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Know before you decide

Informed Decisions – how do you make your healthcare decisions?

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

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

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

Personal Health Decisions

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

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

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

Research Pros and Cons

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

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

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

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

Evidence-Based Medicine

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

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

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

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

Substances without this level of evidence

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

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

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

Healthcare providers and self-treatment

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

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

Purpose of this blog – make informed decisions

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

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

Contact me

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

BIBLICAL APPLICATION

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

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

James 1:5 ESV

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

Philippians 4:6-7 ESV

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

1 John 5:14 ESV

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

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

Proverbs 3:5-6 ESV

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

Jeremiah 29:11 ESV

For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.

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

Blessings,

Michelle

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Are you meds making your memory better or worse?

Your Medications and Your Memory – making things better or worse?

Posted on by Michelle Fritsch, Pharm.D.
Are you meds making your memory better or worse?
Memory

Do you ever feel like your memory is slipping? Are you getting forgetful?

Prescription Medications and Memory

Which of your medicines is helping preserve your memory? There are several medical conditions that can make your memory worse. The medicines that treat those conditions then help preserve your memory. Some examples include medicines for heart disease, seizures, blood thinners, asthma inhalers, or emphysema and bronchitis inhalers. Oxygen is a common theme with many of these medications. If you have a medical condition that could decrease the oxygen getting to your brain, this could worsen your memory.

Which of your medicines is actually making your memory worse? Unfortunately, there are many medications that can do this. Any medication that can make you sleepy or slow your thinking can make it harder to remember things. Any medicine that impacts how your brain functions can alter clear thinking. This does not mean all of these medications should be avoided. It does mean to not assume you have dementia when you have foggy thinking while on these medications. There are many examples; some common ones are medications for pain, anxiety, and depression. Anticholinergic, or very drying, medicines cloud your thinking. Recently, statin medications for cholesterol have also been associated with memory impairment.

There are currently two classes of medicines approved for use in Alzheimer’s Disease. For many medical conditions, once diagnosed, you are prescribed a medication(s) to treat that condition. This is not as simple with the dementia medications. They do NOT cure or prevent dementia. They do NOT help all people with dementia. The best impact they have is to slow the progression of dementia, and again, not everyone who takes them will have this result. They have cholinergic side effects that include nausea and diarrhea. If they are stopped after they have been taken, there can be a rapid decline in the dementia. It is not known if the decline is to the point the person would have been if they had not taken the medicine, or if it is an even sharper decline. So there is much to discuss with your physician and healthcare team before deciding to take these medicines.

How about vitamins?

Vitamins are perfectly safe, right? The more the better, right? For many vitamins, taking more than you need is just a waste; your body gets rid of what it doesn’t need. But some other vitamins are not easily cleared, and too much can cause problems. Vitamin E is a vitamin that has been studied to see if it can help with memory. Although some studies have had mixed results, there is no evidence that vitamin E can prevent dementia. There is some data that suggests it might help slow the progression of Alzheimer’s disease. But, there have also been reports of increased risk of death with vitamin E. This is because it can interact with several medications, especially those that can cause bleeding such as medicines that prevent clots. It is also one of the vitamins that the body can’t easily expel, so it is possible to get too much.

Vitamin B12 is another that has been studied.  If your vitamin level is low, then vitamin B12 can help.  However, if your B12 level is normal  supplements will not help.

The best way to get vitamins is through your diet.

And what about herbal remedies, natural remedies, or supplements?

There have been some studies looking at gingko biloba. It does not appear to prevent Alzheimer’s or other forms of dementia. There is some data that suggests it might help stabilize dementia. In particular, some studies show that it can help stabilize mood. Healthy people who take gingko report feeling more alert. However, there are several medication interactions to consider before you take this. It can increase risk of bleeding and can impact blood sugar control if you have diabetes.

Other substances that will change your ability to think clearly are alcohol, marijuana, and illicit substances. They may not be prescribed (yet), but they can definitely impact how sharply you think. Include these when you talk with your physician and your pharmacist about your medicines.

Some medications can help preserve your memory, and some medications can make your memory worse. Vitamins, over-the-counter medicines, supplements, and herbal remedies all should be considered medications. Share all that you take with your primary care provider and your pharmacist. That will allow them to make sure there are no medicines or interactions that are negatively changing your memory.

For more information about your medications and your memory, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

Just as medication can cloud our thinking and memory, what can cloud our spiritual life? Do you ever feel that you are just not fully connected with God? Does it ever feel like something is clouding the connection? Or do you find it’s easier to just ignore the connection?

In my life the most common culprits are:

  • To-do lists
  • Crazy schedules
  • Worries

Martha got caught up in similar tasks. She was fretting so much about hosting Jesus that she failed to experience Jesus.

Luke 10:38-42 ESV

Now as they went on their way, Jesus entered a village. And a woman named Martha welcomed him into her house. And she had a sister called Mary, who sat at the Lord’s feet and listened to his teaching. But Martha was distracted with much serving. And she went up to him and said, “Lord, do you not care that my sister has left me to serve alone? Tell her then to help me.” But the Lord answered her, “Martha, Martha, you are anxious and troubled about many things, but one thing is necessary. Mary has chosen the good portion, which will not be taken away from her.”

There are several verses that help us realign our thoughts and hearts.

Romans 12:2 ESV

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Matthew 11:28-30 ESV

Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.

1 John 2:17 ESV

And the world is passing away along with its desires, but whoever does the will of God abides forever.

Philippians 3:13-14 ESV

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

To use a sports analogy, keep your eyes up and focused on the long game. Daily struggles become easier to navigate when your focus is on God. He will lead you step by step according to His plan for you.

For it is impossible to be in the presence of Jesus and not be changed.  

– Joanne Weaver

This might sound contrite, but truly give your day to Him, keep your focus on Him, and see what happens.

Blessings,

Michelle