Author: epicnine

You may not be able to metabolize the medication, at all, for it to become effective. Pro-drugs must be converted into their active metabolite in order to work inside the body. Maybe, your body burns through the medication too quickly for it to be of help to you. How can you find out? A gene test for medications.

Most of us have experienced it ourselves or know of someone who has made the statement that a certain medication just did not work for them. What do you do then?

Call your doctor and tell them that it isn’t working? Continue taking the medication anyway? Just stop taking the medication and do not tell the doctor?

Those are the most common things that people do. So, let’s look at them and see what usually happens and how our health may be damaged. Hang on; it’s going to be a bumpy ride. Some of you will nod your head in agreement, some will begin to wonder how to be in better control of their situation and some will shrug their shoulders and just go, “Oh well, it is what it is.” Those of you that are the “shruggers” can stop reading now. This is not for you.

I know that ibuprofen works for me and I know that naproxen is like taking water, for me. Others may have the opposite reaction in their own bodies. That is a minor inconvenience on the scale of taking a medication for a need. What about when you have a surgery?

Pharmacogenomics for opioid metabolism would have made a difference for me

Yes, indeed. I had a surgery and was given a prescription for Percocet® (oxycodone & acetaminophen) for the post-op pain. Remember, we are on IV morphine (usually) before we are released. I was sore and in some pain, but that is just surgery. You will never be completely free of pain that is just not realistic. I am a pharmacist and I know this and am okay with it. I also know that the pain won’t last forever and I will do what I need to do to get better as fast as possible. That is just my nature. Now it is time for a pain pill. I take it and go on about my business. It gets to be about an hour later and I know that it takes 30 – 45 minutes to be absorbed, metabolized to the active drug and move on throughout the body. Something is wrong! I am hurting, really hurting. I take 800mg of Ibuprofen and another pain pill. An hour later, I am behind in pain management.

I call my surgeon and tell them that I cannot tolerate the Percocet®, to call in something else. Of course they think that I want another medication that is a Schedule II narcotic and would have to be written, picked up and then taken to the pharmacy to be filled. I told them no, just call in generic Vicodin®. They did. I could take 2 of them and the Ibuprofen and deal with the post-op pain.

Why didn’t I tell my doctor that the Percocet® was not working? I knew that it wasn’t working but at the time I had no proof as to why. This was the mid-1990’s. You know as well as I do, that when you tell your doctor a pain medication is not working and that you need “Your drug of choice, one that you know works for you.” You are viewed with skepticism and more likely than not a “drug seeker” or worse a “drug abuser.”

“What do you mean it is not working, it is one of the most powerful drugs that we have?” What you want to say versus what you do say is two different things. You want to say, “Dammit, I know that, but it is not working for me. I don’t care that you think it should work. It isn’t and I should not have to suffer because you are being stupid and not able to consider that not every drug works for every patient the exact same way!” Sometimes you have to help the doctors along in understanding drug metabolism and pro-drug vs active drug. The average person doesn’t know that and they should not be expected to know that. It is not their area of expertise.

Until you have had a treatment failure with pain management, you do not understand

Until a physician has experienced the lack of pain relief in their own life, they do not understand it and will not get it. Why? Because they have had one semester of pharmacology in medical school and most do not know how the medications work or do not work in certain populations. Don’t even get me started on drug reps and what they spout out about their products. Crap, we may be here all day on this one topic. That is okay, I will do other blogs on other topics. This is important to a lot of folks.

How is narcotic pain medication dosed? Guess what? It is based on morphine equivalents. Morphine is the standard. You aren’t even getting the morphine unless you are a cancer patient and then you will be given that reluctantly. Look, I get it we need to be more aware and mindful of pain medications. I agree with that. It has been proven that the more effective the pain relief at the beginning the less pain medication is used overall and the quicker the patient is off the narcotic and back to being normal. That is what we all want. I know some of you are worrying about drug addiction. There is a difference between drug addiction and drug dependence. Your body may be dependent upon a medication but that does not mean you are addicted.

There are some folks that are addicted and for them it is way beyond pain control. They have a mental and physical dependence with an uncontrollable desire/behavior in getting and using the substance. I have talked to folks that are addicted to substances. What I found out was that it wasn’t about getting high; it was about not getting sick while coming off the substance. All of the ones that I talked with all stated that you will never get back to the first high that you experienced your first time, but would still keep trying to achieve it. It is the pattern that we see over and over again. That and undiagnosed depression. Quite a few folks are self-medicating and that includes alcohol and nicotine too. Another topic for another time too, moving on to the rest of our story.

I always chase a few rabbits. Keep count. In one of my talks with a group we chased eight rabbits. Everyone had a good time and got the answers that they needed.

What type of metabolizer are you?

Back to the pain medication issues and the whys… We have known for some time that there were differences in pain relief for people, but why? What can we look at or find out to better help these folks without them being looked at as drug seekers or drug abusers. Everyone deserves a better quality of life. Is it in metabolism, absorption and excretion? Yes, yes it is. Now we have the genetic predictors of how you metabolize or do not metabolize certain drugs. This explains why some people get great relief from certain medications and others get no relief at all.

For myself, I am one of the 10% of the population that cannot metabolize Percocet® into the active metabolite (the one that causes the pain relief) nor can I convert enough Vicodin® (which is why I needed a much higher dosage) to get some pain relief. Now I have the proof that the medication that I do need is actually morphine.

I am not a chronic pain patient, but in my brief experience with surgery and other acute painful situations, I get why people will do almost anything to get some relief. I have had two migraines to where I would have taken anything that I could have gotten my hands on to get some relief from that pain.

What if by having the genetic tests done for yourself, you could find out what medications would work the best for you and your needs? What would your life look like? What could your family life actually be like?

I have had mine done and now have the reports to use the rest of my life. Whether I need antidepressants, blood pressure medications, heart drugs, chemotherapy drugs, Alzheimer’s disease medications or Parkinson’s medications, I have the list of medications that will work for me and those that definitely will not work for me and those that may work for me. Another thing to consider, the test will also help you figure out what medication(s) may be causing your terrible side effects and/or adverse reactions.

I researched this type of testing two years ago, but it was cost prohibitive. Over $2,000.00! Now, it is way more affordable. I am not posting the price here, but will be glad to share it with you via email or telephone. The one I am affiliated with was developed in connection with the Mayo Clinic.

Have your test done now and use it for years. Yes, I get a fee for providing this service. Even if I didn’t I would recommend it anyway. Invest in yourself and your health today. As a bonus, you get to talk with me when your test results are ready and we go over them and get you back in control of your healthcare needs.

Have a great day and pass this information along to those who may benefit from this information.

Pat Collins
Empowering Health Options

865-684-8771 (If I am unable to answer, please leave a message.)

Email pat@wun.iax.mybluehost.me

We have heard it, possibly said it and probably thought it … “My mom is killing me!”  You know what I mean and if you don’t then this article is not for you.  She is not literally killing you, but frustrating the hell out of you.

Family Caregiving Conflicting Feelings

You have all of these things running through your mind…I have to be at work, I have to help my kids, I have to show up for my other commitments; there is just not enough time in the day!  What did you overlook?  Your spouse/significant other and yourself, we have all done it.  The things that you are secure about, you kind of push to the side. We always put ourselves and our needs last so, what are one or ten more things?

Signs we may be having conflicting feelings

Ponder a few minutes on neglect.  That is what we are doing. We are neglecting our partners, we are neglecting ourselves.  How long will it be before problems in our relationships pop-up?  How long will it be before we start feeling run down, exhausted, and ailments start popping up?  We may even get sick with a cold or infection of some sort.  Our low back begins to hurt all of the time, our migraines become more frequent, our stomach is just in knots.  Yes, you know what is coming next…the pouncing on anything and anyone that pisses you off.  Even things that normally would not phase you seem like big deals now.  What do you leave in your wake?  Then hurt feelings of your partner, your kids, fellow workers, your friends, and your mom?

Yeah, I know, we were going to talk about conflicting feelings. I see it as you love this person and want the best for them and their care BUT, you are so mad, angry and frustrated at them that you want to either choke them or run away. You truly love this person but you just do not like them right now and you are just plain mad. Oops, how can I feel that way?  I can’t. But, I do?  Then I feel shitty for feeling the way that I feel. Well, hell, now what do I do. You are human Take a breath, and realize it’s your reptilian part of your brain that is reacting and not your logical brain.  The logical brain takes about 3 more seconds to kick in and be available to you for use.  You really aren’t mad at your mom, you are really mad at the situation, the struggles, the problems and all of the confusing and probably contradicting information that you are receiving all at the same time.

Be kinder to yourself.  Realize that your own self- care is not a luxury; it is a necessity for you to be able to provide better care to your loved one.  It still counts, even if you are not the “hands-on” caregiver but more of the “overseer to needed care.”

For those that recognize that they may need some help, as this is not their area of expertise, I offer services and support plans that are specific to you and your loved ones needs.  Let’s have a conversation to see if I may be of service to you.

Pat Collins

865=684-8771 (leave a message, if I am unable to answer and I will return your call)

1. 1. Get Organized

1. 1. Prioritize

1. 1. List Your Resources

1. 1. Assess Needs

1. 1. Prepare a Proactive Plan

Most of us want to stay at home until we die.  We want our independence and our familiar surroundings for as long as possible.  Some of us will have to transition to other levels of care due to our future health needs.  But until that time, we want to stay in our own home for as long as it is safely possible.

5 Tips for Older Adults

How can we live our life on our own terms?  Stay as healthy and physically active as possible.  Yes, we will have to modify some of our activities, but we will still be active and social.  Maybe I should have placed Proactive Plan as number one, but some folks freak at having to figure out a plan when they do not know where to begin.

1. 1.  Get Organized

Find your ducks and get them in the same pond.  What insurance plans do you currently have?  List them with the name, policy number and a telephone number.  Medical, Dental, Long-term care insurance policy and any other insurance benefit policy.  Next, your personal medical history, all of your physicians and healthcare team members, with telephone numbers, list of current medications, dosages and why you are taking them (you may be taking them for some other reason than their intended use).

Do you have a Will, medical and financial power of attorney?  Do you have a living Will that states your wishes and desires for your medical care should you become incapacitated?  If not, have a party and invite your family and friends so that everyone can do it together.  Get it written down.  Now, you need to make it legal.  You can use Legal Shield (or something like that), that is affordable and have your documents legalized.  Now that this is done, continue your party and enjoy. A part of being independent and making your own decision is to take responsibility and the necessary steps to make it happen.

Find your retirement investment(s) information, your pension plan, any other investments that you may have and list the name, policy or account number and telephone number. List all of your banking information and investment advisor’s name and telephone number. Deeds, mortgage loan information, debts owed (credit cards too), vehicle titles,

Get a file box or a fire proof safe and place this information in there.  Do not just throw it in there; you have worked hard to gather this information so let’s keep it organized.  Use file folders for each item or label envelopes for each item.

2. Prioritize

Assess where you are right now.  What might you need to address in the next 6 months?  Chronic health concerns and issues, evaluating the safety of your home, adaptive needs, home repair or even some remodeling to allow for safer aging in place (decreasing fall risks), vision, hearing and balance checks,

Wills and powers of attorney, preventing complications of chronic health conditions, increasing lighting in the home, social engagements, increasing physical activity, transportation needs should you become unable to drive, grab bars in shower/tub, eating for your body’s needs (nutritional balance), money coming in and bill payments going out, etc.

Write them down and then rank them in order of importance.  Why write them down?   What gets written down gets done.

3.   List Your Resources

Write down your income resources and how much you can take in each month.  What investments, pension plans, retirement plans do you have access to and what can you get to easily and what would take time to access?  What are the benefits of your medical insurance?  If you have long-term care insurance what will it pay per day and will it cover in-home care?  For how long?  Would you be willing to sell your current home to move to another home that would be better suited for you and your needs?  Everything that you own is a resource that you can use for your needs.

Consider your non-monetary resources such as family, friends, church, civic organizations, government programs and local offices on aging in your area.  Find out what is available to you for low to no cost.  Resources are things that can benefit you socially, spiritually, emotionally, and even physically.

4.  Assess Needs

Realistically look at and write down what you will need to age in place.  Once that is done, is it realistic or feasible to stay where you are or might you need to find another place?  Can you be objective?  Sometimes we can and sometimes we can’t.  An occupational therapist can come to your home and assess the situation for safety.  Will you need help with cleaning and chores?  Can you afford to pay someone to handle that for you?  Please do not assume your family will do this for you or that they can stay with you whenever you need them to.  They may want to help, but because of their responsibilities they are unable to meet your work needs.  Your needs will change over time and you need to expect that and readjust as needed.  Be flexible and open to the possibility of change.  Change doesn’t have to be bad.

5.  Prepare a Proactive Plan

For those of you that fly by the seat of your pants….. You drive the rest of us crazy.  Stress will make you do things that you would not normally do.  You cannot be rational in a stressful situation.  What will a proactive plan provide you?  A roadmap or guide so that you have what you need whenever a situation arises and you can make better decisions and choices.  You do have to play the “What if” game so that you can look at your choices or options.

Benefits of a proactive plan include:  Less stress, More options, Better communication, You know what resources you have and how to access them, You have the information you need in most of your “what if” situations, You get to be with your loved one at a time when they need you emotionally and physically without feeling like a piece of taffy being pulled in 5 different directions all at the same time.  Remember, whether you have a plan or don’t have a plan, there will be a plan made. It’s all about having that plan to access when you need it and are too stressed out to do your research.

If you need help, contact me Pat Collins @865-684-8771 or email me at pat@wun.iax.mybluehost.me  I work with folks throughout the U.S.

• • Spoiled food that doesn’t get thrown away

• • Check the refrigerator for expired food, grime and mold

• • Multiple jars of the same food in varying states

• • Weight Loss

• • Pots that are burned on the bottoms

• • Food that has been left out

• • Missing important appointments

• • Unexplained bruising

• • Trouble getting up from a seated position

• • Difficulty with walking, balance and mobility

• • Uncertainty and confusion when performing once-familiar tasks

• • Forgetfulness

• • Odd Conversations

• • Acting a little paranoid

• • Unusual fears

• • Nervousness

• • Mom and Dad cover for each other, fill in the gaps

• • Unpleasant body odor

• • Infrequent showering and bathing

• • Clothes have an odor

• • Strong smell of urine in the house

• • Noticeable decline in grooming habits and personal care

• • Dirty house, extreme clutter and dirty laundry piling up

• • Carpet Stains in a normally clean house

• • The yard is not being maintained

• • Holding on to walls or furniture as they walk

• • Stacks of unopened mail or an overflowing mailbox

• • Late payment notices, bounced checks and calls from bill collectors

• • Poor diet or weight loss

• • Loss of interest in hobbies and activities

• • Changes in mood or extreme mood swings

• • Forgetting to take medications – or taking more than the prescribed dosage

• • Frequently misplaces things

• • Diagnosis of dementia or early onset Alzheimer’s

• • Depression

• • Unexplained dents, scratches or dings on the car

It may be normal aging health conditions or it may be more, check with their doctor.

Can I really do self-care for myself? Yes!

You hear a lot about self-care and how we should all be making that a priority in our lives.  If you are a caregiver, you hear it even more.  When you are in the middle of being a caregiver, “take care of yourself first,” “make time for yourself,” “take a break,” and many other phrases by well-meaning folks just make us crazy.

Presently, I am not a caregiver, but I have been one and so when I say “we” it is because I have been there too.  Yes, self-care is important, but when do you find the time?  You will never “find the time.”  You have to make it a priority and schedule it into your day or week just like an appointment.  Write it down.  What gets written down gets done.

Good self-care includes:

Draft some of those well-meaning folks to help with the caregiving chores so that you can do your self-care.  Notice that I said draft them.  That is akin to delegating some of your tasks to others.  Yes, it can be done.  Think about the things that really do not have to be done by you.  Make a list and divvy it up amongst others.

Let’s get back to the actual self-care issue and the benefits of self-care.

Self-care does not have to cost you any money.  You can walk or run every day.  Work up to 30 minutes.  It is a great stress reliever and you get to have some alone time to just let your thoughts wonder.  You don’t even have to figure anything out during this time.  When a thought arises, just say to yourself…”Isn’t that interesting?”

Make plans ahead of time to get away.  Even if it is for one day, heck even if you could only get away for four hours, wouldn’t that be pretty awesome?  Yes, it would.  If you can’t get a volunteer, then draft someone or hire someone.

Self-care for your own health and well-being

Let’s look at self-care from a benefits standpoint.  You will be calmer and more in control of your emotions.  You can think more clearly and make better decisions.  You will actually be more productive and have more energy for caregiving.  It will improve

Your relationships.  Relationships become strained and die because of neglect.  No matter what the reason.

Do something that you enjoy either by yourself of with someone that you love.  Recharge your batteries so that you can be the best caregiver possible.

I know, I know, it is New Year’s Eve and it everyone is asking you what your resolutions are for the coming year.  I don’t have any and come to think of it, I never have been one to make them.  I have seen it year after year at the gym.  It is packed from the first of the year until about February and then it really slacks off.

I am sure that it is that way for most resolutions.  Why?  They are usually made with the best of intentions.  What happens between the declaration and the actual resolution?  Maybe the goal was not specific enough.  This one is usually for losing weight and working out/going to the gym.  Did you remember to state the amount of weight you are going to lose and by when?  You have to be specific and it has to have a time table.  Just like at work you need to set SMART goals.

S – Specific (simple, specific, significant)

M – Measurable (meaningful, motivating to you)

A – Achievable (doable, attainable)

R – Realistic (relevant, reasonable, results-based)

T – Time based (time limited, by when)

If you would like to set a goal for yourself, then by all means go for it.  Get specific and write it down.  Have an accountability partner to support you, not to nag you. Small steps, this is a marathon and not a sprint.  You will mess up, it is okay. Have a plan in place for when you mess up.  I say just start where you are and go forward. Celebrate your successes. Focus on the present and what one thing you are doing today to help you achieve your goal.  Change your thought processes.  If you ever hear yourself saying, “I can’t,” or “I failed at…,” stop right there.  It is okay that you failed, that means that you really did try and maybe you can’t right now but soon you will be able to because you kept working on your goals. You’ve got this!

Did you know that dehydration has almost nothing to do with feeling thirsty? After about age 40, we don’t feel thirst as we once did. That part of our brain doesn,t work quite as well as it once did. But, we still need to hydrate with fluids. Most of us are dehydrated because we wait until we feel thirst to drink water. Our bodies need to stay hydrated throughout the day. 

A 60-year old man was starting to forget little things and he would start a project, but would not finish it… Now, some family members thought that it might be the beginnings of Alzheimer’s disease which made the other family members panic a little. The questions started flying! How long has this been going on? What is wrong with dad? He is just not right. Why didn’t you tell us? The wife was feeling ganged up on. She had not really noticed anything different as this had happened so slowly that she had gotten used to it and it was just the new normal.

Of course, an appointment was made with his primary care doctor, for two weeks later. What in the world were they going to do until then besides stress out and fret?

Nobody ever thinks about dehydration and drinking more water. You see as we age the part of our brain that senses thirst just does not work as well as it used to. We just don’t feel thirsty. Guess what? Our bodies still need that water to function properly and to deliver nutrients and remove toxins from our body. Dehydration can make use hallucinate, become weak and not be able to think clearly. As we age we have to work at preventing dehydration. 

Dehydration in older adults, prime example

It was not dementia or Alzheimer’s disease. He had not been drinking enough water every day and so his thinking was foggy, he was forgetting little things and he was having difficulty thinking.

The remedy, you guessed it! Drink more water throughout the day. How much should most of us drink? About half of your body weight in ounces per day. Example: 170 pounds divided by 2 = 85 ounces of water. That is only 5 of the 1L (16.9oz) bottles.

Family Caregivers Can Develop Resilience and Skills

Relieving Holiday Stress for Family Caregivers

The holidays are fun, exciting, exhausting, maddening, time challenging, overwhelming, full of unmet expectations and family drama.  For the most part we enjoy the get togethers with family and friends; we don’t enjoy all the stress that comes with it. Self-care is still important at the holidays.

Many caregivers have more stress during the holidays

Stress, it’s the six letter dirty word when it is negative stress.  Can holiday entertaining be less stressful and more enjoyable?  Yes, it really can be less stressful and quite enjoyable.  What are the two things that are most important to you?  Focus on those two things and be flexible with everything else. With a few adapted holiday preparations, everyone can have a fun time. 

We all have a picture in our minds of “how it should be,” or “how we want it to be?”  Now, wake up from that dream and look at reality.  It is not going to be that way.  Why?  Because everyone else has their own dreams and ideas of the way it should be too.  Get rid of the “have to’s” and “shoulds.”  Make your own new traditions.  Can you give up your perfectionism for being fully present?  Will you be open to the possibility that whatever you choose to do or not do will be good enough?  Delegate some of the cooking, use paper plates and plastic utensils, and keep menu choices limited to the basics.  No talking of politics, religion or personal family issues.  It is neither the time nor the place.  Lower your expectations and go with the flow.

Enjoy the Holidays

Have outdoor games and indoor games available; enjoy just sitting and talking or watching something on television together.  It does not matter that holiday is not celebrated on the actual calendar day.  We celebrate Thanksgiving on the Saturday after Thanksgiving.  It works for us and we are all together, watching football, playing with the Nerf guns, wrestling, playing a board game, doing a jigsaw puzzle or playing Disney’s Scene It.  Really, we are just enjoying each other for a couple of days.

I know the holidays are a busy time and we can’t get rid of all the stress, but we can decrease it quite a bit if we are open to the possibility that we can enjoy just being together above all else.