DEAR DR. ROACH: Can we receive the respiratory syncytial virus (RSV) vaccine, the new COVID vaccine, and our annual flu shot simultaneously? Or should they be scheduled apart? I am a 69-year-old individual in good health. — L.C.
ANSWER: Technically, it is possible to receive all three vaccines together, but it may increase the risk of experiencing “mild” side effects. The term “mild” is used because these effects are not life-threatening and typically subside after a few days; however, they can cause significant discomfort. Personally, I recommend spacing out the administration of the COVID vaccine and flu shot by a few days, as it is convenient for me to have access to these vaccines regularly due to my work at the hospital. However, if it is challenging for you to access the vaccination site, there is no harm in getting all three vaccines simultaneously.
As for the RSV vaccine, I lack personal experience with it since it is relatively new. According to trials, approximately 12% of individuals experienced local reactions, such as muscle soreness, after receiving the RSV vaccine.
Most individuals can obtain these vaccines at their local pharmacy. The decision to schedule them close together or apart is entirely up to you. Some patients have shared with me that during their time in the military, they received as many as 35 vaccines on the same day, indicating that it is safe to receive multiple vaccines simultaneously.
DEAR DR. ROACH: I am an 80-year-old woman who underwent breast cancer surgery three years ago. After the surgery, my oncologist advised me to take medication for five years to prevent cancer recurrence. However, after three-and-a-half years on this medication, I started experiencing severe shoulder, lower back, and hip pain. I attempted two alternative medications, but there was no improvement. I was informed that no other options were available to me. What is your perspective on discontinuing my medication? X-rays indicate the presence of arthritis in the affected areas, and the pain can be excruciating at times. — S.S.
ANSWER: It appears that you were prescribed an aromatase inhibitor, a medication that lowers the risk of cancer recurrence and death from breast cancer when taken for five years. While the initial years are crucial, the last one to two years also offer additional benefits. Hence, I recommend continuing with the medication.
Nevertheless, I understand that the side effects can become unbearable to the point where the benefits of reducing cancer and mortality may no longer seem worthwhile. In such cases, trying a different aromatase inhibitor is the standard approach; unfortunately, this option did not work for you.
Various methods can be employed to mitigate these side effects. First-line treatments include anti-inflammatory drugs like ibuprofen (Advil) or naproxen (Aleve) and regular exercise. Despite concerns about exercise exacerbating the pain, research shows that 20% of women who were advised to exercise and use NSAIDs experienced significant pain relief compared to only 1% of women who received standard care.
Other medications such as duloxetine have demonstrated pain reduction compared to standard treatment or a placebo. Furthermore, a well-designed study involving acupuncture revealed a slight improvement in pain with this form of treatment.
If none of these approaches prove effective, many oncologists opt to switch their patients from an aromatase inhibitor to tamoxifen, which also reduces the risk of cancer recurrence, although to a slightly lesser extent.
Dr. Roach apologizes for not being able to personally respond to individual letters; however, he will incorporate them into his column whenever possible. Readers may send questions via email to [email protected] or by mail to 628 Virginia Dr., Orlando, FL 32803.
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