DEAR DR. ROACH: I recently had a COVID booster. Not even considering that the vaccine might impact my annual mammogram, I had my mammogram done the day after my vaccine. I had no ill effects from the vaccine. I was not advised against having the mammogram so soon after the vaccine. Because of a concern with my lymph nodes, dense breast tissue and a possible cyst, I was then scheduled for an ultrasound and follow-up mammogram, another ultrasound two months later, and then another ultrasound of my left auxiliary lymph nodes in six months.

Due to weight loss over the past 18 months or so, when I complete a self-exam, I only feel my ribs. I lost my 24-year-old son to liver disease in May 2021, and my husband to stomach cancer in June 2022. It’s been a very difficult couple of years.

I am an otherwise healthy 64-year-old woman. Recent blood work (complete blood count) was all fine. There is a familial history of breast cancer (maternal aunt, two cousins).

Should I have waited for the mammogram? — D.M.

ANSWER: I’m sorry things have been so hard for you recently.

It is true that the COVID vaccine stimulates the immune system, causing some women to get enlarged lymph nodes that can be seen for weeks and sometimes months after vaccination.

Most experts now recommend against a delay in mammogram following vaccination, although it is helpful for the radiologist interpreting the mammogram to know about vaccination. Some women may be developing breast cancer at the time they get the vaccination, and a delay could increase the risk of the cancer spreading.

If there are no other abnormal findings besides enlarged lymph nodes after the vaccine, no additional studies are normally recommended. Those women who ended up having cancer had other abnormalities that made the radiologists concerned. While I hope everything is OK with your results, I think, given your family history and recent weight loss, it ended up being the right choice not to delay the mammogram.

DEAR DR. ROACH: I have been to two lung doctors, and both told me I have asthma. I took Breo, Trelegy and albuterol. None of it has made my breathing any better. I also have AFib. My cardiologist told me my shortness of breath is not from the AFib. I’ve had two CAT scans, and nothing showed up. I cannot do anything physical without losing my breath. It’s only on exertion when this happens. Would you have any suggestions on where to go for an answer? I am 92 and female. — L.O.

ANSWER: Finding the cause of shortness of breath is sometimes challenging, especially when a person has both heart and lung issues. After making sure there isn’t a low blood count (anemia can definitely cause shortness of breath), the most definitive diagnostic test is called a cardiopulmonary exercise test, but not everyone needs one of those.

In my experience, the most common cause of shortness of breath in older people is that their hearts aren’t used to working so hard and become “deconditioned.” Treatment is a gradual exercise program that works at building up endurance. Both your cardiologist and pulmonologist (lung specialist) will know about cardiopulmonary stress tests, but your cardiologist may prescribe a supervised exercise program if they think deconditioning is the problem.

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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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