San Antonio Express-News (Sunday)
No COVID vaccination? No visits with elderly dad
Q: I am one of four daughters, ages 69 to 61. Our dad is 95 and still lives independently, although one of us comes each night to have dinner with him. He doesn’t drive anymore, and we do all his shopping and errands for him. He is frail and has Parkinson’s disease. Our dad and three of the girls have been fully vaccinated and have appointments for the booster.
The youngest refuses to get vaccinated. She has never received a flu shot, and a COVID vaccine is “out of the question.” She is a conspiracy theorist, does not believe in science or medicine, and says the vaccine is a nonstarter. She also told us that her seeing and being with Dad is non-negotiable.
When COVID started, on her nights with Dad, she’d wear a mask around him. Once he and the rest of us got vaccinated, she quit wearing the mask and sits close to Dad. She says she can’t breathe with a mask. I tell her it’s easier to breathe with a mask than a ventilator. She is very strong-willed, and Dad won’t say anything because he wants to avoid confrontation. She is not required to wear a mask at her work, and she has been traveling all over the country.
Now with the delta variant, we have decided to give her an ultimatum: Get vaccinated or forfeit your time with Dad. We understand that even though Dad is vaccinated, he would most likely at his age not survive a breakthrough case. We have taken a chance for far too long. We don’t want to expose him to her (or anyone unvaccinated) anymore. We are not doing this to attack her or her principles. We are doing this to protect our elderly father. Please help us decide what would be best for our dad’s health. Your thoughts, please?
A: There are sure to be strong opinions about your predicament; however, my personal opinion is that you and your vaccinated sisters are correct and the risk to your father is too great. I would not allow her to visit without being vaccinated. Any person with her travel history (and possible exposure) should also either wear a mask or be tested for COVID-19 in addition to vaccination before visiting your dad.
I am afraid many people believe what your youngest sister believes, as I get letters every day from people with similar beliefs. Although it isn’t always comfortable breathing through a mask, nurses, physicians and other health care professionals have been doing so every day now for almost two years.
I can’t say whether your dad would survive a case of COVID-19. I have had patients in their 90s do so. However, his risk would be very high, especially considering his frailty. I realize this will cause stress in your family, but in my opinion, the risk to his health is too great.
Q: My father died two years ago at 73. For about six months, he had been experiencing excruciating back pain, which surgery didn’t help. A few years earlier, he had been treated for bladder cancer. He was due to have a follow-up appointment with his cancer specialist but didn’t because he was overwhelmed with the back pain and didn’t want to think about cancer, too. Well, eventually he ended up in the hospital, and it was found that cancer had spread throughout his body. He died a month later.
My question is whether his back pain was a symptom of the cancer. Should back specialists be alert to the possibility of cancer if standard treatments don’t work? Should people with severe back pain be proactive and ask for further tests?
I’m guessing that if his back specialist had been more alert, he would not have had to suffer for so long, nor would his cancer have been allowed to progress beyond treatment. If that’s
true, then other doctors (and other patients) need to learn from his death.
A: I am very sorry about your father.
New onset of severe back pain in any person with a history of cancer, especially recent cancer, requires urgent evaluation.
Bladder cancer has a propensity to spread to bones, along with lung, kidney, breast, prostate, thyroid and other cancers. These should lead the doctor — whether primary care or specialist — to be alert to the possibility that the bone pain is due to cancer.
What is surprising in your father’s story is that he had surgery. Before surgery, a surgeon will almost always do imaging studies, including X-rays or a CT/MRI. If cancer is suspected, a
radionuclide bone scan may be ordered (the exact type of imaging should be discussed with the person’s oncologist, as different cancers may show up better using different types of imaging). It’s possible the cancer remained undetectable until it was too late.
The fact that the pain did not get better with surgery increases my suspicion that the original pain may indeed have been due to cancer, as you fear. While your father’s back specialist should have done a thorough evaluation (I don’t know what the evaluation was), when he didn’t get any better, he should certainly have seen his oncologist right away, not waited for a regular followup. I don’t mean to suggest it was your father’s fault, but as you correctly say, being proactive
with this “red flag” symptom is important.
Q: I usually have mild symptoms of acid reflux, but my specialist said it was somewhat useless to take omeprazole or famotidine because, over time, they become ineffective. My brother-in-law takes a pill very day and has for years. My doctor supports occasional use only. What do you say, please?
A: Many people have occasional symptoms of acid reflux, also called GERD. The most common symptom is heartburn, but cough, wheezing and voice changes are other symptoms.
I also advise occasional use, but that’s because most people’s symptoms are occasional and I’d rather people not take more medication than they need.
Omeprazole, a type of medication called a proton pump inhibitor, takes a few days to begin working most effectively, so it should not be taken on an asneeded basis. I usually prescribe a six-week course. Famotidine is in a different class, called H2 blockers. These start working right away and are a good choice for occasional symptoms.
Some people absolutely need long-term treatment, such as those with Barrett’s esophagus, a complication of long-standing reflux. A medicine like omeprazole remains effective in longterm use.