Ask Dr. Keith Roach M.D

Ask Dr. Keith Roach M.D

Ask PiTo K©Mßn Mcomdh MLB) DR. ROACH WRITES: Flu season is approaching, and it is time to review the options available to prevent flu for the 2016-2017 season. There are both trivalent and quadrivalent vaccines available: The trivalent protects against three strains, and the quadrivalent against four. If you have a choice, I would recommend the quadrivalent, but I wouldn't forgo getting the trivalent if the quadrivalent isn't immediately available, since what are suspected to be the three most important strains are included in the trivalent vaccine.

There are two vaccines made especially for adults over 65. One is a high-dose vaccine similar to last year's; new this year, there is a vaccine made with an adjuvant, a substance designed to increase the body's response to the vaccine. Either of these is preferred for people over 65, compared with the standard vaccine; however, once again I would not recommend delaying getting the regular vaccine if the high dose isn't available.

There are two egg-free vaccines for those with lifethreatening egg allergies. For people who really don't like needles, there is a vaccine that uses a tiny needle that goes only into the skin, not the muscle. Finally, there is a vaccine available for a jet injector, which uses high pressure, not a needle, to inject the vaccine (think of the 'hypospray' from 'Star Trek'). The intranasal flu vaccine is not recommended by the Centers for Disease Control and Prevention this year due to concerns about its effectiveness.

Vaccines cannot give you the flu. The flu is a serious infection, which kills 20,000 people in the U.S. on average per year (the death toll has ranged from 3,300 to 49,000 per year in the recent past). Vaccines are especially important for the most vulnerable, including the elderly, pregnant women (the vaccine has been shown to be safe in pregnancy, and women who received it tended to have a lower risk of miscarriages) and children. However, it's important even for healthy people not only to protect themselves, but to protect those who can't get the vaccine.

DEAR DR. ROACH: Has anyone ever been cured of mesothelioma? Where is the best place to go for treatment? — A.P.

ANSWER: Malignant pleural mesothelioma is a cancer of the lining of the lung, which almost always is associated with asbestos exposure. Unfortunately, it has a poor prognosis, with half of the people diagnosed succumbing in six to 18 months. Even when aggressive surgery is combined with radiation and chemotherapy, the 10-year survival rate is only 4 percent.

How to find the 'best' place for treatment is not easy. One approach I use is to go to clinicaltrials. gov and search for clinical trials on the condition you are interested in. Even if you aren't interested in being in a trial, you can find the centers that are doing research and are likely to have experience in treating the condition. I found 109 ongoing trials in the United States for mesothelioma, and you can display a map showing open trials near you.

Almost all of the patient information I found via a search engine comes from law firms, and although some of these sites had good information, you can find information from the NIH website at medlineplus. gov/mesothelioma.ht ml. *** 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.cor nell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.