DEAR DR. ROACH: I’m at present on rituximab immunotherapy. I’ve had my first Moderna vaccine, and my second shot is scheduled in 4 weeks. My oncologist just isn’t positive how the rituximab impacts the immunization and the effectiveness of the vaccine. Are you able to clarify how individuals on immunotherapy ought to most successfully take the vaccine whereas present process remedy? My subsequent immunotherapy is three days after my second Moderna shot. — P.H.
ANSWER: Rituximab is a monoclonal antibody directed in opposition to B cells, the cells liable for making antibodies. It’s used for most cancers remedy of B cell-related malignancies, resembling non-Hodgkin’s lymphomas and a few leukemias. It is usually used for autoimmune problems resembling rheumatoid arthritis and autoimmune pores and skin illnesses.
As a result of rituximab instantly targets B cells, it’s recognized to cut back effectiveness of vaccines, significantly polysaccharide vaccines resembling Pneumovax, but it surely additionally blunts the response to the flu shot. When attainable, it’s beneficial to present vaccines both earlier than beginning rituximab or no less than six months after finishing rituximab remedy.
Your oncologist doesn’t know the impact of rituximab on the brand new COVID-19 vaccines as a result of no person does: They haven’t been studied in any respect. Whereas it is rather doubtless that the vaccine is secure, it’s possible that the vaccine is not going to be as efficient in an individual taking rituximab. I might speculate that it will be affordable to contemplate revaccination six months after finishing rituximab. Maybe by then we may have extra information to information remedy.
DEAR DR. ROACH: Just lately my mother was identified with diabetes. Two of her 12 siblings have been diabetic. Whereas I don’t have something that I might name a pink flag symptom, wouldn’t it be clever for me to get examined? Can I’m going to my physician and have them run a check with out having any main signs, or would that be a waste of time? I’m a reasonably wholesome 35-year-old male. I don’t smoke, have an occasional drink, run 20-30 miles per week and have a bodily energetic job in landscaping. The worst half is my weight-reduction plan, which isn’t all the time one of the best resulting from working lengthy hours in the summertime, coming dwelling and consuming previous to going to mattress. Typically that may embrace sweets and/or carbs. — M.D.F.
ANSWER: Individuals with a household historical past of diabetes (mother and father or siblings) ought to completely obtain screening assessments for diabetes. A screening check is completed on an individual with no signs in any respect.
For those who have been to develop signs, resembling extra thirst or urination, blurry imaginative and prescient or unintended weight reduction, you have to be seen immediately and evaluated solely on the premise of your signs. In any other case, a screening check along with your routine wellness go to is acceptable.
Most medical doctors use the hemoglobin A1C check, which appears to be like on the blood sugar over the previous couple of months, moderately than a fasting blood glucose, which is not going to grow to be irregular till the diabetes is significantly extra superior. Probably the most delicate check is a two-hour glucose tolerance check, which I exploit when my suspicion may be very excessive, even when the A1C is regular.
Given your loved ones historical past, it’s significantly essential so that you can keep away from processed meals, refined starches and easy sugars. Complete fruits, entire grains, greens, seeds and nuts are significantly better decisions. You must also keep away from consuming proper earlier than mattress. Strive retaining a more healthy snack with you to eat within the late afternoon or night to maintain you from getting so hungry that you simply make unwise decisions at night time.
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Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column each time attainable. Readers could electronic mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.
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