The CDC has released their schedule telling us docs what shot to give our patients.

Most of the recommendations are about the same.

cdc

A lot of the shots are the same as we have given for years.

But there is one difference for elders:

Now older adults will get a shot to stop “Zoster”. AKA HERPES Zoster (no, not that Herpes). AKA Chicken pox.

You see, the chicken pox virus hides in the cells of nerve roots, and breaks out when you get sick, overworked, develop cancer, etc.

Voila, Shingles.

Shingles is a painful rash along the line of the nerve that was infected. The pain can be terrible, and often requires narcotics. Usually the “acute” phase lasts a few weeks, but the really tough problem to treat is the nerve that is damaged continues for months.

We have to warn our patients who don’t like to take pain pills that “toughing it out” could lead to a higher rate of “post herpetic neuralgia”, where the pain continues for months after the rash disappears.

The most common chronic complication of herpes zoster is postherpetic neuralgia. Pain that persists for longer than one to three months after resolution of the rash is generally accepted as the sign of postherpetic neuralgia.11 Affected patients usually report constant burning, lancinating pain that may be radicular in nature. Patients may also complain of pain in response to non-noxious stimuli. Even the slightest pressure from clothing, bedsheets or wind may elicit pain.

Anti viral treatment might make the blisters disappear faster, but there is no proof that the treatment will lower the rate of this complication, that can last for months and interfere with daily life. Prednisone often cuts the pain of the blisters, and might decrease the pain after the blisters disappear. And the painful “neuralgia” can be treated with the older “sedating” anti depressant medicines and some anti convulsant medicines, both of which work on nerve conduction. Alas, all of these medicines can cause sleepiness and confusion in the elderly.

So anything that will cut down the rate of shingles is a blessing.

The shot won’t stop all cases of shingles, but it cuts the rate in half, and cuts the rate of “post herpetic nerualgia” down even more. That’s the severe pain in the area of the affected nerve that can last for months.

My husband had shingles a few years back, so isn’t a candidate for the shot.

But the rest of you elders might want to talk to your doc about it.

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Nancy Reyes is a retired physician living in the rural Philippines.

This article is a longer version of one posted at HeyDoc Xangablog.

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