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DEAR DR. ROACH: My question relates to a situation where a person gets a vaccine for, say, flu, COVID or shingles and is later exposed to the virus. Is it possible that as the vaccine is helping your body fight the virus, you develop symptoms such as inflammation, a mild sore throat, headaches, etc.? I wonder this because sometimes it seems like all of a sudden, I get generalized joint pains, achiness, or maybe a very mild sore throat without any other major symptoms that indicate a specific illness. -- M.A.B.

ANSWER: The body's immune system is constantly fighting a war against pathogens such as viruses, bacteria and even parasites. The immune system is very good and "wins" most of the time, but you are quite right that symptoms like a low-grade fever, enlarged lymph nodes, or just feeling like you don't have your normal energy might mean that your body is working hard to fight something off.

Vaccines help your immune system by teaching them what to look for. It is very similar to having been infected with the pathogen in the past, just with the major benefit that you didn't get sick. Some of the diseases we immunize people against can be pretty benign, but they have the potential to be devastating. (Measles and chicken pox come to mind here.)

From a sheer numbers standpoint, since there are hundreds of strains of respiratory viruses (not just the flu and COVID but respiratory syncytial virus, adenoviruses, rhinoviruses, enteroviruses, parainfluenza viruses, metapneumovirus, and bocaviruses among others), you are more likely to be fighting off one of these than an illness that you were vaccinated against. Many of these viruses are constantly mutating, so our immune system can't fight them off perfectly.

DEAR DR. ROACH: I was talking with a friend yesterday who said that, for the second time, the prescription (for a controlled substance) that his primary care physician faxed to the pharmacy failed to arrive. I suggested that he go to the doctor's office and get a copy of it, then take it to the pharmacy, but my friend said you can't do this anymore. Is this true? -- J.S.B.

ANSWER: The rules on written versus electronically prescribed (faxing really isn't done much anymore) medications depends on the state. In many states, including mine, written prescriptions for any prescription drugs are not allowed except under unusual circumstances that require a waiver. (Failure of the E-prescribing system or a physician who doesn't have access to E-prescribing are two reasons why this can happen.)

In your state, only controlled substances (such as all opioid pain medicines and many sedatives, testosterone medications, and ADHD medicines) require E-prescribing, but I suspect that E-prescribing will be required everywhere for all prescriptions before too long. Ninety-two percent of prescribers use electronic prescriptions as of 2024.

While it can be an annoying hassle for both patients and prescribers, E-prescribing tends to have less errors and can identify when a person is getting multiple prescriptions for the same or similar drugs. (I used to get a lot of phone calls from pharmacists who couldn't read my "doctor's" handwriting.)

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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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