Life Lesson

Statin Facts and Dementia Risk?

Brain-picture

This report is not a substitute for medical advice and treatment. Never diagnose or treat yourself or a family member. See your doctor. Use your voice. Ask questions and share prescription concerns, if any, with your physician. 

Recently, whether enjoying conversation in a social setting or small talk among acquaintances (including the recent friendly exchange with a car salesperson during a vehicle test drive!) the subject about statin drugs and its increased risk of dementia frequently comes up. Knowing enough people who are on statin drugs, I decided to research this topic to unveil the facts and connection between memory loss and cholesterol lowering prescription drugs. Do statins cause memory loss? Read below for information about statins and why the short answer to this question is “NO”.

What are statins and when are they prescribed?

Statins are prescription drugs that can lower cholesterol in patients who have been diagnosed with heart disease, at high risk of a heart attack/stroke or whose cholesterol levels (results shown from a blood test) are higher than the norm of below 200 mg/dL, combined LDL and HDL. Prescription statins block the production of cholesterol in the liver, can flush cholesterol already formed within artery walls and reduce blood vessel inflammation lowering risk of blood clots.

LDL (Low-density lipoprotein) is the bad cholesterol that sticks to artery walls contributing to blockage (heart attacks) and clots (strokes). The ideal level is below 130 mg/dl and for those who have suffered a heart attack or stroke, the recommendation is to keep LDL below 100 mg/dl. High risk for heart attack or stroke? Your physician may be looking for LDL below 70 mg/dl.

HDL (high-density lipoproteins) is the good cholesterol that acts as a garbage collector, carrying cholesterol from all parts of your body to dispose/process through your liver. A good HDL level is 60 mg/dl or higher. An HDL level that is 40 mg/dl or less is consider low. Medical and environmental factors can negatively impact HDL levels, such as smoking, obesity, Diabetes II and inflammation. High alcohol consumption especially hard liquor, dessert liquors, mixed drinks high in sugar, beer, and excess wine, can have negative effects; “drinking more than what is considered moderate (daily women 1 glass and men 2 glasses), however, has an opposite effect, because it can raise both cholesterol and triglyceride levels.” Can Drinking Alcohol Affect Your Cholesterol Levels? Healthline

To keep HDL high, choose foods with unsaturated fats, low carbs and low sugar and enjoy a healthy lifestyle that reflects regular exercise, moderate alcohol consumption and smoke free. 11 Foods To Increase Your HDL, Healthline, offers great suggestions. There are some prescribed medications that can effect and lower good cholesterol so especially be mindful of your diet if taking these drugs.

Medication that can effect/decrease HDL…Beta blockers, a type of blood pressure medicine, Anabolic steroids, including testosterone, a male hormone Progestins, which are female hormones that are in some birth control pills and Hormone replacement therapy, Benzodiazepines, sedatives that are often used for anxiety and insomnia. HDL The Good Cholesterol, Medline Plus.

Statins are available in fat-soluble or water-soluble. Noted below is a list of such statin prescriptions available in the USA. How are they different? In a study conducted between the two types of statins… No difference was observed between various clinical coronary artery disease settings. Fats Vs Water Soluble Statins by Gerti Tashko, MD.  

Lipid Statins (fat-soluble) pass through the liver with a greater chance of being absorbed in muscle tissue. There is, therefore, an increased risk of liver damage as well as muscle and joint aches with fat-soluble statins.

Lipid Statins/Fat Soluble – pass through the liver

  • Atorvastatin (Lipitor) – most potent of statins
  • Lovastatin (Altoprev)
  • Pitavastatin (Livalo)
  • Pravastatin (Pravachol)

Hydrophilic/Water Soluble – pass through the body and not the liver

  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)

Side effects: headaches, nausea, and muscle and joint aches. More serious side effects include: increase blood sugar/diabetes 2, muscle cell damage, cognitive memory loss, liver damage.

What is the connection between statins and cognitive memory loss?

As a result of reports from some consumers claiming cognitive memory loss while taking statins, the FDA (2012) required all statin drug labels to include a warning about the risk of memory problems with short-term statin use. Studies conducted (as shown in the quotes below) reveal no direct link between memory loss and statin use. Other considerations could effect memory, such as; patient age, drug interactions, quantity of daily prescription drugs taken and perhaps taking some prescription drugs that are in fact linked to higher dementia risk reported by conducted studies. If you or a family member of whom you advocate are experiencing noticeable loss in memory, speak to your physician.

A study conducted out of John Hopkins in 2013, Statin Medications May Prevent Dementia and Memory Loss With Longer Use, While Not Posing Any Short-Term Cognition Problems,  concluded “no threat to short-term memory, and that they may even protect against dementia when taken for more than one year.” The study also reveals…”In contrast, they say that when the drugs are taken for more than one year, the risk of dementia is reduced by 29 percent.”

While statin users have reported memory loss to the FDA, studies haven’t found evidence to support these claims. Research has actually suggested the opposite — that statins may help prevent Alzheimer’s disease and other forms of dementia. Healthline, Statins and Memory Loss: Is There A Link? 

Conclusion –  In patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia. Mayo Clinic Proceedings, November 2013

How can a statin actually decease the risk of memory loss? Dementia/cognitive memory loss can be the result of blockages in small blood vessels that could prevent blood flow and oxygen to certain areas of the brain. The effect of statins to reduce plaque and inflammation would therefore remove blockages and increase blood flow, reducing memory loss risk. John Hopkins, Statin Medications May Prevent Dementia and Memory Loss With Longer Use, While Not Posing Any Short-Term Cognition Problems

Although memory loss/confusion warnings are listed on the label of statin drugs, studies conducted to date do not support a higher risk of dementia when taking these drugs. The next time you attend a social gathering or are talking with an acquaintance and the concern about statins and memory loss comes up, you have some facts to share. Eliminate fears and enjoy the party!!

Next week’s blog post will discuss common prescription drugs that have been associated with higher risk of memory loss. The drug listing has been compiled after conducted studies and conclusion of risk factors.

Resources

Life Lesson

Gut Health and Antibiotics…what you might want to know

This report is not a substitute for medical advice and treatment. Never diagnose or treat yourself or a family member. See your doctor. Use your voice. Ask questions and share prescription concerns, if any, with your physician. 

The purpose of this blog post is to reveal the reality of antibiotic overuse and misuse. This writing is to also encourage communication with your doctor when antibiotics are prescribed to you or the family member you advocate/share in health care responsibility.

Recently someone dear to me, “Barbara” was tested for a UTI. Barbara did not have UTI symptoms. Her bladder, however, appeared to be on a nighttime schedule with the inability to urinate during the day. The initial urinalysis revealed bacteria in the urine and her doctor insisted she be put on antibiotics ASAP, that day.

On the surface, following through with the physician’s request may appear as the only and best option for the patient. However, digging dipper, this was not the case. Barbara recently had C-DIFF (C. difficile/C-DIFF is a toxin-producing bacteria that causes antibiotic-associated colitis, Mayo Clinic…Antibiotic Associated Diarrheafollowing surgery, which extended her stay at a skilled nursing facility by 3 weeks. She experienced horrific symptoms of both, C-DIFF and the necessary antibiotic treatment. There is a HIGH probability of C-DIFF reoccurring when a patient is prescribed antibiotics, in this case treating a possible UTI. Question to the doctor…Knowing Barbara had C-DIFF a few months ago, can we wait for the full culture results before considering antibiotics??” It is not uncommon for some bacteria to appear in urine, especially in the population 75 years old+. The doctor agreed, stating, “I think that it’s reasonable to wait until the cultures come back, but it looks like a real infection based on the cell counts.” Three days later the culture results indicate…NO UTI.  The doctor emailed…The final urine cultures are back and surprisingly did not grow out any specific bacteria. So I would not give her the antibiotics. I would continue to monitor her symptoms. I would only recheck her urine if she is having symptoms.” If Barbara had a reoccurrence of C-DIFF, a high risk “serious symptom infection” possibly triggered by taking the prescribed antibiotic, she would have had to leave the comfort and familiarity of assisted living (very contagious). The C-DIFF treatment administered would have required admittance to either a hospital or skilled nursing facility, in contact isolation. Life would not have been pleasant for Barbara or her family, the aftermath of being treated for a UTI she didn’t have.

A key lesson from Barbara’s experience, communicate with your doctor. Express concerns by using your voice and take ownership to know options in order to make wise decisions for you and your family. The following shares antibiotic facts, its impact on the elderly and what you can do nutritionally to be “gut healthy” reducing side effects from antibiotics as well as some non-antibiotic drugs, to help prevent superbugs and antibiotic resistance (CDC: About Antimicrobial Resistance).

Full Culture Results 

Whenever possible and with physician agreement, request a full culture before taking prescribed antibiotics.

Antibiotics –How They Work, Classifications, When Administered 

Antibiotics are pharmaceutical prescribed medications administered to heal or slow down the growth of bacteria resulting in infections. Click this link for a complete antibiotic guide and their use…Antibiotics Guide, Medically reviewed on Aug 23, 2016 by L. Anderson, PharmD.

Antibiotics are known by these classes: Penicillins, Tetracyclines, Cephalosporins, Quinolones, Lincomycins, Masrolides, Sulfonamides, Glycopeptides, Aminoglycosides, Carbapenems.

Antibiotics are used to treat these top 10 common infections: Acne, bronchitis, Conjunctivitis (Pink Eye), Otitis Media (Ear Infection), Sexually Transmitted Diseases (STD’s), Skin or Soft Tissue Infections, Streptococcal Pharyngitis (Strep Throat), Traveler’s Diarrhea, Upper Respiratory Tract Infection, Urinary Tract Infection (UTI).

Additional details and supporting information can also be found at… Antibiotics: All You Need to Know by Medical News Today, By Christian Nordqvist, Jan. 2017. Article highlights…

  • Alexander Fleming discovered penicillin, the first natural antibiotic, in 1928.
  • Antibiotics cannot fight viral infections.
  • Fleming predicted the rise of antibiotic resistance we see today.
  • If antibiotics are overused or used incorrectly, there is a risk that the bacteria will become resistant
  • Antibiotics either kill bacteria or slow its growth.
  • Side effects can include diarrhea and feeling sick.
  • In some cases, antibiotics may be given to prevent rather than treat an infection, as might be the case before surgery. This is called ‘prophylactic’ use of antibiotics. They are commonly used before bowel and orthopedic surgery.

Before bacteria can multiply and cause symptoms, the body’s immune system can usually kill them. Our white blood cells attack harmful bacteria and, even if symptoms do occur, our immune system can usually cope and fight off the infection. 

Antibiotic Side effects and FDA Warnings

What are common antibiotic side effects?

Common side effects of antibiotics include rash, soft stools, diarrhea, upset stomach, fungal (yeast) infections (like thrush). Contact your doctor immediately if  you are experiencing; severe allergic reaction that includes difficulty breathing, facial swelling (lips, tongue, throat, face), severe watery or bloody diarrhea or stomach cramps, vaginal yeast infection with white discharge and severe itching, mouth sores or white patches in mouth or on tongue. Common Side Effects from Antibiotics, and Allergies and Reactions Medically reviewed on Mar 5, 2017 by L. Anderson, PharmD.

Your intestines contain about 100 trillion bacterial cells and up to 2,000 different kinds of bacteria, many of which help protect your body from infection. When you take an antibiotic to treat an infection, these drugs tend to destroy some of the normal, helpful bacteria in addition to the bacteria causing the infection. Without enough healthy bacteria to keep it in check, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, penicillins and clindamycinC. Difficile Infection by Mayo Clinic

Which Antibiotics Are Most Associated with Causing Clostridium Difficile Diarrhea? On the basis of the available data, clindamycin should absolutely be avoided among patients who are at risk for C difficile infection, particularly in elderly patients and those with frequent antibiotic exposure or hospitalizations. Given the available data, it’s clear that clindamycin is a well-deserving candidate of its boxed warning specifically for C difficile risk. Box Warning can be read by clicking this LINK.

Clindamycin is prescribed most often to treat medical conditions as listed in …What Conditions Does Clindamycin Hcl treat?  Other options that have a reduced risk of triggering C-difficile?

For community-acquired pneumonia, it has been suggested that a tetracycline may be substituted in place of azithromycin (or another macrolide) among elderly patients at higher risk for C difficile infection. In fact, data suggests that tetracyclines may NOT increase risk of C difficile infection at all, with a non-significant odd ratio of 0.9 versus no antibiotic exposure.
 
In patients hospitalized with severe infections who require anti-Pseudomonal coverage, the available data suggests that penicillins (such as piperacillin/tazobactam) may have a lower risk of C difficile infection versus cephalosporins (such as cefepime) or carbapenems (such as meropenem). While this risk is certainly relevant to the selection of antimicrobials, local resistance patterns should also be considered when selecting an agent.
 
Knowledge of high-risk and lower-risk antibiotics for C difficile infection is important, particularly in patients who are already at a higher risk for C difficile infection, such as elderly patients. Avoidance of these high-risk antibiotics when other first-line alternatives exist in certain patient populations should be an antimicrobial stewardship intervention for pharmacists to reduce the risk of C difficile infection both in the inpatient and outpatient settings.

Antibiotic Warnings

Fluoroquinolones are antibiotics that kill or stop the growth of bacteria. While these drugs are effective in treating serious bacterial infections, an FDA safety review found that both oral and injectable fluroquinolones are associated with disabling side effects involving tendons, muscles, joints, nerves and the central nervous system. These side effects can occur hours to weeks after exposure to fluoroquinolones and may potentially be permanent.

Types of Fluoroquinolones that are FDA approved but which fall into this warning include levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, moxifloxacin (Avelox), ofloxacin and gemifloxacin (Factive). FDA updates warnings for fluoroquinolone antibiotics

Non-Antibiotic Drugs and Similar Antibiotic Side Effects

Antibiotics are known to trigger digestive issues and diarrhea, eliminating both the good and bad bacteria in our guts. There are also prescription non-antibiotic drugs that share similar harsh gut symptoms (as antibiotics) such as anti-diabetics (metformin), proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDS) and atypical antipsychotics (AAPs). Use the hyperlinks to see the listing of medications that fall within each category.

Non-antibiotics with antibiotic effects – Some non-antibiotic drugs have been associated with changes in gut microbiome composition, but the extent of this phenomenon is unknown. Athanasios Typas and colleagues screened more than 1,000 marketed drugs and observed that a quarter of them inhibited the growth of at least one bacterial strain in vitro. Scrutiny of previous human cohort studies showed that human-targeted drugs with anticommensal activity have antibiotic-like side effects in humans. The new data provide a resource for future drug-therapy research.  Extensive impact of non-antibiotic drugs on human gut bacteria, Published: 19 March 2018

The Elderly and Antibiotics 

UTIs are known to be common among the elderly and often the symptoms are not as visible making it difficult to know when a UTI exists. However, there appears to be a growing problem with over prescribed use of antibiotics especially for UTIs.

Consensus guidelines have been published to assist clinicians with diagnosis and treatment of urinary tract infection; however, a single evidence-based approach to diagnosis of urinary tract infection does not exist. In the absence of a gold standard definition of urinary tract infection that clinicians agree upon, overtreatment with antibiotics for suspected urinary tract infection remains a significant problem, and leads to a variety of negative consequences including the development of multidrug-resistant organisms. Urinary tract infection in older adults, NCBI 

The elderly are prone to UTIs and other infections but are they being treated more often than not when an infection is actually not present? Antibiotics do not treat frequent urination nor does this infer a UTI. Antibiotics can cause serious symptoms in elderly, weakening those that are already frail; fever, rash, diarrhea, nausea, vomiting, headache, tendon ruptures, and nerve damage. Information above about clindamycin specifically refers to the elderly, along with alternative options for infection treatment.

Elderly have an increased risk to antibiotic resistant bacteria, superbugs. 

Antibiotics may help “drug-resistant” bacteria grow, causing illnesses that are harder to cure and more costly to treat. Your doctor may have to try several antibiotics for treatment. This increases the risk of complications. The resistant bacteria can also be highly contagious/passed on to caregivers, family members and others. Antibiotics for urinary tract infections in older people When you need them—and when you don’t 

A study conducted by The Ottawa Hospital Regional Geriatric Program of Eastern Ontario Geriatric Refresher Day, Rosemary Zvor, Antimicrobial Pharmacy Specialist, (Research on Elder infections with charts zvonar_use_of_antibiotics) found an increase exposure within the healthcare system, antimicrobials, along with decreased immune system and functional status resulting in poor hygiene, as well as the increase use of invasive devices and close contact with other residents and medical staff that could be carriers.

Some antibiotics carry specific risks to the elderly. The article Adverse effects of Antibiotics in the Geriatric Patient Population lists precautions to consider, which you might share the elderly patient’s physician, of whom you advocate.

“Elderly patients have several unique issues related to antibiotic therapy. In addition to age-associated physiological changes and drug-drug interactions, adverse drug reactions are also a noteworthy concern specific to this population. 

  • Aminoglycosides-renal and auditory toxicity 
  • Trimethoprim and sulfamethoxazole-induced hyperkalemia and blood dyscrasias
  • Fluoroquinolone-related seizures and QT prolongation 
  • Doxycycline-related esophageal ulcerations & strictures 
  • Acute liver injury secondary to prolonged amoxicillin/clavulanate therapy”

Antibiotics – Impact On Brain Function 

This article, Link Between Antibiotics and Delirium Strengthened by Tim Newman, February 18, 2016, Medical News Today, explores an interesting discovery that “antibiotics are known to cause neurological issues in some cases, but the interaction has not attracted much study in the past.” Among the neurologic issues is delirium, which can include hallucinations, agitation and confusion, especially among the elderly. Since infection and antibiotics both can trigger delirium, more work and research is needed to measure and understand this relationship but something to discuss with physicians. Delirium can increase the risk of death in critical care cases.

“The antibiotics react not only against the bacteria but also have ‘off-target’ effects by interfering with normal signaling within the brain. Different antibiotics affect the brain differently, hence causing varying patterns of toxicity.”

“Dr. Shamik Bhattacharyya, of Harvard Medical School and Brigham and Women’s Hospital in Boston, MA, conducted a retrospective review using historical patient data. He found that links between antibiotics and delirium might be stronger than previously thought.”

Cranberry Supplements – Heal Or Prevent UTIs?

The Mayo clinic gives good advice about cranberry and UTI prevention in the article… Urinary Tract Infection (UTI)

“Many people drink cranberry juice to prevent UTIs. There’s some indication that cranberry products, in either juice or tablet form, may have infection-fighting properties. Researchers continue to study the ability of cranberry juice to prevent UTIs, but results are not conclusive. If you enjoy drinking cranberry juice and feel it helps you prevent UTIs, there’s little harm in it, but watch the calories. For most people, drinking cranberry juice is safe, but some people report an upset stomach or diarrhea. However, don’t drink cranberry juice if you’re taking blood-thinning medication, such as warfarin.”

Good Gut Health! Building a good gut…prebiotics and probiotic rich foods.

Be proactive and select foods that are high in probiotics and prebiotics for good gut health. The more good bacteria in your gut the less chance of bad bacteria that can cause irritating digestive system issues or trigger uncomfortable symptoms often experienced with autoimmune disorders such as Crohn’s, ulcerative colitis as well as irritable bowel syndrome. Can you take a probiotic supplement? Yes. Supplements, however, are not FDA regulated and you can’t be certain that what is listed on the label is actually in the capsule. I choose to follow wise advice given many years ago when I attend a Celiac Disease conference led by Dr. Peter Green. He shared that the body better absorbs whole foods rich in vitamins, minerals and in this case probiotics and prebiotics rather than taking capsules. If you eat right and skip processed foods, you won’t need to spend the extra dollars on supplements. As we get older and appetites wane, supplements may be needed and this is a conversation reserved to take place with your doctor or a clinical certified nutritionist. Also, probiotic dietary supplements may not be safe, as noted in What are Probiotics?, which may pose risks if you…

  • Get infections often
  • Have a weakened immune system
  • Are allergic or sensitive to the sources of the probiotics (dairy, for example)

What are prebiotics? 

Prebiotics, simply put, are food for probiotics. “They’re necessary in order for the good flora to flourish,” says Kristi King, R.D., a spokeswoman for the Academy of Nutrition and Dietetics. 6 Foods That Are Good for Gut Health 

Prebiotics encourage the growth of good and healthy bacteria in your gut. Prebiotic foods include fruits and vegetables that are loaded with complex carbohydrates, fiber and resistant starch that pass through the digestive system, which feed good bacteria and other micorbes. Prebiotic foods include: legumes such as chickpeas, lentils, navy beans; raspberries and blackberries; barley, bran and bulgar (being gluten free I search for whole grain gluten-free breads). 6 Foods That Are Good for Gut Health, Consumer Reports

The lining of your gut, like every surface of your body, is covered in microscopic creatures, mostly bacteria. These organisms create a micro-ecosystem called the microbiome. And though we don’t really notice it’s there, it plays an oversized role in your health and can even affect your mood and behaviorPrebiotics, probiotics and your health

Vegetables offer the best impact for your gut when uncooked to preserve fiber. Cooking transforms the fiber, lowering fiber content. Prebiotic Food List

What are probiotics? 

Probiotics are live culture bacteria which are found in foods or supplements that promote microorganisms for our guts known to benefit our health, body and brain. Probiotics could also benefit immune function and suggested as an aid for digestive issues, reducing the risk of diarrhea with antibiotic use, lessens risk of C-DIFF infection, and aids in food poisoning and stomach virus. Yogurt, such as non-flavored Greek yogurt, is a great source of probiotics and contains on average per serving 100 million probiotics. Simple… eat a serving of yogurt per day! Some yogurts are marked specifically to contain probiotics, such as Activa. Watch sugar levels in fruit flavored yogurts. Other fermented food products known to contain probiotics; kefer, sauerkraut, tempeh, kimchi, miso, kombucha, pickles, traditional buttermilk, nato and certain cheeses. Click Probiotic Food List for information on probiotic rich foods. Some fermented foods do have gluten, so for GF readers…read the labels.

NOTE: Kombucha bottles are not always well labeled to instruct recommended use, at least on the bottle I purchased. Internet checking I’ve seen serving recommendations at 4 oz and not to be consumed daily. The health benefits claimed have not been proven. Many brands contain alcohol and caffeine since it is fermented tea, therefore not for CHILDREN. There have been resulting health issues reported, such as liver damage, and the recommendation is to purchase from reputable sources and pass on homemade Kombucha. Not all Kombucha is created equal so if specifically looking for the benefits of probiotic and live cultures, look for labels with these ingredients noted. Some Kombucha can be high in sugar or use alternative sweeteners such as stevia. Check the label and choose those low in natural sugar. This video by Dr. Oz that aired Feb 2018 is a great resource about Kombucha in a comparison study to other food products rich in probiotics, titled, The Hype Behind Probiotics and Gut FoodsAnother good resource…What is kombucha tea? Does it have any health benefits? Mayo Clinic, Answers from Brent A. Bauer, M.D.

Conclusion 

Antibiotics rank as one of the greatest discoveries of our time, healing bacterial infections and saving lives. Fast forward 90 years and we are the generation experiencing repercussions of antibiotic overuse and misuse, especially within the elder populous leading to severe side effects, life threatening antibiotic resistant bacteria and superbugs. Failing to complete prescribed antibiotics and its dose recommendation, taking the wrong antibiotics for the wrong infection, borrowing another’s medication when feeling ill, or being prescribed antibiotics when an infection doesn’t exist, can lead to unwelcomed side affects and serious health issues. What can you do? Prepare now and be gut healthy choosing foods naturally rich in prebiotics and probiotics. Communicate prescription concerns with your healthcare provider and explore alternative options when possible. Use your voice and be an advocate for elderly family members. Antibiotic drugs can still be effective and the preferred drug to treat bacterial infections. The responsibility lies with you to know the facts, use your voice, and be proactive by feeding your gut well!

Resources 

Life Lesson

Living Your Story

Living Your story

This past week, on my private Facebook page, I posted a daily quote about gratitude. Life is not perfect and gratefulness sharpens a focus on blessings. Such gratitude reminds me of the gift of life and the people who bring beauty to it. I find this especially beneficial during the week leading to my birthday, which offers an opportunity to adjust my perspective to focus on what is right with the world. This gratitude exercise has encouraged the desire to know my story, a process of which I thought would be a great share with Modify readers. If we know our story and are able to articulate it well, we have a better grip on “self-confidence” to be who we are, comfortable in our own skin in order to live intentionally. Otherwise, we can feel like drifters across the sea of life, allowing shifting winds to set our sail. This post will share how to define your story by becoming well acquainted with who you are, embracing natural giftedness and communicating your story that includes gratefulness. If we know our life story, we can live it!

Creating and telling a story that resonates also helps us believe in ourselves.What is your story? HBR – Herminia Ibarra Kent Lineback JANUARY 2005 ISSUE

Defining Your Story – Getting Acquainted With Yourself

accept-no-ones-definition-of-your-life-define-yourselfThe first step… to define your story is to define YOU. The most difficult part of this first step is to guard against accepting a definition others assume of you that may not align with your thoughts of self, plans to be a better you or the reality of who you really are. This statement goes both ways…those who may critically judge you and those who may overly praise you. The focus here is articulating a personal, deeply introspective, perspective of SELF.

The second step…honestly identify positive behaviors/actions that support the first step as well as negative behaviors that do not validate the person you are or striving to be. “Is the story we are telling ourselves match the story others are witnessing.”Life’s Stories, The Atlantic

The third step…further explore those negative behaviors/actions, which are not mirroring the essence of the person you believe or want yourself to be. This step is about making necessary changes in order to be authentic. We may think incongruent actions are not a big deal, yet they are visible and the message the world receives and reflects back to you appears as… Do as I say and not as I do, which doesn’t bode well for shaping a person of integrity.

Using the Life-Scope

Does your story say you have suffered loss or been hurt so deeply that you will never get over it? Or does your story say, “Life is hard sometimes, but I am resourceful, not to mention still breathing, and I have free choice and the ability to change patterns that don’t work for me.” Defining Yourself: What’s your life story? 

Experiences… shape us, teach us, and guide us. Experiences are our credentials when fullsizeoutput_4db9
properly channeled. Throughout life we have those significant experiences that greatly impact… to strengthen or break us. Experiences that strengthen build character, kindness and compassion, victory over our circumstances. The Oyster and the Pearl is a perfect analogy shared recently by a friend of mine in bible study about the irritating grain of sand that the oyster uses to create a stunning pearl. Experiences that break accumulate anger and form a thick root of bitterness, greatly impacting a story’s sentiment, reflecting a victim instead of a victor. Don’t we all want to be victors in our story?? Which life experiences, both good and not so good, have shaped the person you defined in step one? Take a moment and be grateful for your life experiences, especially those that have been hard and hurtful. Try and see how challenging times and perhaps difficult people allowed you to rise above, step by step, modeling a person of strength and perseverance. Take time to reflect on these experiences and release any bitterness that may still be tied to a difficult situation or person(s) to move forward.

Victors produce choices and don’t live in regret over what might have been or what happened yesterday. Victims obsess on past failures and hurts, feeding a growing cancer of bitterness. As bitterness grows, the obsession with the past dominates and the ability to make choices in the present fades. Victims lose the potential to generate success.Victors and Victims…Are you being held back by a victim mentality? By K. R. Harrison.

Embracing YOUR Giftedness

Make a careful exploration of who you are and the work you have been given, and then sink yourself into that. Don’t be impressed with yourself. Don’t compare yourself with others. Each of you must take responsibility for doing the creative best you can with your own life. Galatians 6:4-5 The Bible – The Message

Photo Your Story.jpegWe are all born with natural gifts. Unfortunately, it is human nature that we don’t always follow through with the giftedness we have and often times work hard to attain the gifts others possess. Deep joy and life fulfillment come from nurturing the gifts given to us as our birthright. There are many surveys that reveal natural gifts through algorithm assessments. However, that pure blissful feeling of joy is an accurate indication when we accomplish certain tasks or lose track of time fully absorbed in a project or working and serving alongside others. And, the value of this giftedness and JOY most certainly is not limited to monetary rewards or income status. The responsibility lies with you to disengage from “noise” that might lead you to believe otherwise. Successfully using natural giftedness can be accomplished through employment or volunteer work or BOTH. Value is measured by thriving through personal joy and happiness and being a positive influence to those around you. The following are some simple questions that can guide you to living life on purpose and not by accident.

What you are is God’s gift to you; what you do with yourself is your gift to God. Danish Proverb shared in The Purpose Driven Life by Rick Warren.  

  • What do I enjoy doing the most? The least?
  • What do I feel I’m best at? Not very good at? Do other people see me the same way?
  • When did I experience pure joy from the fruits of my labor?
  • When do I feel I’m of most value?
  • What brings me sadness? What brings me frustration?
  • What makes me feel triumph? What makes me feel defeat?
  • What do I need to feel balanced? If feeling deprived, even when using our natural skills and talents, we can be robbed of joy. Example…I need minimum 8 hours of sleep, exercise 3 x per week, and prayer time, which must be scheduled in my calendar.
  • Is there any trait(s) I’m currently refusing to accept about myself?
  • If I can change anything about my life what would it be?
  • Describe my ideal life 5 years from now, what I would like to be doing, where I’ll be living and who are the people that will be in my life?
  • Where can I improve…words and actions?
  • A question to those of whom you respect and know well…What do you feel is one of my strengths and one of my weaknesses?

After identifying your natural skills and talents, explore the many ways they can be used in various environments, experimenting to find your deepest joy. Be creative and be open to all avenues of application! Expect that your plans may be met with naysayers, opposition, discouragement, and perhaps also unexpected circumstances that could circumvent short-term goals. Therefore, when making plans to use these gifts in a new and different way in your life, be careful with whom you share your story. As I have quoted in previous postings, my favorite quote by Eleanor Roosevelt, “No one can make you feel inferior without your consent.” Don’t consent. Trust is earned. Know with confidence those within your circle of relationships who are encouragers and qualified to offer solid, constructive and respected advice.

 “A life story is written in chalk, not ink, and it can be changed. “You’re both the narrator and the main character of your story,” Adler says. “That can sometimes be a revelation—‘Oh, I’m not just living out this story, I am actually in charge of this story.” Life’s Stories, The Atlantic 

Always let kindness be reflected in your story. And, if this is not the case for you, take time to find out why. Difficult people are often a reflection of their own insecurities and unhappiness. Is this the storyline you want?

Your own capacity for kindness. It can be hard to feel gratitude for the people in your life at times when you feel hurt, betrayed, or abandoned by them. People can be cruel, and often there is little we can do about it. But we can control our own behavior. We can choose to treat others with kindness, to be the person who brightens someone else’s day or eases their pain. This capacity for kindness is a valuable gift for others, but also for ourselves—research shows that giving compassion and support to others (link is external) can increase our own happiness too.  10 Things You Can Be Thankful For No Matter What Is Going OnPsychology Today

Fully applying your natural skills and talents will shape an authentic story, mirroring in life the totality of your person. Your story is complete when the essence of who you are is able to shine through. The natural giftedness that shapes you becomes like vivid images/illustrations to your story or the seasoning that flavors you to be exceptional!

Sharing your story

Sharing your story is meant to empower others and to continue to empower yourself. Your story can be modified to your audience, for example, to those you are meeting for the first time (getting acquainted) compared to those you have known for many years, where a solid bridge of trust has been constructed. What is most important about your story… is the impact it has on you, living it out consistently and sharing it to inspire others

This is where control comes into play. You must decide the information you share and who you share this information with. In telling these pieces, be certain to take ownership. If you want your story to have significance, do not shy away from what you share out of fear of being judged. Instead take complete power over your story. There are pieces of your story that you may not want to share, but figure out how to share them in a manner that is constructive and if nothing else, will inspire those around you. Defining Your Story, The Only One Worth Telling by Tim Mousseau

Are you ready to create your story and share it? Knowing your story feeds meaning to your life. Your story should be unique to reflect the essence of YOU and your life mission. Our lives reflect the sum of our core beliefs and best intentions to enjoy a full and joy-filled life. What we perceive through the lens of gratitude will fill our story with grace, love, and all that is beautiful. We are to guard against becoming the sum of other people; their passions, judgments, struggles, and weaknesses. Identify and embrace giftedness, which brings a vibrant energy to your story. And, share your story to be inspired and to inspire others to create and share their own!

Resources

Additional Resources

Life Lesson

Triage for the Caregiver

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A Caregiver’s Guide

 

         The capacity to care is the thing that gives life its deepest significance and meaning.                                    Pablo Casals, World-Renowned Cellist

Longer life expectancy means we are becoming a triple-decker sandwich generation, caring for kids or grandkids, helping aging parents as well as managing our own life and medical needs, while often times maintaining a two-income household. Overwhelming! Frequently, we become victims believing the only choice is to make it all work. Stress can be incredible when striving to please everyone and be that perfect caregiver. Elderly parent care can include: medical advocacy, managing financial affairs, shopping and household duties, transportation to personal care appointments and running errands. Sometimes moving a family member home is the best choice but can be daunting managing one’s own personal life and existing responsibilities/relationships. Caregiving can also include attending to ill or disabled children (young or adult) or grandparents assuming responsibility to care for grandkids when adult children are a two-income household. Wherever you may fit in the caregiving category, and whether you are single, married, employed or not, you are juggling care and responsibilities of another and may be placing all or part of your life on hold to make caregiving work. This article offers suggestions on how to survive the role of caregiving without ultimately sacrificing one’s own health and well-being.

“When done in the right way, caring for a loved one can bring pleasure—to both you, the caregiver, and to the person you’re caring for. Being calm and relaxed and taking the time each day to really connect with the person you’re caring for can release hormones that boost your mood, reduce stress, and trigger biological changes that improve your physical health. And it has the same effect on your loved one, too.” Family Caregiving, Helpguide.org

Healthy Boundaries

Every caregiver deserves a cushion to refresh mentally and physically. And, those being cared for need a cushion, too! Sometimes a misconstrued belief convinces both the caregiver and the care receiver it’s best to depend on maintaining status quo, care as always managed in the past. This idea can lead to guilty feelings, straining relationships and blocking the caregiver(s) from reaching out for help and delegating responsibilities.

“If the caregiver is worn down or frustrated or responding to guilt, they are not providing the very best care that they could to their loved one. Those emotions drag us down,” explains Deborah Ford, in practice with Agape Home Care in Williamsburg, Virginia. How to Set Boundaries as a Caregiver, Caring.com

Trying to tackle it all, being available 24/7, is an unrealistic sacrifice that ultimately works to everyone’s disadvantage. Establishing healthy boundaries does not require justification or approval from anyone other than what works best for the caregiver(s), the care receiver, and communicating when help is needed for cover. It’s important to encourage the care receiver to also participate in decision making, when feasible, engaging with suitable choices to build confidence. Although best intentions, family members hoarding choices/decisions can inadvertently lead the patient to survival in a vacuum of despair, isolated by limitations. And, experiencing life on the sidelines can be a fast path to depression. Below is a list of healthy boundaries to consider.

This seems obvious on the surface but you’d be surprised how many of us behave as if we must respond to every demand with an outpouring of our time and energy. I’ve noticed my own tendency to turn requests into objects of resentment because I immediately assume each one is a “should do.”….But then, rather than an email saying, “I can’t do that,” I wondered: what if I sent an email that said, “Here’s what I can do (instead).” The Five Lessons in Setting Boundaries That Every Caregiver Must Learn, Huffington Post

General Boundaries

  • Schedule your day(s) off. This could be one full day per week or more, if you are able. Being available 24/7 is not healthy for anyone.
  • Triage requests received from the person needing care, medical staff and family members. Immediate responses are usually not necessary.
  • Block time each day for caregiving, time for yourself, as well as time for others. Let friends and family know your schedule, such as…I’m available after 4PM. Maintaining your own social network is needed and healthy.
  • Take urgent calls. Incoming doctor calls (set a unique ringtone) take priority and having to return them is not easy; navigating voicemail, long hold times and often playing phone tag. If others know in advance why you are taking a call, (in the middle of a meeting, family time/dinner, or social event) you won’t feel rude doing so and they will (hopefully) understand, without the need for justification.
  • Phone calls, not anticipated, can go to voice-mail. It’s not necessary to pick up every incoming call. Messages will be on voicemail to respond, when you are able, by return call or perhaps sending a text or email.
  • Say “no”. Your full availability before caregiving may not be feasible now. Accept this and others will, too. Overcommitting will eventually affect you, emotionally and physically.
  • Sleep…be consistent with a schedule. Well rested will serve you well and provide needed patience, a caregiving requirement.
  • Exercise… provides needed endorphins that clear the mind and reduce stress. A rigorous daily scheduled walk is just as good as a gym workout. Keep it up!
  • Embrace that you are WORTHY to have boundaries. Don’t be tempted to justify downtime and don’t be swayed to do so based on a comparison of responsibilities. The Five Lessons in Setting Boundaries That Every Caregiver Must Learn, Huffington Post says that being is more important than doing. Resist the temptation to feel...“I’ve often felt that I need to do more in order to make up for something I feel is lacking in who I am. That if I do more that’ll help everyone get past the general concern they all must have about my worthiness.”
  • Manage stress in ways that work best for you. Kaiser Permanente offers solid recommendations in this posted article…Stress Management.

Boundaries That Divide and Conquer

  • Identify all caregiving needs and responsibilities.
  • Identify what you are able to cover and what you can delegate.
  • Identify suitable choices and tasks the care receiver can have ownership. Relieves the caregiver of some tasks and inspires the care receiver with an “I can” attitude.
  • Match responsibilities to family members’ time and abilities and friends offering to help...medical advocate/coordinator, banking and bill paying, financial investments, home/real estate, grocery shopping and meal planning, transportation and general errands.
  • Connect with local community resources.

Seek personal referrals to local community services. Often times medical groups work with social services who can offer resources for home care, transportation services (providing transport to and from errands and medical appointments) as well as to community centers for social interaction. Always check current reviews. Well rated a few years ago may not be well rated today. I’ve identified a few outdated resources while being a caregiver. Share findings, especially to the social worker to update printed resources. Offering such feedback is graciously welcomed! My favorite transportation resource is Get Up and Go through the Peninsula Jewish Community Center.

Time Saving Boundaries

  • Mail order prescriptions is easy! Avoid driving to a pharmacy and long lines.
  • Email medical staff for non-emergency medical communications through protected online healthcare portals. Email directly connects to medical staff and avoids long phone hold times and the need to leave lengthy voicemail messages. I have found emails are forwarded to covering medical personnel if the email recipient is out of office. Email is also ideal to include photos of suspicious skin issues, healing wounds or other pertinent health concerns.
  • Request phone medical appointments instead of office visits, which can often suffice for follow-up exams. If needed, during the call, physician can suggest and schedule an office visit.
  • Text message medical staff if permissible (HIPAA concerns), especially great when communicating with medical coordinators, physical therapists and occupational therapists managing appointments. Huge time saver!!
  • Seek in-home nursing if offered by your medical group to avoid medical office visits for in-person routine follow-up checks.
  • Refuse automatic appointment scheduling, if this does not work for you. It is frustrating to receive a notice about a follow-up office appointment that isn’t feasible and calling the medical office (HOLD time) is the only way to reschedule. An 8AM appointment for someone in their 80’s and your commute is an hour away? You can request another time!! I share from experience.
  • Forward mail to avoid accumulation before you or a family member can get to the mailbox. This is also a time saver for the family member paying bills.
  • Paperless, if feasible, for all bills and monthly statements. Considering online auto bill payment, too.
  • Set up online ordering and delivery such as Amazon Prime Account for shopping, including groceries. Most grocery stores also provide online accounts and grocery delivery. HUGE time saver!!

Communication Boundaries

  • Use an online shared organizer, such as HUB, sharing calendars, lists, tasks, etc, with all those involved in caregiving duties, which prevents additional coordination/communications, overscheduling and efforts being duplicated.
  • Use an online meal organizer for extended families, friends, church groups and neighbors who want to help and prepared meals are needed. Meal Train is a great online resource.
  • Group text or email is ideal to communicate needs and updates to family sharing in caregiving. Text is best for urgent and brief notes. Email is ideal for lengthly updates and to file pertinent information in email folders for easy access, when needed.
  • Use an online connection portal, such as Caring Bridge, to keep all family and friends up-to-date at the same time, when dealing with a chronic health journey.
  • Be transparent with family members involved with caregiving. What one family may know the other may be seeking an answer. Avoid unnecessary duplication and communicate what you are working to solve/know… so everyone is aware.

It is far too easy for a caregiver(s) to neglect personal needs and existing relationships. Guard against feeling stressed and succumbing to a feeling of obligation and guilt, which can lead to unrealistic expectations. Be aware of extreme fatigue, which can skew reality when overshadowed by false perceptions, leading to bitterness and resentment damaging to relationships. Managing your emotional and physical needs, is, your responsibility. Establish boundaries to shape a healthy team instead of being or feeling like a solo act, wherever you may fit in the caregiving category. Find time to honestly assess what you can and cannot do. Reach out for help. Delegate where possible. Include the care receiver to cover suitable responsibilities, which will inspire and build confidence. Respect everyone’s time and contribution, including your own. We can all be effective caregivers and still live life joyfully. Communicating needs and seeking outside resources offers the opportunity to spend quality time with those in care. TRIAGE yourself! Be an effective caregiver and give yourself permission to take care of your needs, too.

Resources

Life Lesson

Planning Pain…what you should know

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Planning is a fundamental part of our culture, from identifying pre-schools for our infants (often at the time of birth!) to preparing kids for high school and college years before admission. We plan for emergencies as discussed in the blog, “Must Have Unexpected Plan” and provide instructions for when we pass away, shared in the blog “Your Living Trust…details you need to know”. New Year goals help us to plan to live better lives as explained in “Target Change”. Yet, there are some areas that we don’t plan, and maybe it’s because we are not aware that we can. One area that often goes unplanned…pain management in unexpected emergency situations. The inspiration to write this blog comes from a recent experience with a family member requiring surgery to repair a fall fracture. The focus was on, “fix it” and a discussion about pain management following surgery was not. This blog will share the importance of having pain management discussions now, for you and those family members you advocate, so you might have a voice in choosing pain meds and being aware of potential side effects. Before an emergency event takes place know all pain management options. Controlling pain should be individualized to the patient’s age, sensitivity levels, health status and other drugs currently taking. Doctors work best when we give them needed information to effectively treat the patient, be it family members or ourselves. Making pharmaceutical decisions based on another person’s success can be dangerous to your loved ones, and to you.

“It is much more important to know what sort of patient has a disease than what sort of disease a patient has? William Osler

Plan Ahead – Physician Discussion

Falls and emergency medical situations happen suddenly, without warning. Here are some questions you can discuss with your physician. Often pain management conversations take place prior to a planned surgery and therefore, I feel, it might also be a good idea to have such discussions ahead of an unexpected emergency.

Questions To Review With Your Physician

Contact your/loved one’s family practice doctor to discuss pain management options in the event there could be a future situation/need.

  1. What pain medications are typically administered following emergency need and/or surgery? Dose?
  2. Length of expected duration on such pain meds?
  3. Can my family member(s)/I request a very minimum dose first and increase only as needed?
  4. What are all the side effects known for this/these drugs?
  5. Can this drug(s) be stopped immediately or is there a tapering off process?
  6. After no longer taking the drug(s), how long do these drug(s) remain in the body? And, what types of withdrawal symptoms, if any, can be expected?
  7. What signs might I expect that would indicate a family member or myself could be having a serious reaction and therefore the need to stop the administered pain medication?
  8. Whom would I immediately notify about this reaction in order to cease taking the pain medication? Would this medication then have to be removed from my pharmaceutical/drug listing? Who would have that authority?
  9. I do not want any form of Opioids. Other options in place of Opioids?
  10. Can age and overall health contribute to the effects of drugs? What long term effects could these drugs have on young children following my child’s surgery? Or the elderly who are frail? Other options with less risks?

The goal from this discussion is to have a written statement sharing your pain management preferences that could be placed alongside a HealthCare Directive, for easy access in the event of an emergency. This might also be something you give to your family practice doctor to add to medical records.

Pain Management Drugs

Before you are administered pain medication, you should be asked about your level of pain. Years ago I remember patients, when asked this question, were given a pain chart. Recently, I haven’t seen this chart and in fact, it took me a while to find one online. The chart illustrated below is found in the article, ZERO PAIN, for your reference.pain_chart

Opioids – Oxycodone (eg, OxyContin®, Percocet®), Hydrocodone (eg, Vicodin®, Lortab®), Hydromorphone (eg, Dilaudid®), Merperidine (Demerol®), Morphine (similar to heroin) Codeine, Fentanyl, Methadone – These are narcotics, which block pain signals from reaching the brain and can affect the whole body (systemic). According to “Technology Versus Pain: Targeted Drug Delivery And Electrical Stimulation – An Alternative to Systemic Opioids” Dr. Lawrence Poree, MD, MPH, PhD, Department of Anesthesia, UCSF,  shares that only 1/100th to 1/300th of the amount of oral pain medication actually gets to the place we need it. The remainder of the drug goes elsewhere throughout the body causing problems such as sedation, confusion, constipation, nausea, vomiting, etc. For this reason, higher doses could be needed to manage pain. And, often times combination drug pain therapy is necessary, as well. Opioids are highly addictive and recent news has been reporting an OPIOID epidemic in our country. Dr. Poree notes that in 2011 prescription drug overdose killed more people than auto accidents. “…each day 44 people die from opioid overdoses and 80 percent of those deaths are unintentional.” The following article is another great resource about Opioids…

Five Tips for Pain Management with Opioids: What You Need to Know About Common Prescription Medications by American Society of Anesthesiologists, 3.14.16

Non-Opioids – Aspirin, Ibuprofen (eg, Advil®, Motrin®), Naproxen (eg, Aleve®, Naprosyn®) Acetaminophen (eg, Tylenol®, Q-Pap®) Anti-inflammatory drugs (NSAIDs), Advil® and Aleve® that are anti-inflammatory and acetaminophen to manage mild to moderate pain. These pain management options can also affect the whole body (systemic) since they do not target/isolate the area of pain. They are not addictive. Internal bleeding/ulcers are a concern when elderly take these medications over a prolonged period of time.

Future of Pain Management

Pain management could be at the precipice of significant change. The video presentation Technology Versus Pain: Targeted Drug Delivery And Electrical Stimulation – An Alternative to Systemic Opioids, referenced earlier, was presented February 2016, by Dr. Lawrence Poree, MD, MPH, PhD, UCSF. Very interesting and informative about the history of and problems we face today with pain management along with technological advances regarding Neuromodulation, current alternative to and future advances in pain management, especially chronic pain.

Zero Pain, June 7, 2017, Mission Magazine, Univeristy of Texas Health Science Center at San Antonio

“All we have now are centrally acting opioid painkillers—fentanyl, hydrocodone and others—which has led to an epidemic of abuse and overdoses,” Dr. Shapiro said. “These medications don’t stop the pain signal but instead cover up the sensation in the brain, which frequently leads to devastating addiction. We want to treat pain at the source, at the sensory neuron, so that the pain signal never gets started in the first place, or if it does get started, doesn’t lead to this vicious cycle of pain and addiction.”

Pain Management and the Elderly

As we grow older we at greater risk to sensitivity and side effects of pain medications as well as to anxiety reducing drugs such as atypical antipsychotics – Risperdal, Seroquel, Geodon, Zyprexa as well as Atavin, Ambilify, etc. These anti-depressant drugs can be administered when hospital and skilled nursing facility patients show signs of frustration and depression, often a result of pain and rehab stress. What works OK for some may have serious adverse side effects on others, whether in different age groups, health status, or the interaction with drugs currently prescribed. Why? Because, how we metabolize drugs determine their effectiveness or … toxicity. Why are elderly (especially if inactive) as well as those with multiple health issues at higher risks of narcotic drug side effects?

According to NCBI Resources Opiates and elderly: Use and side effects, June 2008

“The increasing use of opiates for pain management by healthcare practitioners requires that those prescribing opioids be aware of the special considerations for treating the elderly.”

“With aging, there are changes in body composition: increase in adipose tissue, decrease in lean body mass and decrease in total body water. These changes can affect drug distribution. Therefore, lipophilic drugs tend to have greater volume of distribution, and it can take more time to be eliminated from the body (Linnebur et al 2005). Aging can also bring reduction in hepatic blood flow and volume which can decrease metabolism of drugs.” (Tegeder et al 1999AGS 2006).

MSD Manual Professional Version, Drug Metabolism,  explains…

“Some patients metabolize a drug so rapidly that therapeutically effective blood and tissue concentrations are not reached; in others, metabolism may be so slow that usual doses have toxic effects. Individual drug metabolism rates are influenced by genetic factors, coexisting disorders (particularly chronic liver disorders and advanced heart failure), and drug interactions (especially those involving induction or inhibition of metabolism).”

Too often I have heard the terms delirium and sundowners applied to elderly who are experiencing confusion. I can’t help but wonder if it’s the drugs administered when hospitalized that are actually the root cause, or at the least, considerably contributing to “confusion” and not simply a default reaction to feeling disorientated in an unfamiliar place such as a hospital or skilled nursing facility? In my own experience I witnessed an an individual on anxiety medication and OxyCODONE suffering confusion and hallucinations, which was diagnosed as Delirium. Yet, once taken off these meds, Delirium vanished and the patient resumed her standard of mental clarity after a few days, still at the same healthcare facility. Questions…

  1. Since elderly and inactive patients metabolize drugs at a much slower rate, could there be an accumulation effect leading to toxicity of anti-depressant drugs and narcotic pain medications?
  2. Could possible toxic levels be responsible for triggering Delirium and therefore, not simply the result of feeling disorientated in unfamiliar surroundings?
  3. If (1) and (2) above could be true, what are other options for safely managing elderly anxiety, depression and pain? Suffering hallucinations is a horrific experience. The memory of those hallucinations linger after the episodes are over!
  4. Is it possible to have a trained geriatric specialist (PA, NP, or Nurse) at physician family practice offices, considering our growing baby boomer generation is quickly populating this age group, to guide all elderly patients in best care and pharmaceutical options?

What happened to Geriatric Care? The quotes above by NCBI Resources and MSD make it quite clear; drugs are processed slower/differently because of the physiology of elderly patients. Perhaps a form of Geriatric Care should return to Healthcare, providing specific professional guidance and insight to aging patients and their families.

What I Discovered

  • If there is a reaction from pain medication, request it be removed. It’s important to minimize withdrawal side effects. Check if gradual removal is needed or if the medication can be stopped immediately. Only a doctor can remove a medication on a medical record.
  • Anti-depression drugs such as Ativan or Ambilify can be used to treat anxiety in emergency care and post-surgery recovery. Know drug side effects and red flags to notify healthcare workers. Short term, these drugs can be effective and beneficial. Long term (more than 2 weeks) can present serious side effects best known in advance. Every patient is different and may experience different reactions. I know someone who is so sensitive to medication she experienced the most uncommon side effects, immediately with Ativan. Benefit vs risks should always be considered…with a physician.
  • Important next step…Medications triggering side effects that are taken off a medical care chart must also be added to the “allergic” list or DO NOT ADMINISTER list. Do not assume this is automatically done. Only a doctor has this authority and best you request. If this step is not carried out and the drug remains on the patient pharmaceutical list, it can be prescribed again. Follow through with your doctor as well as visiting your online medical portal pharmaceutical listing, if you have one.
  • All drugs have some form of side affects. It is important to review benefits vs risks… with your physician, to guide decisions. Internet search should only be used as a guide for questions you can prepare in advance to discuss with your doctor.

This blog post is about questions rather than providing answers. Perhaps you feel as I do…the importance of being informed about pain management options to best plan future healthcare. If we are not in a position to make these decisions, then someone else will. Would you prefer having control over what goes into your body and being fully aware of the potential side effects? Hopefully this post will encourage you to meet with your family practice doctor (or PA, NP, attending nurse) to initiate a conversation about pain management… a good introduction to being actively involved in your healthcare and those you advocate. As the saying goes, every journey begins with a single step. When are you planning to take yours?

Resources 

Life Lesson

Who Knew? You Decide!

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A few years ago I discovered wax melts and the amazing aroma from these “fire safe” and beautiful warmers. After purchasing three wax melt units, I placed them strategically throughout my home to optimize seasonal fragrances. Many scents have been enjoyed from spring fresh, summer floral, fall cozy spice to winter pines!!! Although the home always had an incredible seasonal scent, fast forward 2 1/2 years and I’m beginning to have concerns. Is there a possible connection to health issues tracing back to the time we began using, almost daily, scented wax melts and candles? My husband and I, both, have had occasional coughing, sore dry throats, headaches, fatigue, followed by daily morning congestion and most concerning, my husband’s heartbeat irregularity, which eventually led to an **Atrial Fibrillation (AFib) diagnosis. During the past 3 weeks I began searching scientific studies about the safety of home air fresheners, specifically scented wax melts and candles. At that time we also stopped using these air fresheners in our home and soon began to notice a remarkable difference in our overall wellbeing. Coughing and clearing throats slowly ceased. Congestion has cleared. My husband hasn’t had a headache. And most amazing, he hasn’t had ANY AFib occurrences. Coincidence? Did the accumulation of daily use contribute to our symptoms? The following shares some interesting findings to equip you with information about synthetic fragrance and wax products, paraffin and soy. If you are currently using these products, you can then decide whether or not to continue. Home air fresheners, wax melts, scented candles, and/or plug-ins, daily use, could especially effect elderly, small children and infants.

Key Definitions

Click this HYPERLINKED PDF before you continue… Key Definitions – Who Knew_ You Decide! – 

Concerns

#1 Concern –Ingredients are not listed on wax melt and candle labels. Reviewing all products I have on hand, only one company provided an ingredient list, which was vague at best…Wax, Fragrance, UV Stabilizer and Dye. Air Fresheners, candles and wax melts are regulated by The Consumer Product Safety Commission (not the FDA) and ingredients on labels are not required. FDA Regulations states “Other products using essential oils, candles and air fresheners aren’t regulated by the FDA. The Consumer Product Safety Commission is responsible for keeping the industry safe and honest.”

#2 ConcernSynthetic Fragrance is used in many home products such as spray air fresheners, plug-ins, candle wax melts, scented candles, car fresheners, to personal care products, household cleaning products and laundry detergents. Such fragrances are made of synthetic oils in order to offer a wide variety of scents at a much cheaper price point. Synthetic fragrance can be toxic. In a study conducted by Atm.Environ.552012257 (conclusion page 7), scented candles surpassed the toxicity rate of the unscented paraffin based products. “The study of emissions among scented candles concluded the fragrance had more to contribute to toxic emissions than the paraffin wax.” If given a choice, lighting an unscented paraffin candle might be the better option! Synthetic fragrance oils use styrene and Phthalates. Dr. Axe, Dangers of Synthetic Scents …notes the following. This article also includes a comprehensive listing of products that include synthetic fragrance oils, toxic chemicals used, and its potential health impact.

“Sadly, styrene is just one of many ingredients linked to cancer being used to create artificial fragrance. Phthalates are another group of chemicals often disguised as “fragrance.” They are connected to cancer, endocrine disruption as well as developmental and reproductive toxicity. These dangerous synthetics are already banned from cosmetics in the European Union, but are still quite common in products produced and sold in the United States. Phthalates often hide under the “fragrance” ingredient, but they can also appear on ingredient lists as phthalate, DEP, DBP, and DEHP. Be sure to avoid all of those. Dangers of synthetic scents include cancer, asthma, kidney Damage and more.”

#3 Concern – Essential oils, although recommended over synthetic fragrances, can also trigger reactions. Surprisingly…”Oxidized lavender oil showed among the highest frequencies of contact allergy to studied essential oils.”Medical Journal  Essential oils come with warnings about recommended use and storage. And, not all essential oils are created equal, having different purity levels. Before using these oils in your home, whether in candles or by popular diffusers, do your research and perhaps consult with your physician. Some scents are particularly harmful to pets, as noted in Are Essential Oils Harmful to Cats and Dogs? by Amanda Carrozza. This article provides a helpful toxicity list along with a warning about using diffusers, which could be overwhelming to pets having a higher sensitivity to smell. Essential Oil Safety (and Are Essential Oil Diffusers Safe?)  is another good resource reviewing essential oils and their safe use.

#4 Concern – Heat changes the chemical composition of oils, synthetic fragrance and essential oils, and it is not advisable because of potentially toxic particle matter that can be emitted in the air and inhaled. Particulate Matter (PM) (pollution) is a complex mixture of extremely small particles and liquid droplets that get into the air. Once inhaled, these particles can affect the heart and lungs and cause serious health effects.

#5 Concern – Paraffin wax is predominately used in candles and wax melts, especially those that are bargain priced! Paraffin is a by-product of petroleum and found that paraffin-based candles — the most popular kind — emitted toxic chemicals like toluene and benzene. The sources below provide; a history of paraffin wax, its raw material make-up, and the chemicals used in wax products such as candles and wax melts.

#6 Concern – Study Conclusions

Product Material Quality

Emissions Of Air Pollutants From Scented Candles Burning In A Test Chamber Atmospheric Environment, Volume 55, August 2012, Pages 257-262 “It has been found that BTEX and PAHs emission factors show large differences among different candles, possibly due to the raw paraffinic material used, while aldehydes emission factors seem more related to the presence of additives.”

Emission Of Air Pollutants From Burning Candles with Different Composition in Indoor Environments, March 2014, Volume 21, Issue 6, pp 4320–4330 “In this regard, the purity of the raw materials and additives used can play a key role. Consequently, in this work emission factors for some polycyclic aromatic hydrocarbons, aromatic species, short-chain aldehydes and particulate matter have been determined for container candles constituted by different paraffin waxes burning in a test chamber. It has been found that wax quality strongly influences the air pollutant emissions.”

Heat and Smoldering – National Service Center for Environmental Publications (NSCEP), Fine Particle Matter Emissions From Candles “Most tests revealed low PM emission rate except two, in which excessive sooting occurred and the PM concentration approached 1000 J.Lg/m3 with six and nine burning wicks, respectively. Wax breakthrough significantly increased the PM emission rate. Smoldering generated more fine PM than several hours of normal burning, causing very high concentrations in a short period of time, which raises concern over potentially acute health effects, especially for children and the elderly.”

Frequency of Use – Emission of Air Pollutants from Burning Candles with Different Composition in Indoor Environments, Atm.Environ.552012257… “Burning of candles in indoor environments can release a large number of toxic chemicals, including acetaldehyde, formaldehyde, acrolein, and polycyclic aromatic hydrocarbons (Lau et al., 1997; USEPA, 2001; Lee and Wang, 2006; Orecchio, 2011). It is believed that regular burning of several candles in indoor environments can expose people to harmful amounts of organic chemicals (USEPA, 2001).”

Synthetic Fragrances Emission of Air Pollutants from Burning Candles with Different Composition in Indoor Environments, Atm.Environ.552012257 “It has been found that the BTEX and PAHs emission factors show large differences in similar candles without any clear correlations. On the other hand, aldehydes emission factors are quite similar for all the candles, leading to the conclusion that such emissions are mainly related to the presence of a fragrance rather than to the other candle parameters. This has been confirmed by the experiments carried out using candles made by pure paraffin, where almost no emissions of aldehydes have been found. Moreover, a data scattering among the three paraffins investigated even larger than that found for the scented candles is evident for BTEX and PAHs emission factors. This seems to indicate that the kind of raw material rather than the additives determines BTEX and PAH emissions.”

Studies That Refute Health Concerns

In a study titled, Human health risk evaluation of selected VOC, SVOC and particulate emissions from scented candlesevaluated consumer health risks with candle emissions measuring particle matter and their thresholds of toxicity. The conclusion was that under normal conditions the use of scented candles do not pose known health risks to the consumer. I have found that studies which support the use of scented candles also indicate use in well ventilated areas, assume candles are not used by consumers on a daily basis, and consumers are not exposed to candle emissions 24 hours each day.

Consumer Frequency and Exposure Human health risk evaluation of selected VOC, SVOC and particulate emissions from scented candles,“Despite this overall favorable first tier assessment, it remains important to provide a more realistic understanding of potential consumer exposures. Typically, candles are not used by consumers on a daily basis. Neither are consumers exposed to candle emissions for 24 h each day. Modeling of potential consumer exposures to a group of surrogate compounds including formaldehyde, benzene, limonene and particulate matter using consumer research based habits and practice information revealed consumer exposures that were approximately 10 times below those values derived under the overly conservative standard assumptions which were used in the first Tier. Accordingly, all measured compound emissions including indoor or ambient air quality guideline values or established toxicity thresholds (see Table 10). On the basis of this investigation, it was concluded that under normal and foreseeable use conditions, the use of scented candles does not pose a safety concern to the consumer.”

Negating Health Risks Report on the Ökometric Wax and Emissions Study  “A new, internationally funded study on candle emissions has confirmed that well-made candles of all major wax types exhibit the same clean burning behavior, and pose no discernible risks to human health or indoor air quality.”

Allergic Reactions and Sensitivity National Candle Association FAQ – “Although millions of Americans regularly use scented candles without any negative effects, it is always possible that a particular fragrance might trigger a negative reaction in sensitive individuals. Individuals with known sensitivities to specific fragrances may want to avoid candles of those scents. In addition, consumers should remember to burn all candles, whether scented or unscented, in a well-ventilated area.”   

This post simply scratches the surface of all the sources available that shed light on this debated topic about the possible health implications with air fresheners using synthetic fragrances along with a variety of wax types and quality. After much work on this post I’m left with some remaining questions…

  • Chemicals heated by warmers or flame (candle)…is there an increased toxicity level and health risk from the change in oil composition, which we could be inhaling as Particulate Matter (PM)?
  • Is it possible PM toxin levels increase when wax color dyes are combined and burned with synthetic fragrances (candle and wax melts)?
  • Has a study been conducted on the accumulation effect, using these products frequently over a period of time and its health impact? (See blog article Medical Mayhem, 6.20.17…my reaction to fish oil supplement. Even though the manufacturer eventually assured me that the wheat ingredient was within FDA requirements, I still became very ill after 30 days, from the accumulation effect of daily intake.)
  • National Candle Association recommendation is for use in well ventilated areas, but there is no indication why ventilation is required if the product has been tested safe? (The labels on a few of my candles indicate…”avoid drafty areas.”
  • Normal use is often recommended in studies that refute health risk claims. What is normal use and if the product has been tested safe then why is there a “use” restriction?
  • Labeling on the products I own do not include frequency use recommendations or instruction for use in well ventilated areas. If these recommendations are so important for health safety, shouldn’t they be printed on product labels?

Who knew the amount of studies conducted and articles published (internet accessible), discussing and debating home air fresheners and potential health risks! Always, I am a firm believer, if something doesn’t make you feel well…then stop. My husband and I now feel great being an air freshener free home. The faux candles we have will suffice for ambiance. This past weekend (outdoor temperatures being a balmy 55-60 degrees) we opened windows to fragrance our home…with fresh air! When you can experience a remarkable difference in how you physically feel by staying clear of chemical based products, this becomes a debate you clearly WIN! If an ingredient list is not included on your air freshener product, you may want to pass on the purchase, not knowing what chemicals might be lurking in the product itself. Many studies conducted to-date arrive at different conclusions about the toxicity of synthetic fragrances and waxes. Take control, be informed, and make your own decisions on what is best for you and your family. You decide!

**I do not claim nor is there any scientific proof that specifically links air fresheners/scented wax melts and candles to being the root cause of AFib. What we do know is that once these products were no longer used in our home, there has not been an incident of AFib. The question is, can daily exposure to toxic substances identified in the studies of synthetic fragrances and waxes, referenced in this post, be contributing factors that trigger AFib events; BTEX (Benzene, Toluene, Ethylbenzene, Xylene), PAHS (Polycyclic Aromatic Hydrocarbons), Aldehydes (Formaldehyde and Acrolein) and VOC (Volatile Organic Compounds)? A study posted by the American Journal of Cardiologists concludes that acute exposure to air pollution, can acutely trigger AFib.  Acute exposure to air pollution triggers AFib.

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Life Lesson

When To Call It?…making decisions during a health crisis

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The New Year began with an adrenaline rush and not the preferred kind! Monday, January 5th, waking up to the start of the official New Year workweek, Marsha and her husband, Jack, enjoyed their morning routine of freshly brewed coffee while discussing current news and work related business. All seemed to be typical and uneventful. An hour later the ambiance in their home became tense. Jack confesses he has been having chest pains since 5 AM and the discomfort is getting worse. Breathing has become more difficult accompanied by a feeling of nausea and dizziness. He recently had a full physical and heart check and everything was great. What to do?? Planning for an emergency is not on most people’s radar. We all like to believe the sudden onset of concerning symptoms shouldn’t happen to those who are health proactive, have routine medical checks and are not at the age to be affected by such emergencies. This couple admits to being awestruck…do we push the emergency button (911), drive to the ER, or call our family practice doctor?? Let’s look at what the experts advise when a health emergency is in progress.

Emergency 101, When to call 911, offers an excellent guide. This is a great resource to print out and keep someplace handy for all those living in the home (children included) to know and understand. HR departments within companies should have something similar available to employees, visible and easily accessible throughout the office. This article defines a medical emergency as follows:

“A medical emergency is an event that you reasonably believe threatens your or someone else’s life or limb in such a manner that immediate medical care is needed to prevent death or serious impairment of health. A medical emergency includes severe pain, bad injury, a serious illness, or a medical condition that is quickly getting much worse.”

So often, to avoid embarrassment if the concern is ultimately nothing serious, people justify symptoms and avoid calling 911. Well, I would much rather deal with embarrassment than death or physical implications or a lengthy recovery time by waiting too long! It is important to know that when the 911 call is made, dispatch will ask questions to assess the medical emergency, taking the pressure off you, offering wise advice with next steps if paramedics are necessary. The arriving paramedics will also assess the emergency. Non-responsive, chest pains, difficulty breathing, profuse bleeding or severe allergic reactions are reasons to call 911, which often leads to paramedics bringing the patient to the ER.

Before paramedics arrive if the emergency is at a residence location, unlock your front door and place all pets in a safe place (another room with the door closed or the backyard) to avoid interferences. Either have a list handy of all current medications including vitamins and herbal treatments the patient is taking or place all bottles on the counter. Immediately notify EMTs of any allergies. They will need to know this information. Medical Emergency? Help the EMTs Help You as well as Insider’s Guide to the Emergency Room offer great advice. And, stay calm. If you are calm, the patient being attended to will also be calm (if conscious) and therefore share with greater accuracy symptoms and timing of what transpired. The paramedic team will then be able to better assess what is going on with the patient for proper treatment, quickly and thoroughly. If you struggle with calm in such a situation, let the patient and paramedics know you are leaving the room so the team can do their job and where you will be for questions and update status. Marsha took this approach and a paramedic knocked on her bedroom door to ask further questions, share the initial assessment and to let her know which ER Jack was being taken. The main highway was closed that morning and therefore side roads had to be taken. Knowing this greatly troubled Marsha. One of the paramedics gave needed assurance…”once in the ambulance he will get all the emergency care he needs while en-route.” The message here is to know the paramedics will provide necessary medical care in the ambulance, like a mobile mini ER, and also prepare the hospital medical staff for the patient’s arrival.

Before heading to the ER, be sure you have a copy of the HIPAA Release and Authorization Form. If you don’t currently have this document, you can print out this page by clicking, HIPAA Release and Authorization Form. If you also don’t have an Advance Healthcare Directive, contact your estate planning attorney or visit the Everplans website, which offers a wealth of information. The American Bar Association provides an informative overview, Myths and Facts About Health Care Advance Directives.  Additional resources can be found on my blog post Must Have “Unexpected” Plan, May 30, 2017. To have quick access to your HIPAA form and health directives, you might consider the following.

  • Best case is to bring copies of these signed forms to your local hospital to scan into their database in advance, where it needs to be.
  • Your physicians should also have a copy on file.
  • Another idea is to scan the Heath Directive and HIPAA signed form and email it to yourself. Save in a “Medical Emergency” email folder. When needed, wherever you might be, you can retrieve the document easily at any medical facility.

As you get ready to go to the ER, be sure to have the patient’s medical insurance card and drivers license (state ID card), if the patient left without this information. Suggest you also pack your (and the patient’s) cell phone and charger as well as a few power bars or fruit and bottled water, as you could be facing a very long day or night. If possible, consider having a friend drive. Even if you feel fine to drive on your own, the focus might be on the patient and not the road, overcome with all the “what ifs”. Marsha was fortunate a friend was already waiting for her when paramedics left and another friend, in the medical profession, was at the hospital when she arrived.

Patience is a virtue and you will need lots of patience. ER visits are usually long, whether the patient arrives by vehicle or ambulance. Consider waiting time to be seen, patient prep, evaluation, tests scheduled and results reviewed for a diagnosis. HIPAA doesn’t allow walking around the ER where patients are located, for privacy reasons, so you can’t pace the halls. ER room etiquette is required. 50 Secrets the Emergency Room Staff Won’t Tell You by Readers Digest will fill you in on the dos and don’ts of being at the Emergency.  It’s important to communicate accurately and with clarity, either on behalf of the patient or by the patient directly, to the attending ER physician and nurses. They cannot, otherwise, guess your symptoms or discern treatment and next steps when facts are left out or perhaps, embellished facts added in. Before you are discharged, if you are not admitted, the following is a summary of questions from the article, An Insider’s Guide to the Emergency Room, that is helpful.

  • Ask for contact numbers in case you feel worse later.
  • Review symptoms that would require heading back to the ER that you should know in advance.
  • Review the discharge paperwork and at-home care instructions and do ask questions, if you have any.
  • Ask about the medication you might be prescribed. How long to be on the medicine? What are the possible side effects? Will it interfere with other drugs, herbal treatments, and/or vitamins?
  • Ask about activities that you might need to avoid?
  • Follow up? When and with whom? Do you make the appointment or did the ER physician already contact the follow-up physician, and the name and contact information of this physician.

Emergency services are in place for true emergencies. The following from Do You Practice Proper Emergency Room Etiquette outlines considerations when a health issue arises that does not involve heart/chest pains, difficulty breathing, unstoppable bleeding, severe allergic reactions, or a severed or severely fractured limb.

  • Contact your primary care office, physician or local hospital advice line and discuss the situation if possible.
  • Utilize urgent care facilities or walk-in clinics for non-emergent situations.
  • Keep up with preventative care (such as physicals, shots and vaccinations, and annual screenings) to prevent necessity of emergent care.
  • Discuss care plans with your doctor and be well educated about any and all of your chronic conditions to reduce chances of requiring emergency care.

In the case of this couple, the emergency room visit ended well. It was not a heart attack, although symptoms led first responders to feel that it could be. The source of the problem remains unknown awaiting results from further follow up tests. It appears, however, symptoms may have been triggered by a severe reaction to a recently prescribed medication. This whole incident also could have been a heart issue, regardless of age or physical fitness. When symptoms match professional advice to call 911, this is when to call it! Many of us are guilty of being our own specialist when it comes to making decisions about our body. Don’t be this person. Be informed and prepared to make the best emergency decisions for you, and also for your family, friends or work colleagues. You never know when you’ll be in the position to take such a lead that could save someone’s life, including your own.

Note: This is a true story that happened January 5, 2018 and shared with permission. Names have been changed to follow HIPAAprivacy requirements.

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