September Newsletter
September, 2021
Welcome to the September newsletter. This newsletter aims to provide information and analysis of timely topics from recent articles published in the medical literature. I hope you find this information useful and helpful in your health journey. If you have comments or questions, please let us know!
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Booster shots continue to be in the news. Since last month there is more guidance as to who should consider getting a booster vaccination. In mid-August the FDA expanded the EUA of the Pfizer and Moderna vaccines to allow for the use of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. On Sept. 22, the FDA expanded the EUA of the Pfizer COVID-19 vaccine to include booster shots for people who are: over the age of 65 or over the age of 18 and high risk for developing severe COVID-19, or at high occupational risk for COVID-19. These people are now eligible to receive a third dose without a prescription starting six months after their second dose of vaccine. A third dose of Moderna as a booster is not yet available, but expect a similar authorization before too long.

A person is considered immunocompromised if he or she:

  • Is actively being treated for solid tumor or blood-related malignancies
  • Has received a solid-organ transplant and is taking immunosuppressive medications
  • Has received a CAR T-cell or hematopoietic stem cell transplant in the last two years
  • Is actively being treated with certain immunosuppressive medications, including high-dose corticosteroids, alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, TNF blockers and other biologic agents that immunosuppressive or immunomodulatory
  • Has a moderate or severe primary immunodeficiency, such as DiGeorge and Wiskott-Aldrich syndromes
  • Has advanced or untreated HIV infection

The following people should or may get a Pfizer booster shot:

  • Anyone who is 65+ and any long-term care resident should receive a Pfizer booster shot at least 6 months after his or her primary series
  • Anyone 50+ with an underlying medical condition should receive a Pfizer booster shot at least 6 months after his or her primary series
  • Anyone 18–49 with an underlying medical condition may receive a Pfizer booster shot at least 6 months after the primary series, based on his or her individual benefits and risks
  • Anyone 18-64 who is at increased risk of COVID-19 exposure and transmission because of job or institutional settings may receive a Pfizer booster shot at least 6 months after the primary series, based on his or her individual benefits and risks

For most people, the vaccines provide excellent protection against severe illness and death. When available, I will not be able to give Moderna boosters to people who got their primary series at my office. The state requirements for the minimum number of vaccines that need to be ordered are too high for my small office to handle. I would be happy to assist you in finding sites giving Moderna boosters when available and you can monitor this at https://www.vaccines.gov/search/. If you have questions regarding the vaccinations, please let me know.
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I am happy to announce that I have secured access to one of the newest diagnostic tests available. The Galleri test is a blood test that can detect over 50 types of cancer before they are apparent through regular screening testing (and many cancers don't have a screening test). The test detects methylation patterns of cell-free DNA which can indicate cancer and thus has the potential to detect cancer at the earliest stages. If you are interested in learning more about this test please let us know.
Depressed From Insulin Resistance
Can your blood sugar level affect your mood? Many of us have had the experience of being “hangry” and may find that a Snickers Bar (or other sugary treats) temporarily relieves our symptoms. While we can have short-term mood issues like irritability from our blood glucose, can we have long-term effects as well? Can our blood sugar levels predict our risk for depression or anxiety? Are there tests that can help to predict our risk for these problems? 


It's the Carbs!
We have all learned that the secret to losing weight or maintaining weight is the balance of calories in and calories out. Like a scale, we need to balance this ratio. But what if it isn’t that simple? What other factors may have effects on our fat storage and weight gain? Is the “eat less, move more” theory correct? If not, then what is the mechanism of weight gain or weight loss? 
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Time of Exposure Matters
Low-density lipoprotein cholesterol (LDL-C) has been determined to be a major modifiable risk factor for cardiovascular disease. We focus on LDL levels especially after cardiovascular events and use medications to lower cholesterol in these cases. But we also can use cholesterol-lowering medications for primary prevention, which is attempting to intervene before a health effect or even occurs. We have traditionally focused on lipid-lowering therapies later in life, from middle age on and after cardiac events. But should we be focusing on younger age groups for intervention? How much does cumulative LDL exposure matter? Is a rise in LDL later in life more problematic than cumulative exposure? How can we reduce our risk?  
To Your Health...
Thank you for taking the time to read through this newsletter. We hope you have found this information useful. Feel free to pass this on to anyone you think would benefit from this newsletter.

Mark Niedfeldt, M.D.


Old-fashioned medicine with 21st Century convenience and technology