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Know before you decide

Informed Decisions – how do you make your healthcare decisions?

Posted on by Michelle Fritsch, Pharm.D.
Know before you decide
All natural doesn’t necessarily mean safe and useful. Know before you decide so you can make informed decisions.

Years ago I started having a discussion with patients who were making personal decisions about their health. “If you reach the last days of your life and say, ‘Yes, this is what I expected’, then I have done my job informing you of your options.” “If you reach your final days and say, ‘If I had known this I would have made different decisions’, then I have not done my job.”

As a clinical pharmacist and a professor, educating is one of the primary roles I have.

Personal Health Decisions

I am now frequently talking with clients about the substances they choose to take on their own. There are so many options! These can be anything from vitamins to supplements to over-the-counter medicine to naturopathic substances to homeopathic substances to formerly illicit now legal substances to still illicit substances.

It is now rare to encounter a client who is not taking at least one self-selected substance.

My first question is always why a substance was selected and what was the decision making process used to choose it.  Was it a fully informed decision?

Research Pros and Cons

The most common answer is that the client has read a lot and carefully researched the substance. There is usually also a component of recommendation from a friend or other user of the substance.

Doing your research is a GREAT thing! I encourage you to read from a variety of sources.

There seems to be an undercurrent of distrust in Western medicine. Certainly the Pharmaceutical Researchers and Manufacturers of America (PhRMA) has done several things to earn the distrust from pricing to availability to the actions of individual companies and their products. [The example that jumps to mind right now is Purdue Pharma and their questionable practices with Oxycontin®.]

Too often in every segment of society, one bad apple can taint the whole bushel. To many people, anything touting a ‘natural’ source and not within the control of PhRMA seems to be the safer and healthier choice.

Evidence-Based Medicine

A big purpose of this blog is to define evidence-based medicine (EBM) and explain the differences from many of the other substance-based therapies you can choose. The ‘evidence’ comes from well-designed studies that measure both whether the medication works and the safety. Further, it helps to define how much better is it than other known options, what doses work best in what sorts of people, and which side effects are minor and which are major.

Medications approved by the Food and Drug Administration (FDA) must have well-designed studies that demonstrate both efficacy (does it work) and safety. Then, the FDA assures any company making the medication is making it in a clean facility using precise methods assuring each individual dose is per these high standards.

Two examples of the critical nature of EBM that comes to my mind are with heart medicines and with hormone replacement in women. The Cardiac Arrhythmia Suppression Trial (CAST) was the first in my career to completely change practice. It had long been assumed that using medication to keep the heart rhythm normal after a cardiac procedure would be a good thing. Then, this well-designed study demonstrated that in many instances, suppressing the abnormal heart rhythms right after a procedure actually increased risk of death. That was completely unexpected! But, other studies have confirmed that these findings. So, many of the medications that used to be part of standard treatment are no longer even made anymore.

The other big example was use of hormone replacement in women near and beyond menopause. The assumption was that keeping hormone levels where they are during the fertile years would maintain health and prevent many health issues that come after menopause. Then, two well-designed studies demonstrated that assumption was completely wrong! The dangers of hormone replacement were much greater than any advantages.   Premarin ® and Prempro ® went from some of the most commonly prescribed medications to very rarely used.

Substances without this level of evidence

The FDA does not oversee the vast majority of the substances you can choose on your own. (The noted difference is the over-the-counter medications that are overseen by the FDA.) So, unless the company does this on its own, no one is overseeing accuracy of the label, the contents, the conditions of the manufacturing facility, or the consistency from dose to dose.

In addition, there is no requirement for well-designed studies to define when, how, and at what dose the substance is most effective or what are the side effects.

Even medication interactions with your other medications is not well known since this type of data is not required.

Healthcare providers and self-treatment

Many of my clients are disappointed that their doctors aren’t more supportive of their self-selected therapies. Some don’t even tell their doctor about these.

I HIGHLY encourage you to share ALL substances you take with each of your doctors and your pharmacist. Healthcare providers have been trained to care for you using evidence-based medicine. There is too little ‘data’ to give providers confidence with other therapies. Your doctor can’t provide you with assurance of either if the substance will work for you or if it will be safe for you.  Communicate all you know to help make informed decisions.

Purpose of this blog – make informed decisions

I encourage you to share your research, the reason you take the substance, and anything you’ve noticed that is different since starting the substance with your healthcare team. Then, work together to decide all of the substances you will take. Each member of your team needs to known the full picture in order to take the best care of you.

This will also allow you to make the most informed decision possible. Combine your research, your personal goals, and your doctor’s and pharmacist’s input in your decision. Then, monitor your response. In your final days, know that you made the best decisions you could make for your own health allow the way.

Contact me

If you would like to discuss these concepts or have personal input from a board certified specialist, give me a call at 410-472-5078 or e-mail me at michelle@retirewellness.com. Check out my website at www.retirewellness.com.

BIBLICAL APPLICATION

I recently read The Case for Christ by Lee Strobel. It was such a different perspective than I had seen in the past. Mr. Strobel researched and collected the evidence to support multiple events and details found in the Bible. He started as a non-believer and ended fully convinced of the Lordship of Christ.

There are many directives in the Bible to seek God’s guidance when making decisions. There is no ‘informed decision’ that can compare to a God-directed decision.

James 1:5 ESV

If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him.

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.

1 John 5:14 ESV

And this is the confidence that we have toward him, that if we ask anything according to his will he hears us.

God has such amazing plans for you! God loves you more than you could ever imagine! Seek His guidance in your life. He has a very specific plan just for you.

Proverbs 3:5-6 ESV

Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths.

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.

I’m praying you seek God’s plans in your life and with all of your decisions. Live the life planned just for you!

Blessings,

Michelle

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Take in-date medications in 2018!

New Year’s Resolution, Remove Expired Medications

Posted on by Michelle Fritsch, Pharm.D.
Take in-date medications in 2018!
As you start 2018, take the time to dispose of expired medications

The new year is upon us. I hope your 2017 has been full of happy memories and joyous occasions. Now, as we move on to 2018, I have a New Year’s challenge for you. I challenge you to take only in-date medications; remove and properly dispose of expired meds.

WHY worry about the expiration date?

Sometimes we think expiration dates are just there to make us keep buying new medicine. But, in reality, there are TWO big reasons expiration dates are important. Extensive research is done when medications are created to determine for how long they are effective and safe. This date, when either changes, is the expiration date.

Past this date the medicine will not work as well. If you take a medicine to control your blood sugar that is expired, it might not lower your blood sugar as much. If you take an expired medicine for pain, your pain might not go away.

The other risk is a safety risk. Chemicals change over time. Have you ever opened an outdated bottle of aspirin? It smells like vinegar. That is because it changes into new chemicals over time, one of which is vinegar. Other medicines change into chemicals that can be extremely dangerous.

It is not worth the risk.

HOW do I check and dispose of expired meds?

Go through ALL of the medications in your house, cars, purse, etc. Check the expiration date on each one. If it is expired, put it in your discard pile. (But don’t throw it in the trash just yet, there are two more steps).

Next remove all labels that contain information about you or your family. Shred or cut up the label. If you can’t get the label off, scratch out your name and prescription number at least. This is one of many forms of possible identity theft.

Now comes the tricky part. What do you do with all of these medications? There is not an easy answer. In order of ‘best options’, dispose of them in one of these ways:

  1. Take them to a ‘Medication Take-Back’ event sponsored by the Drug Enforcement Agency. Or call the DEA’s Registration Call Center at 1-800-882-9539
  2. Talk with your local pharmacist to see if you pharmacy can dispose of medication. Check this link for participating pharmacies: http://disposemymeds.org/medicine-disposal-locator/ Or, your pharmacist should know who in your community does dispose of medication, if there is a source.
  3. Follow the guidelines in this recently updated FDA directive: https://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm
  4. Dump them out of their bottles and put with kitty litter, coffee grounds, or something else that you can’t eat. Then, seal the container and put it UNMARKED in a garbage bag and out with the garbage.
    1. DO NOT flush the medication or put it down the drain. This leads to it reaching the water supply. This used to be encouraged, and now many medicines/hormones/chemicals have been found in the water supply.
    2. Ultimately, putting them in the trash can lead to them being in the water supply as the trash breaks down and leaches into the ground.
    3. This is why an official ‘take-back’ event is the safest option.

REPLACE the medications you occasionally use

As you are sorting out your expired medicines, keep a list of those you use so you can replace them. If it is a prescription medicine, your can see on the label if there are refills remaining. Note, for non-controlled medicines, there are usually available for up to a year. For controlled medicines, the time might be shorter. If you are beyond that time, and you still need the medicine, call your physician to inquire about another prescription.

As you are replacing medicine, over-the-counter medicine, vitamins, and supplements, know that generic versions are just as good as brand. I purchase generic for my family. They have been carefully tested and regulated by the Food and Drug Administration to assure they contain the same key ingredients and work the same.

This is an important step in your New-Year’s fresh start. It is important for your safety and the safety of your family.

Happy New Year!

For more information about expired medication and proper disposal, contact us at www.medsmash.com/contact, call 410-472-5078, or e-mail michelle@medsmash.com.

BIBLICAL APPLICATION

We are entering a new year. It can be a time to think of fresh starts and hope for the future. It is a great time to reflect on how your life has been changed through your faith.

At the moment we give our life to Christ, we know that our old self is gone. We now live a NEW life in Christ.

Ephesians 4:22-24

To put off your old self, which belongs to your former manner of life and is corrupt through deceitful desires, and to be renewed in the spirit of your minds, and to put on the new self, created after the likeness of God in true righteousness and holiness.

Philippians 3:13-14 ESV

Brothers, I do not consider that I have made it my own. But one thing I do: forgetting what lies behind and straining forward to what lies ahead, I press on toward the goal for the prize of the upward call of God in Christ Jesus.

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.

Philippians 3:13-14 ESV

Brothers, I do not consider that I have made it my own. But one thing I do: forgetting what lies behind and straining forward to what lies ahead, I press on toward the goal for the prize of the upward call of God in Christ Jesus.

Galatians 2:20 ESV

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

What a refreshing reminder! Bask in the glow of your new life in Christ as you enter this new year.

I challenge you to take a challenge I FINALLY took in 2015 and again in 2017. Read the Bible from cover to cover. I have read my Bible, participated in Bible studies, had several Bible-based lessons, but I had never actually read it start to finish. It has been so enlightening! So many things make more sense. And I hear from those who have done this several times, the insights are new and different each time.

I am praying you will be richly blessed in 2018,

Michelle

 

Antibiotic Resistance – REALLY, you should take them all

Posted on by Michelle Fritsch, Pharm.D.

meds and bottleWe are coming into infection season. Colds, the flu, bronchitis, sinus infections, ear infections, pneumonia, and more seem to occur more often as the we stay inside in the colder weather.

Should all infections be treated with an antibiotic? NO

If your infection is from a virus then an antibiotic will provide NO HELP.

If your infection is mild, and your immune system is strong, you can often fight the infection without an antibiotic.

If you do require an antibiotic, have you ever been tempted to take it until you feel better then stop and save the rest for next time? DON’T DO IT!

If you take nothing else from this blog, please take your entire course of antibiotics.

Antibiotics can either weaken an infection until your body’s immune system can completely get rid of it or kill the bacteria. Either way, if the antibiotic is stopped once most of the bacteria are weak or killed, then those few bacteria that are not weak or killed can come back. When they do come back, they can also change just enough that the antibiotic will no longer work.

Antibiotic resistance, when bacteria stop responding to a particular antibiotic, is dangerous. It requires more advanced antibiotics which have more side effects and have a broader effect. Then, if resistance develops to those (usually when the full course is not taken), then even more advanced antibiotics are needed.

When this happens too much you can become resistant to many antibiotics. Also, when this happens over time, entire communities can get strains of bacteria that don’t respond to the usual antibiotics.

I share this to beg you to take every last dose of your antibiotics if you need them this year.

To help you avoid infections, please wash your hands frequently. Especially when you are out in public touching door handles, shopping cart handles, restaurant tables and chairs, etc, you are increasing your risk of picking up a virus or bacteria. When your hands dirty, avoid touching your face, mouth, eyes, and nose.

Have a healthy fall and winter!

For more information about antibiotics and treatment for colds and flu,contact us at www.medsmash.com.

BIBLICAL APPLICATION

It is tempting with antibiotics to stop them once you feel better. But, when you do that, you run the risk of an even more difficult-to-treat infection.

The spiritual equivalent is taking partial doses of all God has to offer. Maybe you go to church once a week and occasionally read the Bible.

Your limited doses of spiritual time can give you glimpses of all of the wonder and glory and peace and joy that is yours in Christ, but not the full view.

Galatians 5:22-23 ESV

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control; against such things there is no law.

John 14:17 ESV

Even the Spirit of truth, whom the world cannot receive, because it neither sees him nor knows him. You know him, for he dwells with you and will be in you.

Romans 14:17 ESV

For the kingdom of God is not a matter of eating and drinking but of righteousness and peace and joy in the Holy Spirit.

Matthew 5:6 ESV

“Blessed are those who hunger and thirst for righteousness, for they shall be satisfied.”

Putting Christ first in your life, taking full doses of all He has to offer you, will lead to joy and peace beyond what you can imagine.

Little doses give glimpses. Full doses can change your life forever!

Blessings,

Michelle

Image credit: Centers for Disease Control Public Health Image Library