Taking Charge of Your Well-being
Manage Your Own Health Care -- From Flu Shots to Family History
By Marie Savard, M.D., with Sondra Forsyth
New York Daily News
April 24, 2000

When was the last time you had a tetanus shot? When do you need the next one? Are you due for a pneumonia or flu vaccine?

If you're typical, you're not sure of the answers to those questions. People tend to keep better records of their children's and pet's inoculations than they do of their own.

IMMUNIZATIONS YOU NEED

Recommendations for immunizations are fairly clear cut, although there are exceptions to the rules:

• Tetanus/Diphtheria Boosters. You should get one every 10 years. If you can't remember when you had your last shot, have one now and start keeping track from here on. It won't hurt you to have a shot now even if your last one was 10 years ago. That way, you won't have to ruin a day at the beach by leaving to get a shot if you step on a rusty nail.

• Influenza Vaccine (Flu Shot). Because the virus is grown in eggs, don't get this shot if you are allergic to them. Otherwise, have a shot every fall if you're over 65. If you're younger but have a chronic lung or heart condition or are a health-care worker, you should have this shot every fall. Many doctors now recommend yearly flu shots beginning at age 50.

• Pneumococcal (Pneumonia) Vaccine. You need this shot once after you turn 65. If you're younger, and have special health problems such as lung disease, kidney disease or any condition that has compromised your immune system, discuss with your doctor whether you should get this shot and whether to repeat it.

• Measles/Mumps/Rubella. If you were born before 1957, you probably had the diseases and developed natural immunity. If you need to know for sure whether you've been vaccinated -- if, for example, you're applying for a health-care, teaching or camp counselor position -- a blood test can check for antibodies.

  Those born after 1957 should have two shots. If you were born before the 1970s, you were probably given your shots when you were too young to develop antibodies. A blood test will confirm this and you can get a booster. Children born after 1970 got their shots at the correct time and don't need boosters. Warning: Pregnant women should not get this shot.

• Chicken Pox (Varicella). Most people had this illness during childhood and have developed antibodies. If you didn't have the disease, you should have two shots one month apart. If you're not sure whether or not you had this illness, a blood test for antibodies will give you the answer. Warning: Pregnant women should not get this shot.

• Hepatitis B. This immunization was not available before the 1980s. It is now automatically given to all newborns and is recommended for adolescents who may become sexually active. It is also recommended for health-care workers, people who share living quarters with an infected person (even if there is no sexual contact), intravenous drug users, people with multiple sexual partners (particularly men who have relations with men), people on hemodialysis and anyone who needs blood products. You need a second shot one month after the first one, and a third shot sixth months later.

• Hepatitis A. This replaces the previously used gamma globulin shot. This immunization is recommended for food handlers, gay men, day care workers, health-care providers, and people with chronic liver disease.

  You also need it if you'll be travelling to certain areas abroad. The best plan is to get two shots six months apart, but you'll be protected enough after one shot to leave right away if necessary.

  Call to be sure your doctor has the medication in hand: You may need to get a prescription, buy the medication yourself and bring it to the office so the nurse can give you the injection.

• Polio. Most Americans were immunized as children. If, for some reason, you weren't, discuss your options with your physician. There is a controversy over whether adults should get the vaccine at all. The inactive virus (shot form) is safer and preferred.

• Lyme Vaccine. This is a newly available vaccine for people who live in high-risk areas where deer ticks carry Lyme disease, a serious illness that can cause chronic arthritis.

TRAVEL TO FOREIGN COUNTRIES

If you're planning to travel, call your local hospital to find out which shots you'll need, based on your itinerary. You can also call the Centers for Disease Control (CDC), 1-800-232-3228, or visit www.cdc.gov or www.immunize.com.

DOES IT RUN IN THE FAMILY?

Your family history is a potent predictor of your predisposition to certain diseases. While there are recommended ages and frequencies for tests and procedures, you should take the time to write down your family health history.

This will help you get an individualized picture of your genetic risk factors, and when you show it to your doctor, he or she will be able to help you decide whether to have screening tests and exams sooner than you might have if you had been going by the general recommendations.

Whom to Profile
Your mother, father, brothers, sisters, maternal grandmother and grandfather, paternal grandmother and grandfather. You can also profile aunts, uncles, cousins and great grandparents if their health history contributes to your risk factors.

What to Write About Each Family Member
Give current age (if living). If deceased, give age at death (approximate is fine) and cause of death if you know it. Then for each family member, list any significant conditions and age of onset as nearly as you can recall. It's important to be as accurate as possible because you should try to be screened for any disease you may be predisposed to getting when you are a few years younger than your relative was when he or she was diagnosed.

Examples of what to list: Diabetes, heart disease, liver or pancreas problems, kidney stones, arthritis, Alzheimer's, depression and alcoholism. Also, list lifestyle factors such as smoking, obesity and lack of exercise.

THE WAY YOU LIVE

Along with your family history, you may have some risk factors associated with your lifestyle that will help your doctor individualize a prevention schedule for you.

Be sure to take into consideration obesity or being overweight, lack of regular exercise and excessive alcohol use. (Moderate alcohol use may actually be beneficial.) Your occupational history may be significant as well. And your age and gender are contributing factors.

Smoking, of course, is another risk, and your doctor will want to know your "pack years." Here's how to calculate them: Multiply the number of packs a day (ppd) you smoke, or smoked, by the number of years you smoked. If, for example, you smoked two packs a day from the age of 20 to 40, you racked up 40 pack years.

TUBERCULOSIS SKIN TEST

This is a test to see whether you've been exposed to the disease. It is not an immunization, but results should be recorded. Note: Some people test positive even though they don't have the disease. This means they are harboring the bacteria and should consult with their doctor before taking steroids. A so-called new converter -- a person who has previously tested negative and suddenly tests positive -- will need to take medication as a preventive measure.

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