The Morning Journal (Lorain, OH)
Pneumonia vaccine still good idea
DEAR DR. ROACH »
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 may not have received these shots should. Is my conclusion too simple?
— M.J.B.
ANSWER» Pneumonia is a term for an infection of the lung. There are many different causes. The pneumonia vaccines — Prevnar and Pneumovax — protect against the most common bacterial cause, streptococcus pneumoniae, also called pneumococcus. Unfortunately, it does not protect against the lung infections caused by viruses, like 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» Ihada half knee replacement nine years ago with nerve damage 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. When the pain is too severe, I use the Tylenol 3 with codeine between the doses of gabapentin.
I asked my primary care physician if I could try the tramadol in replacement of Tylenol with codeine, and she refused. I wonder why. What is your opinion of tramadol?
— J.M.
ANSWER» Codeine and tramadol 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.