Dr. Roach: Confusing pneumonia vaccine guidelines clarified
Dear Dr. Roach: I have a question regarding the new pneumonia vaccine Prevnar for my grandmother. She had the Pneumovax 23 in 2012 (she is in her 80s). Should she get Prevnar 13? She is relatively healthy, except for very mild asthma and seasonal allergies. I’m confused!
Dear A.P.: The two pneumonia vaccines are a little bit confusing, even for us health-care professionals. The current recommendation from the Advisory Committee on Immunization Practices is to get the PCV13 (Prevnar) at age 65, followed by a dose of PPSV23 (Pneumovax) six to 12 months later. Adults over 18 also should receive these two vaccines if they have a condition that compromises the immune system or have no spleen or an abnormally functioning one, spinal fluid leaks or cochlear implants.
Many people already have had the Pneumovax. Anyone over 65 (or with any of the above conditions) who already had the Pneumovax but who hasn’t yet had the Prevnar should get the Prevnar, but at least one year should have gone by between the two vaccines.
Pneumovax alone is recommended for adults 19-64 with chronic heart or lung diseases, diabetes, excess alcohol use, chronic liver disease or a history of smoking. Only people with no functioning spleen or with immune system disease need a booster Pneumovax, given five years after the first dose.
Dear Dr. Roach: My partner’s body heat is always very warm. We keep our home at 75 degrees, and she complains that the house is too hot. Even at night when I touch her, I can feel the heat on her body. Is this normal? What do you think might be causing this to happen? She is in her mid-60s.
Dear C.B.: It is not at all abnormal for people to have different temperatures at which they feel comfortable, and 75 degrees is on the warm side of comfort for many.
One way our bodies regulate temperature is through blood flow to the extremities. When blood vessels are open, one will feel quite warm to the touch, and when trying to conserve heat, the skin feels cold and clammy (I have always found an odd expression, because clams are normally cold).
If she is really bothered by it, it might be worth thinking about two common medical issues: hyperthyroidism and vasomotor instability of menopause. In hyperthyroidism, the entire metabolism is enhanced, so the person is warm all the time. A simple blood test can confirm this diagnosis.
In a woman in her 60s, it is common to have periods of vasomotor instability, usually called hot flashes. In these, the blood vessels open up and the woman becomes uncomfortably hot for a few minutes. It is possible that one of these could be happening for your partner. However, sometimes variations in normal physiology can fool the physician into thinking there is a problem.
Dear Dr. Roach: I read your column about chronic dizziness. My brother suffers from vertigo. I wonder where I should go to find out about occupational therapists and physical therapists in our area doing vestibular rehabilitation.
Dear K.M.: Your best bet is your regular doctor, but otherwise a web search (or even the yellow pages) will get you some phone numbers. Call and find out if any facility has therapists experienced in vestibular rehabilitation. An online resource is vestibular.org.
Email questions to ToYourGoodHealth@med.cornell.edu.