After a recent flu/Covid vaccination, a 5cm bruise appeared which took two weeks to disappear. I also developed a cold which still causes me shortness of breath four weeks later when out walking. I’m normally very fit. I am 71.
Richard Stratford, South Chailey, East Sussex.
Dr Martin Scurr replies: This is a concern I’ve heard many times from people who’ve become ill with a virus after a flu jab, for instance. It seems logical to blame the jab. So I’m grateful for the opportunity to explain that, in fact, there is no medical evidence for this.
The vaccine does not contain a live virus and a more likely explanation is that your jabs coincided with the incubation of a virus you’d recently come in contact with.
It’s also worth stressing that it’s not unusual for a respiratory infection to last as long as four weeks, particularly at your age, even if you are normally fit.
People who become ill after a flu or Covid jab may be tempted to blame the jab
This is because respiratory viruses are often followed by sinusitis or bronchitis, which may cause symptoms of fatigue and breathlessness to persist, as a result of residual inflammation.
Another possibility could be a secondary bacterial infection. In your longer letter you suggest that pneumonia you had in 1969 might have caused lasting damage that’s contributed to your current cold. If that was the case, I suspect you’d have been made aware of this before now, as it’d have meant you struggled to recover from respiratory infections in the years since.
If you continue to be breathless and unwell, then see your GP and request a blood test to check inflammatory markers known as ESR and CRP.
Raised levels of these are linked to a wide range of conditions, but could include a post-viral bacterial infection in the sinuses or lungs. If your levels are raised, you should be referred for a chest X-ray and a phlegm sample sent for lab tests to identify the cause (you may need antibiotics). If breathlessness is your only symptom, it may be you need to give your body more time.
My son takes lansoprazole for a hiatus hernia and should take it for life. I am worried as I’ve heard it may cause stomach cancer.
Christine Thompson, Crawley, West Sussex.
Dr Martin Scurr replies: A hiatus hernia is when part of the stomach squeezes up into the chest through the diaphragm (the wall of muscle that separates the chest cavity from the abdomen).
In some cases, stomach acid spills up into the oesophagus; this acid reflux causes symptoms such as heartburn, nausea or a dry cough. Chronic symptoms should be investigated, but if there’s no underlying issue, patients are often prescribed proton pump inhibitors (PPIs), such as lansoprazole, to reduce acid production.
This is important as acid can damage cells lining the oesophagus, causing a precancerous condition called Barrett’s oesophagus. But all medicines have potential side-effects. Lansoprazole can cause dry mouth and fatigue, while rarer side-effects include anaemia and pancreatitis (an inflamed pancreas).
Lansoprazole is one of the proton pump inhibitors prescribed to patients with a hiatus hernia
More recently, concerns have emerged about a link between taking PPIs long-term (longer than three months) and the increased risk of gastric, oesophageal, colorectal and pancreatic cancers. One theory is that this relates to changes to the acidity or bacterial make-up of the gut.
Not all patients need to take PPIs for life – treatment should be based on the severity of the symptoms. One possibility is a ‘drug holiday’: with the doctor’s agreement, stopping the medication for a few weeks or months to see if symptoms persist or if they can be managed in other ways.
Research shows up to 40 per cent of acid reflux symptoms can be reduced with diet and lifestyle changes. Over-the-counter antacids, such as Gaviscon, may also help. Another option is surgery to correct the hiatus hernia. I’d suggest your son speaks to his GP.
In my view… vitamin you might need all year round
I’ve taken vitamin D every day since the onset of the pandemic, on the advice of an infectious diseases colleague. For not only is this nutrient vital for bone health, research has linked low vitamin D levels to cardiovascular disease, cancer and infections.
Because our main source of vitamin D is exposure to UV light from the sun, the NHS recommends adults take a supplement between October and March.
This may be especially important for the over 75s. New guidelines from The Endocrine Society suggest that this age group take a supplement all year round because of its importance to health – and because certain factors affect their vitamin D levels, including a reduced dairy intake, reduced sun exposure, and, as we age, the body becomes less effective at creating the vitamin even when we’re basking in the sun.
Some doctors, including me, used to encourage older patients to take a large dose of vitamin D once weekly, so it’s less likely to be forgotten. But we know now high doses taken intermittently can lead to nausea, vomiting and weakness – and the benefits may be reduced when doses are intermittent. So daily is probably best.
