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Flu shots ....

by Bill Osler / November 5, 2003 8:59 AM PST

I've been really frustrated about the availability of flu vaccine this year. The official line was that there would not be any overall problem with vaccine availability. So far so good. The catch is that there were some predictions of delays in delivery. What a mess!

We usually receive all of our supply in September. That lets us crank up a vaccination program and get all the high risk folks done by early December. I wish!

We received our first installment of vaccine in September, but it was less than 10% of what we ordered. It was gone in a few days. The next shipment (another 10%) arrived a week or so later. It disappeared rapidly.

An so on. We've run out of flu vaccine 3 times so far this season. As of today we do have some doses available but they may not last until the end of the week. We still don't know when we will get the remaining 50% of our order.

It's really discouraging because every time we put a patient off there is a risk that the patient won't return for the vaccine.

BTW: People who need to get flu shots (unless there is a good reason not to) include anybody who works in health care, anybody over age 50, anybody with chronic lung disease (asthma, emphysema, ...), most cardiac patients, anybody with diabetes, and a variety of people with less common conditions. Also, anybody who cares for elderly patients should receive a flu shot.

A lot of experts are recommending flu shots for all children from age 6 months to age 24 months, but I have to admit that most parents are unenthusiastic about that recommendation. Personally I think we ought to give it to all school aged children but that idea has not caught on, and most insurance policies will not pay for the vaccine unless the child has asthma or diabetes. The reason school age children should be immunized is that they contribute more than you might expect to the annual pandemic. Children are contagious for longer than adults and they are not as reliable at tending to handwashing. The result is that they serve as a population for rapid spread of the virus.

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Re:Flu shots ....
by Roger NC / November 5, 2003 9:15 AM PST
In reply to: Flu shots ....

My company this year announced they weren't offering free flu shots because of the cost. In the past, any employee or retiree could sign up and get one free.

After considerable flack, they put out a memo that they would offer a sign up sheet for current active employees that couldn't get one at their regular doctor, whatever that was suppose to mean. I'm not sure how well the second got circulated.

I confess I'm not consistent about flu shots given by the company. Some years I've taken them, some I haven't.

But for a company to say they're cutting flu shots out to save money? forgive me if I sound like Dave, but come on.

One more thing that makes me think they're attempting to psyche us into accepting requests/demands for cutbacks later. Either that, or preparing to close the facility, inspite of it's size and capacity.

roger

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Just as frustrating on my end,Doc
by Tony Holmes / November 5, 2003 9:52 AM PST
In reply to: Flu shots ....

For the past couple of weeks the local CVS which is around the corner had signs up in the store pushing their flu clinic."Mon Nov 3rd 3:30pm-7pm,get your flu shot".

That's easy for me because I'm off on Mon,I go there at 4:15pm-"Sorry,we're all out".Very poor planning,they advertise a 3.5hr flu clinic that doesn't even last 45min.

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NT) What's a CVS?
by IanC_OZ / November 5, 2003 10:35 AM PST

Ian

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(NT) It's a chain of drug stores (AKA chemists? or pharmacies)
by Bill Osler / November 5, 2003 10:57 AM PST
In reply to: NT) What's a CVS?

.

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NT thx
by IanC_OZ / November 6, 2003 9:09 AM PST

.

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Doesn't seem to be a problem here............
by Del McMullen / November 5, 2003 9:56 AM PST
In reply to: Flu shots ....

.....in the boonies of New Mexico.

The County Health Department is offering free shots at
several locations. Haven't heard any comments about
shortages anywhere.

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General reply/comment
by IanC_OZ / November 5, 2003 10:43 AM PST
In reply to: Flu shots ....

It intrigues me the comments I've read over time about how so many Yanks consider Australia to be a near socialist country.

All the complaints I read in SE about this or that health benefit provided by their employer as part of the standard emplyment package. I'm unemployed, and still paying in excess of $2,000 pa for hospital cover out of debt. I didn't get any health cover from my employer. I don't have dental cover, optical cover, anything like that.

Yes, attendance at a doctor's surgery is subsidised, yes pharmaceuticals are subsidised for low income earners and the unemployed, aged pensioners ets. But they are NOT free.

J. Vega and Cindi both receive medical and income support which is only available here if I was to go to court, win the appeal(s), then receive a flat payment - which is limited in size by law.

Ian

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Cindi doesn't get it anymore.
by Cindi Haynes / November 5, 2003 11:03 AM PST
In reply to: General reply/comment

The insurance company paid for 2 years, and that was a policy and benefit my employer and I paid into while I was able to work. I've been fighting Social Security since 1999 and haven't seen a cent.

It ain't so easy, Ian.

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Social Secutity thought, Cindi...
by J. Vega / November 5, 2003 4:06 PM PST

Thought, Cindi. You might remember my mentioning of a government booklet, with which my wife was able to finally get me legally declared as disabled after the standared (I suspect automatic at first) refusal by Social Security to do so.
With that book, she was able to finally get them to yield after telco conversations. It is a technical book, meant for doctors, showing them what medical conditions make a person legally disabled in the eyes of Social Security. If you have one of those conditions, you are. It's not that hard to read and use. That book is truly worth its weight in gold.
As I mentioned in that thread of long ago on the forum, when she was being "buck passed" onto another person in that telco call, she heard the employee say to the other party, "Watch it, she's got the book!". Bottom line, she was successful and I was declared disabled in quite short order. We owe it all to that book. We never had a lawyer and spent not one red on one cent on one, that book did the trick.
The book is called, "Medical Criteria for Determinations of Disability". (Publication No.64-039). We lost our hardbound copy, as a attorney who said he dealt with disability under Social Security and had heard about my wife's success asked her to let him borrow her copy, as he'd never seen it (ahem). He never returned it.
Well, I finally found it online, and you can download a .pdf copy of it (170 pages,902 Kb). Perhaps a copy of it in hand might help, or anybody else going thur the diasbility fight with Social Security. May help, may not, but as the saying goes,it couldn't hurt.
A link to the page where you can download that book on the web is: http://www.ssa.gov/disability/professionals/bluebook/

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I do remember it, J,
by Cindi Haynes / November 6, 2003 2:59 AM PST

And thank you for the link. I don't think the problem is falling under the definition of disability. They're arguing a specific point, whether a hearsay statement should be admissable or not. It's at the 6th Circuit Court, 1 step below Supreme Court, so we're into it for sure!

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I think what you said sounds like good news,
by IanC_OZ / November 6, 2003 9:09 AM PST
In reply to: I do remember it, J,

and its bad news your payments stop.

Its still relevant that medical benefits were part of employment up until the 1970's in OZ, when a national medical cscheme came into play, went bankrupt, got disolved.

Had workpplace medical insurance been in play, I'd have been paid my salary right up until now. Now that I am less often falling into an emotional heap, we are considering commencing legal action.

Ian

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Hi Ian, I seemed to have missed this thread ..
by RB2D2 / September 15, 2004 1:13 PM PDT

the first time around. I had no idea you were posting again. I was going to ask how things were going in the job field but seeing your remarks about considering legal action I think I get the drift.

Sorry there hasn't been any progress in that area, however, how are things otherwise. Tell us the latest news about the boys.

Rosalie

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Re: Hi Ian, I seemed to have missed this thread ..
by C1ay / September 15, 2004 1:36 PM PDT
I had no idea you were posting again.

Uh, his post is 10 months old...

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LOL. Damn, who keeps dragging up these old threads!?!?!
by RB2D2 / September 15, 2004 1:41 PM PDT

I guess I need to pay more attention to dates but who expects to see a 11 month old thread pop up at the top of the board! Sad

Thank you, Clay, for bringing that to my attention.

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A couple of questions, Dr. Bill
by Diane Harrison / November 5, 2003 11:13 AM PST
In reply to: Flu shots ....

My job strongly pushes us to get the shots since we have so much contact with inmates. They provide free shots, as does my HMO.

I got my shot two weeks ago today, but my arm still hurts (upper arm) not only directly at the injection site, but to even lift or move the arm. Other people have had similar experiences, but of more limited duration. Why does it do that? I've never had that happen with other flu shots.

Second question is that when they were first to come out, the news put out that they were NOT recommended for asthmatics. Now they are saying in all the literature that they ARE recommended. Any idea which is right, or why the confusing change?

On the positive side, this is the first year I did not get sick right after getting the shot. As a result, I'd highly recommend this to anyone.

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It shouldn't still hurt
by Bill Osler / November 6, 2003 9:03 AM PST

The injection usually causes some pain for me for a day or two. Pain is probably putting it too strongly, but some soreness. It should not hurt longer than that. I've sometimes wondered if the soreness is related to the thimerosol preservative or some other ingredient. Beyond that I'd just be speculating.

As to who should receive the vaccine, my understanding is that asthmatics should be vaccinated because asthma increases the risk of serious complications from the vaccine. Asthma patients should NOT receive the new nasal vaccine since there is a risk that the new vaccine will cause 'asthma attacks' in recipients. IOW asthma patients should receive only the injected vaccine. I don't remember hearing about any problems giving the injected vaccine to asthma patients.

A lot of employers offer flu shots to employees because there is evidence that giving the vaccine decreases absenteeism during the winter months.

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NT- Give mine to someone else.
by James Denison / November 5, 2003 11:46 AM PST
In reply to: Flu shots ....

.

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Re:Flu shots ....
by Dave Konkel [Moderator] / November 5, 2003 12:36 PM PST
In reply to: Flu shots ....

Hi, Dr. Bill.

Flu has already shown up in the Houston area Sad I got my shot last week. And I hear anecdotally that more folks than usual this year are complaining of getting mild flu-like symptoms 2-3 days after getting the shot.
-- Dave K.
Speakeasy Moderator
click here to email semods4@yahoo.com

The opinions expressed above are my own,
and do not necessarily reflect those of CNET!

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Protection is not immediate; the vaccine viruese have been killed
by Angeline Booher / November 5, 2003 11:39 PM PST
In reply to: Re:Flu shots ....

Hi, DaveK,

My knee-jerk reaction to those who do experience flu-like symptoms afterwards, is that, IMO, they were lucky to have taken it. Otherwise a full-blown case would hit them very hard.

Or...

They were already infected with a virus.

Those allergic to eggs, or have had a severe reaction from past flu vaccines should not take them.

It takes 2 weeks for protection to build. Protection is not 100%, but those who get sick usually have a milder case.

The shots use killed virues. The new one administered through the nose uses live ones. The selection of the viruses is updated each year. I think it depends on what which are causing flu in some other countries, but I forget which ones.

Angeline
click here to email semods4@yahoo.com

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There may be more to it than that ...
by Bill Osler / November 6, 2003 9:09 AM PST

What you are describing is the conventional wisdom regarding flu vaccine, but there is some evidence that there may be more to it than that.

There do appear to be a few patients who develop myalgia and other symptoms from the vaccine itself. It isn't the same as getting 'the flu' but it does feel a bit like a mild case of the flu even though the symptoms are not from a viral infection. I wonder if it is a mild serum sickness type reaction from the vaccine but I don't think anybody really understands the phenomenon.

But of course you are right: people who really do get 'the flu' soon after receiving the vaccine were probably already infected when they received the vaccination.

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Re:Re:Flu shots ....
by Cindi Haynes / November 6, 2003 3:03 AM PST
In reply to: Re:Flu shots ....

Hi DaveK,

I got my shot at the beginning of last month. I get one every year. This year, I didn't have the "after shot flu" but the arm achiness was more pronounced than in years past.

Wonder if it's just differences in what strain of flu they're protecting us from.

Cindi

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NT ps-no shortage in our area this year, and available earlier than usual!
by Cindi Haynes / November 6, 2003 3:05 AM PST
In reply to: Re:Re:Flu shots ....

.

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Re:Flu shots ....
by David Evans / November 5, 2003 1:19 PM PST
In reply to: Flu shots ....

Glad to see the reminder. I usually get mine in October but I haven't gotten around to it yet this year.

DE

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Re:Flu shots .... another I'd like to throw in...
by Angeline Booher / November 6, 2003 12:01 AM PST
In reply to: Flu shots ....

Hi, Dr. Bill,

I recall (years ago) employees in my husband's store dragging themselves out of their sick beds (then ending up lying on the couch in the employee lounge), and infecting the other employees. This also happened in offices and wherever there was close contact. This was in the time when the target was those at high risk.

The man hours and productivity lost because of a "brave" soul outweighs a few days time lost from the absence of one employee.

In my son's office building, all employees (excepting those who should not) are encouraged to take the shots. IMO, this is a wise move.

In my area there is no shortage of the vaccine- for the first time in 3 years.

The price here for those who pay out of pocket is $20.

Angeline
click here to email semods4@yahoo.com

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Thanks Dr. Bill for reminding me. Just got back. No shortage here by the way. (NT)
by Mary Kay / November 6, 2003 12:48 AM PST
In reply to: Flu shots ....

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Re:Flu shots ....And pneumonia shots....when????
by John Robie / November 6, 2003 1:33 AM PST
In reply to: Flu shots ....

Good reminder on flu shots. Wife and I took it on October 11 at a large health exhibit at the new San Antonio Spurs Arena put on by the city health department. They even had a live band playing. Seems to be no shortage here this particular year. Cost was $15 per shot, free for Medicare eligible. They were also giving pneumonia shots, but it seems like the time limits keep changing when the shot should be given. I recall the first time I took one, they said it was for life. Then years later they said it was good for 10 years. Now, a nurse at the exhibit said for over 65 years old it is every 5 years. What is going on...??

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Everybody's guessing re: pneumonia shots
by Bill Osler / November 6, 2003 9:13 AM PST

My understanding is that nobody has hard data. The recommendation I'm giving patients is that people who have no chronic disease mandating immunization (ie, no COPD, no diabetes, ...) should receive the vaccine at 65 and not worry about boosters.

People who receive the immunization because of chronic disease should receive one booster in 10 years or at age 65, whichever comes later. If they receive the first dose after 65 then they probably don't need a booster.

Remember, though, that all this is subject to change once we get hard data.

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(NT) Thanks Dr. Bill
by John Robie / November 6, 2003 9:57 AM PST

.

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I asked a relative who is a doctor...
by J. Vega / September 15, 2004 12:54 PM PDT

I asked a relative who is a doctor (surgeon). He said supposedly it's good for 10 years, but he advises every 5 years, as that leaves no doubt about being protected. Sounds smart to me, even though some may think that to be over cautious. I view it as a bet in poker, you must ask yourself two questions: What does it cost me to bet, and what can I lose if I lose. The "cost" is 1 minute of time and possibly a little arm soreness for a few hours,Twice in ten years rather than just once, not too high of a bet. But the possible loss if you lose that bet by getting the shot just once in 10 years is just not worth the risk in my opinion.

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(NT) (NT) That was for pneumonia shot,not flu shot.
by J. Vega / September 15, 2004 12:56 PM PDT
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