Preventive Medicine
Dear Lucy: I am in my early thirties and have not had any vaccinations or inoculations for 10 years. What is the difference between the two? Specifically, which booster shots do I need? Does the Traditional MIT Health Plan cover them?—A Shot in the Dark

Dear Shot: Lucy has always said that "an ounce of prevention is worth a pound of cure," so she is quite pleased to see you being proactive about your health in this way.

A local immunization specialist tells Lucy that words like "inoculation," "vaccination," and "immunization" are now used interchangeably. You probably received regular childhood immunizations. Some lose their potency over time, so you may require boosters. For example, the tetanus-diphtheria (Td) vaccine should be given every 10 years. You may also need to receive several new vaccines that have been developed since you were a child. These include hepatitis A (2 shots), hepatitis B (3 shots), and, if you have not had chickenpox, Varicella (2 shots).

Depending on your lifestyle, other immunizations might be appropriate. College students living in dormitories should receive the Menomune vaccine, which protects against meningococcal meningitis. Other vaccines may be recommended for individuals planning to travel abroad. Check with your clinician for specific recommendations.

Routine public health immunizations, such as Td, polio, or measles vaccines, are covered in full for members of the Traditional or Flexible MIT Plans; other vaccines may require a co-payment. For questions about your coverage or charges for any specific vaccine, you may call MIT Medical's Claims and Member Services Office at 617/ 253-5979.—Lucy

Heavy Metal
Dear Lucy: I have an expensive iron kettle with internal enamel coating. It became rusted inside after water was left in it. The rust cannot be scrubbed away. Is it okay to continue using the kettle to boil water?—Rusty

Dear Rusty: To answer this question, Lucy turned to David Diamond, M.D., MIT Medical's chief of medicine and a member of the Institute's Environmental Health and Safety Team.

"Some years ago," Diamond recalls, "researchers reported finding iron toxicity among Bantu tribesmen in Africa who drank large amounts of a traditional beer brewed in nongalvanized steel drums. Initially they attributed the disorder to excess iron in the beer, but subsequent research showed that serious iron overload occurred only in individuals with a specific genetic mutation."

So, unless you have a genetic predisposition to an iron storage disease, no health risk is likely to be associated with use of your kettle. "In fact," Diamond adds, "if you're boiling water for tea, you may be interested to know that the tannins in tea actually inhibit iron absorption."

For most people, Diamond emphasizes, particularly menstruating women, iron deficiency is the more common problem. But hemochromatosis, an inherited type of iron storage disease, is not uncommon in this country, and anyone with a family history of this disorder should be tested.—Lucy

Pro(zac) and Con
Dear Lucy: My doctor recently prescribed Prozac Weekly for PMS. I have never been depressed; I'm just moody and weepy right before the start of my period. Is Prozac an appropriate treatment?—Monthly Moods

Dear M&M: Prozac (fluoxetine hydrochloride), the drug that revolutionized the treatment of depression, is marketed and approved for other uses, including the treatment of pre-menstrual dysphoric disorder (PMDD), or PMS. The selective serotonin reuptake inhibitors (SSRIs), including Prozac, do seem to alleviate pre-menstrual symptoms in some women.

However, Lucy notes that Sarafem (the form of Prozac marketed for the treatment of PMDD) and Prozac Weekly came out just before the patent on "original Prozac" was due to expire. To Lucy's suspicious mind, this suggests that some of the "hype" about these special uses and forms of Prozac may be driven by economic, as much as therapeutic, factors.

Although treating PMS symptoms with an SSRI is reasonable, lifestyle changes can also help. Nurse practitioner Karen Halvorson, R.N.,C., of MIT Medical's OB/Gyn Service had the following suggestions:

• Reduce caffeine intake.
• Reduce sodium (salt) intake to 3 grams daily.
• Eat six small meals a day, so you don't go long periods without eating.
• Eat fewer simple carbohydrates, like candies and desserts. Choose whole grain breads and cereals, enriched pasta, and brown rice. Eat fruits and juices throughout the day rather than consuming many servings at once.
• Do some vigorous, aerobic exercise at least three times a week.
  

Lucy notes that these are good suggestions for everyone, not just women experiencing PMS.—Lucy