Scott Webb (Host): There are a few things in life that you really don't want, and shingles is one of them. My guest is here today to tell us about shingles and stress the importance of the shingles vaccine as our best defense against shingles. And I'm joined today by Dr. Narayan Prabhakar. He's a Board Certified Family Medicine physician practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's so nice to have you here today. We're going to talk about shingles and shingles is one of those things, I hear about it. I hear about the shingles vaccine and I think, do I actually know what shingles is? Do people really know what shingles is? You know, so let's start there. Just kind of explain for me and the audience, what shingles is.

Narayan Prabhakar, MD: We have all had chicken pox at some point in our life and sometimes maybe we don't remember it, recall it, it could have been a milder version. Shingles is basically the chicken pox virus getting reactivated. It can happen at any age really, but it's usually seen as you get older, or if you have any sort of immune conditions, any conditions that lower your immune response, immune system, then you may be more prone to get shingles.

Host: Yeah, I see what you mean. Alright, so, chickenpox when we're younger, shingles sort of reactivates, you know, later, are there any early signs and symptoms of shingles? Like, how do we know? Would someone know?

Narayan Prabhakar, MD: So usually you get a rash, but in some cases you may get the pain or discomfort or itching in the area before the rash even occurs. So sometimes that could cause confusion, you don't know what's going on. And it's usually only on one side of the body. If it's on both sides of the body, it crosses the midline then it's not shingles.

It's usually one sided. You may get this discomfort, irritation of your skin. You could also get some kind of flu like kind of symptoms as well, potentially. And then a few days later, you get a rash in that area. They kind of look like blisters that could be in groups, scattered on one side, following along what we call a dermatomal pattern. The most common sites are along the chest wall area, but you can really get it on any part of the body. You can get on your face as well, which is quite often. Usually it's like on the trunk of the body, you know.

Host: Okay. Alright, so usually on the trunk, one side of the body, not on both sides. This is really helpful. And you mentioned the chicken pox there, in terms of risk factors. Is there anything else? Are some folks just more prone to shingles? Is it age, pre existing conditions? Maybe we've been exposed to different viruses? Like, what are some of the other risk factors, if there are any?

Narayan Prabhakar, MD: Most common risk factors would be, um, you know, if you're going through stress, in your body, you know, or some reason your immune system is lowered, that would also increase your chance of getting shingles.

Host: Alright, so chicken pox, maybe stress, I know there's a lot of talk, doctor, in the world about vaccinations and whether we should be vaccinated for this, that, everything, you know, and we're going to limit our focus today to shingles. So, let's start there then. Is shingles contagious? What can be done to help spread the virus? And if you say that it's the vaccine, do you recommend that for most folks?

Narayan Prabhakar, MD: Oh, absolutely. But first of all, yeah, you cannot give someone shingles if you have shingles. Now, if you're on someone who's never had chickenpox, or someone who's pregnant, then those are the kind of people you have to be careful being around, but you're not going to give shingles to another person, but you can certainly, you know, end up giving chickenpox to somebody else.

Host: I see, okay. And how about the shingles vaccine? What's involved? Is it just generally like all these other vaccines, flu, COVID, and otherwise? You just speak with your provider or go to, you know, drugstore or that kind of thing, and you just say, I want the shingles vaccine?

Narayan Prabhakar, MD: Yes, you know, so we definitely recommend it. It's currently recommended for people 50 and up. The current shingles vaccine is 90 percent effective, basically. So the thing with shingles is if you don't treat it right away, it's not curable, but it's just that the medication helps cut down the symptoms. And also what's called um post therapeutic neurology, which is pain you can get in the nerve endings from shingles, which can be debilitating in some cases, and that pain can go on for quite a few weeks.

So that's why it's important to get the vaccine, which definitely will keep you from getting shingles, especially in ages 50 and up. It's a two dose series. You do the first dose, you do the second dose about two to six months later.

 Personally I've gotten the vaccine myself. Side effects are pretty much like most of these other vaccines, like the flu shot, you know, COVID shot. You get some flu like symptoms, your arm's gonna be a little sore for a few days, maybe you may get a low grade fever, but that's about it. It's pretty self limited, and then you're fine. Or you may not even get any symptoms, you know.

Host: Yeah, it does seem that we're all used to that, right? Sore arm for a few days, kind of flu like symptoms. So when we think about a shingles outbreak, if you will, and what might trigger it, you said before, maybe just folks who are a little bit older, a little bit stressed out, that kind of thing. Anything else that could cause a shingles outbreak?

Narayan Prabhakar, MD: Well, shingles, I mean, I wouldn't call it necessarily an outbreak because you're not giving to somebody else, unlike chickenpox, but it's really up to your immune system, stress, your body, you know, going through some sort of physical, emotional stress, or if you've got a medical illness that weakens your immune system.

Host: Yeah.

Narayan Prabhakar, MD: You know, that increase the chance of getting shingles and that can happen to anybody at any age for the matter.

Host: Right, yeah. We were talking about the vaccine and recommending it, of course. Is that really our only defense? Is that our best defense against shingles, is to just make sure that we're vaccinated, especially if we are in that riskier group, if you will, 50 plus, that kind of thing? Is that really all we can do at this point? You said there's no real cure per se, so is it just being vaccinated, being vigilant about that?

Narayan Prabhakar, MD: Yes, absolutely. Once you're 50 and up, I would highly recommend getting the vaccination just to avoid, I mean, you can get some bigger complications with shingles too, like the pain is the biggest issue which can linger for weeks. And I've seen sometimes people have had to take off work for like a few weeks because the pain was pretty debilitating. So why deal with that, you know, when this vaccine is 90 percent effective?

Host: Right. Yeah, I've heard that from some other providers, that there's just a few things in life that they, that you really don't want, and I, I've been told, you just don't want the shingles, just don't get shingles, get the vaccine so that you don't get shingles because you just don't want it. Is that your opinion, doctor, if we can avoid shingles, we should?

Narayan Prabhakar, MD: Absolutely, absolutely. I mean, the vaccine is very effective, side effects are minimal, and you know, why deal with it when you got so many other things in life to deal with? You know, it's a great vaccine. It's actually even better than the previous version, was 10 years ago, but this is more effective.

Host: That's great. Let's finish up here today and I know we're going to talk about colon cancer in the near future, but for today as we're talking about shingles here, you said there's no cure per se and obviously the vaccine is the best way to prevent shingles from coming on. What sort of treatment options are there, solutions are there for shingles? Is it really just about managing the symptoms, managing the pain?

Narayan Prabhakar, MD: Yeah, so ideally, we would like to see you within three days, there's an anti, we call them antivirals, that we use for a multitude of different viral things like, chickenpox, or whether you call it chickenpox, or herpes, they're all in the same kind of family. We use the same kind of antivirals.

Acyclovir, valcyclovir, famcyclovir, those are generic names. And if we can get you on it within 72 hours, that definitely speeds up the recovery and lessens the chance of getting that neurology of pain. And of course, otherwise, you can do some topical things like cool compress, calamine lotion, some maybe Tylenol, ibuprofen for pain, some cases you can also do a course of steroids. But the key is the antiviral medicine. You should get in within three days, 72 hours.

Host: Yeah, so, early diagnosis, if you will, early treatment is best, avoid shingles if we can, get the vaccination, get the vaccine, good stuff today, Doctor, as I said, we're going to talk again soon, thank you so much.

Narayan Prabhakar, MD: Thank you.

Host: And for more information, visit franciscanhealth.org and search shingles. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.