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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Breast Cancer Treatment

697px-Pink_ribbon.svgIt is Breast Cancer Awareness Month. We are seeing pink in all directions.

Breast cancer is the most common type of cancer in women (with the possible exception of some skin cancers).

One in eight women will be diagnosed with invasive breast cancer.

Ductal carcinoma in situ is a type of breast cancer that is contained in the duct, so it is not an invasive breast cancer. Another 60,000 women will be diagnosed with this during the year.

The risk of breast cancer increases with age and seems to peak in the 70’s.

All women at all ages should get regular mammograms. These can find the cancer early. Most guidelines recommend every year starting at age 40. This screening should continue for as long as a woman is still loving and living life! You might have heard on the news this week the American Cancer Society has changed its guidelines for annual mammograms. For woman at average risk for breast cancer, these new guidelines are to start at age 45 and go to every other year at age 55. Note, for women at high risk, screening starts earlier and remains yearly.

When a diagnosis is made, find a breast cancer center who can support you through each decision and each phase that follows. You want to be surrounded by a team of caring professionals who are patient and explain everything until you fully understand.

Surgery, radiation, chemotherapy, and medications are often parts of the treatment options. Different combinations of these treatments will be used based on the important specifics of your cancer and your preferences.

When breast cancer is estrogen-responsive, the following medications are often part of the treatment regimen.

Tamoxifen is often used after diagnosis and initial treatment. It can also be used to lower breast cancer risk in high risk women. It is an antiestrogen medication, so it decreases the impact of estrogen that often drives the changes that lead to breast cancer. The typical length of treatment has been five years. There is new data that it should be taken for 10 years in some women with breast cancer. Be sure to discuss this with that great team of providers you have to see how long you should take it. The main side effects are hot flashes and changes in your menses if you are premenopausal. Tamoxifen can also cause fatigue and increase your risk of clotting.

Aromatase inhibitors are another class of medication sometimes used as part of the treatment for breast cancer or to prevent breast cancer in high risk women. There are three medicines currently in this class. They are anastrazole (brand Arimidex), exemestant (brand Aromasin), and letrozole (brand Femara). These medications decrease the available estrogens by stopping the conversion of androgens to estrogens. These medications can increase your cholesterol and decrease your bone density (increase your risk for osteoporosis). They can also cause hot flashes and fatigue.

Some women take one of the above medications. Others take one type for a period of time then switch to the other. Which type of medication and for how long is an important decision made with your healthcare providers. The decision is based on some tests about your specific type of cancer, its responsiveness to estrogen, any other medical conditions you have, and your preferences.

I highly encourage you to discuss the benefits of the medications and any risks, including side effects, with your cancer treatment team. Your pharmacist is another source of detailed information about these and other medicines.

For more information about breast cancer treatment medications, contact us at www.medsmash.com.

If you want to get more involved in the search for a cure, I encourage you to read about the Army of Women organized by Dr. Susan Love. This program has made millions of volunteer women sources of new data in the search for a cure. I have participated in a couple of studies. It takes little time. One study collected only information. The other did a bone scan. No tests or procedures or data will be taken from you without your full consent. You can made a difference!

Biblical Application

Diagnoses such as breast cancer can invoke many feelings. One of those can be a fear of loss. Even before diagnoses are finalized, options are considered, prognoses are made, our minds can take us down paths of fear, anxiety, depression, hopelessness, futility, or impending doom.

God is aware of our needs and our weaknesses. He knows how our mind works when faced with a diagnosis like this.

The Bible is full of verses of hope and assurance. You truly can lean on God in all situations, no matter how frightening they may seem.

Isaiah 41:10 ESV

Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.

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.

Psalm 56:3 ESV

When I am afraid, I put my trust in you.

2 Timothy 1:7 ESV

For God gave us a spirit not of fear but of power and love and self-control.

Deuteronomy 31:6 ESV

Be strong and courageous. Do not fear or be in dread of them, for it is the Lord your God who goes with you. He will not leave you or forsake you.”

Claim and cling to this hope, love, and assurance that is yours in Christ. You are never alone. You are never abandoned. You are eternally loved.

I encourage you to share this hope beyond understanding with anyone you know facing breast cancer. You can be a light in their dark time, especially if they have not experienced the power of your God.

“Again and again, I’ve found Him faithful to respond and the closer I move to Him, the safer I feel and the better I rest.”

Patsy Clairmont

Blessings,

Michelle

Image thanks to MesserWoland – own work created in Inkscape, based on the graphics by Niki K