Honestly admit vaccine side effect costs & better support the “hesitant” to increase compliance

When you get your COVID-19 vaccination—and I’d argue that approximately 99% of those reading this post have a moral imperative to do so—a realistic assessment of the facts suggests that you are likely* experience some uncomfortable side effects though they may be very mild.

News coverage, even in sources specifically geared toward those of us living with chronic conditions, heavily emphasizes the societal good which vaccination will bring—which is real enough—but most writers lean too heavily toward cheerleading at the expense of offering valuable information people need to cope with the particular pressures of their own individual lives.

I would like to stress that those of us more vulnerable than average to infirmity should plan for several days of being less effective in our work and daily lives after vaccination. It’s better to be prepared than to be caught flat-footed after the fact.

Politicians and business leaders who want the economy to boom should be offering solutions to make such preparations possible for the millions of Americans living in and at the edge of poverty who can’t afford to construct such safeguards for themselves.

Roughly 30 million American adults want to take the COVID-19 vaccine but haven’t yet managed to actually get the shot(s). Closer to 28 million are instead “vaccine hesitant,” stating they would probably or definitely not get vaccinated.Redacted official CDC COVID-19 Vaccination Record Card

Sufferers of autoimmune disease, getting your jab may well bring on a flare. That was my experience after my first dose, and I’m glad I dug down far enough through coy, dissembling news coverage and popular health reporting to be forewarned about the risk.

Here’s one published case study in The Lancet regarding the health of one gentleman with rheumatoid arthritis after getting the BioNTech-Pfizer vaccine. This article on Creaky Joints is the most honest that I read, speaking directly to specific reactions people with autoimmune conditions might expect.

I would take that first dose again, however, and I did return for my second shot of the Moderna vaccine.

I began composing this post whilst “enjoying” the resultant joint pains, exhaustion, and headache that came with full vaccination. Dose two also induced half a day of resounding nausea that could have been an exaggerated version of the queasiness I routinely get when very tired.

Side effects from the second shot prevented me from my normal activities—already constrained by my autoimmune disease diagnosis—for about two and a half days.

I.e., I would not have felt safe driving for at least two days after my second shot, nor would I have been healthy enough to go to work.

By comparison, after my first jab, I experienced sudden onset of extreme fatigue, headache, and an odd sensation I only associate with coming down with a virus that I can best describe as “the spaces in my joints feeling stretched out and wobbly.”Analog wall clock showing 12:06

Those shot #1 symptoms popped up about six hours after I received it mid-morning. I went to bed early, and the next day, all the viral infection type side effects were far less troublesome. I felt less than 100% the day after, but able to partake in most normal activities.

I.e., I could have worked through the side effects triggered by my first dose.

My arm ached significantly for a total of five or six days, however, and I developed an uncomfortable swollen feeling in my armpit several days later that was probably my lymph nodes reacting.

On the other hand, in the four weeks after my first dose of Moderna’s vaccine, I experienced the most significant stiffness, joint pain, swelling, and fatigue that I’d had since the pandemic began. Staying at home most of the time while society remained mostly shut down was generally very protective for me against my usual, recurrent autoimmune disease symptoms.

I used far less pain medication than usual between March of 2020 and April 2021. I went entire weeks without needing an NSAID anti-inflammatory or using prescription pain killers. Between my two doses of COVID-19 vaccine, I required at least one of those every day.

I.e., I would have struggled to meet the demands of a full time job plus family responsibilities on many of the days between my first and second vaccine injections.Prescription bottle of pain pills

It is worth noting that this potentially vaccine-provoked flare never reached peaks equivalent to the worst ones I had right after my diagnosis. Also, the flare absolutely could have been coincidental. But, again, it’s the only serious one I had through the entire pandemic right up until I got my first shot.

I’m not arguing against vaccination. I am suggesting some of us might need extra resources to meet our daily responsibilities when we elect vaccination, doing our part to protect the entire community. Stepping up comes with a cost.

I have a healthy, supportive spouse. My large family includes relatively helpful, fit teens able to pick up the slack with household chores. Family members have been able to stagger vaccine appointments so we never experienced side effects simultaneously. Our income is sufficient that purchasing takeout meals or prepared foods is not a burden. I am easily able to reach my regular doctor with any concerns because I’m well-served with health insurance and the means to pay for Direct Primary Care out of pocket—including an option to text message my GP directly for urgent issues outside business hours.

In short, I have the good fortune to control most aspects of my daily life, so I could plan around the reality of vaccine side effects. I had sufficient personal resources to fall back on to meet all of my post-vaccination needs. Far too many Americans are less fortunate, many in more than one of the areas I’ve mentioned.

Speaking specifically to the autoimmune-challenged community, I’ve been delighted to find that my second dose of the mRNA vaccine seems to have abruptly ended the prolonged flare I experienced in the four weeks between shots. After feeling much worse due to its side effects than I had in over a year, by the fourth day post-vaccination, I became more energetic—and had less joint pain and stiffness—than I could recall feeling in recent memory. bandage on upper arm

I.e., my RA flare ended abruptly along with my vaccine side effects from the second shot.

Given that vaccination clears lingering symptoms for as many as 41% of COVID long haulers, I was fascinated to observe what could be a related effect in myself after jab #2. Communicating this potential improvement in daily functioning to those who are vaccine hesitant while believing themselves to have had COVID—some of whom never got confirmation of a likely coronavirus infection due to the scarcity of tests early in the pandemic—seems like yet another missed opportunity in public health messaging.

Everyone who wants the economy to rebound fully should take all possible actions to enable workers, especially those at the margins of poverty with limited access to health care, to make, keep, and recover after appointments for inoculation. Full disclosure of the known risks and known benefits—but also realistic potential risks and probable benefits—could bring us closer to herd immunity and full fiscal and medical recovery.

COVID-19 still holds many mysteries for science to uncover. The need to offer accurate information as well as paid time off to over-burdened breadwinners and caregivers so that they can confidently book vaccinations—without risking their livelihood!—isn’t one of them.

America’s front-line, essential workers have already borne more than their fair share of the fight against this pandemic. Today, those who employ these millions should step up with specific support to enable each one to get his or her shots.

* I say “likely” based upon the CDC website stating, for the Pfizer vaccine, “84.7% reported at least one local injection site reaction” and “77.4% reported at least one systemic reaction.” For the Moderna version, they state “[s]ystemic reactions were reported by the majority of vaccine recipients” with over 80% experiencing injection site reactions.

Considering antidepressant medication? Try vitamin B-12 first.

This isn’t medical advice. I’m not qualified* to offer that.

Vitamin bottle B12 - 1I am simply a self-educated consumer who lives with a chronic health condition. I’ve drawn my own conclusions from research done as an intelligent lay person, tempering it with common sense. I invite you to do the same.

Many of us diagnosed with autoimmune conditions, degenerative neurological diseases, and chronic pain will be prescribed antidepressants. There are fine reasons for this.

Some chronic pain responds positively to antidepressant medications. Given in lower doses than those prescribed for psychological reasons, side effects are often less as well.

Here’s a link to a (long, almost 2 hrs!) YouTube presentation by Dr. Dan Clauw, M.D. that offers a great explanation for the current understanding of why these drugs may help certain types of pain.

Depression is also a normal human response to learning you can expect to spend the rest of your life with constant pain or in a rapidly degenerating physical condition.

That is a depressing situation for any rational person to contemplate. Treating mental health problems is important, and I do not sit in judgement of anyone who takes pharmacological steps toward better self care.

If you are a danger to yourself, please seek immediate, aggressive care. Do whatever it takes to get well. Your life matters.

That said, I’ve recently learned that the major physical symptoms of depression mirror almost exactly those of a vitamin B-12 deficiency. Hmm…

Even patients with valid diagnoses of other conditions—here’s a study about multiple sclerosis, for example—often have other stuff going on in the body that can make symptoms worse. Large numbers of hospitalized, depressed patients have measurable Vitamin B-12 deficiencies.

It isn’t known yet whether B vitamin deficiencies help create conditions that allow us to develop disease, result from lifestyle responses to living with chronic illness, or are direct side effects/symptoms of disease processes.

I’d argue that the underlying mechanism doesn’t matter so much when we’re talking about supplementing with vitamin B-12.

Why? There is no known upper tolerable limit for safety for supplemental B-12. Say that in plain English? No one ever “overdosed” on this vitamin.

Here’s a link to a more reputable (than me) resource, a state university, for detailed mainstream medical information on the subject of Vitamin B-12. And another to a US government fact sheet on the vitamin for American consumers.

B-12 is water soluble. If you take too much to be used by your body, it will leave your system naturally via your urine. You might “waste” the vitamins you’ve bought and paid for, but odds are tiny** that they will hurt you in any appreciable way.

If someone is ready to prescribe antidepressants to a patient, that patient must have at least one medical doctor who could also be consulted about taking vitamin supplements. Ask your doctor before starting a new treatment, including Vitamin B-12, but, odds are, you will be told this is safe to try.

You may also hear that vitamin B-12 won’t help you. But, then again, antidepressants aren’t a guarantee either. They include a long list of side effects, some of which are very unpleasant. Those prescription pills can also be expensive.

Also, it’s just as unscientific to assume the vitamins won’t help you as to assume that they will.

I’ve come to realize that no one cares as much about my health outcomes as I myself do. With good insurance and caring doctors, I’m still left with unanswered questions and a merely tentative diagnosis for what causes my chronic pain and fatigue. Where stakes are low and scientific certainty is lacking, I choose to perform nutritional experiments upon myself.

If it is highly unlikely to hurt you, and it could help you, why not take some extra vitamins for a while and see if you feel better, too?

Assuming your doctor said such a trial is safe, the only possible barrier is cost.

I picked up a bottle of store brand vitamin B-12 at wholesale giant Costco with 300 pills for $19. Each offered thousands of percent (20,833%) of the RDA***, making a bottle good for the better part of a year taking one per day.

That works out to $23.12 annually. Costco typically offers very good value.

At an expensive local vitamin specialty retailer, a three month supply (of 16,667% RDA pills) cost $16, coming out to about $64 per year. I suspect it would be hard to spend much more than this for these vitamins.

vitamin-bottle-b12-2.jpgThere are several forms of B-12 available, and both of these offerings are for the most expensive type, Methylcobalamin.

Some users have reported that the most common, cheaper form, Cyanocobalamin, doesn’t resolve their symptoms, but the Methylcobalamin form does. At less than $20 per bottle, it seems within financial reach of most Americans to do this self experiment with the potentially most effective version of the supplement.

My two sample bottles also both contain dissolving lozenges to be held under the tongue rather than swallowed and processed through the digestive system. Again, some argue that a sublingual or injected B-12 is more effective than a swallowed dose. I went out of my way to test this type of supplement, just in case, though science tends to think it is irrelevant for most.

In all of this, note that my primary interest is in clinical results, i.e., how I feel. It will be great if research comes to understand why and how B-12 or any other supplement improves patient outcomes. But I am not a working scientist.

The bottom line for how I make a decision about self-treatment comes down to whether or not I feel better, and at what risk.

The “clinically small” improvement of a group of MS study participants quoted above may be of only slight statistical significance, but when your function or your sense of well being has descended to, say, 25% of your old normal, well, then, 27% or 30% represents a win.

I don’t know what you should do to help yourself live a healthier life. I do have some opinions about which alternative health practices represent good risks worth a try for a person in pain. Perhaps this little experiment can ease some of yours, too.

Your body; your choices. Make them in good health.

*My education in both Biology and Chemistry ended in high school as my college science classes were limited to Physics courses. My major was Mathematical & Physical Sciences with a concentration in Computer Science.

Make no mistake that the side effects can be significant, however. They are also likely to affect your offspring, not just yourself. There are studies showing this in very obvious and less direct ways.

Powerful drugs are appropriate to treat significant illness, but I’d argue that they should be employed after milder alternatives have been tried and found insufficient.

Other sources, regarding. depression.and .neurological and psychiatric disorders

**There are some instances of allergic reactions to vitamin B-12, but I only read of such response to injections (shots), not over the counter vitamin pills. Reports of acne or skin rash in response to large dose vitamin pills do occur with some regularity.

You decide whether temporary skin issues are something that would stop you trying a larger dose of this vitamin for yourself.

***In most cases, we do NOT know the “optimal” level of vitamin intake. Vitamin B-12 reference ranges vary from 180-914 ng/L in the USA, 135-650 pmol/L (183-881 pg/mL) in Australia, and 500 – 1300 pg/mL. (ng/L=pg/mL, so no conversion necessary there.)

If you think this is an important thing for people to know, write to your government representatives and tell them you support basic nutrition research. Private companies have very little motivation to pay for this kind of work; there’s no resulting drug patent to fund the endeavor.

There’s a reason some public services, like infrastructure and basic research, are paid for by taxation. Otherwise, they simply aren’t available to all of us.