Consistently taking non-daily medicine: When it’s time to replace it

I have a minor medical condition for which my doctor suggested an over-the-counter nasal spray, Flonase  (fluticasone propionate).  Sometimes, for months at a time I’ll take it daily, sometimes every other day, sometimes less often, which my doctor says is fine.  The bottle says it contains 120 metered sprays.  How to know when it’s time to replace it?

I keep a scrap of paper and a pen next to it in my bathroom, writing down the date as I administer it to myself each time.  I can count the dates I’ve written so I know when to get a new one.  By doing that, I don’t throw away a bottle with usable medicine, nor keep using a sprayer with no medicine.

This could be useful for anyone who wants to consistently take medicine.  It’s most useful for medications you’re taking on something other than a daily basis.  For daily medicine, a seven-day pill box organizer, or something similar, is probably more convenient.

Five minutes of education: Physician-patient communication upon hospital discharge

From Dr. Jeffrey Schnipper's research:

A patient was admitted for worsening shortness of breath and weakness. Evaluation showed ischemic heart disease [reduced blood supply to the heart], which was managed medically by changing her blood pressure regimen from metoprolol tartrate (50 milligrams, twice a day) to metoprolol succinate (extended release, 100 milligrams, once a day), lisinopril, and isosorbide mononitrate. She came to her nurse practitioner eight days after discharge for a blood pressure check, complaining that she’d been experiencing three days of scalp tingling [paresthesias] and headache; her blood pressure was markedly higher. On questioning, she reported not taking the long-acting metoprolol prescribed at discharge, because of a misunderstanding. She was brought to the Emergency Department, where she was treated, observed for several hours, and discharged home.

This was due to a discrepancy after discharge; she had stopped her short-acting drug and did not realize she needed to start the longer-acting one.

Such misunderstandings are common, partly because changes in medications are made so frequently. Upon an inpatient’s discharge from the hospital, doctors change 40% of the medications the patient has been taking, on average. “Five minutes of education of the patient and having them ‘teach-back’ what they have learned could eliminate the need for an E.R. visit later,” Dr. Schnipper says.

Advice to patients leaving the hospital:

Ask these three questions:

1.What changes should I make to the meds I’ve been taking?

2. Why are these changes needed?

3. What do I need to watch out for?

To ensure you’ve heard the answers correctly, repeat the answers back to the nurse or doctor.

Thanks to Dr. Schnipper, whose article appeared in the March 13, 2006 issue of the Archives of Internal Medicine.

With no sarcasm at all: Medication compliance and tough love with Lewy Body

Blogger KnittingDoc’s story:
This week I had three very good days in a row. So good that I overblogged on those days. Pam even said, “You’re spending a lot of time on the computer. Why don’t you take a break?” I felt well. So well that on this past Wednesday evening I began to ponder whether I really needed to take all these ‘memory pills.’ ‘Dementia pills.’ Nothing wrong with me. I don’t think I need to take them. I could go to work again. On those days you feel poorly, kick yourself a good one and get going. It’s all in your head (oops, excuse the pun).

So I mentioned it to Pam. A good mistake, I guess. Talking about tough love! The earth shook. The dogs barked. And the wind blew. I ended up stammering, “Yes, yes. I’ll take them and no, I didn’t stop taking them. I swear to God with both hands on the Bible.” Caregivers……..tough love does work! My red face grin.

Later that evening, Chad said goodnight to which I responded, “I hope you don’t die tonight.” In my heart, I was trying and meaning to say, “OK. You have a good night and sleep well.” I walked into the bedroom. Again the earth shook. Pam told me how inappropriate my comment to Chad was. I wasn’t sure what she was talking about.

Evidence of lacking good judgment twice within hours of each other. Before going to bed, she said, “You really did stop your medicine, didn’t you?” I had to convince her that I didn’t. Whether it was poor judgment, word or phrase finding difficulty or just plain not thinking, it wasn’t the real David. Pam reminded me of my past couple of years and the symptoms I’ve shown. She reminded me of my abnormal SPECT scan.

And then the next morning — Thursday. I awakened having slept poorly. I was in a fog and feeling fuzzy. My gait was a little stiff and slow. Good morning, Lewy Body Dementia. I see you’re back. Reality smacked me in the face! With no sarcasm at all, Pam said, “Do you still want to go off the Namenda and Aricept?” I had no retort……..

-David

Advice to spouses and people with Lewy Body Dementia: Be gentle with each other – and use tough love as indicated.

Read another story about a physician suffering from Lewy Body Dementia.

Thanks to Dr. David Thomas for his insight, openness and humor in the source story in his blog post, “Swallow This! Bittersweet Memory Pills.”

One fifth of her income: Medication compliance for Alzheimer's medication

Lori Stewart of Champaign, Illinois, is trying to decide whether to discontinue her 66-year-old mother’s Alzheimer's medications, which seem to have only marginal benefit.

"The medication is $182 a month," she said. Lori recently wrote about the dilemma on her blog. "It's been a very agonizing decision for me. It is literally one-fifth of her income."

Advice: Ask your doctor, or your parent’s doctor, about your options in light of the heavy cost of drugs.

Read another story on the effects of the high costs of healthcare.

Thanks to Stephanie Saul for the source article in the NY Times of Oct. 22.

Don't tell my wife: Stretching prescriptions

Martin Schwarzenberger, a 56-year-old accounting manager for the Boys and Girls Clubs of Greater Kansas City, s stretching out his prescriptions. Martin, who has Type 1 diabetes, is not cutting his insulin, but has started scrimping on a variety of other medications he takes, including Lipitor.

"Don't tell my wife, but if I have 30 days worth of pills, I'll usually try to stretch those out to 35 or 40 days," he said. “You're trying to keep a house over your head and use your money to pay all your bills."

Advice: Ask your doctor which of your prescriptions you can stretch with the least harm.

Read another story of access to care.

Thanks to Stephanie Saul for the source article in the Oct. 22 issue of the New York Times.

Satisfied users of medication reminder watches: Patient compliance

These three testimonials appeared on a vendor’s web site, so take them with a grain of salt:

C.C.’s Testimonial:
Your company was very helpful in finding a good electronic reminder for my Mother. She is Diabetic and needed help in trying to remember to take her Insulin at the right time. Before she had the watch that we eventually bought from epill.com, we had experienced a couple of spells where her blood sugar required us to call 911 in the middle of the night. Needless to say, this caused my Father and the rest of our family great stress. Since then, she hasn't forgotten to take her Insulin and actually enjoys the vibrating watch that we got for her. With her hearing problems, she never would have had the same degree of success with an audible alarm. Your complete and informative website directed us to the right alarm for her.

Thanks so much! We will enjoy the watch and having my Mom around for hopefully many years to come.

K.P.’s Testimonial
The watch (e-pill MeDose) is a godsend. Prior to using the watch my grandson had approximately 64 seizures in a 2-month period. Since using the watch he has had only 2 seizures in a 2-month period.

T.M.’s Testimonial
Thank you for creating this product (MD.2). My mother is able to stay at home and take her medication thanks to this pill machine. She was recently declared cognitively unable to take her medications from a traditional pill box.

The visiting nurses have commented on how much better she is doing now that she is getting the correct medication at the correct time. Prior to having your specialized pill machine, my mother was inadvertently taking medication from the wrong day or time or getting confused and trying to put the medication back into the regular pill bottles and fill the pill boxes herself.

This machine has eliminated all of that confusion for her and allows her to live at home and take her medication without supervision.

Thank you for giving my mother additional days/months/years of independence. I know at some point her Parkinsons will get the best of her, but for today, the machine [e-pill Monitored Automatic Pill Dispenser] allows her greater independence. Thank you.



Advice to family members with a forgetful loved one on medication: Consider buying a device like the ones described above.

Read one of our patient compliance stories.