Plunkett's Ponderings

Adult Vaccinations

by Dr. Plunkett
​07/23/2018

About The Author

Dr. Michael Plunkett is an internist in Chicago, Illinois and is affiliated with multiple hospitals in the area, including Presence Resurrection Medical Center and Swedish Covenant Hospital.

He received his medical degree from University of Illinois College of Medicine and has been in practice for more than 40 years.

He is one of 157 doctors at Presence Resurrection Medical Center and one of 107 at Swedish Covenant Hospital who specialize in Internal Medicine.

Common vaccinations for adults

Tetanus

The general recommendation is that you get a tetanus shot every 10 years. It's not a bad idea to get them at age 40, 50 or 60 so you can remember it. The good news about the tetanus shot is that if you haven't had it in 10 years you have two weeks after you would get a bad cut to when you should get the tetanus shot so it can always be done after the fact. About the only place you need to get it preemptively is if you're going to some wilderness area where there is no medical care.

Once as an adult you are supposed to get TDaP, which is a tetanus shot with the whooping cough shot added to it. If you're about to become a grandparent it's also highly recommended that you get this shot so that you don't inadvertently pass whooping cough onto the new baby. If you have had this shot you don't need to get another one.

Pneumonia vaccine

At age 65 that you should get the "pneumonia vaccine." Pneumovax 23 is the traditional one and is supposed to be paid for by Medicare. You only need it once in a lifetime. And there's a new one, Prevnar 13, the utitlity of which is highly suspect.

Adults younger than 65 who have diabetes, heart failure, kidney failure and a few other odd conditions are also recommended to have the pneumonia vaccine. These individuals also get a booster after five years.

The "pneumonia vaccine" is a bit of a misnomer. It doesn't stop pneumovia! It only stops the "invasive pneumococcal disease." That is doctor talk for meningitis or blood poisoning caused by the pneumococcus. These are both exceedingly rare conditions. The number of people who need to be given this vaccination to stop one of these infections is between 2000 and 20,000 people. And it only stops people from acquiring these infections. It doesn't necessarily stop them from dying from these infections.

Bottom line. Get the Pneumovax 23 at age 65. Skip the Prevnar 13.

Shingles shot

Generally at around the age of 60 you should consider getting the "shingles shot." But don't get it this year (2016)! The present vaccine is not very good. There is a new one coming out in about a year that's going to be much better. It's a two shots series. Wait until it comes out.

Shingles is a recurrence of childhood chicken pox. All people over about 50 were exposed to chickenpox as a childern, even if they don't remember having it. So they're at risk of a reactivation of the virus as they get older. That is what shingles is. The chicken pox virus hides in your body and then usually after age 60 it may come out again it manifest itself as shingles. This is a focal blistering rash on one side of the body. It often hurts. The good news is it always goes away. The bad news is it can be painful. That's why it's reasonalbe to get the shingles vaccine generally after age 60. At that age one has about a 2% chance per year of coming down with shingles.

If you already have had shingles as an adult you have a reduced chance of getting it again. But they do recommend a shingles vaccination after you had it. But, once again, wait until the new vaccine comes out.

Flu Shot

The flu shot is certainly recommended for people age 65 and older. Anybody else can get it to. The usefulness of it varies from year to year. It's nobody's fault. The vaccine manufacturers have to try to guess what type of flu is coming next year and do their best to make a vaccine that will cover it.

Influenza is a disease characterized by high fever, a barking cough, and terrible body aches. It's a virus. Once you get it there is really no good treatment for it. There is a pill, Tamiflu, that if you take it within 48 hours of getting influenza you may get better in four days vs. five days. Underwhelming. Better to get the shot.

We do give the flu shots in our office. We usually get the vaccine in September and you should get it sometime between then and December when flu season really starts. But whether you get the flu shot here in our office or the drugstore doesn't matter. It's the same shot.

There is a more concentrated flu shot it can be given to people over age 65. Its usefulness is highly suspect. Its absolute usefulness in older poeple is about 1% better than the regular flu shot.

Practical Points

Today the best place to get most vaccinations is at the drug store. Why is that? Simply because most Health Insurances do not pay the doctor. They pay us less than the vaccine costs. So if I give you one of these shots I have to dig into my pocket and give you $20 too. Makes a lot of sense, doesn't it? The other benefit of gettin it at the drugstore is that they are very good at extracting insurance payments and hopefully none of these vaccinations will cost you very much there. If you get any of these shots please give a call to our office and let us know that you've gotten them so that we can put them into the medical record. The drugstores will often say they will notify us but they usually don't.

Other Vaccines

There are vaccines for hepatitis A, hepatitis B and some other diseases. These are generally just recommended for travelers to exotic places. It may also be recommended for Health Care workers. They are generally not recommended for the average person.

Keeping an Old Person's Bowels Open

Common ways to keep your bowels moving

- Drink extra fluid every day
- Eat extra fiber. Solids, vegetables, etc.
- Take a stool softener: Colace, Dolcolax
- Try eating an apple a day, a glass of prune juice, or 4-6 prunes
- Metamucil

After these simple things you can try the following either singly or adding one to the other:

You can take Senocot, one tablet every day, it's a mild laxative. A Dolcolax tablet is maybe a little stronger.

The next step after that is to maybe try Milk of Magnesia (1 to 2 TBSP) either every night or every other night. That will often give you a bowel movement by morning.

You can use a Dulcolax suppository every other night to train your bowels.

Fleet enema can work.

The last resort is a full cold glass of Magnesium Citrate. It will blast you out!

Norco/Vicodin Users

​...

Too many people are taking Vicodin/Norco (hydrocodone/acetaminophen) and it seems to be one of the issues that's causing middle aged white people to die like flies. Your government would like you off of these things. And to tell the truth they are probaly not far off. Last year there were enough Vicodin tablets sold in the United States so that every adult could take one pill every 4 hours around the clock for one month. In Tennessee last year one out of three people, children included, was given a prescription for Vicodin/Norco. That's a lot of Vicodin.

If you take these medicines on a chronic basis, they are probably no longer helping the pain for which you started them, but rather are feeding your narcotic receptors which have become very used to you taking these medicines. So, for all intents and purposes, you are addicted to these medicines. And if you don't take one your body will tell you "have pain" but what it's secretly saying to you is that your body is going into withdrawal from these medicinces and is rebelling against that withdrawal. Our bodies are pretty clever at getting what they want.

Now, if you find your life appreciably better taking these medicines it's probably not the worst of things. Especially if you only use one or two a day. The general problem with medicines of this class is that one often has to keep increasing them and increasing them. Hopefully that's not the case for you. People who take four or more of these a day are definitley habituated.

If you'd like to be "drug free" you can go off these medicines by very slowly tapering them and your life probably wouldn't be any different except you wouldn't be having to take these medicines all the time. Your pain would probably be just as well treated by nothing, Tylenol, Advil or Aleve.

Please take this into consideration and feel free to discuss it with me at your next visit.

Dr. Plunkett's Travel Advice

A check list for your travel needs

Jet Lag and Sleep

Halcion 0.25 mg, take half a tablet as needed for sleep. It's a short acting sleeping pill and won't give you a hangover. Therefore you can take as a rescue medicine as late as 3 am and still be able to function the next day. If necessary, you could take a whole one, espcially if you're young.

Traveler's diarrhea

If you have a little bit of diarrhea you can take the Lomotil tablets. You can take one up to four times a day to stop you from having diarrhea. On the other hand, if you have really bad diarrhea with fever and abdominal pain you should NOT take the Lomotil but rather let the diarrhea run out of you. And you should take the antibiotic Cipro 500 mg twice a day. If the diarrhea is somewhere in the middle, you could use both medicines the Lomotil to slow down the diarrhea and the antibiotic (Cipro) to kill some of the germs.

Infections

The Cipro is a pretty good broad spectrum antibiotic that would treat urinary tract infection, respiratory infection, and probably even a skin infection.

Vaccinations

If you haven't had a tetanus shot in the last 10 years, get one at the drugstore.

If you're going to a third world country, it isn't a bad idea to get Hepatitis A vaccine. You get a booster at six months but don't let it stop you from getting the first shot.

If you're going to a third world country where typhoid is a question, you can take the oral typhoid vaccine called Vivotif.

If you're going to a third world country and you're planning on shooting up drugs or having intercourse with multiple individuals you should probably get a Hepatitis B shot.

If you're going to a Malaria prone part of the world, most practical medication to take is a prophylaxis called Doxycycline 100 mg once a day.

Treatment of the Common Cold

The reality of treatments

ANTIBIOTICS HAVE NO PLACE IN THE TREATMENT OF COLDS!!!!!!!!  They aren't even recommended for sinusitis except under very uncommon circumstances. 
Good luck!!!  Nothing works.  But the good news is that OTC medicines are as effective as anything that we prescribe.  So you don’t have to go to the doctor for the common cold.  You can try ineffective treatments by yourself! 
Some of the things I've recommended over the years are the following.  For a given person in a given circumstance they might give you some relief. 

Cough 

Dextromethorphan at about 30 mg a day total and is supposed to be the best cough suppressant.  In most products it’s listed as DM.  Robitussin DM is the expectorant Robitussin with some Dextrmethorphanan in it.  Usual dose is 1 or 2 teaspoons up to four times a day.  Codeine is another cough suppressant but it's in prescription medicines only. 

Congestion
 
Oral decongestants work, but they took the good one off the market.  It was phenylpropanolamine.  All we're left with now is Sudafed (pseudoephedrine) or phenylephrine.  They’re not bad but they may wire you.

They can dry up your nose a bit.  In most products it's the D in the name of the product.  Robitussin CF actually has a combination of the expectorant guaifenesin, Dextromethorphan, and a mild decongestant.
 
One thing you generally want to avoid is Afrin nasal spray.  It can be very effective for a day or 2, but after that it causes an addiction where you have to use more and more frequently.  The only appropriate place to use it would be for an airline flight.  It can supposedly dry your nose and ears and make the airline flight more tolerable.
 
DayQuil and NyQuil liquid products can be pretty good to dry up your head and cut down on the cough.  Since they are liquids you can titrate the dose to take less than the full dose.  DayQuil has a non-sedating antihistamine and Nyquil has an antihistamine that will put you to sleep on your ear.  I took a half dose of Nyquil and slept like a log.

Body aches or feeling miserable 

A lot of the combination products have Tylenol or Advil in them.  That's fine.  You can take any of the OTC pain relievers if they make you feel better. 

Flying

If you're worried about your ears during a takeoff and landing, ENT allergy doctors recommend this: 
Claritin or Allegra or Sudafed when you get to the airport. 
Afrin nasal spray each nostril about 1/2 hr. before the flight. 

Nasal steroids

Don't work.  But they are OTC and if you want to use them you can. It's your nose after all.