Greetings, Dr. Roach A three-week journey to South Africa and three other neighboring countries is what my wife and I are organizing. We conducted a trial run of four tablets each of the antimalarial medication Malarone, which we must take for 26 days. My wife experienced extremely itchy skin on her head, ears, and upper body shortly after our first dose, and this condition persisted for several days after we finished the four pills. The itching did not cause rashes or hives.
Although itching is mentioned as a typical side effect, we are really worried that this could develop into a more severe reaction, such anaphylactic shock. Is this likely, in your opinion? In the event of a more severe reaction, would it make sense to carry an epinephrine pen? Alternative antimalarial medications are not particularly effective. — No name.
ANSWER: In regions where other medications are not effective, malarone is one of the first-line options for preventing malaria. For most people, it is both safe and effective. Serious responses like anaphylaxis are extremely uncommon, and up to 10% of people may suffer the itching your wife did. An epinephrine pen is not required, in my opinion.
Mefloquine was a widely used malaria preventative drug prior to the development of Malarone. Many persons taking this medication experienced bizarre dreams.
Lastly, I question whether your calculations are correct. We advise beginning Malarone two days before departure and continuing for a week after returning home, so if you will be in malarial areas for precisely three weeks, it is 30 days.
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Greetings, Dr. Roach At seventy-four, arthritis is starting to show its ugly head. I use Tylenol for pain because I had gastric bypass surgery. I was warned against using NSAIDs due to potential stomach problems. Could you suggest any safe, non-opioid painkillers that can manage these aches? — M.J.
ANSWER: Pain management is never flawless. During a comprehensive pain management program, we make due with the medications we have on hand and occasionally turn to non-pharmacologic therapy and alternative medications. Despite being helpful to many, acetaminophen (Tylenol) is frequently insufficient. There are a number of additional therapeutic options to think about, specifically for arthritic pain:
The most crucial, in my view, isn’t even a medicine. The primary line of treatment for mild to moderate arthritis is regular exercise. Because they believe that exercise is the cause of their arthritis, which is probably not the case for most people, many people with arthritis are reluctant to exercise. The majority of arthritis is not brought on by or made worse by activity, however it can develop following joint trauma. In actuality, a regular exercise program improves tolerance to exertion and reduces pain and impairment.
Topical nonsteroidal anti-inflammatory drugs (NSAIDs), such diclofenac gel, are safe for people with stomach problems and can help some people who have discomfort in their hands, wrists, elbows, and knees. Certain antidepressants, including duloxetine and amitriptyline, lessen discomfort but may not completely eradicate it. Gabapentin is one of the effective medications for seizures.
To help with their arthritis, many of my patients take vitamins. Supplements that show some effectiveness include S-adenosyl methionine, Boswellia, turmeric (or curcumin), and glucosamine/chondroitin. All of these supplements are widely regarded as safe, although a large portion of their benefits are due to people expecting them to work (a placebo effect).
Finally, for those with more severe arthritis who don’t react to previous treatments, nerve blocks and even surgery may be an option.
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
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