Pneumonia vaccination a good idea for over-65s

Prevnar, Pneumovax protect against the most common bacterial cause

Dear Dr. Roach: Many seniors, including myself, have received pneumonia shots within the past five years. Since the flu and coronavirus can result in a form of pneumonia in a severe case, would these shots be helpful to prevent or treat this virus even slightly? If seniors are most vulnerable, then maybe those who might not have received these shots should. Is my conclusion too simple?

M.J.B.

Pneumonia is a term for an infection of the lung. There are many different causes. The pneumonia vaccines — Prevnar (PCV13) and Pneumovax (PPSV23) — protect against the most common bacterial cause, streptococcus pneumoniae, also called pneumococcus. Unfortunately, it does not protect against the lung infections caused by viruses, such as influenza or coronavirus.

However, a bad viral infection, especially flu, can put a person at high risk for pneumonia. Post-flu pneumonia has a very high mortality rate, and many, but not all, are caused by pneumococcus. So, I agree with you that anyone over 65, and many people with chronic heart or lung conditions even if under 65, should get vaccinated against pneumonia.

Dear Dr. Roach: I had a half knee replacement nine years ago with nerve damaged on the side that was not replaced. The only pain relief that would work was the Tylenol 3 with codeine. Last October, I had back surgery, and I also had nerves damaged on the left side above the hip, including the thigh and the same knee. My surgeon has me on 900 mg gabapentin to take with 600 mg ibuprofen every eight hours to contain the pain. Sometimes I cannot make it eight hours. When the pain is too severe, I use the Tylenol 3 with codeine between the doses of gabapentin.

A very popular and effective painkiller now is tramadol. I asked my primary care physician if I could try the tramadol in replacement of Tylenol with codeine, and she refused. I wonder why, since the codeine is so bad. Her only answer is that tramadol has been a controlled substance in New York for the past four years. I believe she is afraid that I might take the Tylenol with codeine at the same time. What is your opinion of tramadol? It has a nice review on the internet.

J.M.

Codeine and tramadol (Ultram and others) are relatively short-acting synthetic opioids with similar structures. Although tramadol was originally marketed as being safer, they both have the potential for habituation.

Neither of these drugs is a good choice for long-term use in people with chronic pain, although if used cautiously at reasonable and stable doses, it might be reasonable in combination with the gabapentin. Opioids are not appropriate for people at high risk for substance misuse, such as people with a personal or family history of alcohol or drug use disorder.

Your primary care doctor is wise to be concerned about concomitant use — taking them both at the same time — of codeine and tramadol. Their toxicities overlap. Further, some preparations of tramadol come with acetaminophen (Tylenol). If taken in combination with Tylenol with codeine, the excess Tylenol can be potentially deadly.

Internet reviews for restaurants can be misleading. For medications, they are worse than useless, as the safety and effectiveness of a medication depends entirely on the highly specific nature of a person and the person’s medical issues.