To Your Good Health: Immunotherapy enhances, not replaces, a person’s antibodies

DEAR DR. ROACH: My doctor has prescribed IVIG therapy for my peripheral neuropathy. As I understand it, this infusion will replace my antibodies with “good” antibodies. Will it replace my COVID vaccine antibodies? Or any of the other immune system antibodies my body has developed to fight off infection? — J.K.

ANSWER: Only some types of peripheral neuropathy are treated with intravenous immunoglobulins (immunoglobulins is another name for antibodies). One is chronic inflammatory demyelinating polyneuropathy, where the person’s immune system attacks the lining to their own nerves. In this case, the IVIG works to block the person’s antibodies to their nerve cells. IVIG is given for several other conditions, such as common variable immune deficiency, where a person isn’t capable of making enough antibodies and is at risk for infection.

In either case, the person receiving IVIG does get some benefit to fighting off infection. But I wouldn’t say the IVIG therapy “replaces” your own antibodies. It’s more like it augments them. If your neurologist has recommended the COVID-19 vaccine, that will be the primary way your body will be protected from you developing COVID-19, and especially from severe infection, resulting in hospitalization or death.

Anecdotally, the cases I have seen of COVID-19 in people receiving IVIG have seemed to be very mild cases. Whether this is a result of the IVIG therapy or just by chance, I don’t know.

DEAR DR. ROACH: I am a 51-year-old woman who underwent a nasal septoplasty two weeks ago to correct some long-term sinus issues. While the recovery has been very uncomfortable, I would say that it has not been very painful, minus a sore nose and a few headaches. My concern comes from the fact that upon discharge from the day of surgery at the hospital, I was prescribed 60 oxycodone tablets. I find this to be an excessive amount and am wondering how I should address my concerns with my surgeon. I only ended up using one and took the remaining amount to a prescription drop-off site, but I am concerned that another patient might become addicted or allow extras to fall into the wrong hands. — E.U.

ANSWER: I honor you for knowing how many opiates to prescribe after surgery better than your surgeon seems to. The guidelines for managing post-operative pain recommend giving only enough medication that pain is expected to last — three days is enough in the vast majority of cases. The prescribing of excess medication is thought to have been a significant factor in the opiate epidemic, for exactly the reasons you mentioned.

DR. ROACH WRITES: A recent column on TMJ (temporomandibular joint) dysfunction generated many letters, most of which recommended a mouth guard at nighttime. People with TMJ symptoms often grind their teeth at night, and a device to prevent this can be very helpful. These should be custom fitted. The ones sold without a dental professional’s fitting are often too thick and can make symptoms worse.

These devices by themselves generally do not solve the problem. It requires other behavioral and sometimes anti-inflammatory treatments at the beginning to calm down the symptoms.

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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