Dear Dr. Roach: Why aren’t hospitals across the country mandating all personnel be vaccinated against COVID-19? I am getting conflicting information. Don’t you think the first-line people treating the ill, whether it is to check a patient in to the hospital or a nurse, should have their vaccine in order to work in the hospital?
K.W.
More and more hospitals and health systems require proof of COVID-19 vaccination for all employees who have contact with patients, and I absolutely agree with this.
Vaccines protect the individual, so I think everyone who can get the vaccine should. But health-care workers have a special responsibility to protect their patients, and even if they don’t want the vaccine for themselves, they are ethically obligated to get the vaccine in order not to infect their patients.
My own hospital system requires the COVID-19 vaccine for employees who work on-site, just as they have required influenza vaccine for decades. Of course, people who are medically unable to get the vaccine may apply for a medical exemption. Our hospital allows individuals to apply for religious and personal beliefs exemptions, and reasonable accommodations must be offered when possible.
Protecting our patients, selves, colleagues, family and community is paramount. Part of being a health care professional is putting your patients’ needs above your own.
Dear Dr. Roach: My systolic blood pressure is high (155), and my pulse is low (55). If I take blood pressure medicine to lower my systolic pressure, will that lower my pulse and create a bigger problem?
A.K.D.
Some blood pressure medicines do slow down the pulse and most doctors would avoid using them in a person who already has a pulse on the slow side. While 55 is not dangerous, it could drop further with a beta blocker or some calcium channel blockers, which slow down the heart and lower blood pressure.
If your diastolic pressure is normal, then you have what is called “isolated systolic hypertension,” and in many cases the best blood pressure medicine to use is a diuretic such as hydrochlorothiazide or chlorthalidone. These have been shown to reduce the risk of stroke better than other blood pressure medicines in older people with isolated systolic hypertension, and they do not lower the pulse rate.
Choosing a blood pressure medicine should take into account a person’s underlying medical conditions, not only to avoid side effects and toxicities, but hopefully to get additional benefits from one medicine.
Dear Dr. Roach: I would like to know more about dropsy. I can’t take water pills because of hard stools.
R.R.C.
Dropsy is a very old name for swelling, or edema, from the Greek word for water. The term is most often used to describe the feet swelling common in congestive heart failure, but it can also be used to talk about swelling of other parts of the body or from other conditions.
Diuretics (“water pills”) are commonly used for people with congestive heart failure resulting from a variety of conditions, but do not always have to be used. Other classes of medicines are effective not only at improving symptoms, but also in reducing the risk of death due to heart failure, which diuretics do not do. Further, if a medicine is so important that it needs to be used, doctors sometimes prescribe a second medicine (such as a stool softener, in your case) to counteract side effects from the important medicine. This is inelegant but sometimes necessary.
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
