Dear Dr. Roach: My daughter is still nursing her 10-month-old son. She decided to get the Pfizer vaccine and continue breastfeeding. Her doctor did not advise her against it. Do you have an opinion or more information about this matter? I’ve read that COVID antibodies are present in breastmilk.
COVID-19 vaccination is recommended for women who are breastfeeding. There is data to show that the vaccine is effective for the breastfeeding woman, but there is little data about the effect on the baby. It is true that breastmilk does have antibodies to COVID-19, but how effective these may be at preventing disease in the baby is not clear. It is clear that there is no way that either the mother or baby could get COVID-19 from the vaccine.
Because women who are pregnant or have recently been pregnant are at higher risk for severe disease if infected with COVID-19, pregnant and breastfeeding women are especially recommended to get the vaccine.
Dear Dr. Roach: Your recent column stated that increased pressure inside the bladder progressively damages the kidneys. This is very important new information in my case, and I would like to know if Flomax (tamsulosin) can help keep my kidney functioning properly as measured by creatinine level. I’ve been resisting taking Flomax because of apparent side effects, even though my urologist prescribed it. But I will enthusiastically take it if it will help my kidney function.
The column you reference was specifically looking at a person whose prostate problem is so bad that he needed to do intermittent self-catheterization, which was absolutely crucial to preserving kidney function. Men with mild prostate symptoms are not at particularly high risk for developing kidney damage; however, since that column was published I did see a new patient who developed significant loss of kidney function (almost half his kidney function) because he had moderate to severe symptoms that he never treated.
Following the creatinine level is certainly important, and if it starts to rise, then treatment — medical or surgical — becomes critical. However, most men want treatment just to improve symptoms, and usually we can find treatment that doesn’t have too many side effects. The most common side effects of tamsulosin are runny nose and lightheadedness, especially on standing. Rare and serious side effects include priapism (an erection that won’t go away).
Dear Dr. Roach: Is it necessary to take CoQ10 with pravastatin?
Pravastatin, like all statins, can cause side effects, including muscle aches. In most people taking statins, muscle aches are not due to the statin. Recent studies showed that the likelihood of muscle aches was just about the same whether they were taking a placebo pill or a statin and didn’t know it.
Coeznyme Q10 is part of the metabolic pathway of many statins, and there has been a theory that depletion of CoQ10 is responsible for muscle aches. But randomized, controlled trials have shown that treatment of muscle aches with CoQ10 is not much better than placebo, and there is no good evidence that CoQ10 can prevent muscle aches. Pravastatin, in particular, does not deplete CoQ10 the way atorvastatin does, for example.
Even though I don’t recommend CoQ10 to treat or prevent muscle aches, it’s considered safe and is not particularly expensive. I don’t insist people stop it, especially if they feel it helps.
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