DEAR DR. ROACH: I have liver disease (my doctor calls it mild cirrhosis) and terrible, painful varicose veins. Is it safe for me to get a vein stripping? — V.P.
ANSWER: The risk of an operation always depends on the type of operation and the underlying medical condition of the patient. Liver disease is highly variable, and the operative risk reflects that. For people with quite mild liver disease, the risk is not much greater than a person with a healthy liver, whereas for people with more severe disease, even a routine elective surgery can have a mortality risk of 50% or greater, and therefore are never recommended.
Procedures to treat varicose veins also range in the degree of risk to the patient. Your vein specialist should be able to recommend lower-risk procedures that can still give an excellent outcome, as long as your liver expert or regular physician feels that your liver is healthy enough. Modern surgical techniques using only local anesthesia and microincisions that don’t even require stitches are often ambulatory procedures, meaning patients can go home the same day.
DEAR DR. ROACH: I am a 56-year-old female elementary teacher with underlying health issues. To receive the most effectiveness from the COVID-19 vaccine, should I receive this vaccine in June/July so that I am better protected to begin teaching in person in August? Or should I receive this vaccine right away? I will continue teaching online for a few more months. — K.
ANSWER: I recommend getting the vaccine as soon as you can. Since you have underlying health issues, it’s very important to get protection against COVID-19 as quickly as possible.
We do not know the duration of protection from the different vaccines. The best information I have read recently suggests that the duration will be at least eight months. It will hopefully be longer, but it is possible that booster shots will be required. Still, a vaccine now should protect you well past the beginning of school, and by then we will have a better idea how much long-term protection there is.
DEAR DR. ROACH: Given that some people infected with the coronavirus are asymptomatic, what would be the result if such person got the COVID-19 vaccine? Would their system be overwhelmed? Would recovery be any quicker? — S.S.
ANSWER: This situation has probably already arisen many times, because the vaccine has become available at a time when there is a great deal of infection still present in the population.
Although there is not definitive data, what is known leads me to believe that a person’s immune system would not be overwhelmed by getting the COVID-19 vaccine with asymptomatic infection. Depending on when they got the vaccine relative to when they were exposed to the live virus, the vaccine may or may not help them get better quicker or avoid severe illness.
The vaccine is also still likely to be effective at preventing future COVID-19 infection when given to someone with active illness. However, it should not be given to someone having symptoms of COVID-19. The vaccine should also not be given for 90 days if a person receives monoclonal antibody treatment for COVID-19.
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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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