You’ve heard, ‘garbage in – garbage out’. Wow, that holds true with our health, too. I want to focus on three particular types of garbage in our lives.
I admit I am not the most healthy eater. But, I do try to make good choices most of the time. I have eaten enough healthy food to notice the impact of unhealthy food.
The other day I was at a meeting in an unfamiliar part of town. Time was tight as I left that meeting and went to teach a class. So, I opted for the fast food restaurant that I could see a couple of blocks down the road rather than search for some other quick food source. When I was growing up, and even earlier in our marriage, it was not uncommon to eat at this fast food chain. I had not eaten there now in a few years. I had a small burger and onion rings. It looked good, tasted, great, and went down easily. Then, within an hour, I felt queasy, bloated, and tired. I was surprised at how different I felt.
There is extensive evidence that our food choices impact our risks for diabetes, heart disease, high cholesterol, and maybe even dementia. Your brain, your veins and arteries, your heart, your kidneys, your liver, your eyes, your skin, your hair, your nails, and more parts of your body are impacted by what you eat.
If you have not seen it, I encourage you to watch the documentary, Super Size Me. I found it very eye opening about the dangers of frequent fast food.
Eating your largest portions with colorful fruits and vegetables, joined by a fist size piece of lean protein (e.g. meat such as lean chicken or fish), and some grains is ideal. You can find more detailed guidelines at Choose My Plate.
What you see and what you hear have a big impact on what you think. Media plays a big part in our lives! Music, television, video games, and social media are huge general areas of so much content. The choices we make about our media help shape how we think, how we view the world, our ability to concentrate, or attention span, and our mood.
If you’re interested in the science linking music and our thoughts and actions, see this interesting article by a known expert on the subject, Dr. Bernard Luskin.
Media that promotes negativity, hate, and crime promotes such thoughts and activities. Pornography changes thinking, desires, and satisfaction. There is even an addiction associated with social media.
On the other hand, spending time with uplifting people, positive music, and other positive media can really brighten your day!
Who in your life lets you know how valuable, appreciated, and loved you are? Keep those relationships!
If you have people in your life who feed you negative, demeaning, or other messages that kill your sense of self-worth and confidence, move away from those relationships. Surround yourself with the positive images of your immense value and lovability.
The messages you receive can impact how you see yourself. Stay around those who are the positive influences in your life.
Choose to replace your garbage with treasure
This is just a brief exploration of how garbage in can damage you. I encourage you to consider how you can replace the garbage. Consider the diet changes that will make you feel better, more energetic, less bloated, and give you more clear thinking. Consider how what you watch and hear could be more positive and uplifting. Consider how you could spend more time with people who lift you up.
To better understand how positive input will enhance your health, contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.
Just like our physical and emotional health negatively respond to ‘garbage’, so does our spiritual health.
What are the sources of ‘garbage’ when it comes to our spiritual health?
We are repeatedly warned in the Bible about people who will look legitimate but actually be teaching false information.
For the time is coming when people will not endure sound teaching, but having itching ears they will accumulate for themselves teachers to suit their own passions, and will turn away from listening to the truth and wander off into myths.
For I fear that perhaps when I come I may find you not as I wish, and that you may find me not as you wish—that perhaps there may be quarreling, jealousy, anger, hostility, slander, gossip, conceit, and disorder.
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.
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.
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 articleabout 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.
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.
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.
“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.
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.
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.
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…
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.
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.
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.
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!
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.
“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.
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.
Do you remember when the treatment options for your type 2diabetes were medicines that could make your blood sugar too low – oral medicine or insulin? The available options would also make you gain weight.
Those treatments are still available, and now there are improved versions of each. So, if you and your doctor and your healthcare team haven’t talked about options recently, now might be the time. The experts in the field, using the information from the latest studies, release guidelines. The latest guidelines from the American Diabetes Association have tables that provide comparisons between the options. These tables make a nice display to help you have a conversation with your doctor about which options might work best for you.
Those early medication options mentioned before would either help your pancreas release more insulin or would be an extra source of insulin.
control how your liver stores extra glucose (sugar) and when and how it lets it back out
control how your kidneys let your glucose out in your urine
impact how sugar is absorbed from the food you eat
mimic hormones that control how your body responds to sugar and insulin
slow down the rate food moves through your body keeping you feeling full longer
increasing how a cell responds to insulin
The body has many different steps in the way it handles the food you eat and how that food is turned from sugar into energy for your cells. Now, with these newer options, your diabetes can be treated with medicines that address more than one of those steps.
Combinations of medications can help control your diabetes more than one way at a time. Also, when you use combinations of medicines, you can usually use a lower dose. This helps cut down on side effects.
New insulin options
If a combination of medicines you take by mouth don’t help you reach your diabetes control goals, there are new insulins. The old insulins were dosed either around meals or twice a day. There are now basal insulins. These are dosed just once per day. They then provide some support to control your blood sugar all day and all night. Then, when you eat, your blood sugar does not climb as high.
Often, people who have been taking higher and higher doses of oral medicines find they can be on lower doses. The basal insulin helps decrease the need for so much oral medicine.
And, like we said before, using several different medicines helps you use lower doses of each. This is often easier to tolerate than high doses of one or two medicines.
NOTE, this information is all for type 2 diabetes. If you have type 1 you need insulin therapy only because your pancreas has quit working. The insulin is absolutely required. The oral medicines mentioned above won’t control your diabetes.
We have much more we can tell you about diabetes and treatment options. For more information, please contact us at www.medsmash.com/contact or call at 410-472-5078.
Diabetes (and other medical conditions) can be best treated with medication using different mechanisms. Treat different parts of the condition from all directions for the most comprehensive care.
I have been embarking on some new (to me) techniques for Bible study. Wow, there are so many ideas and methods out there! I am intrigued by all of the different ways we can approach the same scripture. And, as only God could do, I learn something different every time. Part of the reason I keep learning new things from the same scripture is that I am different every time I read it. The things happening in my life, the things that are exciting me, the things that are concerning me, the things happening with my friends and family are different. This changes my perspective. Also, my moods change. That can definitely impact how I approach anything I read or hear.
Then, there are all of these techniques and approaches I have been reading about. Some are obvious, and some, to me, seem really innovative. Here are some that I have been trying to incorporate:
When reading a small bit of scripture, read it over and over emphasizing a different word each time to see how that changes the meaning.
Research the history at the time it was written. Historical context helps to understand the culture and surrounding events.
Write down in a journal (or I write in the margins) insights, events, or ideas you get from that verse or chapter. (Date it so you can see it later. Often I find it strikes me a completely different way the next time I read it because I’m in a different frame of mind in different circumstances.)
Consider how the scripture you’re reading could be incorporated into your life today.
Sometimes this is an action, sometimes an new idea, sometimes a reflection on how great is our God, sometimes a prayer, sometimes a question to ponder.
Put yourself in the scripture. Try to imagine being there at that time. How did it probably look, sound, feel. How might you have gotten there? What are you probably wearing? Who else is there?
Read about the author of that chapter of the Bible. What do we know about that person? What was their perspective?
I like the Life Application Bible. It has information at the start of each chapter to start answering these questions. It has helped me dig a lot deeper and understand more concepts. There are application tidbits on each page.
Where else is this theme, story, or concept in the Bible?
Listen to the Bible being read to you. There are many online apps that include an audio version. Especially if you like to learn through hearing, this is a great method.
Read the same scripture as a friend and talk about it. Or better yet, talk about it in a Bible study group. I am always amazed at how we can read the very same thing and have completely different insights.
No doubt, there are many more.
God gave us his Word to be an integral part of our life.
God means what he says. What he says goes. His powerful Word is sharp as a surgeon’s scalpel, cutting through everything, whether doubt or defense, laying us open to listen and obey. Nothing and no one is impervious to God’s Word. We can’t get away from it—no matter what.
My prayer is you’ll find it exciting and refreshing to try all sorts of new ways to get into your Bible. There is a never-ending amount of great information in there. It is always pertinent.
If your memory is slipping, do you have dementia? If you fall are you just clumsy? If you need help doing some of your daily tasks, are you just lazy? Or, are these things just a normal part of aging?
I suggest that MANY TIMES, these memory and falls changes are because of medication. Medications can cause these types of issues in a few different ways:
The dose is too high for you.
Your body has trouble getting rid of that medication.
You are on several medications with these types of effects.
Your medications are interacting with each other.
Your medications are interacting with your diet or your other medical conditions.
Medications and Memory and Falls
There are several types of medicines that can fog your thinking. They relax you, make you sleepy, and/or slow your thinking processes. Sometimes you use them for this effect. But know, in making you feel that way, they make it harder to think as quickly and clearly as you normally think.
And by slowing your thinking and response time, they increase your risk of falling, too.
It would be a very long blog to list them all. So, here are some of the more common culprits to impair memory and falls.
I have worked with many people who were planning to move to assisted living. They just couldn’t do some of the daily tasks they had done before. These tasks might be cleaning, keeping up with finances, remembering to take medicines, or ability to cook healthy meals.
In many cases, some medication adjustments made a big difference. Assisted living could be delayed.
How do you decrease your risk?
Please NEVER change any medications without first checking with your doctor.
If you take medication that you think could be impacting your clear thinking or make you feel unsteady, talk with your doctor.
If the types of medications mentioned in the blog are going to be changed, make the changes one at a time gradually. Fast changes can be dangerous. Making too many changes at once can make it hard to determine which change works and which doesn’t. So, making these changes should be a slow, careful process.
One of the key ways to prevent falls, medication-induced memory issues, and functional decline is to make sure your primary care physician knows exactly what medications you take and how you take them. Other physicians might contribute to your regimen, but your primary care physician is one who can analyze and control it all.
Similarly, Jesus is your primary spiritual care provider. You have a pastor, teachers, books, TV evangelists, friends, family, and more who contribute to your spiritual care. But, it is Jesus who is at the center.
The best-intentioned specialist medical provider can make a harmful decision because he/she is treating the specialty and less familiar with all of the other aspects of your care.
Similarly, the best-intentioned teacher/friend/colleague can distort the truth of Jesus. This is rarely done intentionally. We can all make mistakes, misinterpret, or be misled.
So, rather than take any teaching by a human at face value, compare it to the TRUTH of God’s Word, the Bible.
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.
Truth is not something we acquire passively. Just listening to your pastor on Sunday or listening to programs on the radio or TV won’t help you fully understand the truth. Your own reading and studying will give God a chance to talk to you directly. That private time in the Bible can help you recognize truths, understand information, and apply information in a very personal way.
Let your personal Primary Care Spiritual Physician, Jesus Christ, be your primary source of truth. Compare all other teaching to this truth.
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.
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.
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.
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.
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.
When was the last time you made and acted on wrong assumptions? It is so easy to do. You see something from your perspective and your mind fills in the details of the who, what, when, how, and why. It’s often long after you have acted that you are provided with a different perspective that makes the entire situation look different.
A quick, fun example is in this picture. Another proof that I am a geek. I get such a kick out of these pictures. If I believed my eyes I might run in to help the poor guy being lifted into the air.
This happens in healthcare, too. Keep in mind, the provider that is making decisions in the emergency department or the hospital usually knows VERY LITTLE about you. Any information you or a loved one or friend can give is all they have at first.
One day, hopefully soon, these providers will be able to access your medical records and make much more informed decisions. Right now, your doctor has to be contacted then the information sent to the hospital. If it is the weekend or an evening, that can take hours to days. The information then needs to get to your hospital provider from the fax machine or the electronic messaging system. Even then, there might be important information about you that is not even in your doctor’s record.
This leaves those of us making decisions about your care to rely heavily on what we see right now.
I have seen SEVERAL examples in the last few weeks of an older adult reaching medical care confused. The quick wrong assumption has been that the person has dementia. When confused, behaviors often change. A confused person can yell, pull at catheters and IV’s, try to get out of bed, and generally not cooperate. Since the assumption has already been made that dementia is the cause, calming medications are given. These then assure further confusion (but calmer) and make it very hard for the person to get to a point of no confusion.
Emergency contact information – name, phone number(s)
If you are accompanying someone to the hospital who is newly confused, explain this to the medical team. Help them understand what this person was like before this event. They need to know the ‘baseline’. If this person was living independently, driving, managing their finances the team needs to know that. If this person was unable to do those things and was getting frequently confused at home, the team needs to know that.
Share any known history about the current event. If you have been feeling worse and worse for the past three days, make sure they know that. If you have been having pain, explain that including what it feels like, how often you feel it, what makes it better or worse.
If you have been taking different medications for the past few days, make sure they know that. This often happens when we are in pain or have a cold. We take over-the-counter medications or left-over medications from prior prescriptions. These can cause confusion when mixed with our normal medication regimen.
Again, I have seen several instances in the past few weeks where assumptions are made when someone gets to the emergency department or hospital that make a situation worse.
In one instance the person’s confusion started as soon as a particular medicine was given. The family member noted that but didn’t speak up. Then medications were added to treat the confused behaviors. We are still trying to taper off of those medications and get this person independent again.
In another instance, the person had a urinary tract infection. These are famous for making older adults confused. But since no one was there to explain how odd this confusion was for this person, the team assumed this was normal and didn’t find the infection for a while. By then, a couple of medications had been added to treat the confused behaviors. It will take us weeks to taper her back off of these medications.
In a third instance, the collection of pain medications given after a surgery left the person sleeping most of the day and unable to think clearly. The spouse was dutifully giving the prescribed medicines around the clock. The wrong assumption made here was that this very healthy person over 60 could handle these medications like someone in their 30’s.
One more instance involved using a medication to treat the side effect of another medication. The second medication (the one used to treat the side effect) is on a list of medicines to avoid in people over 60. Rather than treat the side effect, it made the person nearly unresponsive. In this case, as in several of the others, rather than treat the underlying issue, wrong assumptions were made and actions were taken to treat the symptoms without understanding the back story.
Why ‘Bad Medicine’
Just a side disclaimer. When I was contemplating this blog I saw it as a chance to use the terms, ‘Bad Medicine’. I am a big Bon Jovi fan. I am also a pharmacist. So, I have to admit I love the song, ‘Bad Medicine’.
For more information about how to protect yourself from wrong assumptions leading to bad medicine, contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.
I can think of a lot of bad assumptions leading to bad decisions in the Bible. One of the first is Eve’s decision to eat the apple. The Israelites made bad assumptions continuously. A few that come to mind are thinking slavery would be better than ‘suffering’ in the desert; people in lands they were to conquer were too mighty to overcome; Moses was not going to return so a golden calf was needed. The list goes on.
So, how often do you make bad assumptions? I suggest we all do it every day. We don’t act on all of them. I don’t think we realize most of them.
I am consulting right now in a place that serves a highly diverse and unique population of people. Assumptions about gender, culture, religion, socioeconomic status, or just about anything will quickly lead you down an incorrect path. It has been an adventure of constant striving to avoid any assumptions.
These verses are good ones for me to remember each day:
Growing up I played countless games of Dominoes with my grandparents. And of course, the other fun thing to do with Dominoes is line them up and watch them fall is some funky pattern.
Hospitalization and memory or behavior changes
Many times in my career I have seen people experience a sudden decline in their health, often around a hospitalization. The general theme that I see far too often resembles falling dominoes and goes something like this:
Someone has a reason to go to the hospital
A medication is given that makes the person confused
An assumption is make this person has some form of dementia
That diagnosis is added to the record
With the confusion, behaviors change (crying out, pulling at IV’s, getting out of bed)
By the way, this is very alarming for the family and friends
More medications are added to control the behaviors
The person now truly looks like someone with advanced dementia
Unable to safely walk
Unable to clearly think and answer questions
Unable to care for him/herself
The person cannot return home and to the independent life led before the hospitalization
The person is sent on to rehabilitation or assisted living or skilled nursing care
The diagnoses and the medication go with them and are continued for the rest of life
In this scenario there might have been some early cognitive decline (early signs of some sort of dementia). The move to the unfamiliar environment with the scurry of activity and then the altered schedule can ‘unmask’ that early dementia and make it seem suddenly incredibly worse. Add an infection or painful condition, and this is even worse still. It could also be a sign of delirium (a short term confused state). That DOES NOT mean this confused state is the way this person will stay. Some of the best actions at this point are to dim the lights, quiet the person’s room, keep someone dear close by to assure the person that all is ok. This quieter reassuring environment can help reduce the confusion and behavior changes.
Another all-to-familiar scenario is similar:
A person has an elective procedure
Part of the sedation and anesthesia for the procedure makes the person confused and disoriented
Any cries out or uncoordinated behaviors are interpreted as pain
More pain medication is given
When the person goes to rehabilitation or back home to recover, a schedule pain regimen is included
Rather than moving and doing all of the exercises that will enable rapid and full recovery, the person is too sedated from the pain medication and sleeps
The lack of post procedure stretching, movement, and exercises prescribed by physical therapy limit the range of motion and full recovery from the procedure
For the rest of life the person has limited use of the limb/joint due to lack of use right after the procedure
How can you better navigate these scenarios?
If there have been any signs of memory changes, know that you might see this sudden confusion. Also, it seems the more critical the admission the higher the risk of delirium. (So, accidents, being in critical care, being placed on a ventilator, and such carry the higher risk).
Talk with the healthcare team about taking the following steps:
Dim the lights
Have a private room/space that stays as quiet as possible
Keep someone reassuring nearby
Keep glasses and hearing aids on to help with orientation
Have a clock and date information visible
Assure there is no infection (can cause confusion and behavior changes)
The healthcare team can make sure no medications are being used that can alter thinking.
If there is a sudden change in your loved one, stay calm. Delirium goes away with time and with these calming steps.
Ask for the minimum amount of pain medication to be given to limit the associated confusion and sedation.
The goal is to take care of the problem that led to the hospitalization without delirium or other confusion. Let those dominoes say standing.
For more information about delirium and steps you can take to prevent or resolve it, contact us at www.medsmash.com/contact.
How confusing can God be to people who have never heard about Him? I was at a conference yesterday where a speaker quipped in reference to Jesus, ‘and who knows what this guy does.’ He was trying to be funny. It was a medical type of conference, not a religious conference. But it struck me as a sentiment that is likely true for a lot of people.
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.
In these confusing times, may the message, hope, and peace of Jesus Christ bring clarity and comfort.
Medicare Open Enrollment for your 2017 plan is from October 15 to December 7, 2016. Before you make a selection, here are some resources to help you compare your options.
Medicare provides a tool where you can compare options before you make a decision. You can find it at this link.
The information you need is:
Your Medicare number
If you have a Medigap or Medicare supplement plan, the name and type of the plan
Your zip code
A list of your medicines prescribed by each of your doctors
The name and location of your preferred pharmacy
You can search through options using your specific information or you can do a general search. I highly recommend you perform a search with your specific information at least once before you make final decisions. That will give you the best look at your anticipated likely costs.
It starts with your zip code and information from your Medicare card.
Enter your current Medicare coverage type. Include whether you get extra help paying for your medication costs.
Enter your prescribed medicines. Include the strength, whether you get your medicine every month or every 3 months, and whether you get your medicines from a local pharmacy or a mail order pharmacy.
Be sure to include all of your medicines
If your doctor has talked about maybe starting new medicine, include these, too. This will make sure the plan you choose will cover all of these medicines.
Select your pharmacy. Note, if your pharmacy doesn’t show up at first, expand the number of miles from your home so that your pharmacy will be on the list.
You can then choose whether you want to compare medication only Medicare D plans, Medicare Health Plans with drug coverage, and Medicare Health Plans without drug coverage.
If you aren’t sure, select all three options
If you know which you want to compare, select just that option
A list of all options will appear on the next page. They appear in order of cost with the lowest annual cost option appearing first after Original Medicare. You have the option to select different sort options.
Select three plans that you want to directly compare.
The three options will be displayed side by side.
You can compare three at a time as many times as you want.
All costs for the year include deductibles, co-pays, gap payments, and other fees will be displayed.
Look at your total annual cost
Look at the deductible which is money you will pay at the first part of the year
Look at the projected money you will pay in the coverage gap
To look at your options with Medigap plans, you can go to this link. This one will let you compare types of Medigap plans and their costs.
NOTE – A friend, and expert in the field, clarified that Medicare Advantage plans can be purchased at any time. Her comment: “Medicare Supplement policies do not have an annual open enrollment, but changes can be made based on your health after your original open enrollment or a special enrollment period.”
If you have any questions about how to use these tools or how to compare your options, please contact us at www.medsmash.com/contact.
For Medicare plan decisions, comparisons are good. They are key to making the best decision.
In the rest of your life, comparisons can be hazardous. How often do you compare yourself to someone else? You might not even realize you’re doing it.
Do you ever have negative thoughts about yourself when you see something you admire in someone else?
Do you ever feel extra good about yourself when you can do something that someone else can’t do?
In what sneaky ways can ENVY enter your thoughts?
I’ve read a couple of really good blogs about this from pastors recently. I know I’m guilty of comparison without ever intending for it to happen. I fall into a thought process of envy or comparison then catch myself and feel so ashamed.
Apparently I’m not alone. There are many Bible verses about the problems with envy.
For where jealousy and selfish ambition exist, there will be disorder and every vile practice.
The antidote to envy is to lay it all before the Lord. God has a very special, very specific plan just for you. Your gifts, your strengths, your weaknesses, your opportunities, your looks, your dreams are very UNIQUELY yours.
It doesn’t matter how other people are blessed. There are other blessings that are all for you!
Many are the plans in the mind of a man, but it is the purpose of the Lord that will stand.
This could be the week to turn your eyes from what everyone else has. Instead, look at what God has in store just for you. Ask, He’d be happy to show you all the good things you have and what is still coming you way!!