Transcription:
What You Need To Know About Shingles

Carl Maronich: Welcome to the Well Within Reach podcast. I'm your host, Carl Maronich. And today, I am joined by Dr. Syeda Ali. Dr. Ali is a primary care provider with the Riverside Medical Group in internal medicine in Bourbonnais. And today, we are going to talk about shingles. Dr. Ali, welcome to the podcast.

Dr. Syeda Ali: Thank you for having me.

Carl Maronich: Very glad you were able to make time for us today. And let's start by asking you to tell us a little bit about yourself and your background

Dr. Syeda Ali: So I'm an internal medicine provider here for almost eight years. And it's always my passion to be in primary care. I've been practicing for almost 16 years now. So, when I see these podcasts and marketing and all that, I always get excited. I'm like, "Okay, I need to be there."

Carl Maronich: Well, we appreciate that. And talking about something that is important, shingles. And I don't know, doctor, if you could maybe explain a little bit about what shingles is. And also, is there a season like the flu for shingles? Tell us a little bit about shingles.

Dr. Syeda Ali: So basically, shingles is the secondary infection of the same virus which causes the chickenpox in the child mostly, like most of us get it in the childhood. Nowadays, the kids are usually safe because they get the chicken pox vaccine. But before the chicken pox vaccine, there was no vaccine and people used to get chicken pox. Now, the chicken pox virus never leaves your body. It stays in the spinal cord. And whenever you are immunocompromised, then it reactivates, which is mostly the time when the people are in 50s and 60s, and that is why it is recommended to get the vaccine to prevent that recurrence.

Carl Maronich: Yeah. I'm in that category of age. Haven't had the vaccine, so I'll need to do that. And I fortunately haven't had shingles, I'm knocking on wood here. I've had friends who've had it and I've heard it's very painful. Maybe you could talk a little bit about how it presents and what the symptoms would be.

Dr. Syeda Ali: So basically, it is a very typical presentation that almost 75% of the people will feel some unusual pain on one side of their body and it usually involves the dermatome, which is actually the distribution of the nerves of that particular skin area. It is very common in the back, in the thoracic region, but it could happen in the eyes and other region as well. So 75% of the people would have this pain on that surface, which is without rash. And most of the time, it actually befools the primary care that it could be cholecystitis, it's going to be appendicitis because there's pain.

And then it is proceeded like three to four days or two days of this thing. And then there is an outburst of rash with a very stabbing sharp burning pain, which is actually the nerve pain, the nerve is on fire. It's actually the acute neuritis and the rash itself. And it stays for like usually four or five days. It goes away by itself. We don't need an antiviral for sure, but except like, you know, if it is very severe, the patient is really immunocompromised. And provided the patient comes within 72 hours of that rash, it does work. And if you have still some fresh lesions, you're going to still start after 72 hours this antiviral, which will help. And most of the time, the person is not contagious after seven to ten days.

Carl Maronich: I see. So there could be this pain, but no outward visible sign of anything.

Dr. Syeda Ali: Seventy-five percent of people show like that. And it befools the physician that it could be something, you know, chest pain, angina or something like that.

Carl Maronich: Yeah. So with all that considered, getting a vaccine is a way to go to try to avoid that altogether.

Dr. Syeda Ali: Absolutely.

Carl Maronich: And is it something you can get more than once?

Dr. Syeda Ali: Oh, yes. You can get shingles, recurrent shingles more than twice in your lifetime or more than that. If you have a shingle vaccine, it prevents this recurrence.

Carl Maronich: Okay. So important to get that. And let's talk a little bit, you mentioned the age group. What is the ideal age at which somebody should consider getting the vaccine?

Dr. Syeda Ali: So at the age of 50, if your insurance covers it, recommendation is to get the vaccine. But Medicare and Medicaid usually covers after the age of 60. So that's the best time to get that thing done. The earlier you get it, the more you are preventing yourself from that, because your immunity is going to create more antibodies against that reactivation. So earlier you get, the more better it is.

Carl Maronich: Yeah. So you kind of talked about this a little bit, but the treatment, if someone is having an episode of shingles, what would the treatment protocol be for that?

Dr. Syeda Ali: So if the person is having this outburst of shingles, we start the antiviral. There are several antivirals. One is valacyclovir, which is easy dose. And then if it is a very severe pain, we may start them on some neuroleptics like amitriptyline or gabapentin. Most of the time, these things work, but there are some times we need to continue giving them amitriptyline for their post-herpetic neuralgia, which is one of the complication of reccurence.

Carl Maronich: And is there anything people can do to prevent it?

Dr. Syeda Ali: The vaccine.

Carl Maronich: The vaccine is really the only way. Once again, we're strengthening the case for getting the vaccine for shingles. And what's the long-term impact? If somebody doesn't get the vaccine, they get shingles, it goes away. You know, they think they're safe. But what's the long-term impact on their body of getting shingles.

Dr. Syeda Ali: So the worst thing which we could have from the shingle itself, I would not say that it's a bad thing to happen, except for that acute pain you have for four or five days, you will be uncomfortable and all that, it will go away even with our antiviral. But the worst complication of that is actually post-herpetic neuralgia. Almost 15% of the people will end up with this, you know, stabbing sharp, burning pain on the same spot where they had the rash. No one can see the rash, but they are in pain all the time, sometimes bad enough to be hospitalized, sometimes they need really IV pain medications to control their pain. So 10 to 15% of the people out of all the shingles are the ones who will benefit from the vaccine, but we never know who is those 10 to 15%. So ideally, everyone should get the vaccine.

Carl Maronich: Yeah. That sounds like it. And you said the age range starting at 50, are there other qualifiers that people would need to fall under to be eligible to get the vaccine or anybody over the age of 50?

Dr. Syeda Ali: Anybody over the age of 50 should get it. You know, sometimes if the person is having some chronic diseases, they may qualify them to get it earlier, like if they are Medicare, Medicaid, but I never, you know, tried to do that so far. But ideally, 50 years. I have seen patients who have shingles even earlier than 50. So if they are in that state, either they are stressful, they are having this, you know, emotional stress, that can also trigger the shingles. So there is no such guidelines so far before the age of 50. But I have seen patient in 30s and 40s having shingles.

Carl Maronich: Any difference between men and women when it comes to shingles?

Dr. Syeda Ali: Not really. No. is no such difference.

Carl Maronich: And is it a vaccine you need to get every year or is it a one-time type vaccine?

Dr. Syeda Ali: It's just like a one-time dose.

Carl Maronich: Very good. There's a lot of talk these days about vaccines. How does the shingles vaccine compare if someone is just getting a COVID vaccine? Can you get them at the same time or within a certain time period of one another? How does that work?

Dr. Syeda Ali: So it used to be live vaccine, not anymore. The recombinant vaccines are pretty safe to be given if the flu vaccine also, you know, is required.

Carl Maronich: Now, the big question, where should someone go if they want to get the shingles vaccine?

Dr. Syeda Ali: Best it is the pharmacy. Any pharmacy can give them. Most of the doctor's office don't keep them because of a very a small shelf life and they are very expensive.

Carl Maronich: So doctor, is there anything else you want to tell us about shingles?

Dr. Syeda Ali: Yes. So if you have shingles, we try to postpone the shingles vaccine for one year before we get it because shingle itself has triggered the immunity for you for the rest of the one year. Otherwise, you can get the shingles vaccine whenever you can get it.

Carl Maronich: Well, doctor, we appreciate you joining us today. Dr. Ali, an internal medicine provider with the Riverside Medical Group. Your office is in Bourbonnais. So we especially thank you for coming across town to join us here at the hospital for our podcast today. And thank you for listening today with our Well Within Reach podcast brought to you by Riverside Healthcare. If you're looking for a primary care provider, Riverside has over 40 primary care providers to choose from including Dr. Ali. And you can find a provider that fits your needs at myriversidedocs.com or by calling (855) 404-DOCS. That's (855) 404-3627. Dr. Ali, thanks again for joining us.

Dr. Syeda Ali: Absolutely. My pleasure.