FROM NORTH AMERICA SYNDICATE, 300 W 57th STREET, 15th FLOOR, NEW YORK, NY 10019 CUSTOMER SERVICE: (800) 708-7311 EXT. 236 TO YOUR GOOD HEALTH FOR RELEASE WEEK OF JUNE 28, 2021 (Col. 4) BY KEITH ROACH, M.D. Unusual bacteria targets weak immune systems DEAR DR. ROACH: I was just diagnosed with nocardiosis. Not knowing anything about it, I started to do some research and, like in most cases, going to the internet really didn’t help. My pulmonary doctor didn’t tell me much except to put me on sulfamethoxazole drugs. I reacted poorly and was switched to minocycline. Are there any diet changes I should be aware of, or life changes? Should I get rid of the 28 houseplants I have in my apartment? I was surprised to find a group page on social media. It is more widespread than I was aware of, but there seems to be very little information on the harmful effects and guidelines to follow. I would appreciate any information regarding this disease and what to expect and signs of getting better or worse. — M.D.G. ANSWER: Nocardia is a genus of bacteria that is an unusual cause of infection. Lung and skin are the most common sites of infection, but it may also affect the brain or become widely spread throughout the body. Most people with nocardia infection have weakened immune systems, such as by HIV, diabetes, cancer or drugs that suppress the immune system. About a third of cases occur in people with no identifiable immune system disease. Far more men than women are affected by nocardia. Symptoms of lung infection are nonspecific and may include cough, fever, weight loss, shortness of breath and night sweats. Lung infections are most acquired by inhaling dust containing the organism. Nocardia is found in the soil, and houseplants are known sources of the infectious soil. It’s possible that one of your plants contained the bacteria. Still, I think that getting rid of all your plants is probably unnecessary. I would recommend an N95 mask if you are repotting or gardening outside. Treatment of nocardia of the lung in people with normal immune systems usu-
ally involves trimethoprim and sulfamethoxazole; since that seemed not to do well for you, minocycline is a reasonable option. Your immune system is going to be doing much of the work, aided by the antibiotics, so you can help your immune system by sleeping well, avoiding excess alcohol and eating a generally healthy diet. Recurrence or failure of your symptoms to get better would be a reason to consider changing therapy. An infectious disease doctor may be an additional resource along with your pulmonary specialist. DEAR DR. ROACH: A family member insists he got Peyronie’s disease because of a shingles shot. Are there any studies that a shingles shot could lead to this side effect? — Anon. ANSWER: There have been no reports of Peyronie’s disease associated with any shingles vaccine. Peyronie’s disease — a painful deformity of the penis affecting about 5% of men — is thought to relate to penile trauma. No association with vaccination would be expected, as there is no plausible connection between the two events. Sometimes the trauma to the penis is very minor and unnoticed at the time. Damage to tiny blood vessels and an abnormal inflammatory response may be responsible. It is human nature to associate one event with another when both are uncommon but happen close in time. It’s so common a logical error it has its own name in Latin: “post hoc ergo propter hoc,” meaning “after this, therefore because of this.” *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. © 2021 North America Syndicate Inc. All Rights Reserved
FROM NORTH AMERICA SYNDICATE, 300 W 57th STREET, 15th FLOOR, NEW YORK, NY 10019 CUSTOMER SERVICE: (800) 708-7311 EXT. 236 TO YOUR GOOD HEALTH FOR RELEASE WEEK OF JUNE 28, 2021 (Col. 5) BY KEITH ROACH, M.D. Is your health provider vaccinated? DEAR DR. ROACH: At a recent appointment I discovered that my nurse practitioner (about 45 years old) doesn’t plan to get a COVID vaccination as he says it’s unsafe and that all of us (vaccinated ones) are just guinea pigs. I tried to argue, but he was the one holding the needle! He works for a very prominent orthopedic surgeon here in town, and I think most patients would be dismayed to learn of this position. As patients, do we have the right to know if our medical team is unvaccinated? Other than change doctors, how should we deal with this? — Anon. ANSWER: Let me first be clear: The medical consensus is absolutely evident that the available COVID-19 vaccines are very safe and very effective at preventing infection, hospitalization and death from COVID-19. While it is dismaying to hear of nurses, nurse practitioners, physicians and other health professionals espouse a contrary view, the available science, with a year’s worth of follow-up data from the initial clinical trials of tens of thousands of patients, and over 250 million doses given, show that the vaccine is safe and effective. As of the time of this writing, medical professionals are not required to be vaccinated. However, as a patient you have the right to expect a safe encounter with your medical team. In my opinion, medical professionals with face-to-face contact with patients are ethically obligated to get the COVID-19 vaccine unless they have a medical reason they are unable to do so. Medical personnel have a right to privacy. As an individual, I do not think you can demand to know whether your health care personnel are vaccinated. However, they are required to use appropriate protective equipment (including masks and sometimes face shields) to protect you from them, which is much more important if the provider is unvaccinated. Personally, I would feel more comfortable seeing a medical provider in a setting
where I knew vaccines were mandatory for all office staff. In the case you mention, I think the orthopedic surgeon for whom the nurse practitioner works should know the wrong, unethical and unscientific advice the nurse practitioner is giving his patients. DEAR DR. ROACH: I have chapped lips, and my condition is worsening since I moved to Florida. Is it possible the Florida sun causes a more severe reaction than in the north? Or is it a reaction to prescribed blood pressure medication and the sun? — D.G. ANSWER: Chapped lips can happen in any climate, but is more likely in dryer, sunnier and windier conditions. The Florida sun is certainly stronger, due to the angle of the Earth, and that might be the whole answer. However, there are medications that can make skin reactions to the sun more likely. Of the blood pressure medications, the diuretic hydrochlorothiazide — used very commonly by itself or in combination (usually abbreviated “HCTZ” after another drug name) — is the most common cause of photosensitivity reactions. Regular use of a lip balm with sunscreen (zinc oxide is a good choice) is likely to help. Some lip balms contain substances that can actually worsen symptoms in people with sensitive skin: Menthol, camphor and phenol cause an initial tingling and cooling sensation, but can irritate the skin and damage the outermost layers of the lips, preventing them from holding on to moisture. Avoid these ingredients. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. © 2021 North America Syndicate Inc. All Rights Reserved
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