Greetings, Dr. Roach I read your most recent shingles piece. At sixty-six, I am in rather decent health. Approximately five years ago, I received both Shingrix shots. I treat my polycythemia vera (PV) with hydroxyurea.
I discovered some patches on my forearm that looked like spider bites around August 1. When I went to my family doctor, she diagnosed me with shingles right away and prescribed gabapentin, which didn’t really help. The following month was utterly miserable. Although I never experienced severe itching or a widespread rash, I did have excruciating pain and burning that spread from the top of my neck to my left thumb and forefinger. I think I had a severe case of shingles even after receiving the Shingrix shots because my wife read that hydroxyurea weakens the immune system.
My cousin worked as an anesthesiologist before retiring. I would benefit right away from the epidural steroid injection (ESI) he suggested. After receiving the injection, my degree of pain decreased by 80% in just one day. The discomfort went down by another 10% to 15% over the course of the following month. Within 24 hours, I was able to recover from my near-death experience. The result changed people’s lives.
It appears that physicians should be updated on ESIs for shingles. Although the studies are equivocal, the results from the actual implementation seem to indicate that it works. To truly comprehend how incapacitating shingles can be, one must feel the anguish. ESIs are reasonably priced. They would be worth the expense even if they only made a small difference. It is invaluable to have the enhancement I discovered. — No name.
ANSWER: I frequently advise getting vaccinated to avoid shingles, but as your situation demonstrates, the vaccine isn’t flawless. I concur that the hydroxyurea treatment for your PV may have made you more susceptible to postherpetic neuralgia (PHN), a consequence of shingles. You’re absolutely correct that the pain can be really intense.
Since I haven’t talked about steroid injections as a treatment before, I’m delighted you did. According to the largest trial, 90% of patients with intractable PHN experienced great or good pain relief from intrathecal injections, which are similar to epidurals but were found to be more successful in a short trial. This is in contrast to 4% of patients who received no treatment, as you mention.
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Greetings, Dr. Roach I am a fifty-year-old man in good health. They mentioned I may receive a pneumonia vaccine when I was at the drugstore recently. Am I supposed to do this? — S.I.
ANSWER: The Advisory Committee on Immunization Practices has recommended that people get the pneumonia vaccine at age 50. Around age 50, the chance of contracting severe pneumonia from the Streptococcus pneumoniae bacteria begins to rise, and it significantly increases beyond age 65. Many strains of this bacterial species are permanently protected by the new vaccines (PCV20 and PCV21, marketed under the name Prevnar).
You should think about getting this vaccination at your next appointment if you haven’t already and you’re over 50. (Getting the vaccine concurrently with the COVID or flu shots is acceptable.)
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
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