When was the last time you did something for someone else? When is the last time you were kind? When did you do something for someone else expecting nothing in return? Kindness is so good for your health!
This is not just my idea. Kindness and thinking of others rather than always thinking about yourself is promoted by most of the world’s religions. All of the major religions encourage treating other people the way we want to be treated. If we would find something hurtful, then we shouldn’t do that thing to other people.
In my mind, if all of the major religions of the world agree to this basic principle, then it might truly be good for you!
Kindness is a choice
Good, beautiful things happen all around you every day.
Discouraging, annoying, negative things happen all around you every day.
Which do you notice more?
Is your first, natural reaction a kind one – or – a negative one?
We might tell ourselves that events are happening TO us, but the reality is, we get to choose our reaction. Our response is in our own control.
Maybe you haven’t always exercised that control, but you can choose kindness over a more negative response.
When we focus on other people, we both benefit!
Kindness and health
As I’ve researched this I have been amazed at all of the studies, literature, and measurements of the health benefits of kindness. Noticing, caring for, and being kind to other people has a positive benefit throughout our whole body.
Kindness is good for your mental and your physical health!
Here are just a few of the changes that YOU will experience when you are kind:
Less focused on your own pain, mood, worries
More positive outlook
Feel better about yourself
Decreased loneliness and helplessness
Sense of feeling connected
Kindness has also been shown to:
Help with weight control
Lower your blood pressure
Decrease your acid reflux in your stomach
Boost your immune system
Help you sleep better
Decrease your pain
Truly, there is so much to gain! When you are kind, the whole world feels like a brighter place.
I have seen medication use decrease, overall health increase, and people love their life so much more when they decided to practice kindness.
Jesus replied: “‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘Love your neighbor as yourself.’
If you are loving your neighbor as yourself, then you are good, kind, helpful, understanding, forgiving, and loving.
We all long to be loved. We all like when kindness is shared with us.
I propose we were designed to express and experience kindness as a key element of our lives.
After thousands of patients and over 20 years of collecting data, I consistently find that 2% of the patients I see don’t need any medication change. I hope you are in this esteemed 2%. It means your medication regimen is safe, effective, dosed correctly, and working just as expected for you. You have no unmet health needs. You are doing the things you want to do in your life with no limitations posed by medicine.
A full 2% understand their medications and take them correctly.
How do you know if you’re part of the other 98%?
A medication use specialist reviewing your health plan might uncover any of these things:
Your medication is causing a side effect that is impacting your day
There is another medication that could have the same benefit without the disruptive side effect
Your dose is too low to completely do what it is intended to do
Your dose is too high for what you need
Your kidneys or liver have changed, so your dose needs to change
A medication for one purpose is making another medical condition worse
You have a problem that could be treated and no treatment has been started
You are not taking the medication that has been prescribed and have not told your healthcare team (doctor)
The medication is so expensive you are having to make decisions about what to purchase each month
Your medication is not covered by your insurance; another safe and effective option is covered
You take your medicine at a time of day that will limit its effect
You take your medicine with other medicine or food that will change its effect
Your medication is making your dizzy or otherwise increasing your chance for falls
Your memory is changing because of your medication
The time of day you take your medication is limiting its effectiveness
You don’t remember which medication is for which indication
You have your medications confused
You pick and choose each day which medication to take (when maybe it only works if taken regularly)
You are taking a medicine that you no longer need
Medications, supplements, vitamins, over-the-counter items, and other things you take aren’t known by your healthcare team, are causing issues or are making you better such that you no longer need some of your prescriptions
Review all of your medications exactly as you use them
Assess all of your supplements, herbals, over-the-counter medicines, vitamins, and the things you take just once in awhile
Evaluate your falls risk (helpful even if you are an athlete)
Evaluate your heart disease risk
Evaluate your memory
Assess your depression, anxiety, stress levels
Prepare you to get the most out of all healthcare visits with your doctor, therapist, or other providers
With your permission, share our findings and recommendations with your doctor and healthcare team
If you prefer, coach you to share our findings and recommendations with your doctor and healthcare team
Help your doctor with prioritizing items and medication titration (very gradually, carefully monitoring changes)
Contacting Meds MASH
A full 98% of people have room for improvement or education with their medications. Nearly ¾ need an actual medication or dose change. Even after I have worked with people for years, about ½ of the time, there is more work to be done. I never make changes all at once. Your health is too important. Any changes, agreed to by you and your doctor, are made one at a time while we carefully monitor your response.
This health blog was about the fact that most people have some room for improvement in their medication use.
Isn’t the same true in our life? I know I have a lot of room for improvement!
The sermon at my church today was about patience. I will readily admit that is not my strong suit. God has taught me a lot on this subject throughout my life so far. Like most of you, events have happened that absolutely stopped me in my tracks. All of my plans were out the window. The future was completely unclear. These are the times when we choose to shut down, take over our own planning, or give it all to God’s plan.
Solomon was the king blessed with great wisdom. He was well aware of the value of waiting on God’s plan.
Many are the plans in the mind of a man, but it is the purpose of the Lord that will stand.
As hard as we try to control these things ourselves, we can’t create, accumulate, or lead to the magnificent degree possible through Christ.
You are loved! God wants to guide you through your life according to HIS plan.
Throughout the Bible we have examples of God’s plan going beyond what we can even fathom. Even in terrible times, when people find themselves in dire situations, God has repeatedly demonstrated how He can turn things around.
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. Then you will call upon me and come and pray to me, and I will hear you. You will seek me and find me, when you seek me with all your heart. I will be found by you, declares the Lord, and I will restore your fortunes and gather you from all the nations and all the places where I have driven you, declares the Lord, and I will bring you back to the place from which I sent you into exile.
Jesus addressed our tendency to stress out, worry, and try to assume control.
“Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? And which of you by being anxious can add a single hour to his span of life? And why are you anxious about clothing? Consider the lilies of the field, how they grow: they neither toil nor spin, yet I tell you, even Solomon in all his glory was not arrayed like one of these. …
serenity as, ‘the state of being calm, peaceful, and untroubled’.
I have just returned from a trip of celebration with my Mom (70), me (50), and my daughters aged 18 and 16. We have been planning this trip for over a year. One of my favorite aspects was the serene places we found. While in the Redwood Forest it was awe inspiring and silent. Even though there were other people in the forest, somehow we couldn’t hear them if we weren’t beside them. To be in the midst of those giant trees and surrounded by giant ferns, it was so calm, awe-inspiring, and yes, serene.
The Redwoods were protected from excess logging by conservation efforts including the formation of the Redwood National Park in 1968. Then President Nixon dedicated a grove in the park to Lady Bird Johnson. Here is a quote on a plaque in that grove that struck me:
‘One of my most unforgettable memories of the past years is walking through the Redwoods last November – seeing the lovely shafts of light filtering through the trees so far above, feeling the majesty and silence of that forest, and watching a salmon rise in one of those swift streams – all our problems seemed to fall into perspective and I think every one of us walked out more serene and happier.’ Lady Bird Johnson, July 30, 1969
The part that grabbed my attention was, ‘all our problems seemed to fall into perspective…’
When was the last time you felt truly serene? How often do you slow down and allow yourself to just truly relax? What are the places or activities that bring you to that place of serenity?
Serenity and health
When you are calm, peaceful, and untroubled your whole body benefits. Your blood vessels relax, your blood pressure lowers, you breath more deeply, and your think more clearly. Your immune system is more active and you sleep more deeply.
I have been fascinated by the book, ‘The God-Shaped Brain’ by Dr. Timothy R. Jennings who is a psychiatrist and psycho-pharmacologist. He makes a compelling case that directly relates to serenity and health. He describes which part of your brain is working for you to think, reason, and plan. There is also a part that allows you to experience empathy, compassion, and love. When you are serene, these parts of your brain are fully operating.
When you are stressed, other parts of your brain take over. They put you in ‘fight or flight’ mode so that you are fully alert and ready to tackle the source of the stress. You were designed to have this stress alarm triggered only in rare truly life-threatening situations. However, in today’s society, so many of us are under constant stress. This system starts taking over our brain on a regular basis. As this stress system takes charge of your brain, your ability to think clearly, calmly, and to genuinely relate to others declines.
You have the power to give your stress signals a rest. As you do, and the more you do, the better your brain will function. You will be able to think through problems, plan, and prioritize. You will feel more connected to your own feelings, be able to manage them, and relate more to other people.
One of the best parts is that you will be free to think less about your own needs and more about the needs of others. That has been explored in previous blogs and will be explored again. There is a mountain of evidence that this is very good for your health!
The Role of Medications
There are many medications available to you that in some way target your mood, your anxiety, your depression, your anger, your emotions, and/or your reactions. These have a role. They cannot produce serenity. They cannot remove your stresses or your responses to them. They can help you cope. They are most effective when combined with therapy that can help you decrease the control of your stress response in your brain and let your thinking and loving parts of your brain resume control.
When medications are used, they should be used with great care and at the best doses. Your best medication and dose depend on several factors:
your kidneys and how they function
your liver and how it functions
side effects you might experience
interactions with your other medications and your other medical conditions
evidence (studies that have been done to demonstrate what works best in a situation like yours)
The Role of Meds MASH
At Meds MASH a medication-use expert who is specialized in people over age 60 will help you and your doctor make sure the best, safest, most effective medication is used and only for the time period necessary. Meds MASH specialists can also help you find the counseling component you need to go with your medications.
He answered, “‘Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind’; and, ‘Love your neighbor as yourself.’”
I mentioned the book I have been reading, ‘The God-Shaped Brain’. Dr. Jennings focused the book on how our brain functions when we are living according to God’s plan of love vs when we are not.
We get further and further from God’s plan the more we focus on ourself. Pride, envy, harbored resentment, anger, judgmental attitudes, and lust are just a few of the ways we turn our focus to ourself and our own needs.
Now the works of the flesh are evident: sexual immorality, impurity, sensuality, idolatry, sorcery, enmity, strife, jealousy, fits of anger, rivalries, dissensions, divisions, envy, drunkenness, orgies, and things like these. I warn you, as I warned you before, that those who do such things will not inherit the kingdom of God.
But the fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness and self-control. Against such things there is no law.
It sounds so simple, but it is so hard to pursue and maintain. It is a daily, moment-by-moment decision to love and keep the focus turned outward. God is with you each of those moments ready to guide you and enable you to make those positive decisions.
Happy Independence Day! On this day of immense gratitude for all who have served to preserve our freedom, I am also thinking about your freedom. My passion professionally is to help people live out their retirement dreams in good health avoiding physical limitations. It sounds so basic. No one thinks medication-related issues will apply to him or her – until they do.
I have talked with hundreds of people who found themselves suddenly limited. It happened ‘out of the blue’ in many instances. In others, it was a gradual approach that was more visible in hindsight.
Pay attention to maintain your independence
In many cases people noted a change but didn’t pay much attention to it. Often a medication had been changed, and their energy level or their clear thinking changed. Maybe they got dizzier or couldn’t exert themselves as much. These little changes led to new symptoms that led to more new medications. This can be a slow, barely noticeable cycle that leads to trouble.
Ask the right questions to maintain your independence
Before any new medication is started, fully understand why it is necessary, what other options were considered, and what you should expect. Read the information that comes with the prescription. Look at the common side effects and pay attention to whether you experience those. If they last more than a couple of days or they make you decrease your activity levels, call your doctor. Talk with your pharmacist.
Take active steps to maintain your independence
Always go to your medical visits prepared. Take a list of every medicine you take – including vitamins, supplements, over-the-counter medicine, and any other substance. Even include the ones you only take once in awhile.
Take two copies of any items you want to discuss. Give one to the medical assistant who takes you to the exam room. Ask that assistant to give it to your doctor. Keep the other copy for yourself. Take a pen or pencil to take notes for each item on your list.
Think about any new symptoms and how you could best describe those. Include any details such as what makes it better or worse, what you have already tried, and when you first noticed the symptoms. These details help your doctor discover the cause more quickly.
Medication is nearly always involved in someone’s loss of independence. So often that is completely avoidable. Don’t let it happen to you. Let us thoroughly review your medication regimen today. We can help you avoid the common pitfalls that lead to lost independence.
For we do not want you to be ignorant, brothers, of the affliction we experienced in Asia. For we were so utterly burdened beyond our strength that we despaired of life itself. Indeed, we felt that we had received the sentence of death. But that was to make us rely not on ourselves but on God who raises the dead.
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.
I am praying you stay healthy, living independently in this lifetime so that you can do all God has called you to do. I am also praying you live in full dependence on the One who can guide your life through the amazing adventures He has planned just for you.
What are the key numbers in your life? I just turned 50. That is a number that seems like a real turning point. I like a viewpoint a friend shared with me: the first half-century is training and preparation for the better half!
Also, my daughter is graduating from high school. So, in her world the key numbers are GPA, SAT, ACT, and college fees.
Other numbers we keep close to us are phone numbers, bank balances, addresses, and birthdays.
Numbers and Health
Now I want to make sure you are aware of key numbers for your health. There is a reason for those labs at your annual physical. And there are goals for those numbers. When you see your lab results you will see your number and a range that contains all of the normal numbers. Ideally, your number falls in this range. If your numbers are little bit outside this ‘normal range’ for a little while, just talk with your doctor. If your numbers stay outside the range, your doctor will probably take action with medication, exercise changes, diet changes, or other plans.
Blood pressure – If you are under age 65, normal is less than 140/90. If you are over 65, some experts agree it’s ok for your systolic blood pressure (top number) to get as high as 150. Your blood pressure is one indicator of how hard your heart has to work. There are several medications that can be used to lower your blood pressure and protect your heart from having to work too hard. I am often asked about how low is too low for your blood pressure. That is not really determined by a number. It is found through symptoms. If you get really dizzy when you stand up, turn around, or try to walk faster, talk with your doctor. A little bit of this is expected with the medicines that are protecting your heart. If it is causing you to fall or keeping you from doing your normal activities, then let your healthcare team know.
Pulse – This is usually between 60 and 90 beats per minute. You can quickly check your own by touching the center of your neck and letting your fingertips slide to the soft area just to the side. Your carotid artery is there, and you can count the beats for 15 seconds then multiple by 4. The more you exercise, the more efficient your heart gets. So, really fit people tend to be at the bottom of this range. This should be measured when you are really at rest. If you are worried, in pain, stressed out, or in a conversation your heart rate will be higher. So, when this is measured, think quiet thoughts and don’t talk. If it gets and stays high, your doctor will order some more tests to check why. The same is true if your heart rate is slower than 60 beats per minute. Tests will be ordered to see what your heart is doing to cause the slow rate.
Cholesterol – We all have cholesterol, or fats, in our blood. This is normal. But there are healthy amounts and unhealthy amounts. These are the key numbers. For most people, your low density lipoproteins (LDL) number should ideally be under 100 mg/dL. If you have a strong history of heart disease, your doctor might have you try to reach an even lower goal. This is your ‘bad cholesterol’. Your high density lipoproteins (HDL) is your ‘good cholesterol’. Ideally you want this number to be over 40 mg/dL. Another cholesterol number is your triglycerides. This tends to go up if you have diabetes that isn’t well controlled. This number should be less than 150 mg/dL. Diet, exercise, and medications are all key in keeping these numbers in the goal range if you have high cholesterol (also called hyperlipidemia).
Blood sugar – Speaking of diabetes, this is a very important number for people with diabetes. It is important whether you have type 1 (requires insulin) or type 2 diabetes (can be treated with medicines you take by mouth, by inhalation, or by injection). Your blood sugar changes throughout the day. It is usually lowest before a meal and highest after. When you have not eaten for at least 8 hours, your blood sugar should be less than 100 mg/dL. (This is a ‘fasting blood glucose’.) Your healthcare team might ask you to measure your blood sugar at home. There are several types of monitors to do this. They might want you to check sometimes before you eat, sometimes after you eat, sometimes before bed, and sometimes when you first wake up. This will give them the best look at what your blood sugar does throughout the day.
Glycosylated hemoglobin (A1c) – This is another way to see what your blood sugar does over a period of time – about 3 months. It is a reflection of your average blood sugar over those months. People who do not have diabetes have an A1c under 6%. Current guidelines encourage a goal of less than 6.5% for people with diabetes. However, if someone is at risk for their blood sugar being too low your doctor might increase this goal closer to 7%. When people with diabetes also have other medical conditions, sometimes ‘tight control’ to under 6.5% is not possible or safe. Talk with your healthcare team for your specific goal and why that is the goal for you.
Body Mass Index (BMI) – This measurement is a reflection of your height, your weight, and your gender. It helps to define what is a healthy weight for you. The goal BMI is between 18.5 and 24.9. If your BMI is 25 to 29.9 you are overweight. If it is over 30 then you are obese. Your healthcare team will help you with a plan to get to a healthy weight and stay in that healthy range.
Blood Urea Nitrogen and Serum Creatinine (BUN and SCr) – These are important measures of your kidneys. They determine if your kidneys are clearing extra fluid, medications, and toxins from your body as they should. They can also tell your doctor if you are dehydrated from not drinking enough. As a pharmacist, I always look at these numbers when deciding if a medication is safe and at the right dose. When your kidneys are not working as they should, then it is hard to get some medications back out of the body. Another interesting numbers – Our kidneys start to very gradually slow down when we are in our late 30’s or early 40’s. This happens to everyone. So, with each birthday in our 50’s and beyond, these are important numbers to assess.
Aspartate aminotransferase and alanine aminotransferase (AST and ALT) – These are measures of how your liver is working. Many medications are metabolized (broken down) in the liver. If these numbers are very high, then the liver is not able to do its job to break down the medication. These are numbers I always look at when evaluating someone’s medication regimen. It helps determine what medicines should be avoided and what doses are best for you based on your liver.
Number of Medications – Sometimes several medications are needed to treat all of your medical conditions. Sometimes they are not. The more medications someone takes, the more risk of medications interacting and causing problems rather than helping them. There is no ‘magic number’, but most experts agree that taking more than 4 medications regularly means you need to have an expert very carefully evaluate your regimen. This is to double check that your medication regimen is providing optimal good with minimal risk.
An Evaluation of YOUR Numbers
Are you curious about your numbers? At Meds MASH we specialize in these evaluations, especially in anyone over age 60. Do you want to better understand your particular numbers? Do want to know that your medicines are providing optimal good and minimal risk? Call us today! We have found that over 50% of our clients need a medication adjustment once an expert evaluation is done. These adjustments come from your own doctor with our collaboration.
Have you read the entire Bible? I am on my second journey through the whole book. In the past I have read my favorite parts, read parts pertaining to Bible studies I was in, or read parts that others have recommended. After years of this focused reading, I thought I knew the Bible fairly well. But, here I am reading it all and learning so many new things!
I was recently working my way through the book of Numbers. I have to admit, I don’t find this to be the most exciting book. It can be downright hard to get through. But, I was hit by a new insight.
In Numbers God directed Moses through the exact, meticulous details of building the temple and the Ark of the Covenant.
He provided exact measurement for each aspect of the temple.
He described elements of the temple in extreme detail.
He gave exact specifications for each furnishing.
Each bowl and utensil was described in detail.
The role of each person in service to the temple was directed.
The clothing of each priest was designed to the last thread.
It hit me how incredibly precise is our God. Not any detail was left with precise design. God is perfect in every way.
Then, I thought about how sloppy I am in my communication with God. I pray, read my Bible, focus when I find the time. I squeeze God into the nooks and crannies of my day. Some days are much better than others. Even now as I am reading through the Bible in a year, I find myself rushing rather than deeply meditating on what I read.
Sloppy is NOT what God wants from me. He is more important than ANYTHING else in my life. My to-do lists, dirty house, and work schedule are not the priorities per God’s plan. They are the distractions. They are Satan’s best weapon to keep me away from a deep, life-sustaining life with my Creator.
How about you? Is your relationship with God truly all-in? What are your distractions?
Paul knew we would all face these distractions and temptations.
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.
Paul also knew we wouldn’t do it just because anyone said so. Rather we are encouraged to stay focused on God to find and lead the life of peace and joy that is ours if we choose this path.
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.
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 articleabout 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.
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.
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.
“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.
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
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.
If it is severe, scary, or won’t go away, be sure to tell your doctor.
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.
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.
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.
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.
Too many times I have asked people what their doctor said and heard, ‘I have no idea; I couldn’t understand him/her.’
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.)
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).
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:
Control medical problems
Make symptoms better
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!
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.
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.
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.
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.
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.
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.
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:
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.
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?
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 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!
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.
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.
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!
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.
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.
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.
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.
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.
“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.