Notes From The Nurse
Adair Small serves as OCUUC’s Congregational Nurse. Her regular column, Notes From The Nurse, is a topical update on health issues for the congregation. Adair also coordinates the Caring Ministry and various health related programs at OCUUC.
Autoimmune Disorders
Adair Small, RN May 2012
My April column was about easily preventible diseases, the communicable ones for which we have developed vaccines. Unfortunately we have no idea how to prevent many conditions and the list of autoimmune disorders is one that just seems to keep growing. There are currently more than 80 widely accepted conditions in this category. Autoimmune literally means an immune response to the self. In other words the immune cells in the body begin to attack and destroy healthy body cells. This is similar to an allergic reaction, but there the stimulus comes from outside the body and not from the body itself. One of the confusing aspects is that an outside stimulus may be the initiator. For example in Celiac Disease or sprue, the intestinal lining reacts to gluten (found in most grains) by destroying the villi necessary to absorb nutrients. Eating a gluten-free diet relieves this, but it can take some time for the intestines to “calm down” and sometimes the inflammation never entirely resolves.
Among Americans, 23.5 million people have an autoimmune disease. Women seem to be more likely to develop one than men. Some disorders seem to have a familial tendency. Environmental exposure to certain things, sunlight, chemical solvents, and even certain viral and bacterial infections can increase the risk. Your ethnicity or race can make you more or less susceptible to various autoimmune conditions and can affect the severity of the disease.
Any organ in the body can be involved. The thyroid gland is a commonly affected gland and is a good example of the ways autoimmune conditions can behave. An affected thyroid can underproduce thyroid hormone (Hashimoto’s Disease) or overproduce it (Grave’s Disease). Thyroxine affects the function of multiple organ systems so its levels are vitally important to normal function. Too much is as bad as too little. Grave’s disease also illustrates how peculiar the malfunction of our immune system can be. In this case, the body makes antibodies that mimic a hormone the pituitary gland makes to regulate the thyroid gland. TSH, thyroid stimulating hormone, is at normal levels, but the thyroid gland responds to the abnormal antibodies and goes into overdrive. This can damage the heart and eyes and cause many distressing symptoms such as anxiety and insomnia. There are several treatments depending on the severity of the condition. Sometimes it completely resolves with minimal treatment.
Many autoimmune disorders profoundly affect a person’s life even though they are quite common such as Type I diabetes. We are all familiar with the fact that just replacing insulin does not solve all the health problems diabetics face. Diet and exercise are of vital importance to maximize control of blood sugar levels and minimize organ damage.
Each autoimmune disorder is unique, but they all share some common characteristics. Most can cause fatigue, dizziness, and low-grade fever. Most are characterized by remissions when symptoms abate and exacerbations or flares when symptoms suddenly increase. Stress, both environmental (such as heat or cold) and emotional, generally cause exacerbations.
Other disorders such as Addison’s Disease, pernicious anemia, rheumatoid arthritis, Crohn’s Disease, lupus, multiple sclerosis, psoriasis, and ulcerative colitis, have been recognized for a long time, but are still hard to control. There are fairly effective medications, but balancing drugs and dosages to minimize side effects is difficult. Most drug regimens involve suppressing the immune system generally to some degree. You can imagine that this has major drawbacks. Making various life style changes and modifying the environment in some way are almost always a part of learning to live successfully with an autoimmune disorder.
Whenever there is no cure for a condition, alternative medicine practitioners become very active. This can be a good thing; the problem is that it is very hard to sort out the valid recommendations from those which have little or no good research behind them. A number of traditional institutions (like UCLA) have Complementary Medicine departments which can be an ideal source for consultation.
Having a chronic condition is never easy, but joining a support group can be very helpful. Thanks to internet technology, even those with a rare disorder can find a community of others to offer practical suggestions and a listening ear.
Adair Small, Congregation Nurse, nurse
ocuuc
org
Resources:
Just type in the disorder you are searching for and you will find information and further resources.
National Center for Complementary and Alternative Medicine
National Library of Medicine, MedlinePlus
Anxiety and the Anti-Vaccine Movement
Anxiety and the Anti-Vaccine Movement
Adair Small, RN April 2012
Why don’t infants and children die at a rate of 20 per 100 as they did just over a century ago? One word: Immunizations. Infectious disease is not the only killer, but it was number one for millenia.
So why does an Anti-Vaccine Movement exist? One word: Fear
Vaccination has been dogged by controversy for more than 200 years. There is something about injecting a healthy child with a substance derived from a deadly disease that just seems wrong to parents unless they have a clear understanding of the science and/or are faced with actual experience of the illness. Even during historical epidemics, there was major opposition to this unknown method among families of ill, dying or dead victims. Experience and education led to the embracing of many vaccines in the last century. This has been so successful, that the rate of the “usual childhood diseases” has dropped so dramatically as to result in the eradication of smallpox worldwide and polio in Europe and the Americas. Unfortunately, the last decades have seen a significant resurgence of whooping cough and measles.
Why is this? When the vast majority are immunized, something called herd immunity occurs. There are so many who are not susceptible that when there is one case, no one else gets it. Not everyone is medically eligible for vaccination and some have religious objections. Herd immunity protects them. But as more people decline immunization, the risk of more widespread disease increases. The most contagious diseases need the highest rate of immunization to prevent an outbreak. Children are experts at contaminating themselves and others! They put everything in their mouths, play close together, share food, drink, etc. And most communicable diseases are contagious before anyone suspects they are ill.
Trying to discuss the importance of vaccination with a non-believer, is extremely difficult. It is like religion and politics. But I will give you a list of specific myths and also make this suggestion. Those who are tempted to avoid vaccination for their children should be asked if they have learned all they can about the diseases that the vaccines can prevent. It is not safe for them to assume that these diseases will remain so rare that they are not a threat.
Only since World War II, have we had antibiotics to fight bacterial infections, and they are no help against viral disease. Diphtheria, whooping cough, tetanus, Haemophilus influenzae type b (Hib), and one type of pneumonia are the bacterial diseases we are most familiar with regarding vaccination. All the rest of the commonly used US vaccinations we have today are for viral illnesses.
I talked about fear at the beginning. Fear leads people to search desperately for reasons and answers. There are risks and side effects to vaccination as there are to everything in life. I actually survived all the usual childhood diseases of my day with no ill effects: measles, mumps, rubella, chickenpox and influenza. But I had a cousin with polio, and a friend hospitalized with measles. Good medicine means a continuous study of how well treatments work and their safety. It takes many different scientific studies to determine accurate results. The field of immunization has proved a great example of misused and misinterpreted science. It has taken many studies over many years to disprove the autism scare; and many still won’t believe the results. There is a principle of human nature called “last bad outcome;” whatever you associate with a bad outcome, becomes the cause of that outcome. Eat dinner out, get sick: you don’t want to eat that or there again. But was it the restaurant or something else? Get a flu shot, get sick a day later: it was the shot. Never mind that the virus in the vial was dead! So when symptoms of autism arise shortly after multiple immunizations, well, that must be the cause.
If you can get one person to reconsider opting out of vaccination, you will have done a lot for public health.
Resources:
Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Paul A. Offit
The Risks of Skipping Kids’ Vaccines By Lisa Farino for MSN Health & Fitness
Common Concerns and Facts About Childhood Immunizations
1. Overloading the Immune System
Every day, infants and children contact millions of particles of pollen, dust, mold viruses, and bacteria that trigger immune response. The triggers in a vaccine make up a very small part of a child’s environment.
2. Serious Side Effects
Local soreness, low fever, and a day of fussiness are the worst that most babies experience. This is extremely mild compared to the severity and duration of the illnesses being protected against. Even chickenpox can be serious. One in 500 children who get chickenpox need to be hospitalized. Mumps can cause infertility. Measles, mumps, chickenpox, Hib can cause meningitis and encephalitis among other complications.
3. “Since other children are vaccinated, my child doesn’t need to be.”
Some children have allergies or immune disorders and cannot be vaccinated. Some families religious beliefs prohibit vaccines. If the immunization level for a highly contagious disease like measles falls below 90-95%, that disease could rapidly become wide-spread once again. In certain communities where that has happened, children have died in recent years from both measles and whooping cough.
4. Testing of Vaccines is Insufficient
Most vaccines are tested in more children and for a longer time than most medicines parents give their child. The pneumococcal vaccine was tested in 40,000 children.
5. Vaccines contain unsafe material
Immunizations for infants and children no longer have mercury in them and have not for several years. Some preparations have aluminum, but the aluminum babies receive from formula is 10 times more than the amount in their vaccines during the first 6 months of life. Some parents have worried about the fact that serum from cows is used in some vaccines. However, the prions that cause Mad Cow disease are contained in brain tissue, not serum.
6. Vaccines cause Autism
Some people are convinced that the thimerosal, a mercury compound that used to be used as a preservative in all vaccines, caused autism. The autism scare stemmed from a very preliminary study of only 12 case reports in 1998. Millions of dollars later, extensive studies and legal reviews have failed to substantiate any cause and effect relationship between vaccines and autism.
Adapted by Adair Small, RN from: Common concerns About Childhood Vaccinations, prepared for the subscribers of Pharmacist’s Letter / Prescriber’s Letter by Therapeutic Research Center, 2009
Resources:
Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Paul A. Offit
The Risks of Skipping Kids’ Vaccines By Lisa Farino for MSN Health & Fitness
New Blood Pressure Monitor at OCUUC
A big thank you to Sally Cowan, RN for contributing to the cost of our new state-of-the-art electronic blood pressure monitor! It automatically takes 3 readings, averages them and let’s you know if you have an irregular heart beat. Come try it out on March 11, between the services.
Sally has been ably assisting me with BP screenings for some time and now we have another helper, Alexis Worth, RN. Alexis has been visiting OCUUC for a while now. She is studying to be a nurse practitioner at Cal State Long Beach.
Periodic screening of your blood pressure is one of the easiest and most important steps you can take in order to live long and well! Hypertension is known as the silent killer, because symptoms don’t occur until significant damage is done. What kind of damage? Basically, imagine those microscopic capillaries, with one cell thick walls carrying oxygen and nourishment to all your vital organs. When the pressure within increases, they tend to blow out like a weak tire, leaving permanent damage behind. This occurs anywhere the blood vessels go; particularly vital are the brain, retina of the eye, and the kidney. A stroke may be the most dramatic result of hypertension, but insidious damage occurs continually.
Our blood pressure changes through out each day and across the life span, but it is a myth to think that any significant higher reading is normal as we age. It is the rare individual that does not have some atherosclerosis or hardening of the arteries with age and this does force the heart to beat harder, thus causing both hypertension and predisposing to heart failure. Ideally, our blood pressure should be below 130/80. The systolic (top) reading measures the pressure of blood in the artery in the upper arm when the heart beats. The diastolic (bottom) number is the pressure in between beats, that is when the heart is at rest. In general, the lower the numbers the better! People with true low pressure may have problems with feeling faint when standing up quickly, but otherwise low is good!
Your blood pressure is on a continuous scale and any persistent elevations need to be diagnosed and treated. Losing weight is never simple, but that, along with increased activity is the number one successful treatment for pre or mild hypertension. And if you smoke, here is another reason to quit! Stress is also a culprit. Even if you can’t eliminate stress there are wonderful, fun ways to cope with it. Yoga, Tai Chi, biofeedback, meditation and simple breathing exercises. We now know that diabetes and hypertension are linked, with one increasing the risk of the other and both increasing the risk of heart disease dramatically. No one likes taking pills, so remember that at any level of hypertension, life style changes can enable you to avoid or decrease the need for medication.
We have handouts on many of these topics at either the Caring Table or at the BP Screenings. I am also happy to provide more specific information to anyone! Some great web resources are:
www.webmd.com/hypertension-high-blood-pressure
www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502
Adair Small, Congregation Nurse
nurseocuucorg (nurseocuucorg)
Upcoming Events of Interest to Seniors
Managing Medications Event for Seniors
Free three-part series at Brea Senior Center, 500 S. Sievers Ave.
Thursday, Feb. 23, 2012, 11 a.m. – noon: Help with Medicare Rx Costs
Information on premiums, deductibles, co-pays, low-cost options; Medicare Drug Plan Choices, Formulary Review
Part II: Thursday, March 29, 11:00 a.m. – Noon: Practical Tips on Medication Storage, Disposing, & Remembering
Part III: Wednesday, April 25, 10:00 a.m. – Noon “Brown Bag Medication Review” with a pharmacist. Call to register: (714) 990-7750
Alzheimer’s Disease and Other Dementias: What Does the Diagnosis Mean?
Tuesday, March 20, 2012, 4:30 – 7:00 p.m. (Refreshments 4:30 – 5:00)
UCI University Club, Irvine
Reservations mandatory: (949) 824-2382, press option 4
Notes From the Nurse, February 2012
February is Heart Month every year, not just because of Valentine’s Day! The American Heart Association and the Red Cross tie a lot of their education to this month. It makes sense; reminders about how to take care of ourselves and how we can save other’s lives are needed periodically.
Here’s a link to the AHA site which has a brief video of Hands-Only CPR™ http://HandsOnlyCPR.org/ You can also get an app for your iPhone, Android, or Palm Pre to guide you through CPR!
Sudden Cardiac Arrest
This means your heart has completely stopped effective beating; survival depends greatly on immediately getting CPR from someone nearby. Unfortunately, less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location get that help. Most people are worried that they might do something wrong or make things worse. That’s why things are being made much simpler for non-medical professionals. And the beauty is these techniques can work as well or better than “old-fashioned CPR”!
If you see an adult suddenly collapse, and he or she is not breathing and unresponsive, call 911 and push hard and fast in the center of the chest. The American Heart Association says, “Don’t be afraid. Your actions can only help.”
Heart Attack and Stroke
In a heart attack, a part of the heart can die from lack of blood. In a stroke, part of the brain can die. These are life-and-death emergencies; every second counts. If you see or have any of the following symptoms, immediately call 911. Not all these signs occur in every heart attack or stroke. Sometimes they go away and return. If some occur, get help fast! There are new and better treatments every day to stop a heart attack or stroke in its tracks. But to be effective, these drugs must be given relatively quickly after symptoms first appear.
HEART ATTACK WARNING SIGNS
- Chest Discomfort
- Most heart attacks cause discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
- Pain or Discomfort in one or both Arms, Back, Neck, Jaw or Stomach
- Shortness of Breath with or without chest discomfort
- Other Signs may include a cold sweat, nausea or lightheadedness
STROKE WARNING SIGNS
If even one of these signs is present, don’t delay:
- Sudden numbness or weakness of Face, Arm, Leg, especially if one-sided
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
Thanks to our partnership with Hoag Hospital’s Health Ministry program, we will be able to offer CPR and or First Aid training through the year! Let’s all be prepared to save lives if we have to.
And don’t forget prevention. Try not to gain weight; try to exercise some every day. Remember, any step you take can be the first of many in the right direction!
Adair Small, nurseocuucorg (nurseocuucorg)
Congregation Nurse
Holiday Blues
Our church family has sustained more than our share of group and individual loss this past year. I wrote about holiday blues in 2010, but I think it is useful to look at again. OCUUC said good-bye to a beloved minister with the retirement of Karen Stoyanoff and has dealt with the deaths of several long-time church members. We also have members with some very serious illnesses. Sometimes we forget that illness and injury are losses too, of our good health. Whether present or past, this season can bring all these losses up with a vengeance. Someone has said, “Loss is like a scar: It will heal over, but it will also leave a mark.”
It is important to be sensitive to those who may find this a stressful period, and if you are one of these folks, to know that you are not alone.
All losses and potential losses count. How can you be full of cheer if jobless and in fear of worse? Events that happen from time to time in all our lives make celebration tougher: illness, death of a loved one, perhaps a separation or divorce.
The holidays accentuate these feelings of loss or loneliness because of ours and others’ expectations, and anxiety about the future. I think the “other’s expectations” part is key. You should be able to share your feelings of loss with those who are close to you and scale down the festivities to something you are comfortable with. This is a time when being with family and friends can be an enormous help, as long as they are sensitive to your feelings.
One way through all this is to try to look for the joy in the present moment and to be with people who lift you up rather than drag you down. The OCUUC community is one where I have always found the love, caring and support to be very special. You already know who the folks are who make you feel good just when you see them or hear their voice. Try to be in their company. Think about the places that have always made you feel good or at peace and seek them out. I find there is nothing like a walk on the beach or at the marsh to make me feel better. Don’t forget that activity is a wonderful antidepressant and anti-anxiety tool!
It is important to be able to separate holiday blues from clinical depression. If you have been feeling an overall disinterest with your life prior to this holiday season, then you should be evaluated by a mental health professional. Call the NAMI WARMLINE, 1-877-910-WARM (9276) or 714- 544-8488, 8 a.m. to midnight daily.
If you already suffer from depression, keep supportive family and friends close during the holiday season. This can be a tough time and you should lean on all the people you can, to get you through it. I have some Tips for Handling the Holiday Blues available at the Caring Table, or I would be happy to send them to you.
I take this opportunity to wish you the brightest 2012,
Adair Small, Congregation Nurse
nurseocuucorg (nurseocuucorg)
Coming Events and Immunization Update, Part II
Blood Donation
The Winter Blood Drive will be on Sunday, December 11 from 8:30 – 2:30 in the OCUUC parking lot. This is a particularly tough time of year on the nation’s blood supply. We have members of our own congregation needing frequent transfusions. Please donate if you can. Appointments are very helpful, but walk-ins are always welcome! Sign Up at the Caring Table or online.
Blood Pressure Screening
December 11 will also be an opportunity for you to have your BP checked whether or not you are donating blood! During the Arts and Crafts Fair, Sally Cowan, RN, will be providing this service at the Caring Table, where Adair’s Heart Healthy Holiday Trail Mix will also be on sale!
Whooping Cough Vaccine
Pertussis, better known as Whooping Cough, has seen a dramatic resurgence in recent years. Although it is rarely life threatening to adults, it is not a minor illness. We are susceptible since our childhood immunity has worn off long ago and when adults do get it, they can pass it to babies and unimmunized children where it is a very serious illness. Now there is an effective new killed vaccine with no mercury preservative. Side effects are very unlikely, except for some tenderness at the injection site. The vaccine is a three-in-one: tetanus, diphtheria and pertussis.
You can get this from your health care provider or, if you have no insurance, the health department. Call them at 1-800-564-8448 for an appointment for: children, women of childbearing age (pregnant or not), any adult who cares for children or comes into contact with them regularly, and all over 64.
December Blood Drive
Link: Who may donate?
Blood Donors Must:
- Be healthy*
- Be at least 17 years old in most states, or 16 years old with parental consent if allowed by state law – see more information for 16-year old donors »
- Weigh at least 110 lbs.
Additional weight requirements apply for donors 18 years old and younger and all high school donors. - Wait at least 56 days since your last whole blood donation
- DONORS MUST SHOW ID containing given name and one of the following: birth date, blood center assigned donor number or photo.
- Eat a healthy meal before donating, even if you do not normally eat three meals a day.
- Drink 16oz of water 10-30 minutes before donating. (Soda, coffee and tea don’t count!)
Immunizations for all Ages
Our free Flu Vaccine Clinic coming up on Sunday, November 13th from 10:30am to 1:00 pm. I thought this would be a good time to review some of the latest information on immunization and what it can do for us. Since I have been in Chicago, I have enjoyed reading up on local history. I just finished a book about Jane Addams’ Hull House. It included the deadly small pox epidemic which spread from the Midway of the World Columbian Exposition (1893) through the city. Many were more afraid of the vaccine than they were of the disease and died or were severely scarred as a result.
There are side effects to vaccines, it is true, but except in rare cases they are insignificant compared to the illness. I am old enough to have had two cousins contract polio before the vaccine was developed.
Influenza: There are now many vaccine options, although we will only have the standard killed virus inoculation at OCUUC. The Center for Disease Control advises everyone from 6 months and up to be vaccinated yearly. Children under 9 years old need 2 shots the first time, so we will only vaccinate those who have had vaccine in previous years. Our vaccine does contain the preservative thimerosal, a mercury based preservative which some people prefer to avoid in children and pregnancy.
It is important to note that fears related to autism and thimerosal exposure from vaccines is completely unfounded. No routine vaccines for children under 6 years of age have contained thimerosal (except flu vaccine) during the past 6 years, and yet rates of autism have not changed. I do recommend that all pregnant women seek the thimerosal-free vaccine from their health care provider since it is unknown what effect thimerosal may have on the fetus. There is good evidence that influenza immunity does pass to the fetus and protects the newborn from infection and hospitalization.
The new quadruple strength vaccine is for those over 65 when one’s natural immune response begins to decrease. Medicare covers that or the regular strength vaccine if you prefer.
The intradermal flu vaccine is injected into the skin instead of the muscle. It uses a much smaller needle than the regular flu shot, and it requires a lower dose to be as effective as the regular flu shot. It is available for those aged 18 through 64. It has no thimerosal.
The nasal-spray flu vaccine is a vaccine made with live, weakened flu viruses. The viruses in the nasal spray vaccine do not cause the flu. It is approved for use in healthy people 2 through 49 years of age who are not pregnant.
HPV (Human Papilloma Virus) has been in the news a lot lately. I suspect that it is only controversial because it is associated with sexual activity. Most first sexual encounters now occur in the seventh grade and HPV is the most common sexually transmitted infection in the US. There are over 100 types of HPV virus that affect humans; two of them cause cervical, oral, throat, anal, and penile cancer. The virus is transmitted by skin to skin or bodily fluid contact. There are two other types that cause genital warts. All four strains are combined in the Gardasil vaccine which is only effective if used before exposure. Three shots over 6 months are needed for immunity; it is recommended for males and females age 9-26. Why not over 26? Statistically almost all those older than 26 already have been exposed to HPV.
Shingles (Herpes zoster) is caused by the chicken pox virus. Once you have had chicken pox (even if so mildly that you never knew it), the virus stays in your system. It tends to manifest years later as shingles with sometimes disastrous results. The vaccine can be given to anyone over age 50. The older you are, the more likely you are to develop shingles. You can get it more than once. Medicare does not cover this, but many supplemental insurances do.
Pneumonia can be bacterial or viral. There is a vaccine for the bacterial type only. This should be given once to those 65 and older. Medicare covers it. Bacterial pneumonia is opportunistic; that is it generally infects someone already sick with something else. When young children and seniors get a very bad case of the flu, it is pneumonia that often kills them.
Important upcoming dates:
Flu Clinic is Nov. 13th
Bloodmobile on Dec. 11th
Notes From the Nurse, October 2011
The AED is here!
What am I talking about? An Automatic External Defibrillator. Learning how to use one enables you to shout “Clear!” like they do on TV, and, of course in real hospitals and ambulances. We all hope we never have to perform CPR or actually use an AED, but lives are saved everyday with this technology. OCUUC’s AED comes courtesy of our association with Hoag and their Health Ministry program. Hoag is both paying for the AED and for any necessary maintenance.
Let me give you a little background. CPR can save lives, but twice as many victims of sudden cardiac arrest are saved with use of CPR in combination with an AED within a 3 minute time frame. Simply, when someone sustains a heart attack, the electrical rhythm of the heart usually changes from effective pumping to ventricular fibrillation. This is a quivering heart unable to pump blood. CPR attempts to create effective pumping by external compression; it rarely converts the heart to a normal rhythm. That is what a defibrillator does. An AED is a computer which analyzes the heart rhythm and speaks out loud to the rescuer about the steps to take to send a shock to the heart in an attempt to establish normal rhythm. You have probably all seen AED’s without realizing it. All airports, fitness centers, convention halls have them now. More and more churches have been getting them as well.
Alan Block will be our site coordinator for the AED. It is not enough to have an AED on the wall; it must be checked monthly and a report sent via computer to the company. Alan will be doing this with Sally Cowan, RN, as back up. It will also do us no good to have an AED unless a significant number of us are trained in its use!
We are going to prioritize church leadership for training registration for our first class. As soon as they have the opportunity to sign up, we will open to the rest of the congregation. Our first training is Saturday, October 29 from 9 to 1:30. It will be limited to 16 people. We plan to have another training in the spring to get as many folks certified as possible. You will be certified in AED and CPR for adult, child and infant.
On another note: FLU VACCINE is coming. We will have our free clinic, Sunday, November 13. However, I do recommend that those of you who can, get vaccinated as soon as possible. Physicians and pharmacies have supplies now and Medicare covers it. Children and pregnant women should also be vaccinated.
Adair Small, Congregation Nurse
