San Antonio Express-News (Sunday)
COVID vaccine urged for breastfeeding moms
Q: My daughter is still nursing her 10-month-old son. She decided to get the Pfizer vaccine and continue breastfeeding. Her doctor did not advise her against it. Do you have an opinion or more information about this matter? I’ve read that COVID antibodies are present in breast milk.
A: COVID-19 vaccination is recommended for women who are breastfeeding. There is data to show that the vaccine is effective for the breastfeeding woman, but there is little data about the effect on the baby. It is true that breast milk does have antibodies to COVID-19, but how effective these may be at preventing disease in the baby is not clear. It is clear that there is no way that either the mother or baby could get COVID-19 from the vaccine.
Because women who are pregnant or have recently been pregnant are at higher risk for severe disease if infected with COVID-19, pregnant and breastfeeding women are especially recommended to get the vaccine.
Q: Your recent column stated that increased pressure inside the bladder progressively damages the kidneys. This is very important new information in my case, and I would like to know if Flomax (tamsulosin) can help keep my kidney functioning properly as measured by creatinine level. I’ve been resisting taking Flomax because of apparent side effects, even though my urologist prescribed it. But I will enthusiastically take it if it will help my kidney function.
A: The column you reference was specifically looking at a person whose prostate problem is so bad that he needed to do intermittent self-catheterization, which was absolutely crucial to preserving kidney function. Men with mild prostate symptoms are not at particularly high risk for developing kidney damage; however, since that column was published I did see a new patient who developed significant loss of kidney function (almost half his kidney function) because he had moderate to severe symptoms that he never treated.
Following the creatinine level is certainly important, and if it starts to rise, then treatment — medical or surgical — becomes critical. However, most men want
treatment just to improve symptoms, and usually we can find treatment that doesn’t have too many side effects. The most common side effects of tamsulosin are runny nose and lightheadedness, especially on standing. Rare and serious side effects include priapism (an erection that won’t go away).
Q: Is it necessary to take CoQ10 with pravastatin?
A: Pravastatin, like all statins, can cause side effects, including muscle aches. In most people taking statins, muscle aches are not due to the statin. Recent studies showed that the likelihood of muscle aches was just about the same whether they were taking a placebo pill or a statin and didn’t know it.
Coeznyme Q10 is part of the metabolic pathway of many statins, and there has been a theory that depletion of CoQ10 is responsible
for muscle aches. But randomized, controlled trials have shown that treatment of muscle aches with CoQ10 is not much better than placebo, and there is no good evidence that CoQ10 can prevent muscle aches. Pravastatin, in particular, does not deplete CoQ10 the way atorvastatin does, for example.
Even though I don’t recommend CoQ10 to treat or prevent muscle aches, it’s considered safe and is not particularly expensive. I don’t insist people stop it, especially if they feel it helps.
Q: Can you elaborate on “long COVID”? Specifically, do people experiencing long COVID carry the virus for an extended period? Are they contagious during long COVID, or does the term refer to lingering symptoms but not necessarily testing positive?
A: People with normal immune
systems are almost never contagious after about 10 days following the onset of symptoms of COVID-19. The greatest period of contagion is during the two days before onset of symptoms through the day after they start, which is why masking is so important. People can be highly contagious without knowing they have the disease. People with severe immune deficiency may be contagious for a longer period of time, so testing to make sure they are negative and consultation with an expert are advisable.
“Long COVID” refers to persistent symptoms after the virus is gone, long past the infectious period. There is no evidence that people with long COVID are infectious for longer times than people who have mild or no symptoms.
Many viruses may continue to cause symptoms long after the acute period. Some viruses may cause damage to various tissues and organs — polio is a classic example. More than 99 percent of people have just a mild cold symptom with polio and get completely better, but a sliver of people will have damage to the nerves and develop muscle paralysis, sometimes fatally. It took many years to work out the mechanism of how polio causes these long-term symptoms; likewise, how COVID causes the long-term symptoms it causes is not yet well understood.
The incidence of long COVID varies by study, but the lowest number published I have seen is 10 percent of people continuing to have symptoms for three months after infection.
Many organ systems can be affected long-term by COVID-19, but fatigue, “brain fog,” sleep disturbances, chest discomfort and shortness of breath are some of the most common symptoms people with long COVID will notice.
I am continually surprised by people who won’t take the vaccine out of fear of it causing possible long-term side effects. This just hasn’t been seen, despite 5 billion doses administered worldwide and despite 300 years of experience with vaccines. No vaccine (other than live vaccines) has ever had long-term complications that haven’t shown up right away. Those who remain unvaccinated don’t seem to realize that they risk not only severe disease and death from COVID-19 but also the possibility of longterm debilitating symptoms.
Q: Would a copper-infused mask be effective against the flu or COVID-19?
A: All masks reduce transmission of COVID-19. Masks have variable effectiveness for the wearer, but they may be more important to stop transmission from the wearer, if they are infected and don’t know it. The best mask remains the N95 mask, but surgical masks and fabric masks made from two layers of cotton and one layer of synthetic material provide outstanding protection.
Copper has antiviral properties, but it is not clear whether adding copper to a mask makes it more effective. I think the type of material used and how well it fits are more important than whether there is copper inside it.