DEAR DR. ROACH: Many years ago, I was diagnosed with atrial fibrillation and then was on medication for 10+ years. I eventually had an ablation done, and I am finally back in normal rhythm. I have been off all meds for AFib for over a year.
Two of my family members have had strokes due to AFib, so I am very concerned. I brought these events up to my cardiac doctor recently, and he has suggested a micro-sized cardiac device. I’ve read up on this device, but I was wondering whether one can continue to record if outside of the country, or would it stop recording and transmitting info to one health care provider. After the pandemic I have plans to go to the Holy Lands for two or three weeks. I also hope to visit a week or two each in Ireland and England. — K.K.
ANSWER: I spoke with a specialist at Medtronics, the manufacturer of one of the implantable recorders. They told me their device has about an hour of memory, and the device is programmed to identify and record any heart rhythm abnormalities, such as an episode of atrial fibrillation, or any time you activate the system if you are having symptoms.
They noted that very often, the device and communication monitor — which you should bring with you when you travel — are able to connect in many countries, but it depends on the cell service where you are. Still, the unit has memory, so it will send a report to your doctor as soon as it is able to connect.
DEAR DR. ROACH: A friend recommended Ubrelvy for migraine. It’s very expensive. Is it worth it? — H.R.
ANSWER: Ubrogepant (Ubrelvy) is in a new class of treatments for migraine, called calcitonin-gene related peptide antagonists. Injection versions can be used for migraine prevention; oral medicines like ubrogepant are used for treatment of acute migraine.
In a trial of 1,327 subjects, the medicine was effective at completely relieving pain for 21% of people with 100 mg at two hours, compared with 12% of placebo recipients. In addition, the medication relieved other symptoms, such as nausea or sensitivity to light or sound two hours after treatment in about 39%, compared with 28% of placebo recipients. The most common adverse events were nausea, sleepiness and dry mouth.
Long-term data is still needed to determine safety and tolerability. In addition, it would be very helpful to have a comparison with a standard class of treatment, the triptans. However, ubrogepant seems a useful medicine, especially for those who don’t do well with or can’t take medicines like sumatriptan.
As to whether it is worth it, a person suffering a migraine is willing to pay quite a lot to get rid of pain. If this medicine works well when nothing else does, it may well be worth it.
DEAR DR. ROACH: Can you tell me if there is any risk to taking Miralax on a regular basis? — J.W.
ANSWER: Miralax is a brand of polyethylene glycol. It is not absorbed by the body, and works by taking water with it, which makes bowel movements less hard. It is safe to use long term. However, the real question is, Why would someone have such severe and long-lasting constipation? An undiagnosed low thyroid level would be a concern, for example. If no medical issue was found, it’s best to try dietary changes before resorting to a medication long term.
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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.