Though the hills be moved

‘But in that coming day no weapon turned against you will succeed.’ Isaiah 54:17.

These feel like some of those coming days. It is comforting that in Isaiah 54 is says, ‘If anyone attacks you, it will not be my doing; whoever attacks you will surrender to you.’ And, ;Thought the mountains be shaken and the hills be removed, yet my unfailing love for you will not be shaken nor my Covenant of peace be removed, says the Lord, who has compassion on you.’

These feel like days of such heaviness right now. I just talked with a friend who is staying away from the news and social media completely. She hears what’s going on through people in her family and at work talking about it. That is all she can take right now. I get that.

We are called to stand strong. And we know the only way to do that is to trust in the the only ONE who knows all, is in all, and will ultimately prevail over all. As Jesus said in John 16:33, “I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world.”

Take heart! God’s got you today!

Medicare Open Enrollment – comparing your options

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October 15 to December 7 is your window to select a Medicare plan. Let us help.

Medicare Open Enrollment for your 2017 plan is from October 15 to December 7, 2016.   Before you make a selection, here are some resources to help you compare your options.

Medicare provides a tool where you can compare options before you make a decision. You can find it at this link.

The information you need is:

  • Your Medicare number
  • If you have a Medigap or Medicare supplement plan, the name and type of the plan
  • Your zip code
  • A list of your medicines prescribed by each of your doctors
  • The name and location of your preferred pharmacy

You can search through options using your specific information or you can do a general search. I highly recommend you perform a search with your specific information at least once before you make final decisions. That will give you the best look at your anticipated likely costs.

The tool will walk you through step by step.

  1. It starts with your zip code and information from your Medicare card.
  2. Enter your current Medicare coverage type. Include whether you get extra help paying for your medication costs.
  3. Enter your prescribed medicines. Include the strength, whether you get your medicine every month or every 3 months, and whether you get your medicines from a local pharmacy or a mail order pharmacy.
    1. Be sure to include all of your medicines
    2. If your doctor has talked about maybe starting new medicine, include these, too. This will make sure the plan you choose will cover all of these medicines.
  4. Select your pharmacy. Note, if your pharmacy doesn’t show up at first, expand the number of miles from your home so that your pharmacy will be on the list.
  5. You can then choose whether you want to compare medication only Medicare D plans, Medicare Health Plans with drug coverage, and Medicare Health Plans without drug coverage.
    1. If you aren’t sure, select all three options
    2. If you know which you want to compare, select just that option
  6. A list of all options will appear on the next page. They appear in order of cost with the lowest annual cost option appearing first after Original Medicare. You have the option to select different sort options.
  7. Select three plans that you want to directly compare.
    1. The three options will be displayed side by side.
    2. You can compare three at a time as many times as you want.
    3. All costs for the year include deductibles, co-pays, gap payments, and other fees will be displayed.
    4. Look at your total annual cost
    5. Look at the deductible which is money you will pay at the first part of the year
    6. Look at the projected money you will pay in the coverage gap

To look at your options with Medigap plans, you can go to this link. This one will let you compare types of Medigap plans and their costs.

NOTE – A friend, and expert in the field, clarified that Medicare Advantage plans can be purchased at any time. Her comment: “Medicare Supplement policies do not have an annual open enrollment, but changes can be made based on your health after your original open enrollment or a special enrollment period.”

If you have any questions about how to use these tools or how to compare your options, please contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

For Medicare plan decisions, comparisons are good. They are key to making the best decision.

In the rest of your life, comparisons can be hazardous. How often do you compare yourself to someone else? You might not even realize you’re doing it.

Do you ever have negative thoughts about yourself when you see something you admire in someone else?

Do you ever feel extra good about yourself when you can do something that someone else can’t do?

In what sneaky ways can ENVY enter your thoughts?

I’ve read a couple of really good blogs about this from pastors recently. I know I’m guilty of comparison without ever intending for it to happen. I fall into a thought process of envy or comparison then catch myself and feel so ashamed.

Apparently I’m not alone. There are many Bible verses about the problems with envy.

Galatians 5:26 ESV

Let us not become conceited, provoking one another, envying one another.

1 Peter 2:1 ESV

So put away all malice and all deceit and hypocrisy and envy and all slander.

Instructions in the Bible can be very clear. It is clear ENVY is to be avoided. And if it’s mentioned this many times, it must be common.

Titus 3:3 ESV

For we ourselves were once foolish, disobedient, led astray, slaves to various passions and pleasures, passing our days in malice and envy, hated by others and hating one another.

James 3:16 ESV

For where jealousy and selfish ambition exist, there will be disorder and every vile practice.

The antidote to envy is to lay it all before the Lord. God has a very special, very specific plan just for you. Your gifts, your strengths, your weaknesses, your opportunities, your looks, your dreams are very UNIQUELY yours.

It doesn’t matter how other people are blessed. There are other blessings that are all for you!

Proverbs 16:9 ESV

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

Proverbs 19:21 ESV

Many are the plans in the mind of a man, but it is the purpose of the Lord that will stand.

This could be the week to turn your eyes from what everyone else has. Instead, look at what God has in store just for you. Ask, He’d be happy to show you all the good things you have and what is still coming you way!!

Blessings,

Michelle

Gratitude and Satisfaction – Healthcare Perspective

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Have you expressed gratitude for your healthcare?

When was the last time you expressed gratitude for your healthcare? How often are you satisfied with the healthcare you receive? When do you suppose is the last time your doctor, nurse, pharmacist, medical assistant, intake/discharge specialist, or billing office received a ‘Thank you!’?

I encourage you to take a moment and list the last five benefits you received from your healthcare providers?

Here is my current list:

  1. Emergency services in the middle of a blizzard for a head injury for a child.
  2. A surgeon and many, many supportive people for a rotator cuff repair.
  3. A patient, engaging ophthalmologist helping a frustrated teen with vision-related headaches.
  4. Access to an annual mammogram with follow up ultrasound whenever something looks suspicious.
  5. Preventative vaccines and personalized guidance from my physician in preparation for third-world healthcare provision.

Healthcare gratitude I experienced in Jamaica

I can’t stop thinking about my week in Jamaica and the many insights I took away. I was honored to serve with a team of about 20 people caring for people in St. Mary Parish, an underserved portion of Jamaica. We had physicians, nurses, pharmacists, medical records, check-in, child-care, and spiritual support specialists. (Remember that spiritual health is a key aspect to overall health).

Two situations have especially stood out to me. One was a woman who was diagnosed with breast cancer in 2014. She was treated with a mastectomy. She did not have access to radiation or chemotherapy. Now, in 2016, she had a lump under her arm. The physician prescribed an antibiotic. We are all hoping and praying it is an infected cyst and not cancer. Guess what? She was grateful for the care and for the antibiotics! She did not demand other therapy. She was not disgruntled. [Maybe she doesn’t know how it would be treated in a developed country with insurance. Then again, her gratitude and lack of stress over options can actually be to her benefit.]

The other situation was a young boy with low hemoglobin, so he was anemic. Hemoglobin carries oxygen throughout the body. There are several possible causes of anemia in a child. We were able to give him multivitamins and iron supplements. His mother was surprised to hear he was anemic. He was outside playing with the other children as we talked about the medicine. When he came in she showed me how strong and healthy he looks. She was very satisfied with the vitamins and iron. I couldn’t help but think how differently that exchange would likely be here in the US. Parents would want a series of tests to rule out any obscure implication of the anemia. [Note, anemia in children is not uncommon in Jamaica. Children are breastfed for an extended period by mothers who do not have prenatal vitamins. Then, because meat is expensive, the diet has less iron in it.]

Health benefits of gratitude

It is so easy to find fault in other people and in systems. Add the element of fear that comes with medical diagnoses, and people often have very negative reactions in the healthcare setting. That increases stress for the patient, any caregivers with the patient, the physician, and all members of the healthcare team.

Consider the benefits of gratitude instead. Gratitude can:

  • Boost your spirits and sense of well-being
  • Boost your immune system making you less likely to get sick
  • Decrease your chances of heart disease
  • Improve your performance (job, concentration)
  • Bust your stress

By all means, when mistakes are made they need to be addressed. But mistakes are not the norm. People go to school for many, many years to be able to provide the best healthcare they can provide.

We saw hundreds of patients in very hot August in Jamaica in churches with no air conditioning and few fans. And I only heard one person complain over five very full days. That woman didn’t understand why the man next to her got more diabetes medication than she got. Once she understood it took more medicine to manage his sugar she was satisfied.

If you would like to hear more about my trip to Jamaica or about the health benefit of gratitude, contact me at www.medsmash.com/newsblog/.

BIBLICAL APPLICATION

Life feels so different when we live in gratitude rather than dissatisfaction. Negativity stresses us out and ultimately kills us.

1 Thessalonians 5:18 ESV

Give thanks in all circumstances; for this is the will of God in Christ Jesus for you.

I have a new source of gratitude this week.

Do you ever have a God moment when something becomes so clear? I received the best analogy this week. And I can’t wait to tell you about it!

It likens faith with a child going on vacation.

When a family is going on vacation, the child knows the mom or other adult will pack the clothes, the snacks, the sunscreen, the towels, and anything needed for that vacation. The child knows someone will take care of the directions, putting gas in the tank, making hotel reservations, and other travel details. The child knows there will be a safe place to sleep, some fun adventures along the way, food to eat, and all basic needs will be met. The child gets in the car when told it’s time and follows the lead of the adults who have planned the trip. The child is along for the fun with no stress and no second-guessing the plans.

Wow, isn’t that like faith? God’s got this! He has plans for your life. He has plans for each year, month, day, minute, … Faith is being the child with full faith in the adults who are in charge of the details.

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.

Isaiah 42:16 NIV

I will lead the blind by ways they have not known,

    along unfamiliar paths I will guide them;

I will turn the darkness into light before them

    and make the rough places smooth.

These are the things I will do;

    I will not forsake them.

I encourage you to spend less time on daily travel details and more time letting God take the lead this week.

Blessings,

Michelle

 

Appropriate medications – same at 30, 60, and 90?

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Appropriate medications over age 60

Should the same medications and doses be prescribed for all ages? No! However, we find that often they are.   If a medication was a good choice for you at 30, is it still a good choice at 60 or 90? Not necessarily. So, why does age matter?  How do you know that you are taking all appropriate medications?

What changes as we age?

Even if you eat right, exercise regularly, and make good choices about alcohol and tobacco, changes occur over time.

  • Kidney function starts a very gradual decline in your late 30’s or early 40’s.
  • Liver size and blood flow to your liver diminish. The number of cells shrinks. There is less activity of the enzymes that break down medications.
  • Food and medications move through the intestine more slowly.
  • The volume of urine that the bladder can hold decreases. Bladder muscles weaken.
  • For men, the prostate gland increases in size.
  • For women, the urethra shortens and comes thinner. So, risk of urinary tract infection goes up.
  • Muscles weaken as growth hormone levels decline.
  • Aldosterone levels decrease, so risk of dehydration goes up.
  • The immune system slows down. So, risk of infection and cancer go up. Also, it can take longer to treat an infection.
  • Heart muscle and blood vessels get stiffer. This can increase risk of high blood pressure. Also, with exercise, the heart can’t pump as much blood or speed up as much as it did at younger ages. So, exercise capacity is lower.
  • The muscles involved in breathing weaken. There is a decline in the number of small sacs in the lungs where oxygen is passed to the blood.
  • The amount of water in the body goes down while the body fat goes up.

This list is not meant to depress anyone. These are just some of the very natural changes that occur in all of us. So with all of this change, the need for medication, the types of medications that are needed, and the doses of medications are all different.

Nearly all medications leave the body through the urine or the stool. Most medications are changed as they pass through the liver. There are enzymes in the liver that break down those medications. When the kidneys and liver become less functional, it takes longer to get the medications back out of your body. This means a single dose can last longer or have a bigger impact.

Most medications have a preference for water (hydrophilic) or fat (lipophilic). Since body water and fat both change, medication concentrations also change.

Guidelines for taking appropriate medications

There are so many changes to manage that guidelines have been written to try to decrease some of the more common mistakes that are made. These are oriented to people over age 65. The Beer’s List was first developed by a group of doctors in 1991. It has since been updated many times. It contains a list of medications not to use and another list to use with special precautions. There is also a guideline called STOPP that lists medications to avoid in adults over 65. For both guidelines, there are safe options to use in place of the medications on the lists.

If you are 60+, is there a specialist in medication use for people of your age monitoring your medication use? Can you really afford to avoid this review? We have found there is some issue to address 98% of the time we provide an assessment. For your personal assessment, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Medications change as you age. And so do so many other things. Many of these changes are wonderful! You benefit from the many lessons you’ve learned through your life so far. You are able to share those experiences, insights, and lessons with others. You probably sweat the small stuff less. You also tend to enjoy the little things more.

I heard a message today that really captured my attention. A picture was painted about grace and faith and their relationship.

As stated by John Stott, ‘Faith’s exclusive function is humbly to receive what grace offers. Grace gives and faith takes’.

Grace is offered to you on a constant basis. But, it has been my experience, it takes time and lessons learned to really develop faith so that grace can be received. Faith tends to grow with time and experience.

Ephesians 2:8 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God,

Hebrews 11:1 ESV

Now faith is the assurance of things hoped for, the conviction of things not seen.

Romans 10:17 ESV

So faith comes from hearing, and hearing through the word of Christ.

Salvation by grace is a gift. Faith is how you receive that gift.

Ponder this great news this week!

Blessings,

Michelle

Flu or Cold – What do you take with high blood pressure?

‘Tis the season of flu, cough, and colds. I’ll be surprised if you don’t know someone with one of these right now. There are many products lining the shelves of the pharmacies and grocery stores ready to treat your symptoms.

If you have high blood pressure or a heart condition

Does it matter which product you choose to treat your symptoms if you have high blood pressure, heart failure, have had a heart attack, or you have some other heart condition? Actually, it does. Most of the products used to treat your cold or flu contain two main ingredients: decongestant and antihistamine.

Decongestants decrease the swelling of the lining of your nose. When these swell, you feel stuffy and have trouble breathing through your nose. Taking one while you have a cold or flu can help you breath better and relieve that stuffed-up feeling. Decongestants can be found in tablets, capsules, nasal sprays, nose drops, and liquids. They are often found in combination with other medicines for fever, headache, cough, sore throat, and mucous.

Decongestants work by increasing your sympathetic system. This is the part of your system that kicks in to gear when you are angry or afraid. It is called the ‘fight or flight’ response. It also causes your heart to beat harder and faster.   Your veins and arteries get tighter. Your blood pressure goes up.

If you have high blood pressure or heart disease, this is not helpful. It puts you at risk of worse heart disease or even heart attack or stroke.

Antihistamines block histamine. This helps to dry up a runny nose, tearing of your eyes, sneezing, and itching in your nose and eyes. They are helpful with these symptoms for allergies or for colds/flu. They come in tablets, capsules, liquid, eye drops, and nasal spray. Some of the antihistamines (first generation) cause you to be sleepy and slow your thinking. The newer, second generation versions have fewer of these side effects, but they can still make you sleepy. Be very careful if you must drive while taking these.

Antihistamines should also be taken with caution with people in high blood pressure or heart disease.

The cold and flu medicines on the market for people with high blood pressure leave out the decongestant. They have the antihistamine and usually acetaminophen for fever. So, still be careful using these if you have high blood pressure. Check your blood pressure while you are taking them. Let your doctor know what you are taking for your cold and flu.

So, if most of the cough and cold and flu medicines on the market are not good for your heart or blood pressure, what should you do?

What can you do without taking cold and flu medicines?

For your fever, take acetaminophen. Medicines like ibuprofen (brand names Motrin, Advil) or naproxen (brand name Aleve) can raise your blood pressure and increase your risk of heart disease.

For your congestion, try a humidifier. Moist, warm or cool air can help break up the mucous and ease your swollen nasal passages.

Get plenty of rest so your body’s immune system can fight the virus. Drink plenty of fluid.

With or without a decongestant or antihistamine your cold or flu is likely to last about 5-7days.

Wash your hands, especially after being out in public. When you are in public or haven’t washed your hands recently, avoid touching your face (mouth, nose, eyes). And finally, please get your flu shot each year!

For more information about managing a cold or the flu with high blood pressure, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

When you have high blood pressure or a heart condition, your treatment options for a cold or the flu are limited. To avoid letting your blood pressure get even higher, you need to carefully select a treatment that is best for you and your specific medical conditions.

Similarly, in your faith walk, what is best for you might not be best for someone else.

Paul mentioned this in at least two of his letters. After Christ came to reconcile us with God, the rules of the past changed. But, this was easier to accept for some people than for others. In particular, new believers found this transition to be confusing sometimes.

So Paul encouraged all believers to consider their friends and neighbors when making decisions. If something would cause confusion for someone else, then Paul encourages us to not do that thing.

Romans 14:13 ESV

Therefore let us not pass judgment on one another any longer, but rather decide never to put a stumbling block or hindrance in the way of a brother.

1 Corinthians 8:13 ESV

Therefore, if food makes my brother stumble, I will never eat meat, lest I make my brother stumble.

1 Corinthians 8:9 ESV

But take care that this right of yours does not somehow become a stumbling block to the weak.

These verses make even more sense in context, so I encourage you to read them within their chapter.

Remember those around you when making decisions. It is easy to get caught up in your own life and not even think about how your actions impact others. Even when you are making ‘good’ decisions, realize other people younger in their faith might not understand your freedoms and reasons for exercising those freedoms.

Blessings,

Michelle

Center of Gravity – Preventing Falls

ps_weebles_playPicture a supermodel in her heels walking heel to toe. Now try it. Do you feel unsteady? When your feet are that close together, or even nearly crossing, it is easy to fall. Your center of gravity is very high. The bulk of the weight is up high with a narrow base. Now think of a Weeble – remember those toys with the rounded bottom wider than the top? They have a very low center of gravity (most of the weight in the bottom). They can tip over on their side and still return to standing.

If you’re ever feeling unsteady when walking, think about your center of gravity. Stand and walk with your feet farther apart. Take shorter steps. Lift your feet to avoid catching on grass, rocks, and other low obstacles.

When someone has fallen or is afraid of falling, you can notice these changes. As we become fearful we widen our stance, bend a little, and shuffle.

  • Arthritis in hips, knees, ankles, and feet can increase falls risk.
  • Dizziness, inner ear problems, or medications that make us dizzy can increase risk of falls.
  • Lack of sleep, getting up at night without light, and medications that make us sleepy can increase risk of falls.
  • Not drinking enough, especially during these hot summer months, can lead to dehydration making us dizzy.
  • Medicines that lower blood pressure can make us feel dizzy when we first stand up or turn.
  • Pets under our feet can be a source of tripping. So can throw rugs.

See the home falls prevention checklist under Resources at www.medsmash.com.

Biblical Application

The location of our faith has similar implications. When all of our knowledge of God is in our head, our center of gravity is high. When our center of gravity is high, it is easy to fall. Small things can whip and blow us about. Do you ever feel battered and blown from all directions?

  • work
  • relationships
  • finances
  • too busy
  • not feeling good

But with prayer, reading the Word, study, focus, faith enters our heart. And then it’s in our gut and our whole being.

As our faith gets deeper and deeper, our center of gravity deepens and we can handle heavy blows from any direction. The bad things still happen, but we can maintain our upright faith and dependence on God.

Then Christ will make his home in your hearts as you trust in him. Your roots will grow down into God’s love and keep you strong. Ephesians 3:17 New Living Translation

Let your roots grow down into him, and let your lives be built on him. Then your faith will grow strong in the truth you were taught, and you will overflow with thankfulness. Colossians 2:7 New Living Translation

May you grow deep roots!

Blessings,

Michelle