When to get a flu shot if you have Lyme disease

 DEAR DR. ROACH: Should people with Lyme disease avoid the flu shot? — L.A.
       ANSWER: Lyme disease is a potentially serious infection caused by the bacteria Borrellia burgorferi, passed on by a tick bite. Lyme disease can go unrecognized for a period of time, especially when the classic rash is not present, which is not uncommon. Without prompt treatment, Lyme disease can progress to affect the brain, nerves, joints and heart.
       In general, people with a moderate to severe illness should not get the flu vaccine while ill. It is safe to give the flu shot to a person with mild illness, such as cold without a fever. In the case of Lyme disease, I would recommend withholding the flu shot from someone with active symptoms (which can sometimes get worse in the first few days of treatment with antibiotics). After finishing antibiotics, it would be safe to take the flu vaccine.
       Some people have symptoms (such as fatigue, numbness, pain and impaired cognitive function) after treatment for Lyme disease, a condition called post-treatment Lyme disease syndrome. It is not clear why some people treated for Lyme develop PTLDS. However, there is no reason I could find nor evidence to support withholding the influenza vaccine for people with post-treatment Lyme disease syndrome.
       DEAR DR. ROACH: My husband’s apnea causes him to stop breathing 50 times an hour. He refuses to use tiny tubes to put over his nostrils. I doubt they work well, because he naps two hours a day with his mouth open and loud snoring. Not only is it annoying, but he’s not getting a good sleep at night. Now he’s found a third solution on the internet, a chin strap that stops snoring. If his brain is not sending the signal to breathe, how is a chin strap going to help? He is convinced apnea is caused by a malformed throat and refuses to hear otherwise. Help! — S.J.
       ANSWER: There are two types of sleep apnea: obstructive and central. Obstructive is far more common, and relates to too much soft tissue around the airway, often (but not always) in association with being overweight. If your husband had a sleep study to make the diagnosis and quantify the number of apnea events (times stopping breathing) of 50 an hour, then he should know which type he has.
       Obstructive sleep apnea is commonly treated with a mask that provides continuous positive airway pressure. However, there are other options, including oral appliances (that move the jaw forward and help open the airway, or move the tongue forward to keep it from obstructing the airway) and surgery.
       Central sleep apnea is when the brain doesn’t regulate sleep properly. It often is associated with heart failure and stroke, but can occur on its own. The first treatment for central sleep apnea is fixing the heart failure, if that’s the issue. If not, then CPAP is used, just as in obstructive sleep apnea.
       It sounds to me that your husband was to be treated with oxygen alone. That is seldom used in OSA but occasionally in CSA. If he has CSA, the device to move his jaw is unlikely to benefit. However, some people have both OSA and CSA.
       It really sounds like he needs to revisit the sleep specialist and hear his options. I would highly recommend you go as well.
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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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