Brand vs. Generic Medications – Does It Matter?

February 23, 2011

Taking prescription medications can be cumbersome. It certainly challenges ones working memory skills to remember the names of medications we take, the dose, what time of day to take it, what the pill is for, the side effects, where we store it in the house so we can find it when we need it, when to call the doctor for a refill, the list goes on. To add more confusion to the mix, most prescriptions have two names, the brand name (like Benadryl) and it’s generic name (diphenhydramine).  So I’ll share a question patients frequently ask me – does it matter?

Traditionally when medication is first approved by the FDA there is a patent placed on the newly “branded” drug. After a certain number of years the patent expires and any other company is welcome to make a copy-cat “generic” of the drug. Is there any difference between the original and the copy? Yes. Does it matter? That depends on who you ask. My opinion -ultimately it depends on the person taking the drug – the patient!

When generics are manufactured, the FDA allows a slight deviation from the amount of active ingredient compared with the original branded version of the medication. Maybe Brand X has 32% of the active ingredient and Generic X has 30%. Probably not a noticeable difference clinically for most people. But, where brands and generics differ the most are in the filler components – the stuff that literally holds the tablet together. These filler components can be completely different, resulting in the pill looking nothing like the original one. The size, shape, and color may be may be unrecognizable when you go to pick it up at the pharmacy. The name – the generic name – may be unrecognizable as well. This is a source of many frustrated phone calls to our office from patients worried that the pharmacy gave them the wrong bottle.

Rule of thumb is that most generics will work fine for most people. However, there are some exceptions so certainly let your doctor know if you are experiencing any change in symptoms or side effects when going to a generic. For example, you could be allergic to the red dye coating of generic Y that wasn’t in brand Y. Or your child may have trouble swallowing generic Z because it’s twice the size of brand Z.

Cost cutting is generally driving the substitution of generic medications in place of the brand. That’s good news if both drugs are equally effective for you. But if you have noticed differences in effectiveness or side effects, ask your doctor to contact your insurance company to do a “Prior Authorization” requesting coverage for the brand. It will usually take 3-5 business days for your insurance company to respond to the doctor’s request so patience and planning are helpful in these situations.

One Approach to Procrastination

February 26, 2010

If you tend to procrastinate until a deadline is on top of you and forcing you to get things done, and you know this is hurting the quality of your work, causing stress to you and probably to your clients, boss or family, then how do you stop procrastinating about dealing with your procrastination?

This might be a fun puzzle if it weren’t so crucial that you find a way to get started changing your approach. One of the common side effects of procrastination is that people in your life lose trust in you and get angry. As you well know, this is usually matched by your own anger at yourself. But this pressure usually doesn’t translate into motivation to get started.

If life were a sport and you were critiquing yourself for missing critical shots because you didn’t keep your eye on the ball, I’d be pointing out that your focus on past mistakes is taking your attention away from the current situation, taking your “eye” off the ball again. Drop the self-critique, get a bit of help with your technique and try again.

The best hitters in baseball look for, and can see, the stitching on the ball as it comes at them at up to a hundred miles an hour. They know that they need to look for this detail to pull their attention to the ball; just looking in the direction of the ball doesn’t allow them to see the tiny changes in directions that they need to see in order to connect with the pitch. Golfers watch the dimples on the ball as it sits on the tee.

To get started on a project, focus on the details of getting started. What project will you start? Schedule it in your calendar. What small, discreet aspect of the project will you do? Define it and plan on doing just that much. What exactly will your next action on the project be? Write it out very simply as a task.

Think about teeing up the project – choose which one you’re going to work on.  Keep your head down, your eye on the ball and hit it just well enough to move it down the course and keep it in the fairway – do a small piece of it.  Now you’re ready for the next shot – concentrate on the new swing no matter whether you’re in the rough or on the course.

For you baseball fans, what you’re looking for is a single, not a home run; don’t over reach. Just connect with the pitch. Basketball aficionados, take one step and move the ball down the court. Every foot closer to the basket increases the odds of a score. Tennis players, make a solid smooth hit and get the ball across the net and into the court. Now set up for the next shot.

What do you need to get done? Right now schedule a time to work on it, and resolve to treat it like an important meeting. What is the first little step to getting the project started or moving it ahead? Write it down on your task list.

Procrastination can be head faked that easily.

Contact Jay Livingston

Self-Correcting

October 19, 2009

Coaching has three distinct steps:

·         Learn how to address a topic or issue you want to change

·         Implement an effective approach or solution

·         Keep at it through the ups and downs of your life

Using a system even when things are going well, or making adjustments in routines so that you don’t fall behind again is one of the major challenges to managing responsibilities more effectively. For many high-energy, bright, creative people routines can quickly become boring and our attention will drift to the next new or interesting project.

I find it tricky to help clients understand they need to stick with the coaching process until they have practiced pulling themselves out of a backslide toward chaos. When coaching has helped get things going better, and there is room to breathe again, it can feel discouraging to contemplate the next failure, but inevitably the pressures will build; you will drop your adherence to the systems that you learned; and pretty soon you will need to stop yourself and re-start the process. Done early, a restart can quickly get things back on track.

Each year sports teams start their season practices with conditioning (most players have let it slide during the off season) and practice of the basics (both to reestablish high quality patterns and responses and to build player skills to a higher level.) Musicians regularly play scales slowly and deliberately so that they can listen and improve the fundamentals their creative music depends on. Those of us that lead complex lives need to practice the fundamental skills that help keep us focused during times of pressure, skills that encourage us to quickly work our way back into proven routines.

You can always call your coach to remind you of what to do when things start coming apart, but your coach should also be helping you develop the ability to become self-correcting. Only with practice will you see a pile of papers that has grown too big and say, “I need to do a quick sort of this pile, but I have to be careful not to get too involved. I’ll set a timer for 15 minutes and try to make one pass through it.”

When a project is late you will stop for a minute and say, “Have I scheduled time in my book to work on this? What is the next small action to take to get started?” Or you will recognize that you don’t feel pressure yet, no one is upset at you – yet, and you will practice the techniques you learned to generate some of your own sense of urgency so that you get motivated to get to work.

Becoming self-correcting is a huge step toward successful self-regulation; be sure it’s on your agenda and your coach’s.

Jay Livingston

Contact Jay

Easy Way to Plan Your Week

September 7, 2009

We live our lives caught amid almost unlimited past, present and future demands. Making decisions about how to use our limited time and energy often means choosing among those projects that feel most urgent, finishing long-postponed tasks or planning for future success; planning almost always gets put aside.

Those with ADD or an ADD style are more likely than most to find themselves involved in urgent projects that have been let go a little too long and if they are going to look toward the future, they often just glimpse discrete, cutting-edge projects that grab their attention and beg for implementation. Future planning to reduce crises and move projects ahead before they become urgent gets no attention.

Planning doesn’t have to be tough. It starts with a simple assessment of your needs for the next few weeks.

  • What would you like to have time for if you were going to function at your best?
  • Time to catch up on paperwork?
  • Time to review which projects need to get done soon?
  • Set-aside time to contact new prospects? Uninterrupted creative time?

Now you know what needs to happen, you only have to figure out when.

Which things need to happen every day? Every Week? Once a month? Get out your calendar and find a time to schedule the task. Your upcoming month will have the beginning of a plan.

Planning can start at both ends of the time line. What will things look like in one to three years? Or what does my next week need to contain? The best idea is to start simple and address a fuller picture as you get more comfortable. Discouraged just thinking about it? Try this…

  •  What would you like to work on this week?
  • What is a simple beginning action that you could take? 
  • What time could you schedule to do that action tomorrow? (15 minutes may be all you need.)
  •  Schedule a block of follow-up time for each day the rest of the week.
  •  When you finish tomorrow decide on the step or steps for the next day.

You’ve planned part of a week! Pick a project to schedule the following week. Of course there are any number of things that you would benefit from learning about planning and long-term strategies, but even week to week planning has boosted the productivity of many of my sales and executive coaching clients.

Jay Livingston

Contact Jay

Why Distractions Grab Us

August 4, 2009

Our worlds are filled with distractions – emails, loud conversations, cell phones, radios and televisions–the list seems endless. But why do these grab and hold our attention when we have projects that are important or urgent?

In her book “Rapt” Winifred Gallagher takes a close look at the science of paying attention. Apparently our brains are hardwired to focus on the most “colorful” thing in our environment; read this as loud, interesting or literally colorful. Brain scans show our brains light differently up when these kinds of events invade our environment.

It is certainly difficult to fight this biologically based pull, and even more so if your brain is hyper-sensitive to distractions. But science shows that we can pull our attention away from a sight or sound that grabs our attention. We can use our pre-frontal cortex, the aware thinking part of the brain to override the intrusion. With practice and solid techniques we can improve our capacity to focus.

We can increase our abilities through biofeedback, regular meditation and cues that invoke our thinking. Ms. Gallagher is a fan of meditation to increase focus, but she admits to using an even simpler method when she’s trapped in a noisy environment – earplugs. She compares this to a personal stimulus control shelter. This is similar to my suggestion to my clients that they consider facing the wall rather than the crowd in a restaurant.

Ms. Gallagher says that after a period of concentration, our prefrontal cortex probably needs a break.  Simple tasks like answering e-mail or returning phone calls can help us rest and be ready to focus again. Beware of getting distracted though, because after an interruption the brain can take 20 minutes to do its equivalent of rebooting and refocusing.

Ms. Gallagher also feels that “Multitasking is a myth.” “You cannot do two things at once. The mechanism of attention is selection: it’s either this or it’s that. People don’t understand that attention is a finite resource, like money.”

To have fewer distractions and fewer 20 minute periods of rebooting, try turning down the frequency of email retrieval, work on difficult or important projects first while your brain is most able to manage distractions well, and arrange uninterrupted work time. For more ideas consider talking with an experienced ADD coach.

Jay Livingston can be contacted at Jay@Livingstonservices.com or 978-446-9600

Competing with a Computer Screen

June 16, 2009

Marty sat talking to me with his eyes on his computer screen and regularly input burst of typing. I tried sitting at the other end of his desk so he would be forced to look away from the screen, but he just pushed his chair back and swung his head from the screen to me until I lost out and he was back to starring at the screen.

More and more jobs seem to necessitate people keeping an eye out for incoming emails or require the completion of a computer form as part of the appointment process. I first encountered this at a specialist’s office where the physician did a remarkably thorough job, but rarely looked up from his screen. Now I see my ADD clients struggle with it.

Some people think I’m entertaining and my wife even thinks I’m funny, but I couldn’t get Marty to take his eyes off his screen. I reminded him that he was not paying attention and he apologized but quickly drifted back. I finally asked him to turn off the monitor while we talked about what to do. He was very willing, but the interesting thing was he kept checking the blank screen every 15 to 30 seconds. That was better though because he would check in with me more often and his conversation was more responsive.

The computer is a huge time safer and it is a huge interruption and distraction. Those with ADD have to be particularly vigilant about letting it dominate their day. A few suggestions:

·         Turn off the monitor when you’re having meetings or business conversations; it’s easy to fire it back up again.

·         Close the email program or set it to not go looking for email but once an hour – you can always manually click the send/receive button.

·         Turn off all signals that you have email and set a kitchen timer for one hour to remind you to check.

·         Move away from your desk when you’re having a business conversation so that you’re not distracted by other non-technological things on your desk.

·         Get a squeeze ball or some other fidget toy to play with while you talk.

Marty came up with an interesting solution on his own, he now takes notes with a pen while we talk; of course he spends a lot of time starring at his notebook. Funny but that doesn’t bother me nearly as much.

Jay Livingston can be contacted at Jay@LivingstonServices.com

Sharing Expertise Isn’t Knowing It All

February 2, 2009

Jack, a young man in his early twenties, and I were talking, and taking more than our share of the guacamole dip, at a friend’s party. We were getting along well because he was dipping with the Fritos and I was using the multi-grain chips. He responded to my question about what he did for income by explaining that he was the day-manager of a men’s store.

 He politely reciprocated the question and I explained that I was an ADHD/Executive coach and briefly described how, among other things, I tried to help people with difficulties around focus of attention and organizational issues find lasting solutions to problems that were standing in their way.

 He brightened up and said, “I’d like to do that kind of work.” I asked him what about it appealed to him. He replied, “I am always able to tell my friends what to do when they’re stuck, and I think I would be good at it.”

 He began to share with me some stories of his successful advice to friends; it was impressive in its scope and boldness. His raw certainty reminded me of more confident times in my life. I had a momentary sinking feeling as I realized, “Boy, are those days gone.”

 The problem with his notion of his strength is that coaching isn’t about telling anyone what to do. Although, as I think about that, I do suppose I tell my self to stop talking and listen more. And I recently had to remind myself to cool it with the pearls of wisdom that sounded so interesting to me, but didn’t really address where my client was at.

 The longer I practice, the more inclined I am to just ask questions.

            “Where did your attention go at that moment?”

            “Have you ever tried anything that worked?”

            “Did you forget, or get distracted?”

            “That was successful! What did you do differently to make it work?”

“How often does that happen?”

 It’s my job to provide some scaffolding around my clients’ judgment, strategy, planning, etc. until they can get on their feet. Of course, there is a need for suggestions to consider when their stuck, but most of my effort is in trying to make the hidden visible and bring awareness to particular patterns, so that they can discover the methods that might work for them

 I’m not sure what I’d tell them to do even if I had unusual perceptiveness. After all, until something is tried it isn’t clear what will work, and once it is tried, they’re often in a better position then I am to know what really works.

 I told my young friend at the party something similar. I said, “I encourage you to explore a coaching career. I’m sure as you look it will become clear whether it is what you hope it might be. Let me know if I can help.”

Read more from Jay at: http://www.livingstonservices.com/

The ADHD Dance

January 4, 2009

 

My dog knows I struggle with planning the steps needed to complete some tasks. Well, he probably isn’t actually aware that I struggle, and come to think of it I don’t so much struggle as sometimes simply skip some of the planning.

 

This all became clear to me as I got giggling at myself the other day. I was reading “Spark,” John Ratey’s new book. He describes what he calls the “pirouette” as his ADHD patients leave a session only to spin back to retrieve their keys or cell phone. I realized I was doing my version of the ADHD dance as I left my house on the way to the office, and my dog was watching the whole process.

 

I pick up my purse and tea mug, say goodbye to the dog and walk out the door. Sometimes I make it to the car before I hurry back in to retrieve a paper or book I want to share with a client and then I’m out again. Often I’m back in again to grab my gym bag or yoga mat. All the time my dog is quietly watching me come in and out organizing my leaving as a sort of “in action” style of planning.

 

ADHD is diagnosed through a series of recognizable attributes, but those same attributes are shared by many people who aren’t diagnosable with ADHD. I also like Ratey’s term to describe these people with ADHD style symptoms but not the full blown diagnosis; he calls this “shadow” ADHD.

 

Understanding this notion can be a real help to individuals who feel the diagnosis has essentially pushed them into an image of themselves that makes them uncomfortable. Having the diagnosis doesn’t make you completely different from others, just different in the specifics of your style of coping with life.

 

Those with ADHD are only distinct from many, many others in the severity or complexity of their issues. They are in step with the American dance, just doing their footwork to a slightly faster more complex beat and occasionally stepping on their own toe.

 

 

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