Divorce around retirement – You’ve seen it in pop culture, in famous people. And, you’ve likely seen it in your own community. It won’t be surprising if you are seeing this trend in your own family, even your own marriage.
The incidence of divorce over age 50 is experiencing a sharp rise. It has nearly TRIPLED since 1990. (Interestingly, the divorce rate among younger adults under age 40 is declining). So, why are the Boomer’s divorcing at an unprecedented rate?
The role of RETIREMENT in divorce
Retirement is one of the top 10 biggest life adjustments. It is a time of huge transition ranking right up there with marriage, having children, moving, and loss of a loved one.
Many people enter retirement unprepared. They often haven’t thought about the daily changes, the sudden loss of routine, and the sudden increase in togetherness time with their spouse.
In a perfect, romantic world, more time together is exactly what each couple wants. Nothing in life is perfect, at least not for long.
That’s not to say that marriages can’t thrive in retirement. They absolutely can. But that usually requires some communication, compromise, and adjusted expectations.
A healthy marriage in retirement
Both partners have a lot of change to navigate with retirement. Time spent together usually increases. Either partner might find that restrictive. The more we are together, the more complicated communication can be as well. (It is much easier to say the wrong thing when you’re talking more).
The most important step to a healthy marriage in retirement is to talk about it before it happens, or at least before relations get very hurtful after retirement. Rarely do both partners have a clear picture of what retirement will really be like. But, both have some ideas of what they want it to be like. How much have you talked about this?
Until it happens, sometimes people don’t even know what might annoy, frustrate, or stifle them in retirement. Agree to be open with one another as these stumbling blocks present themselves. Recognize that they will occur, and before they are personal or hurtful, calmly talk about them.
Plan for how you will maintain some independent interests and activities. If you have had only a few hours in the evening and on the weekends together for decades, 24/7 togetherness can be overwhelming.
Talk about expectations. What are common aspirations, plans, and desires? Unmet expectations are almost always at the center of a divorce. Often, one doesn’t know what the other was expecting until the relationship is too far-gone. Don’t let that happen.
I’ve seen examples where one person wants to travel while the other wants to stay home.
Sometimes one has always dreamed of taking couples dance lessons and the other would rather do anything but that.
A big issue I’ve seen is one spouse wants a lot of togetherness going and doing things while the other wants to spend most time with the grandchildren.
Include the more intimate parts of your relationship in your planning. This is an area of frequent mismatch in expectations. There is NO truth that sex ends at a particular age. It is very helpful when partners can open discuss these expectations and honor what motivates the other partner to share the same desires.
Planning is key
Don’t leave your marriage to chance after retirement. Recognize that retirement is a major life transition. Respect the wide range of emotions and adjustments each partner will make.
Retirement Wellness Strategies is here to help! Let us help you preserve your health and strategically plan for all aspects of your retirement such that it is Meaningful, Active, Sustained, and Healthy!
Marriage is sacred. Marriage vows are committed in the presence of God and witnesses.
Yet, marriage can be very hard. Marriages go through good and bad times (as usually stated in the vows).
Today’s culture values feelings over commitment. Culture supports and sometimes even promotes greater focus on self than on a partner.
I know so many lovely people who have experienced the trauma of divorce. Know that you are deeply loved. God knows the details. Give the grief, disillusionment, and any other feelings over to him who can heal all wounds.
Where have you made mistakes in your marriage?
When have you put yourself above your spouse?
When have you been hurtful and unkind?
When have you taken your marriage for granted?
I believe all married people have done these things. We all have difficult days.
The commitment of marriage doesn’t mean sunshine and roses.
Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrongdoing, but rejoices with the truth. Love bears all things, believes all things, hopes all things, endures all things.
There’s a reason these verses list all of the ways we mess up in marriage or any love relationship.
If you feel like you’ve done it all wrong, don’t give up hope. Love comes from God, and He can fill your love bucket at any time…just ask. Love is so much more than a mushy feeling.
Retirement is often not the golden age of happiness that is dreamed.
Retirement is a MAJOR life transition – up there with marriage, having children, and moving.
I have been researching more and more about retirement. As a healthcare professional, I have seen TOO MANY people lying in a hospital bed with their future retirement plans dashed. And, TOO MANY times, this event that led to the hospital could have been prevented. If only things had gone differently hours, days, months, or years earlier, this hospital visit could have been avoided.
Role of Medication Use
Medication use plays a part in these avoidable events at least 80% of the time. There are many ways medication can be part of the problem:
Not taking a medication that is prescribed.
Taking too much of the medication.
Taking too little of the medication.
Taking a medication for one thing that makes another problem worse.
Taking medications that are not safe together.
Having a severe side effect from a medication.
Not seeking medical care for a problem that should be treated with medication.
Taking a medication when no medication is needed.
And then there are multiple variations of each of these issues.
Medications are not benign.
Medications are not all bad.
Medications can save lives.
Preparing for the future
Sometimes the preventable problem is related to lack of planning for retirement.
Most people think of MONEY when they think of retirement planning. There are many professionals who dedicate their career to helping people secure the finances for retirement. Others focus on insurance and protection of assets.
Few have made plans for the enormous lifestyle transition that is retirement. Those who especially struggle with the transition are:
people who are very busy at work with a lot of responsibility,
those who always have people lined up to talk with them,
those who are the decision makers, and
those who run the company.
The withdrawal from the daily demands of work can be similar to any other withdrawal from an addiction. Symptoms the first few days can include:
sense of loss
sense of loss
Later withdrawal symptoms can be:
feelings of inadequacy or irrelevance
lack of concentration
Planning for Retirement
Finding the retirement years of your dreams takes planning. How will you prepare for the first day the phone no longer rings, people are no longer lined up outside your office, and the big decisions are made without your input?
We dream of retirement practically from the time we start working. The thought of a break from the pressure sounds wonderful. Then it happens…
I have talked to many men, most thinking they had planned well for retirement, who are then surprised and disappointed when the realities of the transition hit. Others plan to never retire to avoid going through this.
A successful transition to many happy years and a long delay of functional decline is possible!!!
And the Lord spoke to Moses, saying, “This applies to the Levites: from twenty-five years old and upward they shall come to do duty in the service of the tent of meeting. And from the age of fifty years they shall withdraw from the duty of the service and serve no more. They minister to their brothers in the tent of meeting by keeping guard, but they shall do no service. Thus shall you do to the Levites in assigning their duties.
And how wonderful to have a phase of life where you keep doing the joyous parts and let the hard work go!
Is your attitude the RESULT of what is happening around you? Is it the RESULT of what others do to you? Is it the RESULT of your life circumstances? —-OR—-Is your attitude your CHOICE?
I propose your attitude is your CHOICE!
We live in such a blame society. People are called haters, shamers, intolerant, biased, and worse.
So often we try to claim that others made us the way we are – sullen, angry, withdrawn, hurt, rejected.
We give others and situations the power to determine how we are going to go through each day and how we are going to approach life.
If you are a balloon bouncing in the winds of circumstances, there is hope!
How to choose your attitude
What are your first thoughts in the morning? How do you approach your day? What music do you choose? What do you read, think about, and how do you plan for your day?
These aspects of your life are associated with maintaining health even in the midst of negative events:
friends to talk to
people who care about you
a sense of self-worth
conflict management skills
The items on this list have all been linked with improved health.
And I will add having a source of HOPE. I believe hope is powerful in the midst of difficulty.
Gratitude and attitude
Another way of thinking that improves your attitude and your health is gratitude. For what are you thankful? No matter how many bad things are around you, what is good? You’re still here if you’re reading this! What parts of your body work? What are you able to do? Who do you care about? Where are your safe places? Where is the beauty around you – pictures, nature, architecture, music, literature, videos, clouds, trees, or babbling water?
Find those good things and be thankful for them. Fill your bucket with all of the good in your life. It makes the bad much more tolerable.
Make it about someone else
Doing something for or being kind to someone else can be a real attitude adjuster. Rather than focus on yourself and your own needs, raise your head and look at the people around you. Find something small you can do to make someone else’s day. You will be amazed that you benefit from those actions at least as much as the person you blessed.
Health benefits of a good attitude
No one can choose your attitude except YOU! This is such a liberating concept. In the midst of and despite the difficulties of life, you can each day CHOOSE to have a GOOD attitude!
When you do, your physical health (blood pressure, breathing, kidney function); your mental health (calm, clearer thinking, more creativity); your emotional health (less reactive, more even emotions); and your spiritual health (happiness, hope, joy) benefit.
And we know that in all things God works for the good of those who love him, who[a] have been called according to his purpose.
If you haven’t heard Francesca Battistelli’s song, Where Were You?, I highly encourage you to listen.
Yes, the difficulties of life will keep coming at you. You know they will, but those are the very events that allow us to grow deeper in our faith and find that hope that keeps our attitude good in the midst of everything.
Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us.
Choose your good attitude each day and let it shine for the world to see!
We spend so much of our time thinking about tomorrow, planning for tomorrow, working for tomorrow, hoping and dreaming for tomorrow. But tomorrow is never here, and we’ve learned that over and over.
We’ve seen so many examples lately of the value of living in the moment. There is value in loving those around you each and every day. You never know which is that last day.
Rather than be depressed about that, we can claim the joy and the opportunities of each day that presents itself to us.
Seasons of Loss
We have lost a dear friend in the last couple of weeks. He was someone who was always thinking of and giving to others. He was a very strong-in-his-faith man. He died in a freak accident doing what he does best – helping others. He was building a Habitat for Humanity house. We will never know what happened. The freak accident occurred, and he was suddenly gone.
A tiny baby died in his sleep at two months. There was so much promise there. Why was that child taken at such a young age?
Then we see the news stories of people harming one another. It seems there are more and more stories of mass deaths and of people managing conflict with murder.
The tragedies of nature have taken even more lives and wreaked havoc in many parts of the world.
It’s been such a heavy season of so many people taken at a time no one would have expected.
How do we keep moving forward?
So with that in mind, how can we live each day to its fullest? The more we live in gratitude and love and recognize the joys that are around us in spite of the tragedies, the more healthy we are. It lowers our blood pressure and anxiety levels. It lowers our risk for heart attack and stroke.
Gratitude and Love
Gratitude and love allow us to think so much clearly. They take us out of that worry mode and in to a more creative space in our brain. We think more clearly, can be more rational, and recognize the good when our brain is fully functioning at calmer times. This calm allows our breathing to slow. It allows us to really see the things around us rather than be so focused on what’s ahead.
I encourage everyone to take a deep breath. Love on the people who are around you. Look around with joy and gratitude at the many blessings that you do have.
Remember with fond memories, and hopefully with some tears and laughter, those who we’ve lost.
Let this be a day of renewed health and joy and love.
Give thanks in all circumstances; for this is the will of God in Christ Jesus for you.
Have you tried making gratitude your very first morning event, before you even crawl out of bed? I find when I start my day in thanks it sets the tone for a much better day. I can be grateful for the fact that a whole new day is before me, and once I get started, there are SO many things to list. Even the warm bed and blankets are a gift that not everyone shares. It’s so easy to take home and family and jobs and clothes and food and friends for granted.
Let the peace of Christ keep you in tune with each other, in step with each other. None of this going off and doing your own thing. And cultivate thankfulness. Let the Word of Christ—the Message—have the run of the house. Give it plenty of room in your lives. Instruct and direct one another using good common sense. And sing, sing your hearts out to God! Let every detail in your lives—words, actions, whatever—be done in the name of the Master, Jesus, thanking God the Father every step of the way.
Oh give thanks to the Lord, for he is good; for his steadfast love endures forever! Let Israel say, “His steadfast love endures forever.” Let the house of Aaron say, “His steadfast love endures forever.” Let those who fear the Lord say, “His steadfast love endures forever.” Out of my distress I called on the Lord; the Lord answered me and set me free. …
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.