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Medication Reconciliation – Why it’s important to you

Posted on by Michelle Fritsch, Pharm.D.
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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

 

 

 

 

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Fear of Failure, Hidden Truths, and Your Health

Posted on by Michelle Fritsch, Pharm.D.
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Fear and hidden truths are bad for your health.  There is GOOD news!

This is a major religious holiday week for two of the most prevalent religions in the world – Judaism and Christianity. Jews are commemorating the Passover and God’s leading the Israelites out of slavery in Egypt. Over the following 40 years they were in the desert on the way to the promised land with delays due to disobedience. Their mistakes and wayward decisions had many consequences.

The Jews were enslaved and mistreated by the people of Egypt. They then were ungrateful and easily distracted from the miracle of their deliverance. They continued to make mistakes.

Christians are celebrating Easter, the risen Christ after a brutal betrayal and death 3 days earlier.

The people who celebrated Jesus’ entry into Jerusalem were the same ones who cried ‘Crucify Him’ a few days later. And even after this supreme sacrifice, Christians continue to sin. We continue to sin, make mistakes, and get absorbed in ourselves.

So, it wasn’t just the people in Biblical times that made mistakes. We ALL continue to do that every day. How do you handle your mistakes? How do you handle the things you choose to do that you later regret? How do you handle the things that are done to you that hurt you?

Fear of Failure

I have known many people who are afraid of failing. Often, they are even more afraid of anyone finding out that they failed. There seem to be two extremes of ways to handle this fear.

#1 – Avoid any situation that could result in failure. Do you shy away from any risk? Do you avoid variation in your life and avoid all opportunities since you aren’t guaranteed success? How deep does this fear run? Do you eat the same meals repeatedly rather than try something new? Do you keep the same schedule to minimize an unexpected situation?

#2 – Hide any hint of failure. Do you take some risks but hide or deny anything that goes wrong? Do you maintain the illusion of perfection? Do you push away people who might get close enough to see your weaknesses?

Fear of failure is a prime source of anxiety. The fear is so intense just the thought of taking a risk provokes stress, rapid heart rate, sweating, feelings of overwhelm.

Fear of failure can lead to depression due to self-selected isolation. Or, if you hide and deny your failures, you can get caught in a web of lies that gets beyond your control.

Hidden Truths

I don’t want to count the number of people I’ve talked with who have a sad secret hurt from their past. These hurts changed their lives. They are terrible things like abuse, rape, molestation, abandonment, or neglect. They have ‘dealt’ with these issues by trying to deny they happened. Or, they have been told by family to keep quiet and never talk about it. Other times the hidden truths are of marital affairs, lost jobs, drug abuse, or heavy drinking.

Whatever the hidden truth, there is no denying the impact. Our conscience knows and doesn’t forget.

Like before, if you keep it hidden, suppressed, and don’t release it, all of that pain comes out another way. I have known so many people with chronic pain that was related to these hidden truths. Others suffered from anxiety and/or depression. There was an ever-present fear and ‘dark cloud’ in their life.

Counseling and Medication

Many people choose to ‘treat’ these fears and hidden truths with medication. Sometimes it is with prescribed medication such as antianxiety or antidepressant medications. Other people choose to self-treat with alcohol, marijuana, or other substances.

The medication can help in many instances. In others, it just dulls the thinking. The memories, the guilt, or the hurt isn’t as sharp when under the influence of the medication or other substance.

Your life is meant to be lived fully aware and present. You miss out on so much when you aren’t engaged in your life.

That is very often where counseling comes in. These fears and hidden truths need to be released. Counseling, clinical or faith based, can be that outlet to help you really deal with these hurts, mistakes, or ongoing issues. Through counseling you can confront these items, face them, learn to process them, and then learn to live beyond them. (Note, I am not suggesting your hurts, fears, and pain are not real. I am not suggesting you will just walk away and forget them. I am suggesting you can benefit from counseling +/- medication.)

This is one of those areas that can’t be ‘fixed by a pill.’ The medication can help, but it is unlikely to actually resolve the problems. A trusted, skilled counselor can help you get back to really living.

To learn more about the role of medication and for help finding a good counselor, contact us at Meds MASH, LLC at www.medsmash.com/contact or 410-472-5078.

BIBLICAL APPLICATION

Christ is risen!!!!!! He is alive and active and so very present in our world today.

I am writing this on Easter. It is such a beautiful day. Not only is it warm and sunny outside, but what an amazing day to reflect and let is sink down deep that Jesus went through the worst people can do to other people all because of his love for me, for you, for all of us!

He put himself in the situation to endure physical pain in the extreme over many hours, rejection, slander, betrayal, humiliation, abuse, and complete degradation. I don’t know about you, but I fear ANY of those things. I can’t imagine purposefully enduring any of that.

I am the sinner for whom he died. I am the sinner – each and every day – who he loves and forgives over and over and over and over…

James 4:17 ESV

So whoever knows the right thing to do and fails to do it, for him it is sin.

Romans 8:1 ESV

There is therefore now no condemnation for those who are in Christ Jesus.

I can’t deny it. I might try to pretend to avoid sin, but you know better. We ALL sin, in spite of our best efforts to not. You are not perfect. I am not perfect. Only Christ was ever on earth as a perfect human.

Let’s get real with each other. Let’s be honest and support each other through the mess of life. We all have our joyful, peaceful times. We all have our dark, difficult times.

1 Thessalonians 5:11 ESV

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

Ecclesiastes 4:9-12 ESV

Two are better than one, because they have a good reward for their toil. For if they fall, one will lift up his fellow. But woe to him who is alone when he falls and has not another to lift him up! Again, if two lie together, they keep warm, but how can one keep warm alone? And though a man might prevail against one who is alone, two will withstand him—a threefold cord is not quickly broken.

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.

My purpose today is to encourage you to celebrate your new life in Christ! He is alive and loving you right this moment. Claim your new life in Christ. Open up to your Christian friends, teachers, and supports. Live the on-purpose, fully alive life Christ died to give you.

2 Corinthians 5:17 ESV

Therefore, if anyone is in Christ, he is a new creation. The old has passed away; behold, the new has come.

If your story includes fear of failure, fear of risks, or any of a multitude of hidden truths, Christ died for you. You can live beyond the worst this world can give you. You are loved. You are not alone. An eternity of joy and peace and love awaits you!

Blessings,

Michelle

Lonely path of chronic illness

The Road of Chronic Illness is (Sometimes) Lonely

Posted on by Michelle Fritsch, Pharm.D.
Lonely path of chronic illness
Take these steps to stay motivated in the care of a chronic illness.

Have you experienced this? You have new symptoms, so friends and family are concerned and checking on you. You get a new chronic diagnosis, and friends and family are concerned and supportive.

Then, the ‘new’ wears off. The condition continues. The treatment continues. But, the concerned and supportive people have moved on to other issues.

How do you stay motivated to stay on your therapy? How do you stay focused on the necessary steps to control your medical condition? How do you maintain your resolve to stay healthy?

Chronic Illness can be Silent

Have you been diagnosed with high blood pressure, high cholesterol, diabetes, asthma, or arthritis? Have you had a stroke or a heart attack? There are so many types of chronic medical conditions.

Some of these conditions you don’t feel. Your blood pressure can be high, and you feel completely fine.   The same is true with your cholesterol. Even with diabetes, it can get pretty far from normal with no symptoms for many people.

Then, there is the fact that all medications can cause side effects. So, sometimes people feel worse on their medicine than they do when they don’t take it. Talk about hard to stay motivated!

Chronic Illness requires Understanding

One of the key factors in taking care of yourself is really understanding your condition and the treatment. If you have a chronic illness and you don’t fully understand it, please talk with your doctor, your pharmacist, or call us at Meds MASH. It is very hard to know how to take care of yourself if you don’t understand the what, why, how, when aspects of your condition. And it is VERY hard to stay motivated without this understanding.

In addition to the condition itself, you need to really understand the therapy that is prescribed. This can be medication, exercise, diet changes, physical therapy, counseling, or many other kinds of therapy. You need to know why, how this therapy can help, and what you can expect. If there are common side effects, you should know that. If it will take a month to work, you need to know that.

Chronic Illness is Easier to Manage with Support

I was talking about this with some friends who are in recovery from substance abuse. Addiction is one of many types of chronic illnesses. It is also an area that has repeatedly proven the value of support when conquering chronic illness. The 12-step program of recovery is built around the need for community, accountability, and belief in a higher power.

There are support groups available for most medical conditions. Some are groups that meet in person. Some are led by a health professional, others are peer led. Some are groups that meet and interact online.

It can be helpful to know that you are not alone. Most people benefit from sharing their experience, exchanging tips of what works and what doesn’t for them, and just supporting each other. We all have our good days and bad. In a group, someone will be having a good day and be able to help you through your bad day. Next time, you can be the helper and supporter.

If we can help you find a support group or help you to REALLY understand your condition and treatments, please contact us at www.medsmash.com or 410-472-5078.

BIBLICAL APPLICATION

The path of chronic illness is easier to walk with support – family, friends, and a support group of people with the same chronic illness. Likewise, the path of spiritual growth is easiest to walk in community with other believers.

Having other believers around you helps in many ways:

  • Work through questions
  • Share ideas and insights
  • Hold each other accountable
  • Comfort each other
  • Celebrate with each other
  • Pray together
  • Live life together

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.

I like the way God created us to work together through life and support each other.

Jesus promises he is with us always. So, no one is ever alone. Having friends, small groups, teachers to remind us of that and share their never alone stories can be very helpful.

1 Peter 5:7 ESV

Casting all your anxieties on him, because he cares for you.

Hebrews 13:5 ESV

Keep your life free from love of money, and be content with what you have, for he has said, “I will never leave you nor forsake you.”

One of the verses that I always find most comforting, especially when I’m feeling lonely, self-conscious, or insecure is this next one.

Romans 8:35-39 ESV

Who shall separate us from the love of Christ? Shall tribulation, or distress, or persecution, or famine, or nakedness, or danger, or sword? As it is written, “For your sake we are being killed all the day long; we are regarded as sheep to be slaughtered.” No, in all these things we are more than conquerors through him who loved us. For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.

You and I are never alone. We are unconditionally loved!

Blessings,

Michelle

 

Medicare Open Enrollment – Which plan type for you?

Posted on by Michelle Fritsch, Pharm.D.
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October 15 to December 7 is your window to select a Medicare plan. Let us help.

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

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

Main TYPES of insurance coverage options over age 65

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

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

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

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

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

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

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

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

Medicare resources to help you

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

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

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

BIBLICAL APPLICATION

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

  • What to wear
  • How to act

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

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

Many of my peers are sorting through messages about:

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

My patients are working through message about:

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

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

So, where does the truth reside?

John 14:6 NIV

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

Psalm 145:18 ESV

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

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

Matthew 7:7-8 ESV

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

When the messages are all confusing, ASK!

Blessings,

Michelle

Hate and Health – Surviving These Days

Posted on by Michelle Fritsch, Pharm.D.

Hate and ugliness can shape your life. It often comes out of nowhere. How you deal with it has a huge impact on your health.

You often can’t prevent it. You can’t predict. It hits you out of nowhere, so you can’t prepare for it. Yet, hate and ugliness touch most, if not all, of us at some time at least once.

What is the ugliest event that has occurred in your life? How have you been touched by hate? How did you handle it at the time? How have you handled it since?

As a nation and a global community we have seen and experienced acts of hate in so many forms recently. There is unrest stirred by fear, threats, and acts of terror. If this fear takes over in your life, your stress levels increase, your heart works harder, your risk of depression goes way up, anxiety increases, sleep is impaired, and your overall health declines.

Last week I talked about the health benefits of thinking about other people and their needs rather than focusing just on yourself. Altruism is very directly linked to improved health.

The other thing that was directly related to this particular medical mission to Jamaica from which I just returned was a tragic act of hate. The group with whom I worked, Teams for Medical Missions, www.t4mm.org, has been served for many years by long-term missionary couples in Jamaica. These couples have developed programs for children, programs for youth, programs to train ministers for local churches, built many houses, provided chronic and acute medical care by hosting medical mission teams, and so much more. They are Christian missionaries with a real passion for the people of Jamaica, in particular those in the more rural and underserved area of St. Mary Parish.

At the end of April, the two men of these couples were riding their motorcycles on some trails at the top of a mountain known to have beautiful views of the island. Two young men were in that area and heard the motorcycle motors. They decided to wait in a particular place where the motorcycles were sure to pass and ambush them. Both missionaries were killed. It was not a targeted act, just a needless act of hate.

This shook the entire island. The young men who had been actively served by events hosted by these couples for years now stay close to the wife who remains, and they have been staying at her house so she is not alone. The Prime Minister, head of island security, and many others have come to show their respect. Many people have expressed their sorrow in many tender ways.

These medical teams typically provide care in provisional clinics in four local churches once a quarter. People are given a 3-month supply of medication for chronic illnesses, and acute illnesses are treated. Many people in that Parish rely on those clinics for their medical care. I had the humbling experience of seeing the love and gratitude shared with the missionary wife and all of the team members. (All had been on these teams several times and knew the slain missionaries well. This was a very emotional trip for all who were simultaneously grieving and expressing the desire to keep moving forward.) Many residents expressed surprise the clinics were continuing. There was an expectation the mission would fold and return to the US after these deaths.

In spite of these acts of hate, the hope continues. Teri, an incredibly strong and faithful woman is staying and planning what the future can hold in this completely new scenario. Her grief is real and raw. Yet, she is not curled in a corner refusing to move forward.

Health in the midst of hate

The elements that are associated with maintaining health in the midst of hate are:

  • friends to talk to
  • people who care about you
  • a sense of self-worth
  • forgiveness
  • security
  • conflict management skills
  • religion/spirituality

These have all been linked with improved health.

And I will add having a source of HOPE. I believe hope is powerful in the midst of difficulty.

So, knowing that hate and ugliness can strike at any time, the best you can prepare is to take care of yourself, cherish your friends and family, develop your conflict management skills, and forgive others. Find your personal source of hope.  Like Teri, find ways to find hope and stay positive and undeterred in the face of hate.

For more information about hate and health, contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

Hate, terror, oppression, racism, and other ugliness are all around. And, the Bible gives us indication this will only get worse.

2 Timothy 3:1-5 MSG

Don’t be naive. There are difficult times ahead. As the end approaches, people are going to be self-absorbed, money-hungry, self-promoting, stuck-up, profane, contemptuous of parents, crude, coarse, dog-eat-dog, unbending, slanderers, impulsively wild, savage, cynical, treacherous, ruthless, bloated windbags, addicted to lust, and allergic to God. They’ll make a show of religion, but behind the scenes they’re animals. Stay clear of these people.

I believe our role in these days is three fold:

  1. Be prepared

1 Peter 3:14-16 ESV

But even if you should suffer for righteousness’ sake, you will be blessed. Have no fear of them, nor be troubled, but in your hearts honor Christ the Lord as holy, always being prepared to make a defense to anyone who asks you for a reason for the hope that is in you; yet do it with gentleness and respect, having a good conscience, so that, when you are slandered, those who revile your good behavior in Christ may be put to shame.

  1. Be discerning

Matthew 24:4-8 MSG

Jesus said, “Watch out for doomsday deceivers. Many leaders are going to show up with forged identities, claiming, ‘I am Christ, the Messiah.’ They will deceive a lot of people. When reports come in of wars and rumored wars, keep your head and don’t panic. This is routine history; this is no sign of the end. Nation will fight nation and ruler fight ruler, over and over. Famines and earthquakes will occur in various places. This is nothing compared to what is coming.

  1. Be reaching out

Philippians 2:1-4 MSG

If you’ve gotten anything at all out of following Christ, if his love has made any difference in your life, if being in a community of the Spirit means anything to you, if you have a heart, if you care— then do me a favor: Agree with each other, love each other, be deep-spirited friends. Don’t push your way to the front; don’t sweet-talk your way to the top. Put yourself aside, and help others get ahead. Don’t be obsessed with getting your own advantage. Forget yourselves long enough to lend a helping hand.

And another version of my favorite verses of the year about hope!

Romans 5:3-5 MSG

There’s more to come: We continue to shout our praise even when we’re hemmed in with troubles, because we know how troubles can develop passionate patience in us, and how that patience in turn forges the tempered steel of virtue, keeping us alert for whatever God will do next. In alert expectancy such as this, we’re never left feeling shortchanged. Quite the contrary—we can’t round up enough containers to hold everything God generously pours into our lives through the Holy Spirit!

Blessings,

Michelle

To feel better – do for someone else – altruism

Posted on by Michelle Fritsch, Pharm.D.
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Altruism helps others and improves your health

I am just back from Jamaica, and I need to write about altruism. I was working with a mission group called TEAMS. You can learn more about them at www.t4mm.org. This medical mission group included 3 physicians, 1 nurse practitioner, 2 nurses, 3 pharmacists, 3 for registration, 2 to be with the children while their parents received care, and 2 to provide prayer and emotional support to those coming for care.

We were serving in St. Mary Parish, one of the poorest of the country. Clinic was held in churches in four different areas of the Parish. A Parish is similar to a state in the United States. Sheets draped over ropes often separated exam rooms for physicians. I counseled people about their medications as they sat among many other people. So this was not a private setting. But, excellent practitioners provided individualized care with great compassion.

Each clinic served a particular community. Within that community you could look out at all who were waiting and see the way they cared for each other. Babies would be passed around, older members would be assisted with steps, others in nearby seats would assist with understanding when I was struggling with the Patois (English with a thick dialect spoken very quickly).

It was very hot. Fans helped to stir the air. There was no running water. (I am so thankful for hand sanitizer). Some children had lice or scabies yet they waited patiently with their family. You know they had to be miserable between the heat and the intense itching. Some people had to wait from early morning until mid afternoon to be seen.

Yet, I didn’t hear one person complain. No one was demanding to know why their wait was so long. No one was complaining about the conditions. No one was asserting their needs or rights before someone else’s.

On the medical team, several people were struggling with their own health issues. One was on crutches due to a broken leg; one was recovering from bronchitis; one had a cold; several had various aches and pains. The age range of the care team was 22 to 82. Personally, my leg is still recovering from a ripped calf muscle, and my back has been hurting from all of the time that I was on crutches and a boot.

What struck me was how none of that mattered! Rather than thinking about our issues, we were completely focused on all of the people who had arrived to receive care. My leg did fine the entire week, even carrying heavy tables and boxes and fans to set up and take down clinic every day up steep hills and steps. I didn’t do my back stretches or sit around rubbing my back the way I do at home. That is because I wasn’t even thinking about my back.

Altruism

Altruism is, ‘feelings and behavior that show a desire to help other people and a lack of selfishness’ as defined by Merriam-Webster. I have read several articles linking altruism as a factor in happiness, health, and how long you live. In general, studies have shown that people who focus on others are happier and even live longer, in general. In 2005, Stephen Post published an article in the International Journal of Behavioral Medicine entitled, ‘Altruism, Happiness, and Health: It’s Good to be Good’. A quote from the article is, ‘The article concludes, with some caveats, that a strong correlation exists between the well-being, happiness, health, and longevity of people who are emotionally and behaviorally compassionate, so long as they are not overwhelmed by helping tasks.’

I have seen truth in this in many instances. While I was doing post-graduate training in Wisconsin a study demonstrated that home-bound elders who were in a calling circle.  Those who called to check on each other and remind each other to take medications felt less isolated and more valued. A project called the Eden Alternative long ago demonstrated the value in having daily purpose for everyone in a nursing home setting. Depending on ability level residents would care for a cat or dog, garden, water plants, feed birds, feed fish, or other activities. It was a huge success and continues today! Everyone needs to be needed. That sense of purpose and belonging plays a big role in overall health, including anxiety levels, pain, and depression.

When was the last time you focused on the needs of someone else? I encourage you to find a way each day this week to meet someone else’s needs. Some examples are to check on an older neighbor; take a meal to someone who recently had surgery; call a mom with small children to see if you can grab some things for her when you go to the grocery store and save her a trip.

For more information about how altruism is connected to health, contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

It is no surprise that altruism is linked to enhanced health. Jesus told us many times about the importance of selflessness.

John 15:12-14 ESV

“This is my commandment, that you love one another as I have loved you. Greater love has no one than this, that someone lay down his life for his friends. You are my friends if you do what I command you.”

Daily devotions, a lot of singing, and prayer with each community were cherished parts of this mission.  The care was among providers, among recipients, among those at the church helping with coordination, and among those providing protection.  My visual each day was being filled up with the Spirit to be completely poured out by the end of the day.

Some say Christian selflessness is not true altruism because we will be rewarded for such care and compassion. Ultimately, eternally a reward is waiting. But while here in this life, you might not see a reward. In fact, your giving isn’t meant to be for show.

Matthew 6:2-4 MSG

“When you do something for someone else, don’t call attention to yourself. You’ve seen them in action, I’m sure—‘playactors’ I call them—treating prayer meeting and street corner alike as a stage, acting compassionate as long as someone is watching, playing to the crowds. They get applause, true, but that’s all they get. When you help someone out, don’t think about how it looks. Just do it—quietly and unobtrusively. That is the way your God, who conceived you in love, working behind the scenes, helps you out.

Paul, Peter, Luke, John, and many other writers in the New Testament extol the virtues of giving to others.

Philippians 2:4 ESV

Let each of you look not only to his own interests, but also to the interests of others.

Luke 6:35 ESV

But love your enemies, and do good, and lend, expecting nothing in return, and your reward will be great, and you will be sons of the Most High, for he is kind to the ungrateful and the evil.

1 Peter 3:8 ESV

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

What can you do today to help someone else?

Proverbs 19:17 ESV

Whoever is generous to the poor lends to the Lord, and he will repay him for his deed.

Blessings,

Michelle

Your Medical Insurance – perfect?

Posted on by Michelle Fritsch, Pharm.D.
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Does you medical insurance meet your needs? Is it a right?

You likely have medical insurance if you live in the United States. As of 2014, 90% of Americans did. When the 2015 data is released, that number is likely to go up a bit. It increased 2.9% from 2013 to 2014.

Does your insurance policy cover all that you want it to cover? Are all of the types of care you desire covered? Is your care ever delayed longer than anticipated due to insurance company authorization steps?

Our family just experienced this for the second time this year. It is very easy to get frustrated with insurance-related delays. Your doctor orders a test or procedure, and your insurance company takes time to authorize it.

There is a series of checks and balances between the healthcare system (doctors, clinics, hospitals, etc.), insurance companies, and lawyers. Sometimes it seems to tip, leaning more in one of these three directions, but each aspect is needed. Insurance provides you with coverage to maintain your health without losing all of your money due to an illness. It also provides checks and balances to assure cost-effective use of resources, such as procedures, surgeries, and devices. Lawyers help assure you have recourse if healthcare harms you rather than help you.

As a healthcare provider, I have seen numerous examples of excellent healthcare that has prevented or effectively treated a medical issue. I have seen unnecessary use of resources such as antibiotics or procedures. I have seen mistakes and the ramifications. I have seen heroic efforts by all involved to pull together, analyze mistakes, and create safety procedures to prevent such a mistake from happening again.

Is healthcare a right?

A question I annually ask students is whether healthcare is a right. It always leads to great discussion. If it is a right, then how should the system look that provides healthcare to the uninsured? Right now the emergency department (most cannot turn people away for lack of payment) is often the only source for uninsured people. That is a grotesquely expensive misuse of the specialized skills of emergency department personnel. But if you had no insurance, and your child was sick, what would you do? I know I would take my child to the emergency department if that were my only choice.

If it is not a right, then what should happen to uninsured people who are unable to access the healthcare system? Should we stand by and watch suffering and disease that could be treated? Could you walk down the street and just pass by someone suffering? (Do we already do that every day? If you live in Baltimore or another city of significant size, I know that you do.) It’s so easy to focus on ourselves and lose sight of those around us. I challenge you to get to know at least one uninsured person and hear his/her story. What should happen next time that person is injured in an accident or has trouble breathing due to asthma?

Is your medical insurance perfect?

I imaging your answer is ‘no.’ I know mine is far from perfect. But, I am so grateful to have insurance! I am grateful for the coverage I do have. Next week my daughter will get a sports physical to be sure she is healthy enough for her sport; my other daughter will be assessed for a nagging cough; my husband will see a surgeon to create a plan to treat his shoulder. All of these things are possible due to insurance. If all of that was out-of-pocket, my youngest would not play a sport, my middle child would continue to cough, and my husband would try to continue to function with one arm.

Perspective

Next weekend I leave on my first international medical mission trip. In the excellent materials I have been given to prepare, there is a statement that I will see more worms, scabies, and lice than I have seen in my entire career. Caring for the homeless of Baltimore, I have seen some of these things, but apparently not in the quantity I will see next week. How many times have you been treated for scabies, lice, or worms? Probably not many, if ever. We will also be caring for people with diabetes, hypertension, asthma, and the chronic conditions we treat in the affluent in the US. I am especially looking forward to analyzing the needs of a growing population over age 65.

I don’t claim to have the answers. But I do know there are several issues to be pondered. If you have ideas and opinions, please share them with me at www.medsmash.com/contact/.

BIBLICAL APPLICATION

There is no shortage of social issues that need to be addressed. Quality of insurance for the insured and what to do about the uninsured are certainly on that list.

Our pastoral team has been delivering a series based on Deuteronomy this summer. Here is a verse that very directly addresses these questions:

Deuteronomy 15:11 ESV

For there will never cease to be poor in the land. Therefore I command you, ‘You shall open wide your hand to your brother, to the needy and to the poor, in your land.’

This is from the Old Testament/Hebrew Bible, but wow, is it not as relevant today as it has ever been?

We are challenged in at least 60 verses to address these issues.

Proverbs 19:17 ESV

Whoever is generous to the poor lends to the Lord, and he will repay him for his deed.

1 John 3:17 ESV

But if anyone has the world’s goods and sees his brother in need, yet closes his heart against him, how does God’s love abide in him?

Luke 12:33 ESV

Sell your possessions, and give to the needy. Provide yourselves with moneybags that do not grow old, with a treasure in the heavens that does not fail, where no thief approaches and no moth destroys.

Proverbs 14:31 ESV

Whoever oppresses a poor man insults his Maker, but he who is generous to the needy honors him.

Proverbs 29:7 ESV

A righteous man knows the rights of the poor; a wicked man does not understand such knowledge.

I am not suggesting you go out and give everything you have right now. I am not suggesting you feel guilty about what you have.

I am suggesting you join me in contemplating these issues. They will certainly be in my face next week. So, I will be back to talk more about this as my own understanding and experience continue to grow.

Blessings,

Michelle

No U-turn available

When a U-turn is not available – end-of-life care

Posted on by Michelle Fritsch, Pharm.D.
No U-turn available
Supportive options when it’s time for end-of-life care.

Now we turn to end-of-life care.  Last blog we talked about the U-turns available in your life and health. These can help you feel better and live healthier. We learned you can still make changes that have a positive impact on your overall health.

What about when a U-turn is not available?

What about when you get that diagnosis of:

The U-turn is not available.

We can’t stop it. We won’t be able to turn it around. There are a number of conditions that at this moment have no cure or way to get rid of them.

When we run out of options, then the end of life becomes our focus. This is peaceful for some. It is frightening and a huge struggle for others. It impacts not only the person diagnosed but also all of their friends and family. Each person involved deals with a number of feelings during this time. There can be guilt, fear, conflict, regret, and grief, among others.

The support of others, education about what is happening, and sources of comfort are critical.

Resources for end-of-life

Following are some resources for everyone involved in end-of-life care.

  • Support groups – There are support groups for most common diagnoses, for people with the diagnosis and for caregivers and family members, and for various stages of the condition.
  • Caregiver stress and burden – Caring for a loved one near the end of life can be emotionally and physically exhausting. There are many resources that provide assistance (such as in-home care agencies) or respite (short term stays while the caregiver takes a break).
  • Caregiver care – A caregiver can’t fully care for their loved one if they don’t also take care of themselves. Emotional, physical, and spiritual health need attention during this demanding time.
  • Resources – Your community will have various agencies available to provide numerous sources of help. These include direct healthcare, legal guidance, financial aid, spiritual support, placement options, and more. If the person nearing end-of-life is over age 65, your local Agency on Aging could be a valuable source of lists of the resources available in your area.
  • Palliative care – This is care that is focused on comfort and support to accomplish goals toward the end of life.
    • Hospice is one form of palliative care. Your hospice organization can support you, provide education about current and future changes, and help you with preparation for all involved.

When the end-of-life can be anticipated (vs suddenly taken), there is an opportunity to prepare and fully live those final months or days.

For more information about end-of-life options, contact us at www.medsmash.com.

BIBLICAL APPLICATION

What’s different about the people that find peace in the end of life?

Romans 6:23 ESV

For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord.

This tells us that death of this life is not he end. It is only the beginning of eternity. What does that mean to you? Is it really true?

John 3:16 ESV

“For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life.”

The hope we can take through those seasons of palliative care and hospice is the result of anticipating the end of this life and moving on to eternal life.

John 5:24 ESV

Truly, truly, I say to you, whoever hears my word and believes him who sent me has eternal life. He does not come into judgment, but has passed from death to life.

Ephesians 2:8-9 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast.

If this life is just the preamble to a life of eternity with Christ, then death loses its sting.

1 Corinthians 15:55-57 NIV

“Where, O death, is your victory?

    Where, O death, is your sting?”

The sting of death is sin, and the power of sin is the law.  But thanks be to God! He gives us the victory through our Lord Jesus Christ.

I pray you find hope and peace as you ponder this perspective of death.

Blessings,

Michelle