Dear Dr. Roach: I would like to know your opinion on the hepatitis B vaccine and its pros and cons. I’m a 39-year-old man who is thinking about potentially getting one.
Anon.
Hepatitis B is a viral illness that can cause both acute and chronic liver disease. It’s much better to prevent it than treat it.
Among adults in North America, the most common ways of getting a new hepatitis B infection are through sexual transmission and injection drug use. Transmission can also occur through household contact when living with a person with hepatitis B and sharing items that could be potentially contaminated with blood, such as toothbrushes, razors or nail clippers.
Any person who might have a new sexual partner or use injection drugs is particularly recommended to get the hepatitis B vaccine, but the vaccine is recommended for all adults under 60 and higher-risk adults over 60.
The hepatitis B vaccination is mandatory for health care workers who routinely get exposed to blood. The main downside of the vaccine is a sore arm. Serious adverse reactions are rare.
Many people have been exposed to hepatitis B, so I often give the first dose of the vaccine at the same time that I test the person to see if they’re already immune. It won’t harm a person who is immune and prevents a person from having to come in multiple times. I prefer the Heplisav-B vaccine in adults, which is two doses (other regimens are three) and provides immunity quickly.
Dear Dr. Roach: I am a very active 72-year-old male. I had quadruple bypass surgery when I was 45. I have atrial fibrillation and congestive heart failure, but I never have shortness of breath and only feel lightheaded if I get out of bed too quickly.
I’m on many medications, and now my blood pressure is normal. My total cholesterol is 122 mg/dL, and my kidney function and blood sugar levels are normal. I work out with a trainer three days a week for 60-minute sessions, and I hike in the hills at a moderate pace for 60-90 minutes, typically twice a week.
After my workouts with the trainer, I take essential amino acids, which seem to help with my muscle recovery. A few years ago, I started taking a creatine supplement and felt a positive difference during exercise and afterward. I stopped taking it for a couple of months after reading mixed reviews about the benefits of creatine for me. I’d like to go back on it, but only if it makes good sense. What do you think?
J.B.
Congratulations on doing so well after a major life-changing event! I’m sure your exercise regimen is helping your heart and overall health.
Creatine has mostly been found to help with short-duration, high-intensity activity such as heavy weightlifting and sprinting. The benefit was an improved power output, but most studies haven’t found a benefit when it comes to improving endurance activity. Young men probably benefit the most, although there is evidence of benefit in female power athletes, but studies in older men have not found a benefit.
Since the aim of these studies was improved high-intensity performance, I’m not sure the benefits that the studies found are completely applicable. On the other hand, creatine is well-tolerated and unlikely to interact with your medications, so there aren’t a lot of downsides if it seems to be helping.
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]
