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Wise as Salamon’s Health News

ssalamon_non_cg_2566Suzanne Salamon, MD is chief associate of clinical geriatrics at Beth Israel Deaconess Medical Center. Email general questions to mdeery@brooklinema.gov or call Maureen: 617. 730. 2790. These excerpts have been edited. Read the full post in this month’s newsletter along with past columns at https://www.brooklinema.gov/Archive.aspx?AMID=37

                                       

 

 

JUST OUT!  Dr. Salamon’s columns are in a new book:  “Ask a Geriatrician,” filled with good words on good health.  Copies are available at the Senior Center. For more information, please call 617. 730. 2777

 

 

 

August: I heard there was a treatment for COVID-19. What can you tell me about that? Also, should I be taking the 2nd booster for COVID, or wait until the fall.

ANSWER: There are some new treatments for COVID-19 which have become available in the past few months. One of them is called Paxlovid, which is a prescription oral antiviral drug. It has been shown to reduce the risk of hospitalization and death for patients with mild-to-moderate COVID-19 who are at risk of severe disease by a whopping 90%. It consists of 2 medications: one is an antiviral medicine, and the other is a “booster” for the first medicine helping it work better.

So who is “at risk of severe disease and death”? Among adults, the risk for severe illness from COVID-19 increases with age, with older adults over 65 at highest risk. Also people with cancer, lung, kidney, and heart disease as well as obese and immunocompromised people are at higher risk.

Paxlovid needs to be taken within 5 days of symptoms and a positive COVID test. You take 3 pills twice a day for a total of 5 days. Generally people start to feel better 1-2 days after starting Paxlovid. However, there are some side effects that can occur, such as a metallic taste in your mouth, diarrhea, increased blood pressure and muscle aches.

About 1-2% of people feel better while taking Paxlovid but will have a return of symptoms after finishing their 5 days of treatment. This is called a “rebound effect” and it is not yet understood why this happens. Fortunately, the rebound symptoms seem to be mild.

There are some medications that Paxlovid may interact with and cause serious complications. The prescriber may then ask you not to take these medicines for the 5 days of Paxlovid. However, if it is not safe to stop these medications, you may be prescribed a different anti-Covid medicine that is intravenous.

Until recently, only primary care providers could prescribe Paxlovid, but in early July, 2022, the FDA authorized state-licensed pharmacists to prescribe the drug.

Although we now have some treatments which help reduce the severity of COVID-19, vaccination remains the key part of prevention, since the virus can develop resistance to antiviral medicines.

As to whether to get your boosters now the CDC recommends:

 Adults ages 50 years and older should receive a 2-dose primary series separated by 4-8 weeks and 2 booster doses. The first booster dose should be administered at least 5 months after completion of the primary series and the second booster dose at least 4 months after the first booster dose.

So, stay safe! Continue to wear a mask when you are inside with a lot of people, get your vaccines/boosters and call your primary provider and/or pharmacist if you have symptoms that might be COVID and you test positive on a home COVID test.

July: The flowering trees and bushes are beautiful, but every spring, my nose and eyes start to water. Although I assume this is from allergies, I worry that it could be COVID. Also, this year  my allergies seem to be worse than usual. Is that possible?

Answer: Spring is a beautiful time of the year, with flowering trees and flowers everywhere. However, for many people, the large amounts of pollen that are released from grass, trees and  flowers can cause or exacerbate allergies, often called “hay fever” or “allergic rhinitis.” Symptoms can include runny nose, sneezing, watery and itchy eyes, and sometimes, cough. Often people think they have a cold.

Most allergy symptoms are mild and resolve as the season progresses. However, some people have severe symptoms. People with asthma can find that their breathing can be worse during allergy season. Some people find that their allergy symptoms last all year long, not just during springtime. They can find out what they are allergic to by having allergy skin testing, called a “prick test” by a specialist in Allergy and Immunology.

Interestingly, there is more evidence that we are seeing more allergies now than in the past because we are becoming “too clean.” Throughout our lives, when we are exposed to “dirt” or such things as pollen or even peanuts, we develop antibodies to these, which then protect us from allergic reactions later in life.  A recent study showed that Israeli children who eat a snack similar to cheese-its, only made from peanuts have far fewer peanut allergies than American children, who are protected from peanut products by cautious parents. Similarly, antibiotic soaps may wash away some of the bacteria we need to be exposed to in order to develop antibodies.

There are also reports that allergy symptoms are starting earlier, lasting longer and are stronger than they used to be. There are many scientists who believe that the changing climate cause the trees and grass to grow faster and thus produce more pollen. The season also seems to be starting earlier and lasting longer than in the past.

Of course, there is additional concern because many allergy symptoms mimic COVID symptoms. People often think they are suffering allergy symptoms and then find they test positive on a COVID test.

It turns out that people who wear a mask to prevent COVID also have fewer allergy symptoms because the mask prevents the inhaling of pollen as well as COVID.

Treatment for allergies can start with air purifiers, filters and to try to clear the inside air filter of pollen.  After gardening or walking in grassy areas, wash clothes and hands, and take off shoes at the door.

Often people need medications to control severe symptoms. Unfortunately, the most effective drugs, over the counter antihistamines, can cause drowsiness and other side effects. The newer antihistamines, such as fexofenadine (Allegra), loratidine (Claritin), and cetirizine (Zyrtec) which are also over the counter medicines, help control symptoms with fewer side effects.

There are also some antihistamine nose sprays and eye drops available. Steroid nose sprays are often used, but long term use of these steroid sprays can cause some of the negative side effects of steroids. Decongestants such as pseudoephedrine can help, but can cause high blood pressure or heart problems.

Over the counter normal saline nose sprays or irrigation with a neti pot where you pour a salt water solution into one nostril and drain it out the other to flush out old mucus and other pollutants can help wash out pollen from your nose and have no side effects. This has been used for centuries and is extremely effective in treating the symptoms of seasonal allergies such as runny nose. Even simple normal saline nose spray can clean out your nose of pollen.

So enjoy those beautiful flowers, but for now, if you are suffering from allergies, keep a mask with you even when you go outdoors.

June: WHAT IS A BAKER’S CYST AND WHAT CAN BE DONE ABOUT IT?

ANSWER: A Baker’s cyst is a lump that is filled with fluid that forms behind your knee. It is also called a popliteal cyst. It was named after Dr. William Baker, a doctor in England in the late 1800s. He described a buildup of fluid behind the knee that is the result of some kind of damage to the knee joint. This causes extra fluid to be produced, forming a cyst in the back of the knee. This damage can be caused by such things as arthritis, direct trauma to the knee or gout. A Baker‘s cyst can sometimes burst on its own with the fluid leaking into your calf.

Some people do not even notice that they have a Baker ‘cyst, while others may find them quite painful. Some symptoms may be feeling a lump at the back of your knee, pain or stiffness in the knee or decreased ability to bend your knee.

The diagnosis of a Baker’s cyst is usually made buy an ultrasound to examine the lump or an MRI  of the knee.

Treatment of a Baker’s cyst generally is done without surgery. This includes applying ice to your knee, elevating your knee while you’re sitting down and using some sort of wrap to compress the area behind your knee to decrease the swelling. This can be either an elastic knee compression sleeve or an ace bandage. It is helpful to be sure that you are not overweight since this can aggravate and cause arthritis which can predispose you to arthritis and a subsequent Baker’s cyst. They often will go away on their own.

However, if the lump is getting larger and causing pain, your health care provider may drain the cyst with a needle or do arthroscopic knee surgery to drain the cyst.

To prevent a Baker’s cyst, it is important to try to avoid knee injuries. Also, being overweight puts added pressure on your knees and is a risk factor for arthritis, show maintaining a healthy weight is an important part of prevention.

MAY: What is the difference between Pandemic, Epidemic and Endemic?

It’s hard to believe that a full 2 years after COVID made its grand entrance to the US, we are still dealing with its ongoing presence. There are several questions about COVID, and it seems that the answers are constantly changing. But for now, in early 2022, here are some of the topics:

  • EPIDEMIC is the spread of a disease throughout an area where it usually is not present.
  • PANDEMIC is when the disease spreads over a larger area, often the entire world.
  • ENDEMIC means that a disease recurs regularly, never really going away, such as the flu. We will have to see if COVID becomes endemic, requiring regular vaccinations.

APRIL: What exactly is anemia and is it part of normal aging?
Anemia is a word that means “without heme.” Heme , or hemoglobin, is contained in red blood cells which supply our body with food and oxygen. At first we may not feel when the red blood cells and hemoglobin become too low. However, if it progresses, we may feel tired, weak, get short of breath, dizzy and even develop chest pain. While some people may have lower levels as they get older, a sharp drop warrants a workup.

MARCH: I hear so much about the Opioid Epidemic. Is that something older adults need to worry about? YES! There is an opioid crisis among older adults, but we don’t hear much about it in the press. For adults aged 65 and older, opioid-related hospitalizations increased by 34% and emergency department visits increased by 74% between 2010 and 2015.

DECEMBER: Where do things stand now, and in what ways has it impacted the lives of health professionals treating patients with COVID? Events related to COVID still are happening so rapidly that it’s good to slow down and take a “trip through memory lane” to think back over the events that have changed the world in such a short time and the miraculous response that continues to evolve. Let’s go through a timeline of events.

OCTOBER:  What is sciatica?  It is a pain that can travel down each leg though it usually only affects one side.  It occurs when something compresses part of the sciatic nerve like spinal stenosis or a herniated disc. People who sit for a long time are more prone. Treatment: ice for a couple of days.  Can be followed by heat.

SEPTEMBER:  Do I need a flu shot? Last year’s flu season was one of the lightest.  It is possible to catch the flu after you are vaccinated however it reduces the severity. You cannot get the flu from the flu shot. Flu vaccine is recommended for everyone older than 6 months. The best time to get the shot is the end of October and early November.  The CDC says it is okay to get the Covid vaccine and the flu vaccine at the same time. (!)

AUGUST: I got both shots. I’m 88, is it safe to leave the house? Yes, and always have your mask. If you’re outside, you are most likely safe. Mass has a high rate of vaccination. Wear the mask inside. We don’t know yet about booster shots.

JULY:  Still hot!  You may be more susceptible to the heat with heart and kidney issues, blood pressure, alcohol, over or under weight, and medications. Heat exhaustion and heat stroke are uncommon but worrisome. Get to a cool place, drink, put your feet up. Heat stroke needs immediate medical attention.

JUNE: It’s hot! Symptoms of dehydration can be: dry mouth, muscle cramps and nausea. Severe dehydration is called heat stroke and often requires hospitalization. Imbibe: water, popsicles, fruit especially melon, tea, coffee, Gatorade, lemonade.

MAY:  What is aortic stenosis?  As we age, the valve becomes narrow and doesn’t open fully to let blood pass through. This causes blood to back up. Stenosis means narrowing. Causes: calcium build up, birth defects, rheumatic fever, and radiation therapy. Treatment: drugs and/or surgery.

APRIL:  How can I prevent diabetes?  Diabetes is caused when sugar and fat cannot be absorbed. They stay in the blood causing blood sugar to rise. Common risk factors: family history, being overweight, some medications, and age.  Symptoms: thirst, urinating often, yeast infections, skin problems, weight loss, and dry mouth among others. To treat diabetes, it is important to maintain a normal weight and get daily exercise.  Without treatment, there is the possibility of damage to the eyes, kidneys and the development of neuropathy.

MARCH: It’s your annual physical. Ask about:  Blood pressure, cholesterol, bone density, colonoscopy, vaccines (flu, DTAP, shingles), hearing, BMI, depression, vision. Checkups work. 

FEBRUARY:  How common is lung cancer? Lung cancer is the most common cause of deaths from cancer in the world. The most common cause is smoking. It can lie dormant for years and suddenly start to grow. Symptoms: cough that doesn’t get better, difficulty breathing, coughing up blood, chest pain, hoarseness, weight loss, bone pain, headache. Diagnosed by chest x-ray and CT scan. Biopsy may be followed by surgery, radiation, chemotherapy, targeted drug therapy and immunotherapy. Treatments are so much more effective now. It is important to diagnose and treat early.

JANUARY: Should I see a cardiologist before or after a heart attack? If before, what symptoms should I look for? Chest pain, or angina, is a common reason. It can be caused by a blockage, which narrows the arteries so much that blood and oxygen can’t get through, especially during physical activity. The doctor may order an EKG, stress test, ultrasound or cardiac catheterization. Other symptoms: pressure, squeezing, heaviness in the chest; pain or pressure in your neck, jaw, back or arm; paleness, cold sweat, or rapid and uneven heartbeats; difficulty catching your breath.

DECEMBER:  What do we need to know about the vaccines? So far, the vaccines require two doses, 3-4 weeks apart.  We don’t know if the vaccines reduce the risk of getting the virus, or they keep us from getting sick and we can still be carriers. We also don’t know how long protection lasts. There is no evidence the vaccines are unsafe. Health care workers will be offered the vaccine first. If you have had the virus, still get the vaccine. Keep wearing masks, distancing and washing hands.

NOVEMBER:  I am tired when I go to bed but then I cannot sleep. As the sun rises, I fall asleep and cannot get up until noon. Do you have suggestions?  As we get older, our sleep may change.  Insomnia may result from stress, depression, anxiety, medications or health problems. Alcohol, the computer, pain, lack of exercise, snoring, and sleep apnea may cause sleep problems. 

Turn off the TV and computer an hour before. Read a book or an electronic device that doesn’t have a light source. Wear ear plugs to block snoring. Get aerobic exercise like walking, dance and golf during the day. Talk to your doctor about melatonin. Short day naps are okay. Avoid alcohol and caffeine late in the day. It is common to have short periods when we have trouble sleeping but it usually passes.

OCTOBER: Asked and answered by Suzanne Salamon – What is it like to have my 98 year-old mother move in with us?

My mom, Lilly, is as tough as they come. Two months ago, she fell. Incredibly, she is pretty much back to herself. We rented an apartment for her, four minutes from our home. She spends hours online; Google is her best friend. When I ask her how she feels about her new stage of life, she said: “I am the luckiest person alive.”  (Read the whole story here in the November 2020 issue: https://www.brooklinema.gov/Archive.aspx?AMID=37   Page 4)

SEPTEMBER: What is Telehealth? Meetings between patients and doctors by phone, computer or smartphone. Have your questions ready along with a list of medications and be ready to write instructions and suggestions. A blood pressure machine at home is handy particularly if your medications are being adjusted.

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 New York Times, Huffington Post, New Yorker

  • A Number That May Not Add Up, by Jane E. Brody, Times, April 14
    Weight Matters
  • The Sixth Stage of Grief, by Joel Yanofsky, Times, April 11
    Buying a Puppy
  • Why a Brisk Walk Is Better, by Gretchen Reynolds, Times, December 4
    Pick up the pace
  • In the End, It’s Not About the Food, by Corey Mintz, Times, November 26
    Just a little
  • Think Like a Doctor, by Lisa Sanders, MD, Times, October 3
    A Green Heart
  • A Youthful Glow, Radiating From Within, by Jane E. Brody, Times, September 30
    You look mahvelous
  • Manson Whitlock, Typewriter Repairman, Dies at 96, by Margalit Fox, Times, September 8
    Work works
  • Online Lessons in Dementia Management, by Judith Graham, Times, Sept 5
    Caring and Coping
  • Eat Your Heart Out, by Gretchen Reynolds, Times, March 7
    Your Heart
  • Gross Ingredients In Processed Foods, by Sarah Klein, Huff Post, May 14
    Eat no meat
  • We Could Be Heroes, by Mark Bittman, Times, May 15
    Eat less meat
  • Nutrition: Options Play a Role in Healthier Choices, by Nicholas Bakalar, The Times, February 13
    Food story
  • The Fat Trap, by Tara Parker-Pope, The Times, December 28
    Sad story
  • In the Body’s Shield Against Cancer, a Culprit in Aging May Lurk, by Nicholas Wade, The Times, Nov 21
    Old story
  • Redefining the Hot Dog, a Cart at a Time, by Jeff Gordinier, Times, August 9 “There are children in New York who have never eaten a hot dog.” Very sad story