Health | 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.

 

 

Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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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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On July 24th, 2022 Dr Tedros, Director-General of the World Health Organization declared Monkeypox a global health emergency. This declaration was escalated from a public health concern from last month’s meeting after the Monkeypox International Health Regulations (2005) (IHR) Emergency Committee failed to reach a consensus.

At a public follow up briefing on July 27th, Dr Tedros went on to outline his decision for this escalation, who is most at risk and how to reduce and prevent further outbreaks. The following is taken from the briefing

As of the date of the briefing:

1. There are 18,000 confirmed cases of Monkeypox

 

2. Of those cases 70% were in Europe and almost 25% in The Americas

 

3. 5 deaths reported

This calculates to a 0.000277% mortality rate. In recent times, the case fatality ratio has been around 3-6%.

4. 98% Monkeypox cases are of men having sex with men

 

5. Anyone can catch Monkeypox regardless of sexual orientation

 

6. 10% of cases were admitted to the hospital for pain management

 

Mode of Transmission
Monkeypox is spread by skin-to-skin contact such as kissing, intimate contact, close contact with respiratory droplets, hugging someone with blisters or other signs of infection, or handling contaminated objects or bedding. Unlike the Covid 19 virus, it is not airborne.

Incubation and Symptoms
Even though they are very similar viruses, Monkeypox is a less severe and less contagious virus than smallpox.

From exposure to incubation period
The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.

Symptoms
Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks.The symptoms are divided into 2 phases, before blistering rash and after rash appears.

Symptoms include
Phase 1(lasts between 0-5 days)

  • Fever
  • Severe headache
  • Swollen lymph glands (unlike smallpox, which doesn’t present with swollen lymph glands)
  • Lack of energy

Phase 2 is the skin eruption, which begins anywhere from 1-3 days after fever

  • 95% of cases have blisters on the face, 75% on palms of hands and feet. Other common areas of blister outbreaks are the inside of the oral cavity and genitalia, cornea and conjunctivae. The rash evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. The number of lesions varies from a few to several thousand.
  • Symptoms resolve within a 2–4-week period

An important side note is that even though chickenpox and Monkeypox are in the same genus and can present in very similar symptoms, chickenpox cases do NOT have lymph involvement. 
NOTE: The chances of contracting monkeypox are very slim, unless you are in one of the high-risk groups.

Symptom management

  • An antiviral drug,Tecovirimat is the first-line medication to treat monkeypox, including in children and adolescents. However, there are no clinical studies regarding safety and efficacy in pediatric populations. This medication reduces viral shedding and shortens the course of the disease.  
  • Pain medication is often prescribed for the intense pain that the lesions bring.

Steps to control outbreak
The WHO outlined the following steps to control and stop the outbreak:

  1. Decrease risk exposure in population affected the most, namely the men having sex with men population by reducing number of partners, disclosing to new partners names of previous partners, limiting, or stopping activities that could put either partner at risk.  Dr Tedros did point out that the stigma surrounding this population could prevent them from seeking medical care and that the stigma could ultimately be worse than the disease itself. 
  2. Exercise discernment and caution when exposed to populations most likely to transmit the virus.
  3. At risk populations- pregnant, very young, immune compromised-to exercise caution and maintain distance from at risk populations, avoiding handling bedding and close body contact.  
  4. Post exposure vaccination
    CDC recommends that the vaccine be given within 4 days from the date of exposure to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.
  5. Vaccinate to control the outbreak
     Dr Tedros states healthcare workers and those with close contact with the general population should get vaccinated. However, there is a limited amount of vaccine currently available.  Although vaccination against smallpox was protective in the past, today persons younger than 40 to 50 years of age (depending on the country) may be more susceptible to monkeypox due to cessation of smallpox vaccination campaigns globally after eradication of the disease
    Dr Tedros discussed two vaccines:
  • MBA-BN  vaccine ( JYNNEOS)- Approved in U.S., Europe and Canada- FDA approved MVA-BN (September 2019) for use in adults aged ≥18 years (including immune compromised individuals) at high risk for smallpox or MPX infection. There are 16 million doses globally of the MVA-BN in bulk, these doses would need to be divided into vials for distribution.
    According to the CDC:
    “Because Monkeypox virus is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting monkeypox. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox. The effectiveness of JYNNEOS against monkeypox was concluded from a clinical study on the immunogenicity of JYNNEOS and efficacy data from animal studies.”
  • LC 16 and ACAM 2000 is being considered but lacks data on efficacy and can take several weeks to work. This vaccine is not approved for the public. ACAM2000 cannot cause smallpox; it does not contain the smallpox virus, but rather the “live” vaccinia virus – not dead virus like many other vaccines. Because of this, the injection site can spread a live virus. It is part of the Strategic National Stockpile (SNS) and is given to military personnel. According to the CDC: In certain groups of people, such as people with serious immune system problems, complications from ACAM2000 vaccination can be severe.

As stated before, the risk of contracting Monkeypox remains very low unless you are in the at-risk group or are exposed to the at risk group. 

We will continue to monitor the situation as it unfolds and provide the most up to date information available.

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Planning on Traveling? Tips to Avoid Motion Sickness

Planning on Traveling? Tips to Avoid Motion Sickness

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Lifesaving Medications

Everyone should be empowered to care for themselves and their loved ones during the unexpected.

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.