welcome to your senior center i'm vicki well in my guest today is marring ereli marini is our public health nurse and we have a healthy segment that she's going to be doing regularly on the show and today's topic will be shingles welcome thank you for having me so can you tell us what shingles is shingles is a disease that's caused by the same virus that causes chicken pox so anybody who's ever had the chicken pox can potentially later in life develop shingles and what it is is a reactivation of the virus after we have chicken pox the virus can hide in our they're called the nerve root gang which is all along the spine we have the little bulb at the end it's the base of the nerve the germ hides in there and then it can travel up that nerve and out to the skin and cause a very painful rash and keyword here is pain it's a very painful condition and it's a blistery rash that goes on for about two weeks and has some potential complications so we absolutely don't want to have to develop it but it is quite common they estimate that fifty percent of people over eighty five will have had it at least once in their lifetime so the other thing to know is that about ninety eight percent of people over sixty have likely had chicken pox so that's a pretty high percentage of the population who have actually who are actually potential candidates to develop the condition now we all know that chicken pox is contagious and if you have shingles are you contagious to other people you can be not in the same way as chicken pox chicken pox is spread by coughing and sneezing people would you know breathe in the german then be able to come down with the disease if they've never had it and it's also contagious by contact with the fluid in the little blisters in chicken pox there are scattered blisters throughout the body whereas in shingles it's in it's in a concentrated area at the end of that derma tomas where those blisters would be focused and contact with the fluid from the blisters when you have shingles could likely cause chicken pox in a person who's never had it so you can't catch shingles but you can catch chicken pox from a person who has strangles so it's really only contagious to someone who's never had chicken pox exactly so if i've had chicken pox and you had shingles you can't cause me to have the shingles because exact cause because of this virus laying dormant in my in your system right i'm ok and i guess that would need to lead to the next question which is you know what would cause it to happen if i've had chicken pox why would i develop shingles at what point in years and you know it can happen in very young people we've seen cases in children but typically it happens in people who are over the age of sixty about half of the cases each year in the united states are in people that are over the age of sixty and it's during times of stress during times of illness and during times of decreased immunity so for whatever reason your immune system  weakened it maybe by taking steroids for another condition it may be because you're on came othera be for a medical issue so anything that would reduce your immunity or just the illness itself can cause reduced immunity sometimes people who are post operative you know will develop it because at that time their immune system is working hard to repair the you know whatever the insult to the body was with the surgery so all of those things can cause a person to develop shingles there was some question about whether sunlight would trigger it and i don't think that's ever been confirmed i don't mean it's more of stress and illness and suppressed immune i how would someone know that they had one what would be the key symptoms that someone would know that they need to seek medical help that they have shingles ok the most common early symptoms you could start with a little fever a little headache maybe some chills some nausea typically what people are aware of as there's some pain they can't really to find that they had an injury you know they're not quite sure what this pain is all about i'll give you an example someone i know had tremendous pain in their arm they suffered with this arm pain all weekend long i don't know what's wrong with me on my arm is absolutely killing me and when i saw this person literally they were writhing in pain could not stand still so uncomfortable the entire on and it had been going on i saw them on a monday it had started on a saturday spent the whole weekend just so one comfortable  his arm pain that was the first sign and when i said well is there anything else going on while i have this rash can i see the rash and sure enough there were blisters all the way up and down the arm so typically you would have the pain or maybe some tingling in the area that it breaks out before the rush even shows so a lot of times people will have gone to the doctor because they have this pain that they can't put their finger on why they're having it but it's uncomfortable enough that they feel they need some medical attention and quite often the diagnosis can be delayed because if there's nothing visible you could have in the back of your mind that it might be shingles but without seeing the rash it's not a definitive diagnosis and so you know they may it may be not until some blisters appear that they that the connection is made between a significant pain how long was it between having the pain and having the rash i mean is there like a typical timeframe or you know i don't know if that's sort of our question yeah i don't probably were sure it's within days yeah i don't i don't i didn't find anything in the literature that said exactly what the timeframe was but i believe it's only a few days between the development of the pan the development of the russia i want to say two or three i just don't recall seeing it right anywhere how often can someone get shingles is that something once you have it like the chicken pox you don't get it again or can you get it several times unfortunately you can't get it again some people do some people don't and yeah it's there's no way to know who will or who won't develop it again i have known of people who have had it recurrently you know maybe three incidences in their lifetime and i've known of other people who've only had it once it can be in a different area than it was initially the estimated that there's about a million cases of it in the united states in a year each year so you know it's quite common i've actually seen a little segment on television about shingles and it said one in three people in the united states will have shingles in their lifetime that is absolutely true and mobile well it's huge and when you think about it that over the age of eighty five it goes up to one and two for one out of two people over the age of eighty five so if you're lucky enough to live a nice ripe long life your odds of getting increases pretty significantly can you show us what the rash looks like so i absolutely can hold this up so the camera top picture is the side of a person's body looks like kind of a chunky gentleman and then the bottom is a closeup of the blistery rash it's usually a reddened base with fluid filled blisters and so are they blistery art crustal and it takes about two weeks for the rash to resolve but ultimately it will crush oh crap cross over crossed over and the other thing to no about this particular rash is that what they the technical word for it is stops at the midline it's only going to be on one side of the body so if you have is that long enough you know if you have it on your trunk it would stop right in the middle or right in the middle of your back it's only going to be because the nerves in your spine there's one on the side and one on the outside so the side controls the you know left side of your body about side controls the right side of your body so  travels up the nerve and out to the skin it's going to stop right at the mid line because it's only on the side where that particular particular gangly and was located that makes and he said what are the long term effects of of having had shingles so unfortunately the long term effects are the most typical thing is it's called post or panic neuralgia and the best word for that is pain the pain that happens with the rash so you know we see it starts with pain prior to the appearance of the rash then the rash after about two weeks crossed over heals and resolves it can leave some scarring which can be disfiguring especially if it's on a person's face you know that can be a significant change in their lifestyle that they've had this tremendously painful thing that left scarring on their face but the pain can persist for and the way it's worded in all of the literature is up to year or permanently so there are people little have pain for a couple of weeks a couple of months and then when it starts going on a year or even  longer it could be a chronic thing they could have pain for the rest of their lives which is really a devastating the reason for that would be the you know the damage that it's done to the nerve all the way as a traveled up the nerve and out of the skin and that in and of itself having that chronic pain is a huge lifestyle change it's very devastating and the effects of having that i actually wrote down a little list of the things i was finding as i did a little more research on it so the effects of the long term poster petak neuralgia or pain chronic fatigue because being in pain is exhausting and loss of appetite weight loss physical inactivity because who wants to go out and play tennis when they have this tremendous pain in their side or their arm or their face insomnia again pain keeps you from sleeping comfortable if you can't get comfortable how are you going to ever sleep anxiety difficulty concentrating depression social isolation and it can interfere with the activities of david daily living such as you know bathing yourself dressing your so grooming yourself so all those things can be affected it really does depend on what part of the body the shingles had presented you know what the long term effect of having pain in that area is but you know it definitely varies from person to person and can be entirely devastating and the other thing that's not really mentioned in the lists of long term effects because the person is in the significant pain over this long period of time substance abuse not i'm not going to say that and with like a negative connotation that a person is a drug seeking but this person is in so much pain the drug grows and it requires for them to even take the edge off of it and have a little bit of comfort we all know that if you're using narcotics that after a the effects you know you need a little more to you know they just sort of become immune to the effect of the drug and so the regime that they end up being on to try to control some of the pain just is it's over the top and then the effects of the constant and justin of these very powerful drugs takes its toll on the body as well if somebody has a recurren woman who had it in her leg in the same spot a few times but you know typically it's somewhere else or i should even say typically it's i don't think that there's any pattern necessarily i think it varies just wherever harris yeah but it certainly can happen again which is unfortunate now what can be done to prevent and it sounds like it's so horrific what can be done to prevent getting shingles in the first place there is a vaccine decreases the incidence of the disease by about fifty one percent and in people who do actually get it the complication of post repetitive neuralgia is also reduced so the what it does is it's a weakened form of the chicken pox virus so it's like a super chicken pox vaccine and the belief is that as we get older when we have a catch to chicken pox our body builds up antibodies and those circulate in our blood stream over the course of many many years but the belief is that as we get older that the tighter the count the number of antibodies we have starts to decrease and that by boosting that with a vaccine that has some protective factors against developing shingles well fifty one percent chance of having it not getting in doesn't sound like much until you think of it means one in six people and instead of running three exactly i know one and the other thing is not having the long term complications reducing the risk of those long term horrible complications you know there if anybody is interested in doing it they can certainly google all of the photographs of this awful disease and they're going to come across there's one in particular that gets shown it's one of the c d c photos and there's a woman who you know half of her face is all  you know it's crossed over rash at the point that they took the picture but you can see the devastation right down to the tip of her nose her entire if everything in this part of her face is affected by it and unfortunately they don't show one after photo where you can see what the how much that darling was left there's no follow up to say this person is a vision or hearing a whatever was affected but the those are actually other if it happens on the face it can damage hearing and vision and those kind of things you know again permanent lifelong changes that are undesirable so you're absolutely right to get a vaccine that reduces the chances of a long term couple of complications as is well worth the trouble having said that yes who is the best vaccine recommended or is it seniors or will you younger right now the c d c recommendation is for persons over the age of sixty so the vaccine is approved for people who are over sixty eight there was some talk about people fifty and over getting it but f d a hasn't made that approval yet as as far as i learned and so they can it can be used as they call it off label so if a physician chooses to vaccinate their under sixty patients that's their prerogative to do that but the recommendation is still for sixty and over and doesn't  insurances to cover it it gets a little sticky it's covered by medicare part d the co payment varies depending on which plan a person has and the private insurance is a good number of them do cover it there are a few that  don't my recommendation is it's become widely available now with the retail pharmacy as you probably driven by and seen signs shingles vaccine available my recommendation would be that you call your insurance company ask them if they cover it and ask them is it covered if i receive it at a pharmacy rather than a doctor's office because that may be a sticky point for some of the coverage as the cost of the vaccine if you were to purchase it at one of those retail pharmacies is a bout two hundred twenty dollars and the co payments vary from about twenty up to think i heard ninety and i did have a woman call me a couple of weeks ago and said to me well you know i was told that my co payment will be about sixty i think she said sixty or sixty five dollars and i was hoping that i could do better than that and my answer was i really think that's a good deal in today's climate because if you had to pay for retail you're looking at two hundred twenty dollars and availability of it is not you know most people are told that it's that they're not able to if they're told that they're not covered by insurance that you know that's going to be a lot of money out of pocket so if you can get it for sixty five i think that's pretty good and i really hate to say it that way but it actually is one of the better deals that i've heard through the insurance companies w just go to your doctor to have a physical you can enquire about this that isn't absolutely so it's not something that the doctor has to decide that you're risking you needed that if you're over sixty you can ask your doctor your to doctors have the vaccine in their offices is readily available as some of them do and some of them don't and what i've seen is that doctors in family practices they would have so the chicken pox vaccine and shingles vaccine need to be stored stored frozen so pediatric offices have the freezer that maintains the temperature to store the chicken pox vaccine so in a family practice where they're seeing children and do in well care visits for children they would have that freezer because they are required to provide you know all the childhood vaccinations so they may be willing to purchase that shingles vaccine because they already have a freezer stored in some of the internal medicine practices it's quite cost prohibitive to them to purchase the freezer and monitor the freezer and then purchase the vaccine with the risk that they may not actually use all ten doses in before they expire so when they're looking at you know balancing between their you know their obligation to protect the patient from this disease and and the cost and the losses that come with you know a it's a business so they really have to be careful that they don't you know purchase themselves out of business it's a very expensive vaccine some of them choose not to do it and they recommend that you know they'll tell people to call the public health nurse and unfortunately the state does not provide this back scenes so some of some of us don't have it some of us are not able to purchase it to offer it out to clients so you know the next step is to check with your local pharmacy and if they do offer it they can pretty much tell you whether your insurance covers it and what your co payment would be but again i recommend that you call your insurance company because you do want to be sure that if it's administered outside of a doctor's office that they do in fact cover it and honor that co payment i actually had that experience going to a pharmacy in that vaccine i think it was a flu shot at the time and and i thought it would be covered and they told me that you know my insurance covers it and all of that but and that i would submit to get reimbursed but when i spoke to my joints company because i had called them further when i spoke to my insurance company they said  we only cover inoculation it's administered by a physician or a nurse not a pharmacist you know it wasn't even the vaccine it was who was administering it right it's really good advice to tell people to first call it i don't need i don't know you know they don't like it i just don't know that insurance was that they would honor that referral i want to go back to what you said about so might just to reiterate if a pharmacy says we'll give you a receipt and you can submit that to your insurance company for reimbursement that's a red flag please don't fall for that always check with your insurance company first but to answer about the physician the physician is likely to say call your public health nurse or  if you can get it there i don't think they can refer to another physician who does offer it there have been physicians who will write the patient a prescription and they take that to the pharmacy and they can pick up that vaccine and if they can pick it up and return to the doctor's office and have it administered within thirty minutes of it coming out of the freezer at the pharmacy then they can have it administered so there have been cases where that's the plan that they choose however it's not ideal the base cost of it like the the wholesale prices of about one hundred between one hundred fifty and one hundred sixty depending on whether you buy a single dose or attend those box and if it stays out of the refrigerator or freezer for thirty minutes it's not administered within that thirty minutes it's considered no longer viable and so that's an awful waste of one hundred fifty dollars so you get stuck in traffic between your pharmacy and going back to your doctor's office or you get to the doctor's office and they're just so busy that they can't attend to you within thirty minutes you've just wasted the money that you paid picking up your magazine and i highly doubt that an insurance company would pay for it a second time yeah when it was like a human error that caused it to be not viable so now once someone has had shingles when can they have the vaccine right away i mean  the virus is in their body but can they have the right and not the way she spoke you know the answer to that is that there is no time interval we used to say you needed to wait eighteen months and i don't know why that know when i looked this up no time interval but ideally wait until the rash is gone and discuss it with your primary care provider about whether or not it's a reasonable option for you to vend have that vaccine you know again the purpose of the vaccine is to boost that antibody titer which you know having having the shingles doesn't seem to do so you know that was really it's really giving you an inoculation against chicken pox yeah that is virus you know when there are a few people that actually should not get the shingles vaccine there are people who are on treatments that reduce their immune system whether it be steroids or chemotherapy is so you know it is wise to is you know always going to be having chemotherapy or high doses of steroids would you prevented if we asked tell them that they should get the shingles vaccine because you know that there it i risk to get it yes and maybe yes  good question absolutely ideally you would have it as soon as the decision is made because you know you want them to have the the  reduced risk of developing it while they're on their chemo treatment or you know steroid whatever it may be as well yes and you know it be nice if they could wait a month after having the vaccine to start that treatment but you know again that's a discussion to have with with the specialist who's going to be providing the treatment you mentioned that there's only about two percent of the population of people sixt haven't had the chicken pox can you talk a little bit about people who haven't had the chicken pox and what all of this means to them in terms of vaccinated and at risk of being exposed to somebody who has the shingles that type  absolutely somebody who's never had the chicken pox well the first thing is when we're talking about administering shingles vaccine the recommendation is that you don't ask if they've ever had chicken pox because the presumption is that ninety eight percent of us have had it and there are what they call sub clinical cases of chicken pox so you know when we were growing up somebody in the household would come down with it and then everybody in the household would get it within a couple of weeks but there would be that you know that huge blister you know head to toe kid and then there'd be one kid who had maybe one lesion or a kid the just had some sniffles and didn't actually develop any of the blisters but if you were to test them they had it you know there they would have an antibody titer so the thinking is that if someone isn't sure whether they ever had it or not doesn't go ahead and vaccinate them because chances are they did have it if someone never had it and they were exposed to somebody who has the shingles well we do recommend that anybody who has the shingles if they know that they're going to be around other people especially pregnant mothers who have never had chicken pox or newborn babies because they don't get the first vaccine till their body year old that if the rash is on a spot on the body that can be covered that you cover it because any contact with that fluid could potentially cause j shingles so you know we do ask you know when when the diagnosis is made typically the person gets asked you know who is in your circle of family and friends are there any newborns are there any pregnant women are there any you know people who are on suppressed immune treatments or have or have you know conditions that suppress their immune system and you know then the advice is that while you have you know using you know if there's fluid there present that you know not be in contact with the person and you know i worked in a pediatric office for many years and a typical phone call was from a parent or grandparent saying you know so and so has been diagnosed with shingles is it ok for them to be around my children and and those are the guidelines we follow if it's in a place on the body that can be covered you know with a bandage or clothing then please by all means cover it and avoid contact because it really is the safest thing to do but if it's you know if it's on your face and you can't you know you can't put a patch over your entire  they have to you know i did know of another woman who had it recently and i was on her trunk and went to work because she said i'm going to be in pain at home and that's all i'm going to think about at least at work i'm busy and i'm pre op you know exactly and so took an ice pack and held it under her arm for most of the day and that was enough to just keep him busy and keeping the ice on it was enough rash very good question i actually do think a woman i know my mom recently had a kind of a subclinical case we had been out i noticed that her neck was very red i thought it was  doctor and they agreed with her that it was very possible that this was early shingles she had had it before so she kind of knew in her own body what it would feel like and they decided to go ahead and do an antiviral right away to prevent it from getting any worse and it really didn't amount to much so i don't think we'll ever really know whether it was that or something else but you know it's better so now when you were saying they gave her an antiviral right away when someone what's the importance of someone getting to the doctor immediately to start those your grandparents if they feel like they might have should go exactly that was my next statement we haven't talked about treatment yet the best thing is that if you suspect that you have it just that get to the doctor right away the sooner you can start on an antiviral and suppress it from continuing to break out and get worse the better the outcome and the best scenario is that you get on so you know there are a lot of different things that they can do for comfort so there are things like light a cane patches that you apply to the area so it's a topical in us that ik medicine that would just reduce the pain right at the site you know of the skin and but some of the pain is nerve pain so that's from the inside so there are medications that get used like neurontin they use you know things like percocet or any of the could in any of the stronger analgesics simply something like tylenol or sometimes they'll do steroids to try to calm things down so those kind of a wide range there are things that people use their homeopathic remedies again talk with your doctor if you're going to yet be thinking of trying something that you know your neighbors cousin recommended really it's a good idea to check into those things and the reason i say that is one of the common things one of the common homeopathic things that are recommended by a lot of people is capsaicin and it would be the same type of thing it's like it's the oil from pepper peppers hot peppers and so people like to use that for arthritis so if you have a sore joint and you put that cream on your knee it's actually got that hot pepper oil in there and what that does is that actually can cause a little burning sensation on the skin but what it does is it interrupts the pain pathway and so instead of feeling the pain within your joint it tricks your body and so all of a sudden you don't notice the pain in your joint not to say that your knee is burning on fire i did try it one time i might have been just ha both right as my husband put it on my hands and i thought are you kidding me my hands were on fire and this is not comfortable but you know there are us there are plenty of people that do believe in that and they use it with excellent success but i have to warn you that if you ha already got inflamed skin because of this rash and you apply a hot pepper pop into your skin you may cause yourself a lot of discomfort so be very careful about you know what what people recommend until you've checked with your doctor that it's you know safe reason and nable to use under the circumstances but again the take home message is the sooner you can get to the doctor and bring up the possibility of the diagnosis the better for the outcome those antivirals do settle things right down and having said that too there are times when people have completed their course of antiviral and the rash would start to flare up again so they need to go on a second course so communicate with your know most offices have a nurse to speak with and you know people will say well i didn't want to bother them so i didn't call that's their job that's what they're there for there is no reason for you to sit home with your discomfort call them is there anything else i can do it's such an awful i mean especially if the providers never experienced shingles themselves they need to have a little compassion about this this is tremendously painful it is tremendously disruptive to a person's lifestyle and the knowledge that the pain can persist long term for months or years weighs heavy on a person's mind when they're home suffering with this horrible pain so again the sooner you get to the doctor and you know get your diagnosis and start on your antiviral treatment the better but you know that doesn't and the process you don't just go home and take your antiviral and that's the end of it when you have questions and concerns call and discuss it with your your provider because  it can be quite a long drawn out awful experience you know you need the support of the people who are trained to handle these kind of cases i know that you have a little diagram of sort of the map of the nerves of the body can you show that you can it's just one side of your body that would be affected if you have something that's so you know this this little page demonstrates what are called the german tones and if you  it's probably you know just to get a picture of it each nerve will show you the nerve first of each nerve to go has a little root so this is the picture of what would be the spinal you know a couple of the vertebrae and so this let's say this bottom one is one vertebrae this little bulb here would be that nerve root ganglion so it's the little bundle of nerves within that that outer sheath and then you can see the lines those lines would be the nerves and they would travel up and out would toward the skin you so it's from the spinal cord out to that nerve root ganglion and then out to the skin and then this one is each different region so each little nerve follows a pathway so if you were to have you know like your vertebrae say in this area it would be you know this section of the body that it would bring it out to some of the bring it out to the you know neck and shoulders some to the head some to the arm some to the leg but it really depends it's probably not the best diagram i've ever seen of it but it depends on which one activates where on the body the symptoms end up being it seems like we've pretty much covered singles and the vaccine that's available what is your kind of final take home message to people who will i mean the i know at risk of going saw me like a broken record but you think you may be developing shingles get yourself to the doctor right away and you know get the opportunity to be put on the preventative antiviral treatment to just kind of halt it and its trucks and keep it from getting a lot worse because the long term complications can be devastating and get vaccinated yeah and good