Consider first aid needs when planning remote travel
DEAR DR. ROACH: How is preventive medical care handled when an individual is traveling to a remote location? For example, I will be hiking this summer in a remote area with no medical care available (it would take three days to get to a doctor). Can a nonmedical person pick up prescription medication prior to the trip, just in case it is needed? A tick-bite antibiotic comes to mind as one example. -- K.S.
ANSWER: That's a hard question to answer without knowing a lot more about the area you will be in, your own medical expertise and the conditions you need to treat.
If you are going to hike in an area where Lyme disease is very prevalent, you should absolutely discuss with your doctor some strategies to prevent illness (e.g., protective clothing, tick repellant, daily tick checks), as well as consider taking along something in case prevention fails, like a single-dose medication treatment.
When my own patients travel to undeveloped countries, I offer advice about avoiding traveler's diarrhea, as another example, and a prescription for early treatment (to be filled and brought along) would be appropriate. The risk of contracting Malaria, yellow fever and many other diseases should be considered, and a travel medicine professional would be your best resource for that kind of trip.
I highly recommend a course on wilderness first aid for people who are taking trips where definitive medical care will not be readily available. A must is an appropriate first aid kit for your locale. Traveling with a knowledgeable person dramatically reduces risk compared with traveling alone.
DEAR DR. ROACH: I recently had a bone density test that showed my T-score is now -3.0. Two years ago, my T score was -2.5. My doctor is recommending Fosamax. She said that insurance doesn't cover Prolia very often. I'm confused as to which is the worst of the two evils. I feel like I've been given a no-win; both have nasty side effects. Is brain cancer a side effect of Fosamax? -- K.H.
ANSWER: Neither alendronate (Fosamax, a type of osteoporosis medicine in the class called bisphosphonates) nor denosumab (Prolia, which works similarly to prevent loss of bone tissue) is an "evil" medicine. Hip fractures are evil. Vertebral body fractures are evil.
The goal with therapy is to reduce the risk of osteoporotic fractures without side effects. In my opinion, bisphosphonates have the best evidence that they reduce fracture risk with a low risk of side effects when used correctly.
While there have been conflicting reports about a possible increase in the risk of esophageal cancer when taking alendronate or other bisphosphonates, the association is unclear. I have not read any evidence suggesting bisphosphonates or Prolia cause brain cancer.
Your T-score of -3.0 puts you at a dramatically higher risk of a serious osteoporotic fracture, and the risk of medication side effect is much lower than the risk of fracture if untreated. Most people in your situation do well with a standard treatment of taking a bisphosphonate for three to five years, followed by a re-evaluation of whether you need to keep taking therapy. Further therapy might be with a different class of medications.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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