Long COVID symptoms need not put off vaccination
DEAR DR. ROACH: Is it safe for an unvaccinated person experiencing long-term symptoms after a COVID-19 infection to get the vaccination, or must they wait until the typical 90-day period for symptoms to diminish or disappear? -- P.M.
ANSWER: In general, people can expect to have symptoms of acute COVID-19 infection for up to four weeks after the onset of symptoms. Beyond four weeks, people with persistent symptoms are considered to have post-COVID conditions, also called "long COVID." The most typical symptoms are fatigue, shortness of breath and difficulty thinking or with memory, often called "brain fog." Other symptoms may include chest pain, cough, loss of taste and smell, and many more. Roughly a third of people with symptomatic COVID-19 symptoms will have persistent symptoms.
I do recommend vaccination after COVID-19 infection, with or without persistent symptoms. People should get vaccinated only after they have met criteria for stopping isolation. This usually means waiting until 10 days after symptom onset; after resolution of fever for at least 24 hours; and after improvement of other symptoms. People with severe disease or with an immune system condition should consult their physicians, as they may need more time. There is no rush to giving the vaccine. The risk of being infected again within three months of COVID-19 infection is very low. People who received monoclonal antibodies should not get vaccinated for 90 days.
Vaccination has not been associated with worsening of symptoms in people with persistent COVID symptoms. There have been some cases of symptoms improving with vaccine. So, for a person who is well past their acute phase, getting the vaccine is safe and may possibly help reduce long COVID symptoms, but is not urgent since immunity is reliable for at least 90 days after infection.
DEAR DR. ROACH: I'm a healthy 66-year-old woman who experienced a "gush" of vaginal bleeding a few days ago. It subsided fairly quickly, and I have not experienced any bleeding or spotting since. I immediately saw my OB/GYN. Her visual assessment of my cervix showed no inflammation and a healthy appearance. She then recommended we do a uterine biopsy to rule out cancer. I was informed that no sedation is used and to expect sharp pain and cramping. I was perplexed. Why, with modern medicine, am I to be subject to medieval torture? Why isn't sedation offered to alleviate pain and discomfort? Would an ultrasound be a more prudent first step? -- L.A.
ANSWER: Uterine bleeding in a woman after menopause always raises the concern for endometrial (uterine) cancer, although only about 10% of cases turn out to be cancer. Still, a thorough evaluation is called for in any woman with postmenopausal uterine bleeding.
Either ultrasound or biopsy is a reasonable first step in excluding uterine cancer in women with postmenopausal bleeding. Most experts recommend the biopsy, since the ultrasound often does not give enough information to exclude cancer, and the biopsy will be necessary anyway. But sometimes, the biopsy is not necessary.
If a biopsy is needed, you have options. Take a pain reliever ahead of time prevent or at least reduce pain. Sedation is perfectly reasonable, although you will need someone to help you home after the procedure. I did also read about using anesthetic for the procedure, but it is not routinely done. Most women do not have severe pain (certainly not "medieval torture" level), according to studies, but you should speak to your gynecologist about the options.
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.
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