Mar 5, 2014

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.

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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.

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