During a rushed 15-minute appointment, doctors rarely have time to cross-reference six or seven drugs prescribed by other providers.

In my latest video walkthrough, I take you to my computer screen to show you how to use professional-grade clinical tools to audit a medication list.

Last week, I showed you 3 types of drug interactions. Go and watch that here if you missed it.

Step 1: Fire Up the Medscape Interaction Checker

You don’t need a medical degree or expensive software to check for drug-drug interactions.

1. Go to Google and search for “Medscape Interaction Checker.”

2. Click the free Medscape tool.

3. Type in every single prescription and over-the-counter medication your parent takes daily.

Step 2: The “Real World” Senior Regimen (7 Interactions Hidden in Plain Sight)

In the video, I put in a very common real-world regimen for an older adult:

• Dabigatran (Blood thinner for AFib)

• Lisinopril (Blood pressure)

• Verapamil (Blood pressure)

• Furosemide / Lasix (Fluid retention/edema)

• Bupropion (Antidepressant)

• Ibuprofen (Over-the-counter for joint pain)

The Result: Medscape instantly flagged 7 drug interactions.

• The Kidney Danger: Lisinopril, Furosemide, and Ibuprofen all target kidney function. Taking all three creates compound stress on aging kidneys.

• The Bleeding Risk: Verapamil increases the potency of Dabigatran in the body, while Ibuprofen adds its own anti-clotting effects—dramatically raising the risk of severe internal bleeding.

Step 3: The Simple Clinical Fix

Even if someone has been on a regimen like this for a long time without an obvious emergency, the potential for a sudden crisis is high.

Watch what happens when we make one simple swap: Removing Ibuprofen and replacing it with Acetaminophen (Tylenol) for joint pain.

Because Acetaminophen doesn’t filter through the kidneys or interfere with blood thinners the way NSAIDs (Ibuprofen) do, the serious kidney and bleeding interactions drop off the board immediately.

Step 4: Testing a New Prescription

The most critical time to use an interaction checker is when a doctor hands you a brand-new prescription.

In the video, we added Erythromycin (a common antibiotic and powerful enzyme inhibitor) to our updated list. Immediately, the system threw a major warning: “Serious - Use Alternatives.”

The 30-Second Script for Your Pharmacist

If an interaction tool flags a Serious or Use Alternative warning on a new or existing prescription, do not panic—and do not stop a prescription cold turkey.

Instead, bring the list to your pharmacist or doctor and use this exact script:

“I ran my parent’s current medication list through an interaction tool and noticed a serious flag between [Drug A] and [Drug B]. I wanted to bring this to your attention to make sure we’ve reviewed this specific interaction—is there a safer alternative we can use?”

🎬 Watch the full 4-minute video walkthrough on YouTube to see me navigate the Medscape tool in real-time.

Keep advocating, and let’s keep them safe—one pill at a time.

David Lee, PharmD, PhD, Lead Pharmacist at MyRxPro

📥 Free Resources & Caregiver Tools

• Download the Caregiver’s Toolkit: Free printable senior medication trackers and step-by-step guides to fight insurance denials: www.myrxpro.com/caregivers-toolkit

• Book a 1-on-1 Concierge Medication Review: Have your parent’s full med list reviewed for dangerous interactions (HSA/FSA Eligible): www.myrxpro.com/consultations

• Grab My Book, Fewer Pills, More Paws: A practical guide to cutting through healthcare red tape and protecting dignity: www.myrxpro.com

• Pre-order the Audiobook Fewer Pills, More Paws:

Watch other related YouTube videos from MyRxPro!

I tried my hand at animation in the tool I know best: Power Point! I hope you enjoy the (bad) animation and the (great) explanation. This video is the first in a series on basic pharmacology and a small insight into how a pharmacist is thinking about how medications are interacting in your body.

Next week, I show you how to check for drug interactions like a pharmacist.

1. Competitive Enzyme Inhibition: The Liver Traffic Jam

The most common type of interaction occurs in the liver’s smooth endoplasmic reticulum, where Cytochrome P450 enzymes (such as CYP2D6) detoxify medications. Normally, CYP2D6 rapidly metabolizes dextromethorphan, the active ingredient in cough syrups like Robitussin DM or Delsym. However, adding bupropion—a potent CYP2D6 inhibitor—blocks this process because bupropion binds to the enzyme first. Unable to be broken down, dextromethorphan concentrations can surge 40 to 60 times higher than normal, reaching hazardous, toxic levels.

​2. Same-Pathway: Blocking the Signal Twice

The Renin-Angiotensin-Aldosterone System (RAAS) controls blood pressure through a cascade where liver-produced angiotensinogen is converted by kidney renin into angiotensin I, which lung ACE enzymes convert to angiotensin II. While ACE inhibitors lower blood pressure by blocking ACE, Angiotensin II Receptor Blockers (ARBs) target the very next step in that same pathway. Combining an ACE inhibitor with an ARB over-suppresses the pathway. This double-blockade can cause blood pressure to drop dangerously low and lead to excessive potassium retention, triggering life-threatening cardiac arrhythmias.

​3. Different-Pathway: When 1 + 1 Equals 4

Interactions can also occur across completely separate biological mechanisms. Elevated dextromethorphan causes sedation by modulating glutamate neurotransmitters. If paired with diphenhydramine (Benadryl), which causes sedation via anticholinergic inhibition, the sedative effects don’t merely add up—they multiply synergistically. This multiplier effect can trigger severe sedation, confusion, and delirium, especially in frail older adults.

​Your Pharmacist is Here to Help

Managing medication regimens doesn’t have to be overwhelming. If you have questions about potential interactions in your daily prescriptions or over-the-counter remedies, reach out to me at MyRxPro.

Schedule a Consultation

Peace and wellness,

​— David Lee, PharmD, PhD, Lead Pharmacist at MyRxPro

Want a Roadmap?

Care partners are finding empowerment in the new book, Fewer Pills More Paw: Caring For Your Aging Parents and Lessons from Our Pets. It’s the roadmap to your new role as the accidental caregiver. Order your copy now!

Order your eBook or Print copy now

Soon to be available as an audiobook. Pre-order your copy now!

Pre-order the Audiobook

Looking to Download Tools Today?

Download the Caregivers Toolkit immediately. It contains the very same tools I use for my patients to organize, clarify health goals, and be the most effective advocate for your parent or yourself.

Download the Caregivers Toolkit

If you have ever opened an insurance rejection letter for an aging parent, you know the immediate feeling of exhaustion that follows.

You see bold text stating “NOT MEDICALLY NECESSARY,” and your brain instantly calculates the hours: phone calls, hold music, doctor notes, appeal forms, and endless red tape.

Here is the dirty secret the health insurance industry relies on: They are monetizing your burnout.

Insurers use automated tools because delay equals profit. In managed care, keeping your premiums while denying or stalling a $50,000 rehab stay or a $5,000 biologic medication protects their quarterly Medical Loss Ratio (MLR). They count on you getting confused by the paperwork and giving up.

Data from the Kaiser Family Foundation reveals that fewer than 0.2% of denied claims are ever appealed by patients or their families. That means for every 1,000 denials, 998 people simply give up and pay out-of-pocket. Insurers know you are exhausted, working full-time, and running on empty—and they build that expectation directly into their financial models. The more you give up, the more they profit. They have every incentive to capitalize on your burn out.

In today’s brand-new video release, I pull back the curtain on how major insurers used algorithms to automatically deny hundreds of thousands of legitimate claims in 1.2 seconds per case—and how recent federal court orders are finally forcing them to expose their internal data.

The 3-Step AI Workflow

Some physician’s offices may not have the resources to fight insurance efficiently. Providing information to a busy doctor’s office an speed the process and smooth the file process.

You don’t need to spend hours on hold or dig through 150-page insurance handbooks. Instead, you can use a privacy-safe AI tool to turn your AI took against their AI systems:

1. Download Your Generic Policy Handbook (EOC): Log into your parent’s insurance portal and download their Evidence of Coverage (EOC) PDF. This is a generic, 100% public policy rulebook containing zero personal medical data.

2. Feed the Denial Reason to AI: Upload the EOC PDF to an AI tool (like ChatGPT, Gemini, or Claude) along with the exact denial reason code from the rejection letter (e.g., “Denied for Step Therapy” or “Not Medically Necessary”). Use this exact prompt:

“I am uploading my plan’s EOC PDF. My claim was denied for [Insert Denial Reason]. Search this document and extract:

1. The exact contractual rules, clinical criteria required for coverage, and the sections I can find these rules.

2. The specific exceptions or ‘Step Therapy’ loopholes to bypass this restriction.

3. A 3-bullet cheat sheet my doctor can read during a Peer-to-Peer call to overturn this.

4. The exact appeal address, fax number, and strict filing deadline for an Expedited Appeal.”

3. To Draft a 30-Second “Peer-to-Peer Cheat Sheet” for Your Doctor:

“Based on Section [X] of this EOC PDF, write a 3-bullet talking point summary that my doctor can read during a 2-minute Peer-to-Peer call with the insurance medical director to force an immediate approval.”

Hand the 1-Page “Smoking Gun” to the Clinic: Print out the exact section title, page number, and exception criteria the AI extracted. Hand it to your doctor’s billing coordinator so they can attach it directly to the appeal without wasting hours digging through policy documents.

Because these documents are so large, there is a possibility that the AI could be hallucinating so always check the output for accuracy.

🎬 Watch the Full Investigation

In today’s video, I break down:

• The real court cases exposing Cigna’s PXDX and UnitedHealth’s nH Predict algorithms.

• The landmark federal court rulings forcing insurers to surrender hidden internal spec files.

• The step-by-step AI workflow to turn your policy’s Evidence of Coverage handbook into an automated appeal generator.

Need Personal Help Fighting a Denial?

You don’t have to navigate corporate red tape on your own while caring for a parent:

• Schedule a 15-Minute Review: We can look at your parent’s denial letter together, and I will give you the precise clinical wording to use in your appeal.

  Book a 15-min Call with David

• Grab My Book: My new book, Fewer Pills, More Paws, is your practical guide to cutting through red tape and protecting your parent’s dignity.

  

Keep advocating, and let’s keep them safe—one pill at a time.

Peace and wellness,

David Lee, PharmD, PhD, lead pharmacist at MyRxPro

Do you want immediate access to the exact worksheets, templates, scripts, and lists of problematic medications that I use? Download the Caregiver's Toolkit to navigate a complex healthcare system and protecting your aging parents.

📥 Download Your Free Caregivers Toolkit: www.myrxpro.com/caregivers-toolkit

The information provided by MyRxPro’s videos and newsletters are rigorously researched by David Lee, PharmD, PhD, a Yale-trained geriatric clinical epidemiologist, PhD-trained clinical pharmacologist, and geriatric pharmacist with 20 years of experience. However, nothing in the video or this newsletter should be construed as medical or legal advice. Consult your doctor and pharmacist for personalized advice about your specific condition.

Cited Sources & Legal Filings:

1. ProPublica Investigation on Cigna PXDX (March 2023). Cigna used an automated system called PXDX (Procedure-to-Diagnosis). Over a 2-month period in 2022, Cigna medical directors rejected over 300,000 payment requests using PXDX. Internal corporate scorecards revealed Cigna doctors spent an average of 1.2 seconds per case. Medical directors approved denials in bulk (batches of hundreds or thousands) using electronic signatures without opening or examining individual patient records: www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims

2. Krenitsky v. Cigna Health & Life Insurance Co. (U.S. District Court, E.D. Cal. 2023). Accuses Cigna of using PXDX to bypass individual physician reviews required by state medical laws, citing the 1.2-second average review time as proof that individual care was ignored. The AMA explicitly cited ProPublica’s 1.2-second finding when calling on federal and state lawmakers to ban automated claim denials without human medical record examination: https://apnews.com/article/cigna-california-health-coverage-lawsuit-4543b47cd6057519a7e8dc6d90a61866

3. KFF Analysis on ACA Claim Denials & Appeals Data (2024). Patients file formal appeals on fewer than 0.2% (less than 2 out of every 1,000) denied claims. When patients do appeal internally, insurance companies overturn their own initial denials 40% to 50% of the time. Independent external reviews overturn denials in favor of the patient up to 70% to 90% of the time: www.kff.org/patient-consumer-protections/claims-denials-and-appeals-in-aca-marketplace-plans-in-2024/

4. Estate of Lokken v. UnitedHealth Group (STAT News / U.S. District Court, Minn.). Accuses UnitedHealth of using an AI model called nH Predict to automatically terminate post-acute nursing facility and rehabilitation care for elderly patients, overriding treating physicians' orders with a reported 90% error rate on appeal: https://www.statnews.com/2023/11/14/unitedhealth-class-action-lawsuit-algorithm-medicare-advantage

Watch other videos by MyRxPro:

Keywords & Topic Summary: If you are searching for how to appeal a health insurance denial, navigate Medicare Advantage claim rejections, or search your Evidence of Coverage (EOC) PDF handbook, knowing your rights as a caregiver or patient advocate is essential. Whether you are dealing with prior authorization delays, medical necessity denials, step therapy exception rules, or automated AI claim rejections—such as UnitedHealth nH Predict or Cigna PXDX—you can fight back. Learn how to use privacy-safe AI tools to search generic policy contracts, extract exact clinical coverage criteria, prepare a peer-to-peer review cheat sheet for your physician, and meet strict internal appeal deadlines to successfully overturn denied medical claims and post-acute rehabilitation care.

Before you accept that diagnosis as inevitable, there is a critical step almost everyone overlooks: auditing their daily medications.

In today’s new video release, I expose the 5 common prescription drug classes that cause cognitive toxicity in older adults—producing symptoms that look identical to late-stage dementia.

To give you even more context for your weekend cabinet audit, I want to explain the mechanism behind why this happens so frequently: The Prescribing Cascade.

The Anatomy of the “Prescribing Cascade”

A 45-year-old body processes medication very differently than an 82-year-old body. As we age, liver and kidney clearance slows down, and the blood-brain barrier becomes far more permeable. A dose that was completely safe twenty years ago can build up to toxic levels today.

When that buildup causes brain fog or confusion, here is how the trap springs:

1. The Side Effect: Patient starts Pill #1 (e.g., an over-active bladder medication or nerve pain pill).

2. The Misinterpretation: The resulting brain fog or memory loss is mistaken for “normal aging” or “early dementia.”

3. The Cascade: Instead of stopping Pill #1, a doctor prescribes Pill #2 (a dementia medication like Aricept) to treat the side effect of Pill #1.

4. The Result: The patient is now double-medicated, the underlying toxicity is ignored, and their cognitive function plummets further.

3 “Red Flag” Signals in Your Parent’s Cabinet

If you notice sudden memory loss or confusion, run through these three quick checks before their next appointment:

• The Timeline Match: Did the cognitive decline start within 30 to 90 days of starting a new prescription or increasing a dose?

• The OTC Trap: Are they taking over-the-counter sleep aids or PM pain relievers? (Many rely on sedating antihistamines like diphenhydramine, which severely impair memory in older adults).

• The 5-Pill Threshold: Are they taking 5 or more daily prescriptions? (The mathematical risk of severe drug interactions and cognitive side effects sky-rockets past 5 medications).

Watch the Full Video

In today’s video, I break down:

• The 5 exact prescription drug classes most guilty of causing fake dementia.

• How aging organs cause standard doses to turn toxic.

• The 3 exact questions to ask your parent’s doctor to safely investigate alternative medications without risking their health.

Caregiver Resources for This Weekend

• 📥 Free Download: Grab our Medication-Induced Cognitive Symptoms Checklist to systematically audit your parent’s medicine cabinet this weekend. This is the list of all medications known to cause cognitive symptoms in older adults.

  Download the Free Caregivers Toolkit

• 🩺 Get a Professional Review: If their medication list feels overwhelming, schedule a 15-Minute Concierge Pharmacist Review with me. We can go over their exact drug list together.

  Book a 15-min Pharmacist Review

• 📘 Grab My Book: My new book, Fewer Pills, More Paws, is your step-by-step roadmap for advocating for an aging parent in a complex healthcare system.

  

  Grab Your Copy of Fewer Pills, More Paws

Peace and wellness,

David Lee, PharmD, PhD, lead pharmacist at MyRxPro

Did you know the same thing has quietly been happening to nursing homes all across the country?

What’s been happening to nursing homes

Private equity firms have quietly acquired thousands of nursing homes across the country using a predatory financial scheme known as the OpCo/PropCo model. By splitting a facility on paper into a Property Company (the landlord) and an Operating Company (the care staff), corporate investors charge exorbitant, inflated rent to siphon away hidden profits. To survive these artificial costs, facilities are forced into severe nursing home understaffing. The result goes far beyond cold food or unanswered call lights—it leads to unwashed residents, undetected UTIs exploding into acute delirium, and overwhelmed nurses resorting to heavy chemical restraints like Quetiapine (Seroquel) just to survive their shifts. Research shows this corporate extraction model directly increases resident mortality by 10%. The issue isn't a lack of compassionate caregivers; it’s that private equity ownership in healthcare has systematically re-engineered nursing home care to prioritize investor profit over human life.

Fight Now For Your Future

While you were watching, you’re probably thinking about the facility your parent is in or one you might be considering. You might be thinking about the staffing you’ve noticed. The medication errors. The falls.

But I want you to think about something else too.

One day, you might be the one in that facility.

That might sound dramatic. But it’s true. Most of us will need nursing home care at some point. And if you don’t fight now to change the system, the system you’re in 20 or 30 years will be even worse than what your parent is experiencing today.

This isn’t just about saving your parent’s life right now.

It’s about saving your own future.

So now that you’ve watched the video, I’m going to show you what you can do about it, right now.

Federal Legislation: The Take Back Our Hospitals Act

In March 2026, U.S. Senator Chris Murphy (D-CT) and U.S. Representative Mary Gay Scanlon (D-PA) introduced the Take Back Our Hospitals Act.

Here’s what it does:

It would ban private equity firms from owning nursing homes and hospitals that receive Medicare funding.

This is the biggest legislative push against private equity in healthcare we’ve seen. And it’s gaining momentum. My own Senator Jeff Merkley (D-OR) and others have joined in support.

What you can do:

1. Find your representatives: Go to Congress.gov and search for your district. Find out who your Senator and House Representative are.

2. Contact them directly:

   • Senate: Find your senator’s contact info at senate.gov

   • House: Find your representative at house.gov

3. What to say: “I support the Take Back Our Hospitals Act because private equity ownership is destroying nursing home care in my community. I want you to co-sponsor this bill.”

   That’s it. Legislators track constituent support on specific bills.

4. Follow the bill: Track S. 4085 (Senate) / H.R. 7920 (House) on GovTrack.us — you’ll can sign up to get updates on its progress.

   

Federal Legislation: Nursing Home Staffing Standards

In February 2026, My other Senator, Ron Wyden (D-OR), introduced the Nurses Belong in Nursing Homes Act.

What it does: Establishes mandatory nurse-to-patient staffing ratios in nursing homes nationwide.

The ratios would be:

• 1 registered nurse per 8 residents (daytime)

• 1 registered nurse per 12 residents (nighttime)

• Certified nursing assistants and nursing staff appropriately scaled

Why this matters: Staffing ratios directly prevent the medication errors, infections, falls, and over-medication we talked about in the video.

What you can do:

1. Contact your Senator using the same process above

2. Say: “I support the Nurses Belong in Nursing Homes Act because my parent’s facility is dangerously understaffed. Nurse-to-patient ratios will prevent harm.”

State-Level Action

States are moving faster than Congress.

The Private Equity Stakeholder Project tracks state legislation. As of March 2026, 79 bills across 25 states are addressing private equity in healthcare.

Connecticut (predictably, given Senator Murphy’s leadership) has been most aggressive:

• Passed (2025): Law requiring nursing homes to publicly disclose OpCo/PropCo ownership structures and rent amounts

• Passed (2026): Multiple bills limiting private equity’s profit extraction methods

What similar bills look like:

• Transparency requirements (who owns it, how much rent is paid)

• Restrictions on related-party transactions

• Minimum staffing ratios

• Limits on dividend payments to parent companies

What you can do:

1. Check what your state is doing: Visit Private Equity Stakeholder Project and click on your state to see what bills are pending

2. Find your state representatives:

   • National Conference of State Legislatures (helps you find state legislature contact info)

   • Your state’s legislature website (Google “[Your State] legislature contact”)

3. Contact them: “I want you to support legislation requiring disclosure of nursing home ownership structures and limiting OpCo/PropCo profit extraction.”

4. Attend hearings: State health committees often hold hearings on healthcare bills. These are public. Show up. Tell your story.

CMS Complaint Portal

Here’s something you can do right now, for your parent’s specific facility:

The Centers for Medicare & Medicaid Services (CMS) has a complaint portal where you can report staffing issues, medication errors, and safety violations.

What to report:

• Medications not administered on time

• Falls and injuries

• Lack of care/hygiene

• Unexplained behavioral changes in your parent

• Any incident that suggests understaffing

How to file a complaint:

1. Go to Medicare.gov

2. Search for your parent’s facility by name

3. Click “Report a Concern” at the bottom of the facility’s page

4. Fill out the complaint form with specific dates and incidents

Why this matters: CMS uses complaint data to:

• Investigate the facility

• Issue citations (which affect their Star Rating)

• Potentially revoke Medicare funding if violations are serious enough

One complaint can trigger an inspection.

Multiple complaints from families create a pattern that CMS takes seriously.

Advocacy Organizations Doing This Work

You don’t have to do this alone. These organizations are actively fighting private equity in healthcare and need supporter participation:

• Private Equity Stakeholder Project — Tracks legislation, provides research, helps families understand what’s happening. Their state legislative tracker is invaluable.

  • State healthcare policy tracker

  • Latest news on healthcare

• American Federation of Labor and Congress of Industrial Organizations (AFL-CIO)

  • Union-led push against private equity healthcare consolidation

• Our Financial Security — Consumer advocacy group fighting private equity abuses across sectors, including healthcare

  • Private equity in healthcare page

  • Home care private equity report

Media Pressure

Investigative journalists are starting to cover private equity in nursing homes. There is a lot of outrage about this and more coverage is only increasing pressure.

If your facility is part of a larger problem:

1. Contact your local news station’s investigations unit — tell them your story

2. Document everything — take photos (if allowed), keep records, save all emails and incident reports

3. Connect with other families — collective stories are more powerful than individual complaints

Recent investigations that led to change:

• Local News 8: Connecticut nursing home evacuations (Genesis HealthCare facilities) — this led directly to state legislation

• Multiple ProPublica investigations on private equity hospital chains

  • Investors Extracted $400 Million From a Hospital Chain That Sometimes Couldn’t Pay for Medical Supplies or Gas for Ambulances

  • Rich Investors Stripped Millions From a Hospital Chain and Want to Leave It Behind. A Tiny State Stands in Their Way.

  • For-Profit Hospital Chain Never Put Aside Money for Malpractice Insurance to Compensate Injured Patients

  • For-Profit Corporations Are Buying Up More Psychiatric Hospitals. Some Flout Federal Law With Scarce Repercussions.

• NBC News: Senate Investigation Exposes Prospect Medical Hospital Chain (January 2025)

• Boston Globe: Rhode Island Hospitals Unite Against Private Equity Takeover (2024-2025)

What You Can Do

This week:

• Find out if your parent’s facility is OpCo/PropCo

• File a CMS complaint if you’ve observed staffing-related issues

• Contact your U.S. Senator and Representative about the Take Back Our Hospitals Act

This month:

• Check your state legislature’s website for pending healthcare bills

• Contact your state representatives about staffing ratio legislation

• Join the Private Equity Stakeholder Project’s mailing list for updates

Ongoing:

• Document all staffing issues (dates, times, what happened)

• Report patterns to CMS

• Share your story with local media if appropriate

The Bottom Line

The predatory OpCo/PropCo model isn't just an abstract corporate structure—it shows up directly in your parent’s daily care. If you are noticing sudden changes or feeling like something is wrong, you aren't imagining things.

Families across the country often search for answers when they notice these critical signs of nursing home neglect and overmedication:

• Sudden Lethargy & Behavioral Changes: If you suspect signs of overmedication in your elderly parent—such as slurred speech, heavy sedation, or a new prescription for Seroquel (quetiapine) for dementia agitation—the facility may be using chemical restraints to keep residents quiet during understaffed shifts.

• Frequent Falls & Physical Red Flags: Unexplained bruises or falls in a nursing home may not be “accidents.” They are often the direct result of delayed care and violations of nurse-to-resident staffing ratios.

• Rapid Cognitive Decline: Sudden confusion, delirium, or aggression in an elderly parent is often triggered by an untreated Urinary Tract Infection (UTI) or missed medication doses that went unnoticed for days by overwhelmed staff.

• Basic Hygiene & Care Failures: Seeing a parent left in a dirty diaper, unwashed for days, or dealing with ignored call lights for hours are major warning signs of systemic understaffing.

What You Can Do Right Now

The OpCo/PropCo extraction model only works if families stay silent and assume these issues are “just part of aging.” They aren’t.

1. Document Everything: Keep a detailed log of late medication doses, ignored call lights, and staff names.

2. File an Official Report: Learn how to file a CMS complaint against a nursing home on Medicare.gov to trigger an independent state inspection.

3. Demand Accountability: Reach out to your state representatives, back mandatory staffing ratio legislation, and speak up.

The moment you document, file a complaint, and demand answers, you break the cycle. Don’t stay silent—your voice breaks the inertia.

Need Help For Your Parent Right Now?

Systemic change takes time, but your parent needs safe care today.

If you are looking for tools you can use now, download our free MyRxPro Caregivers Toolkit for the very tools I use to help families.

Download our Free Caregivers Toolkit

If you need help coming up with a strategy for your parent’s nursing home, I work one-on-one with families in these exact situations. Whether you are dealing with unexplained cognitive changes, medication concerns, or navigating facility accountability, you don’t have to figure it out alone.

Click Here For a Free Consultation

Want to Understand the Full Picture?

I wrote Fewer Pills, More Paws to help families navigate the broken systems they’re up against. It includes the full toolkit for advocating for your parent’s care—from medication documentation to understanding your rights.

Available now:

📱 Audiobook (Pre-order)

📖 eBook

📕 Print Edition

Peace and wellness,

David Lee, PharmD, PhD, lead pharmacist at MyRxPro

PS: I’m planning on covering other ways enshittification has been happening in healthcare. Leave me a comment about what other areas you’d like me to cover.

Key Resources

• Congress.gov — Find your representatives

• Senate.gov — Contact your Senator

• House.gov — Find your Representative

• Private Equity Stakeholder Project — State legislative tracker

• CMS Nursing Home Compare — File complaints

• GovTrack.us — Track federal bills

• NCSL Find Your Legislature — Find state reps

You’ve seen the headlines hinting about the next “breakthrough therapy.” You’ve seen the commercials featuring hopeful, smiling faces. Maybe your parent’s neurologist even mentioned a brand-new drug at the end of an exhausting appointment, offering it as a quiet reassurance.

“Be patient,” the news anchors tell us. “Stay hopeful. Just wait for science to catch up. Five or ten more years.”

I held onto that hope, too. But as a clinician and scientist I know the truth: There is no singular, magic-bullet cure coming for Alzheimer’s disease.

That might sound discouraging at first. But once we strip away false promises, we can finally look at what the science is actually telling us.

And the reality? We already know how to prevent Alzheimer’s and that’s powerful.

Watch the New Video

The 99.6% Failure Rate

Let’s start with a brutal number.

Between 1998 and today, the failure rate for Alzheimer’s drug trials has been over 99.6 percent.

For nearly thirty years, medicine poured over $100 billion into research. We developed monoclonal antibodies, anti-inflammatory compounds, tau-targeting therapies, and amyloid-clearing agents. Hundreds of molecules were tested on thousands of patients. Almost all of them failed.

The very few that managed to scrape through FDA approval—like lecanemab and donanemab—do not reverse the disease. At best, they modestly slow cognitive decline by about 25% to 30% over 18 months. And they do it at a steep cost: a serious risk of brain swelling and bleeding that requires constant, costly MRI monitoring.

Ask yourself: If a medication carrying a risk of brain bleeding only slows down a parent’s decline by a few months, would you honestly call that a “cure”?

Of course not. So why have we hit a concrete wall for 30 years? Because we were operating on the wrong metaphor.

Your Brain Is Not a Computer

For a century, neuroscience relied on a comfortable metaphor: the brain is a computer.

We talked about hardware, software, files, and memory storage. If a computer breaks, you swap out the damaged part, patch the code, and the machine works again. It’s “cured.”

But your brain is nothing like a computer.

[Healthy Neurons] ─── Microscopic Bridges (Synapses) ─── [Memories, Identity, Faces]
                                      │
                           (Alzheimer's destroys these)
                                      ▼
[Withered Neurons] ───     Broken Connections      ─── [Cognitive Decline]

Your parent’s memories—their sense of humor, how they recognize your face, the day you were born—are physical structures woven into the anatomy of living cells.

When Alzheimer’s damages the brain, it doesn’t corrupt a file; it destroys the architecture of the brain. Cell by cell, bridge by bridge, long before you ever see symptoms from the outside.

Asking a medication to cure advanced Alzheimer’s is like spraying fertilizer on a dead houseplant and expecting it to spontaneously turn back into a living plant. You cannot medicate what is no longer there.

The Question to Ask Your Neurologist:

Next time a doctor describes a newly marketed amyloid-clearing drug, ask them this single question:

“What does this medication do for my parent’s DAILY function?”

Not their brain scans. Not their blood biomarkers. Their day. Can they hold a conversation? Can they enjoy dinner? The honest clinical answer for current drugs is that the functional benefit is modest, while the risks are deeply real.

Cancer Was Also Promised a Cure: What Alzheimer’s Has in Common

While the media was busy hyping up mediocre drugs, a quiet revolution occurred behind laboratory doors. Researchers are actively moving away from the language of a “cure”—not in defeat, but in maturity.

Oncology went through this exact shift thirty years ago. We stopped looking for a single “cure for cancer” because we realized cancer is hundreds of distinct diseases. Today, we treat cancer with personalized, targeted combinations of therapies tailored to an individual’s unique biology.

Alzheimer’s care is finally heading in the exact same direction.

Imagine a 65-year-old woman. Her memory is completely intact. But a simple blood test shows early molecular signatures of Alzheimer’s pathology beginning to accumulate.

• The Old Approach: “Your memory is fine. Come back in a year.”

• The Future Approach: She doesn’t get one passive prescription. She gets a multi-target defense system:

  1. A tau-targeting agent to protect neural pathways.

  2. An anti-inflammatory protocol to calm brain immune responses.

  3. Metabolic support to improve how neurons process energy.

  4. Tight cardiovascular management to protect brain blood vessels.

  5. Structured lifestyle interventions (sleep optimization, strength training).

This isn’t a cure. It is a sophisticated, multi-target system designed to keep the dominoes from falling while the structural architecture is still standing.

We treat cardiovascular health the same way. The decision for a statin is not just your cholesterol, but part of a multi-targeted approach. It’s a more sophisticated view that acknowledges the complex biology within all of us.

The Single Most Powerful Tool (No Prescription Required)

If we are talking about multi-target systems, there is one intervention more powerful than any drug currently sitting in a clinical trial: Exercise.

Physical movement is not optional maintenance for an aging body. It is the single most effective neuroprotective treatment available to human beings:

• It increases direct blood flow to the brain.

• It manages blood sugar, blood pressure, and systemic inflammation.

• It stimulates the production of BDNF (Brain-Derived Neurotrophic Factor)—which functions as literal miracle-gro fertilizer for brain cells.

Next time your dog nudges your elbow demanding a walk, he isn’t just asking for a bathroom break. He is prescribing the most evidence-based cognitive therapy on the planet.

Seeing the Smoke Before the Fire

The real breakthrough in Alzheimer’s science isn’t a pill. It’s the ability to see the disease coming 15 to 20 years before the first symptom appears.

For decades, we could only respond to the wreckage. But today, with simple blood biomarker tests (a standard blood draw), we can detect molecular signatures of plaque buildup and vascular changes in a 50-year-old with zero memory loss.

If we can screen people in their fifties and sixties—before the bridges are burned—and introduce multi-target protocols, we can delay the onset of cognitive symptoms by 5 to 10 years.

Delaying symptoms by a decade effectively neutralizes the crisis: a person who would have suffered severe memory loss at 75 now reaches 85 or 90 with their identity, memories, and independence completely intact.

That is not a cure. But it is something infinitely better: A full life.

The Care Partner Action Plan

Here are 5 concrete steps you can take starting today:

1. Ask About Biomarker Testing: If your parent is in their sixties with a family history of dementia, ask their physician: “Can we check early Alzheimer’s blood biomarkers? I want to know where we stand while we still have options.” Insurance companies are quickly agreeing to pay since it’s becoming part of standard care.

2. Target Modifiable Risks: Treat sleep quality, hearing loss, blood pressure, and social engagement not as “lifestyle advice,” but as vital medical interventions for brain health. Just as important as physical exercise.

3. Protect the Heart to Protect the Brain: Heart health is brain health. The micro-vessels in the brain are fragile; ensure their cardiovascular system is running cleanly.

4. Move Every Single Day: Make physical activity a non-negotiable part of their routine (and yours).

Stay in the Room: Be an informed presence in every clinical consultation. The care partner who knows what questions to ask is the person who changes the outcome.

Needs Some Tools Now?

If you are looking for some help organizing tonight, download the free MyRxPro Caregivers Toolkit. We give a Medication List Template so you can organize those medications. Find the template to organize your priorities before the doctor’s visits. Review the plan with the doctor so you are clear on the next steps. Download the list of medications known to cause memory and cognitive problems in older adults.

I provide the very tools that I use every day to audit medications lists. Download your free copy immediately!

Download the FREE Caregivers Toolkit

Need Help Navigating Caregiving Chaos?

We were trying to rebuild the city after the demolition was already finished. What the science is building right now is a way to stop the demolition crew at the gate.

If you want to move from passive hope to active, evidence-based advocacy, download the MyRxPro Caregiver’s Toolkit or book a 1-on-1 medication review with me at MyRxPro.com. We translate complex clinical science into the exact practical steps you need to protect your family’s brain health.

Peace and wellness,

David, PharmD, PhD, Lead Pharmacist, MyRxPro

P.S. If you want a complete, step-by-step system for auditing medication overload, managing 8-minute doctor visits, and protecting your own healthspan while caregiving, my new book Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets is out now—and the Audiobook edition is officially open for Pre-Order! 🎧

Order Your eBook & Print Copy

Pre-Order the Audiobook

For over two decades, family caregivers navigating an Alzheimer’s or dementia diagnosis have been forced to accept an impossible compromise.

If your loved one has been prescribed standard cholinesterase inhibitors like Aricept (donepezil), Razadyne (galantamine), or Exelon (rivastigmine), you already know the story. These medications modestly help with memory and daily function for about six months on average.

But they come with a severe, hidden cost: gut destruction.

Constant nausea, vomiting, diarrhea, loss of appetite, and rapid weight loss. Watching someone you love deteriorate not just from dementia, but from the very medication meant to help them, is heartbreaking. For 20 years, that was the trade-off: Better memory OR a stomach that isn’t in pain. You couldn’t have both.

Until now.

In my latest video, I break down a drug called Zunveyl (benzgalantamine)—why its unique chemistry solves this 20-year stomach problem, what the newest real-world data reveals, and the exact steps you need to take to beat the inevitable insurance denial.

Watch the New Video

Why the Old Meds Wrecked their Stomach

Alzheimer’s disease causes a drop in acetylcholine (ACh), a vital brain chemical necessary for memory. Standard medications stop the breakdown of acetylcholine so more remains available in the brain.

That’s the good part.

The bad part? These medications protect acetylcholine everywhere else in the body, too—flooding the stomach. In the digestive tract, excess acetylcholine triggers severe nausea, vomiting, and diarrhea. Patients hit a physical wall long before doctors can raise the dose high enough to maximize cognitive benefits.

What Makes Zunveyl Different?

Zunveyl (benzgalantamine) is what pharmacists call a prodrug.

When swallowed, benzgalantamine is completely inactive. It passes through the stomach without touching gut receptors—meaning no nausea, no vomiting, no diarrhea. It is rapidly absorbed in the small intestine and converted by liver enzymes into active galantamine after it has safely cleared the stomach.

What the Real-World Data Shows:

In the recent BEACON study, researchers evaluated patients who had previously failed older Alzheimer’s drugs specifically due to severe stomach side effects. 89% of those patients were able to successfully tolerate Zunveyl.

A Reality Check for Caregivers

While Zunveyl breaks the 20-year compromise, setting realistic expectations is essential:

• It is NOT a cure: It provides symptom management for mild-to-moderate dementia; it does not stop disease progression over time.

• It is a twice-daily pill: Unlike heavy-duty IV infusions like Leqembi or Kisunsla (which require frequent clinic visits, expensive MRIs, and carry risks of brain swelling/bleeding), Zunveyl is an oral medication with a strong safety profile and no required MRI monitoring.

What the Prior Authorization Needs To Say

Because Zunveyl is a newer brand-name medication, your insurance company will almost certainly say NO on the first try. They will attempt to force your parent into Step Therapy—requiring them to try cheaper generic drugs first.

If your parent experienced severe stomach issues on older meds, do not accept a rejection as final.

What Your Doctor Needs to Write on the Appeal

Your doctor must submit a Prior Authorization documenting specific, clinical side effects. Have them include this exact language:

“The patient experienced severe, dose-limiting gastrointestinal side effects on [donepezil / galantamine / rivastigmine]—including weight loss of [X] lbs, nausea [frequency], and vomiting [frequency per week]—and is unable to tolerate therapeutic doses. Switching to Zunveyl is medically necessary.”

Action Steps for Caregivers

• Scenario 1: Your parent is currently struggling on Aricept, Exelon, or Razadyne

  Do not let severe nausea or weight loss become “the new normal.” Call their neurology clinic this week. Log their symptoms (exact pounds lost, episodes of vomiting per week) and ask the doctor to submit a Prior Authorization for Zunveyl.

• Scenario 2: Your parent was just diagnosed and hasn’t started meds yet

  Insurance will likely require starting a generic (like donepezil) first. Ask your doctor to start at the lowest possible dose, increase very slowly, take it with food, or split the dose (morning/evening). If stomach side effects occur after 4–6 weeks, document them clearly to build your case for Zunveyl.

Need Help Advocating for Your Parent?

Navigating insurance bureaucracy and doctor visits while caregiving is exhausting. If you’re getting pushback from an insurer or need help preparing documentation for your doctor, you can book a 1-on-1 medication review with me at MyRxPro.com. We’ll review your parent’s entire medication list and arm you with the exact talking points you need to advocate effectively.

Watch the full video for the complete clinical breakdown, and drop a comment on YouTube if this helps your family!

Peace and wellness,

David Lee, PharmD, PhD, Lead Pharmacist at MyRxPro

P.S. The Audiobook is officially available for Pre-Order! 🐾

If you’ve been feeling overwhelmed by chaotic kitchen counters covered in pill bottles, or exhausted by the weight of being an “accidental caregiver,” I wrote a book specifically for you.

It’s called Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets.

Drawing on my years as a clinical pharmacist and geriatric pharmacist, this book is a system-based roadmap designed to help you transform caregiving chaos into a calm, confident home. We dive deep into auditing medicine cabinets, surviving 8-minute doctor visits, navigating hospital crises, and prioritizing real healthspan—all guided by the profound, grounding lessons our pets teach us about restorative care.

Order the eBook or Print copy now!

If you prefer listening while driving to doctor appointments, taking a walk, or running errands, you can secure your audiobook copy today.

Pre-order the Audiobook

You count them up. Eight pills. Ten pills. Maybe fifteen different medications every single day.

And you ask yourself the same question I hear from every caregiver: How did we get here? My mom didn’t used to take all of this.

The honest answer is nobody woke up one day and decided to put your parent on fifteen medications. It happened slowly. One pill here. Another one there. And suddenly you’re managing a nightmare.

Why the System Only Adds (Never Subtracts)

Here’s what frustrates me.

The system is completely fragmented. Your parent’s cardiologist doesn’t talk to their pulmonologist. The urologist doesn’t know what the rheumatologist prescribed. Each doctor is looking at one organ through a keyhole.

So they write a prescription to hit their specific target: a blood pressure number, a blood sugar number, a cholesterol number. Without necessarily thinking about how that medication interacts with the other ten drugs your parent is already taking.

But the real problem goes deeper than that.

Doctors are trained extensively on when to start a drug. There are guidelines. Protocols. Entire training programs focused on it.

But there are virtually no protocols for when to stop one.

The medical system is structurally designed to add. It’s broken when it comes to subtract.

And because nobody is assigned to be the mediator of the medication list, that job falls on you. The caregiver.

The 5 Pathways to Medication Overload

Over my career as a pharmacist, I’ve watched seniors get trapped in medication overload. It always follows one of five pathways. Understanding these pathways is how you protect your parent.

The Specialist Silo

Doctor A prescribes a medication. Doctor B prescribes a medication. They don’t communicate. So your parent ends up on two blood pressure medications that do the exact same thing. Or a pain medication that interacts with their anxiety medication. No one doctor sees the full picture.

The Prescribing Cascade

Your parent takes Medication A. It causes a side effect—ankle swelling, an upset stomach, insomnia. Instead of stopping Medication A, the doctor prescribes Medication B to treat the side effect.

Now you’re on two medications because of one. And sometimes that second medication causes its own side effect, which gets treated with a third medication.

It’s a cascade. And it’s hard to stop once it starts.

The Forever Drugs

Your parent was put on a medication years ago for a temporary issue. A seasonal ulcer. A stressful period when they needed anxiety medication. A brief bout of reflux.

The doctor said, “Take this for three months.”

But three months turned into three years. Three years turned into nine years. And nobody ever went back to check if they still needed it.

I’ve seen patients on proton pump inhibitors for acid reflux they haven’t had in a decade. On anti-anxiety medications prescribed during a divorce that happened fifteen years ago.

The medication is just... still there.

Preventative Overkill

Your parent is eighty-five. They’re on aggressive cholesterol medications and bone density drugs because guidelines say to maintain certain numbers.

But here’s the thing nobody talks about: At eighty-five, the risk of a fall from medication side effects, or kidney damage from long-term drug use, far outweighs any theoretical benefit they might get ten years down the road.

We’re treating for prevention when the person might not live long enough to see that prevention pay off. Meanwhile, the medication is actively harming them now.

Over-the-Counter Creep

Your parent adds a multivitamin. A joint supplement. A sleep aid. These seem safe because they don’t require a prescription.

But they interact dangerously with blood thinners. With blood1 pressure medications. With diabetes medications.

And because they’re assumed safe, nobody thinks to mention them to the doctor.

When More Becomes Dangerous

When your parent crosses the line into taking five or more medications, the risk of serious problems increases dramatically.

Their kidneys and liver slow down with age. They don’t clear medications as efficiently. So drugs build up in their system.

What looks like rapid memory loss. What looks like extreme fatigue. What looks like dizziness that leads to a devastating fall.

Very often that’s not aging. That’s medication toxicity. And it’s preventable.

Your Action Plan for This Weekend

You don’t break the cycle by abruptly stopping medications on your own. You break it by executing a methodical review with your parent’s medical team.

Here’s how to start:

Step One: The One-Table Gather

Bring every single prescription bottle, every over-the-counter medication, every vitamin and supplement into one room. Get the full picture of what your parent is actually taking.

Step Two: Download the Medication List Template

Download the MyRxPro Caregivers Toolkit and print it out.

Use it to log every pill. Which doctor prescribed it. What symptom it’s supposed to treat. When it was started.

Once you have that list completed, you’ve done something powerful. This may be the first time all of these medications names are together to be evaluated.

Step Three: Ask the Right Question

Now, take out the One-page Briefing from the MyRxPro Caregivers Toolkit and print it out. Fill it out.

At your parent’s next doctor’s appointment, hand it to them and ask directly:

“Which of these medications can we start to taper off?”

This question shifts the conversation from “take more pills” to “which can we remove”

If you’re facing resistance from providers, or if looking at that pile of medications feels too complex to navigate alone, you don’t have to guess.

Book a Triage Call with me at MyRxPro.com. We’ll review the list together. We’ll identify the red flags. We’ll build an objective plan to simplify your parent’s life.

Download the free MyRxPro Caregivers Toolkit. And let’s get your parent’s medication list back to a manageable place.

Peace and wellness,

David Lee, PharmD, PhD, lead pharmacist & founder of MyRxPro

P.S. — If this resonates with your journey, sharing this with another caregiver helps more families cut through the medication maze. One caregiver forwarding this to another is how this work actually spreads.

Preorder Fewer Pills, More Paws Audiobook

If you are currently navigating the overwhelming world of aging parents, confusing medicine cabinets, and caregiver burnout, I’ve put my clinical experience into a new guide just for you. Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets is a compassionate roadmap to safely reducing medication overload while drawing profound, science-backed lessons on restorative care from our pets.

Preorder the Audio Book!

If you are still looking to order your physical or eBook copy? You can orders yours today!

Order your print copy and eBook here!

More video explanations on our YouTube Channel

If you enjoyed this deep dive, the best way to support our mission is to subscribe to the channel over on YouTube. I covered this exact topic in our latest video, and popping it on in the background—even just to drop a comment or a like—helps the algorithm find more people who need this information.

They’re pacing the house at 2 AM. Confused. Agitated. You’re exhausted. Night after night.

So you reach for something that seems harmless: Tylenol PM. Advil PM. Benadryl. Something over-the-counter that says “sleep aid” on the label. OTC, must be safe, right?

Here’s what nobody told you: those medications aren’t helping your parent sleep. They’re destroying their brain, causing them to fall, be uncoordinated, and mimicking the symptoms of rapid dementia progression.

And if your parent is on dementia medications like Aricept or donepezil, those over-the-counter sleep aids are actively canceling out the prescription drugs their doctor prescribed to protect their memory.

I just posted a video breaking down exactly what’s happening—and what to use instead.

Watch the 7-minute video here

The Chemical Needed for Memory

There’s one chemical in your parent’s brain that controls memory, learning, and alertness. It’s called acetylcholine.

In someone with Alzheimer’s or dementia, acetylcholine levels are already dangerously low. That’s the disease.

So the doctor prescribed a medication—like Aricept or donepezil—to try to save whatever acetylcholine is left. The goal? Slow down memory loss.

Now here’s the problem.

Most over-the-counter sleep aids are “anticholinergics.”

Anti = against.
Cholinergic = acetylcholine.

You’re literally giving your parent a medication that blocks the memory chemical their prescription is trying to protect.

It’s like paying hundreds of dollars a month for brain-protecting medication, then pouring a chemical down their throat at night that destroys it.

The Two Ingredients You Need to Ban Today

Go to your parent’s medicine cabinet right now. Look at the back of every sleep aid, pain reliever, and cold medicine.

You’re looking for two ingredients:

1. Diphenhydramine

This is the active ingredient in Benadryl. But pharmaceutical companies hide it inside “PM” formulations:

• Tylenol PM

• Advil PM

• Aleve PM

• Excedrin PM

Same anticholinergic chemical. Different branding.

2. Doxylamine Succinate

This is in:

• Unisom

• NyQuil

• Most nighttime cold medicines

If you see either of those names on any label, stop using them.

Here’s why this is so dangerous:

In a young person, these cause mild drowsiness for a few hours.

In an aging person? The medication stays in their system for 24 to 48 hours.

The result:

• Brain fog that lasts all day

• Increased fall risk

• Severe agitation and sundowning

• Confusion that looks like dementia progression (but isn’t)

In the video, I show you images of real pill bottles so you know exactly what to look for when you audit your parent’s medications today.

“But My Parent Can’t Sleep. What Am I Supposed to Do?”

I know.

Caregiver burnout is real. Sleep deprivation is real. You need your parent to sleep so you can sleep.

I get it.

But the solution can’t be a medication that destroys the brain you’re trying to protect.

Here’s what actually works.

The Three-Tier Approach (Do This Instead)

Tier 1: Environmental Changes (Try This First)

Before you reach for any medication, fix the environment:

• Light exposure: 20 minutes of direct sunlight before 10 AM every morning. This resets your parent’s circadian rhythm more powerfully than any pill.

• Evening routine: After 5 PM, dim the lights, eliminate screens, avoid sugar. You’re creating a “wind down” signal.

• Daytime activity: A tired body sleeps better. Make sure your parent is moving and engaged during the day.

Do this for 2-3 weeks before adding any medication. You’d be shocked how much it helps.

Tier 2: Melatonin (But Not the Dose You Think)

If environmental changes alone aren’t working, melatonin can help—but here’s the catch most people miss:

The dose matters.

Most over-the-counter melatonin is 3, 5, even 10 milligrams. In a dementia patient, those doses cause nightmares and hallucinations.

The effective dose is 0.3 to 1 milligram, taken 2 hours before bed.

Not 3 milligrams. Not 5 milligrams. Point-three to one milligram.

It’s not about more melatonin. It’s about the right melatonin at the right dose.

In the video, I explain exactly why higher doses backfire—and I show you which brands offer the low-dose version you actually need.

Tier 3: Prescription Alternatives (If You Still Need Help)

If environmental changes and low-dose melatonin aren’t cutting it, there are prescription sleep medications that don’t block acetylcholine.

Ask your parent’s doctor about:

• Orexin antagonists (Belsomra, Dayvigo) — These block the wakefulness chemical, not the memory chemical. Different pathway. No cognitive damage.

• The Trazodone Caveat: If your doctor prescribes low-dose trazodone, do not treat it as a risk-free drug. While it avoids the severe stroke and mortality black-box warnings tied to antipsychotics, it introduces a physical hazard. Trazodone causes orthostatic hypotension—a sudden drop in blood pressure upon standing. If your parent wakes up to wander at night, this drug creates a direct fall hazard. It also clears slowly in aging bodies, causing prolonged drowsiness that lasts through the day.

In the video, I discuss all of these steps, including these medications.

What to Expect When You Stop Anticholinergic Sleep Aids

Here’s the honest timeline:

If your parent has been on diphenhydramine or doxylamine for a while, their confusion and brain fog might take 2 to 4 weeks to improve after you stop.

The drug needs to clear their system.

But it will improve.

This isn’t permanent brain damage. But every day you continue using these medications is a day of preventable cognitive decline.

Meanwhile, the environmental changes work faster than you’d think. Good lighting, consistent routine, daytime activity—these often solve sleep problems within 2 weeks.

Combined with safe medication alternatives, you have a real solution. Not a Band-Aid. A solution.

Your Action Plan (Do This Today)

Step 1: Go to your parent’s medicine cabinet. Look for diphenhydramine and doxylamine. Stop using anything that contains them.

Step 2: Implement the environmental changes this week. Morning sunlight. Evening dimming. Daytime activity.

Step 3: If environmental changes alone don’t work, try low-dose melatonin (0.3 to 1 mg).

Step 4: If you still need help, show your doctor this video and ask about orexin antagonists

Download the MyRxPro Caregivers Toolkit

I created a resource to check for other medications that are stealing your parent’s memory. It includes:

The Medication-Induced Cognitive Symptoms Checklist: A complete, alphabetical guide to high-risk drugs that can cross the blood-brain barrier, trigger sudden confusion, and mimic dementia symptoms.

This checklist is part of the free MyRxPro Caregiver’s Toolkit.

Download the MyRxPro Caregivers Toolkit

One More Thing (This Applies to You Too)

If you’re taking Tylenol PM or Benadryl because you’re exhausted from caregiving, this information applies to you too.

These medications damage aging brains—and caregiver brains are aging and stressed.

Let’s fix it for both of you.

Watch the Full Video

The newsletter gives you the framework, but the video shows you:

• How to reset their sleep

• Why higher melatonin are not recommended in dementia patients

• How long it takes for brain fog to clear after stopping anticholinergics

Watch the 7-minute video here

This short video could save your parent’s memory!

The Bottom Line

Sleep problems are solvable.

But the solution has to protect the brain, not harm it.

If you’re dealing with nighttime wandering, severe insomnia, or sundowning that’s getting worse, reply to this email. Let’s talk about what’s actually happening and what safe alternatives might work for your parent.

Schedule a free consultation with David!

Peace and wellness,

David Lee, PharmD, PhD, founder MyRxPro

A quick reminder before you go: My audiobook version of Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets is officially available for pre-order! If you prefer listening, you can secure your audiobook copy directly through Pro Audio Voices. If you prefer to read, make sure to lock in your eBook or physical copy today on Amazon, or support local, independent bookstores by pre-ordering your copy on Bookshop.org. Thank you so much for your support!

Pre-order your audiobook today!

I just posted a new video, and I want you to watch it before you crush another pill.

Not all pills can be crushed, and crushing the wrong pill can cause significant overdose.

The rules are simple. But they matter.

Your parent looks at you and says “No.”

Or maybe they’ve physically lost the ability to swallow large tablets safely.

Your first instinct? Reach for a pill crusher. Hide it in food. Problem solved, right?

Not quite.

Here’s what most caregivers don’t know: crushing a tablet could lead to an over dose, the dust present a health hazard for anyone near by, or prevent the pill from working at all. What might seem like a simple task could be a high stakes gamble. Here are the dangers to look out for.

Watch for the Extended-Release Medications

Look at your parent’s pill bottles right now. Do you see the words “Extended-Release” or the letters ER, XR, XL, or CR on the label?

If you do, stop. Do not crush that pill.

Those letters mean the medication is designed to release slowly over 24 hours. Crush it, and you destroy that time-release coating. Now your parent’s body gets 24 hours of medicine in one second.

That could be a dangerous overdose.

But What If There’s No ER or XR on the Label?

You see a pill with a score line down the middle and think, “That must mean it’s safe to crush.”

Unfortunately, no.

The only safe way to know is to call your pharmacist and ask the first question. While you are talking to the pharmacist, ask if it comes in a different form:

1. “Can I safely crush this medication?”

2. “Does this medication come in a liquid or patch form?”

In the video, I review what to look for and how to ask the pharmacist.

The Calcium Rock

Let’s say the pharmacist confirms the pill is safe to crush. Now you’re thinking: mix it into pudding or yogurt, right?

Hold on.

Pudding and yogurt contain calcium. And calcium acts like a magnet to certain medications — binding to them so your parent’s body can’t absorb them at all.

Crush a thyroid pill (like levothyroxine) or certain antibiotics (like Cipro) and mix them into dairy? The calcium and the medication bind together into a calcium rock. It’s like your parent never took the pill.

Applesauce is generally safer because it doesn’t contain calcium. But you still need to ask the pharmacist: “Is it safe to mix this specific medication with applesauce or dairy?”

The “Brew It Like Coffee” Rule

Here’s something most caregivers don’t know:

If you crush a pill and let it sit in applesauce for hours, the medication starts to oxidize and lose potency — just like brewed coffee loses their flavor and gets off flavors when exposed to air.

The rule is simple:

• Crush it fresh (don’t crush it hours in advance)

• Mix it into applesauce right before giving it

• Have your parent take it immediately

I explain this rule in detail in the video.

Hazardous! (The video exclusive)

There is another reason to not crush a pill, and it isn’t about keeping your parent safe. In the video I review several hazardous medications that you shouldn’t crush, why crushing causes a hazard, and how to keep everyone in the house safe.

Watch the 7-minute video here:

Click Here to Watch the YouTube Video!

What About Medication Patches?

If swallowing becomes impossible, a skin patch can feel like a miracle. Stick it on, forget about it, no argument.

Except patches have their own hidden problems:

1. Always remove the old patch before applying a new one (or you risk an accidental overdose)

2. Never put a heating pad over a medication patch (heat makes the medicine absorb way too fast)

3. Always place the patch on the upper back or shoulder blade (so your parent can’t peel it off — and never place a new patch on the same spot as the old one, which can cause overdose)

In the video, I walk you through all three patch safety rules — including why reusing the same skin spot is dangerous.

The MyRxPro Caregiver’s Toolkit

If you’re already managing multiple medications for your parent, I created something for you.

The MyRxPro Caregiver’s Toolkit includes:

• Complete lists of medications available as liquids and patches (so you know exactly what to ask for)

• Medication lists you can use

• Doctor appointment scripts that get you 8 minutes of actual attention instead of dismissal

Download your free Caregiver’s Toolkit!

Download the Caregiver's Toolkit

What You’ll Learn in the Video

• What to look for on the label

• What to ask your pharmacist

• Why calcium-containing foods (pudding, yogurt) can make medications useless

• The “brew it like coffee” rule for crushed medications

• The 3 patch safety rules that prevent overdose

Watch the 7-minute video here:

Click Here to Watch the YouTube Video!

The Bottom Line

It’s not obvious what to do when your parents refused to take a medication. You might be tempted to crush the tablet but here is how to do that safely:

Check the labels today.
Call the pharmacist tomorrow.
Ask if you can crush it.
Ask about switching to a liquid or patch.
And if you need to crush something, grab the applesauce — and use it immediately.

Just a few steps. That’s all it takes to keep your parent and yousafe.

Peace and wellness,

David Lee, PharmD, PhD, founder of MyRxPro

Thank you to everyone who has supported Fewer Pills, More Paws. Your support means this work reaches families who need it. -David❤️

If you are caring for an aging parent, you probably know the exact inventory of their weekly pillbox. You know the round white tablets, the little yellow capsules, and the peach oval blood thinners. You track them like clockwork.

But there is a dangerous blind spot in modern geriatrics, and it is costing family caregivers their peace of mind.

It is the medication you aren’t counting as a pill.

We have been conditioned to believe that if a drug isn’t swallowed, digested, and processed by the stomach, it is somehow “local” or low-risk. We assume skin creams stay on the skin. We assume eye drops stay in the eyes.

When a hurried specialist asks, “What medications is your father taking?” they are looking at a typed list of oral prescriptions. The nasal sprays, the pain patches, and the glaucoma drops are routinely left off the mental clinical arithmetic.

But your parent’s aging body doesn’t separate medications by how they enter the system. What goes on the skin very often ends up directly in the bloodstream. And when it does, the side effects can look exactly like a brand-new medical emergency.

Hidden Med #1: The Eye Drop That Slows the Heart

Consider timolol. It is one of the most commonly prescribed eye drops for glaucoma. Mechanically, timolol is a potent beta-blocker—the exact same class of medication used to aggressively lower blood pressure and slow the heart rate. In the eye, it reduces pressure within the eye.

When your parent puts a drop in their eye, the fluid drains into the tear ducts, which are lined with highly vascular mucous membranes. The drug bypasses the stomach and the liver’s natural filtration system entirely. It absorbs straight into the systemic bloodstream.

In an 80-year-old body, a tiny drop of timolol can cause profound bradycardia (an unsafely low heart rate), sudden fatigue, deep lethargy, and dizzy spells.

What happens next is a classic, catastrophic Prescribing Cascade. Your parent goes to their primary doctor complaining of extreme exhaustion and fainting. The doctor looks at the oral pill list, sees nothing unusual, diagnoses a slow heart rate due to a conduction issue, and schedules an appointment for a pacemaker.

Not all eye drops reaches the whole body like timolol does, but don’t forget to list all of them on your medication list.

Hidden Med #2: The Steroid Skin Absorption

The same invisible danger applies to prescription steroid creams used for chronic eczema, or even heavy-duty over-the-counter pain patches containing lidocaine or wintergreen oil (methyl salicylate/menthol).

An aging skin barrier is thin and highly permeable. If a parent is slathering high-potency steroid creams over large areas of their body for weeks on end, that steroid is being absorbed systemically. The result? Sudden spikes in blood sugar, unexpected skin bruising, and fluid retention that can push a fragile heart into mild congestive heart failure.

Don’t forget the medicated skin creams from the medication list, even if only used occasionally.

Hidden Med #3: The “All-Natural” Supplements

There is another massive collection of uncounted pills hiding in plain sight: herbals, vitamins, and dietary supplements.

Because these items are bought over-the-counter at a health food store rather than dispensed at a pharmacy counter, they are almost never tracked in the electronic health record. Family caregivers often view them as harmless wellness boosters, and aging parents often forget to mention them to their doctors.

But “natural” does not mean safe, and it certainly does not mean inert.

• St. John’s Wort is a notorious liver-enzyme inducer that can quietly neutralize life-saving prescriptions, rendering medications like blood thinners or cardiac drugs completely ineffective.

• Ginkgo Biloba and Vitamin E can drastically increase bleeding risks, creating a ticking time bomb if your parent is already taking a prescribed anticoagulant.

• High-dose Calcium supplements can interact with blood pressure medications or bind to vital antibiotics in the gut, completely blocking their absorption.

Don’t forget to list all of the OTC medications, herbals, vitamins, and dietary supplements on the medication list.

Your Weekend Action Plan: The “Non-Pill & Supplement Inventory”

The modern healthcare system is too rushed, too siloed, and too fragmented to routinely and completely audit your parent’s medicine cabinet for things that aren’t on a standard pharmacy printout. The cardiologist isn’t always looking at the ophthalmologist’s drops; the primary care doctor doesn’t see the herbal capsules bought at the grocery store.

Because the healthcare system does not have a complete medication list, you must provide one that includes all medications, herbals, topicals, supplements, ointments, and drops.

Go to your parent’s bathroom and kitchen counter and look for:

1. Any eye drops or ear drops.

2. Prescription and OTC medicated creams, gels, or ointments.

3. Medicated pain patches (Lidocaine, Fentanyl, or Voltaren gel).

4. Daily nasal sprays or asthma inhalers.

5. All herbal remedies, vitamins, minerals, and dietary supplements.

Write them down. Add them to the medication list. The next time a doctor, nurse, or pharmacist asks what medications your parent is on, do not let them just look at the prescription pillbox. Hand them the full list and ask the single most important question you can ask a clinician:

“Could these non-oral therapies or over-the-counter supplements be interacting with my parent’s prescriptions or causing the systemic symptoms we are seeing at home?”

Peace and wellness,

David Lee, PharmD, PhD, lead pharmacist at MyRxPro

P.S. If Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets has already given you a practical tool or a moment of clarity to use, please consider leaving a brief review on Amazon or Goodreads. Honest reviews are the single most powerful way to help other accidental caregivers find this manual in a crowded marketplace. Thank you!

Get your copy now → Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets

Available in paperback and ebook. The audiobook is now available for pre-order and will ship later this summer

Where to Get It

Paperback & eBook:

• Bookshop.org (supports independent bookstores!)

• Amazon (hardcover is available, coming elsewhere soon)

• Barnes & Noble

• Walmart

Audiobook (Pre-Order):

• Pro Audio Voices

A Quick Note on Pricing

I originally announced the ebook promotion on Amazon would be $0.99. When I tried to set that price, the minimum I could set was $1.99 due to the file size. I apologize for that.

The promotional price of $1.99 runs through Wednesday, June 18th. After that, it goes back up to $9.99. If you have been thinking about it, today or tomorrow is the time.

What This Book Is

For the last several years, I have been answering the same question from care partners over and over:

“How do I know if my parent is on too many medications? And what can I do about it?

This book is the answer.

Inside you will find the clinical framework for understanding polypharmacy and why it matters. The exact conversation scripts — what to say and how to say it so your parent hears concern, not control.

You will understand what has changed in your parent’s body that makes them vulnerable to polypharmacy — and why the medications meant to help them are quietly working against them. You will understand why the healthcare system is so good at adding a medication but seems to be paralyzed when it comes to removing one.

You will get the One-Page Briefing — the single-page document that changes what happens in an eight-minute appointment with the doctor. The Brown Bag Review protocol for using your pharmacist the way they were trained to be used.

And throughout — the lessons from Leo and Sirius. Because sometimes a stoic senior cat or an aging golden retriever teaches you more about healthcare than any textbook. They will teach you lessons about your own body, quiet observation, and the simplicity of being present.

This is not theory. This is the playbook backed by science. Everything you need to audit your parent’s medications, have the hard conversations, and work with their healthcare team to simplify their regimen.

If You Read It, Please Leave a Review

Reviews matter more than you might think.

They help other care partners find this book when they need it. They help the algorithm surface it to the right people. And honestly — they tell me the work mattered.

If the book helps you, I would be genuinely grateful if you would leave a review on whichever platform you purchased it from. It takes two minutes and it makes a real difference.

Thank You

To everyone who pre-ordered. Who shared the announcement. Who asked the questions over the years that made this book necessary.

To my own pet professors — the best clinical teachers I have ever had.🐾

And to the care partners doing this work every single day. Asking the hard questions. Showing up. Refusing to accept that decline is inevitable.

This book is for you.🐾

Get a copy. Read it. Use it. And if you know another care partner who needs it — share it with them.

Get Fewer Pills, More Paws now → Paperback, hardcover, ebook, and audiobook (pre-order). Promotional ebook pricing through June 18th.

🐾

David Lee, PharmD, PhD, founder of MyRxPro.com

I was sitting across from a daughter—let’s call her Mandy—who had just brought her father to see me. He was 82, sharp as ever until about six months ago. Then something shifted. Confusion. Falls. Withdrawal from activities he loved.

His doctor had diagnosed early dementia and added a memory drug.

Instead of improving, he got worse. Deeply disoriented. Agitated.

Mandy pulled out a garbage bag. Inside: 14 prescription bottles.

We did what should have been done months earlier—a medication review. Within 10 minutes, the pattern was obvious. Her father’s “dementia” wasn’t dementia. It was a bladder medication (anticholinergic burden score of 3) causing the exact cognitive symptoms everyone thought were Alzheimer’s.

We stopped two medications. Within three weeks, he was back. Alert. Reading again. Himself.

The confusion wasn’t disease. It was the pills.

But here’s what haunts me:

How many families never get that moment? How many people are chemically sedated into cognitive decline that gets labeled “just aging”? How many care partners are told “there’s nothing we can do” when the answer is literally sitting in the medicine cabinet?

Why I Wrote This

For years, I’ve watched families navigate a system that’s designed to add medications, not remove them. A system where every specialist prescribes without knowing what the other specialists prescribed. Where “polypharmacy” (five or more medications) becomes the norm, not the exception. Where medication-induced harm gets relabeled as disease progression.

And I kept thinking: Someone needs to give care partners the tools to push back.

Not vague advice. Not “talk to your doctor.” But the actual scripts, the clinical frameworks, the step-by-step protocols to audit a medication list, identify what’s harmful, and advocate for deprescribing.

That’s what Fewer Pills, More Paws is.

It’s the playbook for care partners who are tired of being told “this is just what happens” when they know something’s wrong.

What’s Inside

• Shift from Caregiver to Conductor: Step up as the ultimate advocate with step-by-step survival plans for 8-minute doctor visits, chaotic hospitalizations, delirium crises, and nursing home transitions.

• Audit the Medicine Cabinet: Use a pharmacist’s eye to safely reduce medication overload, ensuring every pill serves a clear purpose and improves quality of life.

• Build Your Longevity Toolkit: Master the High-5 for Healthspan to protect your own physical, vascular, and cognitive health against caregiver burnout.

• Learn from Our Furry Professors: Discover the profound, science-backed lessons on aging, function, and restorative care that we can learn from our pets.

It’s Out. And I Need Your Help.

Fewer Pills, More Paws is officially available.

For launch week (June 16-18), the eBook is $0.99 on Amazon.

Not because the book isn’t worth more. But because I want it in the hands of every overwhelmed care partner who’s staring at their parent’s kitchen counter wondering, “Is all of this really necessary?”

The answer is often no. But you need tools to prove it.

👉 Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets

Here’s the ask: If you read it and it helps, leave a review.

Reviews are how a book like this—one that challenges a system designed to extract profit, not preserve dignity—breaks through the noise. They’re how care partners who’ve never heard of MyRxPro find the tools they desperately need.

But mostly, I just want it in your hands.

Because somewhere right now, there’s a Mandy sitting across from a doctor being told her father has dementia. And if she had this book, she might ask one question that changes everything:

“Could this be the medications?”

That question can save lives.

Peace and wellness,

David Lee, PharmD, PhD Founder, MyRxPro

P.S. The $0.99 price ends Tuesday, June 18th at midnight. After that, it goes back to regular price. If you’ve been waiting, now’s the time.

You know the pills have become a problem. You’ve watched your parent slow down, grow confused, lose their balance — and somewhere in the back of your mind, a quiet voice keeps asking the question you haven’t known how to say out loud.

Is it the medications?

And then the second question, equally hard:

How do I bring this up without a fight?

This newsletter is the answer to both.

Why This Conversation Is the Most Important One You’ll Have

Before we talk about how to have it, let’s be clear about why it matters.

Polypharmacy — the clinical term for five or more medications — is not just a management inconvenience. It is a scientifically documented, peer-reviewed risk that compounds with every pill added to the list.

Here is what that risk looks like in real life:

Medication-induced cognitive decline. Anticholinergic medications — found in bladder drugs, sleep aids, antihistamines, and over-the-counter PM formulas — block the brain chemicals essential for clear thinking. They produce confusion, memory lapses, and disorientation that is frequently mistaken for dementia. Your parent may not be losing their mind to aging. They may be being chemically sedated into cognitive decline.

Falls that didn’t have to happen. Many medications cause blood pressure to drop when your parent stands up. You notice the dizziness, grabbing for the counter and furniture, then the fall that changes everything. That is often a medication side effect, not aging. It is documented clinical phenomenon and frequently missed by a casual review.

The prescribing cascade. A side effect from Drug A gets misread as a new condition. Drug B is prescribed to treat it. Drug B has its own side effects. Drug C follows. Each step makes clinical sense in isolation. Taken together, they are making your parent sicker. —> See our newsletter on the prescribing cascade:

Erosion of daily life. Organizing a dozen pills a day — the right ones, at the right times, with the right food — is an invisible tax on independence. It is exhausting in a way that doesn’t show up on any chart.

The healthcare system is not designed to remove medications. It is designed to add them. It gets paid for because it has a billing code. So when you advocate for less, you are doing something the system will not do on its own. There is no billing code for removing a medication.

That advocacy begins with a conversation. And that conversation begins with you.

The Red Flags Worth Watching For

Don’t wait for a crisis before you act. These are the signals that make this conversation necessary now.

New or worsening confusion. Especially if it appeared after a medication was started or changed. Sudden confusion is almost never normal aging. It is almost always a cause worth finding.

Falls or unsteady gait. If your parent is grabbing for furniture, shuffling instead of walking, or has fallen once — these are medication red flags until proven otherwise.

Behavioral shifts out of character. Unexpected anxiety, depression, withdrawal, or apathy that didn’t used to be there. These are often medication signatures, not personality changes.

The specialist coordination gap. Your parent sees a cardiologist, a urologist, a rheumatologist. None of them know what the others have prescribed. None of them have seen the whole list. This is not negligence — it is the architecture of a fragmented system. You are the only person who can build the whole picture.

The most important red flag of all:

Your parent says: “I hate all these pills” or “I think I’m taking too many medications.”

Listen to them. They are telling you something true.

Before the Conversation

Let’s talk about when I took my black cat, Leo, to the vet, I made the same mistake I see care partners make constantly. I brought my concerns about some litterbox problems to his vet causally, without preparation, in the middle of a busy appointment, hoping she would somehow extract the right information from my anxiety.

She was patient with me. But what she needed was what I hadn’t prepared.

She needed Leo’s baseline. She needed to know what his patterns and habits were. She needed specific observations — when the change started, what it looked like, what he’s been eating, what had changed in his environment or his medications.

Leo couldn’t tell her any of that. And even when your parent can — even when they are sharp, verbal, and fully present in that appointment room — they often can’t tell the doctor what you can. They don’t know what their baseline looked like from the outside. They don’t remember exactly when the dizziness started. They may not have noticed the pattern you noticed. You are still the one who holds the outside view.

Your parent’s physician is in exactly the same position. They see your parent for eight minutes, in a sterile room, without access to the baseline you carry in your head every day. They need what you know. But they can only use it if you bring it in a form they can act on.

This is why preparation is the most important part of the conversation — both the one you have with your parent and the one you have with their doctor.

How to Have the Conversation With Your Parent

Choose the right moment.

Not when they are tired, in pain, or stressed. Not during a crisis or at the end of a long day. Find a quiet time when they are rested and the house is calm. Sit down together. This is not a standing-in-the-doorway conversation.

Lead with observation, not accusation.

The difference between these two openings is everything:

“You’re taking too many pills. We need to fix this.”

That is a verdict. It will be defended against.

“I’ve been thinking about something, and I wanted to talk to you about it. I’ve noticed you’ve been managing a lot of medications, and I want to make sure they’re all still doing what they’re supposed to do. Not because anything is wrong — I just want to make sure we have the full picture. Can we look at this together?”

That is an invitation. It respects autonomy while clearly stating concern. It positions you as a partner, not a critic.

Be specific, not vague.

Vague concern closes conversations. Specific observation opens them.

Don’t say: “You take too many medications.”

Say: “I noticed you’ve been dizzy every morning after your pills. Three of your medications can cause that. Can we ask Dr. Evans about it?”

Or: “You’re seeing four different specialists, and I don’t think any of them know what the others have prescribed. That worries me — not because of anything anyone is doing wrong, but because no one has the whole picture.”

Specificity shows you have been paying attention. It gives you something concrete to bring to the doctor. It makes it harder to dismiss.

Use their own words.

If your parent has already said they hate the pills, or that they feel foggy, or that the cost is becoming a burden — that is your opening. Use it.

“You mentioned last week that you feel like you’re taking too many pills. I agree. Let’s ask the doctor about it together.”

You are not imposing your concern. You are reflecting theirs back to them and turning it into action.

Move the conversation toward the clinic.

The goal of this kitchen table conversation is not to solve the medication problem. It is to get both of you into the right room with the right clinician. Frame it that way.

“I’d like to schedule a medication review with Dr. Evans. Not because anything is wrong — just to make sure everything is still working together the way it should. I’ll schedule it, I’ll drive, and I’ll come in with you. All I need is your okay.”

Remove every friction point. Remove every reason to say no.

When They Push Back

“I feel fine.”

“I’m glad you feel well. But some of the things I’ve noticed — the morning dizziness, the trouble sleeping — those can be medication effects that don’t always feel like a medication problem. Let’s just have someone check the whole picture.”

“I don’t want to stop my medications.”

“I’m not suggesting we stop anything. I just want to make sure everything on the list is still necessary and that nothing is working against something else. A review doesn’t mean removing — it means understanding.”

“My doctor knows what they’re doing.”

“I’m sure they do. But your cardiologist doesn’t know what your urologist prescribed, and your urologist doesn’t know what your rheumatologist added. No one has seen the full list in the same room at the same time. That’s what we’re asking for — the whole picture.”

“You’re trying to control me.”

“I respect your independence completely. My goal is to protect it. The best way I know how to do that is to make sure the medications meant to help you aren’t quietly working against you. I’m asking for a professional to take a look — not to take over.”

How to Prepare for the Physician Visit

Once your parent has agreed, the preparation you bring to the appointment will determine what happens in those eight minutes.

The Total Sweep.
Every prescription bottle. Every over-the-counter medication. Every supplement — the Vitamin D from the bathroom, the ibuprofen from the kitchen drawer, the herbal sleep aid from Amazon. Gather everything. Your parent may not be able to account for half of what they are taking. This is the starting inventory.

The Medication List.
Create a single-page document: drug name, dose, frequency, prescribing physician, and — most importantly — the reason it was prescribed. If neither you nor your parent knows why a medication is on the list, circle it. That circled bottle is your first question for the doctor. See our newsletter on how to use The Medication List:

The Brown Bag Consult.
Before the doctor’s appointment, bring the physical bottles to the pharmacy for a fifteen-minute consultation. Call ahead. Ask for a Brown Bag Review. Most pharmacists know exactly what this means. This is where interactions, duplications, and prescribing cascades get spotted — and where you turn your medication list into clinical data before you walk into the appointment.

The One-Page Briefing.
Arrive with your top three concerns, your medication list, and specific observations with dates. Not “she seems dizzy sometimes” — that is not clinical data. Instead: “She has been dizzy every morning since starting the new blood pressure pill — Tuesday, Thursday, and Saturday this week, each time within an hour of her morning dose, each time requiring her to hold onto the counter.” That is a pattern. That gets action. See our newsletter on how to use The One-Page Briefing.

What to request in the appointment:

• Are all of these medications still necessary?

• Are there any interactions or prescribing cascades I should know about?

• Are there candidates for deprescribing?

• Can we simplify the regimen?

And if the conversation is going well, ask this directly:

“Would you be open to a deprescribing plan? We’d like to systematically identify which medications might be safely reduced or stopped.”

Find both The Medication List and the One-page Briefing and many more for download in the MyRxPro Caregiver’s Toolkit.

Download the MyRxPro Caregivers Toolkit

Do Not Stop a Med On Your Own

Deprescribing must always be done under clinical supervision. Some medications require careful tapering. Never stop a medication on your own.

But asking whether a medication is still necessary? Requesting a professional review? Bringing specific observations to the appointment?

That is always safe. That is your job as the Conductor of your parent’s care.

The system added these pills one at a time, in separate offices, by separate specialists, with no one looking at the whole picture. You are the only person who sees the whole picture. You are the only one who knows what your parent looked like before — before the dizziness, before the confusion, before the shuffling walk that wasn’t there last year.

That knowledge is clinical data. Use it.

Tuesday, June 16th

Fewer Pills, More Paws is here!

This is the book care partners have been asking for — the complete system for auditing medications, having the hard conversations, and working with your parent’s healthcare team to simplify their regimen.

Preorder now and get immediate access to the Caregiver’s Toolkit — checklists, scripts, templates, and guidance.

Preorder now at —> MyRxPro.com/books

The MyRxPro YouTube Channel

If you learn better by watching than reading, the MyRxPro YouTube channel is for you. We break down the warning signs, the red flags, and the practical moves — in plain language, without the jargon.

Watch here → https://www.youtube.com/@MyRxPro

Five Signs of a Prescribing Cascade

Each specialist sees one problem. None of them see the chain reaction. You can. Here are the five signs that medications are being used to treat the side effect of another medication.

Five Questions to Prevent Polypharmacy

One of the most important ways to prevent polypharmacy is to prevent the prescribing cascade. When a new medications is prescribed, ask these 5 questions to make sure you have a defense plan against polypharmacy.

Five Medications that Increase Fall Risk

Falls are the leading cause of injury-related death in older adults. These five medication classes are among the most common reasons they happen — and most families never make the connection.

The Conversation That Changes Things

The hardest part of this conversation is starting it.

Not because the clinical argument is complicated — it isn’t. Not because you don’t already know something is wrong — you do. The hardest part is finding the words that open a door without making your parent feel like you are walking through it uninvited.

You have those words now.

The rest is just showing up.

David Lee, PharmD, PhD, founder of MyRxPro.com

This newsletter is for educational purposes. It does not constitute medical advice. Always consult a licensed physician before making changes to any medication regimen.

Go to your parent’s home—or call up the picture in your mind if you know it well enough. Walk to the bathroom cabinet. The nightstand. The kitchen drawer where the pills migrate. Gather every bottle.

Lay them on the counter.

Count them.

Research says most of you will count somewhere between eight and fifteen. Some of you will count more than twenty. And as you stand there looking at this chemical inventory of your parent’s life, you will ask the question that brought you here:

Is all of this really necessary?

The honest, peer-reviewed, evidence-based answer is probably no.

For most older adults taking ten or more medications, at least three to five are unnecessary, harmful, or treating the side effect of another drug. Not maybe. Statistically. Documented in the literature. Known by every geriatrician who has ever done a proper medication review.

Here is what the system will not tell you: there is no financial incentive to remove a pill. There is only a financial incentive to add one.

That is not an accusation. It is arithmetic. And once you understand that arithmetic, everything about your parent’s overcrowded pill organizer begins to make a different kind of sense.

The Trap That Looks Like Medicine

It starts simply.

Your parent begins one medication for blood pressure. A side effect causes dizziness. The dizziness gets attributed to a balance problem. A second medication is prescribed. That medication causes dry mouth and confusion. The confusion gets attributed to early dementia. A third medication is added for dementia.

This is called the Prescribing Cascade—first described by researchers Rochon and Gurwitz (1997), and now documented in hundreds of peer-reviewed studies. A side effect of Drug A is misread as a new medical condition. Drug B is prescribed to treat it. Drug B has its own side effects. Drug C follows. The cascade continues.

Each step makes clinical sense in isolation. Taken together, they are making your parent sicker.

And at every step, someone is getting paid.

The cardiologist who prescribed the blood pressure pill. The urologist who prescribed the bladder medication. The pharmacy that filled both. The insurance system that processed both. The lab that ran the bloodwork that led to the third prescription.

This is not a conspiracy. It is a structure. The healthcare system is not designed to look at your parent as a whole person holding fifteen bottles. It is designed to see one complaint, in one appointment, and respond. The response is almost always a prescription. The response is almost never, “Let’s remove something.”

That removal—that careful, evidence-based unwinding of an unnecessary medication—is called deprescribing. It requires time, clinical judgment, and a pharmacist who has reviewed the whole list. It is the most underused intervention in geriatric medicine. It is also the one that most often changes lives.

The Man Who Got His Father Back

John was a retired librarian. He was sharp and fiercely independent. The kind of man who had read more books than most people have ever owned.

Over three months, he became acutely, frighteningly confused. Not gradually forgetful—dramatically altered. He stopped tracking conversations. He shuffled when he walked. He fell twice. His daughter Sarah watched her father disappear in front of her.

John’s doctor saw him for eight minutes and wrote: Early cognitive decline. Recommend memory-enhancing medication.

The thing is, dementia generally is not dramatic; it’s slow. Sarah did not accept this.

She asked the question the system never pays for and actually costs the system money: What if this isn’t dementia? What if it’s the pills?

She brought John’s complete medication list—every prescription, every supplement, every over-the-counter remedy—to a clinical pharmacist for a full review. They found it immediately. John’s confusion had started within weeks of beginning a bladder medication prescribed by a specialist who had never seen his full medication list. That medication was an anticholinergic drug—a class of medications known to block the brain chemicals essential for memory and clear thinking. The new memory-enhancing medication his doctor had just added was about to pour gasoline on a chemical fire.

They stopped the bladder medication. They held the new prescription. Within weeks, the fog lifted. John was alert, oriented, and back at his books.

His brain had not been failing.

It had been overloaded by a system that never looked at the whole picture.

The confusion wasn’t dementia. It was five medications yelling at each other in John’s brain. And no one was listening.

What Medication Overload Actually Looks Like

The system will call these things normal aging. They are not.

I hear it all the time: “She had a dramatic decline after the fall.” Maybe—or maybe it was a medication that caused the fall and is still contributing to what everyone thinks is “decline.” Maybe it’s not decline. Maybe it’s too many medications.

• Sudden confusion or increased forgetfulness. Especially if it appeared or worsened after a new medication was started. This is the single most important pattern to recognize. Anticholinergic medications—found in bladder drugs, antihistamines, sleep aids, and over-the-counter PM formulas—directly block the brain chemicals needed for clear thinking.

• Gait changes and new falls. Many medications cause blood pressure to drop suddenly when your parent stands up. The medication is the fall risk, not the aging. This is documented, predictable, and frequently missed.

• New behavioral changes. Unexpected anxiety, depression, or lethargy that seems out of character. These are often medication signatures, not personality shifts. The system tends to add another prescription. The right move is to audit the existing ones.

• The specialist coordination gap. Your parent sees a cardiologist, a urologist, and a rheumatologist. None of them know what the others have prescribed. None of them have reviewed the full list. This is not negligence—it is a fractured healthcare system. The system does not build a whole picture because systems don’t talk to each other. You have to build the whole picture.

Five Moves That Change Everything

Here is exactly what to do.

Move 1: The Total Sweep. Every prescription bottle. Every over-the-counter remedy. Every supplement. Vitamin D from the bathroom, ibuprofen from the kitchen, the herbal sleep aid from Amazon. Gather everything. Your parent probably cannot account for half of what they are taking. This pile is your starting point.

Move 2: The Medication List. Create a single-page document—drug name, dose, instructions, prescribing physician, and most importantly: the reason it was prescribed. If neither you nor your parent knows why a medication is on the list, circle it. That is your first question for the doctor. See our recent newsletter for assistance with The Medication List.

Move 3: The Brown Bag Consult. Do not try to have this conversation at a busy pharmacy counter during the lunch rush. Call ahead. Ask for a dedicated fifteen-minute consultation—most pharmacists know exactly what a Brown Bag Review is and will make time for it. Bring the physical bottles. This is where interactions, duplications, and prescribing cascades get spotted. This is also where you use your pharmacist the way they were trained to be used—as a clinical partner, not a dispenser.

Move 4: Prepare for the Eight-Minute Appointment. Your parent’s physician has approximately eight minutes. The RVU system that governs physician reimbursement rewards procedures and prescriptions, not the thirty minutes it takes to properly review a complex medication list. There is no billing code for “talked about how each medication fits with this patient’s goals of care.”

Arrive with a plan. I recommend the One-Page Briefing in the MyRxPro Caregivers Toolkit. Your One-Page Briefing will help you include your top three concerns, your master medication list, and specific observations with dates. “She has been dizzy every morning since starting the new blood pressure pill—Tuesday, Thursday, and Saturday this week, each time within an hour of her morning dose.” That is clinical data. That gets action by the doctor. See our recent newsletter for assistance with One-Page Briefing.

Move 5: Strategic Patience.
Safe deprescribing is methodical. Some medications require careful tapering — stopping a benzodiazepine abruptly is dangerous; stopping certain blood pressure medications can cause rebound hypertension. Work with the clinical team. This is not a sprint. It is a careful, collaborative unwinding — and it is worth every step.

Download the Caregiver's Toolkit

The Caregivers Toolkit includes the Medication List Template and the One-Page Briefing.

A Word on Safety

Deprescribing must always be done under clinical supervision. Never stop a medication on your own.

But asking whether a medication is still necessary? Questioning a new prescription that appeared after a side effect from the last one? Requesting a full medication review from a pharmacist before the next appointment?

That is always safe.

The system added these pills one at a time, in separate decisions, by separate specialists, over years of care, with no one looking at the whole picture. To stop the cascade, what should you ask?

Five Questions to Ask to Limit the Prescribing Cascade

If the doctor’s answer is another prescription, be sure you understand why and that you have a plan for if, and when, to stop the medication in the future. How do you know what to ask? CLICK HERE to watch our short video for 5 questions to ask before you leave the doctor’s office.

Go Back to the Counter

Now you have something you did not have when you started. You have a name for what you are looking at—the prescribing cascade. You have a name for what it produces—polypharmacy. You have a name for what reverses it—deprescribing. And you have five moves to begin.

The system will not sweep those bottles into a bag and ask hard questions about each one. The cardiologist will not call the urologist. The eight-minute appointment will not stretch to thirty. None of that will change before your parent’s next refill.

But you will be in the room. You will have the list. You will know what questions to ask and why they matter. You will be the one person in your parent’s care who sees the whole picture—because you are the only one who has been there long enough to know what the picture looked like before.

You needed one question and the courage to ask it.

What if it’s the pills?

You already have the question. The 5 Moves is your place to start.

Peace and wellness,

David Lee, PharmD, PhD Founder, MyRxPro

Want the full playbook?

Fewer Pills, More Paws gives you the complete system — the scripts, the checklists, the pharmacist’s triage, and the One-Page Briefing template that makes the eight-minute appointment work for you.

The paperback is available now for pre-order:

• Paperback:

  • Indie bookstores: Bookshop.org

  • Major retailers: Barnes & Noble, Walmart (Amazon is coming soon)

• E-Book:

  • Indie bookstores: Bookshop.org

  • Major retailers: Amazon, Barnes & Noble, Walmart

• Direct from MyRxPro: MyRxPro.com/book

(Hardcover will be available for pre-order soon. Audiobook will be available mid-summer.)

Have you seen our latest YouTube videos?

Narrow Therapeutic Index (NTI) drugs are medications on a tight rope.

Too little and it’s like not taking it at all. A little too much could be toxic. The problem: Older adults often have a narrower homeostatic range; in other words, the tightrope has narrowed even more. How do you know if you or a loved one is taking an NTI drug?

This video gives you 5 signs to look out for. CLICK HERE to see the video now!

You don’t have to look at that kitchen counter alone.

If you are staring at a jumble of amber bottles and suspect your aging parent is caught in a prescribing cascade, you do not have to fight the modern medical maze by yourself. The system is built for speed, but you can choose precision.

As a geriatric clinical pharmacist, I look at the whole picture to help you step confidently onto the podium as the Conductor of your family’s care.

Book a Free 15-Minute Medication Consultation with me this week, and we will:

• Audit the List: Identify potential high-risk medications, duplications, and hidden interactions.

• Goals of Care: We’ll discuss your goals of care and how each medication is helping or hurting you realize those goals.

• Uncover the Cascades: Look for instances where a pill is only there to treat a side effect of another drug.

• Build Your Script: Create a targeted strategy for your next 8-minute doctor’s appointment so you get real action.

No strings attached. No systemic pressure. Just a quiet, expert look at the board so you can keep your parent safe, alert, and independent.

Schedule Your Free Consultation

References:

Rochon, P. A., & Gurwitz, J. H. (1997). Optimising drug treatment for elderly people: the prescribing cascade. BMJ, 315(7115), 1096–1099. https://doi.org/10.1136/bmj.315.7115.1096

Her 78-year-old mother, Janet, had started taking Benadryl for spring allergies. Seemed harmless enough—just an over-the-counter antihistamine, the kind you buy at CVS without a second thought.

By the following week, Janet couldn’t urinate properly.

By week three, she’d fallen twice.

By week four, Maria and I were on a video call with a crumpled medication list in her hand and tears in her eyes, asking the question I hear too often:

“How did we get here?”

The answer: The Prescribing Cascade.

And it almost killed her mother.

How One Pill Became Seven

Here’s what happened to Janet—and I promise you, this happens every single day in America.

The antihistamine Janet took is one of the most common allergy pills on the market. For a 45-year-old, it’s a totally fine choice. For a 78-year-old woman, it causes a hidden side effect called anticholinergic toxicity—which shows up as urinary retention, confusion, dry mouth, unbalanced, and blurred vision.

But Janet’s primary care doctor didn’t know she’d started taking Benadryl. She bought it over-the-counter. Why would she mention it?

So when Janet showed up saying she couldn’t urinate, her doctor referred her to a urologist.

The urologist didn’t ask about the antihistamine either. He assumed it was a bladder issue common in aging women and prescribed a medication to help her bladder empty more completely.

That medication—a common one called tamsulosin—works by relaxing smooth muscle. Including the smooth muscle in blood vessels.

Which means it dropped Janet’s blood pressure.

When Janet got dizzy standing up from the couch, her primary care doctor prescribed meclizine, a vertigo pill.

When the dizziness continued and she fell in the kitchen—hard enough to bruise her hip and crack a rib—the emergency room doctor added a muscle relaxer for the pain.

By the time Maria brought her mother to see me, Janet was on seven medications.

Not one of them was treating the original problem.

All of them started because nobody connected the dots back to a $6 bottle of Benadryl.

This Is the Prescribing Cascade

The prescribing cascade happens when a side effect of one medication is mistaken for a new medical condition—and instead of removing the offending drug, a second medication is prescribed to “treat” the symptom caused by the first.

• Then that second medication causes a side effect.

• So a third medication gets added.

• And the cycle continues.

It happens to about 25% of older adults, according to research.

It’s not your parent’s fault. It’s not even your doctor’s fault, exactly. It’s the system’s fault. The system rewards for prescribing more, not discussing the timeline of new symptoms and the start of a new medication.

Nobody’s asking: “What changed two weeks ago?”

And here’s the most dangerous part: These side effects get dismissed as normal aging.

• Confusion? “Well, she’s 78.”

• Dizziness? “Balance gets worse as you age.”

• Falls? “That’s just what happens.”

But it’s not. It’s medication toxicity disguised as aging.

Here’s What Caregivers Miss (And Why It Matters)

When a new symptom appears—confusion, dizziness, falls, digestive problems, insomnia—your instinct might be to panic.

• Is it dementia?

• Is it a stroke?

• Is she falling apart?

Your first question might be: “What new disease does she have?”

But the right question is: “What changed in the last two weeks?”

Because here’s what I’ve learned after decades in geriatric pharmacology:

Side effects can masquerade as aging.

Let me show you the patterns:

The Cognitive Cascade

A sleep medication (like Ambien, Benadryl, or anything with “PM” in the name) causes daytime confusion and memory problems. You assume it’s early dementia. The doctor prescribes Aricept or Namenda for “memory enhancement.”

But your mother wasn’t developing Alzheimer’s. She was experiencing anticholinergic toxicity from the sleep pill.

The Balance Cascade

A blood pressure medication causes orthostatic hypotension—a drop in blood pressure when standing up. Your parent gets dizzy and unsteady. The doctor assumes it’s a balance disorder and prescribes meclizine (a vertigo pill) or refers them to physical therapy.

But the problem wasn’t balance. It was the blood pressure medication dose being too high for an aging body with less blood volume and stiffer arteries.

The Digestive Cascade

Long-term use of NSAIDs (ibuprofen, naproxen) causes stomach irritation and acid reflux. The doctor prescribes a proton pump inhibitor (PPI) like omeprazole to “protect the stomach.”

But PPIs interfere with calcium absorption. Over time, this leads to bone fractures. So now there’s a prescription for a bone-building medication. Which causes severe digestive side effects. Which leads to more medications.

All because nobody asked: “Could we just stop the ibuprofen?”

A Case Study That Changed My Practice

Let me tell you about Sarah.

Sarah came to me on seven medications. She was falling constantly, confused most of the day, and had given up trying to live independently. She told her daughter she felt like she was “losing her mind.”

Her daughter thought it was dementia. The neurologist wasn’t sure. The primary care doctor said it was “just aging.”

I did something that should have been done months earlier:

A comprehensive medication review.

I pulled every bottle out of her bag. Made sure each had a purpose. I cross-referenced every side effect profile against her symptoms.

And there it was—clear as day:

• The confusion started three weeks after her doctor added a sleep medication.

• The falls began two weeks after her blood pressure pill dose was increased.

• The digestive issues appeared right after she started taking ibuprofen for knee pain.

Every single symptom had a medication fingerprint. None of it was “just aging.”

I made three phone calls to her prescribers. We stopped three medications. We adjusted one dose.

Within two weeks, Sarah was back to her baseline.

No confusion. No falls. Sharp as ever. Still independent.

She was never sick. She was medicated.

And here’s what haunts me: If someone had done this review six months earlier—before she gave up her independence, before her daughter started researching memory care facilities, before Sarah started believing she was losing her mind—all of that suffering could have been prevented.

What you Bring to the Table as the Caregiver

Here’s the truth that healthcare systems don’t admit enough:

You are the only person who sees your parent every single day.

You notice when the confusion started. You saw the fall that happened three days after the new prescription. You know that your mother was totally fine until that bottle showed up in the medicine cabinet.

Doctors see a snapshot. A 15-minute appointment every three months or less.

You see more than a snapshot, you see the film. The whole story.

Research shows that 80–90% of older adults are willing to stop a medication if their healthcare provider suggests it’s possible. The barrier to safety isn’t the patient. It’s the lack of a comprehensive medication review—and someone like you who can advocate for it.

Right now, your parent needs a full medication audit. Not a timeline—that comes later. Right now, you need someone who can look at every single medication, understand the interactions, spot the cascades, and work with the prescribers to untangle the mess.

Going forward, though? That’s when the timeline becomes your greatest data point.

Starting Today: Track New Symptoms

From this moment forward, any time a new symptom appears, ask yourself:

“What changed in the last two weeks?”

Write it down:

• “Mom started getting dizzy on March 15th. She started the new blood pressure pill on March 8th.”

• “Dad became confused on Tuesday. He started the sleep medication on Friday.”

That’s the data that prevents the next cascade from starting.

This Week’s Action Plan

Step 1: Schedule a Comprehensive Medication Review

If your parent is on more than five medications, experiencing falls, confusion, dizziness, or any new symptoms—they need a professional medication audit. Not next month. Now.

This isn’t something you can DIY with Google. You need a clinical pharmacist or geriatric specialist who can:

• Review every medication for appropriateness

• Identify drug interactions and cascades

• Work with prescribers to safely deprescribe

• Create a simplified, safer regimen

[Schedule a Medication Review with MyRxPro]

Step 2: Get the Free Caregiver’s Toolkit

I’ve created a free toolkit to help you prevent future cascades:

→ The Master Medication List
Your essential document for doctor visits. One page that shows every medication, dose, prescriber, and reason. So each doctor knows what else your parent is on. Click here to see our Newsletter, “The Medication List: A Step-by-Step Guide.“

→ The One Page Briefing
This helps to organize your priorities and to provide the data to advocate like a pro! Get the most out of each visit. Click here to see our Newsletter, “How to Reclaim Your Parent’s Doctor Visit.“

→ Dementia vs Delirium
Use this handy chart to tell the difference between Dementia vs Delirium. Delirium is an emergency. Put this on your fridge; it could save a life!

→ The Teach-Back Script
Make sure you and the doctor are on the same page before you leave the appointment.

Get the MyRxPro Caregiver's Toolkit

Step 3: Ask the Right Question

At your next doctor’s appointment, before any new medication gets added, ask:

“Could this symptom be caused by her current medications instead of a new disease? Here is her updated medication list; could any of these be causing this symptom?”

That one question—asked respectfully—can stop a cascade before it starts.

The Deeper Story

For those of you who want to go deeper—to understand not just how to spot a cascade, but why the system lets it happen, and what you can actually do about it—I wrote a book.

It’s called Fewer Pills, More Paws.

It’s about the biology of aging, the pharmacology of harm, homeostenosis, the narrow buffer zone your aging parent is navigating, and what you can actually do to support independence.

And yes, there’s a part about what our pets can teach us about caregiving and biology that might surprise you. (Hint: They don’t overthink. They don’t catastrophize. They just respond. There’s wisdom in that.)

The paperback is available now for pre-order:

• Paperback:

  • Indie bookstores: Bookshop.org

  • Major retailers: Barnes & Noble, Walmart (Amazon is coming soon)

• E-Book:

  • Indie bookstores: Bookshop.org

  • Major retailers: Amazon, Barnes & Noble, Walmart

• Direct from MyRxPro: MyRxPro.com/books

Hardcover will be available for pre-order soon. Audiobook will be available mid-summer.

The Real Reason I’m Telling You This

I’m tired of watching this happen.

I’m tired of watching families blame themselves for a parent’s decline when the decline was iatrogenic—caused by the healthcare system itself.

I’m tired of the moment when the caregiver finally realizes:

She wasn’t getting worse. She was being over medicated.

You don’t have to be that family.

You can be the one who sees the timeline. The one who asks the right question. The one who saves your parent from a cascade that nobody else is paying attention to.

That’s the whole point of this work.

Book a Free Consultation with David

Peace and wisdom,

David Lee, PharmD, PhD Founder, MyRxPro

Today, I am incredibly proud to announce that the complete clinical framework is finally available in book form.

Fewer Pills, More Paws: Caring for Your Aging Parents and Lessons from Our Pets is now open for preorder in paperback and e-book formats. Hardcover and audiobook are coming soon!

What’s Inside?

This isn’t just a book of medical advice—it’s an advocacy survival guide. I’ve taken my years of experience as a clinical pharmacist and epidemiologist to give you:

• Deprescribing How to talk to doctors about safely stopping unnecessary medications.

• The Prescribing Cascade: How to spot when one pill is being used to “fix” the side effects of another.

• The Conductor Mindset: Lessons in loyalty, presence, and protection that our pets can teach us about caring for our parents or older adults.

Where to Order

We want to make sure this guide is accessible wherever you prefer to shop. You can preorder the paperback or download the e-book immediately at the following retailers:

Support Local Independent Bookstores:

Bookshop.org – If you want your purchase to support small, local independent bookstores, this is the link for you. You can even search for your favorite neighborhood shop to ensure they receive the credit.

Order from your local indie Bookstores

Other major retailers

Barnes & Noble (Paperback) - Hardcover will be available soon

Order from Barnes & Noble

Walmart (Paperback) - Hardcover will be available soon

Order from Walmart

Amazon (Kindle E-Book) – (Note: The Amazon print editions are rolling out as we speak—check back next week for that link!)

Order from Amazon

A Heartfelt Thank You

This book is a result of the conversations I’ve had with many of you—caregivers who are doing the hard, invisible work of loving their parents well.

By preordering today, you aren’t just buying a book; you’re supporting the movement for Clinical Advocacy. You’re helping us spread the word that “more pills” isn’t always the answer, and that quality of life is the ultimate clinical goal.

Thank you for being part of the MyRxPro community.

Peace and wellness,

David Lee, PharmD, PhD Founder, MyRxPro

If you aren’t prepared, the “Medication Review” usually consists of the doctor asking, “Any refills needed?” and moving on.

This is a missed opportunity for safety. Today’s issue of the MyRxPro Newsletter is about reclaiming that 8-minute window to ensure your parent isn’t falling victim to the Prescribing Cascade.

Why the Medication Review is Your Most Important Meeting

In my book, Fewer Pills, More Paws, I talk about the “Normalization of Symptoms.” We often assume a parent is sleepy or confused because they are “getting older.” In reality, it’s often a drug interaction that only a formal, rigorous review can uncover.

A clinical review is vital to:

• Identify Duplications: Spotting where two specialists prescribed similar drugs.

• Assess Appropriateness: Determining if a drug prescribed at age 65 is actually doing more harm than good now that they are 85.

• Deprescribe: Finding safe opportunities to reduce the pill burden rather than adding to it.

Preparation

1. The Master List (Updated): Do not go to the doctor without your MyRxPro Master Medication List. If you haven’t filled yours out yet, Download the Template Here. Ensure it includes the “Why”—the reason for every pill. See last week’s newsletter for guidance on filling out this Medication List template.

2. The Side Effect Journal: Write down any new falls, dizzy spells, or “foggy” mornings. Do not attribute these to age. In the clinical world, we strongly assume it’s the medication until proven otherwise.

3. The Goal of Care: Is the goal to lower a number on a lab test, or is it to make sure Mom can walk to the mailbox without getting dizzy? Share this goal with the doctor.

Questions to Ask

Shift the conversation from refills to relevance with these four clinical questions:

1. “What is the clinical ‘exit strategy’ for this medication?” (Every drug should have a goal; once met, can we stop?)

2. “Does this new prescription treat a condition, or is it treating a side effect of another pill?” (This stops the Prescribing Cascade in its tracks.)

3. “Is this dose still appropriate for their current kidney/liver function?”

4. “Which of these medications carries the highest risk of falls?”

Your Plan for This Week

1. Print: Get your Master Medication List Template ready.

2. Audit: Fill out the “Why” for every medication. If you can’t fill it in, that’s your first question for the doctor.

If the 8-minute clock feels like it’s ticking too fast, don’t forget that you have an ally in your corner. Let’s make sure those pills are working for your parent, not against them.

Coming Next Week: The Prescribing Cascade

Is your parent’s new symptom actually a new medical condition—or just a side effect of their last prescription? Most "aging" issues are actually chemical "cascades" in disguise.

Next week, I’ll show you how to spot the pattern and stop the cycle of "a pill for every ill."

How MyRxPro Can Advocate With You

Preparing for a high-stakes doctor’s visit is stressful. You don’t have to do it alone. At MyRxPro, I offer Clinical and Medication assessments to help you:

• Perform a deep dive audit before the appointment.

• Draft a specific list of Red Flag questions for your parent’s specialist.

• Provide a clinical second opinion on complex regimens.

Book a Free Consultation with MyRxPro

Now Available: Fewer Pills, More Paws

I am thrilled to announce that my new book—a clinical roadmap for navigating the healthcare maze—is now hitting major retailers. If you’ve been looking for a deeper dive into the strategies we discuss here in the Journal, you can find them all in one place.

• Paperback: Now available at Barnes & Noble and Walmart. Available for order from independent bookstores.

• E-Book: Get the digital version immediately on Amazon.

• Hardcover: Coming soon to all retailers.

Note: The print edition is currently rolling out to Amazon—stay tuned for that update next week.

The Bottom Line

You are the only person who sees your parent 24/7. While the doctor has the degree, you have the data. By walking into that 8-minute appointment with a Master List and a plan, you shift from being a bystander to a clinical advocate. Let’s stop the polypharmacy, prescribing cascade, and start focusing on your parent’s quality of life.

Peace and wellness,

David Lee, PharmD, PhD Founder, MyRxPro

As I noted recently, medication errors don’t happen because anyone is bad at their job, most of the time it’s because of missing information.

When an aging parent sees multiple specialists, the Master Medication List is almost always fractured. One doctor adds a pill, another changes a dose, and suddenly, you’re navigating a dangerous Medication Maze.

Today, we’re fixing that.

Why the List in the Computer Isn’t Enough

Electronic Health Records (EHRs) are notoriously slow to update. If your parent’s cardiologist changed a dose on Monday, their primary care doctor might not see it until next month.

As their care advocate, you must supplying the “Source of Truth.” A physical, updated medication list is your parent’s best defense against:

• Therapeutic Duplication: Taking two drugs that do the same thing.

• Drug Interactions: Mixing supplements with prescriptions that don’t play well together.

• Emergency Lag: Giving first responders the data they need in seconds, not minutes.

How to Perform a Brown Bag at Home

I recommend using the “Brown Bag” Protocol. The Brown Bag is a well known term in pharmacy. Download our new Master Medication List Template to help you get started.

Download the MyRxPro Medication List

1. The Sweep: Gather every single bottle—not just prescriptions, but “natural” supplements, vitamins, and as-needed OTC meds.

2. The Transcription: Record the name (Brand & Generic), dose, and exact instructions.

3. The “Why” Rule: If you cannot fill in the “What is this for?” column, circle that medication. That is your first question for the doctor.

Consult the Expert

Take your new list to your pharmacist and ask them for their assessment. Ask them to evaluate for therapeutic duplications, drug interactions, and any high-risk medications. Ask, “Are there any medication that give you concern for my 80 year-old frail mother with reduced kidney function?”

Whatever you do, do NOT stop any medication until directed by your parent’s doctor. Some medications need to be titrated and could have dangerous withdrawal effects if not carefully supervised. You have gathered the data, you have cleared the fog, now the decisions can be made.

Lead with Clarity

Next time you take your parent to the doctor’s office, this list will help guide your discussion. “The pharmacist flagged her bladder medication as being on the American Geriatrics Society Beers Criteria List of potentially inappropriate medications. I’m concerned this has contributed to her three falls in the last six months. Can we discuss any alternatives?” Instead of the doctor spending precious minutes piecing together the med list and a history of symptoms, you have provided the clear data for a more productive discussion. You are more than a passive caregiver, you are a care advocate.

Fewer Pills, More Paws

My upcoming book Fewer Pills, More Paws dedicates a whole chapter on getting the medication list correct. And if you feel like the doctor’s visit ends before you have a chance to put two sentences together, the book also dedicates a whole chapter on how to get the most out of the few minutes with your parent’s doctors.

Preorders are coming soon!

Look for updates at the books webpage.

How MyRxPro Can Help

Creating this list is the first step, but interpreting it is where the safety happens. If you have completed your list and are worried about “Red Flags” like interactions or high-risk medications, let’s talk. We can talk before you meet with the doctor for my expert audit and suggestions. No matter where you are in the care advocacy journey, we can provide the answers you are looking for.

MyRxPro provides:

• Independent Clinical Audits: We review your completed list for safety and duplicate therapies.

• Advocacy and Clinical Clarity: We give you the clinical data you need to talk to your parent’s doctor with confidence.

Book a Free Consultation with David

If you are not sure, a short consultation with me can give you the peace of mind you are looking. I look forward to talking to you soon.

Peace and wellness,

David Lee, PharmD, PhD Founder, MyRxPro

First, I want to say a sincere thank you.

While we’ve been quiet on the email front recently, it was for a very good reason. We have been working tirelessly behind the scenes on the rebranding of MyRxPro.

You might notice things look a little different around here—we have a new platform: Journal.MyRxPro.com. It’s a platform built to grow with this community of caregivers.

The Big News: Fewer Pills, More Paws

I’ve been incredibly busy getting everything ready for a project that is very close to my heart:

🥳 I’m currently reviewing the final proof for Fewer Pills, More Paws! 📖

This book is the culmination of years of clinical work and research, and a roadmap for anyone trying to navigate the complexities of modern medicine with more heart and less polypharmacy.

Expected release is mid-June 2026! (I’ll have the exact date next week!)

Pre-orders are coming soon!

What’s Next?

Rebranding was just the warmup. Here is what you can expect:

• Regular Newsletters: We are back on schedule.

• Quick Notes: Follow my real-time clinical thoughts at journal.myrxpro.com/notes and all of our social media.

• More YouTube Face Time!: We’re committing to more YouTube content. That means you’ll see me in front of the camera, not just behind the mic. Subscribe here to help us grow!

• You can also find us across social media—come say hi!

We are always experimenting—drop us a line at newsletter@myrxpro.com to tell us what you want to see, or just to say hi.

The next few weeks are going to be a whirlwind. I’m so glad you’re on this journey with us.

Onward,

David Lee, PharmD, PhD Founder, MyRxPro