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

Problem Medications sending people to the ER

emergency
Don’t let problem medications send you to the emergency room

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

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

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

Why are there more medication-related emergency visits?

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

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

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

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

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

Don’t let this statistic apply to you

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

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

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

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

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

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

BIBLICAL APPLICATION

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

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

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

Romans 3:23 (ESV)

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

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

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

2 Timothy 3:16-17 ESV

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

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

I like this version from The Message:

Romans 3:23-24 (MSG)

God Has Set Things Right

But in our time something new has been added. What Moses and the prophets witnessed to all those years has happened. The God-setting-things-right that we read about has become Jesus-setting-things-right for us. And not only for us, but for everyone who believes in him. For there is no difference between us and them in this. Since we’ve compiled this long and sorry record as sinners (both us and them) and proved that we are utterly incapable of living the glorious lives God wills for us, God did it for us. Out of sheer generosity he put us in right standing with himself. A pure gift. He got us out of the mess we’re in and restored us to where he always wanted us to be. And he did it by means of Jesus Christ.

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

John 8:32 ESV

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

John 16:13 ESV

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

John 17:17 ESV

Sanctify them in the truth; your word is truth.

The trust does exist, and you can find it.

John 14:6 ESV

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

Blessings,

Michelle

Medication Choices for ‘Everyday’ Pain

otc-pain-meds
Everyday pain meds are important to discuss with your doctor and pharmacist.

Do you ever have pain when you wake up?   Do you have pain when you sit too long? Does your back bother you on a long car ride? Do you get a headache when the weather changes? Do your muscles hurt the next day when you overdo it?

What do you do about this ‘everyday’ sort of pain? 

You have many choices. Walk in to any pharmacy, grocery store, or super store and you will find several shelves of options. You will find brand name pain medications next to generic, or store, versions of the same medication.

Which ones do you pick? Do you have a ‘stand by’ favorite or do you like to keep switching to try something new? I have had many clients with either of these philosophies.

Here are a few things I want you to know about these options so you can make an informed decision.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are medications such as ibuprofen (brand names Motrin and Advil), naproxen (brand name Aleve), and aspirin (brand names Bayer, Excedrin, Bufferin). These can relieve pain, fever, and inflammation. The over-the-counter doses are lower than the prescription doses.

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.

Another important tip is to make sure your doctor and your pharmacist know you are taking any NSAID and how much. There are many of these available by prescription. I have seen many people who are taking a prescription and an over-the-counter NSAID at the same time. They had no idea because the names are different. So, share all of your medications – prescribed and self-selected – with your healthcare team. Too much NSAID makes the three risks stated above worse.

Acetaminophen

Acetaminophen (brand name Tylenol) is similar to the NSAIDs without the anti-inflammatory part. Acetaminophen can relieve pain and fever. Studies have found it is just as effective as NSAIDs for relieving pain not associated with inflammation.

There are two primary risks with acetaminophen:

  1. Too much can hurt your liver. The current guideline is to take no more than 3 grams (3,000 mg) per day.
    1. Drinking alcohol can make the damage to your liver even worse.
    2. If you already have liver problems, talk with your doctor and pharmacist BEFORE taking acetaminophen.
  2. It can increase the blood thinning effects of warfarin.
    1. If you are on a blood thinner, talk with your doctor and pharmacist about taking acetaminophen.

Note, acetaminophen can be found in many combination products. Please look for it in your headache, cold, flu, sinus, and prescription pain medications. The TOTAL amount for the entire day should be 3,000 mg or less.

Some other options

Sometimes there are simple things you can do that will relieve the pain without the use of medication. Here are just a few:

  • Stretching – for sore muscles and back pain
  • Icing – for sprained or strained muscles
  • Applying heat – for back pain
  • Drinking plenty of water – for headache
  • Closing the eyes and covering with warm compress – for headache
  • Exercising – even a stroll can help with some muscle and back pain and relieve tension related headaches

Your physical therapist is a wealth of information about stretches and exercises to relieve many types of pain. In many states, you can call and make an appointment with your physical therapist without a referral.

For more information about pain treatment options, contact us at Meds MASH at www.medsmash.com/contact.

BIBLICAL APPLICATION

What are the spiritual pains you have experienced or are experiencing now? Life brings plenty of pain and turmoil and struggle. NSAIDs and acetaminophen won’t do much for this type of pain. So what are your options?

Jesus, his disciples, and Paul provide us with a lot of instruction and comfort to guide us through these life pains.

2 Corinthians 4:8-10 ESV

We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be manifested in our bodies.

1 Peter 5:10 ESV

And after you have suffered a little while, the God of all grace, who has called you to his eternal glory in Christ, will himself restore, confirm, strengthen, and establish you.

If you’ve experienced painful experiences in your life, you are certainly not alone. We are guaranteed hardships. Our choice is how we deal with them. Most importantly, it’s how much we lean on God through them that matters.

Romans 8:18 ESV

For I consider that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us.

Romans 5:3-4 ESV

More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope,

I think the following is a very comforting verse to memorize and lean on in difficult circumstances.

John 16:33 ESV

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

Blessings,

Michelle

Your amazing liver

Your Amazing Liver – what does it do exactly?

Your amazing liver
Your liver breaks down medication and many other functions.

You have a liver. Do you have any idea what it does? I would venture a guess that most people don’t.

The liver sits in the upper right quadrant of your abdomen. When your doctor presses on your abdomen and puts fingers up under your ribs, that is what is being checked. Usually they won’t feel it or maybe just feel the very edge.

The liver has several functions:

  • Clotting factors in your blood are produced
  • Proteins in your blood are produced
  • Triglycerides and cholesterol are made
  • Stores vitamins
  • Removes toxins, such as ammonia, from the blood
  • Processes nutrients from our food
  • Regulates sugar in the blood
  • Metabolizes (breaks down) alcohol and medications

Of course it is the medication part that I am anxious to talk about.

What does the liver do to medication?

There are several types of enzymes in the liver.

These enzymes change the form of medications. They usually break medications down to a less active form. This also allows the medication to be processed and then to leave the body. If this slows down, then the medication stays in active form longer giving the medication a bigger effect and making it last longer.

Different medicines are broken down by different enzymes. Most of these enzymes are cytochrome P450 (CYP450)enzymes. There are several different CYP450 enzymes, each impacting different medications.

Some people have genetic differences that change those enzymes. For instance, a particular enzyme can be less active in some people based on their genes. This will make that medication more active, sometimes even toxic, for that person. It is becoming more common for people to be tested for any genetic changes that can help guide best medication use.

When there is more than one medication that is metabolized by the same enzyme that can change how those medications are broken down. This is where it really gets complicated. Some medications will induce the enzyme, or make it more effective. Others will inhibit the enzyme making it less effective. While others compete for the activity of the enzyme. These actions and interactions impact how well the medicine works and the amount of side effects it will have.

Even tobacco, some food, and herbs can impact the enzymes.

So, when your pharmacist is filling your prescription, there is SO MUCH more they are looking at than just getting the right number of tablets in to the bottle. The potential interactions need to be carefully screened each time any of your medicines are changed.

AND, this screening can only be complete if your pharmacist also knows what herbs, vitamins, over-the-counter, and other substances you take.

Pay attention to the extra instructions on your medicine label. These liver enzymes are often the reason for special instructions such as ‘avoid grapefruit’ or take at particular times of the day (to separate from other medications).

If you would like to know more about the liver and how liver enzymes impact medications, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Just as the liver has a very specific function within the body, each element of the armor of God has a specific function.

Ephesians 6:10-17 NIV

Finally, be strong in the Lord and in his mighty power.  Put on the full armor of God, so that you can take your stand against the devil’s schemes.  For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.  Therefore put on the full armor of God, so that when the day of evil comes, you may be able to stand your ground, and after you have done everything, to stand.  Stand firm then, with the belt of truth buckled around your waist, with the breastplate of righteousness in place, and with your feet fitted with the readiness that comes from the gospel of peace.  In addition to all this, take up the shield of faith, with which you can extinguish all the flaming arrows of the evil one.  Take the helmet of salvation and the sword of the Spirit, which is the word of God.

To take advantage of the full protection available to you, put on each piece of armor. Keep each functioning in its most complete and efficient form through prayer and reading the Bible.

If you’ve so much as glanced at the news in the last few weeks, you know that the ‘power of this dark world’ seems to be out in full force. People are hurting people all over the place.

Go out into this hurting world with your truth, righteousness, faith, assurance of salvation, and the Word securely in place.

Now is the time to have some scripture memorized or in your phone where you can reinforce your own understanding or reach out to others in an instant. That sword of the Spirit might be just what someone needs.

I’m praying for the hurt, the evil, the grief, the biases, the fear that separates us from each other and from turning to the love of God. May you be a light in this darkness.

Blessings,

Michelle

Image source: National Library of Medicine; National Institutes of Health; U.S. Department of Health and Human Services

Who knows your WHOLE regimen of medicine?

Pharmacy 005 copy
Let your doctors and pharmacist know your WHOLE regimen.

Which of your providers or pharmacists knows your WHOLE regimen of your medicines? When you go to your doctor you are likely asked about the medications you take. Some practices will ask you to include that information on a piece of paper on a clipboard in the waiting room. Some will hand you a computer with a list of questions that include your medicines. Still others will have the person checking you in ask you about your medications.

Do you take a list of all of your medications with you to the doctor?

Your doctor needs to know the names, the strength, the dose, and exactly how you take each medication.

Rather than try to memorize and remember all of this, make a list before you leave home.

  • Some people take pictures of each medication label and keep them in their phone.
  • Some people use the ‘Medical ID’ app on their smartphone.
  • Some people keep a list printed and in their wallet where it can be easily found by emergency personnel if needed.

Do you include all medicines prescribed by all doctors?

Many of the people I meet think their doctors talk to one another and coordinate their care. Although this is the desire of your doctors, it often does not happen. Your doctors and other providers find it hard to catch up with one another. Even if they work for the same health-system, important details and explanations are often not shared.

  • Include all medications coming from all of your doctors on your list.
  • Don’t assume one doctor explained the latest changes to the other doctors.

Do you include all of the medicines and other substances you take?

All of the substances you take have the potential to interact with each other. This means they can be dangerous when combined. If no one knows each substance you take, then those interactions cannot be checked.  It is important to have a thorough screen of your WHOLE regimen.

Include these items even if you only take them once in awhile.

I highly encourage you to include all of these on your written list.

  • Over-the-counter pain medicine (e.g. Tylenol, ibuprofen, Aleve, aspirin)
  • Stomach ache or acid reflux medicine
  • Headache medicine
  • Allergy medication
  • Eye drops
  • Nose sprays
  • Cold, flu, congestion medicines
  • Constipation or diarrhea medicines
  • Medicated creams or ointments
  • Vitamins
  • Supplements
  • Herbal therapies
  • Marijuana
  • Illicit drugs (at least tell your doctor about these)

I am finding that the people who make the decisions about your prescription medicines do not know all of these important facts. The over-the-counter, herbal, vitamin, and other substances can have side effects, cause problems, and interact just as prescription medications can.

Consider all of these to be MEDICATIONS! Let your doctors and pharmacist know your entire list – your whole regimen!

For more information about the importance of your complete medication list, or for a detailed review of your medication list, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

Just as there are a variety of medications that may be needed for overall health, there are a variety of things we need to include in our lives for our spiritual health. What are the components of your spiritual life?

In what ways do you acknowledge, praise, worship, study, talk with, share, enjoy, and spend time with God?

I liken the prescription medications from your primary doctor to Sunday worship and owning a Bible.

The specialist medications are like the Bible study, Sunday School, and other special short term studies.

What about the components that you choose for yourself from the smorgasbord of options? Do you include prayer, worship music, contemporary Christian music, daily devotions, meditation, accountability partners, online resources, or other choices?

Do you select a wide variety of options?

Do you stick to one or two?

Do you limit yourself to the Sunday morning selections?

Colossians 3:12-17 (MSG) gives several ideas about the many ways you can keep God active in your life.

So, chosen by God for this new life of love, dress in the wardrobe God picked out for you: compassion, kindness, humility, quiet strength, discipline. Be even-tempered, content with second place, quick to forgive an offense. Forgive as quickly and completely as the Master forgave you. And regardless of what else you put on, wear love. It’s your basic, all-purpose garment. Never be without it.

Let the peace of Christ keep you in tune with each other, in step with each other. None of this going off and doing your own thing. And cultivate thankfulness. Let the Word of Christ—the Message—have the run of the house. Give it plenty of room in your lives. Instruct and direct one another using good common sense. And sing, sing your hearts out to God! Let every detail in your lives—words, actions, whatever—be done in the name of the Master, Jesus, thanking God the Father every step of the way.

There are so many ways you can get to know God better. Even if you have been studying and worshipping for decades, there is more to learn and more love to experience.

Then there is prayer. There is real power in prayer.

James 5:13-16 (ESV)

Is anyone among you suffering? Let him pray. Is anyone cheerful? Let him sing praise. Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the one who is sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven. Therefore, confess your sins to one another and pray for one another, that you may be healed. The prayer of a righteous person has great power as it is working.

Prayer that acknowledges God and His will and timing can do great things. Never overlook the power of prayer.

It is my hope this has inspired you to add some more elements to your daily walk with God. The God who created the Universe and who loves you beyond measure looks forward to each and every remedy you select to stay close to Him and know Him better.

Blessings,

Michelle