Dear Dr. Roach: It is nearly flu season and I want to discuss the options for vaccines available in North America this year.
I do not recommend the nasal vaccine, as expert groups have questioned its effectiveness. There are seven influenza vaccines available.
Anonymous
For most people, any vaccine is acceptable. The usual flu shot offered at your doctor or pharmacy most likely is the standard-dose trivalent or quadrivalent vaccine.
The trivalent protects against three strains of flu expected to be prevalent (two “A” strains and one “B” strain), whereas the quadrivalent adds a second “B” strain.
If both are available, I’d recommend the quadrivalent, but don’t skip the trivalent if that’s the only one available.
People over 65 may benefit more from the high-dose trivalent vaccine (Fluzone High-Dose) or from Fluad, which contains an adjuvant (a substance added to the vaccine to make it work better).
Those ages 18 to 64 with a fear of needles might consider the intradermal low-dose quadrivalent vaccine (Fluzone intradermal). This uses a tiny (1.5-mm), ultra-thin needle.
Another option for people with needle phobia is the standard trivalent vaccine (Afluria) using a jet injector device. It is like the hypospray in Star Trek.
(I have yet to talk to anyone who has had this, so if you have, please write to me about your experience.)
People with severe egg allergies can get the Flucelvax, produced in cultured mammalian cells, not eggs, or Flublok, made with recombinant DNA technology, which comes in both trivalent and quadrivalent.
That’s a lot of choices, but the bottom line is that any of the approved vaccines will give some protection against the flu, which is always an unpleasant experience but can be a life-threatening illness.
The U.S. Centers for Disease Control and Prevention estimates that there are 12,000 to 56,000 deaths from flu in the United States each year. Most deaths are of people who were not vaccinated.
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Dear Dr. Roach: Uterine fibroids in the right (wrong) place can cause bowel compression and constipation.
I wasted a lot of time adding more and more fibre to an already fibre-adequate diet to the point where I developed diverticulosis from bowel pressure.
A hysterectomy solved the problem completely. I wish I’d known sooner.
J.Q.
Thank you for writing.
Fibroids are benign tumours of the uterus. They are very common. Up to 80 per cent of women over 40 have them, although many don’t have any symptoms.
The most common symptoms are bleeding, pelvic pain or pressure, or a pelvic mass noted by the woman.
The vast majority of uterine masses are benign. There is a risk of a malignant tumour (sarcoma), but only about two cases per 1,000 women with symptomatic fibroids.
It is not a common presentation, but you are correct that a fibroid in the posterior part of the uterus can press directly on the rectum.
This can cause mechanical pressure, requiring increased straining to void.
Fibroids also can bleed, causing anemia, and the iron tablets many women take to counteract this can also cause constipation.
Not all women with fibroids need surgery. They usually get smaller after menopause. However, very large or symptomatic fibroids can be treated surgically.
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.