How I Travel With Medication

Due to the autoimmune disease Crohn’s, I travel with the medication Humira and use the pre-filled pens twice a month. Humira is an injectable biologic (genetically engineered protein) that blocks inflammation and is used for treating a number of autoimmune diseases. Any kind of traveling with this type of medication can be a pain in the butt because it must be stored at 36 to 46 degrees Fahrenheit. But having to deal with this inconvenience is not going to keep me from living my life as I choose; and right now, I choose to live my life as a full-time traveler.

I have found one must be creative when traveling with refrigerated medication. Long travel days with layovers and such, or no in-room refrigerators can be frustrating. But I have found many people to be quite understanding and helpful in keeping my medication cooled within range. I have given my medication and gel-packs to complete strangers to store even though I can't monitor the temp. On layovers at airports, I extend the time my medication can travel safely by going to one of the lounges or bars and asking them to freeze gel-packs and refrigerate the pens. If they can, they are more than accommodating. In Barcelona, the hotel freezer quit so my gel-packs were not frozen when I was leaving for a long travel day. I found some ice, loaded zip-lock bags and filled my cooler. We were not flying so the ice was no problem. But what would I have done if we were flying? I would have found a restaurant or bar willing to help prior to takeoff, and once on the plane, I would either ice it down or the airline attendant would have refrigerated it depending on the airline’s restrictions.

It helps to keep an open mind and sense of humor anytime, but becomes even more important when traveling with refrigerated medication. Am I worried about keeping the temperature range? Absolutely not! Otherwise, I'd be a nervous wreck and I wouldn’t travel! I try and have a sense of adventure and look at any glitches as a learning opportunity for future travels. I can’t predict all potential problems and I don’t worry about not always being able to monitor the temps. I trust it will be okay. I’m sure you have a lot of what ifs going through your mind, so let’s cut to the chase, what’s the worst that can happen - if the medication is spoiled, damaged, or lost? If that is ever the case, I know I’ll take charge of the situation and sort it out. Pain in the butt, you bet. But I'm willing to deal with it so I can keep myself healthy and enjoy my traveling lifestyle.

I have been asked by a number of people how I manage traveling with this type of medication, so for those who would like to understand more, read on...

• Receiving medications: My health insurance allows me to have up to 3 months medication and my mail-order prescription company will send them to me anywhere in the United States. When out of the country, I must travel with whatever medication I may need for the time I’m gone, and fortunately my health insurance allows me to order one vacation override per year. That has covered the number of pens I have needed.
• Gel packs: Humira is shipped with gel-packs. I always keep a few in a freezer with someone at our home base. These are much easier than traveling with ice because they don't turn to liquid when they melt, and with a good insulated cooler can last for at least 18 hours in the proper temperature range.
• Monitoring temperature rage: I can monitor the temp by carrying a wireless thermometer. The sensor is kept along with the Humira pens and the small readout device fits easily into a very small compartment in whatever else I may be carrying. It’s also handy to monitor refrigerators before storing my meds. I find most hotel and home refrigerators are not in the correct range for the food even if they are currently storing food! Nevertheless, I adjust the temp and keep an eye on the monitor.
• Insulated coolers:
• Thermoelectric Cooler: When driving around North America I use a Koolatron cooler that plugs into a car battery, and has an AC adaptor if necessary for motel rooms without refrigerators. It's an easy way to store medication on long drives - particularly when it is warm outside. I can also add refrigerated or frozen gel-packs for when the car is not running.
• Insulated Cooler: Polar Bear coolers work well along with 2-4 gel packs.
• Air travel and airport security: There are strict guidelines for flying with carry-ons but medications are considered essential carry-on items. Even so, every time I fly I check restrictions prior to flying. Any medications or supplements we carry are labeled, and I carry more extensive information regarding prefilled injection pens in case there are any questions. Most of the time I'm asked by security screening personnel to open the cooler so they can insure nothing will leak. I keep each gel-pack in zip-lock bags for this reason even though Polar Bear coolers do not leak, but try explaining that to security! I’d rather not have to open the cooler as it lets the cool air escape and reduces overall storage time, but I have no choice in this matter either. And believe me, I’ve tried!

Michelle

Finding Space

On a recent crowded hike at Zion National Park, I felt pushed as people were constantly coming up from behind and we were constantly moving over. Then when we would want to stop and refresh ourselves with water, the slower folks would pass us and then we would again have to pass them. After a while it reminded me of the children’s game of leap-frog which, quite frankly, I never cared for. I was about ready to turn around and head back down to the car - even though I knew we were not far from our intended destination of Upper Emerald Pool. I sent my husband, Dennis, ahead as well as numerous groups, and finally there was a huge gap. I enjoyed my little space of quiet. Seems most people these days jabber constantly while hiking rather than listening to the surrounding natural environment, but I digress. Up ahead I saw a large squirrel enjoying what looked like a dust bath. I didn’t make a sound or move because I wanted the squirrel to finish what it was doing. It rather looked as if it were swimming in the dusty trail. Then a group walked towards the squirrel, I pointed to the squirrel and they stomped by nodding and smiling my way as the squirrel scampered away. As I walked to the area where the squirrel had been, I noticed it cleaning itself off not far from the trail. About that time, my peace and quiet ended abruptly as I saw more groups catching up behind me. The first person passing me was a girl who was about ten years old. I pointed to the squirrel and she slowly walked up, saw the squirrel then shrugged her shoulders and screwed up her face. Then the rest of her family passed me by jibber-jabbering along with many other groups. My idea of hiking is to get out into nature and engage my senses while enjoying the diversity of the area I am visiting, but I digress once again. As I continued up the trail, I wondered why some of the people were even on this hike.

When I arrived at Upper Emerald Pool, everyone was around the pool – playing, resting, or having a bite to eat. I had noticed a rainbow shining in the small waterfall spilling into the pool when I was coming down the path, but when I got closer to the pool there was no longer a rainbow. So not wanting to hang with the crowd, I hiked up and out of the way of everyone else and found a continuous rainbow shining over the waterfall. I was the only one above the pool enjoying this lovely rainbow, but soon Dennis joined me, and of course others began migrating our way - time to head back down the even more crowded trail.

On the way down, we passed a young family trying to make their way up the trail. There was a boy of around 5 and his 4-year-old sister. The boy had started to complain about the hike as we were passing them. I stopped and said, “It’s okay, it’s not so bad. And when it seems like it’s too hard, just remember that there is a rainbow at the end of the trail.” The little girl’s eyes got big and the little boy stopped complaining. Their mom told me I knew just what to say. This encounter made me smile and consider my own thoughts about the hike.

Had I turned around and gone back to the car one of the many times I had considered it, I would not have seen the rainbow at the end of the trail. If I’m not enjoying myself, it is up to me to make the choice to either put up with whatever it is and not allow myself to fuss and fume, or to somehow make the necessary changes that might make the difference in my day. I couldn’t change the fact all of humanity seemed to be on the trail that morning, and that they all seem to be so set on the destination they failed to see what was going on around them. Once I figured out that I just needed some space, I found the space and could move forward and enjoy the rainbow at trails end.

Michelle

Finding space photo courtesy of DaMClark's

Eating to Live: Water the Driving Force

“Water is the driving force of nature”

 Leonardo da Vinci

I do what most people probably do first thing in the morning-I head to the bathroom. While sitting on the throne, I begin my day by rehydrating with a 10 ounce glass of water. I drink it slowly and allow my body to soak up its goodness, but this is not how I always felt about drinking water. I had my first bladder infection over thirty years ago. My doctor told me I should consider drinking more water. Up until this point I really didn't care for water and never gave a thought to how much I drank during the day. After the painful bladder infection I was determined to start a new water habit.

We have all heard at one time or another that we need to drink 8 glasses of water a day, but what size of glass? I found a glass refers to 8 ounces. So I began trying to work 64 ounces of water into my day. I decided I should start with a glass of water first thing each morning, because I read that after sleeping 7 or 8 hours we begin the day dehydrated. That was an easy habit to get into-10 ounces down, 54 to go! I worked in an office with a ladies restroom down the hall. By the second day of my hourly trips to the bathroom, Gloria, the secretary, popped her head out of her office and asked me if I was feeling okay. I told her what I was doing and she pointed to her desk. There sat a tall bottle of water. She mentioned my body would get used to drinking water after two weeks and I would not be making so many trips to the restroom. She also mentioned she always had water with her, kept track of how much she was consuming, and that she wrapped up her water drinking before 7 or 8 pm so she wasn't up all night. The next day I had a bottle of water sitting on my desk and it followed me throughout my day. Gloria was right, after about two weeks I no longer made hourly trips to the ladies restroom.

By drinking water on a regular basis I started noticing a number of improvements over a short period of time:

• My skin, hair, and nails were not as dry.
• My face looked revitalized.
• I slept better at night.
• I carried less water weight-go figure! But the fact is, drinking water flushes toxins out of the body.
• My body physically felt better-almost as if I finally had what my body needed!
• I felt more refreshed.
• I got extremely thirsty if I was behind on my water intake, which was not something I noticed before my new water habit.

Interesting facts:

The body contains 55% to 78% water depending on your body size.

Our bodies can lose approximately 68 ounces of water through normal bodily functions. It just makes sense to replace what we lose each day.

Drinking alcohol, caffeinated beverages, or taking various prescription medications is dehydrating so you might consider drinking that much more water to offset the dehydrating effects.

Most people are in a state of dehydration which can lead to a number of health related issues. Because of that fact, we should all be aware of the following:
As part of the blood workups for physicals a CMP (Comprehensive Metabolic Panel) is done. This test covers many different levels including Estimated GFR (kidney function). Recently, I have known more than a few people with a Stage 4 flag on their blood workup. Stage 4 indicates possible kidney disease and advises nephrology (kidney specialist) consult, Stage 5 is kidney failure. And, of course, their doctors told these patients they needed to see a kidney specialist. BUT, before seeing the nephrologist (which can take 6-8 weeks) and after sharing their concern with me, they began drinking 40-60 oz. of water a day for 6 weeks. They asked their regular doctor to recheck their eGFR, and they no longer needed to see the specialist! A one-off test does not make something wrong, and on my blood lab results for eGFR it states that a single determination is not considered diagnostic. Had these people gone to the nephrologist, it would have meant an appointment or two with more tests when all these people needed to do was drink more water, AND continue to drink water on a regular basis! Most general practitioners and internists are willing to work with you if you have a reasonable plan of action (if not then you are going to the wrong doctor). Obviously, if more eGFR testing shows Stage 4 it definitely is time to see the nephrologist.

Over the years they have told us how much water to drink, and they have told us we don’t need to drink as much water as they originally told us. Who knows? Like so many other things they say, we need to figure out what makes sense and works for us. All I know is I feel better when I am consuming around 60 ounces of water a day. I am a driving force in my life and it all starts first thing in the morning with a glass of water. How much water do you drink in a day? Are you willing to allow water to be a driving force for change in your life?

Michelle

Splash photo courtesy of Shawn Harquail

Intimate Apparel

How does one go about leaving their bra at a Big 5 Sporting Goods store? It’s quite easy, really... It was time to replace the worn-out swim suit I use for lap swimming. I thought it would be an easy undertaking in the land of many swimming pools near Palm Springs, California, where we were going to spend the month of March. I would be wrong in that thought. There were plenty of resort wear shops selling nothing but resort wear style swimsuits. When I popped into one, the sales gal looked at me like I had swallowed a frog and said, “Oh, honey, this is a resort wear shop! You might want to look at one of those sport stores in the area.” Now, that may be fine and dandy, but what I have seen previously over the years at sporting goods stores is a very limited selection and not suitable for a serious lap swimmer.

On my first stop at a Dick’s Sporting Goods I found just what I expected to find - not what I was looking for. A few days later, I stopped at a Big 5 Sporting Goods. Low and behold they had a few suits worthy of trying on. I had worn a little summer dress I normally do not wear a bra with, but on this occasion, I thought it necessary to wear one. I tried on several suits that day and found one that fit, purchased it, and went home. As I was dressing the next day, I was unable to find my bra and began looking through my travel bags, on door knobs, hooks, and behind furniture. No, I don’t normally fling my bra around, but one never knows when searching somewhat desperately for an item. Then I got to thinking about the last time I wore it. Aha! I remembered taking it off at Big 5 and hanging it on the end of one of the swimsuit hangers. I was not happy about this revelation whatsoever, but, oh well, so it goes. 

When I got to thinking more about my lost bra and what the staff at the store might think when they found it, I thought it was the kind of funny story I should share with my sister so I called her. We both had a good laugh, but she wanted me to call the store. I told her they might think I walked off with one of their swim tops, and it just wasn't worth the hassle. But she was insistent, which got me wondering where my bra might have ended up.

I called Big 5, talked to Armando, he didn’t seem to think my story odd, he looked for said bra, and he took down my phone number in case they found it. A couple days later I was near Big 5, stopped in, walked to the swimsuits, looked on the inside of the racks, and noticed my navy-blue bra strap right away. I grabbed the hanger with the navy blue swimsuit and my navy blue bra still hanging from it then walked to the cashier. I held up the hanger and told her that I had left my bra here a few days ago when I purchased a swimsuit. A young man standing near her exclaimed, “Michelle, where did you find that?” I said, “Armando!? The cashier then needed to hear more of the story as Armando said, “That - is not - a bra. I was looking for a BRA! You know?” As he held his hands way out in front of his chest. I told him my husband had asked me if I had mentioned what the bra looked like. Other than it was navy-blue I had not said anything about there being no cups. Now, no cups versus cups makes my blue bra look like a two-piece swim top, and that was why I had stopped into the store. I walked out of Big 5 twirling my cup-less blue bra with a big smile on my face.

I tell this rather personal, but funny little story because I love not worrying about what other people may think about me, I love that something like this can happen and I can be so blasé about it that I can just walk right into a store, share a possibly embarrassing intimate apparel story with a young man, and leave the store twirling my bra. You know, sometimes, or should I say most times, we just need to get out of our own way and twirl that blue cup-less bra.

Michelle

Some bras photo courtesy of Almost Michelle

Pressures Rising

QardioArm app start window on my phone, QardioArm in place for pressure reading,

history window on my phone, device ready to travel...

Taking care of myself is a top priority in my life. It helps me be the best I can be in whatever I am doing. While I do a good job of taking care of myself normally, our gypsy lifestyle can make it a bit more challenging. That's where creativity and adaptation help me learn a few new tricks along the way.

Case in point: Prior to being a full-time traveler, I tracked my blood pressure (BP) on a regular basis. Not because I had high blood pressure, but to show my doctor I did not need medication for high blood pressure. You see, I have white coat syndrome (white coat hypertension). In other words, my blood pressure rises as soon as I enter my doctor’s office. 

Last year when I went to Europe for four months, I didn't pack my BP monitor simply because my blood pressure is stable and packing light does not include my bulky BP monitor. I had thought I would occasionally follow up on monitoring somewhere along the way in Europe, but I did't realize it would be difficult finding BP monitoring stations in European pharmacies. When I arrived home, I was due for my annual physical, and once again my BP was sky high and continued to rise throughout the subsequent checking during the appointment. While my doctor didn’t exactly care for the readings, I told him I would be more vigilant in taking my own readings as I had previously been, and we could address the issue on a follow up appointment unless the monitoring showed a significant problem before then.

I did some research and tried a simple lightweight BP wrist monitor. But here’s the thing, the readings were always high. I checked the readings against my bulky reliable monitor and the wrist monitor wasn't correct. After more research I found this can be common with wrist monitors. I returned the wrist style and purchased a wireless QardioArm that works with an app on my iPhone and iPad. I wear it above my elbow on my left arm as I did with my old monitor. The device weighs 10.9 ounces and is 2.7 x 1.5 x 5.5 inches. It is much smaller and weighs half as much as the monitor I had been using. It triple measurement averages and shows heartrate with irregular heartrate detection, which is what I’m used to seeing from my old monitor. It’s easy to set up and use, but moreover validates the readings I had previously recorded on my old bulky reliable.

Consider this scenario: I go to the doctor and have not been monitoring my blood pressure on a regular basis, he sees rather high readings and notes those high readings from previous visits, then proceeds to prescribe medication for a problem I may not have! It’s up to us to be proactive in our health and work with our doctors as a team. Don’t leave your doctor hanging out there with limited information because you don't take the initiative for your own health. In the long run, taking medication you don’t need, or should be taking more of or less of, can lead to catastrophic health issues!

When I see my doctor next time, I’ll be able to show him the QardioArm history on my phone. And even though I'm traveling full time, QardioArm will help me stay on top of my health without adding pressure.

Michelle

QardioArm photo courtesy of DaMClark's