Flu shot coverage lasts about six months
Q: I understand that flu shots lose their potency over time, so I am wondering if I should wait until I am closer to the peak of flu season before I get my shot?
A: I’d recommend getting it now, if you haven’t already. It is true that flu shots provide protection that wanes, but they provide pretty good immunity for about six months. The flu season normally starts in December where I practice and lasts until around April or May (humidity has a lot to do with flu seasonality, as does the fact that people tend to be indoors more during the winter). Getting a flu shot now should still provide protection all the way until the end of flu season. I don’t normally recommend getting the flu shot as soon as they come out in August, for just the reason you are concerned about.
Q: I recently had a health scare about my prostate, but fortunately, I was able to get it treated successfully. Because of my close call (I was diagnosed with a moderately aggressive prostate cancer and was apparently cured by surgery), I encourage my male friends to seek medical advice for prostate issues. But one friend seems cynical and reluctant to seek medical advice. Without being too pushy, how do I convince him it’s in his own best interest to see a doctor?
A: Most women know they need regular screenings for breast and cervical cancer, and I usually have little trouble convincing both men and women to receive colon cancer screenings. However, prostate cancer screening has been a controversial topic, and many men don’t want to think about it, let alone act on it. Even the rectal exam has been a cause for many men to avoid prostate cancer screening. (Good news, guys: You don’t need the rectal exam anymore.)
The PSA blood test is the primary screening modality now, and it is recommended for men from about age 50 to age 75 (family history, other risk factors and other medical issues a man has are taken into account for starting and stopping screening). Most men will have a low PSA level and will be recommended repeat testing every one to two years. Men with an abnormal level, or one that has greatly increased, even if it isn’t yet very high, will be recommended follow-up testing with a urologist. Many of these results will show a benign cause.
However, some men with a high PSA will be diagnosed with prostate cancer, but many cases of prostate cancer found by screening are of the lowrisk variety: These are usually observed over time as part of an active surveillance process. This approach minimizes the amount of surgery, radiation and chemotherapy treatment needed to be given. A few men will have what you had: a prostate cancer that is destined to spread but was caught in time to prevent that. It’s precisely for your situation that we recommend PSA screening.
You are in a position to share that with your reluctant friend, if you are comfortable doing so. A personal story is a powerful motivator. Of course, it’s his decision, but letting him know the test is easy and can lead to a potentially lifeextending outcome may motivate him to get care. Hopefully, his doctor can find out why he is reluctant and cynical, and address his concerns.
Q: I am a female and almost 75 years old. My vital signs are always normal, and I am active but slightly overweight. I get quarterly blood draws, and every reading is in the normal range except for the lymphocytes. That count is higher, just outside the normal range (the lab’s range is 850 to 3,900 cells/uL, and my absolute lymphocytes are 4,377 cells/uL).
This has occurred in the blood draws from the last two or three years, with the exception of one that was back in the normal range. About 12 years ago, after several abnormal results, I saw a hematologist, who reported nothing wrong after doing more extensive blood work. No reason could be given for it. I am concerned, but not obsessing over it. Is there any reason you can give for the slightly high lymphocyte count?
A: Lymphocytes are one of the two major types of white blood cells found in the blood (the other are the granulocytes, the most common of which are the neutrophils). High levels of lymphocytes raise suspicion for serious blood disorders such as some leukemias, lymphomas and related blood diseases, but there are other causes. Acute stress can do it, but you have been living with this for many years. Not having a spleen causes high levels of lymphocytes, whether you are born without one or have it surgically removed. Chronic infection is another reason.
I suspect your hematologist did a more sophisticated set of tests looking for blood disorders, and the fact that your level is the same after 12 years also supports my suspicion that this level is normal for you. Normal levels are generally defined as what is found in people without evidence of disease 95 percent of the time. So, by definition, 5 percent of normal people will have their result on any given lab fall outside of the normal range. Since yours is just outside of the normal range and, as I said, unchanged for years, I think you can relax your level of anxiety. Periodic blood tests do seem prudent, however, and further testing would be recommended in the event the count starts getting higher, or you develop any new symptoms.
Q: I am a 67-year-old male in relatively good health. I exercise regularly (four times a week). I have been taking medication for hypertension, which is getting much better since I started a plant-based diet three months ago.
About every three months or so for the last five years, there are two half-dollarsized blood stains on my pillow coming from my right ear. I have no headaches, and my hearing is what it is for my age. My wife is concerned, but I am not. What do you think?
A: I think your wife is wise to be concerned. This is not something I commonly encounter, and the answer is very likely to be found inside your ear by a clinical exam. I do sometimes see small infections in the ear that may bleed, and there are benign tumors of the ear canal and eardrum that may sometimes bleed as well. I have read about a very rare condition of an aneurysm bleeding from the ear. This has been going on a long time, so it’s worth an evaluation.