“Maybe It’s Your Medication”- Interview With Dr. Hedva Levy

Intro: 0:00

Get ready to hear the truth, the whole truth, and nothing but the truth about the United States healthcare system with your host of the medical truth podcast, James Egidio.

James Egidio: 0:19

Hi, I’m James You’re host the medical truth podcast, the podcast that tells the truth. The whole truth and nothing but the truth about the American healthcare system. We have a medication problem in America. It is marked not only by excessive use of medications, but by errors and how they are prescribed, monitored and taken. An estimated 19 million adults age 65 and older, take five or more medications daily. These individuals and family caregivers know the frustrations of lengthy medication list. Hi, drug cost and frequent questions about the need and value of those medications. All too often, an unrecognized adverse drug effect is mistaken for a new medical condition or worse, a symptom of getting older. But who stops the question the medications. My guest is a geriatric specialist and founder of a unique senior care practice of over 25 years. Working with patients in their homes. She’s an educator and leader in geriatric pharmacy and a dual certified specialists. It is an honor to have on the medical truth podcast. Doctor. Hedva Barenholtz Levy. Dr. Levy, welcome to the medical truth podcast. How are you doing today?

Dr. Levy: 1:35

I’m doing great. Glad to be here.

James Egidio: 1:37

Thank you. Thanks So please share with the viewers and listeners of the medical truth podcast about who you are and what you do

Dr. Levy: 1:45

Sure. So I am a pharmacist who specializes in working with older adults. I’m a geriatrics specialist And I started a very unique senior care pharmacy practice about 25 years ago Where I meet with older adults in their homes And it’s given me a, it’s a unique opportunity to provide unrushed medication reviews. I focused on essentially the drug information part of being a pharmacist and helping patients understand their drug therapy. But my focus has always been on identifying and preventing medication related problems in older adults. So it’s been a very unique vantage point for being a pharmacist and helping older adults with their drug therapy.

James Egidio: 2:26

So you wrote a book called Maybe It’s Your Medicine. And just explain a little bit about the premise of the book and some of the things that you discovered in the course of writing that book.

Dr. Levy: 2:38

Sure. The book had its genesis in the fact that I’ve been inside individuals homes and working with them in their drug therapy to help them understand the medications they’re taking. And over the course of years and years of working with older adults, I saw consistent problems happening again and again, as far as the types of errors that can occur when individuals are taking medications, maybe in how they’re prescribed, or even how they’re dispensed from the pharmacy. And. It all contributes to the potential for having problems with your drug therapy that many of which can be prevented if we had more patients were more informed, if we had, we could address some of the gaps in our health care system. So the book, the concept for the book was really to help older adults understand what they need to know about their medications in order to take them more safely and prevent. those types of problems, a range of problems that can happen when we take medications, but also to help caregivers understand the issues that, that go along with aging and medications. And even for healthcare providers, anyone who works with older adults who may not have that pharmacy background or the geriatric background that working with older adults. So I wanted the book is a. It provides the issue that it summarizes why there’s a problem with older adults and medication use, why we need to be more concerned, but then it also provides tools and tips for how to be more safe about how we use medications, if that makes sense.

James Egidio: 4:23

Yeah. So what are some of the common prescribing errors that take place, especially when it comes to, let’s say, the senior geriatric population.

Dr. Levy: 4:34

So with older adults and medications there the body handles drugs differently. And I state right up front, one of my in, in describing the, why we have this concern is explaining how older adults. handle medications differently, and they respond to medications differently. So there we tend to, there’s, we need to be more careful in how we dose medications because older adults can be more sensitive to the effect. So maybe a medication for blood pressure or even to help with sleep or a depression, lower doses might be appropriate for an older adult. And then there also are a group of medications that tend to be the risk and benefit of the medicine shifts in older adults, so we need to use certain medications more carefully, either avoid them when we can, or. Monitor them more cautiously. So as far as when you ask prescribing errors it really comes down to looking at medicines that are potentially inappropriate for older adults that we want to avoid if possible or just use with a little bit more caution and education, for example. So I can get into more specifics, but There are two big geriatric groups that have published a list of these potentially inappropriate medications in the U. S. and also in Europe, and I talk about those in my book. The AGS BEERS criteria is one that we talk about a lot in the U. S., highlights these potentially inappropriate medications.

James Egidio: 6:04

What are those specific medications

Dr. Levy: 6:06

So I talk about in the book general common groups. So there’s dozens of medicines that are listed, but we some of them, for example, would be the proton pump inhibitors, which are medication, a group of medications that we use to decrease acid production in the stomach, drugs like Omeprazole, Prilosec. Esomeprazole, Nexium, Pantoprazole, they’re available with a prescription without a prescription and these drugs make it onto the list of potentially inappropriate medications when they are used beyond a certain duration and that’s just a very simple example of medications that are fine when used appropriately. Typically, up to eight weeks for reflux is when, why we commonly use them and why they’re available over the counter without a prescription. But when they are continued for months or years on end, it can, they become inappropriate because they’re used without a specific reason for use, and all medicines are associated with the risk of side effects or interactions potential. So that becomes a concern. Okay. There also are medications that increase fall risk, for example, so we want to be careful not to use How we’re using medicines that increase the risk of falls and a person who is who has had a fall It’s important to be aware of those medications and there’s just numerous to list but drug classes that increase the fall risk would be things like the our antidepressants our anxiety medicines some of the opioids used for pain management and a few others. I’m trying to think of the other ones. The so those are the types of medicines we think about. And when we, when a person takes more than one of them, it becomes an increased concern.

James Egidio: 7:47

Sure. Could even be a blood pressure medication, right? Where they, their blood pressure bottoms out.

Dr. Levy: 7:53

Exactly. So certain blood pressure medications increasing that risk of false because of dizziness and the, and blood pressure dropping too low. Exactly.

James Egidio: 8:00

or even diabetes medications,

Dr. Levy: 8:03

right? And the we call them hypo glycemic. So thank you for prompting me for certain medications don’t affect our the blood sugar. It doesn’t increase the risk of the blood sugar falling too low, but there are a handful of drugs that do. There’s a drug class called the sulfonylureas. And I mentioned that described that in the book that have that risk of dropping the blood pressures, the blood sugars too low if the person is not eating properly and that type of thing. And those are medicines that can be potentially inappropriate in older adults. Oftentimes there are safer choices, and that’s what we want to go to as long as we are able to do so for a specific patient.

James Egidio: 8:45

and it seems like the population that you chose to assist, which of course is the senior population, it just seems like there’s so many… Other challenges, aside from what you’re saying, the physiological effects of the medication because, we’re talking about a population that watches a lot of television and we live in a society. And in a country where, almost every maybe that’s an overstatement, but a lot of, you see a lot of commercials for medications, so they’ll run into their physician’s office, these patients, and they’ll say, Oh, I just saw this advertisement for this medication. Can I give this a try, doc? So you see a lot of that too, right?

Dr. Levy: 9:29

So the drug, those direct to consumer advertisements is exactly what you’re talking about. And I have a, there’s an ongoing joke in my house about how many commercials we see. commercial after commercial and the evening hour or almost any time of day. One of the factoids I’d like to share is there’s only two nations that allow direct to consumer advertising, the U. S. being one of them and New Zealand is the other. We have those the advertisements and yeah it certainly is one of the reasons why I describe In the book of why we have this prevalence of medication use in our country specifically. I think there’s Pros and cons that are talked about for this, the, for the, for those commercials on the one hand, it helps patients be aware of certain issues. It helps them feel more confident to bring up a question and maybe about some of those sensitive health conditions. You think about erectile dysfunction or urinary incontinence and things like that. So there’s the pro side of having those commercials there. And then the negative side is that there’s a perhaps undue pressure on the physician. They, when you, as you described, the patient might come to the doctor, can you prescribe this for me? And the doctor feels some pressure. Typically a good conversation with a patient to help them understand the risks and benefits of the medicine, why it may or may not be appropriate for that individual should be the way the conversation should go. But yeah, it certainly does spark some conversation perhaps for the at the medical visit.

James Egidio: 10:55

You hear the word polypharmacy, right? what is polypharmacy and what are some of the consequences of polypharmacy?

Dr. Levy: 11:03

Yeah, and that’s certainly a major tenet of why I why this book is so needed. I feel so polypharmacy in its simplest definition refers to use of multiple medications, poly referring to multiple and pharmacy referring to the medications and The concern is that the more medicines you take, the greater risk of having problems as consequences, as you mentioned, and in older adults, a person’s age to 65 and older, they’re more susceptible to the negative side of medications. So with polypharmacy, we worry about certainly having adverse drug reactions. The more medicines you take, the more likely you’re to have a side effect and drug interactions. There’s also the concern about decreased cognitive and physical functioning. We see studies that have made the association between the use of multiple medications five or more typically is studied. And Perhaps having a decreased performance on cognitive tests or physical functions. So measures of grip strength or ability to walk a certain distance in a certain time Types of things have been evaluated as well as increased health care utilization. So not only are the medications more expensive per you know When you take when you’re taking more medicines each one is going to cost more The increased utilization of the healthcare system, maybe an extra doctor visit will be needed because of a side effect or worse yet, a trip to the emergency department or hospitalization. So those overall healthcare costs are increased with polypharmacy. We see that for sure. And ultimately, and even we, there’s been some studies that linked it with even mortality. So we’d certainly want to think about when we use medicines that we are using only what is. needed for an individual that’s appropriate for them and avoiding those drugs that are not clinically beneficial for the person. And that’s a real difficult tightrope to walk sometimes, but that’s why focusing on what are you taking? Why are you taking it? Is it helping you to get rid of that unnecessary polypharmacy, if you will?

James Egidio: 13:15

Yeah. That a lot too. I know with. With antibiotics with physicians who prescribe antibiotics, it seems that we are in a society that with every little cough and sniffle, the first thing that a lot of physicians want to do is put patients on antibiotics, and it seems like that is an over prescribed medication as well. Is that true?

Dr. Levy: 13:39

I’m going to say it goes both ways. So we do worry about our antibiotic use. And there is a huge I would say movement, a huge awareness of the need for antibiotic stewardship is the term where we can be. We need to be more mindful of as a health care system of how we use antibiotics and it goes. You mentioned how we want. the quick and easy fix. We’re not feeling well. Give us a medicine to help us through this. So both patients are asking for the antibiotics and physicians might be willing to prescribe. But I’ve heard a lot of stories where the patients are actually the ones pushing for those antibiotics. And even when, especially when I’ve heard some pediatric stories, the parents are worried about their young one and, really want that antibiotic when really You need to wait it out and make sure if it’s a virus. Antibiotics are not going to help. So it goes both ways, right? So that’s why an educated patient is important as well as an educated clinician to know when is the antibiotic appropriate and to have that conversation with a person who wants the antibiotic or has the symptoms of an infection to understand is it bacterial or viral. One will help. for medicines will only help for certain situations, right? Yeah, we need to slow down that prescribing all the way around. But I think it, it takes the conversations so patients can understand and the clinicians can understand and come to a common understand common agreement of the best way to manage a person’s Infection in this case.

James Egidio: 15:08

So here, I guess one of my questions too, is how does one overcome providing the appropriate amount of medication or dose? To let’s say a relative who lives on their own, an elderly relative who lives on their own, a parent, for instance, they live on their own there. They can’t afford to be placed in a facility, a skilled nursing facility or something like that. But they’re also not under the supervision of their their son or daughter,

Dr. Levy: 15:44

their caregiver living on their own somewhere.

James Egidio: 15:46

How do they get around that? How do they, get around, making sure that they take their medication. And what are some of the challenges

Dr. Levy: 15:54

for the adult child who’s worrying about or caring for mom or dad from afar, maybe? Yeah, sure. And it’s a challenge because as our nation is aging and most of us are aging in our homes. We’re not going into nursing homes and it’s best to everyone. Everyone wants to be in their home setting and that makes sense. So if mom or dad can’t be nearby, there’s a proxy, ways to, to, get that care. I was going to say technology. There’s a lot of, there’s a lot of different answers, there’s technology as far as making sure mom or dad is getting their medication doses that I’ve talked to talked to lots of patients, of clients, and also there’s lots of examples out there where there’s fancy medication dispensing machines, right? So you can get automated medication dispensing machines of sorts that can be at mom or dad’s home and you are able to kind of program and know if the reminder went off, if mom or dad took their medicine, or you could, call the parent to make sure did you take your medicine mom? So there’s things like that to help with adherence that can facilitate greater drug safety. And if if there’s issues of mom or dad maybe taking extra medicines, that’s why these pre programmed dispensing machines can be very helpful from afar, right? There’s other technology with dispensing caps. There’s smart caps that the pharmacist might be able to dispense to help regulate and know how mom or dad is taking their medication. But there are, there also is the bigger picture of making sure mom or dad has the overall care they need, because it’s not just the medicine sometimes maybe it’s having access to the the food or being able to get to the doctor’s appointments and things like that. So there’s a lot of great support for older adults. The senior service network, I refer to it as maybe getting someone like a care manager, a geriatric care manager involved might be an answer for a son or daughter who lives remotely from a parent in another city. And that way you have eyes on mom or dad locally, which I think is really important. But there’s a lot of smart technology maybe that can help. As well, I’m just not as well versed in some of that, but to have, and then, to have someone accompany mom or dad to a doctor’s appointment or to be on the phone speaker phones, we certainly can utilize that technology to have, be more hands on with what’s going on with your parents. But all, and also helping them manage their medication list, keeping an updated list, even if it’s remote, something you can Make sure mom or dad has with them when they go to their doctor visits being named as a approved person that can talk to the doctor directly. Those are all the ways to maybe stay involved with the. Your parent who’s remote. I’m not sure if that’s what you were thinking as you asked the question, but we can’t it takes a community. And if you can’t be there, I think it’s important to get someone involved who can if, finances allow everything costs at some cost for some of these services. But there are other resources. I think we probably could tap into. We just may not be aware of.

James Egidio: 18:55

Yeah. Yeah. I know when we used to conduct medical house calls years ago it was a wonderful way for us to be able to help the senior because we primarily with a senior population to help them along with their medication and also their environment that they were living around, in their home. It was so interesting. We would have some of these elderly patients that we’d go to their home and we’d say, we need to see your medications. And, we would have the little grandma, she’d run into her room. I remember one time this one lady came out with a shopping bag full of Bottles of medication that she received and she just dumped them on the table and the doctor who I was assisting at the time just looked at me and I looked at him and we were just chuckling about it. But it’s so interesting because yeah, and you just what was nice about that is We were able to really help them manage their medication in that type of environment, in that type of setting, the medical house call setting. Being at the home. Yeah, being at the home, especially for a senior population. Plus, there were less distractions of the office environment for that patient and the doctor too. Which was really nice because they were in their own territory, their own domain.

Dr. Levy: 20:12

Exactly. And me doing the home visits for my pharmacy service. It’s unrushed. You see so much of what’s the, what the environment looks like, but it’s an unrushed environment where you can talk to the patient and give them a little bit more time, but see what they’re juggling and managing at home. Exactly.

James Egidio: 20:29

Yeah, it’s so important because my gosh, you were mentioning, I think one of the statistics is that there’s was it 19 million adults age 65 and older take five or more medications daily?

Dr. Levy: 20:42

Yep. Yep. Percentage is 42 percent of our older adult population, which is tripled from, When I first started as a pharmacist in the last generation, really, we’ve tripled that frequency. So a lot more medicines are being used today, and that’s why we have to just pay more attention to it and talk about the medications we’re using, which is the premise of why I wanted to put this book out there, because too often we say, okay, I’ll take another medicine. As you mentioned, you described someone who. brings out bag fulls of medications. I went through cupboards full of medications for older adults who either they’ve accumulated or they’re being, that the pharmacies are delivering if they’re if medicines are being delivered on an automatic refill and they accumulate if the person’s not taking them properly. So there’s just so many potential issues that could happen.

James Egidio: 21:36

Yeah. And then, there’s a lot of interactions too with medications where, you’ll get a Especially with the large senior populations is they’ll get, they might be on Coumadin or something and they get convinced to use some kind of an herbal supplement or something without, contacting their physician and then there’s just another whole host of issues going on with the interaction of herbal supplements and nutritional supplements and so on and so forth.

Dr. Levy: 22:03

So yeah, you open up another whole bag of can of worms there with the non prescriptions, right? You have both over the counter and the supplements. And again, a very important topic for people to understand why that matters. Those are medications in their own right. They have interactions and potential for side effects, and we need to be very mindful of that use as well. I inform people a lot that dietary supplements are not regulated as drugs by the government. They are regulated as foods. So there’s a whole other ballgame of how they are evaluated and available to patients. So very important topic to bring up. Absolutely.

James Egidio: 22:49

What are some non drug treatment strategies to manage these health conditions as far as?

Dr. Levy: 22:56

Yeah, so it’s so that So important to not just look at the medicine when you have a given any diagnosis. Almost. Yes, there’s typically going to be drug therapy you can look at. But what else can you do that to help that health condition? That’s not. Just the medication. So I highlighted several of them. Again, I have a chapter devoted to the non drug issues for managing health conditions. Some simple ones that I always, I often recommend to people with a, if they have reflux disease, for example, remember I mentioned the use of those proton pump inhibitors for often used for reflux. What else can we do that doesn’t involve the medication? So there’s a host of recommendations that involve avoiding trigger foods, spicy foods. For example, or caffeine not eating before dinner making sure you’re might maybe tilt the head of the bed when you’re at night if you have reflux symptoms at night. And there are several other recommendations. So there’s, that’s an example of a very common condition that maybe shifting, making lifestyle changes can manage that condition just as good as the drugs can. Another very common lifestyle or non drug recommendations I always share with people is the good sleep hygiene. So many people worry about sleep or complain about not sleeping well, especially as we get older and there’s a whole list of recommendations that are more behavioral type things to help us sleep better without having to rely on a medication for that. So I always talk about good sleep hygiene for people, for example, and then there’s the basic healthy behaviors that can go so far. And I think we, we underestimate the value of what we’re putting in our bodies, the nutrition aspect of our lives and physical activity. I hate to say exercise. Some people don’t like that term, but staying physically active is so important. Keep moving. And those are so and sleep is becoming known as a very important healthy behavior that we that helps us stay healthier longer. Yeah. Yeah, there’s some things that were some examples of these non drug ways that we can help our health conditions and maybe we can’t get away from the medicines, but we might. be able to reduce medicines or prevent having to escalate. I think about a high blood pressure an awful lot. If we can do more with our lifestyle and diet and nutrition, that can help our blood pressure. And I think diabetes is a huge one where if we diabetes and obesity, and that’s just such a huge issue in our country, where if we look at our nutritional intake. And movement. There’s other ways to help address some of that.

James Egidio: 25:28

Yeah. It comes down to just managing your health with diet and exercise, especially diet, I think, too.

Dr. Levy: 25:38

Yeah, absolutely. I want to say I would like to talk about maybe say nutrition rather than diet because when you say diet, people think about what can’t I eat? What do I have to eliminate? But I think looking at nutrition as a whole and avoiding those processed foods. I try to, I’d like to share with people as much as possible when studies come out that talk about the dangers of the damage that can be incurred with processed foods, how harmful that is for us. If we can eat foods in their more, more natural state, if you can fresh fruits and vegetables frozen if you need, but to avoid those, the prepackaged stuff, it’s it. We don’t know what we don’t know. And it’s I think it’s, it’s led to some of the health conditions we have. I think obesity is clearly related to some of that. Absolutely. Sugars, a lot of sugar that’s been in the news recently, right? Just excess sugar. Yeah. Yeah, even little things I’ve switched from flavored or getting flavored or fruit yogurt to just plain yogurt and adding my own honey for example, just minimizing those extra sugars when you can.

James Egidio: 26:40

Yeah, we’ve seen a lot of patients turn their entire. Health around with just changes, just subtle, even subtle changes in their diet, losing weight.

Dr. Levy: 26:50

They talk about 5 percent just, yeah, It’s the harder way to do it, but it certainly pays off in the long run to, to be able to minimize the medications, I think is such the better way to go.

James Egidio: 27:14

Yeah. And when they do make the changes and I tell people this too over the years is that they’ll reach a threshold when they do lay off those certain foods. Like we’d have patients that would come into our office and, they were and they were young patients too, by the way. They were like in their twenties and thirties. Okay. Yeah. And they were like 20, 30 pounds overweight. And I, the first question I would ask him is, do you drink soda? And they’re like, Oh yeah, I drink, three or four big gulps a day or whatever, and I said, if you would just lay off the soda in itself, you would probably lose anywhere from minimum 10 to 15 pounds in one month and they would do that and they would come back a month later. With more energy and 10, 15, sometimes even 20 pounds lighter because they were consuming that much sugar every day

Dr. Levy: 28:07

feel better, right? And they’re able to way better. And I love that idea of just make one change. Just look at the soda. That’s it. Just make one change and see how you feel and then see what happens. I love that story. Absolutely.

James Egidio: 28:19

It’s amazing. Your book is called. Maybe it’s Your medication, and it can be found, and I actually posted it right here on barrenholtzlevy. com, right? Yep. Also on skyhorsepublishing. com, correct?

Dr. Levy: 28:35

Yep, and you can get it at any bookstore, Amazon, Barnes Noble, Independence, and yep, absolutely.

James Egidio: 28:42

It goes into a little bit more in depth than what we, of course, we talked about, but it’s a great book.

Dr. Levy: 28:48

It, thank you very much. It, the, as I mentioned, yeah, we touched on a lot of different subjects, but that are in there, but to understand why medications matter as we get older, why that’s a special population, but then also what you can do about it. So hopefully it’s a good resource for anyone who’s aging or caring for somebody who’s aging. I think I, my intent is to help people just know what questions to ask so they can talk with their physician or their pharmacist about their medications in a more mindful way.

James Egidio: 29:17

Yeah, and not even a senior population. You start to see even a lot of the younger population on medications, like I was just saying with

Dr. Levy: 29:24

how can we prevent those chronic conditions from becoming worse and all? Absolutely.

James Egidio: 29:29

Yeah, diabetes, diabetes and even blood pressure problems amongst younger populations of patients.

Dr. Levy: 29:37

Right? And we can, if we can shift that course and prevent that, the trajectory from going off on to severe hypertension or blood pressure issues or diabetes and all the downhill effects that can happen, it’s scary. So yeah, that holistic approach to our health, what we put in our bodies is so important. Starting at a young age, for sure.

James Egidio: 30:00

And again, the book is called Maybe It’s Your Medication. It’s right there. And it’s be found on barrenholtslevy. com or at Skyhorse Publishing. It’s a great book. Thank you so much for joining me for this episode.

Dr. Levy: 30:17

My pleasure. Thanks so much for taking the time and bringing attention to this important topic.

James Egidio: 30:22

Absolutely. Thanks again. Appreciate it. Have a good day.

Dr. Levy: 30:25

You too.

outro: 30:27

Thanks for listening to the Medical Truth Podcast. For the latest episodes, go to www. medicaltruthpodcast. com. You can also find the Medical Truth Podcast on Rumble, as well as all the major podcast platforms like Apple Podcasts, Spotify, Stitcher, and iHeart.