September 2014

Time To Immunize?

As an adult you may think that you are done with immunizations, but guess what? You are not! One of the more common ailments I have been seeing with my patients is adult pertussis or whooping cough. This happens because the vaccine we were given as kids can wear off. For adults the disease is an incredible nuisance. It is what we call the 100-day cough, aptly named because that is how long the side-splitting, spasmodic cough usually lasts.

It is bothersome to us but can be deadly if passed on to infants who may not be immunized for it yet. That is why we all need a booster that is given along with the tetanus shot.  It is called the TDAP.  After you get your pertussis vaccine, you can get the tetanus booster alone every ten years (or sooner if you get attacked by a rusty nail).

The other vaccine I highly recommend is the shingles vaccine.  That can be given at age 60 and one shot is enough. It may not completely prevent shingles but can limit the severity of an outbreak. Shingles occurs in those who have had chicken pox.  At the time you get the disease, the virus hides in a nerve and then one day when you get good and stressed out or your immunity drops, you can get shingles.  This is a disease that results in painful sores.  It will occur on only one side of the body in the distribution of a particular nerve.  It can be any nerve so it can be located anywhere on the body.  If you have never had chicken pox, have your doctor check a blood test to make sure you are not immune and then make sure you get the chicken pox vaccine.  If you have never gotten chicken pox and you get the vaccine, you will never get shingles.

I never used to get the flu vaccine until many years ago when I was working in an urgent care and watched four healthy men in there forties (over the course of a winter) die from the disease.  That was enough for me.  Everyone is freaking out over Ebola, which has killed at least 2000 people this year.  Influenza on average kills 36,000 people in the US.  Should you get the flu vaccine? Yes.

Pneumonia is another potentially preventable disease. The pneumonia vaccine can help protect against multiple strains of pneumococcal pneumonia.  It can be given before the age of 65 to those who are at risk such as asthma and COPD patients, those with cancer, kidney disease, liver disease, etc.  After 65 it is recommended for everyone.  One shot is all you need.

For those who travel and those who work in the medical profession and work with people who may be ill, I recommend vaccines to protect against hepatitis A and B, Meningicoccus, and Hemophilus influenza type b.

I have encountered many young adults recently who have NEVER been vaccinated.  This is a very scary notion. Especially when world travel makes it easy for communicable diseases to be brought into areas where they never have been before.  Measles and mumps are on the rise, polio is still present in the world and I remember what it was like before we had vaccines for these diseases.  It was horrible.  If you or your children fall into this category, please catch up on these vaccines as well as the ones I have mentioned before it is too late.

It is important to have a discussion regarding which vaccines are best for you with your doctor.  He or she can look at your risk for various diseases and help you to decide which ones are best for you. Vaccines are relatively safe and can save lives.


The Importance Of A Second Opinion

As in life, in medicine there are rarely black and white answers to questions and treatments for medical conditions. Many of us have experienced different doctors with different personalities who either fit with us or did not.  When situations arise and you need treatment or diagnostic evaluation, and you feel things are not going in the right direction; it might be time for a second opinion.

This is especially important for those diagnosed with cancer. There are now a variety of approaches for acute and maintenance therapies.  Some doctors may prefer radiation to chemotherapy and others may have other types of treatments in mind.  This is especially apparent for those with prostate cancer. Some doctors may recommend conventional surgery vs. robotic surgery vs. cryosurgery.  For therapy there may be ultrasound vs. radiation pellets vs. hormone therapy vs. a variety of experimental therapies.

As you can see, it is important to find the approach that fits with what you may want and what will work best for you.  It is your body and you need to make an informed decision. It may take a couple of opinions for you to figure it out.  Patients are often afraid they will offend their doctors. However, most doctors welcome a second opinion.  If you have one that does not, perhaps it is time to find another doctor.

Who should you see for that second opinion? I will usually encourage patients to go to a university medical center such as Oregon Health Sciences University or Stanford.  However, there are often specialists that are highly regarded in our own communities. Speaking to people with similar diagnoses and your own physician can help you to find them. As a physician, I welcome another pair of eyes looking at my patients and possibly seeing something I may have missed or finding a treatment I might not have thought of or realized that was available.

Providers are always talking about how important it is for patients to take responsibility for their own health as regards to diet and exercise. Part of being accountable for your own health includes being an informed patient.  Seeking a second opinion is very often essential in order to do just that.











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