2% have great med regimens

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

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

 

When the simple is complex

When Something so SIMPLE is NOT so simple – Tylenol®

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

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

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

 

Medication Reconciliation – Why it’s important to you

Slide1
Medication reconciliation can keep you safe.

Have you heard the term ‘medication reconciliation’? Probably not, it’s an insider’s term within medicine. But it’s an important concept, and I want you to know about it. I want you to ask about it any time you find yourself going into the hospital, going to the emergency department (ED), coming out of the hospital, going into rehab, switching doctors, having any major changes in either your health or who is monitoring your medications.

The term medication reconciliation (abbreviated ‘med rec’) means taking your whole medication list and understanding, how you are taking it and when you are taking. It is about making sure that information goes with you any time you are making a transition. So ideally, at the moment you enter a hospital someone figures out exactly what you take, how you take it, and when you take it. It is awesome if you come with this information. You could carry that information with you and have it ready to share with your health team. It is a huge safety factor in your care. If they know exactly what you take, how you take it, when you take it, they will make much more informed decisions in your care. This is true in the emergency department, the hospital, moving to rehab, moving to assisted living. I applaud the pharmacists who do this well in hospitals, clinics, and other settings around the country.

If you come in with it ready, you have saved them a lot of time and effort. And, you’ve helped assure your own safety. This important information will help guide the next phase when they will make any modification depending on why you are in the health system and what your needs are at that time.

If you’re in the ED or the hospital for a particular reason, there may very well be a need for a new medication to treat the reason you’re there. It is important that any of those changes are communicated all throughout your stay within and beyond the health system.

Formulary

A little caveat that’s important is another important term to understand – formulary. There can be a number of different medicines that do the same thing. We call them medication classes, and each class could have several medications that do the same thing in the same way. Rather than carry every medication on the market, a hospital will carry a few in each category.   It is possible that the one you typically take is not on their formulary. They will switch you while you are in the hospital to one that is on their formulary. The name, color, and size might not look familiar to you. Be sure to ask questions when you don’t recognize your medicine. This is not harmful; it will not put you in danger. Medicines within the same class work the same way as the one your doctor had you on at home. But, it is a source of confusion when you go home or move to another part of the health system. It’s one of the reasons this medication reconciliation process is so important.

It is critical that you know that another medication, similar to the one you take at home, is being used in the hospital. You want, when you go home, to be switched back to the medicine you came in on, the one that was prescribed by your own primary care provider.

Many, many patients have run into difficulty when they go home on the medication the hospital gave them and they continue to take the one they have at home. This is called duplication of therapy. You are getting twice the amount you need – you have the one you have at home and the on the hospital gave you that do the exact same thing. So, using blood pressure as an example, if you are taking the medicine you have at home plus the one in the same class that you got in the hospital, you could lower your blood pressure too much. You want to avoid duplication of therapy; be sure for that class of medicine you are on just one.

Be sure to ask at the hospital if you can go back on the one you were familiar with at home that does the same thing as the one you got while in the hospital.

It is important that several people know exactly the medicines you take when you go back home or get to your next destination. You are one of them, of course. It is also important that anyone involved in your care such as your spouse, child, or caregiver involved in your care; your primary care doctor; any specialists; and your pharmacist know exactly how your medications have changed while you were in the hospital.

It is important that any intermediate step before you go home, such as rehabilitation, knows your entire current medication regimen. But, it is most important that you understand exactly what to take when you get home.

Medication changes while you’re in the hospital

What if problems related to your medication led to you going to the hospital? That is very often the case. Then, the medicines that led to your admission will be stopped or changed. If the problem that took you to the hospital was something new, then it’s likely that new medicines were added to your regimen. Again, it is important that you know what changes were made, why they were made, and exactly what you should do when you get back home. Ideally, ask your questions while you’re in the hospital, but if you get home and have questions, don’t hesitate to reach out for answers.

Medication reconciliation is something we often do at Meds MASH. People get home and realize they don’t really understand what they are to do. They have a list from the hospital, a list from rehab, and their home list. They wonder if anyone has looked at all of the medicines – the old ones, the new ones, and some from other doctors.   At Meds MASH we look at all of the medicines and make sure they are all safe together. We catch those duplications and clear them up with your doctors. One of the things we will do, with your permission, is get information from all of your doctors and from the hospital and pull it all together. Then, after the thorough analysis, any changes will come from your primary care doctor who is the gatekeeper and the one person responsible for all of your medicines.

Three doctors recently wrote an important article about the need for accurate medication reconciliation. And they note that this process must be thorough to be meaningful. Several partial versions have been tried, and if it isn’t complete, it’s not helpful. It’s not going to keep people safe if it is not done right.

If a thorough medication reconciliation can keep you safe and healthy, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This Biblical application might feel a little less associated with the health part. With medication reconciliation we are talking about making sure all of the information related to medication use is clearly communicated. If it is not done completely it isn’t effective. What about our compassion and how we reach out to others? How complete and effective are we?

Something has been weighing very heavy on my mind in the last week. It is the decisions we make about where our compassion lies. Who we can forgive and who we can’t. How do we spend our money and give our support and where we do we not? The thought that has been raised in my mind is – when we know someone is in need, and we do not know their sins, it seems to me it is easier to reach out and provide support for those needs. The example that got me thinking this is the refugee crisis. When you know there are millions of people who have been displaced, a lot of people have compassion for that and for their circumstances. What can we do to help those people and their dire circumstances?

The other things that made me think of this were more local. What are the needs of people who are making choices that are leading them to being in dire circumstances? It might be behavioral and lifestyle choices; it might be financial management choices; it could be self-care choices that lead them to circumstances where their life is not as secure as it might be. Their difficult circumstances are a ramification of lifestyle and self-satisfaction choices they have made.

I am connected to a place right now that serves the LGBTQ community and the HIV population. Some Christians find it easy to be very judgmental of this population and not share their compassion in this direction. Rather, they choose to share their compassion in other circumstances where the reasons and the choices are less known. Is this what Christ calls us to do? Are we called to show compassion or walk away?

Consider the story of the woman caught in adultery in Luke Chapter 8.

Luke 8:1-11 MSG

 Jesus went across to Mount Olives, but he was soon back in the Temple again. Swarms of people came to him. He sat down and taught them.

The religion scholars and Pharisees led in a woman who had been caught in an act of adultery. They stood her in plain sight of everyone and said, “Teacher, this woman was caught red-handed in the act of adultery. Moses, in the Law, gives orders to stone such persons. What do you say?” They were trying to trap him into saying something incriminating so they could bring charges against him.

Jesus bent down and wrote with his finger in the dirt. They kept at him, badgering him. He straightened up and said, “The sinless one among you, go first: Throw the stone.” Bending down again, he wrote some more in the dirt.

Hearing that, they walked away, one after another, beginning with the oldest. The woman was left alone. Jesus stood up and spoke to her. “Woman, where are they? Does no one condemn you?”

“No one, Master.”

“Neither do I,” said Jesus. “Go on your way. From now on, don’t sin.”

Her choices were well known, and she was being very degraded. She was called before the council having been caught in the act.   The council members were ready to stone her. Jesus said those without sin could cast the first stone. We are so quick to categorize sins, but it doesn’t seem Jesus categorizes sins. What are we called to do as Christians? I am struggling with this and I’m challenging others to struggle with this, too. This is not a blog with answers. It is a blog with challenging questions. I would love to hear what people think.

Luke 6:37 ESV

“Judge not, and you will not be judged; condemn not, and you will not be condemned; forgive, and you will be forgiven;

It has become clear to me as a practitioner that sex as defined in the Bible, as designed by God does not lead to trauma, whether emotional or physical, and it does not lead to disease transmission or to promiscuity.

But in society, especially in the current waive of rules avoidance and focus on self, sex is being used in a lot of other ways. When used outside the way described by God, it does lead to a lot of issues. We create our own problems when we are outside this definition.

Another example heavy on my mind is substance abuse. The numbers of people caught in addiction and dying of overdose are astounding. This is a tragedy of great proportion! Yet the local rescue mission is struggling to stay funded. People who have been caught up in abuse and addiction who are now reaching out for help to leave that lifestyle are encountering limited spots available for rehabilitation. Yet Christians are looking for meaningful outreach and missions opportunities.

I am in full support of refugee aid, international response to crisis, local response to crisis, support of children in underserved areas, teens on mission trips, college students on mission trips, medical missions, and so much more. In addition to all of this wonderful outreach, I encourage us to search our hearts and God’s leading for our attitudes about reaching those in circumstances in our own community that are harming them.

I propose when we limit our compassion or draw a line for how we will consider using our resources, it is similar to an incomplete medication review.  Completeness and effectiveness are limited.

James 4:12 ESV

There is only one lawgiver and judge, he who is able to save and to destroy. But who are you to judge your neighbor?

What is your response?

Blessings,

Michelle

 

 

 

 

9 steps to your best health

Taking 9 Key Steps to Your Best Health

9 steps to your best health
Here are 9 steps to get you to your best health

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

  1. 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.
  2. If it is severe, scary, or won’t go away, be sure to tell your doctor.
  3. 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.
  4. 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.
  5. 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.
  6. 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.’
  7. 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.)
  8. 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).
  9. 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

board certified geriatric pharmacist

Why would you benefit from a board certified geriatric pharmacist?

board certified geriatric pharmacist
How Meds MASH promoted safe, healthy, active living

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

serotonin syndrome - know and avoid

Depression Treatment & Serotonin Syndrome – Avoid

serotonin syndrome - know and avoid
Avoid serotonin syndrome with careful medication review by doctors and pharmacist.

Last week we reviewed medication treatment of depression and anxiety. Medications impacting serotonin to help regulate mood were a focus. Did you know you could get too much serotonin? When we overdo it, there is a condition called serotonin syndrome that can occur.

I saw a patient that really made me think about this. He is on three antidepressant medications and a couple of other medications that can interact with those. All of them will increase his serotonin levels. I immediately alerted his primary care provider.

Three main scenarios

There are three key ways serotonin syndrome typically occurs:
1. Too many antidepressants, often from more than one doctor. If those doctors don’t know what the others are doing, more than one can start treating the same condition.
2. Self-treatment in addition to prescribed treatment. In particular, St John’s wort increases serotonin. Because there is no regulation for products such as St John’s wort, one bottle can have a different amount than another, so one bottle might lead to too much serotonin while another does not. Several over-the-counter medications can also increase serotonin to dangerously high levels when used with antidepressant medication.
3. Interactions with other medications. There are several other medications for completely different medical conditions that can increase the serotonin effects of antidepressant medications.

Symptoms

When someone has too much serotonin then a condition called serotonin syndrome can occur. The symptoms, especially early on and with a mild version, can be mistaken for a viral illness. These milder symptoms are fever, chills, diarrhea, muscle aches or spasm or rigidity. Other symptoms can be confusion, feeling irritable, or feeling disoriented. Your heart might beat faster and blood pressure could go up.

With more severe serotonin syndrome, seizures, coma, changes in heartbeat, and even unresponsiveness are possible. The most severe cases can lead to death.

Prevent Serotonin Syndrome

Your best defense against serotonin syndrome is to be very open with all of your doctors and your pharmacist about each medication you take. Ask each of them to carefully evaluate your entire regimen.

Do not change your dose on your own. Increasing your dose without guidance increases your risk of serotonin syndrome.

Adding medications you choose to take on your own can increase risk. Medications that can increase serotonin include those you take for cough, for other mood disorders, for pain, for migraine, for nausea, and for some infections. The list is so long, I encourage you to make sure you always share all of your medicines with all of your healthcare providers.

Note, even herbal medications and illicit medications can increase serotonin.

Please don’t be afraid or stop your antidepressant

The purpose of this blog is to make you aware, not to make you afraid. When taken at appropriate doses, antidepressants have aided in the resolution of depression for many people. Keep in mind; counseling is a key part of depression therapy versus medication alone. Keeping your entire medical team involved in each aspect of your care and how you feel during therapy will help avoid issues such as serotonin syndrome.

I want to remind you to never stop your antidepressant/antianxiety medication all of a sudden. Your healthcare team will guide you through a gradual tapered withdrawal when that is warranted.

For information about depression and anxiety treatment, serotonin syndrome, and drug interactions, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This might be a loose association, so please stay with me here. I found that people with lingering depression and/or their loved ones seek relief from multiple sources. They sometimes combine prescription medications with herbal therapies with cognitive behavior therapies with religion with any other options for which they find anecdotal evidence. I typically do not hear the full picture at my first visit. It is with time and the building of trust that I get the full story. Sometimes those mixtures of therapies work, and other times they lead to more problems.

I think the same can be true with spiritual growth options. There is a lot of information ‘out there’. You can find speakers, books, videos, churches, ministries, and blogs that will tell you just about anything.

I have mentioned before the rapid growth of para-spiritual businesses that exist to help people feel better. Many of them are quite centered on the person rather than on the One True God.

Discernment is key with so many voices and messages to select. And, wow, this is so much easier to type than to do.

Jesus, Paul, John, Solomon, James, and others throughout the Bible encourage us to be careful. Follow God’s word, follow the leading of the Holy Spirit, and don’t fall for just anything that you hear.

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.

I like this passage even better in The Message:

My dear friends, don’t believe everything you hear. Carefully weigh and examine what people tell you. Not everyone who talks about God comes from God. There are a lot of lying preachers loose in the world.

When you’re not sure what you’re hearing is right, take a time out. Go to the Bible. Talk with spiritually mature Christians. Pray for guidance. Hasty decisions can quickly get you into trouble.

James 1:5 ESV

If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him.

You’re smart, but that doesn’t mean you can’t get caught up in false information.

Matthew 24:24 ESV

For false christs and false prophets will arise and perform great signs and wonders, so as to lead astray, if possible, even the elect.

There are so many confusing messages in our World.   Just this past week alone has bombarded you with message of right and wrong and what you should believe.

Romans 12:2 ESV

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

Don’t beat yourself up if you’re confused. It is a smart thing to question all you hear, read, see, and experience.

1 Timothy 6:3-5 ESV

If anyone teaches a different doctrine and does not agree with the sound words of our Lord Jesus Christ and the teaching that accords with godliness, 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, and constant friction among people who are depraved in mind and deprived of the truth, imagining that godliness is a means of gain.

Jesus tells us to expect this confusion. He also tells us to be wise, discerning, smart, and loving all at the same time. And HE is the one who can help us do that. You can’t do it alone.

Matthew 10:16 ESV

“Behold, I am sending you out as sheep in the midst of wolves, so be wise as serpents and innocent as doves.

I’m praying we each seek the truth through the One who is and was and is to come.

Blessings,

Michelle

SSRI dosing

Anxiety and Depression Medications – Step Up, Step Down

SSRI dosing
Depression and anxiety medications should be started and later stopped in gradual steps.

Sometimes you can start a medicine and it starts working right away. Sometimes it takes a while to work. Sometimes you can stop a medicine ‘cold turkey.’ Sometimes you can’t without risky side effects. Some require step up and step down dosing.

I believe it is very important to understand a medication, how it works, how to best use it, and how to avoid problems. There are a lot of these tidbits that are important in the use of anxiety/depression medications. The most commonly used anxiety/depression medications right now are in a class called ‘selective serotonin reuptake inhibitors’ (SSRIs).

The class name describes how they work. I’m going to try to break it down into steps that make sense.

Neurotransmitters

The first step is to have some understanding of neurotransmitters. They are the brain’s messengers. They carry messages from one nerve to another.

Some of the main neurotransmitters are:

  • Epinephrine – adrenalin, drives the sympathetic system and your ‘fight or flight’ response when you are scared, in stress, or in danger
  • Norepinephrine – also drives the sympathetic system causing you to feel awake, ready for the day, able to manage stress
  • Dopamine – mainly related to movement; increasing this is key in the treatment of Parkinson’s Disease
  • Serotonin – manages your mood, appetite, sleep, and movement of your gastrointestinal tract

Neurotransmitters are passed from nerve cell to nerve cell. As a neurotransmitter leaves one nerve cell, it goes into a space between the end of that nerve cell and the beginning of the next nerve cell. This space is called the synapse.

The beginning of the next nerve cell has receptors.   Neurotransmitter in the synapse (the space) will bind to a receptor. That will allow it to get into the nerve cell and create an electrical signal that will travel through it to the end and continue the message to the next neuron in the same manner. At the end, it will be released into the synapse where it can be picked up by the receptors of the next nerve cell. In this way, the message travels through the whole nerve system.

When there is too much neurotransmitter in the synapse, the nerve cell that released it can take it back. This is called reuptake.

The body has amazing processes to regulate itself. In this case, release from a nerve cell, time in the synapse, and binding to a receptor in the next nerve cell are all carefully synchronized.

Serotonin, depression, and anxiety

Serotonin is one of the primary neurotransmitters for the regulation of mood and sleep. When someone is depressed, it might be because serotonin transmissions are too slow.

When someone is experiencing anxiety, serotonin levels might be out of balance.

The role of selective serotonin reuptake inhibitors is to prevent the first nerve cell from taking back the extra serotonin it has released. This will make more serotonin available for the receptor of the next nerve cell. This will allow more serotonin to be passed from nerve cell to nerve cell.

Product delivery analogy

Imagine you have created a product that is a popular gift for special occasions. During most months the demand for your product stays steady for events such as birthdays.

On these months, you keep a regular supply of product in your warehouse. Ten distribution trucks can get the products to the stores that sell your product. This keeps the stores supplied with enough product for customers each month. If a store has several products that have not sold, they will send them back to the warehouse in the delivery truck.

Then, there are two months when the demand goes way up. During these two months, you stock your warehouse with much more product. You hire 10 more distribution trucks. You stop taking any product back to the warehouse from the stores. All product is moved from the warehouse to the stores.

Then, in the month after the rush, demand gradually decreases. It does not immediately go back to normal. People exchanging gifts often exchange their original gift for your product. Others see their friends with your product and want one for themselves. Then eventually, the demand is back to normal.

In this analogy, your product is the serotonin. The warehouse is the nerve cell that stores the serotonin. The delivery truck is the receptor that will transport the serotonin into the next nerve cell to continue the message.

Why Step Up and Step Down?

Increasing the availability of serotonin takes time. The nerve cells can’t immediately stop the reuptake process. The receptors don’t immediately increase in number to use more of the available serotonin. The entire central nervous system doesn’t immediately respond to the extra serotonin. That whole process takes about 8 weeks. At around 4 weeks the doctor prescribing the SSRI might increase the dose if your energy is not starting to pick up.

Similarly, it takes time for the body to adapt when the medication is stopped. Usually, if someone with a first episode of depression has been treated for six months and is feeling good, then the SSRI can be stopped. However, it shouldn’t be stopped all at once. It will again take the nervous system time to adapt to a change in the medication. So, the dose needs to be very gradually decreased over a few weeks. If it is stopped all at once you could feel dizzy, tired, anxious, achy, irritable, nauseous, like your skin is prickly, or other symptoms. The receptors and nerve cells need time to take back over the serotonin transmission without assistance.

NOTE, this does not mean you are addicted. It means your body has adapted to the medication and needs time to adapt back to being without the medicine.

Disclaimers – Everyone will have times in life with highs and lows. Each low is not a type of depression that requires treatment. A professional makes the diagnosis of depression or anxiety requiring treatment. The treated depression or anxiety has usually lasted several weeks to months and is impacting daily life activities.

If this leaves you with questions, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

The step therapy of SSRI’s reminds me a common path of helping other people find Christ.

Often someone who doesn’t know Christ will hesitate to find an accept Him all at once. Sometimes it is years of small events, people, exposures, or discussion that gradually lead to real interest. Even from there, developing understanding and real seeking can take more time. At some point after all of this exposure and searching, the person reaches the point of accepting Christ and moves to leading a life of following Christ. As a believer in that person’s life, you can’t just wash your hands and walk away. This new believer is in a fragile state. The excitement, joy, and intentions are very real. Do you remember how awesome that time period was, if you are a believer who came to Christ over a period of time of searching? If you walk away now, that new believer could be like the seed that falls on rocky ground from the Parable of the Sower.

Matthew 13:5-6 ESV

Other seeds fell on rocky ground, where they did not have much soil, and immediately they sprang up, since they had no depth of soil, but when the sun rose they were scorched. And since they had no root, they withered away.

Jesus goes on to explain this parable (found Matthew 13:1-23), and the explanation of this part is:

Matthew 13:20-21 ESV

As for what was sown on rocky ground, this is the one who hears the word and immediately receives it with joy, yet he has no root in himself, but endures for a while, and when tribulation or persecution arises on account of the word, immediately he falls away.

Following Christ can seem so obvious, so right, so easy at first.   But, life is full of road bumps, dead ends, and hardship. A brand new believer can quickly and easily become disillusioned. You know Satan will be lining up these difficulties to create just this situation. So, you can’t just walk away and feel that your work is done.

Support for a new believer is at least as important as helping others find Christ.

As the new believer learns to communicate, read God’s word and listen for His voice, and find friendships with other believers, then your role will gradually be less critical. It doesn’t go away, but the frequency of your interactions might decrease.

The role of continued fellowship and connection with other believers is found throughout the Bible.

Romans 1:12 ESV

That is, that we may be mutually encouraged by each other’s faith, both yours and mine.

1 Thessalonians 5:11 ESV

Therefore encourage one another and build one another up, just as you are doing.

Hebrews 10:25 ESV

Not neglecting to meet together, as is the habit of some, but encouraging one another, and all the more as you see the Day drawing near.

So, I found it interesting to consider how we step up when introducing someone to Christ and step down as they grow and mature in their faith.

Blessings,

Michelle

Break the Circle of Self

Depression, Pain, Anxiety – the Circle of Self

Break the Circle of Self
The Circle of Self can lead you into a dark self-absorbed place with pain, depression, and anxiety.

I was teaching health profession students this week about mental health and pain. The Circle of Self was a good visual way to capture a current phenomenon. One of the very important things we talked about was the LIMITS of MEDICATION! The students were very insightful about the reasons so many people are struggling with depression, anxiety, and pain. And, the more we talked, the more it made sense that this is a common pattern.

STRESS

We made a list of reasons why the incidence of depression, pain, and anxiety are so common. I would love to hear what you would add to this list. Current themes in our society that contribute are:

  • Stress
  • Anxiety
  • Decreased coping skills
  • Social media – most posts are either deceptively positive to look good or very negative
  • News, especially so much bad news
  • Poor sleep hygiene
  • Expectation of instant gratification
  • Reliance of medications or techniques to ‘just fix it’

THE CIRCLE OF SELF

When someone experiences depression, anxiety, and/or pain, several things tend to happen:

  • Less movement – more sitting or lying around
  • Decreased social activities – stay home more, reject offers to get out
  • Nod off or purposefully take a nap during the day
  • Have interrupted sleep at night
  • Experience pain – either pain when there was none or worsening pain

These changes lead to more and more focus on self. How do I feel? What is happening to me? Why me? Why do I feel this way? Why can’t I sleep? Why can’t I get motivated? Woe is me…

This common pattern of self can also impact heart disease, diabetes, obesity, and more.

The role of SLEEP

Most adults need 7-9 hours of sleep per night. As we age, more and more things seem to interrupt this sleep. You might need to go to the bathroom more often during the night.   Pain can wake you up or keep you awake. Napping during the day can mess with your nighttime sleep.

Too little sleep can increase your risk of depression. It can also make your recovery from depression most difficulty.

Too little sleep can limit your ability to manage with pain. Pain can feel worse, be more frustrating, and limit your activities more when you’re extra tired. Also, the more you hurt, the hard it is to sleep, and a vicious cycle is started.

The role of MEDICATION

Low amounts of key neurotransmitters in the brain can lead to depression and/or anxiety. There are medications that can help increase the amounts of those neurotransmitters. Note, this process takes about 8 weeks, so starting medicine doesn’t make you feel better right away. Usually your energy gets better before your depressed or anxious thoughts.

In the studies that showed that these medications can help, counseling was also a key part of therapy. The medications by themselves don’t help as much as they do when you also have counseling. It is the counseling that can help you find some different ways to think, stop the negative thoughts, and help you focus on more positive aspects of your life.

For pain, some medications block some of the pain signals going between the site of the pain and your brain. Others decrease the intensity of those signals. The pain medication should match the type and intensity of the pain. This means the same pain medication is not the best option for all types of pain. There have been huge issues in our society of overuse of pain medicine, especially opiate medications. These have a role in some types of pain. Once the pain starts to decline, the medication should be decreased and stopped. In another blog, I’ll review all of the many types of pain medications and when/how to use each.

Breaking the Cycle

Breaking the circle of self
Think of others to break the circle of self.

Medications are part of breaking the cycle for many people. Note, medication is often helpful to start the process. It might not be needed long term. Ask you doctor about how long it will be helpful for you.

Counseling is part of breaking the cycle. Learning to change your thinking patterns is key. Having support is also key.

Then, I want to share something that has repeatedly been shown to effectively break this cycle. Do something for someone else! Focus on self leads into the negative circle that gets tighter and tighter, isolating you from others. To purposefully think about others can help you out of this dark place. Call to check on a friend. Help someone with a project. Visit an older relative or friend. Take a meal to a new parent or someone who is sick. Make a donation. Write a letter to a soldier. Plan a special outing with a friend. Join a club that works on a social issue.

There are many options! The point is to find someone else you can think about and help. Distraction is helpful for pain tolerance, anxiety reduction, and depression treatment. Thinking about someone else helps you out of the dark focus on self.

For more information about breaking the circle of self, contact us at www.medsmash.com/contact or 410-472-5078.

BIBLICAL APPLICATION

I believe the circle of self can and does impact all of us. It is one of Satan’s best weapons. How distracted do you get when you are in pain? How about when you are feeling down or anxious? Even a common cold can be very distracting. And, once you are distracted, how hard is it to pull back out of the negative cycle?

Peter encourages us to recognize all of this and to learn to think more like Jesus.

1 Peter 4:1-2 MSG

Since Jesus went through everything you’re going through and more, learn to think like him. Think of your sufferings as a weaning from that old sinful habit of always expecting to get your own way. Then you’ll be able to live out your days free to pursue what God wants instead of being tyrannized by what you want.

In these complex times, we are bombarded with information that can keep us stressed, anxious, and/or depressed. Paul tells us to not focus on these things. He encourages us to focus instead on what comes next. How much time do you spend thinking about your future in Heaven?

2 Corinthians 4:14-18 MSG

 We’re not keeping this quiet, not on your life. Just like the psalmist who wrote, “I believed it, so I said it,” we say what we believe. And what we believe is that the One who raised up the Master Jesus will just as certainly raise us up with you, alive. Every detail works to your advantage and to God’s glory: more and more grace, more and more people, more and more praise!

So we’re not giving up. How could we! Even though on the outside it often looks like things are falling apart on us, on the inside, where God is making new life, not a day goes by without his unfolding grace. These hard times are small potatoes compared to the coming good times, the lavish celebration prepared for us. There’s far more here than meets the eye. The things we see now are here today, gone tomorrow. But the things we can’t see now will last forever.

Thinking about others, loving others as much and in ways we love ourselves, and putting others before ourselves are common themes in the Bible.

Philippians 2:3 ESV

Do nothing from rivalry or conceit, but in humility count others more significant than yourselves.

Romans 12:10 ESV

Love one another with brotherly affection. Outdo one another in showing honor.

1 Peter 3:8 ESV

Finally, all of you, have unity of mind, sympathy, brotherly love, a tender heart, and a humble mind.

I’m praying we can all keep our focus outside of ourselves. Love others and keep your eyes on the future – eternity in Heaven!

Blessings,

Michelle