Doc, I've got a question

Great question! Routine vaccinations are one of the most important things we can do to help keep ourselves and the greater public healthy. Many vaccines need multiple doses to take full effect, but once complete most vaccines will work for a lifetime, although some need boosters every so often. One that needs regular boosters is the tetanus and diphtheria vaccination (Td). It is a standard three-dose regimen in childhood, then needs updating every 10 years. It is recommended that every adult substitute one dose of TDaP in their lifetime for the standard Td. TDaP includes tetanus and diphtheria but also pertussis, which causes whooping cough in infants.

Whooping cough can be life-threatening in young children, so this is especially important if you are around small children! As far as the flu shot goes, it is recommended that people 6 months of age and older receive a yearly flu shot in the fall. We normally start giving them in late September or October. However, if you are late please still get your flu shot; it can still do you some good! The flu shot does need to be given yearly, as the strains of the influenza virus that are causing illness changes year to year and each year’s shot tries to target the strains most likely to be prevalent. The shingles shot, also called the zoster vaccination, is a vaccination against a virus called varicella zoster. This is the virus that causes chickenpox. Once someone has the chickenpox, the person is infected with this virus for the rest of their life. The virus goes dormant in our nerve cells, and can sometimes reactivate, usually later in life, and cause what we call shingles.

Symptoms include a sometimes very painful rash over one area of the body, fevers, muscle aches and fatigue. Sometimes pain can be present before the rash appears or can last even after the rash is gone. About one-third of people are estimated to get shingles at some point in their life. We recommend a single dose of the vaccine in everyone over age 60, although it can be given after age 50 unless he or she has some kind of immunodeficiency.

For pneumonia, there are two different vaccinations that are recommended. Each works a little differently and together provide the best protection against pneumonia. The recommendations are mostly the same for each. All adults over age 65 should receive each vaccine once, spaced 1 year apart. There are several medical conditions, such as diabetes, lung disease, smoking and chronic heart disease which would require someone to get vaccinated prior to age 65. Your physician will be able to discuss with you if earlier immunization is a good idea. Unfortunately, the rates of adults up to date on their vaccinations is quite low in this country.

The CDC has a great amount of information available on the entire childhood and adult vaccination schedule. Your physician will be able to tell you what shots you need, and work toward getting you up to date!

When should you get a second opinion? I trust my doctor but I’m not sure if his treatment is doing me any good.

In general, patients have the right to ask for a second opinion at any time during their care. This can be during the treatment of a specific problem or during your routine care if for any reason you are unsatisfied with the care of your current provider.

Most doctors will happily send you to a specialist when he or she feels that the required treatment is above what he or she can provide, or if the current treatment plan is proving ineffective. If you feel your treatment is not working as expected, I would encourage you to speak with your physician about this and work together to come up with a treatment plan that works for both of you.

Sometimes it’s as simple as a miscommunication between provider and patient that can be corrected, or you may decide to change the treatment plan or seek another opinion from another provider. Your doctors can give their recommendations on treatment for a particular problem, but ultimately you are in charge of your health care decisions.

Is there such a thing as hand cancer?

There is no such thing as “hand cancer” per se, at least in the same way we say “lung cancer” or “breast cancer.” In rare instances, cancers do occur in the tissues of the hand. The vast majority of cancer that originates in the hand are skin cancers such as basal cell carcinomas, squamous cell carcinomas, or melanomas. These cancers are more common in those who are exposed to sunlight regularly without wearing sunscreen.

Any new, suspicious, or changing spots or moles on the skin of your hands or elsewhere should be examined by your physician. He or she may want to remove it or take a biopsy to determine what it is. There are other very rare cancers called sarcomas that can originate in the muscles, bones or connective tissues of the hands. Lastly, the hands can be the site of metastases from other cancers, most notably cancers of the lung, breasts, head or neck although this is extremely rare. Any new lumps or bumps on your hands should be evaluated by your physician.

How much water should you drink in a day? What good is that doing and what time of day should you stop so you don’t have to go to the bathroom several times at night?

The simple answer for how much water you should drink each day is: it depends. Our bodies utilize water for a multitude of cellular and organ functions. Because it is so important we have many regulatory mechanisms for water homeostasis that include our kidneys, intestines, nervous system, blood vessels and heart. Water is a part of all of our bodies’ cells, but also present in the space between cells, within our blood vessels and within our GI tract and urinary systems.

Our daily water requirements depend on a number of factors, including sex, size, weight, environment and activity level. A 250-pound male construction worker who is outside all summer will require more fluid intake than a 130-pound female who works in a climate-controlled office setting.

Although there is a lack of great scientific evidence to support specific guidelines, as a general rule most adult females will need between 2-3 liters daily, and an adult male will need 3-4 liters a day. If this seems like a daunting number, remember that this includes ALL fluid intake. Coffee, tea, soft drinks, juices, sports drinks and liquid in our foods like soup all count toward this daily requirement, as water is the main component of all of these.

What if you don’t reach these “magic” numbers daily? Don’t worry too much; our bodies have a great ability to adjust to too much or too little fluid intake by adjusting the amount of fluid we urinate. Our bodies have developed a great way to make sure we adequately hydrate: thirst. If you drink enough to where you aren’t constantly thirsty, you are probably drinking enough fluids. As far as how long to stop before bed, a good rule of thumb is no fluids within 2 hours of bedtime. Another way to cut down on the need to urinate at night is to limit caffeine and alcohol consumption, which stimulate the bladder. Happy hydration!