Gel relieves pain in superficial joints
Dear Dr. Roach: You recently had several questions regarding using topical diclofenac gel (Voltaren) for arthritis pain. My doctor prescribed topical diclofenac for shoulder pain, but my insurance would not approve this item. Voltaren and diclofenac states do not use for back, hip or shoulder. Why not?
G.T.S.
Answer: Topical antiinflammatories such as diclofenac gel are good alternatives and worth a try, as they have very low risk of systemic side effects and often give pain relief. However, they only penetrate so far into the body, and for that reason are most useful on joints that are superficial. The dose for lower extremity joints (feet, ankles and knees) is double the dose of the joints in the upper extremities (hands, wrists and elbows).
The back, hip and shoulder joints are generally deeper, and the manufacturer has not evaluated the effectiveness of diclofenac in these joints. Insurance companies will often not pay for treatments that have not been shown to be effective. It may still be effective for some individuals.
Other treatments that are helpful for osteoarthritis of the shoulder include exercises (ideally, while supervised by an occupational or physical therapist); oral anti-inflammatories; and Tylenol. Very severe shoulder arthritis is infrequently treated with joint replacement.
Dear Dr. Roach: My wife and I tested positive for COVID-19 on December 20, 2020. Due to our ages, we qualify to receive a vaccine now. But we have heard and read conflicting advice relating to the appropriate vaccination timing for people who have tested positive, ranging from get it as soon as you can, to wait 90 days after the positive COVID test, to wait longer than 90 days, with no specificity as to how much longer. What’s the answer? We have been symptom-free since the end of December 2020.
M.P.
Answer: People who have had COVID-19 have some degree of protection, but that protection is incomplete and may be shortlived. However, it is rare to get reinfected within three months of the first infection, so it is not urgent that you get the vaccine immediately.
But you need not wait three months. You may get vaccinated after COVID-19 infection, as long as the symptoms have resolved. Since you do not have symptoms, you are free to get the vaccine as soon as it is convenient for you.
People who have been treated with monoclonal antibodies (bamlanivimab or the combination of casirivimab and imdevimab) should not get vaccinated for 90 days after treatment.
Dear Dr. Roach: I have Raynaud’s disease, a left bundle branch block and severe glaucoma. I am age 75. I experience low blood pressure and lightheadedness at times. Is the COVID-19 vaccine safe for me? My doctor’s reply to this question was that I “should be OK.” Will I be?
J.N.
Answer: Neither your doctor nor I can predict the future with certainty. Reactions to the COVID-19 vaccine are rare (approximately 1 per 100,000 vaccines). I can say that none of your medical conditions puts you at increased risk for adverse effects from the vaccine. Given the safety of the vaccine so far, and the terrible toll COVID-19 has already taken, I believe the benefits outweigh the risks.