Jane Weese | JASE Medical

Planning on Traveling? Tips to Avoid Motion Sickness

Are you planning a trip but are prone to motion sickness?

Motion sickness can make a much-anticipated trip downright miserable. If you or your loved one are prone to motion sickness, there are some strategies and effective medications that can help alleviate the symptoms.

What causes motion sickness and what are the symptoms?

Motion sickness happens when the movement you see is different from what your inner ear senses. It is a complex series of stimuli between your brain, eye and even your skin that is receiving different signals about what is going on in your environment.

Who is most vulnerable to motion sickness?

  • Children between ages 2 and 12 are the most vulnerable to motion sickness, however almost everyone has experienced motion sickness at some point in their lives.
  • Pregnancy
  • Persons with acoustic neuromas (tumor on balance nerve of the ear)
  • Women are more likely than men to get motion sickness. It is suspected that estrogen may play a part in increase of nausea when the hormone spikes.

Symptoms include:

  • Nausea
  • Vomiting
  • Pale, clammy skin
  • Excessive salivation
  • Apathy
  • Hyperventilation
  • Increased sensitivity to odors
  • Loss of appetite
  • Headache
  • Drowsiness

Prevention

Some non-pharmacologic interventions to prevent motion sickness are:

  • Eat a light meal, no fatty or heavy foods before travel.
  • Limit caffeine and alcohol intake, both can cause dehydration
  • Stay well hydrated, sip on water during the trip
  • To help reduce motion or motion perception be the driver and not the rider
  • Avoid reading while in a moving vehicle
  • Sit up front if the passenger in the car or bus
  • Sit over the wing of the airplane to reduce motion perception
  • Practice deep breathing exercises, this helps give you mind a focal point and off the motion of the vehicle
  • Close eyes, sleep or try focusing on the horizon
  • Aromatherapy such as mint or lavender may help take the edge off or prevent nausea
  • Some people have had limited success with acupressure points to prevent or reduce motion sickness symptoms. These points are located 3 finger widths down from the wrist. However, this has had limited and anecdotal success.

Medications for Motion Sickness

Medications

There are several over the counter and prescription medications that can alleviate motion sickness. Listed below are some of the most common over the counter and prescription medications that have been proven to be effective treatment for preventing or treating motion sickness.

Antihistamines are the most common medication used to treat motion sickness, however there are other medicines that are highly effective. The non-sedating forms of antihistamines are not effective when dealing with motion sickness.

Note: Children under the age of 12 should not take any medications even over-the-counter antihistamines- which are effective in treating motion sickness- such as Benadryl and Dramamine (ages 2-12) and Bonine (Age 6 and up) without consulting their primary care provider.

For adults the following medications are recommended for motion sickness: (click on the hyperlink for more extensive information) Also, all the following medications advise avoiding alcohol while using.

As with all medications (motion sickness and others) if you have any side effects such as difficulty breathing, swelling of the face, lips tongue or throat, rashes, hives, heart irregularities, or difficulty urinating seek medical attention immediately.

Anticholinergic antiemetics

The scopolamine patch is a highly effective motion sickness patch that is applied behind the ear four or more hours before travel and is effective for up to 3 days. It is used for adults and not indicated for use in children. Care should be taken applying and removing the patch and avoid contact with eyes after handling it. The medication can cause temporary blurred vision if it gets into the eyes. Avoid driving, water sports, or operating machinery until you know how scopolamine transdermal will affect you. Some side effects are feeling drowsy or disoriented, irritable, dry mouth and sore throat. Some medicines, such as antihistamines can worsen the drowsiness. Be sure to inform your care provider of the other medications, both prescription and over the counter that you are using especially antidepressants, medicines to treat Parkinsons, bronchodilator (asthma) and overactive bladder medicines to name a few. Also let your provider know if you are or suspect you are pregnant or nursing history of kidney, liver, enlarged prostate, seizures, mental illness, a blockage in your digestive tract (stomach or intestines) or breathing disorders before using.

Antihistamines

Dramamine is a popular anti-nausea medication. Take 30-60 minutes before travel. May cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Side effects include dry mouth, constipation, blurred vision, and excitability in children. Consult your primary care provider if before taking dimenhydrinate with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures. Also let your provider know if you are or suspect you are pregnant, history of kidney, liver, enlarged prostate, stomach or intestinal blockage, hyperthyroid, seizures, or breathing disorders before using.

  • Promethazine (oral and suppository) (Phenergan) (prescription)

Promethazine is in the antihistamine and Phenothiazine antiemetics classes. It has the advantage of being in both pill and suppository form in case the motion sickness is severe and unable to tolerate anything by mouth the suppository can be used. For motion sickness use 1 hour before travel. It is a popular medication with many uses- as a sleep aid, post-surgery nausea and vomiting, allergy symptoms such as itchy skin rashes and hives along with motion sickness.  This drug can impair decision making and cause drowsiness. There are many other medicines that can interact with promethazine. Be sure to review your health history before deciding to use this medication especially if you have a history of seizures, asthma, COPD, sulfite allergy, and heart or liver disease to name a few.

Meclizine is another popular motion sickness medicine that is supposed to cause less drowsiness than Dramamine. However, some claim it is not as effective at curbing the nausea caused by motion sickness. To prevent motion sickness, take meclizine about 1 hour before you travel or engage in activity that causes motion sickness. You may take a dose once every 24 hours while you are traveling, to further prevent motion sickness. Some side effects are headache, vomiting, dry mouth, tiredness, and drowsiness. Do not give to children under the age of 12. Before taking meclizine talk with your care provider if you are using sleeping pills, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures. Also, if you have liver, kidney, glaucoma, prostate, difficulty urinating or asthma consult your care provider before using.

Cyclizine is an antihistamine that is used to treat nausea and vomiting caused by motion sickness. It is taken at least 1 hour before travel and should only be given to persons over age 6. This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Some side effects are blurred vision, constipation, dry mouth, and dizziness. Let your care provider know if you have a history of glaucoma, liver or kidney disease, lung or breathing problems, pregnant, stomach or prostate conditions.

Before taking cyclizine with sleeping pills, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures consult with your care provider

With a little planning and armed with preventative measures and medications you can arrive at your destination without suffering the effects of motion sickness.

 

 

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Heat Related Illnesses- Who is at Risk?

As the dog days of summer continue throughout much of the country, with many regions experiencing record or near record heat, it is easy to forget about the dangers that excessive heat can have on the body.  I recently had an experience that brought this to light that stresses the importance of being aware of the heat and keeping yourself hydrated and cool. I noted the excessive heat warning for our area was expected to reach over 112 in our area for the entire week.

We have a golden retriever who needs his daily exercise, which includes several visits to the local dog park each week.  Since it was going to be too hot to go at our usual time(1pm) I took him early- 8 am and stayed until 9:30 am. He played in the shallow pool they provide at the park while I sat in the shade under a bench. Before we left, I decided to talk a walk around the perimeter of the park, a hilly 5-acre plot of land. This is something I usually do when we visit the park.  By then the temperature had reached 95 degrees, I felt hot and could tell the heat was affecting me. We loaded up in the hot car and drove home.

The rest of the day I felt slightly nauseated, dizzy and had a throbbing headache. Later that day I went out to dinner with my husband. As we were waiting for our food I drank a large glass of iced water, then another. Then 2 glasses of iced tea. By the time our food arrived my nausea and headache had disappeared.  I felt better the rest of the evening. I had experienced mild heat exhaustion and slight dehydration and hadn’t realized it.

Most people think of heat related illnesses in the most susceptible group, infants and elderly. These two groups can have undeveloped or an impaired ability to thermoregulate in extreme temperatures. Which can make the susceptible.

 However, there are other factors that can make one susceptible to heat related illnesses.

1. Not being acclimated to the Heat

Air conditioning is a luxury that our ancestors didn’t have. Going from very cool temperatures to the outdoors where the temperatures are reaching triple digits can throw off our body’s thermal regulation.

2. Medications

Especially diuretics, which are designed to remove fluid from the body, can set one up for dehydration and subsequent heat exhaustion in a hurry. Other medications that can cause dehydration and subsequent heat exhaustion are antihistamines, beta blockers, antipsychotics, and tranquilizers. There are some drugs that can increase your body temperature such as Adderall and Ritalin. Illegal stimulants which include cocaine, ecstasy and methamphetamine are among the most common drugs that can raise your body core temperature.

3. A High Heat Index

The heat index is a single temperature value that considers how both the outdoor temperature and humidity make you feel. When the humidity is high, your sweat can’t evaporate as easily and your body has more difficulty cooling itself, making you prone to heat exhaustion and heatstroke. When the heat index is 91 F (33 C) or higher, you should take precautions to keep cool.

4. Obesity

Body fat acts like an insulator, somewhat akin to wearing a large coat in the heat.

5. Caffeine Consumption

Caffeine is a mild diuretic and can set you up for heat related problems.

6. High Humidity

Your body has difficulty cooling itself when the humidity is high since sweat isn’t able evaporate and cool your body.

The CDC has an excellent graphic of heat related illnesses- and what to do if you are experiencing symptoms:

Take precautions

Heat exhaustion can easily turn into heat stroke and become a medical emergency if steps aren’t taken to relieve symptoms and to move to a cooler climate. Heat stroke is a life-threatening emergency and immediate medical attention is essential. (see above graphic for symptoms)

Taking a few precautions can alleviate either of these heat related illnesses

  • Check with your local weather forecast where you will be spending time outside. Try to avoid being out in the heat of the day if possible.
  • Remember to pack water and sun protective hat if you plan on being outside during the heat of the day- usually between 10am -2pm. However, when an extreme heat advisory is issued, check the hourly temperature and humidity index.
  • Plan exercise during the coolest parts of the day and ace yourself.
  • Protect against sunburn- Sunscreen and protective, lightweight clothing, and avoiding the sun-Sunburn affects the body’s ability to cool itself.
  • Check your medications- there are many medications that can raise your body temperature or can make you heat/sun sensitive
  • Never leave anyone in a parked car, especially children and pets. Last year 23 children died in hot cars, Parked cars have been demonstrated to heat from 80 degrees to 123 degrees in 60 minutes.( in just 2 minutes the temperature went from 80 degrees to 94 degrees)
  • Choose lightweight, breathable clothing to wear in the heat
  • If you or anyone you are with starts showing signs of heat related illnesses get yourself or them into a cool building and treat appropriately or seek medical attention.

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6 Tips to Keep Your Medicines Cool and Safe From the Heat

*Note: Some of the content below is for general medication best practices while other tips are specific to the medication mentioned.

As the summer heat wave in most parts of the country rages on, and rolling blackouts threaten our grid and safety, one area of particular concern is heat sensitive prescription and over the counter medications.

Most medications need to be stored at room temperature (59-86 degrees F) and ideal humidity under 60% to maintain their strength and quality. Some, such as insulin and other hormone related medications require refrigeration after opening. Many medications lose potency when exposed to heat, and are not toxic or dangerous, however this alone can cause life threatening results for those using insulin, heart or respiratory medications.

6 Tips to keep medications cool and safe

  • Store in original container, out of heat and light. Bathroom or kitchen cabinets are ideal for this. If your bathroom or kitchen areas are too humid or hot, consider a bedroom closet shelf to store your medicines. In addition, ask your pharmacist if there are any special precautions or needed care when storing your medicine.
  • If you use a medication that needs to be refrigerated invest in a separate small cooler with ice packs to store your medication in. Do not use this bag for anything else other than refrigerated medicines. Only open the bag when necessary to maintain the cooler temperature. Medications that need be refrigerated should always be kept between 36° and 46°F. A TSA approved insulin pen cooler, which can last up to 74 hours may be a good investment
  • Use this same cooler for plane trips. Don’t check in medications, always carry on your medications. Temperatures in holding areas are not temperature controlled. Plus it is best to always have your medications with you when traveling (lost luggage, etc)
  • If traveling in a car with your medications, take them with you, don’t leave them in a hot car.
  • If you use mail order services for obtaining your medication, ask for heat resistant packaging or overnight delivery. Nitroglycerin is sensitive to environmental changes, and most patients using this are aware and have their pills exchanged on a regular basis. Thyroid hormones are also sensitive to excessive heat. Update: This tip is NOT relevant to the Jase Case or any antibiotics we provide.

A study done on Formoterol capsules (Foradil Aerolizer) , powder filled capsule used in an inhaler, was heated to 115 degrees F, the temperature of an Arizona mailbox, for 4 hours. The capsules were removed from packaging and dispensed into the manufacturers filter tube. Results showed that filter weights of heated medications were less than half of those unexposed to heat, showing that a significantly less amount of the drug had been dispensed after it had been heated. In addition, capsules exposed to heat were grossly distorted in appearance and showed visible clumping. Medication had stuck to the sides of the gelatin capsule. It would not have been available to the patient.

  • Treat your over the counter medicines the same way you treat your prescription ones. These medicines can lose their efficacy when exposed to excessive heat and humidity also (Tylenol, Aleve, etc).

As rolling blackouts and heatwaves continue this summer in many parts of our country, staying cool is more important than ever. In addition to keeping our bodies and food cool, remember medications, both prescription and over the counter require attention and preparation also.

 

 

 

 

Medications That Cause Sun Sensitivity

(And what to do about it)

Summer is in full swing, and with it many are outside, enjoying  outdoor activities and fun in the sun. While the benefits of being outdoors can not be underestimated, sun exposure when using many prescriptions and nonprescription medicines can result in sensitivity and skin damage.

Below is a list taken from the FDA of drugs that can cause skin sensitivity and skin damage when exposed in the sun.

According to the FDA:

  • Antibiotics -ciprofloxacin, doxycycline, levofloxacin, ofloxacin, tetracycline, trimethoprim)
  • Antifungals -flucytosine (Ancobon) , griseofulvin (Gris Peg) , voricanozole (Vfend)
  • Antihistamines -cetirizine (Zyrtec, Zyrtec Allergy, Children’s Zyrtec Allergy, Children’s Zyrtec Hives Relief, PediaCare Children’s 24-Hour Allergy, Aller-Tec, and Wal-Zyr), diphenhydramine (Benadryl, Genahist, Sominex, Unisom), loratadine (Claritin), promethazine (Phenergan), cyproheptadine (Periactin)
  • Cholesterol lowering drugs -simvastatin (Zocor), atorvastatin (Lipitor), lovastatin (Altoprev), pravastatin (Pravachol)
  • Diuretics- thiazide diuretics: hydrochlorothiazide Microzide, HydroDiuril, and Oretic), chlorthalidone, chlorothiazide.; other diuretics: furosemide and triamterene)
  • Non-steroidal anti-inflammatory drugs -ibuprofen (Advil), naproxen(Aleve), celecoxib (Celebrex), piroxicam (Feldene), ketoprofen (Actron)
  • Oral contraceptives and estrogens
  • Phenothiazines -tranquilizers, anti-emetics: examples, chlorpromazine (Thorazine and Largactil) promethazine, thioridazine (Mellaril Topper), prochloroperazine (Stemetil, Buccastem)
  • Retinoids (acitretin, isotretinoin)
  • Sulfonamides – sulfadiazine, sulfamethizole (brand name: Thiosulfil Forte), sulfamethoxazole (Gantanol), sulfasalazine (Azulfidine), sulfisoxazole (Gantrisin)
  • Sulfonylureas for type 2 diabetes- Glimepiride (Amaryl) Glyburide (DiaBeta; Micronase) Glipizide (Glucotrol)
  • Alpha-hydroxy acids in cosmetics

 

Below are some tips to enjoy the great outdoors while on any of the above medications:

Avoid Sun exposure

When outside, seek shade, especially between 10 a.m. and 2 p.m. – some organizations recommend as late as 4:00 p.m. Keep in mind that the sun’s rays may be stronger when reflected off water, sand and snow.

Wear long-sleeved shirts, pants, sunglasses, and broad-brimmed hats to limit sun exposure.

Use a broad sunscreen regularly and as directed. Broad-spectrum sunscreens provide protection against ultraviolet A (UVA) and ultraviolet B (UVB) radiation. An SPF 15 is the minimum number needed to provide measurable protection; however, a sunscreen with an SPF value of 30 or higher is recommended. Rarely, some sunscreen ingredients can cause photosensitivity themselves.

A Word About Sunscreens

Environmental Working Group (EWG) founded in 1990, is a 501C3 nonprofit that specializes in research and advocacy in the areas of agricultural subsidies, toxic chemicals, drinking water pollutants, and corporate accountability. They publish reports on various consumer products such as detergents, cosmetics, food and water safety, etc. They have published their 2022 sunscreen ingredient and testing list that tests sunscreen effectiveness and ingredient safety.

Their peer reviewed study, completed in Fall of 2021 of 51 sunscreens tested showed that many of these sunscreens did not protect as well as claimed. UVA radiation is found to cause skin cancer. SPF is the standard by which sunscreens make their claim that they provide protection against suns rays, however SPF only measures a small portion of the UV light spectrum. This is different than testing against the entire UV light spectrum.

In other words, SPF does not mean that you are protected against UVA cancer causing rays.

How to select an effective sunscreen

Look for a sunscreen that

  1. States it is a broad-spectrum sunscreen
  2. Has a SPF of 30 or greater
  3. Is water resistant or waterproof

EWG has published an up-to-date sunscreen lists for everyday use, safe for infants and children, sport and water activities and more. Check them out before purchasing new sunscreen.

By the way, you should always throw out and purchase new sunscreen every year.   Environmental Working Group approved sunscreens

If you have questions about your medications and the possibility of a photosensitivity, contact your health-care professional or pharmacists. Taking a few precautions can help limit your risk of photosensitivity and keep the sun shining on your fun.

 

Does Ciprofloxacin (Cipro) cause tendon rupture?

There is much concern, and rightfully so about the use and overuse of antibiotics. Antibiotics can be lifesaving when used in a prudent and appropriate manner. Overuse is still a concern and one that shouldn’t be taken lightly.

Black box warnings on one class of antibiotics

What is a black box warning?

Black box warnings are required by the U.S. Food and Drug Administration for certain medications that carry serious safety risks. Often these warnings communicate potential rare but dangerous side effects, or they may be used to communicate important instructions for safe use of the drug, in 2008 the FDA issued a black box warning for fluoroquinolones (FQ).

Fluoroquinolones carry black box warning

One class of antibiotics, the fluoroquinolones (FQ) (ciprofloxacin, levofloxacin, moxifloxacin, and others) have been associated with increased tendon ruptures. A tendon rupture is a partial or complete tear of a tendon. Tendons are tough bands of tissue that attach muscles to your bones. An example of a tendon is the Achilles tendon, which attach the heel bone to the calf muscles.

Fluoroquinolones (FQ) are among the most widely prescribed antibiotics in the outpatient setting, due to their broad-spectrum treatment of bacteria found in respiratory, urinary, joint, and skin infections.

A large study reviewing retroactive patient records was conducted between 2007 and 2016 with over a million subjects from the senior population age 65 and older. This study reviewed the use of FQ against other antibiotics and even similar drugs in the FQ class to assess tendon rupture occurrence.  Only one of the FQ antibiotics displayed a significant tendency to tendon rupture- between a 16% (rotator cuff) and fourfold risk (Achilles tendon). That antibiotic was levofloxacin. Neither ciprofloxacin-one of the antibiotics found in the Jase case- or moxifloxacin- which were part of the study- was found to increase tendon rupture.

Known risk factors for tendon ruptures

Risk factors associated with FQ-induced tendon disorders include age greater than 60 years, corticosteroid therapy, renal failure, diabetes mellitus, and a history of musculoskeletal disorders.

In addition, taking oral steroids increased the risk by 46-fold, and patients greater than 60 years of age who were recently treated with a FQ for 1 to 30 days were at a 1.5-fold and a 2.7-fold greater risk for development of tendon disorders and tendon rupture as compared to patients less than 60 years of age, respectively. Males are twice as likely to be affected as females as much as 2:1.

A study conducted with adolescents aged 12-18 from 2000-2018 which focused on the use of FQ and tendon rupture incidence concluded: The excess risk of tendon rupture associated with fluoroquinolone treatment was extremely small, and these events were rare.

Conclusion

There is much controversy and lack of reliable information on the black box warning of fluoroquinolones

From reliable studies there are a few conclusions we can draw:

  • Not all fluoroquinolones put patients at risk for tendon ruptures
  • Levofloxacin is the one FQ that does exhibit greater risk for tendon ruptures
  • Ciprofloxacin and moxifloxacin show no sign for increase in tendon ruptures
  • Risk factors for tendon ruptures include over age 60, taking corticosteroids, renal failure, diabetes, and history of musculoskeletal disorders. Males are 2x more likely to suffer tendon ruptures than females.
  • Adolescents are rarely at risk for tendon rupture when taking fluoroquinolones.