Hello again, dear readers, and welcome to part two of our letters column about the COVID-19 vaccine. We continue to get questions about this topic and, because it’s so important, will continue to address them as quickly as possible.

-- Many of you are wondering if blood thinners, both prescription and over-the-counter, affect the coronavirus vaccine’s efficacy, and vice versa. It’s a question we’re getting from our own patients. The guidance at this time is to continue with blood thinners as prescribed, and to tell the person administering the vaccine that you are using them.

-- A reader who works in a hospital setting had a question related to Parkinson’s disease. “I’m a 71-year-old female who works part-time in a hospital, and I interact with staff and clinical equipment,” she wrote. “I have a strong family history of Parkinson’s disease and am concerned that the mRNA might have an unknown trigger effect for Parkinson’s disease.” There is no data at this time to support the idea that mRNA vaccines trigger Parkinson’s disease. However, we understand why this is a concern for you. We recommend discussing the issue with your family doctor, who can help guide your decision regarding the vaccine.

-- We heard from a daughter whose 72-year-old mother is eligible for the vaccine. “My mother was diagnosed with shingles this past January and is taking her medical treatment,” she wrote. “Do we need to wait for her to get the COVID-19 vaccine, or can she get it now?” The Centers for Disease Control and Prevention advises that no other vaccines be given within 14 days of getting the COVID-19 vaccine. However, there is no contraindication to receiving the COVID vaccine while taking shingles medication.

-- People who become infected with the coronavirus are often unsure exactly when it happened. A reader who recently lost her brother to COVID-19 has been left with this question. A cluster of infections spread through her brother’s small business over the course of 27 days, with a receptionist never becoming ill. “Could the receptionist have been asymptomatic?” she asked. “How long can an asymptomatic person transmit the virus?” A year into the pandemic, we know that the incubation for COVID-19 is between two and 14 days, hence the two-week quarantine recommendation. If the final person became ill 27 days after the first illness, then the receptionist could not have been the source of exposure for all of the infections.

-- Many people are concerned about allergic reactions to the vaccine. “I am an active 80-year-old and happen to be extremely allergic to bees and ants, and I carry an EpiPen,” a reader wrote. “I am wondering if I should receive the vaccination under a hospital setting?” Each vaccination site is required to have on hand the medicine and equipment to deal with adverse reactions to the vaccine. All patients are asked about their allergy status, and they are monitored for at least 15 minutes after receiving the vaccine. Be sure to disclose your allergy at your vaccination appointment, and speak up immediately if you begin to feel ill.

(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.)

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.)