health

Special Flu Shot for Older People Has More Antigen

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 27th, 2019

Dear Doctor: Our 76-year-old mom is nervous about getting the special Fluzone shot for older people because a neighbor told her it will make her sick. Is that true? What makes flu shots so important?

Dear Reader: Influenza, commonly referred to as the flu, is a seasonal respiratory illness with symptoms similar to those of the common cold. Both illnesses are caused by viruses, but infection with the influenza virus usually results in symptoms that are more severe and longer-lasting than those of a cold. Unlike a cold, which typically comes on gradually, the onset of the flu is often swift. People who get the flu can experience fever, chills, sore throat, cough, lung congestion, body aches and pains, a stuffy and runny nose, and fatigue or exhaustion. Nausea and diarrhea are possible.

Flu season in the United States is concentrated in the fall and winter. Peak activity occurs between December and February. Symptoms show up from one to four days following infection. Depending on the flu strain, as well as the general health of the individual, it can take up to two weeks for the disease to run its course. Most people recover completely. However, at-risk populations with weaker immune systems, such as the elderly, are at increased risk of complications. These can be moderate, such as sinus and ear infections. Severe complications include pneumonia and, more rarely, myocarditis, an inflammation of the heart muscle, or encephalitis, a brain inflammation. In cases where the presence of the influenza virus triggers an extreme inflammatory response, it’s possible for the patient to develop sepsis, a life-threatening infection.

The special flu shot you refer to is called Fluzone High-Dose, a vaccine that contains four times as much antigen as the standard dose. Antigen is the part of the vaccine that causes the body to build up immunity. As we age, our immune response to influenza vaccines declines. The intent of the quadruple dose of influenza antigen is to make up for that reduction in clinical effectiveness. Recent studies have found the high-dose vaccine to be 25% more effective at preventing infection in the elderly. It is also associated with a lower rate of hospitalizations among those who do get the flu. However, it’s also true that side effects to the high-dose vaccine are slightly more frequent than to the standard-dose version.

People getting either type of vaccine may experience side effects including pain, swelling and redness at the injection site, as well as headache, fever, muscle aches and tiredness. Each of these are reported to be mild and temporary, lasting less than a day or two.

Whether your mother overcomes her fear of the high-dose vaccine or opts for the standard-dose variety, we think that the most important thing is for her to get a flu vaccine, no matter which kind, as soon as possible. You should get one, too. In fact, all of our readers should get the flu shot.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

Most Sleepwalkers Have No Memory of the Event

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 25th, 2019

Dear Doctor: I am an 82-year-old woman. When I was in my teens, I did some sleepwalking. A recent occurrence during the night is making me wonder if I have sleepwalked again. What are some of the things that sleepwalkers have been known to do?

Dear Reader: From the time of the ancient Greeks, people have been writing about the mysterious behavior we call sleepwalking. Hippocrates and Aristotle alluded to it in their writings, Shakespeare used it to reveal character in “Macbeth,” and a sleepwalker sets in motion the plot of the novel “Dracula.”

Formally referred to as somnambulism, sleepwalking is one of a larger group of sleep disorders known as parasomnias. During an episode of sleepwalking, the sleeping individual engages in behaviors as though they were awake. These can range from speaking; to getting out of bed and walking around; to completing complex tasks such as dressing, eating, bathing, cooking, rearranging furniture and cleaning the house. In some cases, sleepwalkers engage in violent behavior that puts them -- and their sleep partners -- at risk of injury. One thing the majority of sleepwalkers have in common is a lack of awareness of the experience as it takes place, and no memory of it upon awakening. Many sleepwalkers have discovered their sleepwalking through the discovery of physical evidence of an episode, such as waking up fully dressed or finding the kitchen filled with dirty dishes.

The disorder is estimated to affect from 2% to 15% of the population. It’s more common in children than in adults, and it is believed to have a genetic component. Episodes of sleepwalking, which can last from a few moments to more than an hour, most often occur during the nonrapid eye movement (NREM) stages of sleep. These are the deeper, dreamless stages of the sleep cycle. Studies show that about half of those who sleepwalk do it once a week. Although the disorder has been linked to stress, anxiety, alcohol use and poor-quality sleep, the exact cause is not yet fully understood.

Symptoms of sleepwalking include a glazed or glassy-eyed appearance, not communicating with others despite appearing to be awake, being difficult to awaken while an episode is taking place and feeling confused or disoriented when an episode is interrupted. People who sleepwalk rarely remember anything that took place during an episode. However, the disorder takes a toll on them physically.

Occasional episodes of sleepwalking aren’t considered to be cause for concern. However, if you suspect that you’re experiencing repeated incidents, we think it’s wise to check in with your family doctor. Sleepwalking accounts for the majority of sleep-related injuries, and it can cause drowsiness and exhaustion due to interrupted sleep. The condition can also be a sign of an undiagnosed sleep disorder or other medical condition. There is no known cure for sleepwalking. Your doctor can help you to identify potential triggers and suggest ways to create a safer environment to prevent injury.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

‘Tis the Season To Be Safe

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 23rd, 2019

Dear Doctor: It’s our turn to host our extended family for the holidays. That means my husband and I will have adults, toddlers, teens, babies and a few senior citizens here at the house for at least four days. What should we do to keep everyone safe?

Dear Reader: With the prospect of a full house during an often-hectic time of year, we think it’s wise that you and your husband are preparing not only for the festivities, but for the possibility of mishaps. And, really, whether the holiday season entails hosting multitudes or a small and quiet celebration, some simple precautions can make this time of year safer for everyone.

Let’s start with holiday decor, which can be particularly enticing to children. Tinsel is a potential choking hazard, as are ornament hooks. So are the ornaments themselves, if they’re small enough. If -- or more likely, when -- an ornament breaks, be sure to collect all of the pieces, and then thoroughly vacuum the area to pick up any stray fragments. If you’ve gone old-school and decorated the tree with bubble lights, be aware that the fluid they contain is toxic.

Some of the plants we bring into the house this time of year can pose dangers. The berries on holly and bittersweet and the leaves on mistletoe are known to be toxic. So are amaryllis and daffodils. Although poinsettia is often characterized as poisonous, that’s incorrect. However, certain compounds in the plant can cause skin irritation, or, if ingested, can sometimes result in nausea or vomiting.

Food and kitchen safety are particularly important during a holiday season that revolves around cooking, baking and eating. The number of kitchen fires spikes dramatically during this time of year, so make sure the various chefs never leave their creations unattended. It’s also important to keep the area around open flames clear of papers and debris. Have a working fire extinguisher ready, and make sure everyone knows how to use it.

Be vigilant about handling raw meat hygienically, which includes keeping hands and utensils clean. With cooked food, be sure it’s back in the fridge no more than two hours after serving. And be aware of any serious food allergies among your houseguests.

A few final thoughts: Have your first-aid kit stocked and ready to go. Remind houseguests to keep all medications safely out of sight and beyond reach. Unplug all lights at night and when you leave the house. Be aware of the various batteries that power toys, games and electronics use, as some of them are quite small. Be prepared and know the symptoms of severe food poisoning, which can include persistent vomiting or diarrhea, bloody stools, dehydration, dizziness and fever of over 102 degrees Fahrenheit. If someone falls seriously ill, it’s better to call 911 than to drive them for medical help. EMTs can initiate life-saving procedures upon arrival. And finally, find and post the phone number of your local poison control center. You can also get help from the American Association of Poison Control Centers at 1-800-222-1222, or aapcc.org.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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