Medication Management on Long Trips

Medication Management on Long Trips If you’re going to be away from the US for more than three months, you’ll have to give some thought to how you’re going to get your maintenance meds refilled. What doesn’t occur to you until you get sick overseas is the need to give some thought to your usual OTC remedies.
Together, Linda and I take four maintenance medications, and I managed to get them synced up so that the refills all occur at about the same time. Generally, with mail order pharmacies, you can ask for a refill two-thirds of the way through the prescribed quantities (e.g. after 60 days for a 90-day refill).
Mail order pharmacies won’t ship overseas, so you’ll need a stateside helper for this.  For some plans that permit it, it might be easier to get 90-day refills at a local pharmacy rather than the mail order one. This will reduce wait times by a few days.
Once your helper has the meds, they can be repackaged in a small box or envelope if necessary. We sent the four prescriptions to Europe (once to Ireland and twice to the UK) for $13.50 each time, and it took 5 to 9 calendar days to be delivered. On the customs declaration, we put “prescription refills” and a value of $25, and there were no problems, at least in these countries.
Because of the shipping delay, you will need to identify a place where you can receive the item, and where it might arrive before you do. I asked our pet-sitting hosts for their postal address and permission to do this, and it all worked out well.

By the way, lens.com will send contact lenses overseas for $30, and without having to check with your eye doctor. They have a UK branch so it might be quicker to get them that way, or even to pop into a local optical shop. But they might not have your brand in another country.

What about OTC items?

We were planning a trip of seven months, and that meant about 400 multivitamin tablets, 400 fish oil capsules, and 200 glucosamine tabs. I brought a full bottle of Sam’s Club vitamins (350, I think), the 200-count bottle of fish oil with almost 1000 mg of omega-whatevers, and the remainder of my big bottle of glucosamine. These are fairly big bottles. In Europe, you will not find huge bottles of any medication, and I did not find fish oil with much over 400 gm of the omega oils. I knew I could get these at Boots, though, and decided to settle for those. Sending refills of these in separate shipments would be more expensive, and because of the quantities might not be permitted. By the way, everything should be sent in its original labeled container.
But wait: what if you get sick? What do you use? Most of it is hard to find in Europe, where they customarily use different medicines. You might want to think about:
• Acetominophen (Tylenol): it’s called paracetamol in Europe, and is available only in small quantities (30-60) at a wide variety of prices.

• Ibuprofen (Advil): it’s called ibuprofen or a variation of that, and also available in 30-60 packs at more than you’d expect to pay.

• Decongestant: we use pseudoephedrine (Sudafed) which (in the US) you now have to buy from the pharmacist and give your name, etc. This is to prevent its diversion to the manufacture of meth. In Europe, they don’t sell the pure form, it’s already blended with paracetamol or ibuprofen and usually liquid.

• Antihistamine: they have generic Zyrtec, which goes by a variety of names, and is inexpensive.

• Cough suppressant: There’s no pint bottle of Robitussin like we buy at Costco. I have found tablet dextromethorphine (DM). There are syrups but the taste will not be familiar, to say the least, and the active ingredient is something else. I don’t like to experiment when I’m not feeling well. Bring some DM.

• Expectorant: In the US, this is guiafenesin, which is the main ingredient in Robitussin and Mucinex. Not generally available, although they knew what it was. They offered a tablet equivalent, called ambroxol, which we found just as effective and it’s a much smaller pill.

• Low-dose aspirin: Remarkably, aspirin is a prescription drug a lot of places. There is controversy about whether a daily aspirin is a good idea or not. Bring the 250-count bottle from Costco if your doctor has you on these.

• Melatonin: I’ve seen it, but not with the dosage varieties we have in the US. I’d bring it.

• “Advil PM” or “Tylenol PM”: these sleep aids are either acetaminophen or ibuprofen with Benadryl, whose generic name is diphenhydramine. Not available, although straight diphenhydramine is.

Pharmacies in Europe

On the continent, anything that goes into your body and isn’t food has to be bought at a pharmacy. These vary from tiny to medium, but there is nothing approaching a Walgreens. In cities, there will be at least one pharmacy open at all times, usually on a rotating schedule, and in some countries, like Italy, there will be a sign in the window of the closed pharmacy telling you where the nearest open one is.
In the UK, you will find some OTC meds in larger grocery stores, but any of the ones mentioned above will still need to be bought from a pharmacy. The biggest one is Boots, and they are even in very small villages.
We have always found the pharmacists to be very well qualified. They are permitted to give a little more medical advice than US pharmacists, and some can even prescribe. Almost all spoke enough English, whatever the country. Take the package from whatever you need more of.

Bring your pill-cutter if you have one.

 

Advertisements

Public transportation in Paris; advice and secrets

Paris has a large, complex transport system, consisting of buses, a few trams, a huge metro, and a train system (“RER”). There’s even at least one funicular, which goes up a steep hill to Sacre Coeur. They all operate on the same ticket system, although for the train that’s true only in Paris (the trains go farther than Paris, and those require other tickets, or a pass. See below.)

French street sign St net

Paris street signs ; small and on the side of buildings

There are many websites describing the system and how to use it, so I’m not going to cover much of that detail here.  There are a few things they sort of gloss over, though, which puzzled us upon first attempt to use them.

The basic ticket is called a t+ ticket. It’s good for unlimited bus and tram travel for 90 minutes, and 2 hours on the train or metro. You can transfer all you want among buses and trams, and between metro lines and trains, but not between the two sets (surface and underground). Also, you can’t reverse direction on the bus, or use the same one twice.Paris metro sign 5x7 net

Paris metro 5x7 net

A t+ ticket costs €1.90 (all details as of October 2017) from a machine or human in the metro station, or in a tabac. You should probably buy 10 (14.90), called a carnet. There are several passes, most of which are not cost-effective. The one that is a deal is called Navigo Decouverte, but it has some limitations. The card itself is €5, and a week’s pass is 22.80. The problem is that a “week” means Monday to Sunday, and you can’t even buy this week’s pass after Thursday; you’ll get next week’s pass instead if you try. But it’s sure a great deal if you arrive early in the week, and if you arrive at either airport up through Thursday it’s still a deal because it covers all 5 zones, including the RER outside of Paris. A ticket from the airport to town would otherwise cost 10.30. It’s 7.10 for a round trip to Versailles.

If you’re arriving at an airport, try to buy the pass there. Wherever you buy it, YOU NEED ONE PHOTO, nominally 3 by 2.5 cm, which is smaller than a US passport photo. There are photo booths around. You can bring your own, and it doesn’t have to be great quality or even in color, just to look like you. Scan your passport or driver license photo. At CDG airport, the office is in the train station level; look for “Billets Ile-de-France.” It’s modern, quiet, they speak English, no problem with your credit card, it’s wonderful. The nice lady activated our cards and handed them to us. You’re supposed to put the photo and your name on them before you use them, but even when we ran into ticket inspectors, they just checked the cards electronically, not for pictures.

The ticket machines in the stations speak five languages. They take credit cards, and usually they accept US chip-and-signature ones, at least for amounts as great as 22.80.  When you use one, it will say “enter your PIN” — but if it’s a credit card without a PIN, just wait about 10 seconds and it will proceed anyway. The machines take coins, but not euro notes. There are change machines in some stations, but usually also a human if your card doesn’t work and you don’t have enough coins.

The reason a pass is preferable to tickets is convenience and flexibility. If you make a mistake and end up going the wrong direction, or on the wrong line, there’s no “OMG I’m out of tickets!”, you can just treat it as an adventure (“Oh honey, I meant to do that! We’re exploooooring!”). You can take random buses just to see where they go. You can take a bus three blocks when you’re just too pooped to walk without feeling that you’re wasting a ticket. And if it rains … well, you’ll be glad you’re prepared as far as transportation goes.

So, how to ride the bus. As I said, this is covered pretty well elsewhere. Find the stop (check which direction, it will say on the small route number sign up on a pole). The bus will show its destination as it approaches. Board at the front except on the long multi-section buses which permit boarding in the middle. If you have a pass, place it on the reader just inside the door. If you have a ticket, validate it in the machine behind the driver. Stick it in stripe down and wait for the beep, then take it out (“retirez”). The first time, try to watch someone else. If you’re transferring from another bus, validate the same ticket again.

You can buy a single use ticket from the driver. It’s €2.00 and not good for a transfer, though, so avoid having to do this.

Now, how to get into the metro. This is one of those “glossed over” details. If you have a pass, slap it on the purple spot on the gate. Within a second, it will beep (but you may not hear it!), and a dim green arrow may appear, or an LCD screen might say “passez.” Pick your pass back up. If you have a ticket, insert in in the front of the gate, and take it out when it appears again. Some of the gates in a row of gates only accept passes, not tickets.

NOW for the mystery: There are at least two kinds of gates.  For the ones without turnstiles, after you get the go signal, you have to approach them, and they will open.  If you don’t move forward, they won’t open, and will eventually time out. There is also a kind with turnstiles AND a tall gate. You have to charge through the turnstile AND push on the gate to go through it. This is risky if you have a camera, as it is likely to get bashed. It’s impossible with luggage. There is usually a single wider gate for use by the handicapped or those with luggage. At very large stations, there may be an attendant to help.

At this point, the metro is like most others. You need to know the line and direction, which is the name of the station at the far end. Signage is plentiful but sometimes what I call “New Jersey” style:  too small, imprecise, and beyond where you actually need to turn. If you’ve ever driven on a highway in New Jersey, you’ll understand.

The metro is always well filled, but in rush hour it’s just nuts. We have waited for the next train more than once. They come every 2 minutes at this time of day. Look for the least dense part of the platform. It’s either the middle or the far end from where you entered, depending on how many entrances there are.

Before you exit, know which street exit you want. There’s a map, and a sign “Sortie” which will list them. They have numbers and names. This isn’t crucial, but if you choose the right one you’ll be in the right place headed in the right direction, and you’ll avoid looking like a lost tourist. There is a GREAT neighborhood map outside every Metro station exit, though.

To exit from most metro stations, there is just a metal gate you push on. If you’re exiting into a RER train station, and in a few other places, you’ll have to use your ticket or pass to get out.

By the way, the Metro is not very friendly to the handicapped. In most city stations, ONE exit will have an escalator (and the Sortie signs will indicate which) which goes up, but none that goes down, and no elevator/lift. There are lots of stairs within a station, down to the platforms, and there are almost never any assistance there.

Uber is present in Paris, but can’t pick you up at a train station or airport. The AUTHORIZED taxis are all regulated and there are taxi apps you can use. Outside train stations, you will find unregulated drivers offering to let you skip the line and go with them — only €35, monsieur, for a 5-minute ride!

That’s most of my “secret advice.” There’s a good general explanation here, and I recommend the website parisbytrain.com .

 

 

Pere Lachaise cemetery in Paris; graves of Jim Morrison and Oscar Wilde

We had an afternoon to spend in the famous Pere Lachaise cemetery here in Paris.  It is a remarkable city of the dead.  We will be going back before we leave because 2 hours was not enough time to take some of the photographs that I wanted to take.  This cemetery was founded in 1804 when the city of Paris needed more room to bury the dead. Pere Lachaise is the largest cemetery in the city of Paris.  Père Lachaise Cemetery has more than 3.5 million visitors, making it the most visited cemetery in the world.

 

Many famous people who died in Paris are buried here.   The most famous and the most visited  is the tomb of Jim Morrison of the Doors.

Jim Morrison grave 5x7 net

Jim Morrison’s grave, died 1997 in Paris

Pere Lachaise Edith Piaf 5x7 net

Edit Piaf, famous Parisian singer

Pere Lachaise Oscar Wilde 5x7 net

Oscar Wilde’s grave  

There were many French Jewish families that were sent to German concentration camps when Germany occupied France during WWII.  There are several memorials to these innocent French citizens in the graveyard.  Here are a couple of them;

Pere Lachaise memorial jewish 5x7 net

Memorial to the children killed by the Nazis

Holocaust victims Paris 2 5x7 net

memorial to the people killed in concentration camps

holocaust memoria lParis 5x7 net

And on a much lighter note; here is the grave of Victor Noir.   He was a French journalist who is famous for the manner of his death and the sculpture that lies on top of his grave.   I could not think of a good way to word this description so I will let Wikipedia do it for me.

“A life-sized bronze statue was sculpted by Jules Dalou to mark his grave, portrayed in a realistic style as though he had just fallen on the street, dropping his hat which is depicted beside him.

The sculpture has a very noticeable protuberance in Noir’s trousers. This has made it one of the most popular memorials for women to visit in the famous cemetery. Myth says that placing a flower in the upturned top hat after kissing the statue on the lips and rubbing its genital area will enhance fertility, bring a blissful sex life.”  As you can see from the wearing away of the crotch area, many women have taken up the idea since he died in 1870.Pere chaise Victor Noir 5x7net

Over one million people have been buried here and there are many famous French politicans, inventors and artists who are scattered among many family mausoleums.  It is a cemetery that has many monuments and statues to commemorate the dead.   Here are some of the more interesting photographs that I took.

Pere Lachaise child writing 5x7 net

Pere Lachaise angel 5x7 net

Pere Lachaise woman grief 5x7 net

Pere Lachaise statue 5x7 netPere Lachaise mother and child 5x7 net

And we found one live woman practicing her clarinet in the middle of the monuments.  The music was enchanting.Pere Lachaise girl clarinet 5x7netMore views of Paris to follow.

Battle of Hastings re-enactment 2017

We went to the town of Battle to see the Battle of Hastings re-enacted on the original battle field that it happened on in 1066. It was an exciting piece of theatre that put you into the time and the event.  I took lots of photos of this event that happens every year around the time that William the Conqueror from French Normandy beat King Harold of Saxon England for the crown of England in 1066.  I had known about this battle that changed the course of the English nation from my history books in school.  But it was an entirely different experience to understand the story and see where and how it unfolded.  If you are ever here in South Eastern England in October you should try to go to this pageant .

battle of Hastings actors 5x7 net

Actors that told the Battle of Hastings story before the re-enactment

battle of Hastings women 5x7 net

Re-enactors come from all over Europe to camp for the weekend of the battle

battle of Hastings Liz 5x7 net

Lady Liz from Wales

battle of Hastings tent 5x7 net

Battle supplies

Hastings king Harold 5x7 net

English King Harold on his horse before battle taking a last drink

battle of Hastings battle line 5x7 net

The English troops line up

battle of Hastings warrior 5x7 net

Time for a last chat with a friend

Battle of Hastings bishop 5x7 net

The bishop gives last minute confessions

battle of hastings english line 5x7 net

King Harold gives a battle talk to his troops to inspire them

battle of Hastings French 5x7 net

Duke William has brought horses from France and they charge the English shield wall

battle of Hastings William horse 5x7 net

Half way through the battle William falls off his horse and the men thinks he has died.  He quickly finds another horse and rides in front of his troops to show that he is still alive.

battle of Hastings William riding 5x7 net

Unfortunately, late in the battle, King Harold is hit by an arrow that goes through his eye and he dies. The English troops lose heart.  Duke William’s troops overcome and kill all the English on the battle field. William goes on to London and is crowned the new king of England on Christmas day in Westminster Abbey.  We enjoyed this event and give the English Heritage organization a good review for organization and presentation.

We are off to Paris tomorrow for 16 days of sight seeing, then Barcelona for 3 days and on to the ship for the cross Atlantic voyage home.

Hastings fishing fleet and old town

Hastings is an old fishing town.  Fishing ships still are pulled up to the shore and rest over night on the pebbled beach.Hastings fishing boats 5x7 netThere are historic net buildings where the fishermen used to hang their ropes and nets out of the weather. These black tall buildings are part of the way you identify the Hastings beach.net houses Hastings 5x7 netThis is a rough sea coast.  There are often strong winter storms and fishermen need to be rescued.  They have a good lifeboat group that saves lives every winter. Hastings lifeboats 5x7 netThe beach is a good place to let your dogs have a good run on a sunny afternoon.Hastings beach 5x7 closer netBut be sure to pick up after your puppy if he leaves a gift in the sand.  There is a 1,000 pound fine if you are caught not picking up doggy poop. no poop 5x7 netThere are many historic houses in Hastings.  The house we are pet sitting in is probably from the 16th century.  There are many 15th and 16th century homes that line the oldest streets in the town. hastings tudor house 5x7 netThe house we are in does not have door knobs in the house.  All of the doors are kept closed by latches.

Here is a sunset that I took on one of the few days when we have had a clear sky over the sea.  This is taken over the Hastings pier.Hastings pier sunset 5x7 net

Brighton Beach Pier and the Royal Pavilion

Yesterday was a sunny day.  We did not waste it and jumped on a train to Brighton.  This is a beach resort that was made famous when the Prince Regent, George, hired John Nash to expand his pleasure palace in 1815.  George loved gambling, drinking, eating and women and needed to have a place away from his father, King George III, who did not approve of his lifestyle.  Here is a photo that symbolizes one aspect of the Brighton experience.red legs Brighton 5x7 netI toured the palace. The outside was designed to look like a palace from India.Royal Pavilion Brighton 5x7 netThe inside was lavishly and extravagantly decorated in a Chinese decor, with crystal and golden dragons.  Photography is not allowed inside the building, so here is a picture of the massive dining hall from Wikipedia.800px-Brighton_Banqueting_Room_Nash_editedHis banquets would have over 100 different menu items offered to his guests, and the dinner would take hours.  Needless to say,  George was very obese and had to have his bedroom moved downstairs because he could not climb the stairs as he got older.

After that we walked down to the Brighton Pier which was opened around 1899.  Brighton pier 5x7 net

This pier has many fish and chip, donut, crepe, waffle, and ice cream shops, plus a couple of tattoo artists.  In addition, there are game machines to play.  I found the only skee-ball machine (I guess they are not that popular) and played a couple of rounds.linda skee ball 5x7 net

big minion 5x7 net

Big toy grab machine

They have an amusement park at the end of the pier.  Great place to take a date.  The rides are lots of fun, if you like being upside down.Brighton pier ride upside down 5x7 net

Brighton pier ride 5x7 net

Or sideways

Then there was the big ride.  I could not get all of it in the photo.  There were 2 sets of seats, one on top and one on the bottom, and they rotated into the air.  A guy who was on the ride saw that I was taking photos and signaled me not to ever take this ride.

tall ride 5x7 net

Here is a photo of the people at the top of the tower, sitting there for a long time while they let the people of the bottom off.

big ride top 5x7 net

If we had not just eaten dinner I might have tried one of these thrillers.  Right, and if you believe that I have a bridge to sell in Brooklyn.  welcome to brighton 5x7 net