DEAR DR. ROACH: I’ve been worried for some time whether my prescriptions that arrive in the mail are compromised because they sit in vehicles with the sun beating through the windows and heating them up. Additionally, the plastic bottles in which prescriptions are stored release toxic emissions when they burn in the sun. Instructions that come with some medications also warn against heat.
My pharmacist told me that heat negatively affects the effectiveness of medications. So if this is actually happening, millions of us are taking major medications that are basically not doing their job. After all, medicines that arrive in pharmacies also arrive in hot vehicles. What do you think ? –JZ
ANSWER: All medications should be stored in a cool, dark place because direct sunlight and heat can affect their effectiveness. Studies have proven that mail-order medications can actually fall outside their published temperature range. Although this happens most often in mailboxes, I understand your point regarding high temperatures during the mailing itself.
Liquid medications, hormones and nitroglycerin are among the most sensitive. Medications that need to be dosed precisely, such as transplant rejection medications, biologics, and seizure medications, are also particularly likely to cause problems if damaged in transit. Although some medications are supposed to be shipped in a package that includes a cold pack and insulation, this is not always the case.
I recommend using a local pharmacy, but many people have prescription plans that require them to use mail order. Many states require customers to be able to use retail pharmacies. If this is not your case, try to ensure that the medication will be delivered when you are available to receive it.
If you have a temperature-sensitive medication, like those mentioned above (you can ask your pharmacist for others), ask your mail order pharmacy to send it in special packaging during hot months. You may also consider having them shipped to a location where they will immediately be placed in a temperature-controlled environment.
DEAR DR. ROACH: Since I developed bronchiectasis, I have lost 15 pounds. I can’t understand why this disease would cause weight loss. Can you enlighten us on this? – ECG
ANSWER: Bronchiectasis is a lung condition similar to chronic obstructive pulmonary disease (COPD) and develops after a lung infection occurs in a person at risk due to a number of possible underlying conditions.
Weight loss associated with chronic lung disease, such as COPD and bronchiectasis, is common. There are several possible reasons. The first is that breathing can be hard work! It takes more energy (up to 10 times more energy) to breathe in chronic lung disease. Some medications used for bronchiectasis promote weight loss, often due to a lack of appetite. Bronchiectasis is an inflammatory disease, so it can also lead to appetite suppression.
Although many healthy people want to lose weight, losing weight due to chronic lung disease is a bad sign and a reason to change your diet. I have often advocated nuts and nut butters; the healthy fats they contain are high in calories, and fats are easier on your lungs because they produce less CO2 than proteins or carbohydrates. You must maintain your muscular strength.
Finally, a serious new diagnosis always brings a change in how we view our bodies, so depression (which often exacerbates weight loss) is not uncommon. Your doctor or a mental health professional can help you.
Dr. Roach regrets not being able to respond to individual letters, but he will incorporate them into the column as much as possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu or mail to 628 Virginia Dr., Orlando, FL 32803.
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