Truth

The Dominoes of Medication – Avoid the Tipping Point

Posted on by Michelle Fritsch, Pharm.D.
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Follow these steps to prevent sudden confusion in the hospital like a series of falling dominoes.

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

Hospitalization and memory or behavior changes

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

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

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

Elective procedures

Another all-to-familiar scenario is similar:

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

How can you better navigate these scenarios?

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

Talk with the healthcare team about taking the following steps:

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

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

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

BIBLICAL APPLICATION

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

1 Corinthians 14:33a ESV

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

David and other Psalm writers struggled to understand.

Psalm 119:169 ESV

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

Psalm 119:34 ESV

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

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

Romans 3:21-24 MSG

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.

Hebrews 13:8 ESV

Jesus Christ is the same yesterday and today and forever.

Blessings,

Michelle

Medicare Open Enrollment – comparing your options

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.

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

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

The information you need is:

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

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

The tool will walk you through step by step.

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

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

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

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

BIBLICAL APPLICATION

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

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

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

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

In what sneaky ways can ENVY enter your thoughts?

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

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

Galatians 5:26 ESV

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

1 Peter 2:1 ESV

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

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

Titus 3:3 ESV

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

James 3:16 ESV

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

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

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

Proverbs 16:9 ESV

The heart of man plans his way, but the Lord establishes his steps.

Proverbs 19:21 ESV

Many are the plans in the mind of a man, but it is the purpose of the Lord that will stand.

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

Blessings,

Michelle

Gratitude

Gratitude – keeps you healthier

Posted on by Michelle Fritsch, Pharm.D.
Gratitude
Being thankful for what you have improves your health

Gratitude, grateful, thankful, thanksgiving, appreciation

What do these words mean to you? What role do they play in your everyday life?

Wow, I am amazed how much information is available on this important link between being thankful and health. Just search for these two terms and see what all you will find.

What is gratitude?

This is being aware of all of the good things in your life. And it is being thankful for those things. Have you considered being thankful for:

  • A safe place to sleep
  • Food to eat
  • Clothes to cover yourself
  • Having a friend to call
  • Your job – current or past
  • A beautiful day

This simple awareness of and being thankful for these ‘little’ things can boost your health.

Note, it doesn’t have to be the biggest house or the softest bed or the tastiest food or the latest fashion clothing to be grateful. Gratitude focuses on what you have – all of the good things – rather than what you don’t have.

Expressing gratitude can:

  • Boost your spirits and sense of well-being
  • Boost your immune system making you less likely to get sick
  • Decrease your chances of heart disease
  • Improve your performance (grades, work productivity, concentration)
  • Bust your stress

There are many ways you can make gratitude part of your life. Here are a few recommended in a Harvard Mental Health newsletter:

  • Write a thank-you note
  • Go up and thank someone
  • Keep a gratitude journal
  • Pray
  • Meditate
  • Keep a list of your thanks = count your blessings

See your day and your health improve by focusing on the positive.  Try starting your day with a list of things for which you are thankful.  On those nights you can’t sleep, name all of the good things in your life.  Let that override the worries and things you can’t control.

On this Independence Day weekend, as a country, we have much reason for gratitude!

For more information on gratitude and health, contact us at www.medsmash.com.

BIBLICAL APPLICATION

We have so many reasons to be grateful!

Have you ever been in a ‘funk’ having a bad day and then remembered to be grateful? I have done this so many times. When all looks dark and gloomy, make yourself think about all of the things that are good and right.

1 Thessalonians 5:18 ESV

Give thanks in all circumstances; for this is the will of God in Christ Jesus for you.

I’ll quickly admit I don’t always think to do this. I stay in that dark place far too long. Later, once I’m out I realize I had the ‘magic potion’ to leave that darkness behind. It was given to us by Christ when he died to erase our sins. It was given to us by God who maintained His love and focus on the good in the Jews through centuries of missteps (just as we live a series of missteps).

Lamentations 3:23 ESV

They are new every morning; great is your faithfulness.

I don’t even know where to begin selecting Bible verses to draw us closer to the benefits of gratitude. There are so many!!!

Psalm 118:24 ESV

This is the day that the Lord has made; let us rejoice and be glad in it.

Colossians 3:17 ESV

And whatever you do, in word or deed, do everything in the name of the Lord Jesus, giving thanks to God the Father through him.

Psalm 136:1 ESV

Give thanks to the Lord, for he is good, for his steadfast love endures forever.

Ephesians 1:16 ESV

I do not cease to give thanks for you, remembering you in my prayers,

James 1:17 ESV

Every good gift and every perfect gift is from above, coming down from the Father of lights with whom there is no variation or shadow due to change.

I feel energized, positive, and excited just reading these verses full of hope and promise! I am thankful for each person who takes the time to read this. May you be blessed by these assurances from God!

I pray you can stay focused on the many good things in your life this week and that can keep you out of the dark, gloomy places.

Blessings,

Michelle

Spiritual health

Four Components of True Health – Spiritual Health

Posted on by Michelle Fritsch, Pharm.D.
Spiritual health
Spirituality is a key component of total health

Spiritual health is the third of the four components of health. True health requires health in all four components. Over the last two weeks we covered physical and mental health. Next week we will cover the fourth component.

This blog is being released on the most important holiday of the Christian religion. It seems timely to talk about spirituality and why and how it is linked with your health.

Researchers have studied what are the differences between the most healthy and the least health people in our world. Certainly some of the factors are:

  • our genes
  • our environment
  • our accessibility to healthcare
  • our social system

These are more tangible, or objective, types of factors. We can define and measure them. But, these measures alone can’t explain all of the differences in our health.

A component that many researches have included is the concept of religion. Most studies I have found don’t differentiate which religion. They just look at whether the person identifies with a religion. Studies have found that identifying with religion is associated with better health.

Why would spiritual health and religion be associated with better health?

One potential reason religion could enhance your health could be belief in a higher power. There is assurance and hope in having someone/something overseeing your life. In some religions there is a direct relationship with the higher power. In others, a common belief system provides a group to whom you can belong and share those beliefs.

Religion has also been credited with providing a way of coping with life events. In some religions, God can be asked for help. Some studies have demonstrated a positive benefit of prayer on health. In others, the care of one another by people within a religious group benefits health outcomes.

The sense of belonging, the social opportunities, and the structure of religion appear to add to enhanced health. In addition, religion provides additional opportunities for volunteering. Those who volunteer have been found to be healthier. Of course, there are non-religious ways to volunteer. But, some of the studies found those with a religious affiliation to be more likely to volunteer.

Altruism is one of the attributes associated with improved health. Altruism is defined as, “feelings and behaviors that show a desire to help other people and a lack of selfishness” (Merriam-Webster definition). Some of the major religions – Judaism, Christianity, and Islam – encourage helping others. Then, God will reward such actions. Either way, people who think about and do positive things for other people are healthier.

There is growing interest in studying this. There is now evidence to support the crucial role of spirituality in overall health. Stay tuned to see how this information will be incorporated in to our healthcare system.

There are no medications for spirituality. So, you might wonder why Meds MASH would be posting about this topic. But, it is a core part of overall health. So in the interest of completeness, spirituality is an important topic.

For a list of references used in the writing of this blog, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

Happy holiest of days! Our Savior lives!

The sun has been shining, the days are warming, my favorite color of spring green is starting to turn up everywhere, flowers are blooming! This season makes me so happy!

Have you noticed how circumstances can really improve your mood and make you happy?

I’ve injured my leg (again) and will likely need surgery. Insurance has made the treatment process incredibly long. How frustrating. Have you noticed how circumstances can dampen your mood?

How much is your life tossed up and down by circumstances? The roller coaster ride of the ups and down can be exhausting!

You can’t keep life circumstances from happening. Good things and bad things happen to everyone. There is no avoiding it. But, you have the ultimate hedge of protection around you like a solid house that protects you in a hurricane. No matter what happens in your life, because of what happened Holy Week, you have a source of hope and peace.

Jesus was betrayed by one of his closest friends. Many people worked together behind his back to find a way to destroy him. He was slandered. He experienced the ultimate defamation of his character. He was accused of crimes he never committed. He was humiliated. He was physically abused beyond recognition. He was tortured. Many who had supported him either abandoned him or turned against him. The official who could have protected him did not. He was murdered in public with additional humiliations in the worst, most painful way known to people at that time.

He was completely without sin. He did nothing wrong. He is the only person to ever walk the earth who could claim that.

So, why did he willingly go to Jerusalem on Palm Sunday knowing full well this was what would happen by the end of the week?

Romans 14:9 ESV

For to this end Christ died and lived again, that he might be Lord both of the dead and of the living.

Isaiah 53:5 ESV

But he was wounded for our transgressions; he was crushed for our iniquities; upon him was the chastisement that brought us peace, and with his stripes we are healed.

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.

YOU are the reason Jesus endured all of this. His love for YOU. Your sins. All that separated you from God due your weaknesses is now gone. Because Jesus died for YOU, you have the promise of eternal life! There is no better gift anyone could ever give you.

Jesus did not remain in the grave. After three days He came back to life! Again, all for YOU!

John 11:25 ESV

Jesus said to her, “I am the resurrection and the life. Whoever believes in me, though he die, yet shall he live,

John 6:40 ESV

For this is the will of my Father, that everyone who looks on the Son and believes in him should have eternal life, and I will raise him up on the last day.”

1 Corinthians 6:14 ESV

And God raised the Lord and will also raise us up by his power.

May you be richly blessed as you ponder this love that can protect you from any storm.

Michelle

Image source: colinsclipart.com

Over-the-counter NSAID pain medicines – how safe are they?

Posted on by Michelle Fritsch, Pharm.D.

Slide1Some people think medicines that are available over-the-counter are always safe.   I don’t want you to be one of those people. Ibuprofen and naproxen are a class of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). They can treat pain, inflammation (swelling and redness), and fever. Hundreds of million of Americans take them every year. You probably have some in your home right now.

The NSAIDs that you can buy without a prescription are ibuprofen (brand names Motrin, Advil) and naproxen sodium (brand name Aleve). They are part of a class of over 20 medications that are available by prescription.

5 IMPORTANT THINGS about NSAIDs

There are five important things I want to make sure you know about these medicines:

  1. They do work to treat mild to moderate pain, fever, and inflammation. They all work the same way. No measurable difference between them in how they work has been found. So one is not better than another.
  2. They irritate your stomach lining. If you already have reflux, gastroesophageal reflux disease (GERD), ulcers, or have ever had a stomach bleed, please tell your doctor. Whether or not you already have stomach problems, always TAKE NSAIDs WITH FOOD.
  3. They cause you to retain extra fluid. This can raise your blood pressure. It can also make heart failure worse and increase your risk for a heart attack if you have heart problems. Talk with your doctor if you have high blood pressure or heart problems BEFORE you take an NSAID.
  4. They can worsen kidney function. If you already have diminished kidney function, talk with your doctor before you take an NSAID.
  5. They make your platelets less sticky. This lowers your chance of have a clot. But, NSAIDs do this for a limited time. ASPIRIN can make your platelets less sticky for the entire life of the platelet. That is why aspirin, usually 81mg baby aspirin, is used to help prevent a clot that leads to a heart attack or stroke.

I always buy the generic version. It will save you some money and give you the very same effect.

If you have pain or fever, there is an option that does not have the stomach, heart, or kidney issues. That option is acetaminophen (brand name Tylenol). For pain that does not include inflammation (redness, swelling), acetaminophen controls the pain similarly to the NSAID.

The problem you do have to watch with acetaminophen is it can hurt your liver. The most you should take in a day is 4 grams (2 extra strength tablets four times daily). The Food and Drug Administration might even recommend that you not take more than 3 grams per day soon. Also, if you drink alcohol more than 2 drinks per day or have any liver condition, then acetaminophen might not be your best choice. Please talk to your doctor before you take it if you have liver issues or drink more than 2 drinks per day.

For more information about safe pain medicine options, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Many people think that any medication you can buy on your own, without a prescription must be safe. I hope you now realize this isn’t always true. In some patients, with some other conditions, a relatively safe medication can be downright dangerous.

So, how do we know what is true? On what can we truly rely?

“Voice of Truth” by Casting Crowns took on a whole new meaning for me this week. I love this song. I have heard it countless times. On this particular day, when it came on the radio I wasn’t even listening very intently.

Then, the words, ‘this is for my glory’ hit me suddenly in a whole new, EXTREMELY POWERFUL way. I have been working through a large, unexpected life transition over the past couple of years. It is not a bad situation. It is just a very big transition leading down a path I can’t really see yet. The whole experience has been and continues to be a real faith walk. I often pray for guidance, help with decision-making, and peace while waiting.

Then, out of the blue, I hear the lyrics, “The voice of truth says, “This is for My glory”. It hit me; none of this is even about me. If I could be in the future looking back, I would be telling myself to “stop it, be quiet, just wait and see, God is doing something here.” It’s not about me at all. It’s all about God working through this situation for HIS glory.

I felt a wave of peace, a wave of admonition, and a lot of emotion. I fluctuated between laughing and crying.

I just love such spontaneous GOD moments!

Proverbs 16:9 ESV

The heart of man plans his way, but the Lord establishes his steps.

Acts 18:9 ESV

And the Lord said to Paul one night in a vision, “Do not be afraid, but go on speaking and do not be silent,

Listen to the ‘voice of truth’ and wait to see what He is cooking up that is for His glory in your life.

Blessings,

Michelle