WEBVTT 1 00:00:00.040 --> 00:00:14.260 Victoria Musheff: in, Ann Wetzel's house, and Ann's gonna move to her condo in Greenville. Wow. And then they need… they need to find a place in Birmingham, but they haven't yet. I keep nagging her, but she doesn't like me to nag. 2 00:00:15.190 --> 00:00:22.899 Victoria Musheff: But it's not healthy. We're going to learn about wellness and well-being today, right, Brenda? At least with medications. 3 00:00:24.430 --> 00:00:38.799 Victoria Musheff: The road to happiness is through medication. Correct. Better living through chemistry? I've got to go ahead and share Facebook. 4 00:00:39.940 --> 00:00:57.340 Victoria Musheff: So let's go ahead and introduce our speaker, Dr. Roseanne Pruitt, and for those of y'all online, please let us know if you can't hear us, you know, and we're trying to fix the 5 00:00:57.340 --> 00:01:00.959 Victoria Musheff: I know Victoria's good at picking whatever the sound's going on. 6 00:01:01.070 --> 00:01:18.289 Victoria Musheff: So, Dr. Pruitt is a professor emerita of nursing, and during her time at Clemson, she was the school director and associate college dean, and at that time, the school received some initial recognition 7 00:01:18.290 --> 00:01:37.149 Victoria Musheff: as a National League of Nursing, which many of y'all may not know about, but it's a really prestigious group, as a national center of excellence. Because of the job placement, the licensure and certification rates, all exceeded the national average across the country. 8 00:01:37.230 --> 00:01:54.040 Victoria Musheff: Several programs were initiated during her tenure as director, including the Interdisciplinary PhD in Healthcare Genetics, the Accelerated Second Degree Program for Non-nursing majors, and the development of Family Nurse practitioner Graduate Program. 9 00:01:54.060 --> 00:02:18.730 Victoria Musheff: Much of her research focused on the effectiveness of health promotion interventions. She currently serves on the Emeritus College Advisory Board. She is the chair of our well-being Committee, and she volunteers for the Anderson Free Clinic, her church, Rotary, the Anderson County Master Gardeners, and she enjoys tennis, walking, and yoga. And I do not know if we found time to be with us today. 10 00:02:18.730 --> 00:02:31.020 Victoria Musheff: We're so glad you're here. And she's going to talk with us today about how we do, medication safely, which is something I think we all probably can benefit from, so I'm really happy to turn it around you. 11 00:02:32.690 --> 00:02:36.050 Victoria Musheff: Okay, let's gonna fix slides up. 12 00:02:36.370 --> 00:02:42.069 Victoria Musheff: Here they come Good morning! Thank you all for being here. Okay. 13 00:02:42.090 --> 00:02:59.799 Victoria Musheff: And I have a note here that 20% of U.S. adults take 5 or more medications a day. So, we are a, very heavily medicated society. This is working. Yeah, I was gonna say, but… 14 00:03:00.040 --> 00:03:10.280 Victoria Musheff: With the prescription, it should have your name at the top, the day that it's filled, number of refills, the name of the medication, the dosage of the medication, and you all have 15 00:03:10.280 --> 00:03:24.860 Victoria Musheff: you have these all on your notes. The timing, the frequency, any special directions if it's supposed to be taken with food, how long you're supposed to take it, particularly, like, with antibiotics. You only take them for a limited amount of time. 16 00:03:24.860 --> 00:03:49.210 Victoria Musheff: why it's prescribed. Now, this is something that's sometimes very confusing to individuals, but you want to make sure that you know why you're taking your medication. That's one of the things working at the Free Clinic. I am always amazed at the number of people that… they've been taking a medicine for years, but they have no idea why they're taking it. So being able to have that on the bottle, as a reminder, you know, of why. 17 00:03:49.210 --> 00:03:57.530 Victoria Musheff: You want to make sure you're storing in a cool, dry place, away from a shower or tub, because if it gets moist, a lot of those pills will disintegrate. 18 00:03:58.740 --> 00:04:03.759 Victoria Musheff: Let me ask you a question. Why is the fonts always different on the medical… 19 00:04:03.960 --> 00:04:11.980 Victoria Musheff: The font, you have a tiny font, then you have a big font, but while you're taking it, another font. 20 00:04:12.650 --> 00:04:21.930 Victoria Musheff: That is… that's strictly the pharmacy doing that. There's no reason… there's no reason for that. You can request a large print. 21 00:04:22.070 --> 00:04:33.320 Victoria Musheff: On that, but, there's, you know, that's, that's just a preference of the, the pharmacy itself, and that would vary by the pharmacy. But, 22 00:04:33.460 --> 00:04:40.960 Victoria Musheff: But, like I say, that's something that you can request as far as… One of the things that I see that one of the… 23 00:04:41.150 --> 00:04:53.309 Victoria Musheff: The free clinic has a pharmacy that they, if the individual is eligible for the drugs there, they can get it filled there, but the Well Vista is another one of the, companies that fills those medications. 24 00:04:53.310 --> 00:05:17.950 Victoria Musheff: they have a label that their ink doesn't stay. So, after about a month, you can hardly see what's on the bottle. So I'm always in there with a marker, with a permanent marker writing on the individual's thing so they can see it, because if it's been refilled several times with that same bottle, they can't even see. It's so… it's so light, you can't even see what's on there, so… 25 00:05:17.950 --> 00:05:19.740 Victoria Musheff: You notice something in terms of… 26 00:05:19.740 --> 00:05:37.250 Victoria Musheff: I'm looking at being able to see what it is. Reminders, setting up a system that works for you. Now, some people put it on their watch or their phone. You might want to put it on the refrigerator or bathroom mirror. The pillboxes, and I brought one here that I could pass around, 27 00:05:37.460 --> 00:05:46.019 Victoria Musheff: that has all the different colors of the different days, and then it has multiple times a day. If you want to look at… this is just one. 28 00:05:46.230 --> 00:05:52.169 Victoria Musheff: ones there. Template.net, which is at the end of your resources and your handout. 29 00:05:52.310 --> 00:06:16.429 Victoria Musheff: has a pill schedule, where you can edit and make your own schedule, and then it has a free AI generator that it is real easy to use. But if you want to, you know, if you're taking multiple medicines, to go ahead and put that on a schedule, and then put it somewhere that you would remember. Particularly if you have short-term, sometimes when people are having procedures done, they have to take multiple different medicines. 30 00:06:16.580 --> 00:06:26.139 Victoria Musheff: you know, in preparation for whatever the procedure is and that kind of thing. So, like I say, template.net is one of those resources that makes that easy. 31 00:06:27.360 --> 00:06:33.669 Victoria Musheff: Sorry about that. That happens when I'm answering somebody. Okay. 32 00:06:35.180 --> 00:06:50.729 Victoria Musheff: Okay, here we go. If you can use one pharmacy, and that pharmacy, you can… so you can ask questions and things like that, and they are there for follow-up questions. You may have to wait, depending on the pharmacy you're using, but they will answer you the questions. 33 00:06:50.730 --> 00:07:06.749 Victoria Musheff: Request easy-to-open bottles, if you have trouble with that. I've got a picture of one of the ones that they use most of the time now. It has a childproof little tab on the side that you have to push down and turn, but if you'll take that off and flip it. 34 00:07:06.750 --> 00:07:19.529 Victoria Musheff: If you don't have children that you have to worry about getting into it, makes it really easy. I went to see a friend the other day who had a stroke about a year ago, and she was fussing about her medications. 35 00:07:19.530 --> 00:07:36.060 Victoria Musheff: And nobody had told her that she could flip the lids, and she was like, why didn't they? Because she was really struggling getting those pill bottles, but like I said, flipping it over and it's a regular screw-off, very easy to screw-off cap. Like I said, you can request the large 36 00:07:36.060 --> 00:07:57.050 Victoria Musheff: Brent, if cost is an issue, and, you know, those of us with state insurance, we have good insurance, but it doesn't always cover a lot of the newer drugs. You know, the cocaine is still fairly significant. If that's an issue, say something, because there's frequently a generic that's much less expensive. 37 00:07:57.050 --> 00:08:01.210 Victoria Musheff: And, or the prescriber can put you on something else. 38 00:08:01.210 --> 00:08:05.399 Victoria Musheff: Because I know, like, some of the, 39 00:08:05.420 --> 00:08:13.650 Victoria Musheff: like Lanjaro and some of those, when they first came out, they were very expensive, even with the copay. You know, usually they come down 40 00:08:13.910 --> 00:08:30.690 Victoria Musheff: After they've been out a while. I know. They changed the silver scrub on our state, on our… that's not a state plan, that's a Medicare plan. No, it's a state plan. State… it's a state plan. And then we've been getting these notices, like, you're taking the most expensive 41 00:08:31.280 --> 00:08:38.269 Victoria Musheff: type of medicine, we have these generics we want to recommend that you try. Yeah, yeah. 42 00:08:38.470 --> 00:08:40.190 Victoria Musheff: But then your copay. 43 00:08:40.380 --> 00:08:51.170 Victoria Musheff: is going to be a lot less, too, if you're going for one of the generics. Not always. They just don't have to think. Should be less, because the drug is less. 44 00:08:51.290 --> 00:08:52.120 Victoria Musheff: So… 45 00:08:52.780 --> 00:09:15.760 Victoria Musheff: My husband at one point was on 18 different medications, so it was just, you know, I mean, some of them were supplements, but, I mean, still, it was a huge amount. If swallowing's an issue, ask if the pill can be crushed or broken, or if it comes in another form, because sometimes it will come in an easy dissolve to dissolve, or it'll come in a liquid. 46 00:09:15.760 --> 00:09:20.589 Victoria Musheff: You know, so, and some of those pills are hard to swallow, so if that's an issue, say something. 47 00:09:21.080 --> 00:09:31.180 Victoria Musheff: If you're… ask the pharmacist if you're on a new drug, are there any warnings or restrictions, such as food interaction or alcohol restrictions? 48 00:09:33.290 --> 00:09:53.410 Victoria Musheff: You want to be your own advocate, and do stop me if you have any questions with this. This particular one, thedrugs.com is… has a resource that you can fill out your own form. If you're seeing multiple specialists, it's important for you to have something in your wallet that you can pull out 49 00:09:53.730 --> 00:10:07.780 Victoria Musheff: and be able to show them what you're taking, so that you're not getting things that interact with, you know, with… among the drugs that you're taking. It needs to have the… whether you're allergic to anything, start dates. 50 00:10:07.780 --> 00:10:17.039 Victoria Musheff: Drug name, the strength, the dosage, the timing, the frequency, and the reason that you're taking it. You also want to make sure of vitamins and supplements, because they also can interact. 51 00:10:17.040 --> 00:10:33.960 Victoria Musheff: Like I said, that's the resource with the jokes.com. I usually try to steer away from the dot-coms, because they usually have so many advertisements, but this particular site has a lot of useful, things that can help you with that. Yes? On the first site, you had a… 52 00:10:33.960 --> 00:10:35.239 Victoria Musheff: It was scheduled. 53 00:10:35.240 --> 00:11:00.229 Victoria Musheff: Did that pill schedule be used the same way that this… Absolutely. Absolutely. If you put your schedule down, you could print that off, and then that would… Oh, that would work too, absolutely, yes, and that… well, it depends on how many… The pill schedule… yeah, it depends on how many drugs you're… maybe multiple pieces of paper that may or may not be convenient, but this is another way to do… absolutely, you could use that drug for that schedule. 54 00:11:00.440 --> 00:11:06.459 Victoria Musheff: So that you're telling them. The main thing is you want… you want everybody that you're seeing to know exactly what you're taking. 55 00:11:06.780 --> 00:11:13.570 Victoria Musheff: I'm just thinking that when I do that, I have one in my dolls that's with my… with my, 56 00:11:13.570 --> 00:11:30.980 Victoria Musheff: Medicare and my insurance cards on. Yes. And so that when I pull out those cards, I'll pull out that, because it's got the drug allergies and all those other… Perfect, perfect. And then you can just hand it out and give it to them. Yeah, so if you've got a place in your wallet, if you're doing that, that's a great place you could cut it away. Yeah, yeah. 57 00:11:30.980 --> 00:11:34.379 Victoria Musheff: I went to New York City two weeks ago to art museums. 58 00:11:34.840 --> 00:11:37.200 Victoria Musheff: and the… Oh. 59 00:11:37.930 --> 00:11:40.990 Victoria Musheff: what do you call it? The people that, 60 00:11:41.850 --> 00:11:46.760 Victoria Musheff: that are involved at the airport and check-in, PSA, they have… 61 00:11:47.130 --> 00:11:50.159 Victoria Musheff: New rules about how you carry your drugs. 62 00:11:50.830 --> 00:11:59.060 Victoria Musheff: I don't think you could take your original bottle, because that would be… for somebody to contend, that'd be a lot of space in your package. 63 00:11:59.390 --> 00:12:06.269 Victoria Musheff: But… They don't… they don't look kindly on some of the drug-carrying things with dates on them. 64 00:12:06.760 --> 00:12:16.590 Victoria Musheff: Okay. She was reading on some of that, so she was pretty upset about how… But if you had a… you had a list of the things that you were taking, would that not be… 65 00:12:16.650 --> 00:12:29.179 Victoria Musheff: That's what she got from her doctor, and she laminated this in case they wanted to show why she was taking certain things, so they're getting more strict. Yes, yes. …in the airplane. 66 00:12:29.780 --> 00:12:36.980 Victoria Musheff: Controlled drugs. Exactly. Which most people are taking at least one thing. 67 00:12:37.000 --> 00:12:53.269 Victoria Musheff: Okay, you want, like I said, to evaluate whether they're your symptoms, your side effects, any interactions, and you want them to be fully informed of what you're taking. PRN means as needed, and I actually looked up the Latin. 68 00:12:53.270 --> 00:12:57.260 Victoria Musheff: I know some of you. We're experts in that area, it's… 69 00:12:57.320 --> 00:13:16.880 Victoria Musheff: Provenada, which is as needed. If you're taking things PRN, you want to also make a note to be able to tell your provider the, how frequently you're having to take that particular PRN medication, because that may be something that you want to change the order or change the dosage. 70 00:13:17.990 --> 00:13:23.810 Victoria Musheff: Okay, you blocked me again. I did. Yes, ma'am, you did! 71 00:13:25.080 --> 00:13:43.810 Victoria Musheff: Hold on just a second, we're going to the next one. There we go. Okay, medication reconciliation is where you're reviewing all your medicines. It's recommended that you do that twice yearly, ideally with your primary care provider, so that you're looking at whether or not you still need to be taking all those medicines. 72 00:13:43.870 --> 00:13:49.189 Victoria Musheff: You know, on your list. So, because there may be some that you no longer need. 73 00:13:51.190 --> 00:14:03.169 Victoria Musheff: Okay. Interactions. Drug food interactions. Dairy products can reduce the effectiveness of antibiotics. Grapefruit interacts with Procardia and adelac. 74 00:14:03.250 --> 00:14:11.200 Victoria Musheff: to increase blood pressure. Green leafy vegetables interfere with Coumadin and risk blood clots or stroke. 75 00:14:11.730 --> 00:14:19.780 Victoria Musheff: High fiber foods interfere with lanoxin, digoxin absorption. What's recommended with that is that you separate 76 00:14:19.780 --> 00:14:33.870 Victoria Musheff: that by 2 to 3 hours. So if you're taking that, that you, you know, that you're taking your high-fiber food, eating your high-fiber foods at a different meal than when you're taking the, the lock, the minoxid. Salt substitutes. 77 00:14:33.870 --> 00:14:40.059 Victoria Musheff: have a lot of potassium in them. If you're taking out that cone, it could yield toxic potassium levels. 78 00:14:40.180 --> 00:14:47.459 Victoria Musheff: Licorice can also… the real licorice, not the red candy stuff, can also interfere with linoxin. 79 00:14:49.880 --> 00:15:13.790 Victoria Musheff: Prescription and over-the-counter interactions, a lot of people think that if it's over-the-counter, it's safe that it's not an issue. But those two can interact… your prescriptions can interfere with your over-the-counter, so if you're taking some over-the-counter regularly, you know, you want to look at that. For example, aspirin and Advil will reduce the effectiveness of a beta blocker. 80 00:15:13.800 --> 00:15:21.940 Victoria Musheff: Antacids will reduce the effectiveness of a number of different medications. Allergy and cough remedies interfere with multiple medications. 81 00:15:23.800 --> 00:15:36.339 Victoria Musheff: Okay. Thedrugs.com, again, you can look at putting… you can actually put all your medicines in that website, and it will tell you if there's any interaction between those drugs. 82 00:15:36.470 --> 00:15:42.830 Victoria Musheff: So, for example, antibiotics and blood thinners both interact with the metabolism of each one. 83 00:15:42.830 --> 00:15:50.429 Victoria Musheff: So, if you're taking both of those, that can be an issue. So, like I said, you can actually put all of your medicines in that Drugs.com, and they will tell you. 84 00:15:50.430 --> 00:16:03.670 Victoria Musheff: Because it may be that something that you're taking from a specialist is making something else less effective, or it may be, you know, possible interaction, which is another reason why you need to take that list with you when you go. 85 00:16:04.440 --> 00:16:10.989 Victoria Musheff: Okay, expired medications. You want to check the date of older medications, of vitamins, of supplements. 86 00:16:11.120 --> 00:16:25.990 Victoria Musheff: You want to dispose of them, if you no longer need them, through a take-back program, or what's recommended is to crush and mix it with coffee grounds, kitty litter, or food scraps, and put it in the trash. 87 00:16:25.990 --> 00:16:38.720 Victoria Musheff: Do not ever put it in our water system. Okay, so in the trash with any of those things. CBS and Walgreens and South Carolina Gov, on their website, they have a number of lists. They all have 88 00:16:38.720 --> 00:16:56.689 Victoria Musheff: take-back programs for unused and expired medications, and those two in the Clemson and Anderson area, I looked up for us locally. But they, you know, you can take things back to them, and they will dispose of those properly. Which, you know, of course, they're… the CVS and Walgreens are everywhere, so… 89 00:16:57.700 --> 00:17:02.849 Victoria Musheff: Okay. Side effects. All medicines can cause side effects. 90 00:17:02.940 --> 00:17:19.339 Victoria Musheff: And it varies by the individual response. You want to be aware of common side effects when starting a new medication, which may occur right after you start. It may be, several weeks after you've been in there, or when the dose is increased. 91 00:17:19.710 --> 00:17:29.500 Victoria Musheff: And these are common side effects, so you just want to be aware of those things, because you may not be able to take a medication. If it gives you headaches, if it gives you a rash. 92 00:17:29.510 --> 00:17:42.520 Victoria Musheff: Sleepiness, nervousness, upset stomach, muscle pain, or depression. So, just being aware, like, say, if one of… if your medicine is new, and you start having one of those symptoms, if you… if they've increased the dose. 93 00:17:42.890 --> 00:17:45.320 Victoria Musheff: You know, looking at that. 94 00:17:46.150 --> 00:18:00.350 Victoria Musheff: And you all stop me if you have any questions. Medicines that can weaken your bones. There's a whole bunch of them. The corticosteroids, an example is prednisone, the proton pump inhibitors, like panoproprazole. 95 00:18:00.350 --> 00:18:16.009 Victoria Musheff: The SSRIs, the antidepressants like Prozac, the anticonvulsants like Delantin, the loop diuretics like Lasix, and the anticoagulants like heparin. Most interfere with the calcium absorption and can cause bone loss. 96 00:18:17.220 --> 00:18:25.809 Victoria Musheff: So, want to talk with your primary care provider about options for monitoring that, to see if that's an issue. 97 00:18:25.810 --> 00:18:37.100 Victoria Musheff: had a real… my primary physician didn't pick up on it with the protein pump inhibitors. But when I went to see someone who was a bone specialist doing a bone scan. 98 00:18:37.100 --> 00:18:47.089 Victoria Musheff: They, they recommended that if I took the right count of calcium, that it would be absorbed, and that any kind of stomach medication you might be taking could interfere with calcium carbonate. 99 00:18:47.340 --> 00:19:01.019 Victoria Musheff: absorption, and you go to calcium citrate. I will tell you, it was really hard to find calcium citrate in the pharmacy. I ended up having to order it online. But it was a way of getting around 100 00:19:01.280 --> 00:19:11.719 Victoria Musheff: Bone loss, yes. Okay. And sometimes your primary position, but if you've got a specialist, talk with that specialist about 101 00:19:11.930 --> 00:19:29.089 Victoria Musheff: those other medications you're talking, or supplements that you're taking, because I don't think many of us think about the supplements. I pick up calcium thinking calcium is calcium is calcium, but it's not. Right, right, right. And that may be something you could get your physician 102 00:19:29.090 --> 00:19:40.380 Victoria Musheff: primary care provider to, prescribe, if you're having problems finding the calcium citrates. If he's recommending that, get him to prescribe it, because that's something that the pharmacy then could order 103 00:19:40.560 --> 00:19:50.450 Victoria Musheff: And make it easier for you to get. So it wouldn't need to be a self… I mean, it wouldn't need to be something that you pay out of pocket for if you're needing something specific like that. 104 00:19:50.700 --> 00:19:52.619 Victoria Musheff: Appreciate Costco asset. 105 00:19:52.990 --> 00:20:00.250 Victoria Musheff: Well, if you went there, Amazon delivers it to your door. 106 00:20:00.280 --> 00:20:18.960 Victoria Musheff: Okay, those online? We have, we have some, marketers here, and there's ways to get it, yes. How concerned are you about these, viruses, that, like, cause COVID that went from an animal to human? 107 00:20:19.160 --> 00:20:31.219 Victoria Musheff: Are they gonna increase that possibility, you think, or… Wait, wait, wait. It's totally off-topic, but… Yeah, tell me what your question is. The question is what happened in China with the 108 00:20:31.470 --> 00:20:41.320 Victoria Musheff: bats, or whatever, the COVID virus, moved from animals to humans. Right, to humans, yes. You think that might… 109 00:20:41.460 --> 00:20:50.650 Victoria Musheff: happen again? It very well could, you know, and as, you know, as we have more people living closer together, we have much more exposure 110 00:20:50.880 --> 00:21:00.150 Victoria Musheff: Both to other humans and, you know… And also, I had my last COVID booster. Two weeks to the day after I had it, I had a stroke. 111 00:21:01.160 --> 00:21:11.939 Victoria Musheff: And Pfizer, that made the COVID vaccine, finally admitted that a very, very rare cases. There was, 112 00:21:12.230 --> 00:21:18.889 Victoria Musheff: some kind of blood disorder. It has to be brain, it could be heart, blood clotting problems, or something. 113 00:21:19.160 --> 00:21:22.349 Victoria Musheff: But they had to admit that in old, older people. 114 00:21:22.470 --> 00:21:41.250 Victoria Musheff: This could happen. Sometimes there's a risk. And that's a little… because we're not really talking about vaccines today. But then the other thing is, how bad could it have been if you had a full-blown case of COVID? You know, that, you know, if you have other risk factors, that could have also been a very severe outcome as well. 115 00:21:46.370 --> 00:21:53.300 Victoria Musheff: Yeah, you're blocking me again. You're blocking me again. This minute, we're going to the next one. 116 00:21:54.210 --> 00:22:01.490 Victoria Musheff: Okay, Karen, in her presentation last month, talked about the FRIDS, the Fall Risk Inducing Drugs. 117 00:22:01.490 --> 00:22:21.360 Victoria Musheff: And if you'll… you have examples in your handouts, but FRIDs are medications that cause dizziness, confusion, sedation, increasing the fall risk, and the risk is greatest when two or more of those are taken together. And if you will see all these categories, if you're taking medication, you are probably taking a FRID. 118 00:22:21.440 --> 00:22:27.049 Victoria Musheff: I take Zyrtex, Cetirazine, which is over-the-counter for allergies. 119 00:22:27.150 --> 00:22:37.430 Victoria Musheff: It's right in there. It causes sleepiness, which in turn can be a fall risk, but I take it at night and go to bed. 120 00:22:37.440 --> 00:22:48.060 Victoria Musheff: So, you know, if I talked to someone the other day, and I'm going at the free clinic, and I'm going through, looking at this, and I said, you are taking this at night, and they said. 121 00:22:48.320 --> 00:22:55.170 Victoria Musheff: No, I take it first thing in the morning, but, you know, I usually take a nap about 10 o'clock in the morning. 122 00:22:56.180 --> 00:23:20.619 Victoria Musheff: Wait, wait, wait, wait a minute. Let's look at what you're taking and when you're taking it. So, it does, it can cause sleepiness. It does not cause sleepiness in everybody, but, you know, it is a 24-hour allergy medicine, so for those of us that are allergic to all kinds of stuff, it's good, but it is a threat. And then, like I say, you've got some examples in your handout of some of those different things, but, GoodRx.com. 123 00:23:20.620 --> 00:23:34.880 Victoria Musheff: health topic can give you more information about those different drugs. And there may be something different, or there, like I say, could… the best thing, I think, is if there's a way that you can take it and then go to bed so that you're not… you're not adding to your fall risk. 124 00:23:34.880 --> 00:23:37.670 Victoria Musheff: And what can you do in terms of 125 00:23:37.730 --> 00:23:45.790 Victoria Musheff: Being proactive. If you're worried about balance or falls, you want to review your medication list with your healthcare team. 126 00:23:45.810 --> 00:24:05.440 Victoria Musheff: Often, they can lower the dose, or even stop it altogether, or substitute it with something else. You want to stay active and incorporate strength and balance exercises into your daily routine. And Karen, again, last month, talked to us about some of those things. An eye exam to determine if you need a new or updated prescription for eyeglasses. 127 00:24:05.660 --> 00:24:30.110 Victoria Musheff: Decluttering, making your house safer by eliminating clutter and trip hazards. You want to make sure you're securing the area rugs and using non-slip mats in the bathroom. Bright lights, especially around chairs. Add night lights to bedrooms, hallways, and bathrooms, and make sure you have proper footwear with rubber soles, so non-stock-feeding, unless you have grippers on them. 128 00:24:30.110 --> 00:24:34.429 Victoria Musheff: And if you need it, use a walking aid like a walker or a cane. 129 00:24:37.720 --> 00:24:54.609 Victoria Musheff: Drugs that can cause or worsen depression. Again, there's a whole list of these. Antibiotics can disrupt the neurotransmitters. Typically, with antibiotic, you're only taking it short-term. Some of the heart failure medications affect the central nervous system. 130 00:24:54.610 --> 00:25:03.999 Victoria Musheff: Some of the blood pressure medicines can depress the central nervous system or disrupt the neurotransmitters. Hormones can decrease your responsiveness. 131 00:25:04.000 --> 00:25:15.339 Victoria Musheff: sleep aids may precipitate mood problems due to the slowdown and possible next day hangover. So that's, again, something you wanted to look at, and you may be taking too much. 132 00:25:15.370 --> 00:25:32.449 Victoria Musheff: Antihistamines can be sedating and lowering mood. Heartburn medications, like Zantac and Pepsid may affect the brain chemicals, but Prilosec, omeprazole, which is now over-the-counter, does not affect mood, so if that's an issue, that may be something that you could substitute. 133 00:25:34.930 --> 00:25:44.299 Victoria Musheff: Okay, and then this is just a little, you know, getting help for depression, counseling or therapy, connecting with loved ones, exercise and diet. 134 00:25:44.410 --> 00:25:57.030 Victoria Musheff: Looking at the things you can do in terms of addressing the depression, which is kind of goes beyond what we're doing today. Okay, and you're blocking me again? No, it should be okay, and you did change. 135 00:25:57.350 --> 00:26:04.340 Victoria Musheff: Okay, there we go. Did I change too much? Yeah, no, that's okay. Okay. Common medications linked to liver toxicity. 136 00:26:04.790 --> 00:26:21.659 Victoria Musheff: Tylenol, especially in high doses, are mixed with alcohol. I have to tell you, I was sitting with friends the other day, and one of them has had some chronic shoulder issues, and she said, my doctor put me on opioids, and they scare me to death, so instead of doing that, I have 137 00:26:21.660 --> 00:26:25.810 Victoria Musheff: tripled the amount of Tylenol he told me to take, and I'm just like. 138 00:26:25.810 --> 00:26:43.809 Victoria Musheff: You need to go back to your doctor and renegotiate, because you can't afford to damage your liver, which is what you're going to do if you continue with 3 times the dose that's been prescribed of Tylenol. Tylenol is over-the-counter, but large doses are not safe. 139 00:26:43.980 --> 00:26:48.340 Victoria Musheff: So, this, statins, Lipitor. 140 00:26:48.480 --> 00:26:52.019 Victoria Musheff: Zocor, listening to some antibiotics. 141 00:26:52.050 --> 00:26:54.680 Victoria Musheff: Some chemotherapy drugs. 142 00:26:54.680 --> 00:27:12.490 Victoria Musheff: Some of your herbal supplements, if you get… now, that's green tea extract, not drinking green tea. That's if you're using the pill, the extract, taking a lot of it. And then it has several of the others that if you have high doses of those herbal supplements, they can be rough on your liver. 143 00:27:12.490 --> 00:27:19.560 Victoria Musheff: A high intake of sugar-sweetened beverages is also associated with the increased risk of fatty liver disease. 144 00:27:21.630 --> 00:27:25.520 Victoria Musheff: What about, anthbio. 145 00:27:26.210 --> 00:27:36.190 Victoria Musheff: What about… versus Lipitor Tylenol. Yeah, Tylenol's different. Yeah, Advil is, is, better? 146 00:27:36.420 --> 00:27:41.300 Victoria Musheff: Well… You still wouldn't want to take a whole lot of it. 147 00:27:42.100 --> 00:27:56.419 Victoria Musheff: You know, but it's an alternate, and a lot of times with mild to moderate pain, they will alternate Tylenol and Ibuprofen, you know, for a short period of time, so that you're not taking a whole lot of either one. 148 00:27:56.490 --> 00:28:09.370 Victoria Musheff: But, again, you don't want to take too much of that. Part of the problem with both of those medications, if they're over-the-counter, they're in everything else. So if you take a drug for the flu. 149 00:28:09.690 --> 00:28:26.009 Victoria Musheff: it may already have Tylenol or… A lot of Tylenol in it, yes. And so they've got both of them, one or the other. And if you take this Tylenol separate for your fever, but you're taking this medication that has it in it, then that's where I see people getting 150 00:28:26.030 --> 00:28:41.960 Victoria Musheff: real problem with overdoses with medication. A good point. Can you all… can they hear? You might just want to repeat it. Yes, what she was saying is that if you're taking, for example, something for flu, it has a lot of either ibuprofen or Tylenol already in it. 151 00:28:41.960 --> 00:28:54.130 Victoria Musheff: So that, you know, you are at danger of getting too much if you're also taking Tylenol and Ibuprofen along with that, for example, for colds or flu or that kind of thing. So you want to look at what's in it. 152 00:28:54.290 --> 00:29:07.779 Victoria Musheff: And not add to it. Because you'll need a magnifying glass to read the ingredients. Yes, yes. Otherwise, you will not know, but it… I'm stunned with what all they've put into some of these mixed 153 00:29:07.780 --> 00:29:27.380 Victoria Musheff: medications. Right, right. Yeah, so the point is, is how much is in those mixed medications. You're going to feel better, but you want to make sure that you're not taking something that's going to interfere with things you're already taking or adding to the problem. And you don't want to have to have a liver transplant because you've, over time. Right, right. 154 00:29:28.310 --> 00:29:37.910 Victoria Musheff: And, going on more with the liver, a hearty organ, the liver is the body's clearinghouse. Everything you consume goes into the GI tract. 155 00:29:37.910 --> 00:29:56.870 Victoria Musheff: is absorbed, and the first place it goes is the liver. Age-related changes in the liver make the organ less resilient to stress and less effective at metabolizing substances, resulting in potentially more damage. So, as we get older, we need to be concerned about it. You can't live without your liver. 156 00:29:57.250 --> 00:30:02.510 Victoria Musheff: And these are signs of drug-induced liver injury. 157 00:30:02.650 --> 00:30:20.840 Victoria Musheff: Abdominal pain and swelling, dark urine, yellowing of the skin, also known as jaundice. A liver function test will show you elevated liver enzymes if there's a concern for liver damage due to medication or supplement. So, but if you're having any of those symptoms. 158 00:30:20.840 --> 00:30:29.480 Victoria Musheff: You want to check it out and see what you can do, because if it's picked up early, there are things that can be done to reverse it. If you go on too long. 159 00:30:29.610 --> 00:30:31.629 Victoria Musheff: That is not the case. 160 00:30:33.090 --> 00:30:37.410 Victoria Musheff: Okay, livertox.nih.gov. 161 00:30:37.560 --> 00:30:49.629 Victoria Musheff: is a database, from the National Library of Medicine that lists over a thousand drugs and supplements, updated regularly, and includes, the non-toxic substances. 162 00:30:49.730 --> 00:31:05.869 Victoria Musheff: Supplements are not regulated and may contain medication, molds, and metal. So, be real careful in terms of… you want to look at, when you're going to the drugstore to get a supplement, look at 163 00:31:05.910 --> 00:31:22.190 Victoria Musheff: who the provider is. This is a study that was done by the University of North Carolina, and, they did a, they did a hepatology study and found that 51 of the 272 supplements 164 00:31:22.190 --> 00:31:29.769 Victoria Musheff: that they studied were mislabeled. They had other stuff in them, or they didn't even have that in them. 165 00:31:30.060 --> 00:31:36.249 Victoria Musheff: So you want to be real careful with your over-the-counter supplements. Like, say, look for a, 166 00:31:36.550 --> 00:31:39.539 Victoria Musheff: A brand that, you know, is, 167 00:31:40.180 --> 00:31:43.789 Victoria Musheff: A little bit better. It's not worth saving a few pennies. 168 00:31:43.920 --> 00:31:47.790 Victoria Musheff: To be putting something in your system that, could be harmful. 169 00:31:48.960 --> 00:31:58.220 Victoria Musheff: Okay. Up to 3 cups of coffee for you coffee drinkers act as an antioxidant and can reduce inflammation of the liver. 170 00:31:58.370 --> 00:32:07.179 Victoria Musheff: However, that is as long as you avoid a lot of milk, sugar, or sugar alternatives, which can be harmful. So… 171 00:32:07.330 --> 00:32:21.749 Victoria Musheff: Coffee by itself is a good thing, but if you put too much stuff in it, then you are not… you're negating the effectiveness of it. I know, I'm not pointing fingers. 172 00:32:21.930 --> 00:32:26.430 Victoria Musheff: Okay, some of you I know are caregivers. 173 00:32:26.430 --> 00:32:44.540 Victoria Musheff: And I wanted to go over some of the resources that are available. The Pill Identifier, drugs.com, which is also in your resources, you can actually use to identify pills. Thedrugs.com, we talk about the drug interactions when you enter your list to determine the interactions. 174 00:32:44.720 --> 00:32:58.259 Victoria Musheff: And then I'll go through each one of these, but these are some different things that are also here for caregiver resources, and I'm going through these with the next slides, the memory aid worksheet, the medication dispensers, and the prepackaged medications. 175 00:32:58.370 --> 00:33:16.200 Victoria Musheff: This picture that you just showed, Rosanna, to me, it's so good because you showed… I know people that will put their pills all in one bottle like that, and then they have to take them, and they take them out, take them, and they're doing it by color of the pill, or by something else, and I'm looking at that thinking, well. 176 00:33:16.200 --> 00:33:27.769 Victoria Musheff: You know, sometimes you get a generic and the pill color changes. Well, and that's what this Memory A worksheet is, because that's what happened with, like, say, my husband was taking 18 different things. 177 00:33:27.820 --> 00:33:32.680 Victoria Musheff: And every once in a while, the whole pill would change 178 00:33:32.730 --> 00:33:52.149 Victoria Musheff: when he changed to a different provider, or changed to a different generic, and it looked different. And so, what I periodically do is, as a new one came in, and then I actually, you know, took a picture of it, and then fixed the… take one daily, what it's for. 179 00:33:52.280 --> 00:34:03.990 Victoria Musheff: And then you can see that one of the things that he got in trouble with, Zolpidem is for insomnia for up to 2 weeks, and that's what the medication says. You can take it for up to 2 weeks. 180 00:34:03.990 --> 00:34:14.900 Victoria Musheff: Because after 2 weeks, you start having side effects from Zolvedim, which he had. Unusual dreams, he had ringing in the ears and joint pain. 181 00:34:14.900 --> 00:34:35.619 Victoria Musheff: And it was because Zolban had been ordered long-term as opposed to the short term that was what was on there. So, his wife was the one that stepped in and said, she can't take it anymore, this is why. So, and the symptoms disappeared after he stopped taking it. Wow, that's scary. So, but the provider had not 182 00:34:35.810 --> 00:34:39.589 Victoria Musheff: Looked at that warning on the medicines itself. 183 00:34:39.900 --> 00:34:56.309 Victoria Musheff: But anyway, looking at that, just as far as if you've got somebody that's having two, and you don't want to, mix the pills all in one bottle. Was that the front and back of the pills that you have? Yes, the front and the back. Yeah, yeah. 184 00:34:56.310 --> 00:35:05.749 Victoria Musheff: Because they, you know, in the different sides. Sometimes it's plain, but that's the different size, yes. Some of the options, one of them is a prepackaged medication pack. 185 00:35:06.050 --> 00:35:18.730 Victoria Musheff: These are monthly medication blisters, and they put them in prepackaged. You can get a pack of 6 different ones that are secured for seniors, and they're like, you know, you just punch them out. 186 00:35:18.850 --> 00:35:23.039 Victoria Musheff: But it's $20 for a 6-month pack of 1 drug. 187 00:35:23.090 --> 00:35:47.649 Victoria Musheff: Or you can get their colors available for the different times of the day. That's… Walmart was the primary carrier of that. But that's just something that, if somebody could use that, if that would help. I think these others that were coming up, too, probably are a little bit better, but this is one option in terms of helping somebody keep up with their medicines. And then somebody could come in and see if that person's taking them like they're supposed to be taking them with them. 188 00:35:47.650 --> 00:35:48.360 Victoria Musheff: this. 189 00:35:48.580 --> 00:36:06.590 Victoria Musheff: This is one of the more expensive options, but it would be a lot cheaper than having to have somebody with somebody all day in order to make sure they were taking their medicine, and that's called a smart dispenser. It alerts you when it's pill time with the sound and a blinking light. One button, press… 190 00:36:06.610 --> 00:36:12.590 Victoria Musheff: sorts and dispenses the dose, it holds up to a 90-day supply of 10 different medications. 191 00:36:12.830 --> 00:36:36.340 Victoria Musheff: supports any size, pill, or shape, and fits on the kitchen counter. But it costs $44.99 a month, or you can prepay for $360 a year. Again, it would be cheaper than having somebody with that person to make sure they took their medicine, so it's already got the medicine. When it comes, it's got the medicine. No, no, no, no. Oh, yes, yes. 192 00:36:36.340 --> 00:36:40.690 Victoria Musheff: So it comes with the medicine. It comes with the medicine already pre-packaged. 193 00:36:40.740 --> 00:36:47.410 Victoria Musheff: I think… I think that's a good question. I think you actually… somebody actually has to load it. 194 00:36:47.940 --> 00:37:03.640 Victoria Musheff: Let me look that up. Yeah, look that up, because I didn't, I didn't even think about that. Okay, the next one I know you do, it's a lot cheaper. Well, $360 a year, that's 10 beds. They use this in nursing homes. In some of the nursing homes, they use this. 195 00:37:03.640 --> 00:37:09.629 Victoria Musheff: with different people coming in to get the… I mean, you know, when the nurse is dispensing the pills because of the number of pills? 196 00:37:10.110 --> 00:37:16.020 Victoria Musheff: But, I, yeah, you'll look at that and see if it's preloaded, or if it has to be loaded. 197 00:37:16.510 --> 00:37:20.189 Victoria Musheff: Okay, and then the next one is the less expensive. 198 00:37:20.190 --> 00:37:44.560 Victoria Musheff: This is called Life Fine Automatic Pill Dispenser. It's a 28-day electronic medication organizer. It's designed for memory issues related to taking the medication. It's a month's supply with a 12- or 24-hour scheduler, and that is LCD program screen, and that's liquid crystal something. Anyway, so you look at that, and you pre-program it. 199 00:37:44.670 --> 00:37:58.540 Victoria Musheff: This is… this would be… somebody would pre-program it for the individual and put the pills in there. The dispenser rotates to the compartment and sounds an alarm and a flashing light, which continues until the dose is removed from its compartment. 200 00:37:58.800 --> 00:38:11.960 Victoria Musheff: The organizer is tamper-proof for future doses, and currently they are $32. But that's something that a provider or a family member would need to preload and set it. 201 00:38:12.280 --> 00:38:22.509 Victoria Musheff: with the, you know, with the program in on the screen. But it's a lot less expensive, it's a one-shot deal as far as purchasing it, as opposed to paying something every month. 202 00:38:22.590 --> 00:38:33.740 Victoria Musheff: Did you find out about the Huber? It says it does not come pre-filled. Okay, so, yeah, so either one of them would have to be pre-filled by… either by a healthcare professional or by family member. 203 00:38:33.740 --> 00:38:37.429 Victoria Musheff: In terms of doing that, but… but each of those would be… 204 00:38:37.430 --> 00:38:55.590 Victoria Musheff: Being able to give that individual more independence in terms of their medication, because this would essentially, for a lot less, would essentially do the same thing in terms of they would have that flashing light and the, and the light that would recommend, you know, that would let them know when they need to do that. 205 00:38:57.110 --> 00:39:15.280 Victoria Musheff: Okay, and then the… okay, the future of gerio… gerotherapeutics. I had not seen that word before, but, what to look out for in the future. Medications that are designed to target the aging process by reducing inflammation and repairing cellular damage are in the works. 206 00:39:15.460 --> 00:39:32.209 Victoria Musheff: The GLP-1s, like Ozempic, Wegovy, Manjaro, originally were for diabetes and obesity, but they're showing promise in reducing the risk of heart disease, Parkinson's, and Alzheimer's. And, so this is something that, you know, in terms of looking 207 00:39:32.390 --> 00:39:51.070 Victoria Musheff: looking at that, we may see in the future, so… Questions, comments? Have I overwhelmed you? That's okay, though. Yes, I think the thing that I'd like to comment on is this notion of the liver toxicity stuff. 208 00:39:51.150 --> 00:39:57.179 Victoria Musheff: Because as you… as your body ages, something that you've been taking forever 209 00:39:57.270 --> 00:40:10.439 Victoria Musheff: And it's never given me trouble mine. And I ran into a case where somebody was taking Dramamine, and they're always taking Dramamine, or carsick, and they wouldn't mark their mouth, it did pop up Dramamine. 210 00:40:10.590 --> 00:40:30.079 Victoria Musheff: And it wasn't working as effectively, and so they took 2 instead of one, and then they were getting 30. And basically, they got critically ill, had to be hospitalized. Because of an overdose of dromamine. Overdose of dramamine, but damage to the liver, and other drugs. 211 00:40:30.080 --> 00:40:32.129 Victoria Musheff: It was the fact that the body… 212 00:40:32.160 --> 00:40:35.880 Victoria Musheff: Didn't process it, it wasn't working effectively around with 213 00:40:36.110 --> 00:40:41.410 Victoria Musheff: We have such great resources online nowadays. I mean, when you read the… 214 00:40:41.490 --> 00:41:05.679 Victoria Musheff: side effects and the dangers of Dramamine, it very clearly states that elderly people should be extremely careful taking it. Okay, and so for those of you online, what, what Debbie is talking about is that Dramamine, for this individual, it was not working as well, so she doubled and then tripled the dose, and actually got critically ill because of the toxic levels and caused liver damage. 215 00:41:05.900 --> 00:41:19.929 Victoria Musheff: from taking too much dromamine, but if you look it up online, the Dramamine description clearly says that it should be taken with caution by older individuals because of the risk. 216 00:41:19.930 --> 00:41:34.339 Victoria Musheff: Benadryl's another one that, over time, it can be dangerous. You know, again, it's over the counter, a lot of people take it, they continue to need more, and it has all kinds of side effects over time, and again, it could be more harmful to 217 00:41:34.340 --> 00:41:35.380 Victoria Musheff: Elderly. 218 00:41:35.670 --> 00:41:43.309 Victoria Musheff: So, you know, so there are things that you need to, you know, because it's over-the-counter, does not necessarily mean that it's safe. 219 00:41:44.380 --> 00:41:53.939 Victoria Musheff: Yes, I do. Quest in here and here. Okay, go ahead. So, educated, I'm sure we're looking these things up. I'm not sure the general population does, but most of us will… 220 00:41:54.450 --> 00:41:57.609 Victoria Musheff: You know, search a website and look things up, but… 221 00:41:57.900 --> 00:42:00.909 Victoria Musheff: It may not be true of the general population. 222 00:42:01.030 --> 00:42:12.399 Victoria Musheff: I find it disturbing early in the morning, especially, because I think a lot of elderly people are up a little earlier trying to get the views. The drug ads on TV are very… 223 00:42:12.650 --> 00:42:15.140 Victoria Musheff: Disturbing to me, because… 224 00:42:15.500 --> 00:42:33.779 Victoria Musheff: They put up the name of the drug, and then they got people dancing and singing, and the name is like Otexla. Fair enough Live did a comedy sketch this past Saturday night about Otexla. It's a plax psoriasis drug. 225 00:42:33.910 --> 00:42:42.130 Victoria Musheff: And they… the comedians on Saturday night, I'm a favorite, What's this drug do? 226 00:42:42.250 --> 00:43:06.360 Victoria Musheff: Anybody that could tell them what the drug does, and how it does it. But then you'll see the side effects are in little, little print across the bottom, as they're dancing and singing. And the side effects often with the thing are just rounded off in high speed. High speed, not on. Small side effect, almost all of their drugs is death. 227 00:43:07.240 --> 00:43:21.119 Victoria Musheff: getting ready to regulate that. I thought they knew at some point… Yeah, yeah, it regulates all that stuff. I love the way they do the side effects, Jim. I'm like, and when they get the blindness, I say, I'm not taking… 228 00:43:22.310 --> 00:43:28.440 Victoria Musheff: I've got a question. Yes, Don has a question, or a comment. Oh, okay. 229 00:43:28.440 --> 00:43:35.739 Don Collins: Yeah, so I, about the drug drops for expired, or when you change medications. 230 00:43:35.990 --> 00:43:40.379 Don Collins: Not every Walgreens or every CVS has that. 231 00:43:40.490 --> 00:43:44.970 Don Collins: I knew they had it because the one in Mebane, where I live, had it. 232 00:43:45.270 --> 00:43:57.769 Don Collins: But I had my… my old drugs in the cup holder in the car, and I forgot to take it in, so I go… I go on a trip, and I stop at 3 other CVS stores, and they said, no, we don't have one here, you have to go here, or here, or here. 233 00:43:58.110 --> 00:44:03.059 Don Collins: And, so I, you know, it's right there at the pharmacy. 234 00:44:03.380 --> 00:44:13.540 Victoria Musheff: stand where you go, but I would call ahead before you run all over town looking for a place to drop it. You're supposed to all have that now, so that. 235 00:44:13.540 --> 00:44:13.880 Don Collins: Yeah. 236 00:44:13.880 --> 00:44:14.780 Victoria Musheff: Everybody. 237 00:44:14.780 --> 00:44:17.479 Don Collins: The other thing I wanted to mention, and ask you about. 238 00:44:17.480 --> 00:44:20.689 Victoria Musheff: They put it in the trash. Okay. 239 00:44:20.690 --> 00:44:22.560 Don Collins: Alright, but I got a second comment. 240 00:44:22.760 --> 00:44:27.730 Don Collins: And yesterday, I went to the dentist for a filling to be replaced. 241 00:44:28.140 --> 00:44:37.389 Don Collins: And, they gave me the… the painkiller, or whatever it was called, I don't know. And then they came in and said, we want to take your blood pressure. 242 00:44:37.970 --> 00:44:41.590 Don Collins: And I have never had my blood pressure taken at a dentist before. 243 00:44:42.830 --> 00:44:49.869 Don Collins: And it was, like, 135. I came back about 10 minutes later and tucked it again. It was, like, 166. 244 00:44:50.510 --> 00:44:51.220 Victoria Musheff: Whoa. 245 00:44:51.220 --> 00:44:57.210 Don Collins: And, so it turns out that they were using something that had epinephrine in it, or however you say that. 246 00:44:57.960 --> 00:44:58.990 Victoria Musheff: Yeah, that's right. 247 00:44:58.990 --> 00:45:05.579 Don Collins: And, it… you know, you use it in the back of an ambulance to raise somebody's blood pressure. 248 00:45:06.570 --> 00:45:16.610 Don Collins: So, they counseled the procedure and rescheduled me, and they said they've marked my chart now not to use that particular painkiller. 249 00:45:17.210 --> 00:45:19.629 Don Collins: You have any information on that? 250 00:45:21.660 --> 00:45:35.879 Victoria Musheff: Well, I'm glad they took your blood pressure to see how you responded to that. You know, dentists do use pretty high dosages of medication during the procedure, but they also should have made sure you stayed there until it went back to normal. 251 00:45:36.880 --> 00:45:44.099 Victoria Musheff: But, yeah, that would be something… that would be an individual, individual response to that medication, which, like. 252 00:45:44.100 --> 00:45:49.019 Don Collins: I could tell my blood pressure was up. I mean, I didn't… I felt really strange. 253 00:45:49.700 --> 00:45:53.520 Victoria Musheff: Yeah, yeah, but they should have kept you there in office until you felt better. 254 00:45:53.520 --> 00:45:57.210 Don Collins: Oh, they did. They kept me there for a good 25 minutes or so. 255 00:45:58.410 --> 00:46:04.089 Don Collins: And but she said, apparently, we hit a… we hit a… hit it right into a vein. 256 00:46:04.850 --> 00:46:08.290 Victoria Musheff: Oh, great. 257 00:46:08.410 --> 00:46:21.310 Victoria Musheff: Yeah, yeah, so again, something to be concerned about. I wanted to comment on what you were saying. I did look it up, and as of this past September, the federal government is aggressively beginning to regulate the 258 00:46:21.310 --> 00:46:30.169 Victoria Musheff: direct-to-consumer pharmaceutical advertisements, and they've sent out, like, 100 cease and desist letters and all kinds of stuff, so hopefully that will 259 00:46:30.570 --> 00:46:36.229 Victoria Musheff: you know, continue on and reduce those allergies. And when they say, talk to your doctor about this drug. 260 00:46:36.520 --> 00:46:40.280 Victoria Musheff: Should you talk also to your pharmacist? 261 00:46:41.500 --> 00:46:57.699 Victoria Musheff: Certainly, you could, but they're wanting you to talk to your doctor, because if he's the one… he's the one that's gonna order it for you. And they are direct-to-consumer trying to sell you and pitch that product. I'm worried about drug interaction. Wouldn't you be better off to talk to your pharmacist? 262 00:46:57.920 --> 00:47:11.250 Victoria Musheff: about… I know doctors know a lot about that. I would go to that Drugs.com interaction. Okay. Because that will… you can put all your medicines in there and see what's going on, 263 00:47:11.630 --> 00:47:17.210 Victoria Musheff: Doctors know a lot about the drugs that they usually prescribe. 264 00:47:17.370 --> 00:47:33.910 Victoria Musheff: But a lot of times, they're prescribing with what their representatives have sold them on with different medicines, and they're also looking at the reactions, and I'm not putting them down at all as far as the knowledge, but when they're looking at, particularly when you have somebody in a general practice. 265 00:47:34.260 --> 00:47:42.550 Victoria Musheff: They have… there's a wide range of medications, and they, you know, so that expecting them to know everything about every drug 266 00:47:42.850 --> 00:47:49.309 Victoria Musheff: You know, if you could look at it yourself and be your own advocate. 267 00:47:49.480 --> 00:47:53.500 Victoria Musheff: along… in addition to talking with them, I think you're better off. 268 00:47:56.430 --> 00:47:58.630 Victoria Musheff: Do you have a question? 269 00:47:59.230 --> 00:48:12.269 Victoria Musheff: Well, first, I'd like to say thank you for all you do in the area you're doing it in. I don't have a lot of all those discs that go off in alarms. I live with a nurse. Okay. You have an alarm? 270 00:48:13.190 --> 00:48:20.780 Victoria Musheff: She would be here this morning, and she not had something else that she'd already said she was going to go do, and she's really missing this right now. 271 00:48:21.380 --> 00:48:23.610 Victoria Musheff: But… 272 00:48:24.480 --> 00:48:31.059 Victoria Musheff: She, she does a lot of good things like this, like what you are, so I wanted to say really thank you for that. 273 00:48:31.420 --> 00:48:32.410 Victoria Musheff: And… 274 00:48:32.820 --> 00:48:38.960 Victoria Musheff: the… she mentioned, she said, well, maybe you could ask one little thing. Some of her friends go out and do weight loss. 275 00:48:39.880 --> 00:48:54.800 Victoria Musheff: And weight loss folks now, and sometimes in the neighborhood, people you see, you almost don't recognize those folks, at least after a while, do that, but she said, well, maybe you would say something about weight loss and the cure that you have to do in that, but… 276 00:48:54.870 --> 00:49:02.550 Victoria Musheff: She goes down to the clinic, to… pre-clinic, she does all those things, so I'm very blessed. Anything about weight loss that she might… 277 00:49:02.670 --> 00:49:16.079 Victoria Musheff: Especially the shots. Well, and some of them, some of them, you know, like the GLP-1s, are really… are working quite well. The tricky thing is when you stop taking them. 278 00:49:17.020 --> 00:49:30.159 Victoria Musheff: most of those people gained the weight back. You know, they were designed for people with diabetes, with type 2 diabetes in particular, and the weight loss was a side effect, a positive side effect. 279 00:49:30.280 --> 00:49:36.830 Victoria Musheff: But, you know, people that are taking them for weight loss, if they don't make the lifestyle changes. 280 00:49:37.230 --> 00:49:42.719 Victoria Musheff: Because eventually, you know, once they lose the weight, they're not eligible for those medicines anymore. 281 00:49:42.770 --> 00:50:00.930 Victoria Musheff: And you know, and then they'll gain the weight back if they haven't made the lifestyle changes and, you know, changed their nutrition and their activity level and everything. So, you know, I think particularly for the people that are morbidly obese, it's a great thing 282 00:50:01.290 --> 00:50:05.429 Victoria Musheff: As long as they are motivated to do the things that they need to do. 283 00:50:05.620 --> 00:50:16.169 Victoria Musheff: But, you know, a lot of those medicines, you know, a lot of the pills and things have more side effects, too, and hopefully whoever is prescribing them is also, you know, giving them the 284 00:50:16.600 --> 00:50:22.129 Victoria Musheff: you know, letting them know the risk factors and stuff, because I know one of the pills is essentially speed. 285 00:50:22.480 --> 00:50:27.049 Victoria Musheff: You know, and it increases the metabolism, and that's the weight loss. 286 00:50:27.160 --> 00:50:30.419 Victoria Musheff: But… but there's an addictive factor with that, too. 287 00:50:30.840 --> 00:50:49.520 Victoria Musheff: So, yeah. I don't know. A friend of mine works in one of those bariatric clinics and was very frustrated. They have moved more to the GLP once now, but he was very frustrated because the people that were coming in to see him weren't losing the weight they needed to because they wanted to stay on the drug. 288 00:50:49.810 --> 00:51:07.449 Victoria Musheff: I have a question, since you've got that experience. So, I read an article recently where they had reported people who were developing anorexia. They were like the… because they didn't want to get off the drug, and they had lost the weight, but they… 289 00:51:07.450 --> 00:51:21.029 Victoria Musheff: still didn't… didn't… they didn't want to gain the weight back. They weren't… but they were losing more and more weight, but they had no appetite to eat. Right. And that it was just a circular thing that was very close to 290 00:51:21.260 --> 00:51:35.919 Victoria Musheff: what I would have called anorexia, where you just keep doing the things that you can because you're… the body image of it. Right. Successfully. Yeah, and that's a risk. They're not meant to be long-term drugs. 291 00:51:36.020 --> 00:51:46.640 Victoria Musheff: And once you get to your goal, you should… you should be weaned off of them. And why would Serena Williams' doctor recommend one of those drugs for her? 292 00:51:47.380 --> 00:51:48.779 Victoria Musheff: Serena Williams. 293 00:51:49.150 --> 00:51:53.099 Victoria Musheff: I don't think she was a… she wasn't a beach, was she, when she was playing? 294 00:51:53.460 --> 00:51:56.579 Victoria Musheff: She may have had that meeting. After she had a… 295 00:51:56.750 --> 00:52:14.330 Victoria Musheff: A child, she had trouble with her weight. With her weight. Yeah. Yeah. I didn't know this, but… I think some people are starting to do maintenance doses, though, whether their insurance company pays for them or not. I know some women who, like, they lose the weight on the shots, and then they just move down to, like, a regular 296 00:52:14.620 --> 00:52:38.490 Victoria Musheff: The small dose. Right, right. But that's part of the weaning… that's part of the weaning process. Well, no, they're doing it like lifetime. I'm just gonna be the small dose. I don't know… I mean, I think… No, that's still… it's still weaning. They may be on it long-term, but it's still getting them off of that higher dose. Yes, definitely. But I've seen articles where, I've told Debbie about this, where people lose their eyesight and stuff. I mean, what… 297 00:52:38.630 --> 00:52:57.309 Victoria Musheff: That's scary. Those are scary, like, permanently lose eyesight under the shots. Is that… That is a… but it's a documented side effect of… A rare… A rare side effect. And supposedly it's rare, but I guess what Victoria and I were talking about was… 298 00:52:57.310 --> 00:53:09.270 Victoria Musheff: It may be rare, but… But if it's huge, it's not rare! It's huge! So, you know, and it's quick, and it's permanent. Yeah. It's not, you know, it's not reversible. 299 00:53:09.270 --> 00:53:16.639 Victoria Musheff: And so I think all of those ads that we're seeing on TV, and Jim, this is really important, that's quite an important topic. 300 00:53:16.640 --> 00:53:30.680 Victoria Musheff: Because these ads seem to be geared toward a particular time of the day when the elderly are awake and nobody else may be. And it doesn't matter which channel I go to early in the morning. 301 00:53:30.680 --> 00:53:42.889 Victoria Musheff: Every other commercial, if not every commercial, is a drug. I don't even reg… I have to look up the disease, because some of them are disease or abbreviations, acronyms, and things that… 302 00:53:43.290 --> 00:53:49.210 Victoria Musheff: That you've never heard of. Yes. They've got to be so rare. They're coming out with drugs that have to be so rare. 303 00:53:49.210 --> 00:54:08.640 Victoria Musheff: that they're really looking for people to take them. Yes, yes. Because the development was so expensive, they're trying to make big bucks off them now. You know, we… 20, 30 years ago, there were no advertisements for drugs on television. I don't know when that actually started. 304 00:54:08.640 --> 00:54:13.810 Victoria Musheff: But that, I mean, you know, the difference and the pressure on providers. 305 00:54:13.810 --> 00:54:24.229 Victoria Musheff: with people coming in and asking for stuff, you know, skyrocketed when that happened. You know, as a prescriber, I was mostly only using generics. 306 00:54:24.230 --> 00:54:43.889 Victoria Musheff: Because generics had been around long enough that we knew what the side effects were, we knew what the general population, how they were going to, you know, but now we've paid, you know, doctors have people coming in demanding some of those newer, more expensive drugs because of what they're promising to do. And, you know, again, keeping up with that. 307 00:54:43.930 --> 00:54:57.340 Victoria Musheff: 20 years ago, they started with the antidepressants, maybe 25 years ago, they started advertising… I don't remember the exact year it was. And that, to me, was the very first time that I saw a lot of effort put into… 308 00:54:57.370 --> 00:55:15.859 Victoria Musheff: encouraging people to try this antidepressant, but then you'll be happy. And now they've got things, they're advertising, schizophrenia medication, they're, bipolar, and so I'm seeing a whole bunch of different kinds of, of, 309 00:55:15.990 --> 00:55:21.860 Victoria Musheff: antidepressant medications, but I'm also seeing all these other, what I would consider, sort of. 310 00:55:22.550 --> 00:55:27.249 Victoria Musheff: rare disease. It's… it's like everybody has cirrhosis now. Yeah. 311 00:55:27.250 --> 00:55:48.000 Victoria Musheff: Well, you know, I was with a group of young people the other day, and I was amazed… I was kind of on the periphery of what they were talking about, and almost everybody in the group was taking Adderall. One minute, when did this happen, you know? I was gonna say, I think that happened about the same time, when the primary physician began to just 312 00:55:48.000 --> 00:55:56.050 Victoria Musheff: dose medication for anxiety, and, you know, that used to be sort of relegated to the mental health… Yeah, yeah. 313 00:55:56.050 --> 00:56:10.760 Victoria Musheff: But I do think the primary physician is the person that I take my drug list to, and I say, help me make sure that I still need all this, because I teach so many specialists that somebody needs to serve as the 314 00:56:11.070 --> 00:56:22.419 Victoria Musheff: gatekeeper. Yes, and that's exactly… that's the medication reconciliation that's recommended twice a year. If you're going to specialists, they're giving you things that they don't necessarily 315 00:56:22.540 --> 00:56:27.209 Victoria Musheff: link into the fact you're already taking something else, so having that gatekeeper 316 00:56:27.490 --> 00:56:32.720 Victoria Musheff: That's the ideal. So you… Jim, I think you have to decide who your gatekeeper is. 317 00:56:32.740 --> 00:56:50.560 Victoria Musheff: It can be your… it can be any one of those people, but once you decide who your gatekeeper is, that's the one you ask that question. Should… are these drugs the right one? And that's the person who can also change your dosage. So, the pharmacist can't. The pharmacist can look at them and say, these drugs don't work well. 318 00:56:50.560 --> 00:57:00.430 Victoria Musheff: But they wouldn't know which drug to take you off of that wouldn't hurt something anymore. Right, right. And that's why… that's why I ask your doctor if that can make the changes to correct a problem. 319 00:57:00.430 --> 00:57:06.419 Victoria Musheff: is important. Is the pharmacist required to, say, wait if they see them 320 00:57:06.420 --> 00:57:21.089 Victoria Musheff: a contra interdiction, or whatever it's called. Does a pharmacist required by any sort of regulation to not… or to, like, say something to you, or… I would have to look that up to see, and after looking at that, I know that 321 00:57:21.240 --> 00:57:46.190 Victoria Musheff: We were using a private pharmacy with John, and he was saying, I'm concerned that he's on these two different medicines, and that had alerted me to use thatdrugs.com. Gotcha. But he actually said something to me first. Got it. And that's a very responsible pharmacist, but I just wonder if they're required to, like, at least say something. When you're filling a medication, they don't necessarily have your whole list, and if you 322 00:57:46.190 --> 00:57:49.799 Victoria Musheff: You go… that's why you need to go to one pharmacy. Yes. 323 00:57:50.110 --> 00:58:06.670 Victoria Musheff: As opposed to, you know, at one point, I was at 3 different pharmacies, because when Monjerma first came out, the other 2 couldn't keep it stocked. And he was on the sensors for his diabetes, and those pharmacies said you have to go 324 00:58:06.690 --> 00:58:31.340 Victoria Musheff: to this pharmacy for that, so I was going for specific things, but I was going 3 different ones, which that is not a good scenario. And you want to try to avoid that if you can. I do know in a hospital that it's the nurse who will often challenge the physician if they see a medication that looks inappropriate, because it would be a discussion with the physician. I see. Where they might bring it up, and a pharmacist might 325 00:58:31.340 --> 00:58:41.900 Victoria Musheff: We're looking at that. Well, the pharmacist said a hospital should have your entire list. Yes, your entire list of drugs. Yes. That's the only place where I know that there would be… 326 00:58:42.090 --> 00:58:47.949 Victoria Musheff: Other than your… other than you taking in that list, with supplements. Yeah. Yeah. 327 00:58:48.460 --> 00:58:52.989 Victoria Musheff: Isn't there a new type of family practice 328 00:58:53.170 --> 00:59:05.370 Victoria Musheff: a doctor now that, that, uses holistic medicine. Videos. And there's a… in a medical school over in Spartanburg that, that trains these holistic doctors. 329 00:59:05.370 --> 00:59:10.710 Victoria Musheff: Yeah, that's the doctor of osteopathy? Yes, that's right, that's what I'm trying… yeah. Yeah. 330 00:59:10.710 --> 00:59:26.900 Victoria Musheff: Yeah. They've been around a long time. It has. I mean, I don't know about the Spartanburg program, but they have been around for a long time, and that is a little bit different in terms of how they do that. I think it would depend on the individual as to whether or not 331 00:59:26.930 --> 00:59:29.550 Victoria Musheff: They would have all the information that you need. 332 00:59:29.790 --> 00:59:39.720 Victoria Musheff: I mean, they would approach it differently enough that it would meet your needs. They can prescribe medication? Yes, yes. She believes in… 333 00:59:40.390 --> 00:59:51.559 Victoria Musheff: not using drugs, if at all possible, using exercise and lifestyle and things like that. But, when you answer a lot of her questions, she makes up her mind that then. 334 00:59:51.680 --> 00:59:55.440 Victoria Musheff: If a subscription would be appropriate. Yes. 335 00:59:56.630 --> 01:00:04.070 Victoria Musheff: But she's coming from a… Let's not over-prescribe format, which is good. 336 01:00:04.200 --> 01:00:07.540 Victoria Musheff: Because, you know, you don't want to take more than you need to take. 337 01:00:08.470 --> 01:00:23.579 Victoria Musheff: Express Scripts is sure, in the move a lot with veterans. We get a lot of our needs comes through mailbox. Of course, we go and see the doc. We don't do that, but Express Scripts is really… 338 01:00:23.900 --> 01:00:25.710 Victoria Musheff: Getting out there and throwing a lot of… 339 01:00:25.930 --> 01:00:29.790 Victoria Musheff: A lot of medications, they get it into your mailbox, and you got it. 340 01:00:31.270 --> 01:00:36.540 Victoria Musheff: The ease and convenience of having it delivered to you. 341 01:00:36.650 --> 01:00:38.850 Victoria Musheff: Walgreens delivers them, too. 342 01:00:39.380 --> 01:00:57.250 Victoria Musheff: They Uber it to you. They Uber it? Wow. They're gonna be in one of those automatic Uber cars. They don't wear any, Walgreens… 343 01:00:57.350 --> 01:01:10.550 Victoria Musheff: paraphone. Interesting. And they're coming in a car, like, if you got your pizza delivered from somewhere. Do you really want to trust any little joke to deliver your medication? 344 01:01:10.550 --> 01:01:18.689 Victoria Musheff: Are you doing that? Are you watching that? Yeah, yeah. David just jumped on, yeah. Okay. 345 01:01:18.690 --> 01:01:27.059 Victoria Musheff: I'll just send a copy of the video. Okay, yeah, I'll put it in the handout. Yes. In the handout. You guys have any questions online? Yeah, any questions? 346 01:01:27.760 --> 01:01:29.770 Victoria Musheff: You ever thought about doing a podcast? 347 01:01:29.880 --> 01:01:34.510 Victoria Musheff: Your, your information is very vague. Thank you! 348 01:01:34.920 --> 01:01:47.249 Victoria Musheff: I'm afraid the general public is not very well informed about drug interactions and a lot of these things. Well, if it's based on what I see every week, it definitely group is definitely not doing much. 349 01:01:48.480 --> 01:01:54.000 Victoria Musheff: Because you're doing things that are harmful, you know, without realizing that. 350 01:01:54.510 --> 01:02:13.250 Victoria Musheff: So how do you feel about some of the drugs that used to be prescription now being over-the-counter, like Pepsid and those kind of things that GPD, you know, the, protein pumps, inhibitors, and all those things have gone, you know, half of them now are prescription, half are not. You can get them over the counter. 351 01:02:13.380 --> 01:02:23.469 Victoria Musheff: Benadryl was another one that used to be prescriptional. Mofarin. Voterin, which is, you know… And it's usually a patch, yeah. 352 01:02:23.820 --> 01:02:29.360 Victoria Musheff: Ibuprofen used to do a… When it first came out, it was a prescription. 353 01:02:29.970 --> 01:02:36.299 Victoria Musheff: You know, I think it puts more responsibility on the consumer, and as we know, they're not all well-informed. 354 01:02:36.590 --> 01:02:42.620 Victoria Musheff: I think the convenience I've taken something short-term for symptoms. 355 01:02:42.910 --> 01:02:52.960 Victoria Musheff: But there's danger with that as well, because, you know, sometimes people become… you know, where they're using things long-term that were never meant to be used long-term. 356 01:02:53.510 --> 01:03:03.199 Victoria Musheff: And like I say, with some of that interference, you know, with some of the antacids, for example, that interfere with other drugs, so they're setting themselves up for problems. 357 01:03:03.910 --> 01:03:08.259 Victoria Musheff: So… I'm gonna scrape for juice. 358 01:03:08.260 --> 01:03:08.880 David Bodde: hierarchy. 359 01:03:08.880 --> 01:03:12.630 Victoria Musheff: But you can't take it, you can't drink breakfast juice when you're taking, 360 01:03:12.630 --> 01:03:13.350 David Bodde: heaven. 361 01:03:13.350 --> 01:03:14.290 Victoria Musheff: Pretty cool. 362 01:03:15.190 --> 01:03:16.380 David Bodde: We've got a moment. 363 01:03:16.540 --> 01:03:17.950 Victoria Musheff: You can do harsh juice. 364 01:03:18.300 --> 01:03:19.160 Victoria Musheff: Sure. 365 01:03:20.180 --> 01:03:29.880 Victoria Musheff: Well, I have to tell you, it's real interesting, because I asked my family practitioner, how much great furniture would I have to fit in order for it to interfere with his torture? 366 01:03:30.460 --> 01:03:42.420 Victoria Musheff: And it was sort of like saccharin. How much saccharin do you have to put in your coffee to report as you can't like it does rats? Really? So, I've given them grapefruit juice for years, because it just… 367 01:03:42.420 --> 01:03:51.890 Victoria Musheff: General knowledge that it sort of interacts with everything. It will interact with some things, but you have to drink a lot of it with your pill. It's not so… 368 01:03:52.130 --> 01:04:06.119 Victoria Musheff: So anyway, I didn't… I'm back eating grapefruits. Yeah, I love grapefruit. But I don't eat them every day, and I don't eat them 5 times a day. I might eat them for… But, like, a half a grapefruit in the morning will not create a problem. 369 01:04:06.270 --> 01:04:22.869 Victoria Musheff: Not according to my family practitioner. This happened to come up in the discussion. This happened to come up in a discussion with my doctor this week, where she prescribed something, and I pointed out 370 01:04:23.270 --> 01:04:40.109 Victoria Musheff: Oh, no, she suggested I have more citrus fruits, like oranges, grapefruit, and I said, well, wait a minute, you got me on this, so I can't have grapefruit. And she paused for a second, she said, you can't be separated by several hours. 371 01:04:40.170 --> 01:04:51.059 Victoria Musheff: Yeah, that's why, like with the Digoxin, the high-fiber foods, you still can eat them, but if you can separate it, you know, by 2 to 3 hours, you're not going to have that interaction. That's why you take the Lipitor at night. 372 01:04:51.190 --> 01:04:52.600 Victoria Musheff: Hmm, travel. 373 01:04:55.500 --> 01:05:11.809 Victoria Musheff: But what the public, all of us have been told is just avoid break records. Yeah, of course. I think it's easier to have a better patient education. 374 01:05:11.970 --> 01:05:24.449 Victoria Musheff: I should ask the nutrition expert. Yeah, what do you say? Do you have anything? Oh, I agree, I agree. A little bit. Occasionally. 375 01:05:27.610 --> 01:05:34.340 Victoria Musheff: Okay, I think we're officially done. Anything else? Any questions online? Yeah, it's really great. 376 01:05:34.570 --> 01:05:48.440 Victoria Musheff: Thanks, Bodie, it's good to see you again. We haven't seen you for a while. He's got a nice smile on his picture, on his photo. You're talking to me. 377 01:05:49.450 --> 01:05:52.119 Victoria Musheff: Okay, welcome, yup. 378 01:05:52.120 --> 01:05:52.710 David Bodde: Okay. 379 01:05:52.710 --> 01:05:58.019 Victoria Musheff: We're good. Thank you! I say hello now, I'm very happy. Okay, now I'm back. 380 01:06:00.000 --> 01:06:03.129 David Bodde: Apologies, I, I, I got, 381 01:06:03.660 --> 01:06:05.390 David Bodde: I thought it was 10 o'clock. 382 01:06:05.670 --> 01:06:12.760 David Bodde: But I'm on Central Time, and so when I put down 10 o'clock, I failed to map it back to Central Time. 383 01:06:13.510 --> 01:06:15.290 Victoria Musheff: So I came in on the end of it. 384 01:06:15.520 --> 01:06:16.250 David Bodde: Apologies. 385 01:06:16.250 --> 01:06:20.940 Victoria Musheff: She's gonna send you, she's gonna send you the slides. I'll send you the recording link. 386 01:06:21.560 --> 01:06:24.350 David Bodde: Oh, great, okay. Yeah, 387 01:06:25.160 --> 01:06:36.339 David Bodde: Okay, great, I appreciate that. Yeah, this is, I'm sure very helpful and needful. So, all to the good. Thank you very much. Apologies for being late. 388 01:06:36.340 --> 01:06:39.870 Victoria Musheff: Thank you. Yeah, no problem. Take care. Thank you. 389 01:06:40.450 --> 01:06:43.790 Victoria Musheff: I wonder if that's confusing.