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DEAR DR. ROACH: I get all of my medicine by mail. Since the manufacturers stress keeping the pills at cool room temperatures, I wonder what the excessive heat does to them. The medicine must cook all day in the mailbox – way over 100 degrees here in Florida. I wonder how much the pills or liquids are deteriorating, and how the effectiveness is influenced. – F.N.
ANSWER: You are right to be concerned. All medicines should be stored in a cool and dark place, as direct sunlight and heat can damage their effectiveness. Hormones, such as oral contraceptive pills, thyroid hormone and insulin, are among the most sensitive. Nitroglycerine is as well. Although some are shipped in packaging with cold packs and insulation, that’s not always the case.
I recommend using a local pharmacy, but many people have prescription plans that require them to use mail order. If that’s the case for you, try to make sure the medicine will be delivered when you are available to receive it. If you have a temperature-sensitive medicine, such as the ones I mention above (ask your pharmacist about others), ask your mail-order pharmacy to send it in special packaging during warm-weather months.
DEAR DR. ROACH: I am a 68-year-old male. I had triple bypass surgery two years ago. Post-surgery complications included diabetes, pneumonia and renal failure. I spent approximately three months in intensive care. After discharge I started physical therapy, as my arms and hands had atrophied. I am still doing therapy, but continue to have limited use of my arms and hands (I cannot curl my hands without force). Any insight you have as to why I am unable to use my hands would be appreciated. – C.M.
ANSWER: Muscle weakness is common after an ICU stay (it’s seen in more than 25 percent of patients), due to several separate causes. Prolonged immobility can lead to weakness, atrophy and even contractures (involuntary bending at certain joints, such as the elbow and ankle). Both critical illness myopathy (affecting muscles; it’s common in people who received steroids, like prednisone) and critical illness polyneuropathy (affecting nerves; it’s common in people with severe infection, like sepsis) can lead to weakness and atrophy.
Medications are sometimes needed to paralyze muscles in surgery or in critical illnesses, and these can have long-lasting side effects, including weakness. Malnutrition is common in ICU patients, not because ICU doctors and nurses don’t know to or don’t want to feed patients, but because the body may be unable to absorb necessary nutrients. Some or all of these may combine to leave lasting physical effects from a long ICU stay.
Physical and occupational rehabilitation services are the key to the recovery of function. Return of physical strength is slow and may be incomplete, so it may be necessary to use aids and to learn new ways to perform tasks. It has been my repeated experience that almost everyone can benefit from therapy, and patients who work harder, are more driven and are more optimistic tend to have the best results. Although most benefit is seen in the first year after loss of function, you still may continue to improve with therapy, perhaps utilizing different modalities. Definitely seek an occupational therapist if you haven’t already.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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