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June 2021

Advancing Care

COVID-19 vaccine and mammograms: What you need to know 

Radiologists, studying results of mammograms and other diagnostic imaging exams, have noticed an increase in enlarged lymph nodes under the arms of some women who reported receiving the COVID-19 vaccine in the weeks leading up to their appointments. 

Enlarged lymph nodes related to the vaccine may be mistaken for signs of breast cancer or other diseases such as lymphoma because breast cancer also can cause swelling in the armpit if cancer cells spread to the lymph nodes. This may lead to additional testing or even biopsies – and unnecessary stress and anxiety. Typically, enlargement of lymph nodes in the armpit is a normal reaction to the COVID vaccine and nothing to worry about, said Regina Hooley, MD, a radiologist at the Breast Center at Smilow Cancer Hospital. She answers a few of our readers’ questions in this month’s Q&A:

How does the COVID-19 vaccine affect lymph nodes?

The vaccine that prevents COVID-19 can cause swollen lymph nodes under the arm in which the shot was given. Your lymph nodes are part of your body's germ-fighting immune system. The swelling in the lymph nodes is a sign that your body is responding to the vaccine and building up defenses against the virus that causes COVID-19.

Vaccines trigger a normal immune response by the lymph nodes, which may become enlarged. Lumps near the armpit, also known as swollen glands or axillary lymph nodes, may be seen in approximately 10 -15 percent of women after the first or second COVID vaccination. The change in the glands under your arm is due to your body's normal response to the vaccine and is not due to cancer.

What happens when the mammogram shows enlarged lymph nodes?

Occasionally, these enlarged glands may be seen on a screening mammogram if the mammogram is performed within about four weeks of the first or second vaccine shot. 

At the time of your mammogram, our technologists will ask you if and when you had the vaccine shot and in which arm the vaccine was administered. If the enlarged nodes on the mammogram match the vaccine history, we note that in the report. The radiologist will consider this when recommending whether additional imaging is needed. No follow-up is necessary unless the patient’s doctor suspects something else is going on.

For people getting a two-part coronavirus vaccine (such as the Moderna or Pfizer vaccine), is lymph node enlargement more likely after the second shot? 

Yes. 

Is COVID-19 vaccine lymph node enlargement permanent?

No. Your lymph nodes will return to normal size a few weeks after your vaccination regimen is complete.

Can other vaccines cause lymph-node changes on a mammogram?

Yes. Flu shots, hepatitis vaccine, bug bites or shaving can also cause lymph node enlargement. Sometimes cancers such as breast cancer and lymphoma can cause axillary lymph node enlargement. 

Should I reschedule my mammogram if I just got COVID-19 vaccine?

It is safe to have your mammogram. If we see enlarged lymph nodes on the same side as the arm that you received the vaccine, it is OK. Don’t cancel or delay your mammogram if you've recently received your vaccine. 

The proper care and maintenance of your vaccine card

You got your COVID vaccine! That vaccine card you received is more important that you may think. Here’s what you need to know about your vaccine record, why it’s important and how to keep it safe.

“It’s important to keep track of your medical records, including immunizations,” said Richard Martinello, MD, medical director of Infection Prevention for Yale New Haven Health. “If requirements change in the future, having proof of your vaccinations will make it easier for you to get up to date.”

What’s on the vaccine card?

The card, issued by the CDC, includes the dates of your vaccination (two dates if you received the Pfizer or Moderna vaccines; one date if you got the Johnson & Johnson vaccine), the vaccine manufacturer and the place where you got your shot. 
Vaccine records are not new. Proof of common childhood immunizations is often required for schools, and certain vaccines and medications are necessary for international travelers. As states start to loosen restrictions, venues and businesses may require proof of vaccination. Think larger gatherings like sporting events or concerts. You also might need your vaccination card if you plan to travel. 

Can I post a photo of my card online?

Think twice about sharing your vaccine card on social media. Posting personal information online can make you a target for scammers.

Should I laminate my vaccination card?

Do not laminate your vaccine card because you may need a booster shot in the future. If that happens, your provider will need to record the date of your booster shot on your card. Keep your card with other important documents in a safe place. Consider taking a photo of your card to keep as a backup.

What do I do if I lose my vaccine card?

If you have a MyChart account with Yale New Haven Health, you can use the app to look up the date of your vaccination and the vaccine's manufacturer. You can also get a copy of your card from the Immunization Information System called CT WiZ at the Connecticut Department of Public Health

COVID-19 vaccines for ages 12 and up 

In recent months, Yale New Haven Children’s Hospital has seen an increase in the number of children admitted to the hospital with COVID-19. However, kids can get severe cases of COVID-19. Vaccination is the best way to protect your child from COVID-19.

All age groups contribute to transmission of the virus, and vaccinating children helps to reduce spread of COVID-19 across families, schools, and communities.

Just like with adults, common side effects can include pain at the injection site, fatigue, headaches, muscle and joint pain and fever. Side effects are usually mild and should only last 1-2 days. Reports of severe allergic reactions, such as anaphylaxis, have been rare. 

Parents can make their child’s vaccine appointment on our vaccination page or by calling the Yale New Haven Health Call Center at 833-ASK-YNHH (833-275-9644). You will be asked to verify your child’s age and attest to any comorbidities. Right now, the only vaccine available for children 12 years and older is the Pfizer vaccine. When scheduling the appointment, select a day when the Pfizer vaccine will be administered at your preferred location. 

Contact your child’s pediatrician if you have questions or to discuss your options. Learn more about COVID-19 vaccine safety for children.

Understanding Fatty Liver Disease

Work at home, school at home, eat at home – no thanks to the pandemic, this at-home lifestyle dramatically reduced many people’s physical activity levels over the past year and increased weight-related health issues that may go undetected. Early detection becomes critical in diagnosing conditions such as fatty liver disease.

Fat is stored in body tissue, but excess fat can accumulate in organs such as the liver, where it can cause non-alcoholic fatty liver disease. Fat build-up causes stress within the liver, often leading to scarring and additional health problems. Fatty liver disease typically occurs with other obesity-related conditions such as high blood pressure, high cholesterol, sleep apnea and diabetes.

“Nonalcoholic fatty liver disease and other fatty liver diseases are by far the most common chronic liver diseases in the United States and likely in the world. These diseases, however, often go undetected,” said Albert Do, MD, clinical director, Yale New Haven Hospital’s Fatty Liver Disease Program through the Digestive Health Service.

Dr. Do explained that fatty liver disease is a silent disease, much like high blood pressure, diabetes or heart disease. The good news is that fatty liver disease can be readily diagnosed with blood and imaging tests. The liver also has a high capacity to repair itself if the disease is identified in time.

“The most important goal of early detection and care is to diagnosis and prevent the disease from progressing to cirrhosis, which is severe liver scarring,” Dr. Do said. “A focus on preventing metabolic and cardiovascular diseases is also important because heart disease is the most common cause of death in patients in nonalcoholic fatty liver disease.”  

How is fatty liver disease treated?

Treatment focuses on weight loss. Studies show that even a moderate weight loss of 5 to 10 percent of body weight can improve inflammation, reduce scarring and allow the liver to regenerate. Ninety percent of patients with fatty liver disease show improvement after bariatric surgery, which also may reduce the risk of liver cancer.

YNHH’s Fatty Liver Disease Program offers evaluation and medical and surgical weight-loss treatments including body composition analysis, liver testing, dietitian consultations, medications for weight loss, meal replacement programs, and referrals for bariatric endoscopy and surgery. 

“We provide a comprehensive, multimodal and patient-centered approach to treatment including medical weight loss, motivational interviewing and coaching, and pharmacotherapy-driven and dietary programmatic approaches,” Dr. Do said.

For more information about the Fatty Liver Disease Program, call 203-287-6210. 

BE FAST to detect signs of stroke

Think you’re too young to have a stroke? Statistics show that they can —and do— occur at any age.  In fact, the Centers for Disease Control and Prevention (CDC) estimates that 34 percent of people hospitalized for stroke are under 65 years old. 

Stroke symptoms can resemble symptoms of less severe diseases, so many people are not aware that they have experienced a stroke until it is too late. It’s important to know the warning signs and can act fast if you or someone you know might be having a stroke. The chances of survival are greater when emergency treatment begins quickly. 

Stroke symptoms? BE FAST

In addition to sudden severe headache, the most common symptoms of stroke can easily be remembered by the letters BE FAST. Don’t delay. The faster you get to a hospital, the sooner you can get treatment or medication to reverse stroke’s effects. 

  • Balance unsteady
  • Eyesight changes
  • Facial droop 
  • Arm weakness
  • Speech difficulty
  • Time to call 911

The most common risk factors for a stroke are high blood pressure, smoking and uncontrolled diabetes. Remember to have regular healthcare visits to check your blood pressure and blood sugar. Also avoid smoking and second-hand smoke.

From prevention to treatment and recovery, Yale New Haven Hospital provides the most experienced doctors and the latest diagnostic tools, techniques and treatments for exceptional stroke care, 24 hours a day. Yale New Haven Hospital’s York Street Campus is certified by The Joint Commission as an Advanced Comprehensive Stroke Center, and the Saint Raphael Campus is certified as an Advanced Primary Stroke Center. These national recognitions signify expertise in providing the highest level of care to stroke patients. For more information visit the YNHH Stroke Center online or call 203-737-1057.

Take a walk with YNHH doctors

Take a walk and chat with local healthcare providers as part of Yale New Haven Health’s Get Healthy Walk ‘N Talk with a Doc. Walks are every Saturday from now through September 25 at the Farmington Canal Greenway Trail in New Haven. All ages and fitness levels are welcome! 

Please arrive by 8:45 am on each walk day. Walks begin at the entrance on the corner of Shelton Avenue and Starr Street and last approximately one hour. Masks are required and we will follow social distancing and safety measures. Parking is available at New Freedom Missionary Baptist Church, 280 Starr St., New Haven.  For more information, email Andy Orefice or call 203-688-5671. 

Online classes for meditation and yoga 

Yale New Haven Hospital patients can relax, renew and rejuvenate in the comfort of their own home with specially designed classes offered online through Zoom. 

The free classes include gentle and restorative yoga, guided imagery mediation, Zumba Gold and T'ai Chi/Qigong. They are designed to guide you through stretching and strengthening exercises, mindful breathing practices and systematic relaxation that results in an overall improvement in health and well-being. No previous experience is necessary.

Classes are held throughout the week and you can register online. Register online in our events section. 

Smilow patients should check with their treatment team to see if exercises are appropriate during treatment. 

New MRI enhances our world-class NICU 

The world-class Neonatal Intensive Care Unit (NICU) at Yale New Haven Children’s Hospital (YNHCH) is now home to a state-of-the-art neonatal Embrace MRI machine – one of only two in the United States. This special machine provides faster and safer imaging for YNHCH neonatologists and neurologists to better detect and manage brain issues in premature infants. 

“The Embrace MRI machine in our NICU is specifically designed for the newborn population and is only the second in operation in the United States, and the third in the world,” said Matthew Bizzarro, MD, medical director, Yale New Haven Health NICU Network, vice chair of clinical affairs, pediatrics. 

Unlike MRI machines used in other hospitals, YNHCH’s Embrace MRI is designed specifically for use inside the neonatal intensive care unit. Infants may be scanned anytime within minutes. Tubing and IV sets can remain in place, which saves time and avoids added pain, stress and possible risk of infection for the infant.  This allows neonatologists and NICU staff to more quickly and effectively assess, diagnose and treat these critically ill pediatric patients, while reducing any potential risks associated with transporting the baby away from the NICU to another floor for an MRI scan.

“Advances in obstetric and neonatal care have resulted in survival of a more medically complex NICU population, particularly those born extremely premature. This population is highly fragile, which greatly limits the ability to safely transport them off our unit,” said Dr. Bizzarro. 

Learn more about the NICU at Yale New Haven Children's Hospital.

Questions about cancer? “Yale Cancer Answers”

“Yale Cancer Answers” is a weekly radio program produced by the Yale Cancer Center that provides listeners with the most up to date information on cancer screening, detection, treatment, and prevention. The program is hosted by Anees Chagpar, MD. Each week guest cancer specialists talk about the most recent advances in cancer therapy, prevention and supportive care.

“Yale Cancer Answers” airs Sunday evenings at 7:30 pm on. Tune in live online at wnpr.org, or browse the podcast episodes and listen to a specific topic. Subscribe to the podcast and never miss an episode! 

If you have a question for possible use during a show, please email [email protected].

What would you like to know? 

Want to learn more about a particular health topic or service? Questions about classes and events at YNHH? We want to hear from you! Tell us what you like about Advancing Care or how we can improve. Email us at [email protected] and let us know how we can better serve your health needs.

MyChart: Your medical information in one place

MyChart gives Yale New Haven Health System patients secure, online, 24/7 access to portions of your electronic medical record (EMR). There you can see your medical history, most laboratory and test results, appointment information, medications, allergies, immunizations and other health information. You can schedule appointments with your doctor, request or renew prescriptions, pay your bill, and send and receive secure, confidential electronic messages with your doctor’s office. Sign up by using the activation code on the after-visit summary from your doctor, request a MyChart Activation Code at your next appointment or visit mychart.ynhhs.org and tap or click on “New User?”

Referrals for physicians and surgeons

YNHH provides free information about and referrals to more than 2,600 affiliated physicians 24 hours a day. Call 888-700-6543 or visit our Find a Doctor feature on the hospital website for information on physician specialties, office hours and locations as well as insurance plans accepted. YNHH physicians represent more than 70 medical and surgical specialties and subspecialties, including internal medicine/family practice, obstetrics/gynecology, orthopedics, pediatrics and psychiatry. 

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Make a lasting impact at YNHH

Help support the mission of Yale New Haven Hospital with a donation! Your contributions support vital programs, services and facilities within the hospital and help keep Yale New Haven at the forefront of innovative treatment. When you make a gift to YNHH, you are part of the advanced medicine and compassionate commitment that touch so many lives in our community. 

Billing questions?

Yale New Haven Hospital offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.