Truth

Clean up the garbage in your life with healthy choices

Garbage in can turn you to rubble – change your choices

Posted on by Michelle Fritsch, Pharm.D.
Clean up the garbage in your life with healthy choices
Garbage in your life leads to negative consequences.

You’ve heard, ‘garbage in – garbage out’. Wow, that holds true with our health, too. I want to focus on three particular types of garbage in our lives.

  1. Garbage food

I admit I am not the most healthy eater. But, I do try to make good choices most of the time. I have eaten enough healthy food to notice the impact of unhealthy food.

The other day I was at a meeting in an unfamiliar part of town. Time was tight as I left that meeting and went to teach a class. So, I opted for the fast food restaurant that I could see a couple of blocks down the road rather than search for some other quick food source. When I was growing up, and even earlier in our marriage, it was not uncommon to eat at this fast food chain. I had not eaten there now in a few years. I had a small burger and onion rings. It looked good, tasted, great, and went down easily. Then, within an hour, I felt queasy, bloated, and tired. I was surprised at how different I felt.

There is extensive evidence that our food choices impact our risks for diabetes, heart disease, high cholesterol, and maybe even dementia. Your brain, your veins and arteries, your heart, your kidneys, your liver, your eyes, your skin, your hair, your nails, and more parts of your body are impacted by what you eat.

If you have not seen it, I encourage you to watch the documentary, Super Size Me. I found it very eye opening about the dangers of frequent fast food.

Eating your largest portions with colorful fruits and vegetables, joined by a fist size piece of lean protein (e.g. meat such as lean chicken or fish), and some grains is ideal. You can find more detailed guidelines at Choose My Plate.

  1. Garbage media

What you see and what you hear have a big impact on what you think. Media plays a big part in our lives! Music, television, video games, and social media are huge general areas of so much content. The choices we make about our media help shape how we think, how we view the world, our ability to concentrate, or attention span, and our mood.

If you’re interested in the science linking music and our thoughts and actions, see this interesting article by a known expert on the subject, Dr. Bernard Luskin.

Media that promotes negativity, hate, and crime promotes such thoughts and activities. Pornography changes thinking, desires, and satisfaction. There is even an addiction associated with social media.

On the other hand, spending time with uplifting people, positive music, and other positive media can really brighten your day!

  1. Garbage relationships

Who in your life lets you know how valuable, appreciated, and loved you are? Keep those relationships!

If you have people in your life who feed you negative, demeaning, or other messages that kill your sense of self-worth and confidence, move away from those relationships. Surround yourself with the positive images of your immense value and lovability.

The messages you receive can impact how you see yourself. Stay around those who are the positive influences in your life.

Choose to replace your garbage with treasure

This is just a brief exploration of how garbage in can damage you. I encourage you to consider how you can replace the garbage. Consider the diet changes that will make you feel better, more energetic, less bloated, and give you more clear thinking. Consider how what you watch and hear could be more positive and uplifting. Consider how you could spend more time with people who lift you up.

To better understand how positive input will enhance your health, contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

Just like our physical and emotional health negatively respond to ‘garbage’, so does our spiritual health.

What are the sources of ‘garbage’ when it comes to our spiritual health?

False teachers

We are repeatedly warned in the Bible about people who will look legitimate but actually be teaching false information.

2 Timothy 3:5 ESV

Having the appearance of godliness, but denying its power. Avoid such people.

We are warned about times coming that will tempt us to turn away from God’s truth.

2 Timothy 4:3-4 ESV

For the time is coming when people will not endure sound teaching, but having itching ears they will accumulate for themselves teachers to suit their own passions, and will turn away from listening to the truth and wander off into myths.

Colossians 2:8 ESV

See to it that no one takes you captive by philosophy and empty deceit, according to human tradition, according to the elemental spirits of the world, and not according to Christ.

Temptations

We are surrounded by strong temptations. As we saw above, media and other social messages teach a message much different than God’s truth.

Galatians 5:16 ESV

But I say, walk by the Spirit, and you will not gratify the desires of the flesh.

1 Corinthians 15:33 ESV

Do not be deceived: “Bad company ruins good morals.”

Negativity in our society

2 Corinthians 12:20 ESV

For I fear that perhaps when I come I may find you not as I wish, and that you may find me not as you wish—that perhaps there may be quarreling, jealousy, anger, hostility, slander, gossip, conceit, and disorder.

Titus 3:10 ESV

As for a person who stirs up division, after warning him once and then twice, have nothing more to do with him,

So to avoid the ‘garbage’ that is all around you, follow God’s plan. In the midst of it all, keep this in mind.

Philippians 4:8 ESV

Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things.

Blessings,

Michelle

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Fear of Failure, Hidden Truths, and Your Health

Posted on by Michelle Fritsch, Pharm.D.
Slide1
Fear and hidden truths are bad for your health.  There is GOOD news!

This is a major religious holiday week for two of the most prevalent religions in the world – Judaism and Christianity. Jews are commemorating the Passover and God’s leading the Israelites out of slavery in Egypt. Over the following 40 years they were in the desert on the way to the promised land with delays due to disobedience. Their mistakes and wayward decisions had many consequences.

The Jews were enslaved and mistreated by the people of Egypt. They then were ungrateful and easily distracted from the miracle of their deliverance. They continued to make mistakes.

Christians are celebrating Easter, the risen Christ after a brutal betrayal and death 3 days earlier.

The people who celebrated Jesus’ entry into Jerusalem were the same ones who cried ‘Crucify Him’ a few days later. And even after this supreme sacrifice, Christians continue to sin. We continue to sin, make mistakes, and get absorbed in ourselves.

So, it wasn’t just the people in Biblical times that made mistakes. We ALL continue to do that every day. How do you handle your mistakes? How do you handle the things you choose to do that you later regret? How do you handle the things that are done to you that hurt you?

Fear of Failure

I have known many people who are afraid of failing. Often, they are even more afraid of anyone finding out that they failed. There seem to be two extremes of ways to handle this fear.

#1 – Avoid any situation that could result in failure. Do you shy away from any risk? Do you avoid variation in your life and avoid all opportunities since you aren’t guaranteed success? How deep does this fear run? Do you eat the same meals repeatedly rather than try something new? Do you keep the same schedule to minimize an unexpected situation?

#2 – Hide any hint of failure. Do you take some risks but hide or deny anything that goes wrong? Do you maintain the illusion of perfection? Do you push away people who might get close enough to see your weaknesses?

Fear of failure is a prime source of anxiety. The fear is so intense just the thought of taking a risk provokes stress, rapid heart rate, sweating, feelings of overwhelm.

Fear of failure can lead to depression due to self-selected isolation. Or, if you hide and deny your failures, you can get caught in a web of lies that gets beyond your control.

Hidden Truths

I don’t want to count the number of people I’ve talked with who have a sad secret hurt from their past. These hurts changed their lives. They are terrible things like abuse, rape, molestation, abandonment, or neglect. They have ‘dealt’ with these issues by trying to deny they happened. Or, they have been told by family to keep quiet and never talk about it. Other times the hidden truths are of marital affairs, lost jobs, drug abuse, or heavy drinking.

Whatever the hidden truth, there is no denying the impact. Our conscience knows and doesn’t forget.

Like before, if you keep it hidden, suppressed, and don’t release it, all of that pain comes out another way. I have known so many people with chronic pain that was related to these hidden truths. Others suffered from anxiety and/or depression. There was an ever-present fear and ‘dark cloud’ in their life.

Counseling and Medication

Many people choose to ‘treat’ these fears and hidden truths with medication. Sometimes it is with prescribed medication such as antianxiety or antidepressant medications. Other people choose to self-treat with alcohol, marijuana, or other substances.

The medication can help in many instances. In others, it just dulls the thinking. The memories, the guilt, or the hurt isn’t as sharp when under the influence of the medication or other substance.

Your life is meant to be lived fully aware and present. You miss out on so much when you aren’t engaged in your life.

That is very often where counseling comes in. These fears and hidden truths need to be released. Counseling, clinical or faith based, can be that outlet to help you really deal with these hurts, mistakes, or ongoing issues. Through counseling you can confront these items, face them, learn to process them, and then learn to live beyond them. (Note, I am not suggesting your hurts, fears, and pain are not real. I am not suggesting you will just walk away and forget them. I am suggesting you can benefit from counseling +/- medication.)

This is one of those areas that can’t be ‘fixed by a pill.’ The medication can help, but it is unlikely to actually resolve the problems. A trusted, skilled counselor can help you get back to really living.

To learn more about the role of medication and for help finding a good counselor, contact us at Meds MASH, LLC at www.medsmash.com/contact or 410-472-5078.

BIBLICAL APPLICATION

Christ is risen!!!!!! He is alive and active and so very present in our world today.

I am writing this on Easter. It is such a beautiful day. Not only is it warm and sunny outside, but what an amazing day to reflect and let is sink down deep that Jesus went through the worst people can do to other people all because of his love for me, for you, for all of us!

He put himself in the situation to endure physical pain in the extreme over many hours, rejection, slander, betrayal, humiliation, abuse, and complete degradation. I don’t know about you, but I fear ANY of those things. I can’t imagine purposefully enduring any of that.

I am the sinner for whom he died. I am the sinner – each and every day – who he loves and forgives over and over and over and over…

James 4:17 ESV

So whoever knows the right thing to do and fails to do it, for him it is sin.

Romans 8:1 ESV

There is therefore now no condemnation for those who are in Christ Jesus.

I can’t deny it. I might try to pretend to avoid sin, but you know better. We ALL sin, in spite of our best efforts to not. You are not perfect. I am not perfect. Only Christ was ever on earth as a perfect human.

Let’s get real with each other. Let’s be honest and support each other through the mess of life. We all have our joyful, peaceful times. We all have our dark, difficult times.

1 Thessalonians 5:11 ESV

Therefore encourage one another and build one another up, just as you are doing.

Ecclesiastes 4:9-12 ESV

Two are better than one, because they have a good reward for their toil. For if they fall, one will lift up his fellow. But woe to him who is alone when he falls and has not another to lift him up! Again, if two lie together, they keep warm, but how can one keep warm alone? And though a man might prevail against one who is alone, two will withstand him—a threefold cord is not quickly broken.

Hebrews 10:25 ESV

Not neglecting to meet together, as is the habit of some, but encouraging one another, and all the more as you see the Day drawing near.

My purpose today is to encourage you to celebrate your new life in Christ! He is alive and loving you right this moment. Claim your new life in Christ. Open up to your Christian friends, teachers, and supports. Live the on-purpose, fully alive life Christ died to give you.

2 Corinthians 5:17 ESV

Therefore, if anyone is in Christ, he is a new creation. The old has passed away; behold, the new has come.

If your story includes fear of failure, fear of risks, or any of a multitude of hidden truths, Christ died for you. You can live beyond the worst this world can give you. You are loved. You are not alone. An eternity of joy and peace and love awaits you!

Blessings,

Michelle

Memory, Falls, and Function – Oh Meds!

Posted on by Michelle Fritsch, Pharm.D.
ID-10093880
Medications can make function difficult and lead to memory and falls issues.

If your memory is slipping, do you have dementia? If you fall are you just clumsy? If you need help doing some of your daily tasks, are you just lazy? Or, are these things just a normal part of aging?

I suggest that MANY TIMES, these memory and falls changes are because of medication. Medications can cause these types of issues in a few different ways:

  1. The dose is too high for you.
  2. Your body has trouble getting rid of that medication.
  3. You are on several medications with these types of effects.
  4. Your medications are interacting with each other.
  5. Your medications are interacting with your diet or your other medical conditions.

Medications and Memory and Falls

There are several types of medicines that can fog your thinking. They relax you, make you sleepy, and/or slow your thinking processes. Sometimes you use them for this effect. But know, in making you feel that way, they make it harder to think as quickly and clearly as you normally think.

And by slowing your thinking and response time, they increase your risk of falling, too.

It would be a very long blog to list them all. So, here are some of the more common culprits to impair memory and falls.

  • Anxiety/nerve medications
    • Benzodiazepines (e.g. alprazolam, lorazepam, diazepam)
    • Buspirone (Buspar)
  • Depression medications
    • Tricyclic antidepressants (e.g. amitriptyline, nortriptyline)
    • Selective serotonin reuptake inhibitors (SSRI’s) (e.g. escitalopram, sertraline, fluoxeting)
    • Wellbutrin
    • Buspirone
  • Sleep medications
    • Zolpidem (Ambien)
    • Ramelteon (Rozerem)
    • Eszopiclone (Lunesta)
    • Diphenhydramine (Benadryl, Tylenol PM, Aleve PM)
  • Pain medications
    • Oxycodone
    • Hydrocodone
    • Morphine
    • Hydromorphone
    • Tramadol
  • Anticholinergic medications
    • Incontinence
      • Oxybutynin
      • Darifenacin (Enablex)
      • Solfenacin (Vesicare)
      • Trospium (Sanctura)
      • Tolterodine (Detrol)
    • Parkinson’s Disease (e.g. benztropine, trihexyphenydil)
    • Allergy medications – sedating
      • Diphenhydramine (brand Benadryl)
      • Chlorpheniramine
      • Hydroxyzine
    • Antispasmodic agents (e.g. chlordiazepoxide, belladonna)
    • Diarrhea treatments
    • Muscle relaxants (e.g. cyclobenzaprine, orphenadrine)
    • Dizziness, sea sickness medication (e.g. meclizine, scopolamine)
    • Nausea/vomiting medication (e.g. prochlorperazine, promethazine)
    • Antipsychotic (e.g. thioridazine, chlorpromazine, clozapine, olanzapine)
  • Seizure medication
    • Carbamazepine
    • Valproic acid
    • Several others
  • Nerve pain medication
    • Gabapentin (Neurontin)
    • Pregabalin (Lyrica)

Medications and Function

I have worked with many people who were planning to move to assisted living. They just couldn’t do some of the daily tasks they had done before. These tasks might be cleaning, keeping up with finances, remembering to take medicines, or ability to cook healthy meals.

In many cases, some medication adjustments made a big difference. Assisted living could be delayed.

How do you decrease your risk?

Please NEVER change any medications without first checking with your doctor.

If you take medication that you think could be impacting your clear thinking or make you feel unsteady, talk with your doctor.

If the types of medications mentioned in the blog are going to be changed, make the changes one at a time gradually. Fast changes can be dangerous. Making too many changes at once can make it hard to determine which change works and which doesn’t. So, making these changes should be a slow, careful process.

If you want help –

  • talking with your doctors,
  • coordinating between your doctors, or
  • want to better understand this information

please call us at 410-472-5078 or e-mail at michelle@medsmash.com.

Our website is www.medsmash.com.

BIBLICAL APPLICATION

One of the key ways to prevent falls, medication-induced memory issues, and functional decline is to make sure your primary care physician knows exactly what medications you take and how you take them. Other physicians might contribute to your regimen, but your primary care physician is one who can analyze and control it all.

Similarly, Jesus is your primary spiritual care provider. You have a pastor, teachers, books, TV evangelists, friends, family, and more who contribute to your spiritual care. But, it is Jesus who is at the center.

The best-intentioned specialist medical provider can make a harmful decision because he/she is treating the specialty and less familiar with all of the other aspects of your care.

Similarly, the best-intentioned teacher/friend/colleague can distort the truth of Jesus. This is rarely done intentionally. We can all make mistakes, misinterpret, or be misled.

So, rather than take any teaching by a human at face value, compare it to the TRUTH of God’s Word, the Bible.

John recorded Jesus referring to God’s truth:

John 16:13 ESV

When the Spirit of truth comes, he will guide you into all the truth, for he will not speak on his own authority, but whatever he hears he will speak, and he will declare to you the things that are to come.

John 17:17 ESV

Sanctify them in the truth; your word is truth.

Truth is not something we acquire passively. Just listening to your pastor on Sunday or listening to programs on the radio or TV won’t help you fully understand the truth. Your own reading and studying will give God a chance to talk to you directly. That private time in the Bible can help you recognize truths, understand information, and apply information in a very personal way.

Let your personal Primary Care Spiritual Physician, Jesus Christ, be your primary source of truth. Compare all other teaching to this truth.

2 Timothy 2:15 ESV

Do your best to present yourself to God as one approved, a worker who has no need to be ashamed, rightly handling the word of truth.

Blessings,

Michelle

serotonin syndrome - know and avoid

Depression Treatment & Serotonin Syndrome – Avoid

Posted on by Michelle Fritsch, Pharm.D.
serotonin syndrome - know and avoid
Avoid serotonin syndrome with careful medication review by doctors and pharmacist.

Last week we reviewed medication treatment of depression and anxiety. Medications impacting serotonin to help regulate mood were a focus. Did you know you could get too much serotonin? When we overdo it, there is a condition called serotonin syndrome that can occur.

I saw a patient that really made me think about this. He is on three antidepressant medications and a couple of other medications that can interact with those. All of them will increase his serotonin levels. I immediately alerted his primary care provider.

Three main scenarios

There are three key ways serotonin syndrome typically occurs:
1. Too many antidepressants, often from more than one doctor. If those doctors don’t know what the others are doing, more than one can start treating the same condition.
2. Self-treatment in addition to prescribed treatment. In particular, St John’s wort increases serotonin. Because there is no regulation for products such as St John’s wort, one bottle can have a different amount than another, so one bottle might lead to too much serotonin while another does not. Several over-the-counter medications can also increase serotonin to dangerously high levels when used with antidepressant medication.
3. Interactions with other medications. There are several other medications for completely different medical conditions that can increase the serotonin effects of antidepressant medications.

Symptoms

When someone has too much serotonin then a condition called serotonin syndrome can occur. The symptoms, especially early on and with a mild version, can be mistaken for a viral illness. These milder symptoms are fever, chills, diarrhea, muscle aches or spasm or rigidity. Other symptoms can be confusion, feeling irritable, or feeling disoriented. Your heart might beat faster and blood pressure could go up.

With more severe serotonin syndrome, seizures, coma, changes in heartbeat, and even unresponsiveness are possible. The most severe cases can lead to death.

Prevent Serotonin Syndrome

Your best defense against serotonin syndrome is to be very open with all of your doctors and your pharmacist about each medication you take. Ask each of them to carefully evaluate your entire regimen.

Do not change your dose on your own. Increasing your dose without guidance increases your risk of serotonin syndrome.

Adding medications you choose to take on your own can increase risk. Medications that can increase serotonin include those you take for cough, for other mood disorders, for pain, for migraine, for nausea, and for some infections. The list is so long, I encourage you to make sure you always share all of your medicines with all of your healthcare providers.

Note, even herbal medications and illicit medications can increase serotonin.

Please don’t be afraid or stop your antidepressant

The purpose of this blog is to make you aware, not to make you afraid. When taken at appropriate doses, antidepressants have aided in the resolution of depression for many people. Keep in mind; counseling is a key part of depression therapy versus medication alone. Keeping your entire medical team involved in each aspect of your care and how you feel during therapy will help avoid issues such as serotonin syndrome.

I want to remind you to never stop your antidepressant/antianxiety medication all of a sudden. Your healthcare team will guide you through a gradual tapered withdrawal when that is warranted.

For information about depression and anxiety treatment, serotonin syndrome, and drug interactions, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This might be a loose association, so please stay with me here. I found that people with lingering depression and/or their loved ones seek relief from multiple sources. They sometimes combine prescription medications with herbal therapies with cognitive behavior therapies with religion with any other options for which they find anecdotal evidence. I typically do not hear the full picture at my first visit. It is with time and the building of trust that I get the full story. Sometimes those mixtures of therapies work, and other times they lead to more problems.

I think the same can be true with spiritual growth options. There is a lot of information ‘out there’. You can find speakers, books, videos, churches, ministries, and blogs that will tell you just about anything.

I have mentioned before the rapid growth of para-spiritual businesses that exist to help people feel better. Many of them are quite centered on the person rather than on the One True God.

Discernment is key with so many voices and messages to select. And, wow, this is so much easier to type than to do.

Jesus, Paul, John, Solomon, James, and others throughout the Bible encourage us to be careful. Follow God’s word, follow the leading of the Holy Spirit, and don’t fall for just anything that you hear.

1 John 4:1 ESV

Beloved, do not believe every spirit, but test the spirits to see whether they are from God, for many false prophets have gone out into the world.

I like this passage even better in The Message:

My dear friends, don’t believe everything you hear. Carefully weigh and examine what people tell you. Not everyone who talks about God comes from God. There are a lot of lying preachers loose in the world.

When you’re not sure what you’re hearing is right, take a time out. Go to the Bible. Talk with spiritually mature Christians. Pray for guidance. Hasty decisions can quickly get you into trouble.

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.

You’re smart, but that doesn’t mean you can’t get caught up in false information.

Matthew 24:24 ESV

For false christs and false prophets will arise and perform great signs and wonders, so as to lead astray, if possible, even the elect.

There are so many confusing messages in our World.   Just this past week alone has bombarded you with message of right and wrong and what you should believe.

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.

Don’t beat yourself up if you’re confused. It is a smart thing to question all you hear, read, see, and experience.

1 Timothy 6:3-5 ESV

If anyone teaches a different doctrine and does not agree with the sound words of our Lord Jesus Christ and the teaching that accords with godliness, he is puffed up with conceit and understands nothing. He has an unhealthy craving for controversy and for quarrels about words, which produce envy, dissension, slander, evil suspicions, and constant friction among people who are depraved in mind and deprived of the truth, imagining that godliness is a means of gain.

Jesus tells us to expect this confusion. He also tells us to be wise, discerning, smart, and loving all at the same time. And HE is the one who can help us do that. You can’t do it alone.

Matthew 10:16 ESV

“Behold, I am sending you out as sheep in the midst of wolves, so be wise as serpents and innocent as doves.

I’m praying we each seek the truth through the One who is and was and is to come.

Blessings,

Michelle

Perspective

Wrong Assumptions lead to Bad Medicine

Posted on by Michelle Fritsch, Pharm.D.
Perspective
Avoid wrong assumptions that lead to incorrect actions.

When was the last time you made and acted on wrong assumptions? It is so easy to do. You see something from your perspective and your mind fills in the details of the who, what, when, how, and why. It’s often long after you have acted that you are provided with a different perspective that makes the entire situation look different.

A quick, fun example is in this picture. Another proof that I am a geek. I get such a kick out of these pictures.  If I believed my eyes I might run in to help the poor guy being lifted into the air.

This happens in healthcare, too. Keep in mind, the provider that is making decisions in the emergency department or the hospital usually knows VERY LITTLE about you. Any information you or a loved one or friend can give is all they have at first.

One day, hopefully soon, these providers will be able to access your medical records and make much more informed decisions. Right now, your doctor has to be contacted then the information sent to the hospital. If it is the weekend or an evening, that can take hours to days. The information then needs to get to your hospital provider from the fax machine or the electronic messaging system. Even then, there might be important information about you that is not even in your doctor’s record.

This leaves those of us making decisions about your care to rely heavily on what we see right now.

I have seen SEVERAL examples in the last few weeks of an older adult reaching medical care confused. The quick wrong assumption has been that the person has dementia. When confused, behaviors often change. A confused person can yell, pull at catheters and IV’s, try to get out of bed, and generally not cooperate. Since the assumption has already been made that dementia is the cause, calming medications are given. These then assure further confusion (but calmer) and make it very hard for the person to get to a point of no confusion.

What can you do to prevent wrong assumptions?

  1. Carry in your wallet a list of your:
    1. Allergies
    2. Medications
    3. Diagnoses
    4. Emergency contact information – name, phone number(s)
  2. If you are accompanying someone to the hospital who is newly confused, explain this to the medical team. Help them understand what this person was like before this event. They need to know the ‘baseline’. If this person was living independently, driving, managing their finances the team needs to know that. If this person was unable to do those things and was getting frequently confused at home, the team needs to know that.
  3. Share any known history about the current event. If you have been feeling worse and worse for the past three days, make sure they know that. If you have been having pain, explain that including what it feels like, how often you feel it, what makes it better or worse.
  4. If you have been taking different medications for the past few days, make sure they know that. This often happens when we are in pain or have a cold. We take over-the-counter medications or left-over medications from prior prescriptions. These can cause confusion when mixed with our normal medication regimen.

Speak Up

Again, I have seen several instances in the past few weeks where assumptions are made when someone gets to the emergency department or hospital that make a situation worse.

  • In one instance the person’s confusion started as soon as a particular medicine was given. The family member noted that but didn’t speak up. Then medications were added to treat the confused behaviors. We are still trying to taper off of those medications and get this person independent again.
  • In another instance, the person had a urinary tract infection. These are famous for making older adults confused. But since no one was there to explain how odd this confusion was for this person, the team assumed this was normal and didn’t find the infection for a while.   By then, a couple of medications had been added to treat the confused behaviors. It will take us weeks to taper her back off of these medications.
  • In a third instance, the collection of pain medications given after a surgery left the person sleeping most of the day and unable to think clearly. The spouse was dutifully giving the prescribed medicines around the clock. The wrong assumption made here was that this very healthy person over 60 could handle these medications like someone in their 30’s.
  • One more instance involved using a medication to treat the side effect of another medication. The second medication (the one used to treat the side effect) is on a list of medicines to avoid in people over 60. Rather than treat the side effect, it made the person nearly unresponsive. In this case, as in several of the others, rather than treat the underlying issue, wrong assumptions were made and actions were taken to treat the symptoms without understanding the back story.

Why ‘Bad Medicine’

Just a side disclaimer. When I was contemplating this blog I saw it as a chance to use the terms, ‘Bad Medicine’. I am a big Bon Jovi fan. I am also a pharmacist. So, I have to admit I love the song, ‘Bad Medicine’.

For more information about how to protect yourself from wrong assumptions leading to bad medicine, contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

I can think of a lot of bad assumptions leading to bad decisions in the Bible. One of the first is Eve’s decision to eat the apple. The Israelites made bad assumptions continuously. A few that come to mind are thinking slavery would be better than ‘suffering’ in the desert; people in lands they were to conquer were too mighty to overcome; Moses was not going to return so a golden calf was needed. The list goes on.

So, how often do you make bad assumptions? I suggest we all do it every day. We don’t act on all of them. I don’t think we realize most of them.

I am consulting right now in a place that serves a highly diverse and unique population of people. Assumptions about gender, culture, religion, socioeconomic status, or just about anything will quickly lead you down an incorrect path. It has been an adventure of constant striving to avoid any assumptions.

These verses are good ones for me to remember each day:

Proverbs 18:2 ESV

A fool takes no pleasure in understanding, but only in expressing his opinion.

Matthew 7:1 ESV

“Judge not, that you be not judged.

Proverbs 25:8 ESV

Do not hastily bring into court, for what will you do in the end, when your neighbor puts you to shame?

Bad assumptions and temptations to act on them are one more test.

As I understand the Word, truth trumps all of the assumptions. Love trumps all of the wrong actions.

1 Corinthians 13:6 ESV

It (love) does not rejoice at wrongdoing, but rejoices with the truth.

1 Corinthians 13:7 ESV

Love bears all things, believes all things, hopes all things, endures all things.

The laws in Deuteronomy give us good advice even here in 2016.

Deuteronomy 17:13 ESV

And all the people shall hear and fear and not act presumptuously again.

I encourage you (and me) to guard against assumptions and focus on truth and love.

Blessings,

Michelle

Problem Medications sending people to the ER

Posted on by Michelle Fritsch, Pharm.D.
emergency
Don’t let problem medications send you to the emergency room

Problem medications are leading to an increasing number of emergency department visits. And more and more of those are ending up being admitted to the hospital. A study published in the Journal of the American Medical Association in November 2016 revealed these findings. The study was conducted by the Centers for Disease Control.

For every 1,000 emergency department visits, four are for people over the age of 65 with problem medications. In the last decade the number of people going to the emergency departments with problems with their medicines has gone up at least 10%.

The types of medications most often involved are opioid pain medicines, diabetes medicines that lower the blood sugar, blood thinners (anticoagulants), and antibiotics. There is still a significant use of medicines that have been long-recognized as a poor choice in people over 65. [I am still seeing that in my patients as well. Pain medication, anxiety and mood therapy, and anticholinergic (drying) medication use have been issues in nearly all of my referrals in the past 2 months.]

Why are there more medication-related emergency visits?

Part of the reason for this increase in emergencies could be the growing number of people over 65. But, that can’t be the only explanation.

Speed – Healthcare is moving and being provided at a very fast pace. The time your doctor gets to spend with you is very limited. Often the reason for your visit takes all of the time. This doesn’t allow for a thorough review of all of the rest of your health and your medicines.

Fragmentation – Your doctors, pharmacists, nurses, therapists don’t have enough time to talk to each other. When one doctor doesn’t know what the other one is doing, problem medications can be prescribed.

Incomplete information – Your doctors don’t often know what you REALLY do at home with your medicine. I have identified thousands of instances where medication is taken differently than prescribed. This can be for many reasons. Sometimes medications are stopped without telling the doctor. Sometimes extra doses are taken. Sometimes medications get confused such that each is taken incorrectly. Other times vitamins, herbal supplements, over-the-counter medications, and other substances are taken without the knowledge of the doctor or pharmacist. These are just a few of the examples of how medication can be different than what your doctor thinks it is.

Specialized knowledge – Only a small percentage of people aged 65 plus receives care from a specialist in healthcare for people in this age group. There are not nearly enough geriatricians and board certified geriatric pharmacists to oversee the prescribing for these adults.

Don’t let this statistic apply to you

What can you do to avoid being one of these people in the emergency department because of problem medications?

First, make sure your doctors (all of them) and your pharmacist know absolutely EVERY medication you take AND how you actually take them.

Second, ask your primary care doctor AND your pharmacist to carefully review all of those medications for:

  • Interactions
  • Lowest possible doses
  • Continued need for each medication
  • Safer options available
  • Removal/replacement of any medication known to be problem medications in people over 65
  • Assurance each is working as planned

Third, contact the board certified geriatric pharmacist at Meds MASH for a thorough medication review today. All findings will be shared with your healthcare providers so all can work together to keep your medication regimen safe. You can reach Michelle at www.medsmash.com/contact or by calling 410-472-5078.

Mistakes, oversights, misinformation, incomplete information, misunderstandings occur in all aspects of life. They certainly exist in healthcare. NO healthcare provider wants imperfect care, but it certainly happens. This is why a multi-check system where several people work together in your care is superior to independent practice. Different providers with varying backgrounds and perspectives can catch and fix issues before they ever reach you.

BIBLICAL APPLICATION

Is healthcare the only place where mistakes, oversights, misinformation, incomplete information, or misunderstandings happen? Of course not.

Can this happen in the church? Oh, yes! I’ll bet we could all share several stories.

Pastors, Sunday School teachers, small group leaders, professional speakers, authors, and media personalities are all fallible. We are all human. Jesus makes it very clear we are far from perfect. No matter how hard we try, we will never be perfect.

Romans 3:23 (ESV)

for all have sinned and fall short of the glory of God,

Does this mean you should consider all spiritual teaching as wrong? No!

It does mean you should check what you see, hear, and read and compare it with the absolute truth – the Bible.

2 Timothy 3:16-17 ESV

All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness, that the man of God may be competent, equipped for every good work.

Remember playing communication games in elementary school?   Games like telephone showed us how easily we can misconstrue information. Now, remember any class from your school days. Did you capture absolutely every word you teacher said? Did you ever miss important information because you weren’t paying attention – even for a second? Did you ever get an exam question wrong because you misunderstood the information?

I like this version from The Message:

Romans 3:23-24 (MSG)

God Has Set Things Right

But in our time something new has been added. What Moses and the prophets witnessed to all those years has happened. The God-setting-things-right that we read about has become Jesus-setting-things-right for us. And not only for us, but for everyone who believes in him. For there is no difference between us and them in this. Since we’ve compiled this long and sorry record as sinners (both us and them) and proved that we are utterly incapable of living the glorious lives God wills for us, God did it for us. Out of sheer generosity he put us in right standing with himself. A pure gift. He got us out of the mess we’re in and restored us to where he always wanted us to be. And he did it by means of Jesus Christ.

These issues continue in healthcare and in spiritual teaching. Just like in healthcare, studying and learning from several spiritual sources will help you identify misinformation and reinforce the truths found in scripture.

John 8:32 ESV

And you will know the truth, and the truth will set you free.

John 16:13 ESV

When the Spirit of truth comes, he will guide you into all the truth, for he will not speak on his own authority, but whatever he hears he will speak, and he will declare to you the things that are to come.

John 17:17 ESV

Sanctify them in the truth; your word is truth.

The trust does exist, and you can find it.

John 14:6 ESV

Jesus said to him, “I am the way, and the truth, and the life.” (emphasis mine)

Blessings,

Michelle

Over-the-counter NSAID pain medicines – how safe are they?

Posted on by Michelle Fritsch, Pharm.D.

Slide1Some people think medicines that are available over-the-counter are always safe.   I don’t want you to be one of those people. Ibuprofen and naproxen are a class of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs). They can treat pain, inflammation (swelling and redness), and fever. Hundreds of million of Americans take them every year. You probably have some in your home right now.

The NSAIDs that you can buy without a prescription are ibuprofen (brand names Motrin, Advil) and naproxen sodium (brand name Aleve). They are part of a class of over 20 medications that are available by prescription.

5 IMPORTANT THINGS about NSAIDs

There are five important things I want to make sure you know about these medicines:

  1. They do work to treat mild to moderate pain, fever, and inflammation. They all work the same way. No measurable difference between them in how they work has been found. So one is not better than another.
  2. They irritate your stomach lining. If you already have reflux, gastroesophageal reflux disease (GERD), ulcers, or have ever had a stomach bleed, please tell your doctor. Whether or not you already have stomach problems, always TAKE NSAIDs WITH FOOD.
  3. They cause you to retain extra fluid. This can raise your blood pressure. It can also make heart failure worse and increase your risk for a heart attack if you have heart problems. Talk with your doctor if you have high blood pressure or heart problems BEFORE you take an NSAID.
  4. They can worsen kidney function. If you already have diminished kidney function, talk with your doctor before you take an NSAID.
  5. They make your platelets less sticky. This lowers your chance of have a clot. But, NSAIDs do this for a limited time. ASPIRIN can make your platelets less sticky for the entire life of the platelet. That is why aspirin, usually 81mg baby aspirin, is used to help prevent a clot that leads to a heart attack or stroke.

I always buy the generic version. It will save you some money and give you the very same effect.

If you have pain or fever, there is an option that does not have the stomach, heart, or kidney issues. That option is acetaminophen (brand name Tylenol). For pain that does not include inflammation (redness, swelling), acetaminophen controls the pain similarly to the NSAID.

The problem you do have to watch with acetaminophen is it can hurt your liver. The most you should take in a day is 4 grams (2 extra strength tablets four times daily). The Food and Drug Administration might even recommend that you not take more than 3 grams per day soon. Also, if you drink alcohol more than 2 drinks per day or have any liver condition, then acetaminophen might not be your best choice. Please talk to your doctor before you take it if you have liver issues or drink more than 2 drinks per day.

For more information about safe pain medicine options, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Many people think that any medication you can buy on your own, without a prescription must be safe. I hope you now realize this isn’t always true. In some patients, with some other conditions, a relatively safe medication can be downright dangerous.

So, how do we know what is true? On what can we truly rely?

“Voice of Truth” by Casting Crowns took on a whole new meaning for me this week. I love this song. I have heard it countless times. On this particular day, when it came on the radio I wasn’t even listening very intently.

Then, the words, ‘this is for my glory’ hit me suddenly in a whole new, EXTREMELY POWERFUL way. I have been working through a large, unexpected life transition over the past couple of years. It is not a bad situation. It is just a very big transition leading down a path I can’t really see yet. The whole experience has been and continues to be a real faith walk. I often pray for guidance, help with decision-making, and peace while waiting.

Then, out of the blue, I hear the lyrics, “The voice of truth says, “This is for My glory”. It hit me; none of this is even about me. If I could be in the future looking back, I would be telling myself to “stop it, be quiet, just wait and see, God is doing something here.” It’s not about me at all. It’s all about God working through this situation for HIS glory.

I felt a wave of peace, a wave of admonition, and a lot of emotion. I fluctuated between laughing and crying.

I just love such spontaneous GOD moments!

Proverbs 16:9 ESV

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

Acts 18:9 ESV

And the Lord said to Paul one night in a vision, “Do not be afraid, but go on speaking and do not be silent,

Listen to the ‘voice of truth’ and wait to see what He is cooking up that is for His glory in your life.

Blessings,

Michelle