San Antonio Express-News (Sunday)
Having blood drawn can have drawbacks
Q: While most aspects of modern medical care don’t bother me, I despise blood draws from either arm. I always faint when it’s done, and I feel awful afterward for what seems like a long time. It’s a visceral response I can’t control.
There are many noninvasive medical technologies now, so why are doctors still relying on this brutal way of seeing what is happening inside our bodies? There has to be a better way. Please tell me this will happen soon. Meanwhile, is there anything I can do to make the experience more tolerable?
A: I don’t think blood draws will be completely replaced anytime soon. The blood contains so many substances that give doctors information about health and diseases, so we rely on blood testing for a great deal.
You are quite right that there has been much work to develop new technologies to replace blood testing. Some of them are already here. Continuous glucose monitors get placed on the arm and can read blood sugar levels for weeks. In addition, oxygen sensors have largely replaced the truly brutal method of gathering arterial blood to check oxygen levels.
For people who faint with blood draws, there are several ways to help. The first is to get blood tests only when really necessary. For example, once a person is on cholesterol medicine and the number has been proven to be in the desired range, there is no reason to recheck it unless a person has a change in their health status.
When blood tests really need to be taken, warn your phlebotomist. They can sometimes take blood while a person lies down, sometimes with the head positioned below the heart. Also, make sure you’re hydrated (although, in rare cases, this might not be allowed). Readers have written to me about strategies they have used, including:
• Coughing, talking or smiling during the blood draw.
• Using a cold pack on the neck.
• Alternating between flexing and relaxing muscles before the blood draw (but keeping muscles relaxed during the actual blood draw).
Q: What is in a person’s makeup that determines if they are considered to be cold-blooded or warmblooded?
I’m a 93-year-old male in good health. From a young age, I have considered myself cold-blooded. Here in Southern California, it can get to 40 degrees Fahrenheit in the winter, and for me, that’s cold. I play golf, and when I go to my club to play, I have five layers of clothing on, and I’m still cold. Meanwhile, there are other players dressed in shorts and a golf shirt. I have questioned a few of them, and they just shrug their shoulders and say that they’re fine.
A: In general, younger people,
men, people of above average weight and very active people tend to be warm-blooded and tolerate cool temperatures. Women, those who are older, people of below average weight, those who are less active and smokers tend to be cool-blooded and prefer warm temperatures. Stress and fatigue can make many people less cold-tolerant. Thyroid levels may also play a role, along with where you grew up. But that doesn’t mean it’s always one of the factors listed above.
Q: What do you recommend to reduce healing time for cold sores on the lip? These flare-ups are so frustrating because they can take so long to heal. Is anything available that is better than oral acyclovir? Is there any difference between topical and oral meds? Are there any supplements that help?
A: For cold sores caused by recurrence of the oral herpes simplex virus, early treatment with antiviral medicine can
speed up healing. Most of my patients prefer the more potent valacyclovir to acyclovir, since the dosing of 2 grams twice daily for one day is much more convenient than acyclovir. Some of my patients know the feeling they get just before a breakout, and early treatment can even prevent the breakout at times.
There is a topical treatment, but it’s very expensive. Oral treatment is more effective and less expensive. Valacyclovir is generally well-tolerated, but needs to be used with caution or at lower doses in people with kidney disease.
Some people have cold sores that are triggered by sunlight, so sunscreen can help prevent this. Finally, I have had a few people whose cold sores are so frequent and painful that they took medicine every day to prevent them. This strategy is more commonly used with genital herpes.
Many of my patients write to me about lysine. The data on lysine isn’t encouraging, although a small trial found a reduction in recurrence rates when taken at the relatively high dose of 3 grams per day.
Q: I’ve gotten a regular flu shot for many years.
This year, I am 75 and decided that I would get the high-powered flu shot instead of the regular dose. About 15 hours after receiving the high-powered dose, I became very sick with sinus pain, runny nose, cough and unbearable headaches that sent me to bed with ice packs on my head for two days straight.
My husband did not “catch” this illness, nor did a number of people I had close contact with just before the shot. It appears I was not contagious. What do you think? I’m female and 5 feet tall; I weigh 103 pounds. I feel that this was too strong a dose for me.
A: I do not think you had a contagious disease at all; I think this was a side effect of the vaccine. As you probably know, the flu shot doesn’t give people the flu, but side effects can feel similar to the flu, usually for less than a day. You had a more severe reaction than normal.
There are two different kinds of the higher-potency flu shots. One (the “high dose”) literally uses double the antigen, while the other includes a substance (called an “adjuvant”) that makes the body’s response to the vaccine greater. Both make for a more effective flu shot, but with a higher likelihood of side effects.
While it is reasonable to suppose that your petite size may affect the necessary dose of the flu shot, there isn’t strong evidence that this is the case. The vaccine acts on immune cells, which are pretty much the same size no matter how big a person is.
Given your powerful response, I recommend you stick with the regular adult flu vaccine in the future.