Dr. Roach: Guillain-Barre syndrome is an autoimmune response
Dear Dr. Roach: I have multiple sclerosis, Addison’s disease, rheumatoid arthritis and lupus. I am on steroids daily as well as potent immunosuppressives. In November 2013, I received a flu shot, and 10 days later I came down with Guillain-Barre syndrome. I was paralyzed for six months. Half of my doctors say I should take the COVID vaccine; the other half say I shouldn’t. Do you have any statistics on the Pfizer or Moderna vaccines and GBS? What is your opinion?
Dear D.D.: With nearly any decision in medicine, there are both risks of treatment and risks of withholding treatment.
In your case, the risks of remaining unvaccinated are high. COVID-19 infection would be very dangerous for you because of your medical conditions and because of the medications you are taking for them. You are at higher risk for all the complications of COVID-19, but given your history, you are at particular risk for developing Guillain-Barre syndrome, an autoimmune disease usually triggered by infection. It’s very important to do what you can to protect yourself from COVID-19.
On the other hand, it’s natural to be concerned about reports of GBS after COVID-19 vaccination. An update from the Food and Drug Administration from July 2021 identified 100 preliminary reports of GBS following vaccination with the Johnson & Johnson vaccine, an adenovirus vector vaccine, after approximately 12.5 million doses were administered. This is substantially higher than would be expected from chance alone. Consequently, I advise against you getting the Johnson & Johnson vaccine if another vaccine is available.
The Pfizer and Moderna vaccines are mRNA vaccines, and the FDA noted there has not been an increased number of GBS among recipients of either of these vaccines. I recommend you get an mRNA vaccine. You should, of course, discuss this with your doctors. I understand you must be frustrated with the mixed messages you are getting from your doctors, so if possible, discuss it further with the doctor who is most current on the COVID-19 situation, which changes daily. An infectious disease doctor might be a good choice.
Dear Dr. Roach: Does surgery really “fix” a torn meniscus? Does anything, for that matter?
Dear J.F.: The menisci are structures resembling a doughnut that’s been cut in half and stuck onto the tibia, or shin bone. The hole is positioned at the femoral condyles, the round parts of the thigh bone.
The menisci provide shock absorption and stability to the joint. In young people, the menisci are usually torn by substantial trauma, especially by landing on the leg in an unfavorable way, often with a twisting movement, so the knee, not the muscles, takes the blow. However, in older people – and I am sad to say that “older” in this context means over 50, on average – the menisci can tear just from degeneration, without any extreme trauma.
The usual initial treatment for a torn meniscus is conservative: rest, ice and elevation followed by gradual strengthening of the knee, ideally supervised by a physical therapist. Most people do well with three to six weeks of physical therapy. However, some people, especially those with greater trauma, acute onset of symptoms and more extreme initial physical limitations continue to have symptoms despite therapy. In these cases, surgery can improve function and relieve pain.
Surgery does not “fix” the tear, but 90% of people treated surgically for an acute traumatic meniscal tear have a good outcome. The results are not as good with degenerative tears.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.