Hello again, dear readers, and welcome to our monthly letters column. Virtually all of the mail we received in the last month concerned the coronavirus vaccine. In fact, we heard from so many of you, we need two columns to cover it all. Onward to part one:

-- A reader shared that she is using an over-the-counter nasal antiseptic so that she will be less likely to spread the coronavirus should she become infected. “I read that killing germs in the nose can reduce your risk of bacterial infections such as MRSA and staph,” she wrote. “And some experts believe it can help fight COVID-19.” It’s true that some patients use an antiseptic nasal spray to “decolonize” the bacterium Methicillin-resistant Staphylococcus aureus, also known as MRSA. However, these nasal sprays target bacteria, and not viruses. It’s a crucial distinction, because COVID-19 is caused by a virus, and it doesn’t respond to antibacterials. We’re not familiar with data supporting this practice for COVID-19, and we would not recommend it to our patients.

-- A reader who tested positive for COVID-19 in August asked about antibodies and immunity. “Do I need to get tested for antibody levels?” she wrote. “Should I get the vaccine? When will my immunity run out?” At this time, it’s believed that antibodies persist for about 90 days after COVID-19 infection. The degree of immunity that they confer is not yet known, so the only reason to get the test would be out of curiosity. And, yes, we recommend that everyone get the vaccine. This includes those who have tested positive for the coronavirus in the past and don’t currently have COVID-19 symptoms.

-- A reader wondered whether the anti-inflammatory she takes for a type of arthritis known as pseudogout presents a problem regarding the vaccine. “Does it affect the efficacy of the COVID-19 vaccine?” she asked. “Is one vaccine manufacturer better than another?” We are not aware of any data about decreased efficacy of the vaccine in individuals using either NSAIDs (non-steroidal anti-inflammatories) or steroids. As for the vaccines, they are equally effective. We strongly recommend that our patients get the first one available to them.

-- We heard from a number of readers asking if the vaccine is safe for people with disorders such as multiple sclerosis and Parkinson’s disease. Both the Parkinson’s Foundation and the National MS Foundation convened panels of experts to research this question. Their conclusions are that, yes, individuals with these diseases should get vaccinated. It’s important to note that these recommendations apply only to the Pfizer and Moderna mRNA vaccines.

-- A reader with Type O blood, which has been linked to a lower risk of serious illness with COVID-19, wondered about her need for a vaccine. “Do I need to get the vaccine since I have a low risk of getting COVID-19? If so, which one is best for me to get?” Yes, we recommend that our patients with Type O blood get vaccinated with either the Moderna or Pfizer vaccine, whichever is available.

Please come back later this week for part two of the vaccine letters column.

(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.)

Dear Doctor: Our neighbor was diagnosed with cancer in his right eye. It’s called ocular melanoma. I don’t want to bother him or his wife with a lot of questions, but I’d like to know more about the disease. Can you explain about risk factors and symptoms? How common is it? I thought melanoma was a skin cancer.

Dear Reader: Ocular melanoma is what is known as a primary intraocular cancer. That means that the disease begins within the eye itself. It’s a rare type of cancer that occurs most often in adults, and it affects only 5 or 6 out of every 1 million people each year. It can occur at any age and in people of all races, but it tends to be more common in those with lighter skin and eye color.

You’re correct that we’re most accustomed to hearing about melanoma in connection to skin cancer. However, the root of the word derives from melanocytes, which are cells that produce and contain the pigment known as melanin. These cells are found both in the skin and the eyes and, depending on their density and distribution, lend each their specific color. The word “oma” denotes swelling, tumor or other abnormal growth. Melanoma, therefore, refers to cancers that begin in the melanocytes.

Ocular melanoma usually arises in the uvea, which is the middle of the three layers of the eye. The positioning makes it difficult to see, and this type of cancer causes few, if any, symptoms. When symptoms do occur, they can include a dark spot that is visible on the iris, a change to the shape of the pupil, visual distortion or a blind spot in the peripheral vision, the perception of flashing lights or the sensation of pressure within the eye. Most often, ocular melanoma is identified when the eyes are dilated in the course of a routine exam. Ultrasound and a range of scans may then be used to confirm a diagnosis.

In addition to lighter eye color, risk factors for this type of cancer include exposure to sunlight or UV light, increased pigmentation on the uvea, having a mole in or on the surface of the eye, older age and being of Caucasian descent.

This is an aggressive type of cancer that can potentially spread to other areas of the body, most often to the liver. Immediate treatment is often necessary. The approach depends on the size and placement of the tumor, and the stage at which it is found. The two most common treatments are radiation therapy and surgery. Depending on the size and placement of the tumor, vision may be preserved. In advanced cases, aggressive treatment may be necessary, and vision is lost.

When an eye must be removed, patients can opt for reconstructive surgery, including the use of an artificial eye, or prosthesis. When tumors are small, they can sometimes be removed with laser treatment, which heats and destroys the cells. Investigative therapies that have shown promise include cryosurgery, which involves freezing the affected cells, immunotherapy and drugs that target proteins involved in tumor growth.

(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.)

Dear Doctor: I hate switching to and from daylight saving time every year. My husband says it’s just a nuisance, but it messes up my sleep, and I think it’s affecting my health. Haven’t there been some studies about that? We’re both interested in your answer.

Dear Reader: You’re far from alone in your feelings about being forced to either lose or gain an hour as daylight saving time begins and ends each year. The energy-saving origins of the idea have since been disproven, as studies show that the drop in lighting demands is offset by air conditioning use during the longer summer days. Meanwhile, as you are experiencing, the practice has been shown to lead to widespread sleep disruptions. Numerous studies have linked the time shift to increases in workplace and automobile accidents, heart attacks, depression and sleep disorders. Considering all that we continue to learn about the close link between the functioning of our bodies, and the daily cycle of light and dark, these findings don’t come as a complete surprise.

A large new study into the health effects of daylight saving time, published last June, analyzed health data from 150 million patients in the United States and 9 million patients in Sweden. In addition to the ill effects we already mentioned, the researchers reported that the semi-annual time shift also played a role in increases in digestive disorders such as noninfective enteritis and colitis, complications related to pregnancy and childbirth, and autoimmune and inflammatory disease. Some of these showed a modest uptick of about 3%, while others, such as car accidents that resulted in injury, spiked up to 30% on the day of the shift into daylight saving time.

It’s important to note that, depending on your personal work and life schedules, daylight saving time affects everyone differently. People who have to be at work at an early hour suddenly find themselves waking up and commuting in the dark. Younger kids are being sent to bed while the sun is still in the sky. Location plays a role, as well, with people living farther south less affected by the time shift. And while it’s true that we do adapt, the research continues to suggest that even just a 60-minute realignment can have real repercussions.

Meanwhile, unless you live in Hawaii or Arizona, which don’t switch their clocks, there are a few steps you can take to try to reduce the degree of disruption. Sleep specialists suggest planning ahead. Several weeks before daylight saving time begins, start going to bed a few minutes earlier each night and waking up a few minutes earlier each morning. This helps ease you into the one-hour loss of time. Then, make it a point to expose yourself to early morning daylight when the sun does rise, which can help your body clock to adjust. Keep the rest of your schedule as regular as possible, including exercise and mealtimes, so your body isn’t dealing with additional change and stress. These won’t erase the challenges caused by that lost hour, but they may make adjusting a bit easier.

Remember to change your clocks this Sunday, March 14, the start of daylight saving time.

(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.)