How to properly manage your medications with Dr. Hedva Barenholtz Levy

Let's Say Hello

[00:01:26.690] – Allan

Hey, Ras, how are things?

[00:01:28.300] – Rachel

Good, Allan. How are you today?

[00:01:30.320] – Allan

I'm doing all right. I'm doing all right. We're getting closer to my vacation.

[00:01:34.570] – Rachel

Yay.

[00:01:36.830] – Allan

And so a couple of big things. One is I won't be taking new clients during September. So today's the 22nd. You got about a week. If you go to 40plusfitness.com/discovery, you can book a call with me and we can go ahead and get you going. If you don't hit me this week, then I'm going to be closed for September. I'll still service my existing clients, I'll still do the podcast, and I got a special little surprise I'm going to talk about in a minute that I am going to do, but I'm not going to take on new clients during that period of time. So if you're not in the door before I get on the ferry to leave this island on September 1, I can't talk to you. I won't bring you on until October, probably October 2. Based on what my wife has shown me, my itinerary is because she's doing all that, I'm just tagging along.

[00:02:26.510] – Rachel

Nice, that sounds awesome.

[00:02:28.400] – Allan

So if you want to work with me, this is the time you could email me or you can go into 40plusfitness.com/discovery. That's a direct link to my calendar. Literally. You see days on there that are available to book. That's the days I'm available to book. So go check it out. Also, I want to do something a little fun in September. I want to play health and fitness bingo.

[00:02:52.510] – Rachel

Oh, boy.

[00:02:53.990] – Allan

Okay, so I'm going to roll out the first of hopefully many 40+ Fitness Bingo games. Okay. And the way we're going to play this is it's going to be in the Facebook group, but you can go to 40plusfitness.com/bingo to get the details, but you basically will get a bingo card with some health and fitness activities, that you can do during the month of September. So it's going to run for 30 days. There's three levels of game and prizes at each level, it'll be drawn off of people who complete that level. So there's going to be, of course, the straight line, the way you normally play bingo. There's going to be the x, the middle space is a free space, and then there's also going to be a blackout. And so the prizes will be relative to how far you make it through your bingo card of whether you get a line, an x, or a blackout. And I'll have some prizes available for that and we'll finish that up in September. So just a little heads up, there are 25 squares in a bingo card and there are 30 days in September.

[00:04:05.000] – Rachel

Oh, cool. This sounds so fun.

[00:04:08.270] – Allan

This isn't like you're going to have to do this all the time, but the rule is it's one per day, so you can't fill multiple squares in the same day. This isn't like I go out there one week and just bust all this stuff out and say, well, yeah, of course I got my protein and I had 30 grams of protein on this day. I'll check both. That's not how it works. Each day you score something on the card. And this is based on an honor system, but it still can be fun because there'll be things that you wouldn't maybe necessarily have really focused on. So it's going to maybe take you outside your space a little bit. If you're not doing resistance training, you know there's going to be a square for resistance training. You absolutely know it's going to be in there if you're not moving much, if you're sedentary. Yeah. There's going to be park your car at the back end of the parking lot instead of at the front, and it's going to be the little things like that, but I think it's doable by just about everybody. But you can find your line.

[00:05:02.960] – Allan

You can find your line. If you just can do a line, then that's great. It's better, maybe better than what we've done or an x or a blackout. But there'll be prizes involved, so I'm hoping to get some folks involved. You can go to 40plusfitness.com/bingo.

[00:05:17.270] – Rachel

Sounds awesome. What a great challenge.

[00:05:20.880] – Allan

Yeah.

[00:05:21.830] – Allan

All right. Well, how are things up there, Rachel?

[00:05:24.210] – Rachel

Oh, wonderful. Getting ready for a camp out this weekend. We're taking the camper out to a park up here in Michigan and just looking for weekend of peace and quiet.

[00:05:33.760] – Rachel

Getting away.

[00:05:34.760] – Allan

Yeah. You got about another month and a half.

[00:05:37.850] – Rachel

I know, I know I'm losing to be. I gotta enjoy as much as I can outside before it starts snowing.

[00:05:48.040] – Allan

Yeah.

[00:05:48.610] – Rachel

Not that I'll not go outside because, you know I do.

[00:05:51.390] – Allan

But you will. But you won't be camping.

[00:05:53.430] – Rachel

No. Yep.

[00:05:55.770] – Allan

Mike will be ice fishing in a few months.

[00:05:57.510] – Rachel

Oh, for sure but let's let's just wait. I'm not ready for summer to go away.

[00:06:02.130] – Allan

Yeah, I'm not either. All right, well, are you ready to have a conversation with Dr. Levy?

[00:06:08.600] – Rachel

Sure. Sounds great.

Interview

[00:06:34.510] – Allan

Dr. Levy. Welcome to 40+ Fitness.

[00:06:37.630] – Dr. Levy

Thanks so much, Allan. Glad to be here.

[00:06:39.780] – Allan

Now, the name of your book is Maybe It's Your Medications: How to Avoid Unnecessary Drug Therapy and Adverse Reactions. And I think everybody wants to avoid adverse reactions, but I like the word you used therapy.

[00:06:54.230] – Dr. Levy

Okay.

[00:06:55.430] – Allan

Because we don't have a drug deficiency. This is meant to get us over a period of time when we can actually fix ourselves versus just deal with the symptoms. So I love that you use the word therapy, and I love that you use the concept of that health is a team sport, because I think too many times we just think, well, there's the doctor, he's the coach and the quarterback, and I'm just doing my part. I'm an offensive lineman. It's thankless I just take my pills, and I go on with my life. Right.

[00:07:27.360] – Dr. Levy

And it's a little bit more than that, right?

[00:07:29.060] – Allan

Yes.

[00:07:29.760] – Dr. Levy

So I definitely talk about the concept of your healthcare team, and I think that's maybe an important thing. We could start off with that understanding. Of course, we think about the main players the physicians, the pharmacists, the nurse. But there's occupational therapists, physical therapists. When I was talking to a group of older adults, someone mentioned the dentist. Right. These are all part of our healthcare team, but the most important person on that team is you, the patient, the consumer, the one who's taking those medications. And I think all too often, people don't recognize that they are an important part of their team. They have a voice, and they're actually in the game, as you said. Right. Using that analogy. So that's an important thing. And then if you start with that premise that I have a voice, my opinions matter, my preferences matter, what I'm experiencing when I take medications matter, then you're at a different starting place, I think, with the drug therapy and that's talk about that phrase again, too. Medication we can talk about medications we can talk about pharmacotherapy is another term for drug therapy, and I never really thought twice about it, so I appreciate you bringing that up.

[00:08:28.740] – Dr. Levy

But it's drug therapy. It's another approach to managing our health, and it's one aspect of managing our overall health. And the link with healthy aging, I think, is so important, which is where this book came about. Too often, we continue taking medicines as we get older, and they may not be helping us age in the most healthy manner if they're unnecessary or causing problems.

[00:08:52.170] – Allan

Now, I came from an accounting background, so when you give me a number and a list someone called it a listicle once, but when you give me a list of things, it's like I'm kind of drawn to that. I kind of like that idea of a list. And so you identified five characteristics that increase the risk of adverse drug events. Like I said, I think most of us want to avoid that. Can you talk about each of those briefly and why they're important?

[00:09:15.730] – Dr. Levy

Yeah, sure. So I present these five characteristics as when you look at them together, it's kind of unique for the older adult population. And in medicine, we talk about age 65 and olders is the cut off of sorts. And so those five points, the first one is taking multiple medications puts you at increased risk of having an adverse drug event. And that kind of makes sense. The more medicines you're exposed to, the greater the chances are of having a problem from them. Why does this happen? Lots of reasons, but one is we have more chronic conditions as we get older, and that leads to the need often for at least one medicine, but sometimes two or three, depending on the condition. Right. We think about diabetes and even heart failure and other conditions where you need several medicines. The other characteristic is or the second characteristic is the involvement of multiple physicians on your care team. So think about how our healthcare today is a little bit divided. We have specialists all over the place. The number of older adults who are seeing specialists has almost doubled in the last 20 years. So that's something to think about.

[00:10:19.910] – Dr. Levy

When physicians are prescribing their own medicines for you, are they communicating with each other? Do those medicines interact? Does one physician know everything that you're taking? So that's where some of those other risk factors come in, when you have more prescribers involved.

[00:10:35.210] – Allan

I worked in a pharmacy when I was in college, and I can tell you the pharmacists back there, yeah, they've got the little computers, but they are so slammed to just keep turning pills out because the retail environment is just they will do a consult with you. But it's even hard for them if they're just seeing a script unless the computer tells them there's a definite deal. But this goes even further to say, okay, because two doctors talking to each other, pharmacists looking at you could get your stuff filled in the same place. And it doesn't necessarily mean it's being reviewed and covered off.

[00:11:11.880] – Dr. Levy

And there's some safeguards in place. I don't want to scare people, but definitely not all of the information is at the pharmacy system. And we can go into how to know what medication is the right choice, the right drug for a person. We have to have some of that medical information, the health background, which pharmacy systems don't have. So, yeah, that's another concern. Right. We can only do so much checking at that community retail dispensing setting. So clearly, the more doctors involved, studies have shown that there's an increased risk of having an adverse drug event occurring. The next two reasons kind of go together. And they're big words, but I do introduce them in the book. I think it's important for people to at least know these terms are there and then talk about them in more easy word with easier words, pharmacokinetics and pharmacodynamics. And this simply refers to pharmacokinetics, is how our body handles medications. And as we get older, our body handles medications differently. Our kidney function changes, our liver function changes, and that impacts how our bodies process and get those medications out of our system. Some medications can have a much longer duration in the body because of these pharmacokinetic changes, if you will.

[00:12:23.810] – Dr. Levy

So suddenly, as we get older, we might need lower doses or we might need to avoid certain medications because our bodies are handling medicines differently. So that piece is another that's a third characteristic that's really important. And then the fourth one I mentioned, pharmacodynamics, another big word, but that simply refers to how the drug affects our body. And the most simple way to address this for older adults to understand how our bodies change and deal with these medicines differently, is our bodies are more sensitive to the effects of medications as we get older. And that's the pharmacodynamic piece. But that really means maybe smaller doses will be just as good for older adults. It means that there's certain drug classes that we might want to avoid as we get older because we're more susceptible to having a serious, more significant side effect, like Drowsiness. Dizziness, that fall risk, things like that. And then the fifth characteristic I include is the fact that older adults are not enrolled in clinical trials as much as the younger population, those under 65 years old. And that's because it's hard to study a drug, its effectiveness, if a person is taking many other medications and has many other health conditions.

[00:13:33.550] – Dr. Levy

So it's not as clean, if you will. But we cannot know how a drug will affect an older person or an older person with different health conditions unless we study or have it exposed in someone with those conditions. So that means when a drug is newly available on the market after it's been approved by the FDA, we may or may not know exactly how the safety and effectiveness in an older individual. So those five characteristics, putting them together, kind of make that older adult a little more unique situation and at higher risk of having an adverse drug event.

[00:14:10.270] – Allan

Yeah, and I think that's easy to see. There's nothing inherently wrong with any one of these things. It's just a part of the way the system works. They want to get a market, a drug to market quickly. If they can't get enough older adults in there and one of the things I would say is it's probably chronological age, biological age, two different things. So you might not be 65, but you might be in a 65 year old body. And so drugs would affect you. If your liver or kidney is not functioning the way that it's supposed to, then you might have the wrong drug, you may have too much of the right drug and all that. So I think one of the keys to me is if you start a new drug, you need to have that conversation is to know, okay, what does this drug do? Why is this doing it? What are the potential risks? Because there are no wholly safe, fully effective drugs out there.

[00:15:04.740] – Dr. Levy

Correct.

[00:15:05.400] – Allan

Okay. Something could go wrong, and in fact, it goes wrong a lot more often than we would hope. And you listed the stats in the book, which, again, it's scary stuff. If you're on multiple medications, it is something that you definitely want to pay attention to. And you identified that as medical related problems or MRPs. So we won't keep saying medical related, medication related. Now, poor Frances, in your book, she exhibited all eight of these.

[00:15:38.440] – Dr. Levy

Well, you had to make a good example, but it wasn't too far of a stretch.

[00:15:46.190] – Allan

Frances, frances had it rough. And as she went through her evaluation, and we're going to talk about this evaluation process later, but as Frances went through it, she hit on all eight of these things. Like I said, I love lists, but poor Frances, can you talk through the eight MRPs that you could deal with when you're dealing with medications?

[00:16:06.880] – Dr. Levy

Yeah. And so I introduced those MRPs, not to make it more convoluted or complicated, but to help individuals understand that there's a lot to look at when helping a person look at their full medication regimen and is everything appropriate in helping them. And the goal is to minimize the risk of harm, obviously. So the MRPs that I talk about, so this is like a standard way I would do a medication review. I think most pharmacists would take this general approach. The first type is the adverse drug reactions. Right? So very obviously linked to medications have side effects, adverse drug reactions, it's kind of the same name. And so we have to look for is a person experiencing any adverse drug reactions or side effects at the time? Drug interactions is another important medication related problem. And also with this, we have to remember to always looking for not just prescription drug interactions, but also the non prescription medicines a person might take. Don't forget the over the counter medications as well as the dietary supplements. And I also talked go into a little more detail in one of the chapters about interactions. How drugs can interact with disease states a person's health condition.

[00:17:16.560] – Dr. Levy

So we need to be careful of someone who's taking a non steroidal anti-inflammatory if they have heart failure or high blood pressure, it can worsen those conditions. We look at dosages doses that are too low or too high. As we talked about, doses can be too high. So we worry about that for our older adults, especially if there's kidney issues, liver problems, for example. But something that can be overlooked is a dose too low. So another important consideration we should have with the medications we're taking is is it effective? Is it doing what it's supposed to be doing? And if not, is it because there's a dosage issue? So if we're going to treat high blood pressure or treat high cholesterol, let's make sure we're at a correct and effective dose that the drug is going to work for the person. So those are the two kind of partner problems too high and too low. A fifth medication related problem is the selection of improper drug. And this is I spend more time in a couple of chapters in the book on this topic because as we get older, geriatric experts have identified a list of medications that are considered potentially inappropriate for older adults.

[00:18:20.130] – Dr. Levy

And I do emphasize the potentially part because everybody is different. But it just brings to mind that as we get older, again, because of those changes I mentioned earlier, the pharmacinetics and pharmacodynamics medicines may not be the best, certain medicines may not be the best choice as we get older. Another problem is an undertreated or untreated condition. So that's just as serious. If someone has a condition that really does need medical care and they're not getting it, that can lead to further problems. Anything from maybe it's an undiagnosed respiratory infection, someone's treating a cough, and it really becomes becoming something more serious. Or what feels like reflux of stomach issue. Maybe it's a heart issue. I know you talked about that on a recent episode. So we want to make sure that nothing is being missed. Osteoporosis, the weakened bones. Is a person getting enough calcium and vitamin D, for example, not getting a medication? That's another again, a whole chapter is devoted to someone not getting a medication for various reasons. Maybe they're not taking it the way they should be taking it at home. Maybe they can't afford it and they never fill the prescription or they stopped filling it.

[00:19:27.030] – Dr. Levy

Maybe they didn't fully understand when and how to take it, so they're just not taking it properly. And then the last one is the unnecessary medications. And that's a really big concern in healthcare today and working with older adults because we have these growing medication lists and is everything still needed? So that's a real big topic we can talk about too. Those are the eight problems.

[00:19:49.610] – Allan

And I think, again, one of the reasons I wanted to talk about this in particular is that this kind of shows you the complexity of the model. You got the number of medications, what they do, what the risks are, and then all of these little kind of caveats of, are you getting enough? Are you getting the right thing? Are you actually taking it the right way? Are you taking it regularly enough? Are you now kind of making decisions? You talked about a patient who said, okay, this is too much. So instead of going and having the dose brought down, she's like, I'll take it every other day. And her condition didn't improve, so the doctor gave her another medication, and then she decided, well, I don't want to take this the same day I'm taking that one again, not how it was prescribed. And every other day she's taking that one again. The condition doesn't improve. So the doctor is like, well, we got to put you on a third blood pressure medication. And now they're on three blood pressure medications, where perhaps if they had just asked the doctor to lower the dose of the first one to the appropriate dose, it wouldn't happen.

[00:20:47.870] – Allan

But that's hard and add to the complexity. You're listening to this podcast. So if you've made substantial lifestyle changes, some of the medications you may have been on, you may no longer need. A lot of people have high blood sugar, high blood pressure. They start eating better, they start moving better. Their blood pressure comes down naturally, their blood sugar comes down naturally, but they're still on the same dose of those medications. Your blood pressure might go too low, your blood sugar might go too low. And now you're going into the doctor, why is your blood sugar too low? And it's like, I don't know. Now they're putting on a third medication.

[00:21:25.930] – Dr. Levy

You're nailing a really important point, or I've fallen. I don't know. I've had these experiences of falling in the past month. Doctor, what's going on? And you find out the blood pressure has been dropping too low. So that densifying therapy and what you're bringing up the topic of communication, which I sprinkle throughout the book, because it's so important for us as consumers to communicate with our healthcare team, with our physicians. She may or may not have been on the right dose, but she wasn't feeling right, or she didn't like it. She needed to say something to her doctor rather than go on silently and tolerating whatever she thinks she's doing, making her own adjustments.

[00:22:07.590] – Allan

The other thing is, people will go to the doctor, they'll get a prescription, the condition will not improve, and they'll just continue to take what they were told to take, even though the stomach isn't better, this isn't better, they don't feel better

[00:22:22.040] – Dr. Levy

or pain not improving or something like that. Right. So is it the way the person is taking it? Is it the dosage too low, perhaps? Is it maybe just the wrong medicine for the person? But yeah, to continue and that's where we get into these unnecessary medicines and for people to think it's been approved by the FDA. My doctor's prescribing it. There's absolutely no risk, I think is just misleading for us. And we fall into that complacency. We just get comfortable with the medicines. I think we need to be a little bit more vigilant. Not to doubt all the medicines, but just to make sure, do I need it? Because ideally, we want that fine line of taking just what you need that's helping you and avoiding what is not helping you. But you make a great point about people who are making lifestyle changes and improving their blood pressure, blood sugar control, all that wonderful stuff. The medicines might be over too high of a dose at that point, right?

[00:23:19.340] – Allan

At least letting your doctor know that you're making these lifestyle changes and therefore they'll know, okay, well, you may have to lower this drug. Measure your blood sugar, measure your blood pressure. Let's see where it's trailing. If it starts to go low, call in and we'll lower the dosage on your medication.

[00:23:37.350] – Dr. Levy

So that's part of that monitoring. And there's so much we can do at home. And that's, again, being on the healthcare team. Help your doctor monitor, do what you need to at home. Check the blood pressure. If you have the blood sugar monitoring, do what you need to do and make sure you're talking with your doctor about those results.

[00:23:54.090] – Allan

Now, one of the things about that team is that this is I'm not going to call it rocket science, but the biology of medications, particularly when they're combined and as we age, is very confusing, can be really confusing and really maybe above our head. And it's okay. It's okay to admit that this is above my head. I don't have all the answers, but there is kind of a solution out there. I think if we search for it, we can find it. But getting a comprehensive medication review by a professional that does these things, particularly for older adults, can be a valuable thing. Because the other things you brought up in the book that we haven't even touched on are things like over the counter drugs, the supplements we might be taking, our dietary changes in the way we feel or look, if you've lost significant weight, if you're not moving as much as you were. So sometimes lifestyle is going in the opposite direction of what you were doing. I mean, sometimes it's just you're losing bone mass, you're losing muscle mass, and it might be one of the drugs you're taking that's causing some of that to happen.

[00:25:03.670] – Allan

Can you talk a little bit about the comprehensive medical review, what would be involved, and then how we would go about the process of deprescribing? Because I think a lot of people think, well, I'll just quit a medication, and sometimes that creates more problems than the medication did. So you can kind of talk about that, because I don't think this is something where you just make the decision, I'm going to take this every other day because I'm not feeling good on it. Can you talk about that review and how it would go?

[00:25:30.860] – Dr. Levy

Yeah, sure. So I think a most valuable tool is to have a medication review. And like you mentioned, it needs to be by somebody who knows the drug therapy, who knows the medications, and for the older population, which is where my focus is, it's going to be someone with that geriatric specialist, geriatric specialty. And pharmacists have that specialty, geriatricians, or the physicians who are specialized in geriatrics. But nurse practitioners and physicians assistants can also have that Geriatric specialty. So the medication review is a chance to look at everything a person is taking. And as you touched on thank you for mentioning it, the over the counter, the OTC products, things like antacids and even aspirin a lot of people don't think about aspirin being on their regimen because they get it without a prescription. Right. I've come across that all the time to other pain medicines, cough and cold preps anything you might be taking without a prescription is important to be included in that medicine list for the review, as well as the dietary supplements. And dietary supplements is a whole other ballgame because it's just important to mention that they're regulated as food by the Food and Drug Administration, not as medication.

[00:26:35.910] – Dr. Levy

So there's a whole other little ball of concern we have with the supplement. But a medication review is a chance for that medication expert to look at everything you're taking and look for all of those eight medication related problems that I mentioned earlier and identify not only actual problems. What I do a lot is looking for potential problems because if we can prevent something from happening, then we prevent the additional doctor visit, the added prescription, the emergency department visit, or even a hospitalization. Right. So all those statistics that we know go with having an adverse event with a medication, we want to prevent it. Right. So a lot of people might say, I'm doing fine right now. I'm taking what the doctor has told me to take. There still are things to find when you open up the lift, the hood and you look under the hood of the car, you can find some of those eight problems. And things like very hard it's very hard to identify without talking with a person and doing a review is finding out how they're taking their medicines at home and looking for the under treatment issue and are they even getting their drugs and taking them the way they should be taken.

[00:27:40.260] – Dr. Levy

So where you go about finding a review is a challenging part. And I touch on as best I can. I truly believe pharmacists have the therapy. So I always encourage people to find a pharmacist who can do this type of review. And if you're enrolled in Medicare Part D, there is a comprehensive review that is part of that program. I just cannot say universally these are the criteria of who's going to qualify. I encourage people to call their part D plan to find out if they qualify. And then there's senior care pharmacists out across the country who do this on a private basis kind of thing as well. So does that answer anything else you want to touch on with the medication review?

[00:28:20.450] – Allan

Because I think that the situation is the doctor, he gets maybe seven, eight minutes with you, and he's looking at your medicine list, so he knows what you're taking, but he's got to make some decisions, and he's not necessarily going to ask you or tell you how to take this medication. Now, you go to the pharmacy and you get your prescription filled. They may give you information or maybe a booklet or something that you didn't read. It's like, oh, everyone knows how to use an inhaler, or Everyone knows how to use eyedrops.

[00:28:48.330] – Dr. Levy

No sometimes. Right.

[00:28:50.330] – Allan

Right. So it's just those concepts of let's talk about it, let's set up a plan, find the right teammate to come in and help you complete this so that you're in it. And I think you recommended, if you can and it works for you, to try to get this done about once a year, because your medications may change in that time, your lifestyle might change and well, sorry, we're one year older.

[00:29:16.370] – Dr. Levy

Absolutely. It's like the regular tune up. You just want to make sure and with a little luck, maybe some medicines are no longer needed and those can be removed.

[00:29:25.440] – Allan

You save that copay and you can hire a coach.

[00:29:28.710] – Dr. Levy

There you go. I think that lifestyle just yeah, there's so much we can do to be looking at the full picture. Right. So it's not just the medications. That's one piece of this puzzle of how to age healthy and taking care of ourselves is such an important part, and you kind of touch on it. The physician doesn't have a lot of time. Pharmacists are the most accessible healthcare profession. We're there, unfortunately, yes. Pharmacies look very busy these days. But I also will continue to say that pharmacists are trained to communicate and educate about drug therapy. This is what we love to do.

[00:30:03.470] – Allan

They have that little kiosk over that little booth thing. You go over the other window away from everybody. You can have that private conversation

[00:30:09.370] – Dr. Levy

consultations over there. Right. And I'd like to see them use more. We have our healthcare system. We can stand to have some improvements, but pharmacists do have the skill and this interest. So I would always tell people, don't be so intimidated. Ask if the pharmacist has time. For sure when you pick up a prescription and you are asked, do you want to have any questions for the pharmacist? How many people ever say, yes, very

[00:30:30.010] – Allan

We're in a hurry to grab that bag, give them our credit card and walk out. People at this pharmacy there sick people at this pharmacy.

[00:30:36.990] – Dr. Levy

I don't want to stay, but I encourage people say yes. Try saying yes and talk with the pharmacist. You don't know what you don't know is another important theme, I think. But if the pharmacist is busy, then find another time when they can speak with you. He or she can talk to you about your medications to do a more thorough review. Probably they can't do that on the spot. You're going to have to set aside a separate time. And I'm hoping pharmacy will continue to evolve where we do have more time with the patient to do what we call primary care, to go through these medications to help people understand their drug therapy and identify problems. So when I do my work, any potential or actual problems, I find I'm communicating with the patient's physician because that's where the changes can get made. Pharmacists can't prescribe. It's the physicians that do that. And that brings us to maybe the deprescribing considerations. That's okay. So as you said, just stopping something on your own can be very scary. Of course, you hear a lot of people say they did it and everything's okay, and you're like, by the grace of God, if it was fine, things can happen.

[00:31:38.930] – Allan

Yeah, a lot of people jump out of airplanes and don't die.

[00:31:43.070] – Dr. Levy

Right? It depends on what risk you want to take. Right. But your health is additive. So with the deprescribing so this is a fairly new term that has taken hold in the medical world because and I have a love hate relationship with the term initially. I view deprescribing. By definition, deprescribing means reducing or eliminating drug therapy when appropriate. And I've been arguing for 25 years that's what I do. I review the medications, I identify ways to optimize drug therapy. What can we remove? Where is a dose too high? What is still necessary? Is the person taking it correctly? So I try to clean up the medication list for a person with their physician. The deprescribing movement, though, is relevant because we have to name it to be able to talk about it. We do need some research about deprescribing because when it comes down to is it safe to stop a certain medicine and how do we stop it? Can it be stopped cold turkey? Does it need to be tapered in the person with these conditions? Is it okay to stop it? What are the risks of the problem recurring if you stop it?

[00:32:43.990] – Dr. Levy

we don't have all of that science, right? So that's where deprescribing as a science, needs a name and needs that attention. So we do have a lot of research going on in this deprescribing area. When we bring it down to the individual, it means, like I said, as we talked about that medication review, finding what may might look like a medicine that may no longer be needed, then we have to have the conversation looking at all the health information, how stable is the disease or the health condition? What are the patient's preferences? That's a really important piece. What matters most to the individual taking fewer medicines? Or maybe they want to prevent something in the future from happening. And sometimes some of our medicines are prevention. Right. Are you willing to risk possible side effects now to prevent a heart disease or something later on? Or are you more concerned about how you're doing right today? There's some interesting studies that have looked at even, like with sleep, do you need immediate sleep relief that taking care of that symptom right now is most important? Or are you willing to you understand the risks of some of those medicines and you'd rather figure out the harder way to improve your sleep right.

[00:33:51.150] – Dr. Levy

The sleep hygiene and other factors that might help. So there is a lot that goes into deprescribing, and then we come down to, okay, if it is agreed upon that we will stop a medicine. Typically in general, it's safer to slowly lower that dose, but patients need to be educated. So if you're going to slowly reduce the dose, what symptoms might you be looking for in yourself or your mom or dad, whoever's involved? And what do you do should they return? Right. Those symptoms come back. So that part of that educational piece needs to be part of that deprescribing, if you will. I want to make sure I cover it.

[00:34:26.620] – Allan

Yeah, absolutely. No, that's why I think this book is so valuable is this is really a good primer for you if you're dealing with a lot of medications or if you know someone who is, because let's face it, with 10,000 people are turning 65 or older every month, I think you said. And so most of us, we're going to turn 65 and we're going to be in that age group. And so the medications we start taking today don't necessarily have to be the medications we're taking and probably shouldn't necessarily be the dosage and medications we're taking then. So getting ahead of the curve and understanding what we're on now and understanding what it's for and how we feel and is it helping us. I think there's just a lot of opportunities there for us to not nip this in the bud, but be on more solid footing as we age to make sure that we're doing the right things and our team is there supporting us and helping us do the right things too.

[00:35:21.290] – Dr. Levy

Yeah. And I want to say I think this statistic is even 10,000 per day.

[00:35:25.190] – Allan

Are turning per day. Okay. Yeah.

[00:35:26.790] – Dr. Levy

Turning 65. We have millions and millions of these baby boomers. We're all there or almost there are turning 65. So those numbers are upon us, and that puts more strain on the healthcare workforce right. To manage these older adults. And that Geriatric specialty. Unfortunately, there's not enough of us trained in Geriatrics to fully know these nuances about the drug therapy, which makes it even more important that you kind of stay on top of it. And the book, yes, it has a lot of information and it doesn't always have the fix. But the point is to ask the questions, to empower you, to feel confident that I do need to ask questions about the medications and I'm entitled to ask those questions. And these are the questions I can be asking. At least start the conversation right.

[00:36:12.150] – Allan

So, Dr. Levy, I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?

[00:36:22.010] – Dr. Levy

And one thing that's really important that I always focus on is what matters most to the patient. So that happiest and it's a very subjective thing of what of wellness and where you are, where are you on the realm of possibility? So I love the question and the three things I came up with would be one, adherence. So that's another term I bring up in my book. But it's taking the medications as instructed. If you're prescribed a medicine, your doctor has identified a condition that can be treated with this medication, make sure you're taking it correctly. So that means if you have side effects or cost issues or maybe you don't quite believe in the medication, so those health beliefs matter. You need to communicate with your physician about the medication. But if you had medications, take them as instructed. Don't take them here or there when you feel like it. So that's an important piece. The other piece, which is I talk about a lot in that book, is minimum in the book, is minimizing the unnecessary medications, right? So wellness is when you're trying to be your best and feel your best. You don't want the drowsiness or with the risk of a fall or other issues, that's common side effects or stomach issues or whatever it might be.

[00:37:38.360] – Dr. Levy

So minimize unnecessary medicines and take only what's really needed and helpful. The third strategy I think is really important is that self advocacy. Speak up for how you feel day to day concerns you have and when it's going great. I mean, that's something important to share too. This feels right. This medication, I think, is important to me. That's an important piece to share also, but how you feel day to day. I use the analogy of chain. The healthcare is a link chain, if you will, and you are the end of that chain. So you have the physician, the nurses, the pharmacist, but you ultimately are at the end of that chain knowing how you feel every day, how those medicines are affecting you, good or bad. If you notice something different, you need to say something about it. Maybe it's the medications which that title came after many years, a couple years of using another title. I came to that title very last minute. But maybe it's your medications, you need to talk about it

[00:38:34.820] – Allan

thank you. Dr. Levy, if I were to send someone to learn more about you and learn more about the book, Maybe It's Your Medications. Where would you like for me to send them?

[00:38:44.230] – Dr. Levy

My website for the book is maybeitsyourmeds.com, and there you have links to my blog as well as to more information about the book and myself.

[00:38:55.210] – Allan

Cool. You can go to 40plusfitnesspodcast.com/604, and I'll have the links there. Dr. Levy, thank you so much for being a part of 40+ Fitness.

[00:39:06.750] – Dr. Levy

My pleasure. Thank you so much, Allan.

Post Show/Recap

[00:39:09.550] – Allan

Welcome back, Ras.

[00:39:11.190] – Rachel

Allan, oh, my gosh, I loved it. Starting with the title, maybe it's your Medications. I love that title so much. I mean, there are time and a place there is a time and a place where we need something. We need some medications, but sometimes it's like opening Pandora's box. There's a lot that can go sideways whether you intend it to or not.

[00:39:31.740] – Allan

Yeah, it was on Twitter a couple of days ago, and there was a health and fitness influencer. She likes to be called an influencer. I just want to help people. But she's an influencer. And so she went on this little live rant because that's what you do now, is you find something to be just up in arms about, and you rant about it on social media. Well, her rant was that she had been using this birth control pill for years consistently, so she wouldn't have a period because her doctor said that's the way you can do it. So you don't get pregnant. Very low likelihood you get pregnant and you don't have periods. So she's been taking this stuff consistently for years, and then she's ranting because now she's finding out that there is a side effect to this medication that includes cancer.

[00:40:23.750] – Rachel

Oh, my goodness.

[00:40:24.770] – Allan

And so her rant was, well, my doctor never told me. My doctor never told me that there was a side effect of cancer.

[00:40:33.970] – Rachel

Oh, my gosh.

[00:40:34.910] – Allan

And I'm thinking there's a little piece of paper in the box. You fill that prescription if you're going to be taking it consistently and skipping the little sugar pills or whatever they use now for the little pills that are in there that you're supposed to take. I don't know. I haven't had a person that needed birth control in a couple of decades, but it used to be these little foil pack things, and you took one every day, and there was a couple of them that were basically they said sugar pills.

[00:41:00.060] – Allan

Yeah. Okay. I'm thinking now, maybe they'd moved away from the sugar pills, but she was upset with Was because no, she's probably getting three or four of these at one time just to keep her going for a few months. And then she'd go and get it filled again. And there'd be a little piece of paper in that box and that little piece of paper would never get unfolded, it would never get read, and it would never be understood. And so, yeah, every medication you take, even most supplements, have potential side effects. And so if you're taking something, you really need to know the core three things why am I taking this? What's the possible downside and the risks associated, particularly for someone in my condition or my age or whatever? And then three, how do I take it properly?

[00:41:52.510] – Rachel

Oh, my gosh. That's a big one right there. Taking it properly.

[00:41:57.230] – Allan

Well, it seems like a simple thing. but sometimes it's not take with food. So if you're taking four or five or 15 medications and eight of them are with food and three of them are not, and some are in the morning and some are in the evening, you need to math something. You need a box. I don't even Google. Maybe that's something Google would be really good at, is, okay, Google, I want these alarms each day at this time and remind me, I got to take these with food. And maybe AI can do that stuff where you're just sending you a message or text and saying, hey, it's time for you to take your glaucoma medicine, or whatever. But it's just one of those things where you have to understand what you're doing and why you're doing it, because you're the CEO, and if you've taken a medication and you didn't know the side effects, that's a problem. If you're taking a medication and don't know how to take it, and beyond knowing how to take it, the question comes up. Okay, so, yes, you know how to use your inhaler. You have asthma, and you know how to use your inhaler.

[00:43:03.270] – Allan

But can you do it when you're stressed? Can you do it when you're kind of freaking out because you're having an attack, and now you had to go back into the kitchen, you're having difficulties, and you grab it out of the counter and you're trying to take it? And can you do it properly when you're in that stressed situation? And we talked a little bit about this. Yes, you want to work with your doctor. Yes, they're part of your care team, but you've got to do those three core things, right?

[00:43:32.440] – Rachel

Well, it's important. Alan I just started taking thyroid medicine for hypothyroidism, part of my menopause journey, and this is the first time that I've had to take a medicine without having an illness. Like, I've taken antibiotics before, but this is a full time, probably for a very long time medicine that I got to take. And so my doctor gave me some information, but when I got home, I did read that little tiny piece of paper that comes in my pill box, and I actually learned some things that my doctor did not fill me in on. So if anyone's not taking a thyroid medicine, you actually have to take it on an empty stomach FYI you can't just take it willy nilly at any time of the day when you feel like you've just remembered to taking it. And then I've also learned, too, that there are certain foods that will make it less absorbable. So I take it on an empty stomach, you have to wait 30 minutes before you can even eat anything. And then there's some foods that you shouldn't be eating. You shouldn't be taking an iron supplement. At the same time, you should not be having walnuts and some other random food items.

[00:44:36.060] – Rachel

So I did all that research, I did all that little fine print reading to figure out I need this thyroid medicine to work. That's my a goal. So I want to do everything I can to not sabotage that by eating the wrong things at the wrong time. But I can only imagine with blood pressure medicine, heart medicine, diabetes medicine, there's got to be a ton of rules for all these other things.

[00:44:59.740] – Allan

Yeah. And then the other side of it is what happens if there's a change in you. So you're listening to this podcast, and so I'm going to go on the general assumption that you want to improve your lifestyle and live a long, healthy life. So let's say you lose 30 pounds. What does that change? Because some medication doses are based on how big a human you are.

[00:45:25.740] – Rachel

Weight. Yes.

[00:45:26.620] – Allan

Okay.

[00:45:28.090] – Rachel

Yes.

[00:45:28.680] – Allan

And so if you lose some weight and now do you need the same medications? And so it's worth going to even if just go to the pharmacist, go to the counter. They've got the little quiet little booth over there. It's kind of private. You can go there and say, hey, I'm just curious. I've done a little bit of reading, but I weigh 30 pounds less than I did when these medications were prescribed. Should I be taking the same amount if I weigh 30 pounds or 60 pounds less? That's a big difference. You tell your doctor, hey, I'm going to go low carb, or basically say, I'm going to cut out sugar. How should I manage my medication when I start reducing the sugar that I'm eating? Because what I don't want to do is have my blood sugar go too low. And now what am I doing? I'm drinking orange juice or soda just to make it all work right. And so it's one of those things you need to know why, you need to know what the risks are, and you need to know how. And that's most of what this book is. But she has a lot of great information in there.

[00:46:36.290] – Allan

How to approach your doctor, how to have these conversations, how to get one of those reviews done,

[00:46:43.740] – Rachel

one point I want to make really quick, Alan, is that we rely on our doctors to tell us all of this information about the medicines we should be taking and how to take them. But I want to remind people that all of the doctors that we go to may not always be on the same page. So, for example, if you're going to a cardiologist and he has you on a blood pressure reducing medicine, and then you go to your general practitioner and she sees that your blood pressure has dropped so low that she puts you on a different blood pressure medicine to get it back up to normal, obviously, it's a contradiction there. So just I want to point out that you need to make sure that all of the doctors that you see are fully aware of all of the medicines that you take so that they're not counteracting what each of them are trying to achieve with helping your health.

[00:47:31.140] – Allan

And that's one thing well, that's one of the things Dr. Levy got into, was she know if your kidney's not functioning very well, and then because your blood pressure, your doctor puts you on a diuretic, I think you can see there might be a problem there. Your doctor knows that you have some kidney issues. At this point, I'm not on any medications at all. I did take aspirin the other day because I had a headache, but the only thing I can remember taking in, I don't know, three or four years was maybe a little bit of aspirin here and there. But if I were on multiple medications, when I went into any doctor, any doctor I walked into, I would have that piece of paper and I would say, okay, here, you can put this in my record. If you need to, but I want them to be able to pull it out when we're having I'm going to get a copy here, maybe, but just here's. List of everything I'm taking. Here's when I'm taking it, here's how much I'm taking. So I want you to have a complete transparency, and then any issues that are going on.

[00:48:33.920] – Allan

I lost 30 pounds. I've gained 30 pounds. My hair is falling out. Other things are going on in my body. And if the doctor tells you, well, that's just getting old, I would probably go find another doctor.

[00:48:46.660] – Rachel

Yes, please.

[00:48:49.530] – Allan

But have conversations. Yes. They'll give you seven to eight minutes, but be ready. If you just sit there and listen to them for eight minutes, you're not going to learn everything that you need to know.

[00:49:01.720] – Rachel

Yeah. Neither are they. You need to tell your doctor what's going on. You need to keep them 100% informed with what's going on so that they can treat you properly.

[00:49:10.740] – Allan

Absolutely.

[00:49:11.950] – Rachel

Yeah. Great. I love this book. It could be your medication.

[00:49:16.690] – Allan

Well, it is, and it's definitely the right conversation to know, because your pharmacist and even your pharmacist will take more time, but your doctor just isn't given enough time. I talked about that last week with the urologist, Dr. Boone. They're just not given enough time to really tell you everything they want to tell you or should tell you. And so you have to be an advocate. You have to ask the right questions.

[00:49:39.180] – Rachel

Absolutely.

[00:49:39.980] – Allan

This book can be a good start to that.

[00:49:42.060] – Rachel

Super helpful. Yeah.

[00:49:44.110] – Allan

All right, well, I'll talk to you next week.

[00:49:46.730] – Rachel

Great take, Allan.

[00:49:48.050] – Allan

You too. Bye.

[00:49:49.060] – Rachel

Thank you. Bye bye.

Music by Dave Gerhart

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