San Antonio Express-News (Sunday)
Former COVID-19 patient asks: When should I get the vaccine?
Q: My wife and I tested positive for COVID-19 on Dec. 20. 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.
A: 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.
Q: 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 it should not be used for back, hip or shoulder. Why not? What do you suggest I use for the shoulder other than pain pills?
A: Topical anti-inflammatories such as diclofenac gel are good alternatives and worth a try, as they have very low risk of systemic side effects and often offer pain relief. However, they only penetrate so far into the body, and for that reason they 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 often will not pay for treatments that have not been shown to be effective. It may be effective for some individuals, however.
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.
Q: I have Raynaud’s disease, a left bundle branch block and severe glaucoma. I am 75, and I struggle to keep weight on. I experience low blood pressure and lightheadedness at times. Is the COVID-19 vaccine safe for me? My doctor’s reply to this question (given through the receptionist) was that I “should be OK.” Will I be?
A: 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.
Q: What is celiac artery compression syndrome? I’m told I have this, and it’s causing an aneurysm that needs to get repaired. I found out on a scan taken for another reason. I have had some pain after eating.
A: The celiac artery is one of three large arteries that provide blood to the abdominal organs, especially the stomach, parts of the small intestine, liver and spleen. The artery can be compressed from the outside by a structure called the median arcuate ligament. When this happens, other blood vessels take over the job the celiac artery can’t do because of the compression, but sometimes people can get abdominal pain after eating due to low blood flow. People with symptoms due to celiac compression benefit from opening the artery, usually using a stent to keep the artery open. The celiac artery may also become blocked by atherosclerosis, cholesterol and calcium deposits within the blood vessel.
The increased blood flow in the other blood vessels can occasionally cause abnormal dilatations, called aneurysms. Unfortunately, these aneurysms can rupture, which is a catastrophic event. The risk of fixing the aneurysm is much smaller than the risk of rupture, so it’s recommended to first fix the celiac compression, then treat the aneurysm, usually by a coil embolization. The coil causes a blood clot around and within the aneurysm that protects the weakened part of the blood vessel wall and reduces risk of rupture.
Vascular surgeons perform this surgery, usually endovascularly (through the blood vessels), without the need to open a person’s abdomen.
Q: I had a prostatectomy over 10 years ago. After the surgery, I required 10 sessions of radiation treatment. My incontinence is not going away. I tried Kegel exercises, but that didn’t help. I am using pads regularly and also using Cunningham clamps. Unfortunately, the leakage is still there. I have to change pads three or four times a day. I heard about the product called AMS800. I am 84 years old. Don’t know how to solve this problem. It’s very frustrating.
A: Incontinence after prostate cancer surgery is common and often improves in the year or so after surgery. Some men continue to have moderate or severe long-term symptoms. You have already tried some of the treatments: Pelvic floor (Kegel) exercises can be helpful for men as well as women, but when the nerves are more severely damaged, these may not be very helpful. A Cunningham clamp, an external clamp that closes the urethra in the penis, is usually effective, but many men find it uncomfortable. Condom catheters are a good solution for some men.
When no other treatments are effective, surgical solutions are considered. There are several options, but one of the most effective and reliable treatments is an artificial urinary sphincter. The AMS800 is a brand name of one of these devices, which is placed surgically. More than 90 percent of men report satisfaction with the device. Complications include infection and erosion of the surrounding tissues, both of which happen 5 percent or less of the time.
Only your urologist has the expertise to say whether this is a potential treatment for you, but it is an effective treatment for many men with long-term incontinence that has not responded to other treatments.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell .edu or send mail to 628 Virginia Dr., Orlando, FL 32803.