Dr. Kieth Roach
                                Contributing columnist

Dr. Kieth Roach

Contributing columnist


DEAR DR. ROACH: I am concerned, and have been for some time, about whether my prescriptions that arrive by mail are compromised, since they sit in vehicles with the sun beating through the windows, heating them up.

Also, the plastic bottles in which the prescriptions are stored give off toxic emissions as they “broil” in the sun. The instructions that come with some of the meds warn about heat as well.

My pharmacist told me that heat does affect a medication’s effectiveness negatively. So, if this is true, millions of us are taking important medications that are basically not doing the job. After all, the meds that arrive at pharmacies come in hot vehicles, too. What’s your take? — J.Z.

ANSWER: All medicines should be stored in a cool, dark place, as direct sunlight and heat can damage their effectiveness. Studies have proven that medicines sent by mail order can indeed get out of their published temperature range. While this happens most often in mailboxes, I understand your point about medications “broiling” in hot temperatures during the shipment itself.

Liquid medicines, hormones and nitroglycerin are among the most sensitive. Medicines that need to be dosed exactly, such as transplant rejection medicines, biologicals, and seizure medicines, are also particularly likely to cause problems if they are damaged during shipping. Although some medicines are supposed to be shipped in packaging with cold packs and insulation, this isn’t always the case.

I recommend using a local pharmacy, but many people have prescription plans that require them to use mail order. Many states have requirements about customers using retail pharmacies. If that’s not the case for you, try to make sure that 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 (you can ask your pharmacist about others), request that your mail-order pharmacy sends it in special packaging during warm weather. You might also consider having them shipped to a place where they will be put into a temperature-controlled environment right away.

Weight loss fom bronchiectasis is common

DEAR DR. ROACH: Since I developed bronchiectasis, I have lost 15 pounds. I can’t seem to get an answer as to why this disease would result in weight loss. Can you shed any light on this? — E.K.G.

ANSWER: Bronchiectasis is a lung condition similar to chronic obstructive pulmonary disease (COPD). It develops after a lung infection occurs in a person who is at risk due to a number of possible underlying conditions.

Weight loss with chronic lung disease, like COPD and bronchiectasis, is common. There are many possible reasons. One is that breathing can be hard work! It takes extra energy (as much as 10 times more energy) to breathe with chronic lung disease. Some medications used for bronchiectasis promote weight loss, often through poor appetite. Bronchiectasis is an inflammatory condition, so this can also lead to appetite suppression.

Although many healthy people want to lose weight, losing weight with chronic lung disease is a bad sign and a reason to make some dietary changes. I’ve often advocated for nuts and nut butters; the healthy fat in them contains a lot of calories, and fat is easier on your lungs, since it makes less CO2 than protein or carbohydrates. You also need to maintain muscle strength.

Finally, a new serious diagnosis always leads to a change in how we think of our bodies, so depression (which often exacerbates weight loss) is not uncommon. Your doctor or a mental health professional can help.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].