The Dominoes of Medication – Avoid the Tipping Point

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Follow these steps to prevent sudden confusion in the hospital like a series of falling dominoes.

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

Hospitalization and memory or behavior changes

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

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

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

Elective procedures

Another all-to-familiar scenario is similar:

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

How can you better navigate these scenarios?

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

Talk with the healthcare team about taking the following steps:

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

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

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

BIBLICAL APPLICATION

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

1 Corinthians 14:33a ESV

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

David and other Psalm writers struggled to understand.

Psalm 119:169 ESV

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

Psalm 119:34 ESV

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

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

Romans 3:21-24 MSG

But in our time something new has been added. What Moses and the prophets witnessed to all those years has happened. The God-setting-things-right that we read about has become Jesus-setting-things-right for us. And not only for us, but for everyone who believes in him. For there is no difference between us and them in this. Since we’ve compiled this long and sorry record as sinners (both us and them) and proved that we are utterly incapable of living the glorious lives God wills for us, God did it for us. Out of sheer generosity he put us in right standing with himself. A pure gift. He got us out of the mess we’re in and restored us to where he always wanted us to be. And he did it by means of Jesus Christ.

In these confusing times, may the message, hope, and peace of Jesus Christ bring clarity and comfort.

Hebrews 13:8 ESV

Jesus Christ is the same yesterday and today and forever.

Blessings,

Michelle

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Hypertension ≠ High Tension

I have Heart - NIHhad several clients who have interpreted the medical condition hypertension as ‘high tension’. They thought this was a condition related to stress. And then, several thought the condition was only present when they were feeling stressed.

How much stress is there in your life right now? How much stress is there in the world? Some of us feel stressed much of the time. Others take a laid back approach to life and rarely feel stress.

Is it true that the stressed people have hypertension and the laid back people don’t?

NO

Hypertension (also known as high blood pressure) is a medical condition that goes way beyond stress or tension. It is a complex condition that is related to our genes (which we can’t control), our environment (some of which we can control), our behaviors (which we CAN control), and likely other factors that are still to be discovered.

Because it is such a complex condition with so many systems in the body involved, there are many medications that are used to treat it. Each category, or type, of medicaion treats hypertension in a different way. So, for some people, hypertension can be controlled with one medication. For other people, it could take two, three, four, or more medications, each acting on a different aspect of the condition.

How high is too high? The very general answer is a blood pressure over 140/90 is too high based on current guidelines. If someone has a history of heart disease or diabetes or some other conditions, your doctor might give you a lower goal such as less than 130/80.

How low is too low? Too low is not a strict number. Rather, it is more related to symptoms. If you feel dizzy when you stand or turn, have seen a marked decrease in your energy since starting your hypertension medicine, or are having trouble catching your breath, talk with your doctor.

Blood pressure that gets too high can be dangerous. It can lead to a myocardial infarction (heart attack) or stroke.

So what can you do about hypertension if you have it?

Check back next week for a ‘prescription’ for lowering and controlling your blood pressure.

For more information, contact us at www.medsmash.com.

Biblical Application

Do you have stress in your life? Do you worry? Does your mind keep you awake at night thinking about all you need to do, or the things you are worried about?

I don’t know about you, but just watching the news can increase my stress level. It all seems so out of control.

It is at those times that we can be assured that God is in control. Ultimately, God wins. This universe, all of history, all current events, and the future belong to Him.

On Sunday our pastor mentioned that you could sum up the entire Bible in two words – GRACE and PEACE. Jesus came to provide access to both. His grace and peace are with us at all times; we just need to quiet ourselves, turn our hearts and minds to Him to experience it.

Philippians 4:6-7 ESV

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

Matthew 6:34 ESV

“Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble.

1 Peter 5:7 NIV

Cast all your anxiety on him because he cares for you.

John 14:27 NLT

“I am leaving you with a gift—peace of mind and heart. And the peace I give is a gift the world cannot give. So don’t be troubled or afraid.

Don’t let your hearts be troubled. God is in control.

Blessings,

Michelle

Image Source:  National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services

Stiff and Inflexible – Arterial Stenosis

atherosclerosis NIHSo why shouldn’t you eat all of the high fat foods that you want? They really do taste good. You know other people who eat those foods. So why shouldn’t you?

What can it hurt?

Your arteries are the part of your venous system that carry the clean, full-of-oxygen blood from your heart throughout your body. Your veins then carry the blood that has given up its oxygen to ‘feed’ your body and is now ready to go back to the heart to get a fresh supply.

In addition, your veins and arteries dilate (open up wider) or constrict (squeeze down tighter) based on the pressure needs in your body to keep the blood flowing. This ability to change how open they are is essential for blood pressure control, heart protection, kidney function, and more.

Arterial stenosis is a condition where those flexible, open tubes start to get thicker and less flexible. When this happens, they cannot respond to the body’s pressure needs as well. Specific areas where this thickening can be problematic is in the renal arteries (main arteries of the kidneys), carotid arteries (main arteries to the brain), and the aorta (main artery leaving the heart). This can cause quicker fatigue, decrease exercise tolerance, and increased risk of heart attack or stroke.

Those fatty foods can increase the cholesterol in your blood. That cholesterol can then ‘stick’ to the walls of your arteries making them even more thick and inflexible.

Too much cholesterol, too little exercise, smoking, diabetes, and being overweight can all increase risk of and worsen this condition.

So, making those good decisions about the food you eat, getting regular exercise, and not smoking can keep your blood flowing easily. This will keep your heart, your kidneys, your brain healthy and keep you living your dreams!

For more information, contact us at www.medsmash.com.  There you can find a short movie demonstration of a clean verses a stenotic artery.

Biblical Application

How often do we become too stiff and inflexible in our lives? Has God ever compelled you to do something, and you ignored or refused?

Have you ever had your feelings hurt and shunned the person who hurt you without trying to talk it through?

Do you know anyone who has stopped going to church or attending church functions because they don’t agree with some aspect of the service, or the people in leadership, or who sits where, or whatever reason?

Why do we get so caught up in small matters that we miss the BIG PICTURE of love and grace and eternity?

Like thickening of our arteries, sin, greed, jealousy, strife, self-interests can thicken our spiritual life-line causing us to be inflexible and obstinate.

God’s word mentions the stubbornness of us humans from the very first book.

Genesis 16:12 ESV

He shall be a wild donkey of a man, his hand against everyone and everyone’s hand against him, and he shall dwell over against all his kinsmen.”

Psalm 81:11-12 ESV

“But my people did not listen to my voice; Israel would not submit to me. So I gave them over to their stubborn hearts, to follow their own counsels.

Hosea 4:16 ESV

Like a stubborn heifer, Israel is stubborn; can the Lord now feed them like a lamb in a broad pasture?

2 Timothy 4:3-4 ESV

For the time is coming when people will not endure sound teaching, but having itching ears they will accumulate for themselves teachers to suit their own passions, and will turn away from listening to the truth and wander off into myths.

Job 36:11 NIV

If they obey and serve him, they will spend the rest of their days in prosperity and their years in contentment.

The only way I will keep a pliable, obedient spirit in the larger decisions is to look to Him and to obey in the smaller ones.”  Catherine Marshall

Next time you’re feeling irritable and obstinate, take a minute to reconnect with the One who can keep your spiritual arteries clean and flowing. Let His love and acceptance flow unimpeded through you with prayer, time in the Bible, and fellowship with faithful people.

Blessings,

Michelle

Image source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services