Numbers: Do you know the importance of each of your numbers?

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Know how your numbers are key to your health.

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.

You can call for your appointment at 410-472-5078 or e-mail at michelle@medsmash.com or through our website www.medsmash.com/contact.

BIBLICAL APPLICATION

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.

1 Corinthians 10:13 ESV

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.

1 Corinthians 7:35 ESV

I say this for your own benefit, not to lay any restraint upon you, but to promote good order and to secure your undivided devotion to the Lord.

I pray we can all keep striving to keep God at the center as in the words of David:

Psalm 19:14 ESV

Let the words of my mouth and the meditation of my heart be acceptable in your sight, O Lord, my rock and my redeemer.

Blessings to you my sloppy but trying to be better friends!

Michelle

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Narcotic Addiction – the epidemic and new strategies

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Prolonged use at higher than necessary doses can lead to opioid (narcotic) addiction

Narcotic addiction is now at epidemic proportions. Drug abuse has been with us for all of recorded time. The specifics of the drug(s) most commonly abused change over time. Sometimes the most abused drugs fall out of favor for a while and then reemerge. Common examples from the past few decades include LSD, cocaine, crack cocaine, and inhalants.

Right now, prescription opioid pain medicines (narcotics) are being abused at an alarming rate.

According to the Centers for Disease Control (CDC), 2 million people abused or were dependent on opioid analgesics in 2014.

Refer back to last week’s blog. Terms are very important here. Dependence is a physiologic response to these medications. Anyone who takes them over time will have some changes in how their body handles pain signals. The body’s normal response takes a backseat to the medication. In order for the body to take over again, the medication needs to be titrated off slowly. If you stop the medication all of a sudden, the body goes through withdrawal. It can’t take back over the pain control that quickly. It needs time to gear up. NOTE, this type of dependence and withdrawal is different than ADDICTION.

Addiction

Genetic, psychosocial, and environmental factors all play a role in the creation of an addiction.

Addiction usually occurs when the opioid medication is continued after the pain has gotten better. Sometimes people keep taking the medication for the effects beyond the pain relief. Some people feel a euphoria or high while others are very laid back.   If they keep continuing the medication for this purpose, then addiction can occur. Not only are the body’s receptors letting the medication handle pain it is seeking these other effects. Over time it takes a higher dose more frequently to get the same amount of desired effect. So, doses keep going up and desire to take the medication is very strong.

The FBI and the DEA created a documentary about this addiction. If you would like to know more, I highly encourage you to watch this video. You can find it at this link: https://www.fbi.gov/news/stories/2016/february/raising-awareness-of-opioid-addiction/video/chasing-the-dragon-the-life-of-an-opiate-addict.

In March of this year (2016), the CDC released new guidelines for prescribing of these medications. If you would like to read them, you can find it at this link: http://www.cdc.gov/drugoverdose/prescribing/guideline.html . These guidelines are emphasizing less use.  Use only for moderate to severe pain.  Use at the lowest possible dose for the shortest time possible. There are other, non-addictive options for lesser pain.

When people addicted to prescribed opioid pain medications can’t get more prescriptions, they often turn to heroin. This is another opioid substance that is illegal but sadly, easier to get ‘on the street’. This allows the addicted person to keep getting the effects they are seeking. Note, at this point, addicted people realize this is a miserable, horrifying state. But the demands for more drugs override common sense. Again, I highly recommend watching the video created by the FBI and DEA.

So overcoming this epidemic is being addressed from the prevention side by the new prescribing guidelines. It is also being addressed through new medications and techniques to help people escape the addiction. So, there is hope for the future with this addiction!

If you would like to know more about narcotic addiction, new steps to address it, or similar topics, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Temptation has been part of our world since Adam and Eve, the very first people. It did not take mankind long at all to prove how difficult resistance to temptation can be.

I first want to send a loud, clear message that love, compassion, forgiveness, and constant support are key elements of walking away from addiction. Rather than avoid, isolate, and punish those who find themselves addicted, we have a calling to reach out in love and be part of that crucial support network.

Proverbs 17:17 TLB

A true friend is always loyal, and a brother is born to help in time of need.

1 Peter 4:8 NIV

Above all, love each other deeply, because love covers over a multitude of sins.

I want to write about temptation and the fact that it is a fact of life. God knows all about the temptations in our path. He is also there to help us through. And when we are entangled in a temptation that we did not resist, He is there to bring us back away from it.

1 Corinthians 10:13 ESV

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.

1 Peter 5:8 ESV

Be sober-minded; be watchful. Your adversary the devil prowls around like a roaring lion, seeking someone to devour.

James 1:12-15 ESV

Blessed is the man who remains steadfast under trial, for when he has stood the test he will receive the crown of life, which God has promised to those who love him. Let no one say when he is tempted, “I am being tempted by God,” for God cannot be tempted with evil, and he himself tempts no one. But each person is tempted when he is lured and enticed by his own desire. Then desire when it has conceived gives birth to sin, and sin when it is fully grown brings forth death.

1 John 2:16 ESV

For all that is in the world—the desires of the flesh and the desires of the eyes and pride in possessions—is not from the Father but is from the world.

I pray you are always aware of the temptation around you and the help available to you at all times from God. I also hope you find opportunities to reach out to those who have fallen into temptation and love them back out of that snare. That love might be tough love, but the Bible is full of examples of that too. Check out Luke 6:27-49.

Blessings,

Michelle

Narcotics, opioids, and addiction – important facts

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Learn the facts about safe use, natural physiologic changes when you take opioids, and addiction.

There is a lot of information in the news about narcotics, opioids, overdose, death, and a heroin epidemic. Now there is new legislation to try to stop this downward spiral. Have you found it confusing? If you say yes, you are not alone!

First, narcotics = opioids

The correct medical term for these pain medicines is ‘opioid’. This refers to the way they work. These pain medications interact with the mu-receptors and other opioid receptors throughout the brain (and the gastrointestinal tract). As they trigger the mu-receptors, they block pain sensations. They can also cause euphoria, dysphoria, or sedation. So, they can make you feel really good, really laid back, or really sleepy.

There are several medicines that fall in this category of opioids. Here are a few (and some brand names):

  • Morphine (MS Contin, Avinza)
  • Hydromorphone (Dilaudid)
  • Codeine – combined with acetaminophen (Tylenol #3)
  • Hydrocodone – combined with acetaminophen (Lortab, Norco, Vicodin)
  • Oxycodone (OxyContin, Roxicodone)
  • Meperidine (Demerol)
  • Fentanyl (Sublimaze, Duragesic)
  • Methadone (Dolophine)

These medications have been used for decades to treat moderate to severe pain. Pain relief is important in many instances not only for your quality of life but also to get you moving again after a painful event. For instance, it is critical that you get moving again soon after a knee replacement, back surgery, or other similar surgery. As you get moving again you increase your chance of really getting back to full function. You also decrease the risk of a blood clot from lack of use. But, those surgeries are painful. The opioid medication helps relieve that pain allowing you to start your rehabilitation.

When used short term for pain, addiction is not likely

Addiction is usually associated with long term use and/or use for the feeling you get from the medication beyond the pain relief. It is also associated with using more than you are prescribed. To safely use opioid pain medication, use the lowest dose that allows you to move through your pain. Also, use it for the shortest time possible. As the pain level decreases, you can move from an opioid  to a nonopioid pain medicine. Work with your prescriber to determine when you are ready for this change and which option will work best for your pain.

Key terms

The body contains a wonderfully complex system of signals and receivers to transmit and control pain sensations. The body and these communication pathways in the brain and the central nervous system are well organized. When the pain signals are too distressing and an opioid pain medicine is added, the normal body signals and receivers adapt to the effect of the opioid pain medicine. There are natural, physiologic changes that occur in your body as these medicines are used over time. I want you to understand these changes. When they occur, they do not mean you are addicted!

Physical dependence – As the body lets the medicine treat the pain, the body’s normal pain process relaxes.

Tolerance – When you take an opioid pain medicine over time, those nerve transmitters (signals) in your body adapt. Over time doses have less effect and last a shorter period of time. So, over time, the dose needed for the same pain relief goes up.

Withdrawal – When the opioids are suddenly taken away, the body can’t take over the pain control immediately. If this sudden stopping of the medicine happens, you will feel body aches, irritability, fast heart rate, weak. and have difficulty sleeping. You might also yawn, shiver, and have an upset stomach.

These are the body’s normal reaction to having the opioid pain medicine take care of the pain. When your pain level drops to mild to moderate pain, your prescriber will start to slowly decrease your dose of opioid pain medicine. This will allow your body’s normal process to take back over in controlling your pain.

Next week we will cover more about addiction and steps being taken to stop the current epidemic of opioid pain medicine abuse. Addiction involves continued use over time, inability to control drug use, compulsive drug use, continued use even when you know the drug is hurting you, and craving of the drug.

These opioid medications can play a very healthy role in controlling your pain when dosed appropriately and used for the shortest time possible.

If you would like to know more about opioid pain medicines and how they affect you, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

Addiction is so very complex. It is one of many examples of how something good for you can become something bad for you.

It is not possible to look at someone and say, ‘He is an addict.’ Or ‘She is likely to be an addict.’ It is not true that ‘bad people’ become addicts while ‘good people’ avoid that outcome. Parts of the addiction process seem to be within our control while others take us by surprise. We will go in to more detail next week.

So, this is a key area when we can share our compassion and the love of Christ.

It is also a reason to reflect on our self-control. This is one of the fruits of the spirit.

Galatians 5:22-23 ESV

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control; against such things there is no law.

We are all tempted by various things. One of Christ’s messages to us is to let Him be our strength and shield.  This was shared by Paul as he was explaining why and how we should stay away from idols and temptations that lead off the path to Christ.

1 Corinthians 10:13 ESV

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.

Psalm 28:7 ESV

The Lord is my strength and my shield;

    in him my heart trusts, and I am helped;

my heart exults,

    and with my song I give thanks to him.

Peter sums up our role to work on our own self control and in the process share love and compassion with our fellow humans.

2 Peter 1:5-7 ESV

For this very reason, make every effort to supplement your faith with virtue, and virtue with knowledge, and knowledge with self-control, and self-control with steadfastness, and steadfastness with godliness, and godliness with brotherly affection, and brotherly affection with love.

Blessings,

Michelle