My story about painkillers is not a prescription. It’s simply an honest account of my story. What I hope to model is not a step-by-step how-to, because the steps that I’ve chosen may not necessarily be the steps that you choose. Instead, I hope to model self-trust. Over and over again, I’ve found self-trust to be my path to healing. That doesn’t mean I never try something that turns out poorly and then switch gears. In fact, allowing myself to pivot when needed is an essential part of self-trust! As you’ll see in this story…

Chapter 1: The Beginning

I got my first migraine in 2007, on the first day of my very first job as a video editor on a reality TV show. That was also the first time I can remember taking a pill for a headache. I stumbled out of the office to a drugstore, searched the painkiller isle and chose “Excedrin Migraine.” The description on the bottle seemed to match what I was experiencing. Thankfully, it worked — the torturous feeling in my head dissolved into a slight euphoria and I was able to return to work and keep my job. I didn’t think too much of it.

Chapter 2: Prescription

Migraines popped up occasionally as I continued my new, high-pressure career in television. They were rare though, and I would just take Excedrin to make them go away. It was years before the migraines became frequent enough that I brought it up with a doctor. I was sent to a neurologist who prescribed Sumatriptan (also known as Imitrex) — a common migraine “emergency medication” (meaning, take as-needed, not on a daily basis.) Sumatriptan, I was told, was more effective than over-the-counter drugs and had less chance of causing “rebound headaches.” So, I replaced the Excedrin with Sumatriptan.

Chapter 3: Something’s Gotta Give

Sumatriptan worked well for me and allowed me to continue my life with minimal disturbance for a few more years. But the frequency of headaches continued to gradually increase. 10 years into my journey with migraines, I was getting them up to three times a week. Sumatriptan as-needed was no longer a sustainable plan, partly because the U.S. only allows an allotment of 9 Sumatriptan pills per month (more than that is not advised from a safety standpoint), and partly because they didn’t always work when I took them that often.

So, I went back to the neurologist, and this time the recommendation was daily preventative painkillers. My gut said “no.” There had to be a way out of this ever-increasing spiral of head pain and meds. So, I dove into Googling. Fortunately, a mind-body pain reduction app called Curable, which was only 2 years old at the time, popped up in my searches.

I started down the path of mind-body healing (which you can read about here) and soon began to experience a decrease in migraines! I knew I was onto something and I was excited.

Chapter 4: Keeping Score

As I used the Curable app, I tracked my progress closely, writing down every time that I took a Sumatriptan, and watching the number of pills decrease month by month. Seeing my progress in numbers gave me hope and a reason to believe in it. At first.

But then something happened: One month, instead of decreasing, the number of Sumatriptans went up again. And then decreased. And then increased. And leveled out. And increased again. With the help of several mentors, I was introduced to two key lessons of mind-body healing:

1. Recovery is not a straight line. And expecting it to be a smooth ride only puts pressure on the process, which puts stress on your nervous system, which works against recovery.
2. Keeping score — and defining progress by the number of painkillers — also puts pressure on the process, which increases stress, which works against recovery.

Chapter 5: Letting Go

I gave up my Sumatriptan tracking log. Deleting it from my phone felt scary at first, but I could tell that I needed to let go of this perfectionistic score-keeping.

And I set an intention to change my goal: Instead of aiming for fewer painkillers, my aim shifted to increasing self-acceptance and self-care. By “self-care,” I don’t mean pedicures or massages — although those can be part of it. But I mean actually caring about myself. Loving myself. Listening to myself. Spending time learning how to make myself happy — like you would learn how to care for a beloved.

I also made a decision: I was going to stop viewing painkillers as “bad.” I’d picked up this view from some of the mind-body books and lectures I’d come across: The idea that taking painkillers works against mind-body healing; that it’s a way of “giving away your power.”

Some mind-body practitioners believe that it’s important to wean yourself off of pain meds in order to concentrate on mind-body healing. And others don’t. There’s a variety of opinions out there. The opinion I’ve landed on is this: Being kind to myself and helping myself feel better is my path of healing. When I get a flare and it doesn’t subside within a reasonable amount of time, denying myself a painkiller can feel like self-punishment and perfectionism, and that only brings more distress to my nervous system.

As long as I’m not experiencing detrimental side effects from the meds, and as long as I’m heeding safety protocols and contraindications, I will simply take a painkiller and I won’t agonize about it.

Chapter 6: Hiding the Truth — and Self-Trust

The shift of letting go was exactly what I needed. Life got easier and less fraught. My focus and energy began to shift away from tracking painkillers, and I could redirect my energy toward things I actually care about — work, creativity, family and fun!

But there was one lingering piece still gnawing at me: I wasn’t being completely honest with my clients about how often I still take painkillers. Even up until recently, I’ve used the phrase “once in a blue moon.” When the actual truth is, I tend to take a painkiller about once a week.

It’s been a few years since I’ve had a full-blown migraine, but I still have a tendency toward head tension when I’m stressed. And when the tension doesn’t subside reasonably easily through emotional soothing and release techniques, instead of going through my day with head tension, I take a painkiller.

Since I don’t keep a log anymore, I don’t know exactly how many pills I take. I know that there have been particularly stressful weeks when I’ve taken more than one, and particularly relaxed weeks when I haven’t taken any. But the average seems to be once a week these days. That’s less than it was when I started this healing journey, and I imagine that as my nervous system continues to unwind, there will be a time when I’ll take even less and maybe none. However, I don’t hold that as my goal.

When I first began helping others with chronic pain recovery, I thought it was important to model hope and possibility by emphasizing how much I’ve healed. But what I’ve come to realize is this: Hiding the truth about my relationship with painkillers is driven by perfectionism, fear of judgment and shame. None of these are things I want to model for clients. Whereas trusting myself and accepting my truth lets my nervous system feel safer — which continues to further my healing. And that is something I want to share.

I hope that my story inspires you to bring greater acceptance and self-trust to your journey — whatever yours looks like.

Sending love, gentleness and infinite faith in you,

💖 Anna

The post An Honest Account of My Relationship With Painkillers appeared first on Medika Life.

I introduced Henry in an earlier article; here is his story in more detail. Henry is a 69-year-old widower living alone in a small town about 60 miles from the nearest metropolitan area. He has a small pension and healthcare coverage via Medicare, a Medigap policy, and a Medicare Part D drug policy. He was recently hospitalized in the ICU with a serious urinary tract infection that spread to his kidneys [pyelonephritis] and to his bloodstream [septicemia], and then his lungs [acute respiratory distress syndrome.] This was a recipe for rapid demise, but the needed intensive acute care is where American medicine excels. It was the full court press to save his life, and it was successful.

A week later, he called me and asked for some advice. He was discharged from the hospital to take his former medications plus a few more. He was now to take twenty-three — yes, 23 — different prescription drugs, some once, some twice, and some three times per day, along with one by shot monthly. He was not sure why many of them had been prescribed and asked if I thought he needed them all.

I responded that, at 400 miles distant, I could not be his doctor, but I would review the list and offer some questions he might ask his physician. He sent me the list, and I reordered it by category: two for heart failure (he did not know that he had heart failure!,) two for diabetes, three for high blood pressure, one to lower his cholesterol, a monthly shot of testosterone for impotence, one to shrink his prostate (it was felt in the hospital that an enlarged prostate had been a predisposition to his urinary tract infection), one for depression, an antibiotic to finish up the treatment of his kidney infection and a few others.

I asked him who his primary care physician was and learned he did not have one but went to four different doctors, each of whom treated different issues, and none of whom shared all of his information with each other. Whenever one of them checked his blood pressure, it would be elevated, so that doctor would either add a drug or increase the dosage of one or more.

He told me that it was always normal when he went to the local drug store and checked his blood pressure. I told him it might well be that he had “white coat hypertension,” meaning it was only high in the doctor’s office. Perhaps if he took these regular readings to his doctor, the physician would get him off one or more of the blood pressure meds. Besides, two of the three had a known side effect of impotence. Finally, I noted that he was on one drug to shrink his prostate, yet the testosterone might well be causing some of his prostate enlargement.

Henry’s story represents much of what is not working in the delivery of medical care today. He has four complex, chronic illnesses – heart failure, diabetes, hypertension, and depression. These all require careful attention and care coordination, preferably by a single primary care physician who knows the patient’s home and social setting as well as his direct medical issues.

The blood pressure medication story is representative. He was getting many too many drugs that he did not need and had become impotent as a result. Rather than looking for the cause, he was given another drug [testosterone] that probably had no value but was likely enlarging his prostate. As a result, he developed an infection that almost killed him. The hospital doctors had added a drug to shrink his prostate but left the testosterone in place. And all these drugs were expensive for him and his Medicare Part D insurance plan.

Heart failure and diabetes together consume more than 50% of our healthcare dollars. Here is a person whose care is not being adequately monitored; instead, he is getting one drug after another without attention to what else is happening. This lack of care coordination is a prime reason why the costs are so high yet the quality so low. The problem is less that drug companies charge too much for many drugs (they do) but rather that too many drugs are prescribed unnecessarily or inappropriately.

It is also instructive that Medicare pays without question for intensive hospital care – tens of thousands of dollars in Henry’s case, yet pays primary care physicians minimally – even though with time to listen, think and consider, a PCP could have, with limited costs, prevented the hospitalization.

My first suggestion was that Henry needed a primary care physician, one to call his own. He learned that a young doctor he had met at a nearby hospital would be setting up private practice near his town, so he became one of the first patients. Since the PCP did not have many patients yet, he gave Henry the time needed. A few months later, he called and told me that he was now taking just seven medicines, felt better, and was saving a lot of money.

But during our initial discussion, I also asked him what he weighed. I have known him for over forty years but had not seen him for more than twenty. I recalled a stocky, muscular man with perhaps a bit of a beer belly, so I was surprised when he said he weighed 285 pounds. His wife of more than 50 years had died a few years before and he found himself lonely and isolated. He rarely went out and told me he did not exercise; it was just too difficult. He fixed his own meals, mainly from prepared foods.

I asked him what he planned for lunch and was told soup and a sandwich. The soup was a canned one, so I asked him to read the sodium content to me. It was 320mg, or 35% of the daily recommended amount. The can had “two servings,” but he planned to eat the whole thing or 70% of his daily salt requirement (assuming he was not on a restricted salt intake because of his high blood pressure and heart failure) in the soup alone! The sandwich was salami on white bread with some lettuce and mayonnaise.

That sounded great for his high cholesterol problem. Together we figured out that he ate about 2000 calories per day, which he thought was about right based on the soup can label. I suggested that 2000 calories was about right when he was 22 and in the Army, but now, since he did not exercise and needed to lose weight, this was way too much.

My next suggestion was that he needed to get out, interact with people again, carefully consider his diet and begin a modest exercise program, perhaps just a short walk each day. When he called later, he told me that a friend had gotten him to start going with him to the local senior center, where he had made some new friends. Eventually, he agreed to go to evening dances, where he met a widow whose company he enjoyed. His depression seemed to have lifted; he was exercising and enjoying dancing again. I could hear the smile in his voice.

Henry still has four serious chronic conditions. But with a single physician serving as his primary care physician who was aware of all of his medical, emotional, family, and financial issues, his care became much more effective. And when he did need a specialist, which was now rare, the primary care physician became the orchestrator, not just the referrer. As a result, Henry now has better quality medical care, he has a much higher quality of life, he is spending less of his money and much less of Medicare, Medigap, and Medicare Part D’s money. In short, it is a win-win for all concerned.

The key to improving Henry’s care was to find a PCP who would and could spend the time with Henry necessary to offer such comprehensive care. Today, because of high overhead costs and low insurance payments per visit, most PCPs need to see about three patients per hour. They just do not have the amount of time a person like Henry requires. But those that do provide such time offer much better care. Yes, more time per patient means fewer patient visits per day, so someone has to pay for the difference. Insurance rarely does, which is unfortunate. The patient will have to pay the PCP directly, “Direct Primary Care” or DPC. But as we will see in later articles, the total cost of care comes way down, quality goes up, and patient and doctor become less frustrated. Henry is a great example of how totally dysfunctional care can, quite simply and a very low cost, be converted to excellent, cost-effective care.

The post More Time With a Primary Care Provider Means – Better Care, Lower Costs and Less Frustration – A Win, Win, Win appeared first on Medika Life.

1. We’ve heard your embarrassing question before.

Unless you make a big deal, we likely won’t remember how you once asked us about toenail fungus.

By the time we’ve graduated, we’ve been exposed to all types of questions and scenarios. We have heard the stories about how patients accidentally brushed their teeth with hemorrhoid cream, tried to swallow suppositories, and have been unable to remove tampons.

Those of us working in hospitals have likely experienced trauma patients and death. Although we never get used to it, familiarity does make it easier.

So relax, we would rather you ask us than guess or choose not to treat your condition. We promise not to laugh (unless you want us to).

2. Although we are drug experts, we know about general health conditions too.

Pharmacy school isn’t only studying drugs. We spend the first few semesters on basic anatomy and physiology. Once we know how the body normally functions, then we move on to disease states. Learning what can go wrong helps us to understand how drugs work. Each lesson builds on the other.

So, we will know about chronic disease states like high blood pressure, diabetes, and osteoporosis, and be able to answer questions you may have.

3. Please don’t ask us where the sale items are in the store.

We probably don’t know, and unless it’s a slow day, usually don’t have the time to check for you. And don’t expect us, or the people in line behind you, to appreciate checking out all the items in your cart.

That being said, we don’t mind going into the cold medication aisle and pointing out a few choices since that is within our scope of practice.

4. We’re masterminds at solving insurance issues, but we appreciate your patience.

Every insurance card is a puzzle. Some of them require a zero before the member ID, some want the person code after. Some don’t want the letters, some require a special group number that isn’t on the card. We likely know the major carriers, but sometimes we get thrown for a loop.

We are also used to insurance rejections. “Refill too soon”, “drug not covered”, “prior authorization required”. All of these issues require time to dig into.

Also, please know that we have no control over your copay. Yes, last time it was $20, and now it’s $30. Copays go up all the time. Deductibles start over every year.

If we have billed the insurance, the price comes from them.

5. We will remember if you are rude to us and our technicians.

We see a lot of patients and fill a ton of prescriptions every day. Unless you are a frequent guest, we will likely have forgotten your name five minutes after saying goodbye.

However, we remember the ones that yell. We remember the ones that make unreasonable demands. We remember the ones that try to bully our students and technicians for problems that are out of their control.

We understand that you may be sick and in pain. We know you likely spent hours in the ER or doctor’s office and just want to go home. We’ll give you a pass for that, but we are still human and deserve to be treated with respect.

6. Technicians aren’t pharmacists, don’t ask them drug questions.

Speaking of our technicians, they do a heck of a lot of work. Without them, our pharmacies would implode. They receive special education and training to be able to perform their job.

That being said, save your medication questions for the pharmacist. Legal requirements aside, the pharmacist is the one with 6 plus years of education, residencies, and credentials.

On the flip side, we are extremely busy and if every caller asks to “speak with the pharmacist” just to find out the price of their medication or if it’s ready for pick-up, questions a technician is more than qualified to answer, then we can’t do our work efficiently.

7. We work tirelessly behind the scenes during your hospital stay too.

A pharmacist will review each medication order for every patient who enters the hospital. Just like at the drug store, you can rest assured that we have screened the order against your allergies, checked if the dose is appropriate for your weight and age, and reviewed it for interactions with other medications you may be taking.

Sometimes we even consult with other members of your health care team in determining your treatment plan.

If you have ever received an antibiotic or blood thinner in the hospital, chances are a pharmacist calculated the initial dose and monitored it daily.

8. Don’t bring a grocery bag full of your prescriptions to the hospital.

Patients are not usually allowed to keep medications at the bedside, so guess what will happen to the prescriptions you bring in with you? Your family member will be asked to take them right back home.

The alternative is to have your medications stored in the pharmacy. This means they go into a drawer somewhere in the back corner. The nurse who drops off your medication receives a receipt. It’s up to them (and you) to remember to pick them up at discharge.

You can imagine how many “patient’s own meds” get left behind.

The exception to this rule is if you are taking a rare, brand-new, or essential drug. Hospital pharmacies stock the basics, but we won’t carry everything. If we don’t have it, we will ask a family member to bring it in so it can be continued during your stay.

9. If we don’t have the drug in stock, we will help you find it.

Did your doctor order a medication that we don’t stock? No problem. Chain drug stores are all connected by the same computer system making transferring prescriptions easy.

The same goes for hospital stays. We can call our buddy hospitals and borrow medications from them. A courier will pick up the drug and deliver it to us. Again, we appreciate your patience as this process can take a few hours.

10. We are human.

We have an outstanding assortment of technology at our disposal. Robots fill medications. Barcode scanners ensure the correct bottle of pills is chosen. Electronic prescriptions reduce transcription errors. Automated dispensing machines allow nurses to choose the correct drug at the hospital.

Many sets of eyes see a prescription order from start to finish but remember that the last link in the chain is you.

When you get your refill home, take a moment to look at it. Are the pills the same color and shape as last time? Is it a new prescription? Most pharmacies include descriptions of what the tablet looks like on the bottle’s label. Did the nurse scan your wristband before scanning the medication bar code at the hospital?

All of these steps will help to ensure your safety. Medication mix-ups happen. They can be bad. Help us to prevent them.

11. Doctors’ handwriting really is terrible.

Sometimes we rely on clues in the strength or indication. Sometimes we pass it around and everyone takes a guess. Worst case, we have to call the office. That’s why we are grateful that most prescriptions these days are electronic.

However, electronic doesn’t mean fool-proof. Doctors can still choose an incorrect drug from a drop-down or predictive text list.

That’s another reason you should always ask questions about your prescription. We can determine pretty quickly that the wrong medication was filled if we counsel you on diabetes medication for your earache.

12. We went into this to help others, not for the money.

Even though we sometimes look frazzled and stressed, please know we genuinely want you to understand your medications. We will always take time out for questions, counseling, and concerns.

We went into pharmacy school to be health-care providers, not to drive around in Lamborghinis.

Trust us, the money we are making barely covers the cost of our education. Most of us work more than one job. There are easier ways to make money.

We do it because we care.

The post 12 Things Pharmacists Want You to Know appeared first on Medika Life.