Transcription:



Scott Webb: Shingles are horrible and none of us want shingles. Joining me today to tell us who gets shingles and why and stress the importance of the shingles vaccine is Dr. Pablo Romero. He's a family medicine doctor with SVMH.

This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Dr. Romero, it's so great to speak with you again. Today, we're talking about shingles, which is, I guess, fairly common. And it's one of those things that maybe I know what it is, but I'm not entirely sure, so I'm going to rely on your expertise today. Let's start here. What are shingles?

Dr. Pablo Romero-Beltran: Well, shingles is a reactivation of a virus that gets introduced to us as children in general. So, the herpes virus goes around looking for victims and finds noses and eyes and whatever, and infects the victim. The victim has no idea of what's going on until suddenly you see the crusty things and then mommy and daddy or whoever decide to take him in. And then, they go in and say, "Oh my goodness, you have chickenpox." And sometimes, it's so subclinical that you probably don't even realize that. So, that's how the virus gets introduced into our bodies. And then, of course, from there, it goes into storage and waits for the second phase, which is going to be then the reactivation of the virus, and that's when we end up with a diagnosis of shingles.

Scott Webb: Right. Shingles. So, I see what you're saying. It kind of just hangs around just waiting for its moment to shine, right? So, what are the signs and symptoms? Is it painful? How long does it last?

Dr. Pablo Romero-Beltran: Well, varicella itself, you know, can be very significant, but in general it is not. It's very, very simple. Now, the real issue then comes as shingles and that, as we go along in life, it always seems to affect the older folks. And of course, anybody who's immunocompromised or is taking other medications, of course, is much of a victim. But in general, by the time we get to the fifth, six, seventh decade, then we have a problem and a few things. We start getting these weird sensations, which can be, you know, called neuritis, which means that somehow our skin is hurting, we don't see necessarily anything. And then, later of course, then the eruptions pop up and then they always come in a band-like distribution from the half of the spine to the front of the chest. And of course, then it becomes much more evident that something is serious. 

Now, the problem with this thing is that sometimes, at least 10% of the time, it goes more to the face and, of course, the nose and the eyes. And then, we're talking about more complications. Most of the time, it's in the chest and trunk, but sometimes we see those go into the genitals. And then again, the biggest issue is, of course, the head and neck.

Scott Webb: Yeah, I see what you mean. So, there's sort of like the typical and then sometimes it might move beyond that and can see just how sort of uncomfortable, possibly painful, certainly unsightly it is. I'm sure one of the questions you get asked a lot is are shingles contagious?

Dr. Pablo Romero-Beltran: Both are. The varicella, the chickenpox is contagious. And then, the shingles, of course, it is contagious if you have close contact. It doesn't fly across the hallway. You have to touch it and then touch yourself and, yeah, then you can get infected with shingles, especially if you haven't had the vaccines yet.

Scott Webb: Yeah. With all the things floating around in the air this time of year, cold, flu, possibly COVID, the last thing we want is also shingles just kind of floating around. Is it ever possible for shingles to be so bad that it's life-threatening?

Dr. Pablo Romero-Beltran: Absolutely. So, essentially what it is, is that it opens the portal to secondary invaders or infections. Say that you have it in the face and the nose and the eyes and whatever, and then you have that area completely, the skin gets destroyed, allows the bacteria to get in. And yes, you can end up with meningitis. Yes, you can end up with death. In general, shingles in itself, even in the rib cage and trunk is super, super painful. And I know of nobody who has ever told me that, "You know what? This is kind of nice. I want it again."

Scott Webb: Yeah, "No big deal, shingles," right? Yeah, no one says that. So, let's talk about the risk factors. You mentioned it begins to impact older folks in their 50s, 60s, 70s. So, I'm assuming age is one of the risk factors. But are there some other diseases, cancer treatments, maybe some medications that also can put us at higher risk?

Dr. Pablo Romero-Beltran: Absolutely. For example, if you're immunocompromised, rheumatoid arthritis, irritable bowel, and that, of course, you know you're at high risk. And on top of that, people who have been subjected to transplants. If you had a kidney transplant, then you're at much risk. And of course, let's not forget something else I kind of grew up with, which is HIV. People with HIV even under control of the antiretroviral, they're still at a high risk of getting shingles.

Sex, yes, women are a little more susceptible to it. Race, African Americans seem to be less susceptible. Then, you have physical trauma. If you're an elderly person and you fell down and hurt your ribs or whatever, that seems to open up the portal for this virus to come in and give you that.

Scott Webb: Interesting. I'd never heard that some sort of fall or trauma could also sort of activate it, sort of bring it out. That's really interesting. Certainly glad to have your expertise today. So when should we see a doctor, right? So if there's a pain and rash, if it gets to our face and our eyes, when would it be important for us to reach out? 

Dr. Pablo Romero-Beltran: I can just say that the sooner, the better because, you know, given that the most of us know what we are looking for, that is physicians and nurse practitioners or PAs or whatever, as soon as you think you have a worry that somehow the painful thing or eruption is falling on one side or whatever especially in their face, reach out and see somebody. Now, you know, people can say, "You know what? I'm not sure that this is what it is," but they can do some testing. You know, you can do a sample testing of PCR and then you can find out the next day, "Oh, by the way, you do have shingles. And by the way, let me give you some treatment." So, I think the sooner the better. Obviously, at two o'clock in the morning, going to the ER probably is not necessarily needed. But by eight in the morning, call the office and call your provider, say, "I think I may have this thing." And they can always say, "Oh yeah, we can make some room for you to be seen. If not by me, but by one of my partners."

Scott Webb: Yeah, definitely. And you mentioned earlier, we've all sort of become familiar with vaccines unfortunately. But vaccines are very helpful things, whether it's flu, COVID and shingles as well. So, let's talk about the vaccine for shingles. When should folks get it? How many doses? How does that all work?

Dr. Pablo Romero-Beltran: So, the way that they have it licensed right now is that people after 50, age of 50, normal people, immunocompetent people should get the other vaccine, which is in two doses and, you know, it's separated by two to six months. There were two models and one kind of went away, but now the new one came out. 

Myself, I was so scared of these things that I got the first batch. And then, when the new one came out, I said, "You know what? I want that one too." And same thing like with every vaccine, there's a lot of drama in there. "Oh my God. It felt so bad." It's no different than the flu. It's no different than COVID to me. But the difference is that it protects you against something that is horrible and has potential deadly side effects.

Scott Webb: Yeah, always like to trust the experts, right? We ask the experts on this podcast and then we try to listen to them. And as you say, the word you use there is shingles is horrible. You don't want shingles. So along with our other vaccines that we're encouraging folks to get, right? Flu, COVID. If you're of age or you have the risk factors, get your shingles vaccination. Certainly, doctor, from your experience, we know it's the right decision, right?

Dr. Pablo Romero-Beltran: Absolutely. I mean, you know, again, the children are not qualified with this thing. But anybody after 50, or if you happen to have a lung transplant or a kidney transplant or anything, check with your provider. "By the way, I have no idea. If I've had my transplant five years ago and I'm 45, should I get my shingles?" Check and see what they say. Very likely they will say that.

Scott Webb: Yeah, I think you're right. Well, Doctor, it's always great to speak with you. You always have all the answers, and we've learned more about shingles today. So thanks so much. You stay well.

Dr. Pablo Romero-Beltran: Thank you. And you too. 

Scott Webb: And for a complete list of all of our podcasts, please visit svmh.com. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate, and review this podcast and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.