

A successful transition to many happy years and a long delay of functional decline is possible!!!

BIBLICATION APPLICATION

Retirement is a Biblical concept. We are designed for a period of rest from work, but not from ministry.

Going back to the Levites –

Numbers 8:23-26 ESV

And the Lord spoke to Moses, saying, “This applies to the Levites: from twenty-five years old and upward they shall come to do duty in the service of the tent of meeting. And from the age of fifty years they shall withdraw from the duty of the service and serve no more. They minister to their brothers in the tent of meeting by keeping guard, but they shall do no service. Thus shall you do to the Levites in assigning their duties.

And how wonderful to have a phase of life where you keep doing the joyous parts and let the hard work go!

Acts 20:24 ESV

But I do not account my life of any value nor as precious to myself, if only I may finish my course and the ministry that I received from the Lord Jesus, to testify to the gospel of the grace of God.

It might feel frightening to let go of a decades-long career and enter the unknown of retirement. Then again, that is right where you should be, and God can use you in amazing ways!

Jeremiah 29:11 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.

Philippians 1:6 ESV / 67 helpful votes

And I am sure of this, that he who began a good work in you will bring it to completion at the day of Jesus Christ.

Psalm 71:17 MSG

You got me when I was an unformed youth,
God, and taught me everything I know.
Now I’m telling the world your wonders;
I’ll keep at it until I’m old and gray.

Consider how God wants to use you in retirement. What blessings are just around the corner, when you give the part of your life completely over to His guidance?

Blessings,

Michelle

Taking 9 Key Steps to Your Best Health

Posted on April 23, 2017 by Michelle Fritsch, Pharm.D.

I know you want to feel good. I’ll bet you have a whole list of experiences in your plans for the future. You might be feeling great these days. You might be struggling with some health issues. You might be navigating some transitions in your life or some emotional conflicts.

I want you to be the healthiest version of you, in your best health! As I’ve been thinking about this, I’ve broken a process into steps. I’m hoping by following these steps, your health continues and gets even better.

Steps to your Best Health

Pay attention to your body. Remember when a new symptom starts; what makes it better; what makes it worse; how long it lasts; what you think caused it.
If it is severe, scary, or won’t go away, be sure to tell your doctor.
Before you see your doctor, make a list of the items in #1 so you won’t feel pressured to remember. Write your list and make 2 copies – one for you and one for your doctor.
Take to all healthcare visits a complete list of all medicines and other substances you take, how you take them, and when you take them. This includes your vitamins, supplements, recreational substances, and over-the-counter medications. Include even the ones you only take for a stomachache, allergies, or a headache.
Take notes during your visit. We all know how easy it is to miss something, forget, or get it all confused when trying to remember it all from memory.
Make sure it all makes sense to you and you clearly know what you are to do next before you leave. It is ok to ask to hear it all again until you really understand. Once your doctor explains what is causing your symptoms and recommends a plan, ask when you should feel better.
1. Too many times I have asked people what their doctor said and heard, ‘I have no idea; I couldn’t understand him/her.’
If you receive a prescription for a new medication, make sure you know the name, what it is for, how to take it, and what you can expect. All medications have the potential for side effects, at least right at first, so know what these might be. Know if you will be taking it for a short time or a long time. Ask your pharmacist to be sure this new medication is not going to interact with your current medications. (Be sure your pharmacist knows everything you take.)
Keep track of your original symptoms and any other changes you notice after you start your new treatment. If you don’t feel better in the timeframe the doctor told you, call and report that. If you feel worse when you start a new medication, let your doctor and pharmacist know. Either of them can help you determine if your new problem is caused by the medication and what you should do (do something to stop the side effects or give you a different medication).
Take care of yourself! Once you are feeling better, make an effort to take even more healthy steps such as healthy eating and regular exercise. I know we hear that all of the time. That is because these are the changes that will truly help you feel your very best.

What is the link between medications and your best health?

You’ll note that some of the steps specifically include medications. Medications can:

Cure
Control medical problems
Make symptoms better
Prevent problems
Harm

Depending on the medical condition and the medication, any of these four good purposes or the bad effect can occur.

Medications are prescribed for at least one of the positive effects of medications. Your doctor and your pharmacist want the medication to play a direct role in you reaching your best health.

Medications can interact with other medications. The ONLY WAY your doctor or pharmacist can check for this is if they know absolutely EVERY medication you take. Medications can interact with other medications, with food, or with other medical conditions. That is why you want your healthcare team to know everything about your prescription medicines, your over-the-counter medicines, your supplements, you herbal remedies, your vitamins, and any recreational substance use. It is all important!

This is one of the key services we offer you at Meds MASH. If you want someone to very carefully evaluate all of your medications, your symptoms, and things you think might be caused by your medications, we can do that!

To get started, contact us at 410-472-4078 or www.medsmash.com/contact. Let’s talk about how we can help you reach your best health!

BIBLICAL APPLICATION

I am reading a book that led to an interesting insight as I have been thinking about the stepwise approach to best health. The steps outlined above are each important to reaching your best health.

What about your best spiritual health? After all, true health has physical, mental, emotional, and spiritual components. Nothing outranks your relationship with Christ.

The book I have been reading is related to our brain. A neuroscience physician has studied the brain and its function in the light of both science and the Bible. If you haven’t read, ‘The God-Shaped Brain’ by Timothy R. Jennings, M.D., I highly recommend it.

In a very insufficient summary, our brains are at their peak function when we are in a secure, peaceful, loving environment. The brain is a very adaptable organ. There is one part of the brain that drives our ‘fight or flight’ response. This is what happens when we sense we are in danger. When this part of the brain is functioning, all deep reasoning is blocked. All brain effort is focused on primal survival. It is when we are more relaxed that other parts of our brain creating deep thoughts, logical decision-making, and empathy can function.

I was in high school when Pac-Man was first available. We had to go across the state line to another nearby town to play it in a pizza restaurant. The object is to maneuver Pac-Man through a maze to eat as many ‘points’ as possible. Some of the turns lead to danger for Pac-Man or to dead-ends.

Strangely enough, living in love, peace, and harmony made me think of our life like Pac-Man. Picture, if you will, a large canvas with a circuitous, clear path that has no obstacles that you can see when you look down on the entire canvas. This path is full of points, many points. Surrounding this path, at every turn, there are obstacles. Many of these obstacles are distractions. They are things that feel good, things that look good, or things that feel necessary. From within the maze, you can’t see the clear path. You can only see what is right around you. Those distractions look so good! They often seem to be on the easiest route. They promise you lots of points. So, you easily get off track with the distractions.

Our brain, our life, and our health are at their best when we are on the clear path. And yet there is not one human on the planet who has not left the path and made mistakes. Not ONE! Only Jesus was ever able to do that.

We can each be so much more at peace and living in love when we stay on the path. There is only one tour guide. Jesus can and will tell you step by step which way to turn. He will tell you which items are distractions and which are on his planned path for you. Your brain will be functioning at higher levels as you live in peace and love.

1 Corinthians 10:13 ESV

No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.

God knew from the beginning, as soon as Adam and Eve ate the fruit, that we would be on this path with many distractions. Eden, before that fruit eating, was the only place where people ever lived in perfect harmony, peace, and love. As soon as those first people used their own will to go outside God’s command, everything changed.

To allow your brain to operate in its most effective way, and to live in love and peace, let Jesus be your tour guide.

Psalm 119:15 ESV

I will meditate on your precepts and fix my eyes on your ways.

Philippians 4:8 ESV

Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things.

1 Corinthians 7:35 ESV

I say this for your own benefit, not to lay any restraint upon you, but to promote good order and to secure your undivided devotion to the Lord.

Here’s to being in your best health – physical, mental, emotional, AND spiritual!

Blessings,

Michelle

Why would you benefit from a board certified geriatric pharmacist?

Posted on April 2, 2017 by Michelle Fritsch, Pharm.D.

I started a company that I call Meds MASH in 2015. I am a board certified geriatric pharmacist. That means I specialize in medication use in people over the age of 60.

What Meds MASH doesn’t do for you:

Fill your prescription
- Your local pharmacist will do this
Change any of your prescription medications
- I will make suggestions to your doctors or help you discuss them with your doctor
Take over your healthcare
- You will keep your doctors who will lead your healthcare

What Meds MASH will do for you:

Talk with you to find out what are your health and life goals

Review all of your medications
- Prescribed
- Over-the-counter
- Vitamins
- Supplements
- Herbal remedies
- Any other substances
Obtain your medication history
Review your labs to check for medication safety
- Kidney function
- Liver function
- Medical condition control
- Side effects
Review your medicines compared with your allergies
Evaluate in-depth for risks of falling
Review for some common issues that are often missed
Make sure you understand each of your medications and how to best take them
Take time and answer your questions
Provide you with detailed information you can review later and share with your doctor
Talk direct with your doctors at your request and authorization
Engage your family at your request and authorization

Does Meds MASH make a difference? On average in an initial review-

We make 4.5 interventions
A recommendation is made to improve two medications
A recommendation is made to change a medication for 82% of clients
Over 98% of the time a significant suggestion about medication is made!

Questions frequently asked

Doesn’t my doctor already do this?

Rarely does your doctor know absolutely every medication you take and how you actually take it.
- Meds MASH specializes in obtaining this before reviewing the medications.
Only a small percentage of people over 60 have a doctor board certified in geriatrics.
- Meds MASH provides a board certified geriatric expert.
Most people have 7-15 minutes with their doctor.
- Most Meds MASH initial visits are 45 minutes.
Rarely are people fully prepared for their doctor visit.
- Part of a Meds MASH review includes specific strategies to get the most out of each medical visit with your doctors.

Doesn’t my pharmacist already review all of my medications?

Rarely does your pharmacist know all of the medications you take.
- They know the prescriptions only, even if you only use one pharmacy.
  - You absolutely should use only one pharmacy!
- Your pharmacist has a limited time to carefully review your medicines.
- There are not many geriatric board certified pharmacists in the country.

Contact us today for a free consultation! Meds MASH 410-472-5078 or e-mail michelle@medsmash.com or on the website www.medsmash.com/contact.

BIBLICAL APPLICATION

There is a lot of talk about and emphasis on being ‘transparent’ today in our society. It has taken me months to clearly, succinctly state what we do at Meds MASH. I am still honing the message so that it really makes sense to people. We need to be able to put things in someone’s own perspective to help them really understand.

If an alien from Mars came to visit and talked to you about places, customs, and politics on Mars, it is unlikely you would understand very much of it. You would have no perspective of how things look or operate on that planet.

I had this same thought this week as I was reading the Psalms, especially the ones written by David. David was the king. He was responsible for all of the people. His perspectives were oriented around keeping people safe and alive.

He frequently talks about enemies and God’s protection in wars. I’m sure they were attacked, or at risk of being attacked, most of the time. God made it clear that when the people of Israel went into battle with God’s protection, then they would prevail.

Deuteronomy 28:7 ESV

“The Lord will cause your enemies who rise against you to be defeated before you. They shall come out against you one way and flee before you seven ways.

When they went into battle on their own, the outcomes were not so good.

Numbers 14:39-45 ESV

Israel Defeated in Battle

When Moses told these words to all the people of Israel, the people mourned greatly. And they rose early in the morning and went up to the heights of the hill country, saying, “Here we are. We will go up to the place that the Lord has promised, for we have sinned.” But Moses said, “Why now are you transgressing the command of the Lord, when that will not succeed? Do not go up, for the Lord is not among you, lest you be struck down before your enemies. For there the Amalekites and the Canaanites are facing you, and you shall fall by the sword. Because you have turned back from following the Lord, the Lord will not be with you.” But they presumed to go up to the heights of the hill country, although neither the ark of the covenant of the Lord nor Moses departed out of the camp. Then the Amalekites and the Canaanites who lived in that hill country came down and defeated them and pursued them, even to Hormah.

Our personal battles aren’t with swords, but they are still battles. And if God is for us and leading us, then our outcomes are infinitely better than when we do battle on our own without Him.

David also makes frequently reference to rain, crops, vineyards, and grain. We don’t tend to spend our days focused on those things. Our grocery stores and markets are filled with all we need.

But what are the daily struggles in your life that mean just as much to you as ability to grow crops meant in David’s time? Is it your finances, your job, career opportunities, relationships, finding your meaning in life? Our daily struggles are no less important that David’s. Our world and our perspectives are just different.

So, whatever your battles, lay them before the Lord. Honestly lay it all out there. Be completely transparent and clear in your requests before God. He already knows. He loves the trust you place in Him as you bring it all to Him.

Psalm 71:14-17 ESV

But I will hope continually

and will praise you yet more and more.

My mouth will tell of your righteous acts,

of your deeds of salvation all the day,

for their number is past my knowledge.

With the mighty deeds of the Lord God I will come;

I will remind them of your righteousness, yours alone.

O God, from my youth you have taught me,

and I still proclaim your wondrous deeds.

If you’re ever at a loss for what to pray, consider the Psalms. They are the prayers and songs of praise of David. Put it in today’s perspective, and you’ll find they are completely relevant to your needs today.

Blessings,

Michelle

Are you the meat in the sandwich – for those caught in the middle

Posted on March 20, 2017 by Michelle Fritsch, Pharm.D.

Have you heard of the ‘sandwich generation’? Are you the meat in the middle – still finishing the child raising and caring for aging parents? This sandwich generation is now different than it has ever been before. It is the older Generation X and the younger Boomer generation now in this position. This means this sandwich generation has more dual career couples, more divorces, and generally more independent people juggling the younger and older generations.

Certainly you are blessed when you have children who are nearly or newly on their own AND you still have your parents. So many of us miss that opportunity.

If you do have this opportunity, it can be very challenging. Typically there are several other things happening around the same time.

Other changes while you’re the meat in the sandwich

The sandwich phase usually comes while in your late 40’s through your 60’s. During this time some other commonalities are:

You’re at the peak of your career
Friendships/relationships are no longer made through your children’s activities
Your own health is changing
If you’re a woman, you’re somewhere near menopause which brings its own health changes
You’re thinking about your ‘bucket list’

Tips for you to be the best ‘meat’ possible

It is so easy to get caught up in the needs of your parents and children and to forget about you in the process. If you fall ill, get injured, or burn out, then everyone loses. I don’t mean to add to your pressure. I just want to encourage you to take care of yourself as the caregiver.

Sleep to maintain clear thinking and patience
Exercise to stay healthy and stay strong
Healthy diet with fruits and vegetables vs grab-n-go fast food
Time off to maintain your mental health

Resources to help you

There are many resources available to help you as you help your aging parents. With the aging of the population, the numbers and types of resources are rapidly increasing.

Medications are often involved when someone reaches a point where they have difficulty living without assistance. That is our specialty at Meds MASH. Over 80% of people we see have a specific medication issue that we work with you doctor to address to help you stay safe at home. For 100% of all people we have seen, we have provided important education about medicines and how to get the most from healthcare visits.

There are several types of services that can assist with safely aging at home or in a place designed for safe aging. There are homecare services that can provide someone to help with tasks such as companionship, housekeeping, bathing, cooking, driving, and more. There are independent living communities with assisted living options when needed. There are assisted living facilities at many sizes, price ranges, and amenities.

If your parents’ home would be safer with some modifications, look for a contracting that is a certified aging in place specialist. You can learn more at http://www.nahb.org/en/learn/designations/certified-aging-in-place-specialist.aspx

A certified aging life care manager is an expert on your local resources that can assist with healthy aging. I think of these people as one-stop-shopping for many of your questions and needs. You can learn more at http://www.aginglifecare.org.

Legal and financial questions can be complex. These are elements that are easiest to address while your parents are still fully in command of their own finances. That is a good time to plan for the future in case you, your siblings or other friends/family will assume control of those key areas of your parent’s life. Decisions about advanced directives, power of attorney, and memorial wishes are easiest to make while your parents are fully able to make their own decisions. However, even if you miss that window, these resources (elder care attorney and financial advisor) can help guide you through each step. Here is a resource that can help you find an eldercare lawyer http://www.naela.org/findlawyer.

This is a very brief overview of the many resources that exist to help you and your parents navigate this sandwich time of life. We are glad to help you navigate this complex time and to identify these helpful resources. Please don’t hesitate to contact us at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This blog has acknowledged how difficult and consuming this time of life can be – in the phase of supporting children and aging parents. Resources and tips for self-care have been provided.

Another essential aspect for all of the complex phases of life is an awareness of the sufficiency of God.

2 Corinthians 12:9 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.

As in this verse, Paul is very clear that he was weak and unable to do what God called him to do. But, God was more than sufficient to get Paul through the many struggles, the imprisonment, the rejection, and the difficult travel.

To further understand that verse, let’s put it in perspective. Paul describes a health problem he had that he asked God to remove. Here is the response:

2 Corinthians 12:7-10 ESV

So to keep me from becoming conceited because of the surpassing greatness of the revelations, a thorn was given me in the flesh, a messenger of Satan to harass me, to keep me from becoming conceited. Three times I pleaded with the Lord about this, that it should leave me. 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.

Paul further encourages us that Christ can sustain us through all of the highs and lows.

Philippians 4:12-13 ESV

I know how to be brought low, and I know how to abound. In any and every circumstance, I have learned the secret of facing plenty and hunger, abundance and need. I can do all things through him who strengthens me.

We try and try to do it all ourselves. And, have you noticed how that doesn’t work?

2 Corinthians 3:4-5 ESV

Such is the confidence that we have through Christ toward God. Not that we are sufficient in ourselves to claim anything as coming from us, but our sufficiency is from God,

So, as you work through this complex time as the meat in the sandwich, remember the source of your strength. No, you can’t do it alone. So remember, you are NEVER in this alone.

Psalm 73:23 ESV

Nevertheless, I am continually with you; you hold my right hand.

Blessings,

Michelle

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Wrong Assumptions lead to Bad Medicine

Posted on December 14, 2016 by Michelle Fritsch, Pharm.D.

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?

Carry in your wallet a list of your:
1. Allergies
2. Medications
3. Diagnoses
4. Emergency contact information – name, phone number(s)
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.
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.
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 December 6, 2016December 6, 2016 by Michelle Fritsch, Pharm.D.

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

The Dominoes of Medication – Avoid the Tipping Point

Posted on November 7, 2016 by Michelle Fritsch, Pharm.D.

Follow these steps to prevent sudden confusion in the hospital like a series of falling dominoes.

Growing up I played countless games of Dominoes with my grandparents. And of course, the other fun thing to do with Dominoes is line them up and watch them fall is some funky pattern.

Hospitalization and memory or behavior changes

Many times in my career I have seen people experience a sudden decline in their health, often around a hospitalization. The general theme that I see far too often resembles falling dominoes and goes something like this:

Someone has a reason to go to the hospital
A medication is given that makes the person confused
An assumption is make this person has some form of dementia
That diagnosis is added to the record
With the confusion, behaviors change (crying out, pulling at IV’s, getting out of bed)
- By the way, this is very alarming for the family and friends
More medications are added to control the behaviors
The person now truly looks like someone with advanced dementia
- Unable to safely walk
- Unable to clearly think and answer questions
- Unable to care for him/herself
The person cannot return home and to the independent life led before the hospitalization
The person is sent on to rehabilitation or assisted living or skilled nursing care
The diagnoses and the medication go with them and are continued for the rest of life

In this scenario there might have been some early cognitive decline (early signs of some sort of dementia). The move to the unfamiliar environment with the scurry of activity and then the altered schedule can ‘unmask’ that early dementia and make it seem suddenly incredibly worse. Add an infection or painful condition, and this is even worse still. It could also be a sign of delirium (a short term confused state). That DOES NOT mean this confused state is the way this person will stay. Some of the best actions at this point are to dim the lights, quiet the person’s room, keep someone dear close by to assure the person that all is ok. This quieter reassuring environment can help reduce the confusion and behavior changes.

Elective procedures

Another all-to-familiar scenario is similar:

A person has an elective procedure
Part of the sedation and anesthesia for the procedure makes the person confused and disoriented
Any cries out or uncoordinated behaviors are interpreted as pain
More pain medication is given
When the person goes to rehabilitation or back home to recover, a schedule pain regimen is included
Rather than moving and doing all of the exercises that will enable rapid and full recovery, the person is too sedated from the pain medication and sleeps
The lack of post procedure stretching, movement, and exercises prescribed by physical therapy limit the range of motion and full recovery from the procedure
For the rest of life the person has limited use of the limb/joint due to lack of use right after the procedure

How can you better navigate these scenarios?

If there have been any signs of memory changes, know that you might see this sudden confusion. Also, it seems the more critical the admission the higher the risk of delirium. (So, accidents, being in critical care, being placed on a ventilator, and such carry the higher risk).

Talk with the healthcare team about taking the following steps:

Dim the lights
Have a private room/space that stays as quiet as possible
Keep someone reassuring nearby
Keep glasses and hearing aids on to help with orientation
Have a clock and date information visible
Assure there is no infection (can cause confusion and behavior changes)
The healthcare team can make sure no medications are being used that can alter thinking.
If there is a sudden change in your loved one, stay calm. Delirium goes away with time and with these calming steps.
Ask for the minimum amount of pain medication to be given to limit the associated confusion and sedation.

The goal is to take care of the problem that led to the hospitalization without delirium or other confusion. Let those dominoes say standing.

For more information about delirium and steps you can take to prevent or resolve it, contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

How confusing can God be to people who have never heard about Him? I was at a conference yesterday where a speaker quipped in reference to Jesus, ‘and who knows what this guy does.’ He was trying to be funny. It was a medical type of conference, not a religious conference. But it struck me as a sentiment that is likely true for a lot of people.

1 Corinthians 14:33a ESV

For God is not a God of confusion but of peace.

David and other Psalm writers struggled to understand.

Psalm 119:169 ESV

Let my cry come before you, O Lord; give me understanding according to your word!

Psalm 119:34 ESV

Give me understanding, that I may keep your law and observe it with my whole heart.

What would you say to someone who finds the whole concept of God confusing?

Romans 3:21-24 MSG

In these confusing times, may the message, hope, and peace of Jesus Christ bring clarity and comfort.

Hebrews 13:8 ESV

Jesus Christ is the same yesterday and today and forever.

Blessings,

Michelle

Medicare Open Enrollment – comparing your options

Posted on October 23, 2016October 23, 2016 by Michelle Fritsch, Pharm.D.

October 15 to December 7 is your window to select a Medicare plan. Let us help.

Medicare Open Enrollment for your 2017 plan is from October 15 to December 7, 2016. Before you make a selection, here are some resources to help you compare your options.

Medicare provides a tool where you can compare options before you make a decision. You can find it at this link.

The information you need is:

Your Medicare number
If you have a Medigap or Medicare supplement plan, the name and type of the plan
Your zip code
A list of your medicines prescribed by each of your doctors
The name and location of your preferred pharmacy

You can search through options using your specific information or you can do a general search. I highly recommend you perform a search with your specific information at least once before you make final decisions. That will give you the best look at your anticipated likely costs.

The tool will walk you through step by step.

It starts with your zip code and information from your Medicare card.
Enter your current Medicare coverage type. Include whether you get extra help paying for your medication costs.
Enter your prescribed medicines. Include the strength, whether you get your medicine every month or every 3 months, and whether you get your medicines from a local pharmacy or a mail order pharmacy.
1. Be sure to include all of your medicines
2. If your doctor has talked about maybe starting new medicine, include these, too. This will make sure the plan you choose will cover all of these medicines.
Select your pharmacy. Note, if your pharmacy doesn’t show up at first, expand the number of miles from your home so that your pharmacy will be on the list.
You can then choose whether you want to compare medication only Medicare D plans, Medicare Health Plans with drug coverage, and Medicare Health Plans without drug coverage.
1. If you aren’t sure, select all three options
2. If you know which you want to compare, select just that option
A list of all options will appear on the next page. They appear in order of cost with the lowest annual cost option appearing first after Original Medicare. You have the option to select different sort options.
Select three plans that you want to directly compare.
1. The three options will be displayed side by side.
2. You can compare three at a time as many times as you want.
3. All costs for the year include deductibles, co-pays, gap payments, and other fees will be displayed.
4. Look at your total annual cost
5. Look at the deductible which is money you will pay at the first part of the year
6. Look at the projected money you will pay in the coverage gap

To look at your options with Medigap plans, you can go to this link. This one will let you compare types of Medigap plans and their costs.

NOTE – A friend, and expert in the field, clarified that Medicare Advantage plans can be purchased at any time. Her comment: “Medicare Supplement policies do not have an annual open enrollment, but changes can be made based on your health after your original open enrollment or a special enrollment period.”

If you have any questions about how to use these tools or how to compare your options, please contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

For Medicare plan decisions, comparisons are good. They are key to making the best decision.

In the rest of your life, comparisons can be hazardous. How often do you compare yourself to someone else? You might not even realize you’re doing it.

Do you ever have negative thoughts about yourself when you see something you admire in someone else?

Do you ever feel extra good about yourself when you can do something that someone else can’t do?

In what sneaky ways can ENVY enter your thoughts?

I’ve read a couple of really good blogs about this from pastors recently. I know I’m guilty of comparison without ever intending for it to happen. I fall into a thought process of envy or comparison then catch myself and feel so ashamed.

Apparently I’m not alone. There are many Bible verses about the problems with envy.

Galatians 5:26 ESV

Let us not become conceited, provoking one another, envying one another.

1 Peter 2:1 ESV

So put away all malice and all deceit and hypocrisy and envy and all slander.

Instructions in the Bible can be very clear. It is clear ENVY is to be avoided. And if it’s mentioned this many times, it must be common.

Titus 3:3 ESV

For we ourselves were once foolish, disobedient, led astray, slaves to various passions and pleasures, passing our days in malice and envy, hated by others and hating one another.

James 3:16 ESV

For where jealousy and selfish ambition exist, there will be disorder and every vile practice.

The antidote to envy is to lay it all before the Lord. God has a very special, very specific plan just for you. Your gifts, your strengths, your weaknesses, your opportunities, your looks, your dreams are very UNIQUELY yours.

It doesn’t matter how other people are blessed. There are other blessings that are all for you!

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.

This could be the week to turn your eyes from what everyone else has. Instead, look at what God has in store just for you. Ask, He’d be happy to show you all the good things you have and what is still coming you way!!

Blessings,

Michelle

Medicare Open Enrollment – Which plan type for you?

Posted on October 16, 2016October 16, 2016 by Michelle Fritsch, Pharm.D.

I find Medicare and Medicare Open Enrollment to be very confusing. Do you? Let’s spend the next two weeks trying to better understand your options and guide you through the Open Enrollment process. I highly encourage you to delay your final decisions until we walk through this process and you compare your options.

The first big decision is which TYPE of insurance coverage is best for you.

Main TYPES of insurance coverage options over age 65

Original Medicare – When you turn 65 and meet eligibility criteria (use this link), you can have Medicare Part A, Medicare Part B, and Medicare Part D. Medicare has a list of items they do and do not cover at this link. Medicare covers part of the expenses, and you pay the rest through your copay and deductible.

Part A covers hospital, long term care, home care, hospice, lab tests, and surgery.
Part B covers doctor visits, other healthcare provider visits, outpatient care, durable medical equipment, some prevention, and home health care.
Part D covers medicines.

Medigap – This is a supplemental insurance to go with your Medicare Part A and Medicare Part B. Medigap will cover some of the copayments, coinsurance, and deductible expenses not covered by original Medicare. You purchase a Medigap policy through a private insurance company. You will pay a monthly premium for this co-insurance.

Medicare SELECT – Medicare SELECT is a managed care version of Medigap. It is the health maintenance organization (HMO) of Medigap plans. These plans contract with specific provider groups for a lower fee. So, they are typically less expensive. Be sure your provider or a provider with whom you are comfortable is participating before you select this type of plan.

Medicare Advantage – This is also known as ‘Medicare Part C’. Medicare Advantage plans are private insurance plans that you can select IN PLACE OF Medicare. They have similar coverage to Original Medicare and can have additional benefits as well. These have a wide range of prices.

A Medicare Medical Savings Account Plan is a high deductible Medicare Advantage Plan with a bank account. The plan puts money from Medicare into the account, and you use that money to pay for Medicare-covered expenses. This limits your out-of-pocket expenses to meet your deductible.

NOTE: you cannot have both a Medigap and a Medicare Advantage plan. You can have one or the other.

Other – You might have insurance through your former employer, insurance through special programs, Tricare, Veteran’s benefits, Indian Health Service plans, or other unique plans.

Medicare resources to help you

The Medicare website has a list of eight questions to consider when you are thinking about changing plans. You can find them at this link.

Next week we will talk about the tool(s) available to you to help you compare your plan options. These will let you predict your costs over the next year. You can compare several aspects of the types of plans you want to consider. I encourage you to compare your options before making your final decision. I’ll walk you through it step by step.

For more information about your Medicare options, contact us at www.medsmash.com/contact. If we can’t answer, we have some colleagues who are experts in the field.

BIBLICAL APPLICATION

Medicare is not the only area of life where there can be a lot of confusing messages. I have teens. I know just a few of their areas of confusing message are:

What to wear
How to act

Many of my recent pharmacy students are working their way through messages about:

What job to choose
How much of their income to spend on houses, cars, vacations
When to start a family; or whether to start a family

Many of my peers are sorting through messages about:

Helping children with college and career decisions
How much independence to allow teen children
Preparing for empty nest and soon retirement

My patients are working through message about:

Living at home vs. a senior living community
Options to move in with children when assistance is needed
Activities that enhance quality of life and keep them active

And we know there are countless people struggling with even more life-altering decisions surrounded my many confusing messages.

So, where does the truth reside?

John 14:6 NIV

Jesus answered, “I am the way and the truth and the life. No one comes to the Father except through me.

Psalm 145:18 ESV

The Lord is near to all who call on him, to all who call on him in truth.

Not to sound too pious, God is with you always. Whether you ‘feel’ His presence or not, He’s there…with you…always! When the messages from the many sources are confusing, you can just ask.

Matthew 7:7-8 ESV

“Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you. For everyone who asks receives, and the one who seeks finds, and to the one who knocks it will be opened.

When the messages are all confusing, ASK!

Blessings,

Michelle