Dear Dr. Roach: I鈥檓 expecting a baby in a few months, and my doctor told me that everyone who will come into contact with her must get the Tdap vaccine. If some family members don鈥檛 get it, should I keep them from meeting the baby until she鈥檚 old enough to be fully vaccinated?
H.C.
Hope and congratulations are in order. May your baby be healthy.
It鈥檚 clearly recommended that parents, siblings, grandparents and other close contacts with an infant be up to date on their Tdap vaccine.
鈥淭鈥� is for tetanus, which is not transmitted from person to person. 鈥淒鈥� is diphtheria, which is extremely rare in this country. The concern is the 鈥淎P,鈥� acellular pertussis, because although it causes an annoying and long-lasting cough in adults, it is life-threatening to newborns. In the pre-vaccine era, thousands of infants died from pertussis (also called鈥渨hooping cough,鈥� even though adults don鈥檛 whoop), mostly infected by adults.
I recommend that all close contacts be immunized, and that you take care to protect your baby from anyone with a cough (immunized or unimmunized, since the vaccine is鈥檛 perfect) until she is fully immunized. Babies get the Tdap vaccine at two, four and six months, then boosters at 18 months and four years.
Dear Dr. Roach: A letter that appeared in your column recently surprised me greatly. The writer, who was 86, referred to having a colonoscopy 鈥渢wo years ago.鈥� I am 93, and about 15 years ago I was rejected for a colonoscopy because I was over 75; I was told that it had just been learned that the risk of perforation was too high after that age. So far, I have escaped the consequences of not having a colonoscopy, but my wife of 67 years was not so fortunate. Earlier this year, she was diagnosed with colon cancer that had spread to her liver. She died 23 days after the diagnosis. What is the current thought on colonoscopy for seniors?
T.
I am sorry to hear about your wife.
All medical procedures have both risks and benefits, and the doctor鈥檚 job is to make recommendations based on his or her knowledge of the patient and the patient鈥檚 health, medical conditions and preferences.
Guidelines are helpful, but they don鈥檛 apply to every patient. The United States Preventive Services Task Force鈥檚 guidelines are clear that people 75 and under generally are good candidates for screening; those between 76 and 85 should have an individualized approach; and screening over 85 is not recommended.
Risks of complications from colonoscopy definitely increase as people get older.
Of course, some 85-year-olds are healthier than others: One good rule of thumb is that those with a life expectancy that is less than 10 years not get screened; however, physicians aren鈥檛 always so good at making that determination. I bet the doctor who decided not to screen your wife probably regrets it now; I can鈥檛 cast any blame (especially not knowing any details) though, since it鈥檚 also possible that she would have had a complication from the colonoscopy.
Physicians do not want to do something to a patient that will cause harm. Of course, there are times when NOT doing something causes harm, too (like not getting a colonoscopy), but we may be more likely to err on the side of caution.
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 [email protected].
