Purchasing supplements in the US…

Tom has been taking this supplement for 18 years to prevent kidney stones. It has worked well for him. If you have kidney stones, please see your doctor for advice on this supplement.

This morning I placed an order for supplements we use, enough to last for the next four months or so. There’s no question about it. It is expensive for most items in the US. When we return to the US in September, we can restock until we return to Marloth Park nine months later, where they cost less.

When purchasing these same vitamins in South Africa, different but reliable brands, we spent about 40% less. The best pricing I could find for brands I trust in the US was from Puritan’s Pride.

6 Items: $196.12
Puritan’s Perks Points: 1,961 
Vitamin E-200 iu Mixed Tocopherols Natural
100 Softgels / Item #450 (2 bottles)
Low Dose Aspirin 81 mg
240 Tablets / Item #595 (1 bottle)
Vitamin B-6 (Pyridoxine Hydrochloride) 50 mg
100 Tablets / Item #1160 (1 bottle)
MK-7 Vitamin K2 90 mcg
60 Softgels / Item #22011 (2 bottles)
Krill Oil Plus High Omega-3 Concentrate 1085 mg
60 Softgels / Item #34783 (3 bottles)
Ubiquinol 200 mg
60 Rapid Release Softgels / Item #50096 (3 bottles)
Some items were listed as “buy 1, get 2 free.” But the single bottle’s price was higher to allow for the “2 free,” preventing them from being much of a bargain. I didn’t fall for this trickery, but I otherwise trusted this company’s products and decided it was an excellent place to spend almost US $200 on supplements.
Why do we take supplements? Tom takes B6 three times a day but has enough on hand to last with this one bottle added to his current supply until we return to the US in September. After having three kidney stone surgeries over three consecutive years, the doctor told him some people had success with B6. Why didn’t he tell Tom this after the first surgery?
He’s been taking 50 mg B6 three times daily for the past 18 years and has never had a recurrence. I take all of the remaining supplements listed here, which are documented in medical studies as having some benefit to those with arteriosclerosis. I did tons of research to discover these studies and feel confident they may have some benefit.
Besides the above, we both take 2000 mg of Vitamin D daily, and I take magnesium which is also good for the heart. One never knows if supplements are working since it’s too difficult to monitor. Please contact your medical professionals before adding any supplements to your diet in case interactions may result if taken with certain prescription medications.
While in South Africa, with the help of the fantastic pharmacists in Komatipoort,  they cross-checked all the supplements I take with the few prescription medications I am taking, giving me peace of mind. We’ve noticed that US pharmacists aren’t willing or able to provide medical advice.
The pharmacists in the US are behind enclosed areas, and when we asked for assistance, they told me to check with a doctor or refer to the various aisles with over-the-counter products. Every country has its rules regarding how much pharmacists can be involved with their customers. I guess it’s a liability issue in the US, whereas, in South Africa, there aren’t as many stringent regulations and resulting lawsuits.
In some countries, many otherwise prescription medications can be sold without a prescription, as occurred when we were in lockdown in India and I developed a tooth abscess. I purchased the necessary antibiotics to treat the condition by ordering them through the hotel’s reception desk, and they were delivered later in the day, no questions asked.
As for today…it’s movie night, and late this afternoon, we’ll head out to Lake Sumter Landing to the Old Mill Playhouse for the movie starting at 6:00 pm and to meet up with Linda and Burt. We still have Karen and Rich’s vehicle for five more days so that we can drive. Once Tom picks Rich up at the airport on Tuesday, May 30, and returns the car to him, we’ll return to using the golf cart. That’s fine with us.
Be well.

Photo from ten years ago today, May 25, 2013:

This AED 282.45 translates to US $76.91, an excellent price for all these items. For details on everything we’d purchased today, see the list at the end of this post. Please click here.

Warning to all tourists taking prescription drugs…Could result in a Costa Rica nightmare…

Yesterday we shared a photo of an Owl Eyed Butterfly, and today, we have a winking Barn Owl.

“Sightings from the Veranda in Costa Rica”

Ulysses was creating a perfect trim on the hedges at the villa.

After yesterday’s scathing tongue lashing on Monday’s less than a pleasant attempt at renting a car, we hesitated to go down a somewhat negative path two days in a row.

For the majority of tourists, today’s post will have little significance. You book a vacation/holiday in Costa Rica, staying at a resort for a week or two. If you take prescription meds, you bring along a sufficient amount for your entire stay. If innovative, you bring enough for an additional few weeks in the event of some mishap or delay in returning to your home country as initially planned.

Creatures in Costa Rica are colorful, including this massive spider in her web.

However, suppose travelers like us plan to stay for an extended period. In that case, it’s an entirely different scenario when no prescription drugs (including non-narcotic meds) may be shipped into the country. Also, no vitamins or supplements may be shipped into Costa Rica and will also be confiscated.

Why is this? These are stringent drug laws, coupled with Costa Rica’s intent to create a revenue source from selling their prescription medications in the local and chain pharmacies. As a result, other than prescribed narcotics, mood-altering, or brain function medications, most medicines are sold over the counter without a prescription.

I take low doses of three non-narcotic meds for the following conditions (bad genes); hypertension, thyroid, and a hormone…fairly innocuous items, all typically requiring prescriptions from a doctor in the US.  (Other country’s laws may vary).

It was frustrating, taking photos through the fences, but these birds weren’t ready to return to the wild after their rehabilitation.

When I noticed my supply dwindled these past months, I decided to purchase over these next few months from ProgressiveRX, where I’ve been buying refills regularly over these past five years through their online service, comparable to buying from any online pharmacy in Canada.  

Easy as always? So I thought. This has never been an issue in any country in which we’ve lived over these past years. So I’d make the online purchase well before I needed them (slow delivery times) and have them shipped to wherever we may be at any given time. 

Although one shipment was lost while we were in Italy, the company happily replaced the lost items at no additional charge. Luckily, I’d planned the shipments months before I needed the pills and never missed a dose through the lengthy process of replacing the lost items.

Three Barn Owls at Zoo Ave, the bird and animal rescue facility in the Alajuela Valley.

While in Australia, for the sake of convenience, I received new prescriptions from a doctor we’d visited for physical exams while in Trinity Beach. But, unfortunately, I couldn’t get more than a six-month supply, which is typical, even through online pharmacies. 

Thus, again with a several months supply on hand, I ordered more from ProgressiveRX, which we had shipped to us in a box of supplies from the US from our mailing service.

I’d also considered making the purchases of a few month’s supply while here in Costa Rica since both of us must have physical exams no more than 60 days before the upcoming cruise to Antarctica. So we’d have the necessary exams and purchase my meds while here at any pharmacy.

Three Barn Owls were sharing a tree branch.

On Monday, the day of the rental car fiasco, I’d brought along the pills in the bottles with clearly marked labels to the Walmart Pharmacy. As it turned out, I’ll run out of two of the meds before the time we leave on November 22nd, thinking they could easily be replaced by some Costa Rica versions of the same frequently prescribed drugs for these conditions, common throughout the world.

Oh, foolish me. Walmart could not supply me with any of the three meds without changing doses and brand name components. One of the meds required the brand name when I tried alternates to no avail in years past.

After the pharmacist and I counted what I had left, we discovered I’d run out before leaving. “Local pharmacies don’t carry what you need,” explained the kindly pharmacist. So it’s a lost cause. I contemplated my options which included taking wrong doses and wrong meds and decided against it.

These birds were too high up to get clear shots without a tripod.

During the last month, when I’ll run out of two of the three meds, I’ll take doses every other day.  Doing so should not be life-threatening, although it may create some unpleasant symptoms. I’ve experienced worse. I’ll be fine.

In the interim, I’ll place an order from ProgressiveRX to arrive at our mailing service in September or October (at the latest) and have them shipped in a box of other supplies we’ll be sending to our hotel in Miami, where we’ll stay one night before boarding the 30-night cruise to South America.

How will we ensure the proper timing? We’ll have the shipment arrive from Nevada to Florida at least two weeks before our arrival on November 22nd. The hotel will hold the package for us until we arrive. 

Parrot sitting atop a perch at Zoo Ave (Ave means “aviary” in Spanish).

At that point, I’ll have enough to hold me for a few months until I place another order for a shipment to South Africa. That will work. We received a shipment while we were in Marloth Park in 2014 without incident.

The result…bring enough medication with you when you come to Costa Rica unless you’re confident you can purchase refills from a local pharmacy of the products/brands/doses you typically use. You are allowed to bring a regular supply into the country commensurate with your stay, plus extra for unexpected events.

Did I learn a lesson? I suppose regarding Costa Rica, I sure did. And, of course, in the future, I will check if there will be an issue receiving medication by mail from countries where we aren’t quite sure. But, after five years of world travel, this is the first time we’ve run across such a situation. 

A bit blurry from afar but a pretty parrot nonetheless.

But, like the rental car situation (BTW, we did get a refund from rentalcars.com for which we’re relieved and pleased), one never knows what may be encountered in unfamiliar territory. Neither of these scenarios would be an issue for a typical short stay by most travelers. 

Our unique nomadic lifestyle can be challenging at times. And we continue to learn as we go.

Be well.

Photo from one year ago today, August 30, 2016:

Shorter than he’d usually prefer, Tom’s buzz cut in Phuket Thailand held through the 33-night cruise, which began on October 31st. For more details, please click here.

Health concerns for travelers of any age…Questions and answers applicable to all…

Sunday’s sunset from Jeri and Hans’ third-floor veranda, the last rain-free day.

The following comments are not intended in any manner to substitute for professional medical advice. This post is entirely based on our personal travel experiences regarding preparedness in the event of medical issues or emergencies.  Please seek the care of your medical professionals in regard to your personal healthcare.

Coupling our interest in health and well being with our worldwide travels has been important to us. Many seniors and younger travelers alike choose to address health concerns before traveling. Many others “wing it” hoping for the best, in many cases a poor decision or, simply a lack of a decision at all.

Checking online over the past almost two years, we have discovered a wealth of resources available that may be of assistance, too many to list here.

We’ve found that researching credible medical sites are crucial, not simply the opinions of a few travelers with a good or bad experience, often seeking a place to vent frustrations and unfortunate experiences.

Some of the questions we had and the answers we’ve discovered that have worked for us, that we’d asked ourselves when planning our world travels include and on an ongoing basis:

  • Will we get intestinal distress from eating uncooked fruits and vegetables? If so, how does one reduce that risk? Yes, illness is often a result of produce eaten raw. This risk does exist when non-purified water is used to rinse produce, which is then eaten raw, such as lettuce, celery, and fruit. Usually, cooking vegetables destroy most of the bacteria. We rinse all of our produce in a bowl of purified water, replacing the water as needed. Always remain mindful of cross-contamination of washed and unwashed produce. We washed all of our produce immediately before placing it in the refrigerator.  This may reduce shelf life, but our “shelf life” is more important.
  • Is it safe to drink the water? Before we arrive at each location we research to determine if the water is safe to drink.If not, we arrange for the property owner to have a several-day supply of purified water awaiting us to ensure we have ample time to get to a grocery store.
  • What about brushing our teeth? This is often a cause of illness. We keep small bottles of purified water in the bathroom for wetting the brush, rinsing our mouths after brushing and rinsing our toothbrushes. Daily, we brush with baking soda and then do a full 20-minute coconut oil gargle which kills bacteria in the mouth, spitting it out when done. Once a week we disinfect our toothbrushes (and my contact lens case) in hot boiled purified water.
  • What happens if get water into our mouths while taking a shower? Immediately, spit it out and promptly rinse the mouth with mouthwash, and brush our teeth following the above process using purified bottled water.
  • Can water be boiled to become safe to use? We don’t recommend this process. Considerable bacteria may remain if the water is not boiled long enough, 15 to 20 minutes, or more. This would only be done in the case of a dire emergency.
  • What about washing dishes?  Ideally, we could use purified water to wash dishes.  Unfortunately, the cost of bottled water is prohibitive and if done properly this isn’t necessary. Wash and rinse dishes, pans, and flatware in the hottest cleanest soapy water your hands can take. Drain on a clean cloth. Wipe dishes dry with another clean towel and leave out, not stacked, to further dry on the clean counter to ensure that no water molecules remain.  Wash your hand before handling dishes which we each do so often it’s ridiculous.
  • Do we need to take malaria pills or other prophylactic medications while traveling? Taking pills for the prevention of malaria depends on the location of your travels. Check with your local travel clinic for detailed maps and information for every country in the world. Other prophylactic medication? For us, we take a Bifidus Probiotic  (30 billion CFU minimum) supplement daily to keep the balance of good bacteria in the gut.  These may be purchased online or at any quality health store.  Research for a quality brand, most of which require refrigeration for freshness.  We have been taking multiple individual supplements for years.
  • What do we do if our luggage is lost or stolen containing all of our daily medications? Do we need to bring along copies of our current prescriptions, written letter explaining the use of medical syringes, if applicable, etc.? Yes! Yes! Yes! We have copies of all of our prescriptions and a doctor’s letter listing all of the supplements we use. Even so, we had trouble boarding a Carnival Ship in Belize (see the posts of April 9th and 10th, 2013 for details of our ordeal).  Also, we carry several Epipen syringes, in the event, we have an allergic reaction (anaphylaxis) to stings from insects or other substances, including a doctor’s letter of authorization.
  • Will our insurance pay if we become ill?  Do we need to purchase emergency evacuation insurance?  Is it costly? Every policy is different.  Check with your policy benefit well in advance of travel to determine what will or won’t be paid. Generally, Medicare usually doesn’t pay outside the US, but check on your supplemental policy’s terms and conditions.  Emergency Evacuation insurance is a must if you’re traveling outside your home country unless your regular policy provides this coverage. Check for specific details well in advance of travel.  On its own, emergency evacuation insurance usually is US $200 to US $300 per person for a two-week vacation. Keep in mind, that “travel insurance” and “emergency evacuation insurance may be entirely different from one another; one if in case of cancellation on non-refundable fares, etc. and, the other is for medical purposes. A few policies have both features combined. Check carefully for details.
  • Do we need vaccinations to travel abroad?  Again, check with your local travel clinic, a highly valuable resource when planning a trip abroad.  Countries in Africa may require proof of vaccination for Yellow Fever and other communicable diseases.  We keep a copy of our entire vaccination record (we had around 18 separate vaccinations) on the inside flap of our passport holders. We haven’t been asked to produce these records yet , but entry into a country can be refused if not provided.
  • How much in advance must we plan for the vaccinations? We both began the vaccination process 6 months in advance of our departure from Minnesota.  Many vaccines require waiting periods between boosters.  Many vaccines may be given at one appointment, which is not detrimental to their efficacy.  The question becomes…how will you tolerate multiple vaccines in one appointment? If dubious, space them out as I did with no side effects.  Many vaccines such as Yellow Fever don’t require a booster for 10 years.
  • Did our insurance cover the cost of the vaccinations?  At the time we had the vaccines, both of us were covered under Tom’s policy from work which much to our surprise, paid 100% of the cost.  With the number of vaccines we chose to receive, the total cost would have been over $1500 each.  If you have Medicare or under the new guidelines, this may not be covered. Please check with your company to determine what, if any is now covered.
  • Will the tours and excursions in which we plan to partake fit within the confines of our current physical conditions and limitations?  Most tour operators specific the “difficulty level” of each of their tours and excursions.  However, these are often minimized, leaving participants gasping for air and exhausted or perhaps at severe risk.  Read reviews and comments online at travel websites such as Cruise Critic and Trip Advisor.  These comments are often a better resource of “factual” information as opposed to the sales orientated tour companies and cruise lines.
  • Did we bring along extra prescription eyeglasses, contact lenses, and supplies, (and hearing aid batteries, if applicable).  What if we lose any of these?  How do we plan to replace them?  We both have our optical prescriptions with us, even if they expire.  In the event of a loss, most prescription eyewear and contacts can be replaced locally or through the mail.  Tom has three pairs of backup prescription eyeglasses and sunglasses. I brought along 24 boxes (6 packs) of contact lenses enough to last three years. I do purchase lens solution at a local pharmacy due to the added weight of the bottles which may be difficult to find in some locations (Belize and Italy).
  • If we use any particular medical supplies, what happens if they’re lost or quit working? Although Tom nor I use any particular devices, we suggest bringing a backup in the event of loss or failure.  We do have a thermometer, small blood pressure cuff, emergency suture kit, and emergency dental supplies (dental glue) in the event a crown or filling falls out or dislodges.
  • What over the counter medications did we include? We packed Aleve, Tylenol, Tylenol PM, aspirin, Milk of Magnesia and Benadryl, cortisone cream, antihistamine cream, antibacterial cream, and hydrogen peroxide.
  • What first aid supplies did we bring? Besides the above comments above, we have Bandaids, bandages, sterile gauze pads, sterile gauze wrap, ace bandage, liquid bandage, and Lidocaine patches.
  • Immediately upon arrival,l in a new location, what precautions do we take in the event we become ill or injured? Upon arrival at our new home, we ask the owner/landlord or property manager the location/phone of the best local hospital, medical clinic, physicians, and dentists in the event of any emergency. For example, here in Kenya, we have the phone number of a physician who will make a house call in the event of a non-life-threatening emergency.  Otherwise, there is a hospital within 10 minutes on the main road.

Yes, I know, this stuff is difficult to address. And for many of you who seldom travel it may be boring. But, for those who travel even short distances on a day-long road trip, being away from one’s home base can present challenging health concerns.

Years ago, I was meeting up with a bunch of girlfriends in Mexico for pre-arranged dinner plans. When they hadn’t arrived after a two-hour wait, I tried calling to no response. A day later, I received a call from one of the other friends in the group informing me that the friend had fallen into a hole under a “grate” on the sidewalk resulting in a serious compound fracture of the leg.

The only way to receive quality medical care was to return her to the US immediately.  With her not having emergency evacuation insurance and the requirement of payment in full in advance of the flight with the air ambulance service, the friend had no alternative but to ask family members for their credit card numbers to cover the then cost of US $25,000 when her own card had a US $5000 limit. Can you imagine the stress of returning home facing your own credit card bill, but also that of the cards of family members? That airfare was 30 years ago. Can you imagine how much it would be in this day and age?

This scenario remained stuck in my mind for 2 reasons; one, don’t walk on grates, wooden boards, or any potentially unstable surfaces on roads and sidewalks (in any location). Of course, Tom has adopted this practice also, as we’ve always alerted one another to possible hazards.  And, the second reason, always have an emergency evacuation policy in effect when traveling outside your home country.

Last night, we ventured out to dinner during a massive rainstorm that had started on Monday continuing all the way through today, Wednesday.  As is typical in Diani Beach restaurants, the walk from the taxi drop off area to the restaurant is long and treacherous with uneven steps, many often twice as steep as we’d expect, multiple tripping hazards, slippery surfaces, and the risk of falling tree limbs and coconuts.

Always carrying our LED mini flashlights has proven to be vital to our safety.  Last night, leaving the restaurant in torrential rains and gusty winds, luckily under an umbrella provided by the restaurant, I hung onto Tom for dear life.  If one of us went down, we both were going down. The long, steep outdoor steps were particularly hard to maneuver when their design was inconsistent and there was not a light or handrail at any point.

We both sighed with relief when we found Alfred, our trusty regular taxi driver, waiting for us and quickly jumping out to open the car doors as we handed off the umbrella to the restaurant server who escorted us. We were soaked all the way through to our underwear, but grateful to have made it to the taxi without incident.

No traveler can sit back and make the assumption that they are invincible and exempt from possible injury or illness when traveling.  With all the effort we’ve made, on a few occasions, we’ve fallen prey to unforeseen illness and injury. We can only hope and pray that we’ve exercised more than adequate foresight to guide us through those tough situations.

As they say on a mindless drivel TV show, Big Brother…” expect the unexpected.”  Doing so need not reduce the quality of our experiences or result in needless worrying.  But, preparedness, certainly minimizes the risks enhancing the quality of our experiences.

1000’s of pills to go?…We’re not kidding!…

We take vitamins. Do they work?  For us, yes.  How do we take them with us?

OK, here’s the deal.  Over the past several months I have shortened the list of vitamins and supplements that we have been taking, continuing to use those that credible scientific research has proven to be important for some people in some cases. That’s us.

Cutting out any questionable supplements (for us), we have been able to narrow down the list to the following.  (Please be aware that we are in no way suggesting that you take any of these supplements.  Please see your doctor for medical advice.  Supplements may interact with your current prescriptions).

1.  Vitamin C 1000 mg, timed released – Due to our low carb, gluten free, sugar and fruit free diet, we found that supplementing with this vital nutrient is important.  We don’t drink juice or eat citrus fruits.  Tom doesn’t like many vegetables containing vitamin C.  This was our solution over the past several years.  No scurvy!
2.  Vitamin K2 100 mcg – Good for building bone.  After two years, taking this supplement, my DEXA scan improved, taking me out of the osteopenia range and back to normal.  I am convinced this supplement was helpful. 
3.  Alpha Lipoic Acid 600 mg– An antioxidant with many benefits as we age.  
4.  Magnesium 500 mg – Often deficient as we age 
5.  Fish Oil 1200 mg – Tom doesn’t eat fish. Primary used for heart and blood vessels.  As one ages, it appears this may be valuable.
6.  Probiotics 35 billion live cultures – Probiotics can be helpful in boosting one’s immune system and in the prevention of stomach distress while traveling.
7.  Vitamin D3 2000 mg – Tom tends to avoid the benefits of this vital nutrient due to his Irish heritage and light skin.  We have both been supplementing with D3 for some time.
8.  Vitamin B6 50 mg 3 x day – Kidney stone prevention prescribed by urologist.  Seems to be working!
9.  Vitamin B12 100 mcg – Specific to one’s needs.  Worth reading literature.

Do they work?  Are they worth hauling a few year’s supply with us? The topic of supplements is controversial. As we know, the media rattles us with contradictory information; something is good for us, another is not, to later discover they have reversed the advice.  

How are we to know? Check with your physician.  Read the information provided by reputable unbiased medical sites:  Mayo Clinic, National Institutes of Health, CDC and our ability and choice to try what may work for us.

Yesterday, I placed an order for three years of supplements, considering that we also had enough on hand to get us through the next few months.  With free shipping, “buy 2, get 3 free” plus a 10% discount the total $301.51, a chunk at one time but another task out of the way.

Many will ask, “Why don’t you take the minimum with you and buy them abroad?” There are several reasons:

1. Safety – we’ve been buying from this company for years, feeling comfortable that they don’t contain dangerous substances. Supplement sales is a business wrought with illegal activities and ingredients.

2. Convenience – Every few months we’d be scrambling to restock our supply. We want our travels to be as stress free as possible. We won’t be receiving mail and if we did, we’d be paying international shipping costs from our pre-arranged mail service driving up the cost.

3. Peace of mind.

Next time, I will update you on our prescriptions dilemma for which we now
have a solution. Be well.