Q: It has been seven weeks since I had my annual flu shot, and my arm is still sore at the injection site. I do not think I have a Shoulder Injury Related to Vaccine Administration (SIRVA) from having the vaccine injected into the wrong area. Nonetheless, the shoulder feels like I received the shot two days ago.
There appears to be anecdotal information that the new quad vaccine has left many recipients with sore arms for an extended period. Have you read any reports that this sore-arm issue is widespread this year?
A: Anecdotal reports online suggest that other people also have experienced prolonged soreness after getting a flu shot. The quadrivalent vaccine is intended to protect people against four different strains of influenza virus. Roughly half the flu shots administered this year are quadrivalent, so perhaps that accounts for the sore arms.
You mentioned SIRVA, shoulder pain and limited range of motion that comes on suddenly after a vaccination. It is believed to be due to an injury to the tendons, ligaments or bursa of the shoulder from a badly aimed needle.
Adverse reactions to flu vaccines are, unfortunately, not well-studied (JAMA Internal Medicine, June 10, 2013). That makes it hard for people to weigh the benefits against the risks. This year’s flu shot does not protect people well from the most prevalent and severe flu virus, H3N2.
Q: I have high blood pressure, for which I take metoprolol, hydrochlorothiazide (HCTZ), hydralazine and lisinopril. I have developed pins and needles in my fingers and numbness in my hands that keeps me from picking up small things like a safety pin. I have trouble walking and often feel faint. I have fallen a few times.
I suspect the medication may be to blame, but my doctor has sent me for Doppler tests for my legs and arms. The results came back fine. Couldn’t my doctor prescribe different medication that won’t cause these problems?
A: Dizziness is often perceived as a minor side effect of blood pressure medicine, but a fall could be devastating. Every one of your medications might contribute to this serious complication.
The nerve damage you describe can be triggered by the drug hydralazine. It may lead to numbness and tingling, as well as leg weakness and trouble walking.
Your doctor needs to re-evaluate your regimen. To help, we are sending you our Guide to Blood Pressure Treatment, which discusses nondrug approaches as well as other medication options. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. B-67, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Q: I love grapefruit. I have been prescribed simvastatin for high cholesterol, and I am not supposed to eat grapefruit or drink grapefruit juice while I am on this drug. Is there any way to control my cholesterol that won’t interfere with enjoying grapefruit?
A: If your doctor thinks you need a statin-type drug, ask her to consider fluvastatin, pravastatin or rosuvastatin (Crestor). According to the world’s expert on grapefruit interactions, David Bailey, M.D., these statins are safe alternatives to atorvastatin, lovastatin and simvastatin (CMAJ, March 5, 2013).
In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”
