Dear Dr. Roach: About 40 years ago, I was given a tetanus shot after a large cut to my hand. Hours later, I developed a severe case of lockjaw. My lockjaw occurred around midnight. I聽phoned my doctor immediately and was told to take some aspirin. This worked, and I have not had any tetanus shots since. When is聽it聽safe for me to be close to a newborn baby?
M.C.
I鈥檝e never heard of someone getting lockjaw after a tetanus shot. I searched the VAERS database (the Centers for Disease Control and Prevention鈥檚 list of all reported events after vaccination, whether or not they might be related to the vaccine) and found only four ever reported. Muscle aches and joint pains are reported after tetanus vaccine, but what you had apparently is extremely rare (and vaccines have changed in 40 years).
In any event, the tetanus vaccine is a toxoid, a purified and inactivated protein similar to the deadly toxin made by the bacteria species C. tetani. It is not infectious at all, and you may be with a聽newborn immediately. There are some live vaccines that require receivers to take caution around newborns or people with weak immune systems.
鈥�
Dear Dr. Roach: My wife was in聽the process of getting her hip聽replaced but had symptoms of聽a blood clot, and her primary care physician sent her for a CT聽scan before releasing her for聽hip surgery. While there was聽no clot, they did find a two-centimetre tumour on her left adrenal gland. He sent her for聽a 24-hour urine test, which came back showing high metanephrines. She was sent to聽an endocrinologist, who did a聽blood test and said she was OK聽to聽have hip surgery, although this test still showed high norepinephrine and dopamine. He聽was supposed to send the information to her doctor, but didn鈥檛. Most recently, he鈥檚 said that 鈥渢he group had reviewed her聽case鈥� and they came to the conclusion that she is OK to have surgery, as he鈥檚 blaming the abnormal test results on the Tofranil she takes for anxiety. Bottom line: Two CT scans have shown no growth over a three-month period. Would it be wise to聽seek another opinion, or could the Tofranil be the culprit?
Anon.
The concern with an adrenal mass and high urine metanephrines (or epinephrine/norepinephrine in the blood) is聽for a pheochromocytoma, a聽rare and (usually) benign tumour of the adrenal gland that secretes these hormones, which almost always raise the blood pressure. Performing surgery on聽a person with a pheochromocytoma is dangerous unless very careful steps are taken before and during surgery. Definitive treatment is聽surgical removal of聽the tumour.
In people with a pheochromocytoma, the levels of the hormones usually are very high. It聽may be that the 24-hour urine test results were just mildly abnormal, which would make pheochromocytoma less likely. Anxiety itself can raise the level of the hormones in the 24-hour urine test. Imipramine (Tofranil) can interfere with some of the laboratory tests, but not the newest generation of tests.
I am a bit puzzled by the treatment your wife has had, and聽I am not yet certain, from the聽information you have provided, that she does not have a聽pheochromocytoma. I think additional tests may need to be done to be certain of the meaning of the abnormal tests and the type聽of adrenal tumour. I聽would await more certainty before surgery, and get a second opinion if the endocrinologist can鈥檛 provide it.
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聽[email protected]
