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Safe meds and independence!

Independence – Live the Retirement of your Dreams

Posted on by Michelle Fritsch, Pharm.D.
Safe meds and independence!
Maintain your independence through safe medication use.

Happy Independence Day! On this day of immense gratitude for all who have served to preserve our freedom, I am also thinking about your freedom. My passion professionally is to help people live out their retirement dreams in good health avoiding physical limitations. It sounds so basic. No one thinks medication-related issues will apply to him or her – until they do.

I have talked with hundreds of people who found themselves suddenly limited. It happened ‘out of the blue’ in many instances. In others, it was a gradual approach that was more visible in hindsight.

Pay attention to maintain your independence

In many cases people noted a change but didn’t pay much attention to it. Often a medication had been changed, and their energy level or their clear thinking changed. Maybe they got dizzier or couldn’t exert themselves as much. These little changes led to new symptoms that led to more new medications. This can be a slow, barely noticeable cycle that leads to trouble.

Ask the right questions to maintain your independence

Before any new medication is started, fully understand why it is necessary, what other options were considered, and what you should expect. Read the information that comes with the prescription. Look at the common side effects and pay attention to whether you experience those. If they last more than a couple of days or they make you decrease your activity levels, call your doctor. Talk with your pharmacist.

Take active steps to maintain your independence

Always go to your medical visits prepared. Take a list of every medicine you take – including vitamins, supplements, over-the-counter medicine, and any other substance. Even include the ones you only take once in awhile.

Take two copies of any items you want to discuss. Give one to the medical assistant who takes you to the exam room. Ask that assistant to give it to your doctor. Keep the other copy for yourself. Take a pen or pencil to take notes for each item on your list.

Think about any new symptoms and how you could best describe those. Include any details such as what makes it better or worse, what you have already tried, and when you first noticed the symptoms. These details help your doctor discover the cause more quickly.

Medication is nearly always involved in someone’s loss of independence. So often that is completely avoidable. Don’t let it happen to you. Let us thoroughly review your medication regimen today. We can help you avoid the common pitfalls that lead to lost independence.

You can reach us at www.medsmash.com/contact, 410-472-5078, or michelle@medsmash.com.

BIBLICAL APPLICATION

This blog has been about maintaining your independence. It is about leading your life to the fullest with no avoidable decline in function.

On the flip side, we live our best life when we live in full dependence. Dependence on God, that is.

John 15:5 MSG

“I am the Vine, you are the branches. When you’re joined with me and I with you, the relation intimate and organic, the harvest is sure to be abundant. Separated, you can’t produce a thing.

Paul lived in complete dependence on God. He lived only to serve and do what was asked of him, even when he knew extreme hardship, flogging, and prison were waiting for him.

Galatians 2:20 ESV

I have been crucified with Christ. It is no longer I who live, but Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me.

2 Corinthians 1:8-9 ESV

For we do not want you to be ignorant, brothers, of the affliction we experienced in Asia. For we were so utterly burdened beyond our strength that we despaired of life itself. Indeed, we felt that we had received the sentence of death. But that was to make us rely not on ourselves but on God who raises the dead.

2 Corinthians 12:9-10 ESV

But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong.

I am praying you stay healthy, living independently in this lifetime so that you can do all God has called you to do. I am also praying you live in full dependence on the One who can guide your life through the amazing adventures He has planned just for you.

Blessings,

Michelle

 

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No more isolation

Isolation Avoidance – You Never Need to be Alone

Posted on by Michelle Fritsch, Pharm.D.
No more isolation
Isolation is very bad for your health. It can be avoided.

Isolation is a growing issue in our society.   Isolation is being chronically alone with no support.

Many cultures function as a family unit, and as family members advance in age, they are incorporated into the daily life of younger generations. Senior living, assisted living, and nursing homes are not options in those cultures.

For other families, members spread out to various parts of the country or even to other countries. Members no long live in the same community where they can care for each other. Or, members might live close together but have busy schedules that hamper time together. Then, there are instances when there are no family members to provide care. Perhaps friends have their own needs and are unable to be supportive.

Risks of Isolation

Isolation is sometimes a gradual situation, as it gets hard to get out and about. Other times, an injury or medical event rushes someone from an active lifestyle to a homebound situation.

Unfortunately, I have seen too many examples lately of medication changes that led to sudden isolation. These medication changes cause dizziness, sedation, nausea, diarrhea, incontinence, or some other side effect that made it hard to leave the house. Often people don’t recognize the link to the medication change. Many people try to ‘live with it’ and consider it a new normal.

Isolation is not good for your health. It is not good for your physical, mental, emotional, or spiritual health. Through many studies and experiences of people of all ages, the negative effects of isolation are many! Some of the most common are:

  • Depression
  • Anxiety
  • Alcoholism
  • Increased blood pressure (due to more stress hormone production)
  • Higher reaction/perception of stress
  • Heart disease
  • Decline in thought processes
  • Alzheimer’s disease
  • Changes in sleep patterns
  • Increased suicide rates

Isolation remedies

A concept considered in these blogs before is that we all need to be needed. Isolated people suffer from sensory deprivation, lack of social interaction, and that important concept of being needed. Total lack of interaction can actually play with your mind leading to loss of time perception and even hallucinations.

So, how do we help people avoid this isolation?

There are a number of different kinds of living communities for adults over 55. These include independent living, assisted living, dementia care, and more skilled care. All aspects of care are integrated into one community with a wide range of activities to engage all interests. These are designed to avoid isolation. If you are living alone and feeling isolated, consider the many senior living options in your area. [We can help you find a professional to show you the local options and help you through the process.]

If you don’t think your budget will allow a community option, or if you really don’t want to leave your home, there is another low-budget, high-reward option. You are not the only person feeling isolated. You have two primary responses.

Be resentful and hopeless ==> takes you down a negative, unhealthy path

Reach out to others ==> you and those you reach will both win!

There are SO MANY people feeling isolated. And, as our population ages and the culture continues to change, the numbers are rapidly growing. Finding someone else in a similar situation can be a solution for both. Calling to check on each other, remind each other to take medication, and just share life can be so healing.

I have been marveling at a member of our church. She had an accident riding a horse and is now paralyzed. She has very limited use of one hand, just enough to operate a special wheelchair. She can’t type, drive, dress herself, or fix her hair. So many in her situation would experience the symptoms listed above. She went from living life fully functional to loss of most functions in one incident. (Now, I’m sure she has had some very low moments.) Overall, she is hopeful and finding new ways to live a full, fulfilled life. One of the things she is pursuing is training as a ‘Stephens Minister’. This will put her in the first line to help other members of the church during a time of distress. The main pastors can’t always get there immediately, so the Stephens Ministers can be first responders. I’m sure she will encounter hurdles that she will need to overcome, but she is putting herself out there to continue to be needed and avoid the deep depression and isolation that could so easily consume her.

So, if you can make a phone call, answer a phone call, type a message, let someone in the door to visit, there are some important, exciting ways you can be fulfilled, needed, and avoid isolation.

We would love to help you figure this out. If you are feeling isolated and aren’t sure what to do, please contact us at www.medsmash.com or 410-472-5078 or michelle@medsmash.com. Together we will help you avoid isolation in ways that inspire and fulfill you.

BIBLICAL APPLICATION

We are designed to be members of a community. Jesus surrounded himself with his disciples and many others. He regularly visited close friends, like Mary, Martha, and Lazarus. In Acts, the new church lived, worshiped, studied, and shared all things together.

There are even several verses in the Bible that emphasize these principles.

Hebrews 10:24-25 ESV

And let us consider how to stir up one another to love and good works, 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.

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.

As members of the church, I encourage each of us to especially aware of those in our community who might become isolated. It is amazing how much assistance you can provide with simple visits, phone calls, text messages, e-mails, or any outreach. Let those people know they are not forgotten. Help them find those opportunities to still reach out to others and find purpose in helping others avoid isolation.

Galatians 6:2 ESV

Bear one another’s burdens, and so fulfill the law of Christ.

1 Corinthians 12:14 ESV

For the body does not consist of one member but of many.

I will be praying for God to show me where I can be helpful others, especially those who are isolated. The negative impact of that is so great! And the remedy is so attainable. I pray the whole church finds those opportunities to reach out and keep all connected in the love and fellowship of community.

Blessings,
Michelle

 

Use reflective statements to enhance communication and decrease conflict

Communicate Your Way to Better Health

Posted on by Michelle Fritsch, Pharm.D.
Use reflective statements to enhance communication and decrease conflict
Communicate to decrease conflict and increase understanding using reflective statements

How do you handle conflict? For most of us the answer is, ‘not very well’. Conflict can raise your blood pressure, constrict your veins and arteries, and make your heart beat harder and faster.

Did you know that communication is NEARLY ALWAYS at the heart of conflict. As people, we miscommunicate on a regular basis. Part of what makes good communication so difficult is that it involves at least two people. Once is communicating and one is interpreting that communication. Let’s take a look at both important parts.

Communicate a consistent message

I was at a retreat this weekend where we played a game about consistent messaging. Think about a time when someone was talking with you and their message was not consistent. Their words said something that did not match their tone or their face or their body language. Imagine someone saying, ‘I love you’ with a grimace on their face and a mocking tone. Or picture someone saying, ‘So nice to meet you’ while glancing around the room looking for someone else. Has anyone ever tried to express anger with you then started laughing? It is hard to express anger while laughing. Someone was just telling me a story about a toddler rearranging a bunch of decorations and falling into a box headfirst with her feet sticking out of the top. The decoration was too heavy and pulled her over. This parent had to stifle giggles and get a picture before retrieving and correcting the toddler.

So, when you are communicating, carefully think about saying the same message with your words, your tone, your eye contact, your facial expression, and your body language. That will help avoid misinterpretation.

Check for understanding

When you are the one communicating, make sure the receiver actually understands what you are saying. It is ok to ask them to repeat it back. Or to ask what questions they have. If we assume the other person understood exactly what we were thinking and trying to communicate, we can often be disappointed. Think about the last time you thought someone understood and they did something completely different than what you asked.

If you are the listener, this is a critical step to assure you are understanding the message.

Reflective Statements

When you are the listener, one of the best techniques you can use is ‘reflective statements’. State back to the person communicating with you what you hear them saying. Put it in your own words. Here are some examples:

  • You are saying you are upset about _________ because _________.
  • You are asking me to _________________ and have it done by _________.
  • ___________ frustrates you when he/she ______________.
  • You want to ________________ before you agree to a hip surgery.
  • You heard that I ______________, and it has upset you.
  • Your son forgot to _______________, and not you don’t know what to do.

When you respond with a reflecting statement, you are making sure you understood the person’s message. It is a chance for them to clarify if you misunderstood. It is also a chance for them to feel heard and understood if you are correct.

Making sure you understand before taking any action, even before getting angry, and help avoid a lot of conflict.

If someone is upset or angry and respond also upset and angry, the situation escalates quickly. I have seen this happen where the two people don’t even realize they are saying the same thing. Neither is listening, they are just yelling. Now that will really get your blood pressure up!

I have found that FREQUENTLY, what I think I heard and what the person really intended were different. Especially when the topic is emotionally charged. It is our natural reaction to get defensive when someone comes at us angry. It is very hard to listen well in that state. So, a really deep breath and a calm reflecting statement can often help the situation calm back down. Sometimes when we are angry or frustrated we just want to vent. Once the venting is done, and the recipient reflects understanding, the situation doesn’t seem so bad.

Communicate with your Healthcare Team

These same techniques are very helpful when you communicate with your doctor. Sometimes the news we receive from our doctor can be upsetting. The words used in medicine are big and scary all by themselves. It can be hard to understand all of the technical information.

I highly encourage you to state back to your doctor what you just heard. Say it in your own words.   This will help the doctor know where to clarify. I have had many patients get upset by a medical term that was actually no big deal. It just sounded scary. My grandfather, after 40+ years of smoking, a heart attack, a stroke, and stomach ulcers quit smoking cold turkey. We had been trying to get him to quit for years. None of those scary medical issues made him quit. But, when he was diagnosed with hiatal hernia he quit on the spot. [Hiatal hernia is when the sphincter between the esophagus and the stomach can’t close all the way. This allows stomach acid to come back up giving you heartburn. For him, this was the mildest of his issues.] I ask him why. His answer, ‘That’s a really scary word.’ I was in pharmacy school at the time. I had all sorts of scary words I could have given him. Who knew that was all it would take to get him to quit.

So, I encourage use to be clear and consistent with your communication. And, ask clarifying questions and use reflective statements when you are receiving communication. Especially if it seems upsetting, make sure you really understand the message before you make any decisions. This could help you avoid a lot of conflict.

Your heart will thank you for managing conflict better and keeping your blood pressure down.

For more information about communication techniques for your health, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

When we react without first understanding, we often get ourselves into trouble. Throughout the Bible we see examples of people making bad assumptions followed by bad actions.

The people of Israel, after God had gotten them out of slavery and out of Egypt and led them through the desert supplying food and water and protection, still made bad assumptions. While Moses was on the mountain with God himself, they assumed he wasn’t coming back, so they made a golden calf to be their god.

Exodus 32:1 NIV

When the people saw that Moses was so long in coming down from the mountain, they gathered around Aaron and said, “Come, make us gods[a] who will go before us. As for this fellow Moses who brought us up out of Egypt, we don’t know what has happened to him.”

When Jesus was talking with his disciples about what was coming next for him, including his death, Peter jumped right in and disagreed.

Matthew 16:21-23 NIV

From that time on Jesus began to explain to his disciples that he must go to Jerusalem and suffer many things at the hands of the elders, the chief priests and the teachers of the law, and that he must be killed and on the third day be raised to life.

Peter took him aside and began to rebuke him. “Never, Lord!” he said. “This shall never happen to you!”

Jesus turned and said to Peter, “Get behind me, Satan! You are a stumbling block to me; you do not have in mind the concerns of God, but merely human concerns.”

In the bible we are also told to expect miscommunication in the future. There will be false prophets and all sorts of misinformation.

Matthew 7:15 ESV

“Beware of false prophets, who come to you in sheep’s clothing but inwardly are ravenous wolves.

1 John 4:1 ESV

Beloved, do not believe every spirit, but test the spirits to see whether they are from God, for many false prophets have gone out into the world.

We are called to be discerning. Ask questions. Get the full story. Make sure you understand and that what you hear matches the messages of the Bible.

I feel better when I read this passage. There will be no doubt when Jesus returns. Other people can claim what they want. I won’t believe it until it is this obvious:

Matthew 24:29-31 ESV

The Coming of the Son of Man

“Immediately after the tribulation of those days the sun will be darkened, and the moon will not give its light, and the stars will fall from heaven, and the powers of the heavens will be shaken. Then will appear in heaven the sign of the Son of Man, and then all the tribes of the earth will mourn, and they will see the Son of Man coming on the clouds of heaven with power and great glory. And he will send out his angels with a loud trumpet call, and they will gather his elect from the four winds, from one end of heaven to the other.

That doesn’t sound too subtle. So, until it is extremely obvious and visible to all of creation, let’s not fall for false messages.

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

 

Medication Choices for ‘Everyday’ Pain

Posted on by Michelle Fritsch, Pharm.D.
otc-pain-meds
Everyday pain meds are important to discuss with your doctor and pharmacist.

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

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

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

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

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

Nonsteroidal anti-inflammatory drugs (NSAIDs)

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

There are three big risks associated with these that I want you to know about:

  1. They can be hard on your kidneys. Be sure your doctor and your pharmacist know that you take these, how much you take, and which ones you take. They will monitor your kidney function and likely ask you to stop taking them if your kidneys show signs of injury.
  2. They can be hard on your stomach. Your risk of stomach ulcer goes up when you take these. ALWAYS take them with FOOD. If you develop stomach pain, more indigestion, reflux, or burning, tell you doctor.
  3. They can raise your blood pressure. This in turn can increase the stress on your heart. If you have high blood pressure or a heart condition, talk with your doctor and pharmacist BEFORE choosing to take an NSAID.

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

Acetaminophen

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

There are two primary risks with acetaminophen:

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

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

Some other options

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

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

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

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

BIBLICAL APPLICATION

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

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

2 Corinthians 4:8-10 ESV

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

1 Peter 5:10 ESV

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

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

Romans 8:18 ESV

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

Romans 5:3-4 ESV

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

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

John 16:33 ESV

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

Blessings,

Michelle

The Dominoes of Medication – Avoid the Tipping Point

Posted on by Michelle Fritsch, Pharm.D.
slide1
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 – 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

Quality of Life – your attitude and health

Posted on by Michelle Fritsch, Pharm.D.
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Your quality of life is shaped by your attitude, and that also impact your health.

Your quality of life is different than just living. If you are breathing and your heart is beating, then you are alive. Within that life there can be a HUGE range in your quality of life. Quality of life is your overall well-being or satisfaction. How is yours?

Being satisfied with your life encompasses many different factors. There is no one ‘right recipe’ for gloriously high quality of life. Your quality of life will likely change throughout your life with your changing circumstances. But, some people maintain a relatively good quality of life in spite of their circumstances. It is interesting that the factors some people would rate as important don’t actually lead to high quality of life scores.

  • For instance, many people would propose more money would increase their quality of life. Yet there are many miserable people who have a lot of money.
  • Many people would propose that better health is the key to quality of life. Yet there are sick/disabled/injured people with a wonderful quality of life and super healthy people who are miserable.
  • Some would list having many friends around as the key to quality of life. But there are some people who are at parties all of the time surrounded by friends who are miserable. There are others who lead very quiet lives with few friends who are very happy and content.

So what is the key to a magnificent quality of life? 

Your attitude

I have been very interested in the large range of responses people give when asked about their life satisfaction. I am not the only one interested in this. I have read many articles from all sorts of authors on the subject of health and attitude. If you are interested, to get started, just search for the terms ‘attitude and health’. I think you will be surprised by all that you find.

Will there be dark days when things are not going right? Will you lose loved ones? Can your life slip out of your control on more than one occasion? YES!

You then make a choice as to how you respond.   Your attitude matters.

Great example

Your physical health, mental health, emotional health, and spiritual health are all wrapped up in how you live your life. There will be many things that happen ‘to you’. But you alone decide how you respond. Here is a story I’ve read in many places that captures this truth:

A 92-year-old, petite, well-poised and proud lady, who is fully dressed each morning by eight o’clock, with her hair fashionably coifed and makeup perfectly applied, even though she is legally blind, moved to a nursing home today. Her husband of 70 years recently passed away, making the move necessary.

After many hours of waiting patiently in the lobby of the nursing home, she smiled sweetly when told her room was ready. As she maneuvered her walker to the elevator, I provided a visual description of her tiny room, including the eyelet sheets that had been hung on her window. “I love it,” she stated with the enthusiasm of an eight-year-old having just been presented with a new puppy.

“Mrs. Jones, you haven’t seen the room …. just wait.”

“That doesn’t have anything to do with it,” she replied. “Happiness is something you decide on ahead of time. Whether I like my room or not doesn’t depend on how the furniture is arranged, it’s how I arrange my mind. I already decided to love it. It’s a decision I make every morning when I wake up. I have a choice; I can spend the day in bed recounting the difficulty I have with the parts of my body that no longer work, or get out of bed and be thankful for the ones that do. Each day is a gift, and as long as my eyes open I’ll focus on the new day and all the happy memories I’ve stored away, just for this time in my life.”

She went on to explain, “Old age is like a bank account, you withdraw from what you’ve put in. So, my advice to you would be to deposit a lot of happiness in the bank account of memories. Thank you for your part in filling my Memory bank. I am still depositing.”

And with a smile, she said: “Remember the five simple rules to be happy:

  1. Free your heart from hatred.
  2. Free your mind from worries.
  3. Live simply.
  4. Give more.
  5. Expect less.

(Copied from this source.)

If you would like to know more about how your attitude impacts your quality of life and your health, please contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

How is your attitude? How easily do you become bitter, frustrated, angry, and discontented? Wow, doesn’t that happen so easily!!!!

The devotions that come to my e-mail every day from Pastor Rick Warren have been focused on envy for several days. What a nasty, cruel, pervasive worm is ENVY.

Doesn’t that negatively impact your day?

Paul outlines to Timothy many facets of living a God-centered life. And he repeatedly makes reference to the fulfillment, joy, and quality of life that comes with that kind of living.

1 Timothy 6:6-7 ESV

But godliness with contentment is great gain, for we brought nothing into the world, and we cannot take anything out of the world.

Paul tells Timothy about all of the pitfalls in this world. He even talks about how things will get worse the closer we get to the coming of Christ. So, finding contentment in the midst of so much negativity is not easy. It is a choice and an active pursuit. A pursuit that is well worth the effort.

1 Timothy 6:11-12 MSG

But you, Timothy, man of God: Run for your life from all this. Pursue a righteous life—a life of wonder, faith, love, steadiness, courtesy. Run hard and fast in the faith. Seize the eternal life, the life you were called to, the life you so fervently embraced in the presence of so many witnesses.

The following kind of advice from Paul makes me feel more at ease. I like the visual I get and the response from other people when this is put into action.

Ephesians 4:31-32 MSG

Make a clean break with all cutting, backbiting, profane talk. Be gentle with one another, sensitive. Forgive one another as quickly and thoroughly as God in Christ forgave you.

Now that you are on your road to a fabulous quality of life and true contentment no matter what is going on around you, here is some encouragement from Paul.

Ephesians 4:1-3 MSG

In light of all this, here’s what I want you to do. While I’m locked up here, a prisoner for the Master, I want you to get out there and walk—better yet, run!—on the road God called you to travel. I don’t want any of you sitting around on your hands. I don’t want anyone strolling off, down some path that goes nowhere. And mark that you do this with humility and discipline—not in fits and starts, but steadily, pouring yourselves out for each other in acts of love, alert at noticing differences and quick at mending fences.

Blessings,

Michelle

 

 

 

Senior Service Providers – a huge network of resources

Posted on by Michelle Fritsch, Pharm.D.
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There are many types of senior service providers for you to research in your area.

Our population is aging! And there is a rapidly growing network of Senior Service Providers to help promote healthy, safe aging. I was first introduced to this ever expanding network about a year and a half ago.

So I want to introduce you to the many resources available to you, to your aging loved ones, and to anyone you know who is anxious to stay as healthy as possible.

I don’t think it would be possible to make a list like this complete. So know if you have a specific need not listed, search for what you need. I’m fairly certain someone has thought of that need and designed a solution. At the end of this blog I’ll point you toward a think-tank of even more innovative solutions being pursued.

Senior Service Providers to seek in your area

  • Aging-in-Place/Home Safety
  • Assisted Living Placement Services
  • Assistive Technology Devices
  • Certified Care Management
  • Computer & Technology Services
  • Daily Money Management
  • Estate Liquidation & Cleanout
  • Financial Services & Insurance
  • Fitness and Balance Classes
  • Home Modification and Repairs
  • In-Home Primary Care Provider
  • Legal Services
  • Licensed Massage Therapy
  • Medicaid Planning
  • Medical Alert Systems
  • Medication Management
  • Mortgage & Reverse Mortgage
  • Move Coordination from your home
  • Nutrition
  • Occupational Therapy
  • Personal Historian
  • Physical Therapy
  • Private Duty & Home Care
  • Real Estate
  • Senior Living Communities
  • Transportation

Ways to find senior service providers

Again, this is not an exhaustive list. If you want to modify a home to make it safer, there are specialists that can help you. Look for the ‘Aging in Place’ certification. If you want to know what resources are available in your particular community, find a local Lifecare Manager at www.aginglifecare.org. If you are faced with downsizing, moving from home to assisted living or in with children, or arranging for someone to move in with you, there are a host of specialists to help. There are realtors specialized in homes designed for safe aging; mortgage and reverse mortgage specialists to help find the best rates, companies that specialize in helping you sort through your belongings and sell those you don’t plan to keep to convert them to cash; and companies that specialize in sorting through horded materials. There are companies that will pack you, move your belongings, and unpack them so that they are right where you want them.

There are lawyers specializing in the sensitive needs of older adults making financial and legal decisions. You can find specialists that will manage your bills and finances for you in your home – http://aadmm.com.

Note, some of these services are covered by insurance while others are out-of-pocket. Be sure to ask about costs as you research your options.

And, as promised, I want to tell you about Aging 2.0. This organization is pulling together innovative people with any kind of solution that will enhance healthy aging. It gives those innovators a platform to share their innovation, perhaps find funding, and network with other providers so they can collaborate and offer a more robust service. You can learn more at https://www.aging2.com/about-us/.

I have been amazed at all of the available resources. I hope you find hope in the many kinds of senior service providers that can help you in your quest for healthy aging. For more information about options, please contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

As Christians, we have a lot of resources at our disposal, too. Within the body of believers we have every kind of gift and skill. In Acts the believers supported each other and shared everything. We don’t do that, but we can use our gifts to help each other in whatever God is calling us to do.

Acts 4:32-37 ESV

Now the full number of those who believed were of one heart and soul, and no one said that any of the things that belonged to him was his own, but they had everything in common.  And with great power the apostles were giving their testimony to the resurrection of the Lord Jesus, and great grace was upon them all.  There was not a needy person among them, for as many as were owners of lands or houses sold them and brought the proceeds of what was sold and laid it at the apostles’ feet, and it was distributed to each as any had need.  Thus Joseph, who was also called by the apostles Barnabas (which means son of encouragement), a Levite, a native of Cyprus, sold a field that belonged to him and brought the money and laid it at the apostles’ feet.

The messages about helping each other are found in the New Testament and the Hebrew Bible.

Hebrews 13:16 ESV

Do not neglect to do good and to share what you have, for such sacrifices are pleasing to God.

Philippians 2:4 ESV

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

It is through going to Church, being part of small groups, participating in Bible studies, and other times of fellowship that we can find out about the needs. Then, as we consider our own gifts, we can align ourselves with the needs where we can be of assistance. We can also help connect those with needs to those with matching gifts among our Christian community. It is so beautiful when those matches come together!

Blessings,

Michelle

Image source: National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services

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