Stay away from baby unless you’re vaccinated
DEAR DR. ROACH: I’m expecting a baby in a few months, and my doctor told me that everyone who will come into contact with her must get the Tdap vaccine. If some family members don’t get it, should I keep them from meeting the baby until she’s old enough to be fully vaccinated?
ANSWER: Hope and congratulations are in order. May your baby be healthy.
It’s clearly recommended that parents, siblings, grandparents and other close contacts with an infant be up to date on their Tdap vaccine.
T is for tetanus, which is not transmitted from person to person. D is diphtheria, which is extremely rare in this country. The concern is the AP, acellular pertussis, because although it causes an annoying and long-lasting cough in adults, it is life-threatening to newborns. In the pre-vaccine era, thousands of infants died from pertussis (also called whooping cough, even though adults don’t whoop), mostly infected by adults.
I recommend that all close contacts be immunized, and that you take care to protect your baby from anyone with a cough (immunized or unimmunized, since the vaccine isn’t perfect) until she is fully immunized.
Babies get the DTaP vaccine at 2, 4 and 6 months, then boosters at 18 months and four years.
DEAR DR. ROACH: A letter that appeared in your column recently surprised me greatly.
The writer, who was 86, referred to having a colonoscopy “two years ago.” I am 93, and about 15 years ago I was rejected for a colonoscopy because I was over 75; I was told that it had just been learned that the risk of perforation was too high after that age.
So far, I have escaped the consequences of not having a colonoscopy, but my wife of 67 years was not so fortunate. Earlier this year, she was diagnosed with colon cancer that had spread to her liver. She died 23 days after the diagnosis. What is the current thought on colonoscopy for seniors?
ANSWER: I am sorry to hear about your wife.
All medical procedures have both risks and benefits, and the doctor’s job is to make recommendations based on his or her knowledge of the patient and the patient’s health, medical conditions and preferences.
Guidelines are helpful, but they don’t apply to every patient.
The United States Preventive Services Task Force’s guidelines are clear that people 75 and under generally are good candidates for screening; those between 76 and 85 should have an individualized approach; and screening over 85 is not recommended.
Risks of complications from colonoscopy definitely increase as people get older. Of course, some 85-year-olds are healthier than others.
One good rule of thumb is that those with a life expectancy that is less than 10 years not get screened; however, physicians aren’t always so good at making that determination.
I bet the doctor who decided not to screen your wife regrets it now; I can’t cast any blame (especially not knowing any details) though, since it’s also possible that she would have had a complication from the colonoscopy.
Physicians do not want to do something to a patient that will cause harm. Of course, there are times when not doing something causes harm, too (like not getting a colonoscopy), but we may be more likely to err on the side of caution.
The booklet on colon cancer provides useful information on the causes and cures of this common malady. Readers can obtain a copy by writing: Dr. Roach, Book No. 505, 628 Virginia Dr., Orlando, Fla., U.S.A., 32803. Enclose a cheque or money order for C$6 with the recipient’s printed name and address. Allow four weeks for delivery.
DEAR DR. ROACH: I suffer from varicose veins in my lower left leg, into the ankle and top of the foot. My question is whether it is good for my veins if I wear compression socks (knee or ankle) over the bad area, or if I should be wearing the higher thigh or full compression hose alone?
I am 56 and a little overweight; I am on my feet a lot. Would I be better off getting vein surgery, or would I still have to wear the support hose even after surgery? Is the success rate good for the surgery?
My main goal is to prevent problems later on. However, I often have discomfort in my veins now, especially when I am on my feet a lot. I am less worried about cosmetic results.
ANSWER: Compression stockings should be high enough to compress all of the affected area. In your case, I suspect below-the-knee would be fine. If you have any doubts, your physician or nurse can tell you what height (and strength, since some provide more compression than others) to get.
Some surgical-supply stores will do custom fitting. In addition to the stockings, periodic leg elevation (lifting the legs above the heart for 30 minutes, three times daily) and regular exercise are helpful.
Medications are not especially helpful for swelling of the feet and varicose veins. I often see diuretics used, but they are not effective for the long term.
Some evidence supports the use of horse chestnut extract, but my experience with my own patients was that it was only modestly beneficial (if at all).
For people with symptoms despite these conservative measures, it is reasonable to consider surgery, which improves both symptoms and appearance.
There are many kinds of procedures, including the classic “vein stripping” — injection of medication to close the veins — heat or laser therapy and others.
The best one depends on the individual's circumstances, so therapy must be individualized by a vascular surgeon.
The success rates vary by type of procedure, but somewhere around 80 per cent of people who have a surgical procedure done are very happy with the results.
For people who choose surgery, stockings are recommended to be worn for a period of time after surgery (a few days to a few weeks), but most people do not need them long term.