Quinn writes:

I have a question for Daniel Griffin about tuberculosis. There was stigma around tuberculosis, but it went down at some point. Was this correlated with it becoming curable? If so, did it go up when drug resistant strains became prevalent, thus making it incurable in some or more cases? Thank you for your time.

Sincerely,

Quinn

Helene writes:
Good afternoon, I am a 56 years old woman with no health issues. I received 2 sinovac covid vaccines and 3 Pfizer all original vaccine. My last dose was in July 2022, never had covid , I think. Since the updated vaccine is not available here in the Dominican Republic , neither Paxlovid should I get another shot of the original vaccine or wait to see if it will become available in the Dom Rep .

Thanks,

Helene

Irene writes:

Dear Vincent and Daniel, 

Thank you so much for your weekly clinical updates! For those of us in Primary Care, your summaries of most up to date data and recommendations have been a Godsend! 

A while ago you reviewed treatment for Influenza and I believe mentioned that Oseltamivir is not actually effective. Now that we’re starting to see influenza, could you review your recommended treatment course for this viral illness? UpToDate lists Oseltamivir as the preferred regimen. 

Thank you so much!

Irene Teper, MD (Internist in SF Bay Area)

David writes:

70 y.o. male with no particular risk factors that I’m aware of other than age, fully and recently vaxxed. Recently tested positive for Cov-2 (I’m doing ok, thank you) and reached out to my physician’s office for a Paxlovid prescription, which they promptly submitted to the pharmacy after consulting my medication chart—no interaction problems–and asking a few relevant questions. However, when I picked it up, it was the renal dose. When I looked at  my blood work results for the past couple of years, all renal function findings were in the normal range. Nothing in the dosage literature that I am aware of indicated that my situation required the reduced dose. When I reached out the to the physician’s office to make sure that this wasn’t an accident, I received the following response:

We also give this dose to patients over the age of 65 to help prevent any kidney issues.  Push lots of fluids and rest when you can. Take tylenol of for headache and body aches. 

I haven’t found anything in the literature to suggest this is necessary, and wonder whether it might even reduce effectiveness or—worst case scenario—raise the likelihood of selecting resistance. In any event it seems rather arbitrary to ignore the dosing guidelines without a better explanation Do you know of findings in the literature suggesting this is the proper course?. Are they being over cautious here? While this is unlikely to cause me any issues, might it not cause a problem for those more at risk?

Thanks for any thoughts, have thoroughly enjoyed the podcast over the years, and especially the clinical update!

Cheers!

\David

Ginny writes:
Dear Dr. Griffin,

Listening to the letters you receive, I am always amazed at the differences in care that people receive from different medical providers. I am now 67 and was diagnosed with multiple myeloma in March. Like the recent letter writer (episode 1062), I am being treated with dara and revlimid, and I also take decadron two days a week. The letter writer and I are both immunocompromised due to this treatment. Unlike her doctor, though, my oncology team encourages me to get all recommended vaccines, which was also your response to the letter.

My oncologist, unlike my PCP, was also quite willing to make an advance plan for antivirals in case I got COVID. As a result, when my husband (who had not been masking in public as I had!) brought home COVID last month, I had my first dose of Paxlovid only 2 1/2 hours after I noticed symptoms and had a positive home test. I felt much better in just a few days, and, testing negative, I was able to have my dara infusion the following week. My PCP is not the only doctor who wouldn’t discuss Paxlovid in advance; my friends have tried to “make a plan,” as you have encouraged, with no luck. Sometimes the doctors say they don’t recommend Paxlovid because of the side effects. Very frustrating.

I know it is very discouraging for you that many practitioners aren’t providing appropriate care because of misinformation or their opinion. It makes me grateful to be in the care of what seems to be an excellent hem-onc team (under Dr. Frank Passero) here at Strong Memorial Hospital in Rochester. And I can’t tell you how much what I learn on your Clinical Updates has helped me in seeking out care for myself and my family.

Thank you for all you do.

Ginny