Susan writes:

Dear Daniel and Vincent,

I am a 75 year old healthy woman currently undergoing complicated treatments for a large squamous cell carcinoma on the palm side of my thumb that was shown by immunohistochemistry to be caused by an oncogenic strain of HPV.   Fortunately, the cancer cells stayed in the epidermis.  But so much tissue had to be removed  that a normal skin graft failed and I had to have a subsequent second flap surgery that  involved grafting of blood vessels as well as skin.  And now I  may also need a nerve graft to restore full function to my thumb. 

I have been told that this kind of HPV-induced cancer is very rare.  Yet I now know of several people in my life with recent cases of HPV associated tongue, throat, and anal cancers. And, of course, most cervical cancers are caused by HPV variants. 

My questions are these:  is there any reason that the existing HPV vaccine could help  prevent these non-cervical related cancers?  And, if so, why is that vaccine only being recommended for young teens? In fact, why is this the only population eligible to get the vaccine to prevent cervical cancer?   And, lastly,  could there be any value for me to get that vaccine now, even if it would mean my paying for it out of pocket?

Your thoughts would be greatly appreciated. 

Susan

Susan, Psy.D., Ph.D.
Licensed Clinical Psychologist

Connie writes:
I can’t thank you enough for your show !!  My question concerns pneumonia vaccines.  I’m 74.  IN 2015 I had a series of shots:  Prevnar 13 and then PPSV 23.  Is that “good enough,” or should I receive the Prevnar 20 ?  I have asthma and last year developed pneumonia, so I just want to make sure I’m not missing anything.  

Thank you !

Christian writes:
Hi Daniel,

in your last clinical update you mention the prices in Germany for PAXLOVID.

For your information : Prices have been no longer funded by Government (there are rumors that Goverment payed 650 Euros) since Beginning of the year. It´s no longer at 59 Euro but now also at 1100 Euro.

So though a little bit below US prices but still far too high to be provided widely when needed.

Regards from Germany,

Christian

Martin writes:

Hi Daniel / Vincent (Hope you’re both doing well).

During a recent episode, you touched on some very preliminary research that (if I recall correctly) involved the use of a particular nasal antibiotic to stimulate interferon, possibly with a view to ‘prophylactic or early exposure use’ for Covid. (I appreciate neither you nor Vincent were very excited by the idea at this stage).

I happen to follow Medcram, which (as you likely know) is a medical training organisation that helps students gain formal course credits. Their Dr. Roger Seheult (Associate Clinical Professor at the University of California, Riverside School of Medicine, and an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University), previously mentioned – on their Youtube Channel – that, at the first signs of Covid Infection, taking certain specific steps to deliberately raise – and temporarily maintain – one’s temperature for successive ‘intermittent’ short durations (at a level below danger threshold) during week-one, is a way of trying to initiate a ‘sustained’ interferon response, in the hope of overcoming Covid’s Strategy of blocking that pathway.(My understanding is that the downstream benefit of stimulating interferon throughout week-one of infection, is a reduction in viral load thereby, hopefully, moderating cytokine storm in week two).

I’m trying to recall if you’ve ever advocated this as a tactic (and, if not, whether you think its a reasonable approach to adopt)? If you broadly support that idea then, might ‘simultaneously’ co-opting the nasal antibiotic you mentioned, help accomplish the interferon goal? I appreciate that the antibiotic’s use – purely as a prophylactic – currently has limited appeal, but if the intention is, instead, for someone infected to nudge interferon into action (and keep it going for the first week of infection) then that’s a somewhat different proposition.

FYI Only:

Here in the UK, you currently can’t get Paxlovid, even if paying cash to a Private Doctor for a Script. It’s only available through the NHS ‘if’ you’re over 70 AND in a Nursing Home / Hospital (or on a Cancer / Other ‘Extreme Medication’ Regime). This is mainly down to ‘cost’ but NHS Doctors and their professional body, have also adopted the stance that ‘prescribing obstacles’ (e.g., patients ‘other meds’ and comorbidities etc) are just too complicated for them to confidently work-round, so have kicked ‘prescribing’ back to local health authorities. Messy and Depressing.

Regards, Best Wishes & Thanks for all the Channel’s Advice.

Martin

John writes:

Dear Dr. Griffin,

Thank you for your weekly podcast with Dr. Racaniello. Your willingness to share science based medical information provides the listeners of TWIV with valuable insights and guidance.

My question is regarding measles protection for our 8 month old grandchild since she is not old enough to receive an MMR vaccine. We will be traveling to states with reported measles cases in the next few months and we are concerned we might be exposed and be a possible risk to her. As grandparents over 65, should we get an MMR vaccine prior to traveling to raise our antibody levels during our travels to reduce our risk of infection so we don’t unintentionally expose her?

Kind regards,

John

Marc writes:

Congratulations on another excellent TWIV clinical update!

After listening to the episode I was hoping you can expand on a couple of points.

You frequently refer to standard versus increased risk for more severe COVID illness.  While I am pretty sure I could list all of the increased risk comorbidities, what do you define as standard risk?

I am also seeing tremendous hesitancy for patients to get COVID vaccination.  Seems like the majority of my patients’ last vaccine was in 2022.  There is a small cohort of the over 65 crowd that has been keeping up on vaccines.  I  also been getting questions about recent journal articles highlighting the association between COVID vaccination and cardiomyopathy.  Any insight you can share would be greatly appreciated

Marc  

____________________

Marc Schechter, D.O.

Medical Director | Optum Long Island/ NYC