Friday, August 29, 2014
Preventative Health Lecture Follow-up: Talking with Patients and Vaccinations
After Dr. Nunez’s informative and entertaining lecture on Women’s Health and Prevention Issues this afternoon, a few additional thoughts came to mind. As she pointed out, sometimes there’s a little bit of a disconnect (or at least order of priorities) between what the patient is seeking help for and what the physician considers most urgent. In the case presented, the patient was concerned about joint pain (osteoarthritis), but the physician would also be concerned about cardiovascular risk (hypertension, obesity, hyperlipidemia in a post-menopausal woman). One way of trying to tie the two together to unite common goals might be to explain to the patient that weight loss (which would benefit her lipids and blood pressure control) would also likely ease the stress on her joints (knees) and decrease some of the pain she is experiencing.
On a different note, physicians often forget about vaccinations as an effective preventive care measure. This patient should have been receiving annual flu vaccinations (as we all should) and should also be asked about the last time she received a tetanus vaccine. If she is due for a tetanus shot (which many adults neglect/forget since it is received ~ every 10 years), she should receive Tdap. This tetanus toxoid combined with pertussis vaccine is now recommended for all adults who have not already received it and is especially important for those who may have small children (e.g. grandchildren) in their household, since pertussis is most serious, even potentially fatal, in infants. When she turns 60, she will be eligible for the shingles vaccine (ZOSTAVAX) and at age 65 for two pneumococcal vaccines (PREVNAR 13 and PNEUMOVAX 23, which are recommended to be given sequentially). If she were part of a high risk group such as individuals with diabetes, heart disease, chronic liver or lung disease, pneumococcal vaccination would be administered at a younger age. Guidelines are currently in flux with the availability of two vaccines now for adults, so stay tuned for the CDC to issue new guidelines soon!