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 phoned my doctor immediately and was told to take some aspirin. This worked, and I have not had any tetanus shots since. When is it safe for me to be close to a newborn? -- M.C.
ANSWER: I've never heard of someone getting lockjaw after a tetanus shot. I searched the VAERS database (the Centers for Disease Control and Prevention's 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 newborn immediately. There are some live vaccines that require receivers to take caution around newborns or people with weak immune systems.
DEAR DR. ROACH: My wife was in the process of getting her hip replaced but had symptoms of a blood clot, and her primary care physician sent her for a CT scan before releasing her for hip surgery. While there was no clot, they did find a 2-cm tumor on her left adrenal gland. He sent her for a 24-hour urine test, which came back showing high metanephrines. She was sent to an endocrinologist, who did a blood test and said she was OK to have hip surgery, although this test still showed high norepinephrine and dopamine. He was supposed to send the information to her doctor, but didn't. Most recently, he's said that "the group had reviewed her case" and they came to the conclusion that she is OK to have surgery, as he's 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 seek another opinion, or could the Tofranil be the culprit? -- Anon.
ANSWER: The concern with an adrenal mass and high urine metanephrines (or epinephrine/norepinephrine in the blood) is for a pheochromocytoma, a rare and (usually) benign tumor of the adrenal gland that secretes these hormones, which almost always raise the blood pressure. Performing surgery on a person with a pheochromocytoma is dangerous unless very careful steps are taken before and during surgery. Definitive treatment is surgical removal of the tumor.
In people with a pheochromocytoma, the levels of the hormones usually are very high. It 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 I am not yet certain, from the information you have provided, that she does NOT have a pheochromocytoma. I think additional tests may need to be done to be certain of the meaning of the abnormal tests and the type of adrenal tumor. I would await more certainty before surgery, and get a second opinion if the endocrinologist can't provide it.
READERS: The arthritis booklet discusses rheumatoid arthritis, osteoarthritis and lupus. Readers can order a copy by writing:
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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] 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.
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