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Dr. Roach Writes: It is nearly flu season, and I want to discuss the options for vaccines available this year in North America. I do not recommend the nasal vaccine, as expert groups have questioned its effectiveness. There are seven influenza vaccines available.

For most people, any vaccine is acceptable. The usual flu shot offered at your doctor or pharmacy most likely is the standard-dose trivalent or quadrivalent vaccine. The trivalent protects against three strains of flu expected to be prevalent (two “A” strains and one “B” strain), whereas the quadrivalent adds a second “B” strain. If both are available, I’d recommend the quadrivalent, but don’t skip the trivalent if that’s the only one available.

Adults over 65 may benefit more from the high-dose trivalent vaccine (Fluzone High-Dose) or from Fluad, which contains an adjuvant (a substance added to the vaccine to make it work better). Adults age 18-64 with fear of needles might consider the intradermal low-dose quadrivalent vaccine (Fluzone intradermal). This uses a tiny (1.5-mm), ultra-thin needle. Another option for people with needle phobia is the standard trivalent vaccine (Afluria) using a jet injector device. (It is like the hypospray in “Star Trek.” I have yet to talk to anyone who has gotten this, so please write me with your experience if you get this.)

People with severe egg allergies can get the Flucelvax, produced in cultured mammalian cells, not eggs, or Flublok, made with recombinant DNA technology, which comes in both trivalent and quadrivalent.

That’s a lot of choices, but the bottom line is that any of the approved vaccines will give some protection against the flu, which is always an unpleasant experience, but can be a life-threatening illness: The Centers for Disease Control and Prevention estimates that there are 12,000 to 56,000 deaths from flu in the U.S. each year. Most of these are in people who are not vaccinated.

Dear Dr. Roach: Uterine fibroids in the right (wrong) place can cause bowel compression and constipation. I wasted a lot of time adding more and more fiber to an already fiber-adequate diet to the point where I developed diverticulosis from bowel pressure. A hysterectomy solved the problem completely. Wish I’d known sooner.

J.Q.

Dear J.Q.: Thank you for writing.

Fibroids are benign tumors of the uterus. They are very common: Up to 80 percent of women over 40 have them, although many don’t have any symptoms. The most common symptoms are bleeding, pelvic pain or pressure, or a pelvic mass noted by the woman. The vast majority of uterine masses are benign: There is a risk of a malignant tumor (sarcoma), but only about two cases per 1,000 women with symptomatic fibroids.

It is not a common presentation, but you are completely right that a fibroid in the posterior part of the uterus can press directly on the rectum. This can cause mechanical pressure, requiring increased straining to void.

Fibroids also can bleed, causing anemia, and the iron tablets many women take to counteract this also can cause constipation.

Not all women with fibroids need surgery. They usually get smaller after menopause. However, very large or symptomatic fibroids can be treated surgically.

Email questions to ToYourGoodHealth@med.cornell.edu.

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