Medication Reconciliation – Why it’s important to you

Posted on by Michelle Fritsch, Pharm.D.
Slide1
Medication reconciliation can keep you safe.

Have you heard the term ‘medication reconciliation’? Probably not, it’s an insider’s term within medicine. But it’s an important concept, and I want you to know about it. I want you to ask about it any time you find yourself going into the hospital, going to the emergency department (ED), coming out of the hospital, going into rehab, switching doctors, having any major changes in either your health or who is monitoring your medications.

The term medication reconciliation (abbreviated ‘med rec’) means taking your whole medication list and understanding, how you are taking it and when you are taking. It is about making sure that information goes with you any time you are making a transition. So ideally, at the moment you enter a hospital someone figures out exactly what you take, how you take it, and when you take it. It is awesome if you come with this information. You could carry that information with you and have it ready to share with your health team. It is a huge safety factor in your care. If they know exactly what you take, how you take it, when you take it, they will make much more informed decisions in your care. This is true in the emergency department, the hospital, moving to rehab, moving to assisted living. I applaud the pharmacists who do this well in hospitals, clinics, and other settings around the country.

If you come in with it ready, you have saved them a lot of time and effort. And, you’ve helped assure your own safety. This important information will help guide the next phase when they will make any modification depending on why you are in the health system and what your needs are at that time.

If you’re in the ED or the hospital for a particular reason, there may very well be a need for a new medication to treat the reason you’re there. It is important that any of those changes are communicated all throughout your stay within and beyond the health system.

Formulary

A little caveat that’s important is another important term to understand – formulary. There can be a number of different medicines that do the same thing. We call them medication classes, and each class could have several medications that do the same thing in the same way. Rather than carry every medication on the market, a hospital will carry a few in each category.   It is possible that the one you typically take is not on their formulary. They will switch you while you are in the hospital to one that is on their formulary. The name, color, and size might not look familiar to you. Be sure to ask questions when you don’t recognize your medicine. This is not harmful; it will not put you in danger. Medicines within the same class work the same way as the one your doctor had you on at home. But, it is a source of confusion when you go home or move to another part of the health system. It’s one of the reasons this medication reconciliation process is so important.

It is critical that you know that another medication, similar to the one you take at home, is being used in the hospital. You want, when you go home, to be switched back to the medicine you came in on, the one that was prescribed by your own primary care provider.

Many, many patients have run into difficulty when they go home on the medication the hospital gave them and they continue to take the one they have at home. This is called duplication of therapy. You are getting twice the amount you need – you have the one you have at home and the on the hospital gave you that do the exact same thing. So, using blood pressure as an example, if you are taking the medicine you have at home plus the one in the same class that you got in the hospital, you could lower your blood pressure too much. You want to avoid duplication of therapy; be sure for that class of medicine you are on just one.

Be sure to ask at the hospital if you can go back on the one you were familiar with at home that does the same thing as the one you got while in the hospital.

It is important that several people know exactly the medicines you take when you go back home or get to your next destination. You are one of them, of course. It is also important that anyone involved in your care such as your spouse, child, or caregiver involved in your care; your primary care doctor; any specialists; and your pharmacist know exactly how your medications have changed while you were in the hospital.

It is important that any intermediate step before you go home, such as rehabilitation, knows your entire current medication regimen. But, it is most important that you understand exactly what to take when you get home.

Medication changes while you’re in the hospital

What if problems related to your medication led to you going to the hospital? That is very often the case. Then, the medicines that led to your admission will be stopped or changed. If the problem that took you to the hospital was something new, then it’s likely that new medicines were added to your regimen. Again, it is important that you know what changes were made, why they were made, and exactly what you should do when you get back home. Ideally, ask your questions while you’re in the hospital, but if you get home and have questions, don’t hesitate to reach out for answers.

Medication reconciliation is something we often do at Meds MASH. People get home and realize they don’t really understand what they are to do. They have a list from the hospital, a list from rehab, and their home list. They wonder if anyone has looked at all of the medicines – the old ones, the new ones, and some from other doctors.   At Meds MASH we look at all of the medicines and make sure they are all safe together. We catch those duplications and clear them up with your doctors. One of the things we will do, with your permission, is get information from all of your doctors and from the hospital and pull it all together. Then, after the thorough analysis, any changes will come from your primary care doctor who is the gatekeeper and the one person responsible for all of your medicines.

Three doctors recently wrote an important article about the need for accurate medication reconciliation. And they note that this process must be thorough to be meaningful. Several partial versions have been tried, and if it isn’t complete, it’s not helpful. It’s not going to keep people safe if it is not done right.

If a thorough medication reconciliation can keep you safe and healthy, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This Biblical application might feel a little less associated with the health part. With medication reconciliation we are talking about making sure all of the information related to medication use is clearly communicated. If it is not done completely it isn’t effective. What about our compassion and how we reach out to others? How complete and effective are we?

Something has been weighing very heavy on my mind in the last week. It is the decisions we make about where our compassion lies. Who we can forgive and who we can’t. How do we spend our money and give our support and where we do we not? The thought that has been raised in my mind is – when we know someone is in need, and we do not know their sins, it seems to me it is easier to reach out and provide support for those needs. The example that got me thinking this is the refugee crisis. When you know there are millions of people who have been displaced, a lot of people have compassion for that and for their circumstances. What can we do to help those people and their dire circumstances?

The other things that made me think of this were more local. What are the needs of people who are making choices that are leading them to being in dire circumstances? It might be behavioral and lifestyle choices; it might be financial management choices; it could be self-care choices that lead them to circumstances where their life is not as secure as it might be. Their difficult circumstances are a ramification of lifestyle and self-satisfaction choices they have made.

I am connected to a place right now that serves the LGBTQ community and the HIV population. Some Christians find it easy to be very judgmental of this population and not share their compassion in this direction. Rather, they choose to share their compassion in other circumstances where the reasons and the choices are less known. Is this what Christ calls us to do? Are we called to show compassion or walk away?

Consider the story of the woman caught in adultery in Luke Chapter 8.

Luke 8:1-11 MSG

 Jesus went across to Mount Olives, but he was soon back in the Temple again. Swarms of people came to him. He sat down and taught them.

The religion scholars and Pharisees led in a woman who had been caught in an act of adultery. They stood her in plain sight of everyone and said, “Teacher, this woman was caught red-handed in the act of adultery. Moses, in the Law, gives orders to stone such persons. What do you say?” They were trying to trap him into saying something incriminating so they could bring charges against him.

Jesus bent down and wrote with his finger in the dirt. They kept at him, badgering him. He straightened up and said, “The sinless one among you, go first: Throw the stone.” Bending down again, he wrote some more in the dirt.

Hearing that, they walked away, one after another, beginning with the oldest. The woman was left alone. Jesus stood up and spoke to her. “Woman, where are they? Does no one condemn you?”

“No one, Master.”

“Neither do I,” said Jesus. “Go on your way. From now on, don’t sin.”

Her choices were well known, and she was being very degraded. She was called before the council having been caught in the act.   The council members were ready to stone her. Jesus said those without sin could cast the first stone. We are so quick to categorize sins, but it doesn’t seem Jesus categorizes sins. What are we called to do as Christians? I am struggling with this and I’m challenging others to struggle with this, too. This is not a blog with answers. It is a blog with challenging questions. I would love to hear what people think.

Luke 6:37 ESV

“Judge not, and you will not be judged; condemn not, and you will not be condemned; forgive, and you will be forgiven;

It has become clear to me as a practitioner that sex as defined in the Bible, as designed by God does not lead to trauma, whether emotional or physical, and it does not lead to disease transmission or to promiscuity.

But in society, especially in the current waive of rules avoidance and focus on self, sex is being used in a lot of other ways. When used outside the way described by God, it does lead to a lot of issues. We create our own problems when we are outside this definition.

Another example heavy on my mind is substance abuse. The numbers of people caught in addiction and dying of overdose are astounding. This is a tragedy of great proportion! Yet the local rescue mission is struggling to stay funded. People who have been caught up in abuse and addiction who are now reaching out for help to leave that lifestyle are encountering limited spots available for rehabilitation. Yet Christians are looking for meaningful outreach and missions opportunities.

I am in full support of refugee aid, international response to crisis, local response to crisis, support of children in underserved areas, teens on mission trips, college students on mission trips, medical missions, and so much more. In addition to all of this wonderful outreach, I encourage us to search our hearts and God’s leading for our attitudes about reaching those in circumstances in our own community that are harming them.

I propose when we limit our compassion or draw a line for how we will consider using our resources, it is similar to an incomplete medication review.  Completeness and effectiveness are limited.

James 4:12 ESV

There is only one lawgiver and judge, he who is able to save and to destroy. But who are you to judge your neighbor?

What is your response?

Blessings,

Michelle

 

 

 

 

9 steps to your best health

Taking 9 Key Steps to Your Best Health

Posted on by Michelle Fritsch, Pharm.D.
9 steps to your best health
Here are 9 steps to get you to your best health

I know you want to feel good. I’ll bet you have a whole list of experiences in your plans for the future. You might be feeling great these days. You might be struggling with some health issues. You might be navigating some transitions in your life or some emotional conflicts.

I want you to be the healthiest version of you, in your best health! As I’ve been thinking about this, I’ve broken a process into steps. I’m hoping by following these steps, your health continues and gets even better.

Steps to your Best Health

  1. Pay attention to your body. Remember when a new symptom starts; what makes it better; what makes it worse; how long it lasts; what you think caused it.
  2. If it is severe, scary, or won’t go away, be sure to tell your doctor.
  3. Before you see your doctor, make a list of the items in #1 so you won’t feel pressured to remember. Write your list and make 2 copies – one for you and one for your doctor.
  4. Take to all healthcare visits a complete list of all medicines and other substances you take, how you take them, and when you take them. This includes your vitamins, supplements, recreational substances, and over-the-counter medications. Include even the ones you only take for a stomachache, allergies, or a headache.
  5. Take notes during your visit. We all know how easy it is to miss something, forget, or get it all confused when trying to remember it all from memory.
  6. Make sure it all makes sense to you and you clearly know what you are to do next before you leave. It is ok to ask to hear it all again until you really understand. Once your doctor explains what is causing your symptoms and recommends a plan, ask when you should feel better.
    1. Too many times I have asked people what their doctor said and heard, ‘I have no idea; I couldn’t understand him/her.’
  7. If you receive a prescription for a new medication, make sure you know the name, what it is for, how to take it, and what you can expect. All medications have the potential for side effects, at least right at first, so know what these might be. Know if you will be taking it for a short time or a long time. Ask your pharmacist to be sure this new medication is not going to interact with your current medications. (Be sure your pharmacist knows everything you take.)
  8. Keep track of your original symptoms and any other changes you notice after you start your new treatment. If you don’t feel better in the timeframe the doctor told you, call and report that. If you feel worse when you start a new medication, let your doctor and pharmacist know. Either of them can help you determine if your new problem is caused by the medication and what you should do (do something to stop the side effects or give you a different medication).
  9. Take care of yourself! Once you are feeling better, make an effort to take even more healthy steps such as healthy eating and regular exercise. I know we hear that all of the time. That is because these are the changes that will truly help you feel your very best.

What is the link between medications and your best health?

You’ll note that some of the steps specifically include medications. Medications can:

  • Cure
  • Control medical problems
  • Make symptoms better
  • Prevent problems
  • Harm

Depending on the medical condition and the medication, any of these four good purposes or the bad effect can occur.

Medications are prescribed for at least one of the positive effects of medications. Your doctor and your pharmacist want the medication to play a direct role in you reaching your best health.

Medications can interact with other medications. The ONLY WAY your doctor or pharmacist can check for this is if they know absolutely EVERY medication you take. Medications can interact with other medications, with food, or with other medical conditions. That is why you want your healthcare team to know everything about your prescription medicines, your over-the-counter medicines, your supplements, you herbal remedies, your vitamins, and any recreational substance use. It is all important!

This is one of the key services we offer you at Meds MASH. If you want someone to very carefully evaluate all of your medications, your symptoms, and things you think might be caused by your medications, we can do that!

To get started, contact us at 410-472-4078 or www.medsmash.com/contact. Let’s talk about how we can help you reach your best health!

BIBLICAL APPLICATION

I am reading a book that led to an interesting insight as I have been thinking about the stepwise approach to best health. The steps outlined above are each important to reaching your best health.

What about your best spiritual health?   After all, true health has physical, mental, emotional, and spiritual components. Nothing outranks your relationship with Christ.

The book I have been reading is related to our brain. A neuroscience physician has studied the brain and its function in the light of both science and the Bible. If you haven’t read, ‘The God-Shaped Brain’ by Timothy R. Jennings, M.D., I highly recommend it.

In a very insufficient summary, our brains are at their peak function when we are in a secure, peaceful, loving environment. The brain is a very adaptable organ. There is one part of the brain that drives our ‘fight or flight’ response. This is what happens when we sense we are in danger. When this part of the brain is functioning, all deep reasoning is blocked. All brain effort is focused on primal survival. It is when we are more relaxed that other parts of our brain creating deep thoughts, logical decision-making, and empathy can function.

I was in high school when Pac-Man was first available. We had to go across the state line to another nearby town to play it in a pizza restaurant. The object is to maneuver Pac-Man through a maze to eat as many ‘points’ as possible. Some of the turns lead to danger for Pac-Man or to dead-ends.

Strangely enough, living in love, peace, and harmony made me think of our life like Pac-Man. Picture, if you will, a large canvas with a circuitous, clear path that has no obstacles that you can see when you look down on the entire canvas. This path is full of points, many points. Surrounding this path, at every turn, there are obstacles. Many of these obstacles are distractions. They are things that feel good, things that look good, or things that feel necessary. From within the maze, you can’t see the clear path. You can only see what is right around you. Those distractions look so good! They often seem to be on the easiest route. They promise you lots of points. So, you easily get off track with the distractions.

Our brain, our life, and our health are at their best when we are on the clear path. And yet there is not one human on the planet who has not left the path and made mistakes. Not ONE! Only Jesus was ever able to do that.

We can each be so much more at peace and living in love when we stay on the path. There is only one tour guide. Jesus can and will tell you step by step which way to turn. He will tell you which items are distractions and which are on his planned path for you. Your brain will be functioning at higher levels as you live in peace and love.

1 Corinthians 10:13 ESV

No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.

God knew from the beginning, as soon as Adam and Eve ate the fruit, that we would be on this path with many distractions. Eden, before that fruit eating, was the only place where people ever lived in perfect harmony, peace, and love. As soon as those first people used their own will to go outside God’s command, everything changed.

To allow your brain to operate in its most effective way, and to live in love and peace, let Jesus be your tour guide.

Psalm 119:15 ESV

I will meditate on your precepts and fix my eyes on your ways.

Philippians 4:8 ESV

Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things.

1 Corinthians 7:35 ESV

I say this for your own benefit, not to lay any restraint upon you, but to promote good order and to secure your undivided devotion to the Lord.

Here’s to being in your best health – physical, mental, emotional, AND spiritual!

Blessings,

Michelle

Fear of Failure, Hidden Truths, and Your Health

Posted on by Michelle Fritsch, Pharm.D.
Slide1
Fear and hidden truths are bad for your health.  There is GOOD news!

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

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

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

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

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

Fear of Failure

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

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

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

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

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

Hidden Truths

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

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

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

Counseling and Medication

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

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

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

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

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

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

BIBLICAL APPLICATION

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

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

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

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

James 4:17 ESV

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

Romans 8:1 ESV

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

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

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

1 Thessalonians 5:11 ESV

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

Ecclesiastes 4:9-12 ESV

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

Hebrews 10:25 ESV

Not neglecting to meet together, as is the habit of some, but encouraging one another, and all the more as you see the Day drawing near.

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

2 Corinthians 5:17 ESV

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

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

Blessings,

Michelle

board certified geriatric pharmacist

Why would you benefit from a board certified geriatric pharmacist?

Posted on by Michelle Fritsch, Pharm.D.
board certified geriatric pharmacist
How Meds MASH promoted safe, healthy, active living

I started a company that I call Meds MASH in 2015. I am a board certified geriatric pharmacist. That means I specialize in medication use in people over the age of 60.

What Meds MASH doesn’t do for you:

  • Fill your prescription
    • Your local pharmacist will do this
  • Change any of your prescription medications
    • I will make suggestions to your doctors or help you discuss them with your doctor
  • Take over your healthcare
    • You will keep your doctors who will lead your healthcare

What Meds MASH will do for you:

  • Talk with you to find out what are your health and life goals
  • Review all of your medications
    • Prescribed
    • Over-the-counter
    • Vitamins
    • Supplements
    • Herbal remedies
    • Any other substances
  • Obtain your medication history
  • Review your labs to check for medication safety
    • Kidney function
    • Liver function
    • Medical condition control
    • Side effects
  • Review your medicines compared with your allergies
  • Evaluate in-depth for risks of falling
  • Review for some common issues that are often missed
  • Make sure you understand each of your medications and how to best take them
  • Take time and answer your questions
  • Provide you with detailed information you can review later and share with your doctor
  • Talk direct with your doctors at your request and authorization
  • Engage your family at your request and authorization

Does Meds MASH make a difference? On average in an initial review- 

  • We make 4.5 interventions
  • A recommendation is made to improve two medications
  • A recommendation is made to change a medication for 82% of clients
  • Over 98% of the time a significant suggestion about medication is made!

Questions frequently asked

Doesn’t my doctor already do this?

  • Rarely does your doctor know absolutely every medication you take and how you actually take it.
    • Meds MASH specializes in obtaining this before reviewing the medications.
  • Only a small percentage of people over 60 have a doctor board certified in geriatrics.
    • Meds MASH provides a board certified geriatric expert.
  • Most people have 7-15 minutes with their doctor.
    • Most Meds MASH initial visits are 45 minutes.
  • Rarely are people fully prepared for their doctor visit.
    • Part of a Meds MASH review includes specific strategies to get the most out of each medical visit with your doctors.

Doesn’t my pharmacist already review all of my medications?

  • Rarely does your pharmacist know all of the medications you take.
    • They know the prescriptions only, even if you only use one pharmacy.
      • You absolutely should use only one pharmacy!
    • Your pharmacist has a limited time to carefully review your medicines.
    • There are not many geriatric board certified pharmacists in the country.

Contact us today for a free consultation! Meds MASH 410-472-5078 or e-mail michelle@medsmash.com or on the website www.medsmash.com/contact.

BIBLICAL APPLICATION

There is a lot of talk about and emphasis on being ‘transparent’ today in our society. It has taken me months to clearly, succinctly state what we do at Meds MASH. I am still honing the message so that it really makes sense to people. We need to be able to put things in someone’s own perspective to help them really understand.

If an alien from Mars came to visit and talked to you about places, customs, and politics on Mars, it is unlikely you would understand very much of it. You would have no perspective of how things look or operate on that planet.

I had this same thought this week as I was reading the Psalms, especially the ones written by David. David was the king. He was responsible for all of the people. His perspectives were oriented around keeping people safe and alive.

He frequently talks about enemies and God’s protection in wars. I’m sure they were attacked, or at risk of being attacked, most of the time. God made it clear that when the people of Israel went into battle with God’s protection, then they would prevail.

Deuteronomy 28:7 ESV

“The Lord will cause your enemies who rise against you to be defeated before you. They shall come out against you one way and flee before you seven ways.

When they went into battle on their own, the outcomes were not so good.

Numbers 14:39-45 ESV

Israel Defeated in Battle

When Moses told these words to all the people of Israel, the people mourned greatly.  And they rose early in the morning and went up to the heights of the hill country, saying, “Here we are. We will go up to the place that the Lord has promised, for we have sinned.”  But Moses said, “Why now are you transgressing the command of the Lord, when that will not succeed?  Do not go up, for the Lord is not among you, lest you be struck down before your enemies.  For there the Amalekites and the Canaanites are facing you, and you shall fall by the sword. Because you have turned back from following the Lord, the Lord will not be with you.”  But they presumed to go up to the heights of the hill country, although neither the ark of the covenant of the Lord nor Moses departed out of the camp.  Then the Amalekites and the Canaanites who lived in that hill country came down and defeated them and pursued them, even to Hormah.

Our personal battles aren’t with swords, but they are still battles. And if God is for us and leading us, then our outcomes are infinitely better than when we do battle on our own without Him.

David also makes frequently reference to rain, crops, vineyards, and grain. We don’t tend to spend our days focused on those things. Our grocery stores and markets are filled with all we need.

But what are the daily struggles in your life that mean just as much to you as ability to grow crops meant in David’s time? Is it your finances, your job, career opportunities, relationships, finding your meaning in life? Our daily struggles are no less important that David’s. Our world and our perspectives are just different.

So, whatever your battles, lay them before the Lord. Honestly lay it all out there. Be completely transparent and clear in your requests before God. He already knows. He loves the trust you place in Him as you bring it all to Him.

Psalm 71:14-17 ESV

But I will hope continually

    and will praise you yet more and more.

My mouth will tell of your righteous acts,

    of your deeds of salvation all the day,

    for their number is past my knowledge.

With the mighty deeds of the Lord God I will come;

    I will remind them of your righteousness, yours alone.

O God, from my youth you have taught me,

    and I still proclaim your wondrous deeds.

If you’re ever at a loss for what to pray, consider the Psalms. They are the prayers and songs of praise of David. Put it in today’s perspective, and you’ll find they are completely relevant to your needs today.

Blessings,

Michelle

support for the sandwich generation

Are you the meat in the sandwich – for those caught in the middle

Posted on by Michelle Fritsch, Pharm.D.
support for the sandwich generation
Support is available while you are the meat in the sandwich between children and aging parents

Have you heard of the ‘sandwich generation’? Are you the meat in the middle – still finishing the child raising and caring for aging parents? This sandwich generation is now different than it has ever been before. It is the older Generation X and the younger Boomer generation now in this position. This means this sandwich generation has more dual career couples, more divorces, and generally more independent people juggling the younger and older generations.

Certainly you are blessed when you have children who are nearly or newly on their own AND you still have your parents. So many of us miss that opportunity.

If you do have this opportunity, it can be very challenging. Typically there are several other things happening around the same time.

Other changes while you’re the meat in the sandwich

The sandwich phase usually comes while in your late 40’s through your 60’s. During this time some other commonalities are:

  • You’re at the peak of your career
  • Friendships/relationships are no longer made through your children’s activities
  • Your own health is changing
  • If you’re a woman, you’re somewhere near menopause which brings its own health changes
  • You’re thinking about your ‘bucket list’

Tips for you to be the best ‘meat’ possible

It is so easy to get caught up in the needs of your parents and children and to forget about you in the process. If you fall ill, get injured, or burn out, then everyone loses. I don’t mean to add to your pressure. I just want to encourage you to take care of yourself as the caregiver.

  • Sleep to maintain clear thinking and patience
  • Exercise to stay healthy and stay strong
  • Healthy diet with fruits and vegetables vs grab-n-go fast food
  • Time off to maintain your mental health

Resources to help you

There are many resources available to help you as you help your aging parents. With the aging of the population, the numbers and types of resources are rapidly increasing.

Medications are often involved when someone reaches a point where they have difficulty living without assistance. That is our specialty at Meds MASH. Over 80% of people we see have a specific medication issue that we work with you doctor to address to help you stay safe at home. For 100% of all people we have seen, we have provided important education about medicines and how to get the most from healthcare visits.

There are several types of services that can assist with safely aging at home or in a place designed for safe aging. There are homecare services that can provide someone to help with tasks such as companionship, housekeeping, bathing, cooking, driving, and more. There are independent living communities with assisted living options when needed. There are assisted living facilities at many sizes, price ranges, and amenities.

If your parents’ home would be safer with some modifications, look for a contracting that is a certified aging in place specialist. You can learn more at http://www.nahb.org/en/learn/designations/certified-aging-in-place-specialist.aspx

A certified aging life care manager is an expert on your local resources that can assist with healthy aging. I think of these people as one-stop-shopping for many of your questions and needs. You can learn more at http://www.aginglifecare.org.

Legal and financial questions can be complex. These are elements that are easiest to address while your parents are still fully in command of their own finances. That is a good time to plan for the future in case you, your siblings or other friends/family will assume control of those key areas of your parent’s life. Decisions about advanced directives, power of attorney, and memorial wishes are easiest to make while your parents are fully able to make their own decisions. However, even if you miss that window, these resources (elder care attorney and financial advisor) can help guide you through each step. Here is a resource that can help you find an eldercare lawyer http://www.naela.org/findlawyer.

This is a very brief overview of the many resources that exist to help you and your parents navigate this sandwich time of life. We are glad to help you navigate this complex time and to identify these helpful resources. Please don’t hesitate to contact us at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This blog has acknowledged how difficult and consuming this time of life can be – in the phase of supporting children and aging parents. Resources and tips for self-care have been provided.

Another essential aspect for all of the complex phases of life is an awareness of the sufficiency of God.

2 Corinthians 12:9 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.

As in this verse, Paul is very clear that he was weak and unable to do what God called him to do. But, God was more than sufficient to get Paul through the many struggles, the imprisonment, the rejection, and the difficult travel.

To further understand that verse, let’s put it in perspective. Paul describes a health problem he had that he asked God to remove. Here is the response:

2 Corinthians 12:7-10 ESV

So to keep me from becoming conceited because of the surpassing greatness of the revelations, a thorn was given me in the flesh, a messenger of Satan to harass me, to keep me from becoming conceited.  Three times I pleaded with the Lord about this, that it should leave me.  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.

Paul further encourages us that Christ can sustain us through all of the highs and lows.

Philippians 4:12-13 ESV

I know how to be brought low, and I know how to abound. In any and every circumstance, I have learned the secret of facing plenty and hunger, abundance and need.  I can do all things through him who strengthens me.

We try and try to do it all ourselves. And, have you noticed how that doesn’t work?

2 Corinthians 3:4-5 ESV

Such is the confidence that we have through Christ toward God. Not that we are sufficient in ourselves to claim anything as coming from us, but our sufficiency is from God,

So, as you work through this complex time as the meat in the sandwich, remember the source of your strength. No, you can’t do it alone. So remember, you are NEVER in this alone.

Psalm 73:23 ESV

Nevertheless, I am continually with you; you hold my right hand.

Blessings,

Michelle

Image source: <a href=”http://cliparts.co”>Clip arts</a>

Numbers for health

Optimal Operating Conditions – Live your Healthiest Life

Posted on by Michelle Fritsch, Pharm.D.
Numbers for health
Know your optimal operating conditions

What are your optimal operating conditions? How often do you change the oil in your car? How warm/cool do you keep your home? How often do you change your furnace filter? When do you change your car’s tires?

I find we tend to be more aware of these guidelines for our cars and homes than we do for our bodies. Perhaps it is more clearly communicated how to care for your car or your home.

Most people find a temperature of 72 degrees Fahrenheit to be comfortable. Your car’s tires were designed to perform best when driving at the speed limit. You car’s oil is designed to lubricate the moving parts of your engine for 3500 miles (up to 7-10,000 if synthetic).

Our bodies have been designed to operate BEST within certain parameters. Do you know the numbers that will help keep you most healthy? Here are a few.

Your Best Numbers for your Heart

Why are your blood pressure and pulse checked every visit to your doctor? It is because there is an optimal range to help your heart stay in top performance.

Pulse 60-90 bests per minute

Blood pressure under 140/90 without being dizzy

When your heart beats in this range, it is able to fill with the right amount of blood with each beat. It can also send out to the body the right amount of blood with each pump. If your heart pumps too slowly, there might not be enough blood per pump to get enough to all of the other parts of the body. Similarly, when the heart pumps too fast, each squirt is just a small amount of blood rather than a full load. Those small quick squirts don’t get enough blood throughout the body where it is needed.

When your blood pressure is too high, it makes your heart work extra hard. Think about a body builder gradually increasing his muscle mass. If he tries to lift too much weight all of a sudden without working up to that weight, he is likely to hurt himself. He could even rip or harm a muscle to the point his weight lifting days are over. When your blood pressure shoots up quickly or it stays high over time, you move from a strong heart muscle to an injured heart muscle. A heart attack is destruction of part of the muscle wall. Once part of the heart is no longer working correctly, the rest of heart has trouble doing its work. It has to compensate for the wounded part.

Your Best Numbers for your Sugar

At least yearly during your physical, your doctor checks your blood sugar. Sugar (technical term glucose) is essential ‘food’ for your cells. Now, sugar doesn’t just come from eating sugary, sweet food. It is the result of your body breaking down other foods into usable cell ‘food’. There are a lot of other ways the body stores, releases, and breaks down sugar. Also, insulin is what helps that sugar ‘food’ get into the cell. Your body works best when your sugar is in the optimal range, and you have the right amount of insulin to keep it in that range.

Blood glucose 60-110 mg/dL if you do not have diabetes. (Your goal might be a bit higher if you have diabetes – talk with your doctor).

A1c (glycosylated hemoglobin – this gives an indication of your blood sugar over the last 90 days)

4-5.6% if you do not have diabetes

5.7-6.4% your doctor will talk with you about ways to make changes with your diet and exercise to avoid diabetes

less than 6.5% goal for well-controlled diabetes

just over 6.5% for some people with diabetes

– your doctor will help decide your best goal

When your blood sugar is too low, you get dizzy, shaky, sick to your stomach, you sweat, and it is hard to think clearly. When your blood sugar is too high, it causes damage throughout your body. Uncontrolled blood sugar can lead to poor kidney function, blindness, and loss of feeling in your hands and feet and other parts of your body. Also, type 2 diabetes is linked with high cholesterol, heart disease, stroke, high blood pressure, and being overweight.

Your Best numbers for your Weight

Your weight is also checked with nearly all doctor visits. Extra weight is hard on a lot of parts of your body. It creates more work for your hips, your knees, your ankles, and your feet. You are more likely to have diabetes. There are more cells to feed, beyond what your body was intended to feed. Your risk of heart attack and stroke go up. Your risk of falls goes up.

Your ideal weight is linked with your height. There are two best ways to determine if your weight is in a healthy range. One deals with your total weight. The other pertains to where you carry your extra weight.

Body Mass Index (BMI) – you can calculate your BMI here. It is based on your height.

Your BMI should be between 18.5 and 24.9

Waist Circumference – see this link to learn how to measure your waist circumference.

Women should be less than 35 inches

Men should be less than 40 inches

Can you live with numbers that are outside the normal range? Yes, you can. There will be consequences, though. When we live outside of the optimal range, systems don’t function as efficiently. They don’t operate like they were designed to operate.

Note, medications can help with these numbers. And, in all of these circumstances, our daily choices are also important to maintain optimal operating conditions. What we eat, how much we sit, how we exercise, and how we control our stress are also important in staying in these goal ranges. So, you have a lot of ability to help control your numbers!

Please contact us at Meds MASH to learn more about how to stay in your optimal operating conditions! You can reach us at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

Our body will function best when it can operate at optimal numbers. God designed our bodies and these healthy parameters. God has given us optimal operating guidelines for our spiritual life, too.

This struck me hard this week while I was reading Numbers. [I’ll admit, I don’t love reading some of the Bible chapters like Numbers. They can be dry and tedious. I have accepted the challenge of reading the Bible in a year. I highly encourage you to do this. You can start any time. So many insights jump out each time.]

While reading Numbers it hit me how God REPEATEDLY told the Israelites exactly what He was going to do and what He wanted them to do. He guided them with when to move, when to stay, and where to go. He provided the food while they were in the desert with few food sources. He explained before they reached each place who they would conquer and how He would make that happen.

If they had just listened, things would have been so much easier for them. That time in the desert could have been focused on worship and praise and relaxation waiting for all the wonderful things that they were promised.

Instead, they were impatient, untrusting, and impressionable. They were easily pulled away from God’s message and onto the opinions, concerns, or temptations presented by other people.

[If you’re a Veggie Tales fan, remember the peas in Josh and the Big Wall? They said, ‘silly children’ when addressing the children of God.] Silly children!

Numbers 14:11 ESV

And the Lord said to Moses, “How long will this people despise me? And how long will they not believe in me, in spite of all the signs that I have done among them?

We sit here and read about their mistakes and wonder how they could have been so dense. Through Moses, God spelled out what they needed to do in great detail. It was very clear. What were they thinking?

Then, I remember my own thoughts, actions, impatience, lack of trust, and how gullible I can be. Who am I to judge? Because Jesus died for us and removed the rules of the Hebrew Bible, our access to God is so much easier! We really have no excuse.

Galatians 3:13 ESV

Christ redeemed us from the curse of the law by becoming a curse for us—for it is written, “Cursed is everyone who is hanged on a tree”—

We don’t have to obey the tedious rules and sacrifices of the Hebrew people. Christ removed all of those rules and barriers between God and us. You have a straight link to the creator of the universe through Christ. Day by day, minute-by-minute God will guide you if you just ask.

I’ve mentioned before, my day is entirely different, less stressful, more productive, and more peaceful when I give it all to Christ. So, you’d think I would do that every day. Duh! If I give it to Christ it is an incredible day. If I get into a rush, too busy, too much too do, no time to slow down, then the whole day stays rushed and stressful.

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.”

I encourage you to consider this week how God is calling you to live. How does your ready access and potential relationship with Him change everything? If you look in the Bible, we are given the exact recipe for a life of peace and love. It’s our own decisions, impatience, lack of trust, and distractibility that takes us off that path.

2 Thessalonians 3:16 ESV

Now may the Lord of peace himself give you peace at all times in every way. The Lord be with you all.

Blessings,

Michelle

Image source: Medline Plus, National Institutes of Health, U.S. Department of Health and Human Services.

We need to be needed

We NEED to be NEEDED to maintain our HEALTH

Posted on by Michelle Fritsch, Pharm.D.
We need to be needed
We all need to be needed even if it is to care for an African Violet

Have you ever thought about the link between being needed and health? As I’m thinking about it, that link could probably go both ways. I am wanting to tell you about the health benefits of being needed. But, I’m sure you could make a case that being overworked in constant demand can have negative health implications.

Think of a woman you know who went from caring for children and her husband to now being in an empty house with infrequent visits from children.

Think of a man or woman who worked in a very demanding job with a lot of responsibility who has now retired.

Often, we dream of the day everyone is raised and on their own. We dream of the day we reach the point of retirement.

Then, when that day comes you find yourself lonely. It is not as exciting as you expected. Reading books and relaxing can get boring.

Aging joints, accidents, and new medical conditions can create changes to retirement plans. Loss of a spouse can create changes to retirement plans. Children with jobs that take them away can create changes to retirement plans.

Social isolation

Social isolation is a real hazard to your health. Social isolation is when you don’t feel like your belong, don’t have much interaction with other people, don’t have people to call to get out and do something, and no/few close personal friends.

Social isolation can be bad for your health when it leads to drinking, being less active, or eating less healthy meals. It can increase your risk of heart disease, stroke, dementia, or depression.

We all Need to be Needed

A very innovative program was launched in the early 1990’s called Eden Alternative. They call their method, ‘person-directed care’. When I first heard about it in the 1990’s a very clear picture was left in my mind. A senior living facility had enhanced their environment by bringing in a cat, a dog, birds, a garden on the lawn, indoor plants, and a baby chick. There was a woman who wanted to spend all of her time in her wheelchair. The physical therapists were trying all they could think of to encourage her to walk and get stronger. She refused. Then she saw the baby chick. She did not want it to be eaten by the cat, so she put the chick in her wheelchair and pushed it. That chick, of course, became a chicken that continued to get first-class rides in the wheelchair.

Even people who were extremely incapacitated were given ‘jobs’. Even if it was caring for an African Violet. Some planted and worked in the garden. Some fed and cared for the birds. Some brushed the dog. Residents could sign up for the responsibilities that met their interests and abilities.

It was impressive how depression, anxiety, and pain were so much better with these changes. Since that time, the Eden Alternative has grown and spread and documented even more inspiring outcomes.

New Ideas to Decrease Isolation

I know many people who live in areas where they don’t feel safe getting out to walk. Some no long feel safe driving. Some don’t have the desire to get out and about without a partner.

So, some really smart minds have been working on ways to keep all of the health benefits of interacting with other people. Here are some of the creative options:

Virtual senior center. Using technology, you can take art classes, chat with others, participate in yoga or tai chi, and other activities. There are a lot of ways to keep in touch with family, read to someone, discuss topics, and support each other with technology.

Concierge driver options. Uber and other driving services are starting to offer unique options to take the stress out of getting out. There are groups working on strategies to provide more helpful driving service for people with walking aids, ways to coordinate outings such as restaurant or art gallery trips, and ways to make driving services more easy to coordinate.

This is only a very quick overview of the importance of interaction with other people, the dangers of isolation, and some of the many new ideas being developed. Stay tuned; I think we will all be amazed at what is to come.

For more information about the need to be needed and the dangers of isolation, or for updates on the amazing new advances we are hearing about, please contact us at www.medsmash.com or 410-472-5078. We’d love to tell you more!

BIBLICAL APPLICATION

We just discussed how our continued health needs us to stay active and engaged after retirement. Becoming alone is hazardous in many ways. We need each other. We never lose our need for purpose and fellowship.

And, we all have a purpose. We get so caught up in our daily details. We get so discouraged by our limitations, frailties, our weaknesses.

But, we are here for so much more! I’ve always heard this life is just a short, short preamble to a life of eternity in the presence of Christ! Can you even fathom that? I try then find it is so hard to begin to grasp!

We are assured of this truth numerous times in the Bible.

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.”

John 5:24 ESV

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

Romans 10:13 ESV

For “everyone who calls on the name of the Lord will be saved.”

And while we are here in this life, we aren’t asked to sit around and twiddle our thumbs. We have a purpose!

Romans 8:28 ESV

And we know that for those who love God all things work together for good, for those who are called according to his purpose.

Jeremiah 29:11 ESV

For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.

Sometimes we wonder what that purpose might be. In my experience to date, the purpose can even change over time. Things happen that seem strange and nonsensical, then suddenly, it turns into something only God could have planned.

I do my best to not make my own plans but rather stay open to what God has planned. That’s not meant to be pious. I have learned through a lot of changes, huge mistakes, and amazing teachers that my life is more fulfilling when I’m doing what God is calling me to do. It’s become a really wild ride, but I wouldn’t miss it. In the darkest times I need to remember that God can turn it all into his purpose and his plan.

Proverbs 16:9 ESV

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

I’m praying you find comfort in the promise of eternal life when God is Lord of your life. And, I pray you are asking Him for your purpose and blindly trusting Him to lead you on your personal adventure until He calls you to eternal life!

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

 

Newer diabetes options

Are You TOO Sweet? Newer Options for Diabetes

Posted on by Michelle Fritsch, Pharm.D.
Newer diabetes options
Newer diabetes medications to consider if you’re too sweet.

Do you remember when the treatment options for your type 2 diabetes 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.

Newer diabetes medication options

Here are ways other, newer medicines help control your diabetes:

  • 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.

BIBLICAL APPLICATION

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.

2 Timothy 3:16-17 ESV

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

God’s Word can be a huge source of answers when you’re feeling lost, alone, hurt, confused.

Psalm 119:105 ESV

Your word is a lamp to my feet and a light to my path.

There’s not just one right way to study scripture. Like a combination of meds approach to diabetes, try a combination approach to reading your Bible.

Hebrews 4:12-13 MSG

 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.

Blessings,

Michelle

Memory, Falls, and Function – Oh Meds!

Posted on by Michelle Fritsch, Pharm.D.
ID-10093880
Medications can make function difficult and lead to memory and falls issues.

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:

  1. The dose is too high for you.
  2. Your body has trouble getting rid of that medication.
  3. You are on several medications with these types of effects.
  4. Your medications are interacting with each other.
  5. 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.

  • Anxiety/nerve medications
    • Benzodiazepines (e.g. alprazolam, lorazepam, diazepam)
    • Buspirone (Buspar)
  • Depression medications
    • Tricyclic antidepressants (e.g. amitriptyline, nortriptyline)
    • Selective serotonin reuptake inhibitors (SSRI’s) (e.g. escitalopram, sertraline, fluoxeting)
    • Wellbutrin
    • Buspirone
  • Sleep medications
    • Zolpidem (Ambien)
    • Ramelteon (Rozerem)
    • Eszopiclone (Lunesta)
    • Diphenhydramine (Benadryl, Tylenol PM, Aleve PM)
  • Pain medications
    • Oxycodone
    • Hydrocodone
    • Morphine
    • Hydromorphone
    • Tramadol
  • Anticholinergic medications
    • Incontinence
      • Oxybutynin
      • Darifenacin (Enablex)
      • Solfenacin (Vesicare)
      • Trospium (Sanctura)
      • Tolterodine (Detrol)
    • Parkinson’s Disease (e.g. benztropine, trihexyphenydil)
    • Allergy medications – sedating
      • Diphenhydramine (brand Benadryl)
      • Chlorpheniramine
      • Hydroxyzine
    • Antispasmodic agents (e.g. chlordiazepoxide, belladonna)
    • Diarrhea treatments
    • Muscle relaxants (e.g. cyclobenzaprine, orphenadrine)
    • Dizziness, sea sickness medication (e.g. meclizine, scopolamine)
    • Nausea/vomiting medication (e.g. prochlorperazine, promethazine)
    • Antipsychotic (e.g. thioridazine, chlorpromazine, clozapine, olanzapine)
  • Seizure medication
    • Carbamazepine
    • Valproic acid
    • Several others
  • Nerve pain medication
    • Gabapentin (Neurontin)
    • Pregabalin (Lyrica)

Medications and Function

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.

If you want help –

  • talking with your doctors,
  • coordinating between your doctors, or
  • want to better understand this information

please call us at 410-472-5078 or e-mail at michelle@medsmash.com.

Our website is www.medsmash.com.

BIBLICAL APPLICATION

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.

John recorded Jesus referring to God’s truth:

John 16:13 ESV

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

John 17:17 ESV

Sanctify them in the truth; your word is truth.

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.

2 Timothy 2:15 ESV

Do your best to present yourself to God as one approved, a worker who has no need to be ashamed, rightly handling the word of truth.

Blessings,

Michelle