Archive for May, 2014

Which Medicines to Pack?

Q: What medicines should I travel with? We have several vacations planned this summer and I want to make sure I pack the right stuff.

Vacations are wonderful opportunities to get away from your usual routine and see new horizons. Just because you are on vacation doesn’t mean you can’t get injured or sick. Motion sickness, aches and pains and intestinal disturbances can derail your vacation if you aren’t prepared.

First, before you walk out the door make sure you’ve packed all of your regular prescription medicines plus a current list of all your medications and your doctor’s name. Using pillboxes for taking your medicines on the road keeps your main bottles at home (less hassle in case you accidently leave your pills behind) and takes up less space. Filling up your pillboxes before you leave also alerts you to whether you’ll need any refills before you return.

If you’re going to need a refill before you get back into town you can either ask for a larger quantity from your doctor or ask if your pharmacist could refill your medicine a little early. Some insurance programs have a grace period of one “vacation refill” per year. If you take prescription pain or anxiety medicines, talk with your doctor or pharmacist beforehand about what to do about refills during the time you will be gone. Some medicine requires a new printed prescription each time you get it filled, which can be very difficult to get if you need another fill while out of town.

When traveling outside the United States, you can avoid spending your vacation visiting the local bathrooms instead of the beaches or museums by being extra cautious about your food and drinks. My daughter made it through 9 months as an exchange student in Bangkok, Thailand with no sickness until buying a snack from a street vendor. She got so sick her host family had to take her to a hospital. Avoid unpeeled fruits, uncooked veggies like salads, and prepared meals that may have been stored at improper temperatures or not completely cooked. With beverages, “boil it, cook it, open it, or forget it”. And watch out for ice cubes or shaved ice: don’t drink a freshly opened bottle of water or soda that has been poured over ice!

If you do end up with nausea, vomiting or diarrhea, DON’T take NSAIDs (non-steroidal anti-inflammatory drugs) such as naproxen (Aleve®) or ibuprofen (Advil®, Motrin-IB®) for pain, swelling or fever. Taking an NSAID like naproxen or ibuprofen while dehydrated can damage your kidneys. Take acetaminophen (Tylenol®) instead.

Along with your prescription medicines be sure to pack some non-prescription medications for common conditions.

Here’s what I bring with me when I travel:

1. Acetaminophen (Tylenol®). Good for tension headache from staring at maps, backache from riding all day in a car, or fever.
2. Meclizine (Bonine®, Dramamine® Non-Drowsy Formula). The chewable 25mg tablets are my go-to motion sickness medicine for trains, planes, boats and cars. Also helpful for amusement park roller coasters that go backwards and upside down.
3. Loperamide (Imodium®-AD). This is the very best way to stop diarrhea in its tracks. I NEVER leave home without it.
4. Pseudoephedrine (Sudafed®). Since my ears can really plug up when traveling by plane, I make sure I have the original (most effective) formulation with me since in some states it’s now only available by prescription.
5. Diphenhydramine (Benadryl®). This is a miracle worker for bee stings, bug bites, minor rashes and allergic reactions. If you have any swelling around your face or tongue, though, seek medical help immediately.
6. Naproxen, 220mg tablets. This NSAID is great for emergencies like tooth pain or muscle aches. Avoid if you take a blood thinner (like aspirin, warfarin or clopidogrel), have serious heart failure, are allergic to aspirin, or have had a bleeding ulcer. Use acetaminophen (Tylenol®) for aches and pains if you can’t safely take an NSAID like naproxen or ibuprofen.
7. Dried Prunes. Prunes, you ask? I pack these as insurance against constipation. It’s been shown that eating 5 prunes is just as effective as taking a stool softener, and I can adjust the “dose” up or down according to my needs. You can pack your favorite laxative instead. I recommend Miralax® because it’s powerful yet gentle on the body.
Bon voyage and safe travels!

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The Importance of Vitamin B12

One of my patients is a retired Marine. A few months ago he told me that he had been suffering from pains in his legs and feet for a couple of years. His doctor had tried several different pain medicines, but none of them really did much so he quit them all and just put up with it. Then he started taking a B vitamin with a lot of B12 in it, and to his amazement, within 3 days his feet and legs stopped hurting. It’s been over 6 months and the pain hasn’t come back. He’s decided to continue the vitamin, just to make sure.

Vitamin B12 is a water-soluble B vitamin that helps your body make new red blood cells , helps your nerves work, and prevents certain kinds of anemia. A deficiency in Vitamin B12 can show up as fatigue, weakness, depression or pain in your feet or hands.

According to the National Institutes of Health (NIH), Vitamin B12 is found mostly in animal proteins, such as fish, meat, poultry, eggs, milk, and milk products. Most healthy adults get enough Vitamin B12 in their diet; those who don’t either don’t get much animal protein in their diet or aren’t able to absorb Vitamin B12 very well.
Strict vegetarians may not get enough animal protein in their diet to satisfy the recommendation of 1 to 2 mcg daily of Vitamin B12. Others become deficient because they cannot absorb it very well, like the elderly, those who have had gastric bypass surgery and people who take certain medicines.

The most common cause of Vitamin B12 deficiency is not being able to absorb it. This can be due to a condition called atrophic gastritis, which affects 10-30% of the elderly. Atrophic gastritis interferes with the ability to absorb Vitamin B12 from your food because it decreases secretion of digestive juices such as gastric acid.
Our bodies only absorb about half the Vitamin B12 we get in our diet, which is usually attached to animal based protein like ground beef or chicken. Without enough stomach acid, your body can’t break down proteins and Vitamin B12 stays stuck to the protein.

Those who don’t absorb Vitamin B12 well may notice benefit from higher amounts of supplementation.
Medicines that can contribute to poor absorption and deficiency of Vitamin B12 include acid-reducing medicines such as Prilosec® (also known as omeprazole), Prevacid® (also known as lansoprazole), Protonix® or Nexium®. Older acid-blocking medicines which also impair absorption of Vitamin B12 include Zantac® (ranitidine), Pepcid® or Axid®. Metformin, a common pill for diabetes can also interfere with absorption of Vitamin B12.
Vitamin B12 contains cobalt and is available in several forms. The Vitamin B12 that is given as a shot is cyanocobalamin. Oral supplements are available as either cyanocobalamin, or methylcobalamin, and can be purchased without a prescription.

Most people who can absorb Vitamin B12 well only require 1 or 2 mcg daily. If you are over 70, take medicine for heartburn or an ulcer or have had gastric bypass surgery, you may need more than that. 1000-2000mcg daily of Vitamin B12 as an oral or a sublingual tablet can overcome poor absorption. Be sure to avoid the timed-release or long-acting products, because they may not be as well absorbed as the immediate release forms.
Since Vitamin B12 isn’t found in plant foods, if you are vegetarian the National Institutes of Heath suggests fortified breakfast cereals as an alternative source.

Vitamin B12 deficiency can be detected with a blood test. There are several ways to get more of the vitamin: monthly injections from your medical provider, tablets that you swallow and tablets that dissolve under your tongue. Your doctor or medical provider can advise you which would be best for you to take, and how much. There’s more information about Vitamin B12 at

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