San Antonio Express-News (Sunday)
Daily sneezing fits unlikely to offer protection from colds
Q: Your recent column on colds and flus made me realize that you’re the person I’ve been looking for regarding research. I’m 82 years old, and since I was in high school, I have sneezed daily. I never get a cold; although five years ago, I had pneumonia (minus cold symptoms).
Now, to be completely honest, when I came home from a cruise at the end of August with seven family members, all of whom had colds during the cruise, I experienced minimal symptoms of a cold. I haven’t gone a day without sneezing since then. My sneezes are hardy, usually two or three at a time. I generally sneeze at least twice a day.
So, Dr. Roach, is there a relationship between my daily sneezing and not catching a cold?
A: Sneezing is a protective reflex to keep irritants out of your nose. In theory, frequent sneezing might somewhat reduce your exposure to germs.
In reality, I doubt that there is significant protection. Bacteria and viruses are very small and don’t trigger a sneeze response; plus, they can be infectious at very low levels.
Most older adults don’t get colds because they are seldom exposed to people with colds. The fact that you got a cold while you were with infected family members tells us you aren’t completely immune. Your sneezes may be allergic or nonallergic, and if they aren’t particularly bothering you, you don’t need to treat them. Although there are effective treatments, sneezing twice a day is in the range I’d call normal.
Q: I have been a registered nurse for 55 years. I’m writing in about my 42year-old son who recently suffered a focal seizure while driving. He has a history of neck pain, possibly caused by his history of skateboarding on pipes during his early teen years and drumming in a band.
My daughter (also a registered nurse) read an article stating that neck nerve compression could cause a seizure. Do you have any knowledge regarding this? My son has no history of seizures, and a scan in the ER came out negative for any brain abnormalities.
A: Seizures have many different causes. Anyone can have a seizure under the right conditions of stress, but epilepsy is a condition of recurrent and unprovoked seizures.
I found quite a few articles in both the lay and medical literature stating that nerve compression in the neck can cause seizures, but I am unconvinced that this is a likely cause. The peer-reviewed papers I read included case reports of people who developed focal seizures after an injury, but the injury didn’t have to be in the neck; the seizures were reported even with burn injuries to the hand.
Most of the reported cases had other risks for seizures, including having a family history of epilepsy. Many cases of epilepsy are from an unknown cause. I suspect that a person often attributes epilepsy to something that is actually unrelated, but it’s possible that there is a connection between peripheral nerve injuries and seizures, which hasn’t been well-elucidated.
It is abundantly clear that brain and spinal cord injury, whether from trauma, stroke or cancer, can be a seizure focus and lead to epilepsy. In the ER, a CT scan is often done, but most experts in epilepsy want to see a highresolution MRI scan to look for any brain lesions that might lead to seizures.
Q: I am an 80-year-old woman. Three years ago, I had breast cancer surgery. After surgery, my oncologist said I should take medication for five years to prevent cancer recurrence. After three-and-a-half years on this medicine, I began having terrible shoulder, lower back and hip pain. I tried two other medications, but nothing changed. I was told that no other options were available
for me. What is your opinion on stopping my medication? I’ve had X-rays on the area that show arthritis. The pain can be very bad at times.
A: It sounds like you were recommended a medication called an aromatase inhibitor, which does reduce your risk of cancer recurrence and reduces your risk of dying from breast cancer when taken for five years. The first few years are the most important, but even the last one to two years still give additional benefit. So, I recommend staying on the medicine.
However, I understand that side effects can be so bad that even the benefit in reducing cancer and death may not seem worth it. In those cases, trying one of the other aromatase inhibitors is standard, but unfortunately, that didn’t work
There are other ways to try to reduce these side effects. Anti-inflammatory drugs, like ibuprofen (Advil) or naproxen (Aleve), and exercise are the first-line treatments. Many people worry about exercising due to the pain, but 20% of women who were recommended exercise and NSAIDs felt a significant improvement in their pain, compared to 1% of women who got the usual care.
Other medicines, such as duloxetine, have also been shown to reduce pain compared to the usual treatment or placebo. A well-done trial involving acupuncture found that this treatment also led to a small improvement in pain.
When nothing works, many oncologists will switch their patients from an aromatase inhibitor to tamoxifen, which also reduces risk of recurrence, but not quite as well.
Q: Can we get the respiratory syncytial virus (RSV) vaccine, the new COVID vaccine and our annual flu shot all at the same time? Or should they be spread out? I am 69 and healthy.
A: You can, but you will have an increased risk of “mild” side effects. I say mild because they aren’t life-threatening and will go away in a few days, but they can make you feel pretty badly. Personally, I separate the COVID vaccine and flu shot by a few days because I am in the hospital all the time and can attain those shots very easily. If it were difficult for me to get to the place where I receive the shots, I would definitely get them all at the same time.
The RSV vaccine is new, so I don’t have any personal experience with it. In trials, about 12% of people had local reactions, such as a sore muscle, from the RSV vaccine.
Most people can get these vaccines at their local pharmacy, so it’s up to you to spread them out or get them all together. I have had patients who told me that when they were in the military, they got as many as 35 vaccines in the same day, so it’s certainly safe to get a few vaccines done on the same day.
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 Drive, Orlando, FL 32803.