Search for tag: "shingles"

Interviewer: You may have heard there's a new shingles vaccination, and your doctor might have recommended that you get it. Should you? Well, we'll talk about that next on The Scope.

Announcer: Access to our experts with in-depth information about the biggest health issues facing us today. The Specialists, with Dr. Tom Miller is on The Scope.

Interviewer: Let's talk about shingles. First of all, let's just set the stage. What is shingles?

Dr. Miller: Let's talk about that. So shingles is what we call recurrent chicken pox. Now, before the chickenpox vaccine was given routinely to children, most of us, probably greater than 95% of us, have had chicken pox and may not even remember it as kids. Now, once you've had it, it never goes away. The virus goes into your nerves in your spine and hides, and for reasons that are not entirely clear, probably because our immune system sort of forgets that the virus is hidden over time, chicken pox comes out again as shingles or herpes zoster. So it doesn't present as a fulminant, itchy rash like we get when we're kids, but it comes out in specific areas where the nerves innervate parts of the skin.

Interviewer: Meaning it's painful.

Dr. Miller: Well, it's painful, and what's even more concerning and more damaging, probably 10% to 20% developed what we call postherpetic neuralgia, which is a pain that continues after 90 days. And it's very severe and very hard to treat. Some people when they have postherpetic neuralgia can't even wear a shirt because it's painful.

Interviewer: Sounds miserable.

Dr. Miller: Treatments are not very good either. So the best you can do is prevent shingles.

Interviewer: And there is a shingles vaccine. And a lot of people have already gotten it, and now I'm hearing about a new shingles vaccine. So help me kind of reconcile if I should get it or not.

Dr. Miller: Well, that's right. So we say there's about a 30% lifetime chance that you'll develop shingles, and shingles rises in incidence after the age of 50, and by the time you're 80 years old, probably about 20% of people who develop shingles will have postherpetic neuralgia, which is this chronic pain that goes on and on and on.

If you vaccinate, it's basically waking up your immune system to watch out for that virus sneaking out of its hidden cave and coming back and bothering you. So the first vaccine was a live vaccine that was developed in the middle of the last decade. And it was pretty darn effective. But there's a new vaccine that is recommended even if you've had the older vaccine, that is not a live vaccine. And the advantage to that is we can now give this newer vaccine to patients who are immunocompromised. That is to say that their immune system is not quite up to par. It would have been dangerous to give them even a weakened live vaccine because they could develop full chicken pox. So we didn't we didn't give that older vaccine to folks who are immunocompromised.

Interviewer: So if you've been told you couldn't get the shingles vaccine before, now you can?

Dr. Miller: Now you can.

Interviewer: Okay.

Dr. Miller: If you have a history of being immunocompromised.

Interviewer: So that person for sure should get it. Who else should think about getting it?

Dr. Miller: Well, anyone who's over the age of 50 and certainly over the age of 60, the advantage to the newer vaccine is it is a more potent and efficacious vaccine. It works better than the older vaccine. So, in time it will become probably the sole vaccine available.

The issue with the newer vaccine is, one, it has more side effects. And two, it's costly and the older vaccine was costly, but this is a little more costly. So side effects, and what I mean by that is about 10% of the time people after getting the vaccine will develop a flu-like illness that's bad enough that they may not want to go to work.

Interviewer: So symptoms like chills, body aches . . .

Dr. Miller: Chills, aches, malaise, you just don't feel quite right. It lasts for 24 hours to 48 hours and then it's gone. This is not a reason to not get the vaccine. It's self-limited. It doesn't mean that it's going to go on. It was also a sign that this is a very immune genetic vaccine, that it is revving up the immune system and making the immune system remember that it has to go after the zoster or go after the shingles virus if it comes out of the nerves in the spine. And we know that this new vaccine is more effective in the sense that it lasts longer.

Interviewer: So if I got a shingles shot a couple years ago, and I'm 65, if I'm over 50, should I really consider turning around and getting this one?

Dr. Miller: The recommendation is to receive the new vaccination, even if you had Zostavax, the first vaccination, the live vaccination that was out.

Interviewer: At any point?

Dr. Miller: At any point.

Interviewer: Okay.

Dr. Miller: Well, I probably say, if you've had Zostavax, you would wait a year, maybe two or three years before getting the new one.

Interviewer: You can talk to your physician about that if that's the case, yeah.

Dr. Miller: You can talk to your physician. And then I think the second thing is some people assume that this particular vaccine is covered under Medicare. Certain vaccines are covered under visits during for people who have Medicare insurance, such as the flu shot and a couple of other vaccines, pneumococcal vaccine for instance. This one is not. It's covered under Part D. So you really need to find out from your insurance what the cost of this vaccine will be. The other slight disadvantage with the newer vaccine is it's a two-shot vaccine. You take the first shot and then come back in three months for the second shot.

The total course of therapy on average or treatment on average is about $340 if you were just to pay out of pocket, and for many people who don't have insurance, that's a big inhibitor. But since most of us over 65 will have Medicare and some coverage, it'll be cheaper. But again, check with your private insurance or check with Medicare to know what it's going to cost you so you don't get hit with sticker shock.

Interviewer: Yeah, and then take a look at I mean, it sounds like if it develops into the long-term chronic pain, not being able to put on a shirt, I mean, that sounds like it might be worth figuring out how you could come up with a little extra money if you're not able to.

Dr. Miller: Well, that's true. I think one of the problems that we see folks experience, they come in and they hear about it, and then they get the vaccine, but they experience the sticker shock. And either they decide not to get the vaccine or they wait.

And just as long as you know what the cost is, you can make an informed decision. And I certainly recommend it in all of my patients over the age of 50 and certainly over the age of 60.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Scot: Zoster: you've probably never heard of that, but you've probably heard of its more common name. You'll find out more about this disease coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists that you can use for a happier and healthier life. You're listening to The Scope.

Scot: I was in the pharmacy the other day and saw a sign up there saying, "Get your shingles vaccination," and I thought, "That's strange." I'm used to seeing a flu vaccination, but shingles? I don't even know much about it, so we're talking with Dr. Tom Miller at University of Utah Hospital. Shingles, first of all, is it a big deal?

Dr. Miller: It is a very big deal.

Scot: Yeah, tell me about it.

Dr. Miller: Well, it's called herpes zoster, and it's commonly known as shingles. That's this rash that people get on one side of their body, but it's more than just a rash. It's about the pain that it causes.

Scot: You were telling me about some of this pain. Describe what people have to go through when they get it, like in some of these extreme cases.

Dr. Miller: Scot, I had a patient in my office in the other day, and he was in unbelievable pain. He developed this rash, this shingles rash, back in January, and he still has the pain. His pain is so bad that he couldn't put a shirt on over the shoulder where this pain occurred. He has to come into the clinic with it buttoned only halfway up.

Scot: That's crazy. So a month and a half later . . .

Dr. Miller: He didn't put the arm on. He didn't put the shirt sleeve on because it hurt so badly. Anything touching his skin feels like a branding iron has been put on it.

Scot: Is that pretty normal for shingles?

Dr. Miller: No, most people that develop shingles have the blistering rash, and that goes away in about a week, but about half of a percent of patients will develop main that is just incredible and it goes on long after the rash disappears. So it is painful when it occurs, but it can be really painful over a long period of time. Unfortunately, the older one becomes, the higher the risk of that pain developing after shingles. It's just a higher percentage.

Scot: Okay, gotcha. My wife, who is in her 40s, got shingles. She went to her doctor who said, "Oh, that rash? That's shingles." It shocked her, because she's just in her 40s.

Dr. Miller: Did she have a lot of pain with that?

Scot: No, it wasn't. It was like you described, about a week long, but it was kind of nasty and gross looking. You wouldn't want to get it just for that.

Dr. Miller: Right, that reason alone. I mean, the rash isn't necessarily the bad part of it. The thing that I think most people would be concerned with is the chronic pain that can develop after that.

Scot: Even after it goes away?

Dr. Miller: Well after it disappears, yeah. This gentleman that I had in clinic had the rash and it disappeared in a week, but here we are a month later and he's in incredible pain. He's had to go to the pain clinic and have different treatments to try and reduce the pain, and this may go on for several months actually.

Scot: The crazy thing about shingles is if you've had chicken pox, you can get it. How are they related?

Dr. Miller: It's the same virus. Ninety-five percent of us have had chicken pox. We may not even remember it because it usually occurs in childhood. Now of course, since 1995, there's a vaccine that kids get. So most kids don't ever have chicken pox, the active virus, but all of us born before '95 probably have been exposed to the virus. A very small percent of the population hasn't been exposed. Here's the deal: after chicken pox goes away, it goes to sleep. It goes to bed inside the nerves in the spine, and it just lives there on and on and on until it wakes up and comes back out.
So during anyone's lifetime, you have about a 10-20% risk of developing zoster. It doesn't recur as chicken pox as we know it as a kid, with the little blistering, itchy rash. It comes back as this focal, one-sided, painful rash that lasts about a week. As I said before, the older you get, the higher the likelihood that you might have this terrible pain that occurs long after the rash disappears. That's hard to treat.

Scot: And this is preventable?

Dr. Miller: It is preventable. That goes back to the vaccine that you saw at the pharmacy. The vaccine is available now for folks 60 and older who want to prevent it. Most people born before '95 have this risk of zoster coming back out and developing. So if you take the vaccine, it reduces the risk of the rash by 50%. Even more importantly, it reduces the risk of the postherpetic neuralgia, that chronic pain, by 75% percent. It really is a very effective way to keep from having that really bad pain if you're 60 and older.

Scot: Is it limited to 60 and older just because if I'm 40 it's probably just going to be a week and gone, so they just don't think it's worth it?

Dr. Miller: Yeah, that's one of the reasons. That's exactly right. They're thinking that the effectiveness of the vaccine is probably best when given around 60 years old.

Scot: Okay. So for those of us under 60, if we notice the symptoms of shingles, is there something that we can do or do we just have to ride it out?

Dr. Miller: That's a good question. Actually, if you get to the doctor within about 72 hours, there is evidence that if we give you an antiviral, that it will put that virus back to sleep again. You need to get to the doctor soon and they can treat you. It reduces the length of time that the rash is there, and it may reduce the postherpetic neuralgia.

Scot: So no point in me getting a shot, but if I've got a grandparent or something like that that's over 65, they should get it?

Dr. Miller: Right, and it's only a one-time shot. It's a one-time shot. Now here's the deal: so it is kind of an expensive shot, and I don't think Medicare covers it. Medicaid doesn't cover it. Some private insurance does, so you have to check. I think it's well worth it. The shot is probably around $250, but that would save one a lot of anguish if they develop the zoster rash.

Scot: So your recommendation is to get that that shot. It's a good idea.

Dr. Miller: Sixty and above, get the shot. Don't hesitate. It is very, very helpful.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope. University of Utah Health Sciences Radio.