Transcription:
Are You at Risk for Shingles?

Melanie Cole (Host): According to the CDC, almost one out of every three people in the United States will develop shingles, also known as zoster or herpes zoster, in their lifetime. There are an estimated one million cases of shingles each year in this country. Anyone who’s had the shingles knows what a painful condition this can be. My guest today is Dr. Suzanne Vandenhul. She’s a family physician with Southeast Lincoln Family Medicine, part of Bryan Physician Network. Welcome to the show, Dr. Vandenhul. What is shingles?

Dr. Suzanne Vandenhul (Guest): Shingles is a recurrence or a reawakening of the chickenpox virus. If anyone has ever had chickenpox infection in the past, maybe a couple of years ago, maybe decades earlier, if you have that infection, when the infection goes away, the virus actually remains in the body. It’s not like a cold that you fight off the infection and the virus is gone for good. This specific virus remains dormant in the body and whenever there’s an opportunity, it can just waken up and cause a different kind of rash that’s different from chickenpox and we call that “shingles”.

Melanie: Is this considered an autoimmune disorder?

Dr. Vandenhul: Shingles is not an autoimmune disorder. Autoimmune disorders occur when our body attacks itself or makes antibodies against some specific part of itself. Shingles is when the virus wakes up and causes another infection.

Melanie: So, how do people get shingles and is there a genetic component at all?

Dr. Vandenhul: Well, like I said, shingles can occur if somebody has had chickenpox before. The virus lies dormant in the dorsal nerve root of the spinal cord. If that person’s immune system becomes weak for a variety of different reasons, that virus that’s already in their body can wake back up and cause a new infection. A lot of different things can weaken the immune system. HIV or AIDS is one thing that definitely weakens the immune system. If somebody has cancer, their immune system is not as strong. If they’re on specific medications to treat the cancer or even some medications that can treat autoimmune disorders can actually weaken the immune system and let that virus wake up and cause the infection.

Melanie: So, how would you recognize shingles?

Dr. Vandenhul: Well, shingles usually starts as some type of strange sensation. It might be an itching or a burning or a pain. Then, maybe a day or two or three days later, you actually see a rash and this rash can look like blisters or pimples. Because it’s in the, originally was in the dorsal nerve root of the spinal cord, this rash never crosses the midline in a person. So, if you were to draw a line down the very middle of a person’s face or the middle of a person’s chest or right down their spine and their back, the rash would never cross that midline. It’s only on one side of the body.

Melanie: Can shingles be passed from one person to another?

Dr. Vandenhul: Singles can be contagious. The CDC says that it can be spread by actual contact with the blisters but it’s not near as contagious as chickenpox is. Nowadays, so many people are getting the vaccine for the chickenpox that they have antibodies to chicken pox which also gives them antibodies to shingles because it is the same virus. It’s just manifesting in a different way. So, shingles can be contagious if you come into contact with someone who has never had the chickenpox vaccine, somebody who is immunocompromised, someone like a baby that’s too young to get the vaccine yet. Those are the people that would probably be at risk for getting chickenpox from the shingles. You can’t actually get shingles from somebody who has shingles, but you could get chickenpox from someone who has shingles if you come into contact with the actual active blisters.

Melanie: Now, speak about treatment for shingles. If somebody notices these feelings that you’ve had or the rash, what kind of doctor do you go see and is there anything that can be done about it?

Dr. Vandenhul: Well, you want to get in and see a doctor as soon as possible. It does not have to be a skin specialist like a dermatologist. Most primary care physicians have experience with this, so you can see your regular family physician, pediatrician, internal medicine, urgent care clinic, or emergency room doctor. Anyone who’s ever seen the rash before knows what it looks like. Once they hear the history and see what the blisters look like, they’ll be able to say, “Oh, yes, that’s definitely shingles,” or, “It’s nothing to worry about.” You do want to get in and be seen as soon as possible because the longer you wait, the harder it is to treat it. If you treat it early on, you have a better chance of preventing any bad side effects. Some of the side effects might be horrible pain; depending on where it comes, it can cause a lot of other side effects. The main treatment is an antiviral medication like Acyclovir or Valacyclovir or Famciclovir. Those are all generic names of antiviral medications and those are all taken orally and can help shorten the length and the severity of the illness.

Melanie: But they do not cure or clear up the illness. They just shorten the length and severity.

Dr. Vandenhul: Right. And, depending on how quickly you get that medication started, it can definitely help tremendously. If you wait a week, it’s not going to work near as well as if you start taking that medicine the first day. It might shorten it from a ten-day rash down to a six- or seven-day rash or maybe even three days of the rash depending upon how old that patient is and how strong their immune system is.

Melanie: And, we mentioned that this can be quite a painful condition and even if you go on the antivirals, does that help with the pain or the post-herpetic neuralgia that sometimes accompanies shingles?

Dr. Vandenhul: It can help with it. The sooner you get started up on the medicine, the more it will help. If you wait longer, there’s a greater chance that you will that post-herpetic neuralgia; and that means nerve pain that happens after the infection. That pain can be a burning pain. It can be a throbbing pain. I’ve had patients say it is the worst pain of their life. And, other than the antiviral medication we can give them, sometimes there’s some nerve medication like Gabapentin that can help with that pain. Sometimes specific topical pain medicine can also help, like a topical lidocaine patch may help. There’s a Capsaicin medicine that also kind of confuses the nerves and may help with that post-herpetic neuralgia somewhat too. Cold compresses may help. There’s all kinds of different over-the-counter treatments that may help but they don’t help much.

Melanie: Then, let’s speak about prevention and vaccines. Who should get the shingles vaccine and at what age?

Dr. Vandenhul: Everybody over the age of sixty should get the vaccine. It has been tested in patients as young as fifty, but there is no insurance company that will cover it before the age of sixty. So, if you’re sixty and you have had chickenpox at any time in your life, you should definitely get that vaccine. You don’t want to wait until you’ve had shingles because then it’s too late. Although getting the vaccine after you’ve had a case of shingles may help for preventing a future episode, it’s still better to prevent that very first episode of shingles with the vaccine as soon as you turn sixty.

Melanie: Is it only one vaccine, doctor, or do you have to repeat it every few years?

Dr. Vandenhul: It is just one any time after the age of sixty and that’s it for the rest of the patient’s life. If you have a seventy- or even ninety-year-old patient who has not had shingles, I would highly recommend they get it as soon as you find out that, “Oh, you haven’t had the vaccine. You better get it now.”

Melanie: And, you mentioned recurrence and some people mistakenly believe you can only get shingles one time. Is that true?

Dr. Vandenhul: That is not true. I have seen patients get it more than once and I’ve seen patients get it even two or three times. If you’ve had it once, you are at greater risk for getting it again later in life, especially if your immune system becomes weaker as time goes on and the second time you get it, it’s going to be worse than the first time.

Melanie: So, in the last few minutes, Dr. Vandenhul, wrap it up for us. Let us know what you tell patients every single day about shingles, what you really want them to know.

Dr. Vandenhul: When I see a patient who is sixty years old or coming in for their very first Medicare Wellness Exam, I ask them if they’ve ever had chickenpox and then I review all of their vaccines with them. If they have not had this shingles vaccine, I highly recommend it. They can get it at the pharmacy or they can get it at their doctor’s office. A lot of people don’t think that that’s very important but if you want to avoid debilitating pain, the vaccine will help prevent that. It’s a very safe vaccine and it’s very effective. It can prevent pain but I didn’t get the chance to say earlier, it can also prevent blindness in some people or even deafness. Depending on what part of the body this virus wakes up in, it could damage the nerve that makes the eyes work or the ear work on that side of the body and it could cause blindness or deafness in addition to a horrible rash and bad pain.

Melanie: Well, thank you so much for being with us today, doctor. It’s such important information to hear. You can talk to your doctor about getting the shingles vaccination and if you do not have a doctor, you can go to bryanhealth.org/doctors. That’s bryanhealth.org/doctors. This is Melanie Cole. You’re listening to Bryan Health Radio. Have a great day. Thanks so much for listening.