Shingles: Why the Fuss, and What to Do About It
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Update Spring 2018 Shingles: Why the Fuss, and What to Do About it Many of us hear about the medical condition The treatment for shingles is one of several antiviral medications, which shingles from friends or relatives who have are most effective if started as early as possible in the course of the illness. had this unpleasant illness. In recent years, This can be difficult, since the rash often develops only after the pain is media advertising has brought this to the present for days, and may not look very dramatic in some cases. We often public’s attention. So, what is shingles, how do give cortisone-type medication along with the antiviral, in an attempt to you treat it, and is there a way to prevent it? lessen the inflammation and damage to the involved nerve. There are also several types of medications that are usually helpful for the pain. Anyone who had chickenpox at some point in his or her life is at risk for shingles. Many The older the age of the individual, the greater his or her likelihood of more baby boomers remember this viral illness severe and more prolonged pain. That is why the population over age 60 is seen as a critical target to recognize and treat shingles early in the course Peter Stack, MD, FACP as a child, characterized by an itching rash that can leave a few scars. In fact, research and to offer preventative measures. studies have confirmed that virtually all Americans over age 40 have had In 2012 the Zostavax® shingles vaccine was approved by the FDA. It contains chickenpox, though some either had no appreciable rash or no memory of a live but weakened chickenpox virus. This stimulates the immune system it. We see many fewer cases nowadays, since the widespread use of the to regain strength against the virus, so as to keep it in check along the chickenpox vaccine has protected more recent generations. spinal nerve endings. It has been modestly effective in preventing shingles When you resolve the chickenpox illness, the majority of the virus particles and in decreasing the severity of those cases that do develop. However, the ® are killed off. However some virus remains in your body, and goes into a FDA recently approved a newer vaccine, Shingrix , which should be widely ® dormant state within the nerve endings adjacent to the spinal cord. Years available within the next several months. Shingrix is far more effective later, when your immune system memory of the illness declines, the virus can in preventing shingles in older people, and should rapidly become the vaccination of choice. It does not contain live virus. As a result, it should be proliferate and grow along one of those nerves. There are separate sets of much safer to take compared with Zostavax® if you have a condition that may spinal nerves for each side of the body, so one of the hallmarks of shingles impair your immune system or are taking medication that can suppress your is that it always affects only one side of the body and virtually never involves immune function. This is another significant advantage over Zostavax®. both sides. The symptoms that develop with shingles include a blistering rash that is in some ways similar to chickenpox, but occurs in a localized Both of these vaccines are expensive, in the range of several hundred distribution. Some people experience low grade fever and may feel mildly ill. dollars. Shingrix® is a two shot series that has a low incidence of side The rash can be present in any region of the body, from the scalp to the toes, effects. The cost for both vaccines is often covered by private insurance, since the location depends upon which spinal nerve is affected. but may not be covered by Medicare. Both are approved for people over 50. However, we usually recommend waiting until age 60, since shingles The shingles rash is usually associated with varying degrees of pain and is often a milder condition prior to that age. The risk for a more severe or itching. In milder cases, it may be minimally uncomfortable, but some prolonged episode of shingles is significantly greater after age 60. people suffer more severe and intense pain. The rash itself is self-limited, in that it will resolve without any treatment. However, because shingles We are seeing more shingles cases as the number of elderly Americans is is actually a viral infection of a nerve, the pain can persist for months or increasing, particularly those “oldest old”, age 85 and older. Vaccination for longer until the nerve finally heals the damage. In the unlucky few, the prevention and early treatment are important measures to keep shingles nerve is permanently damaged, and can be a source of lifelong pain. from tarnishing their “golden years”. In this issue: 2 A Review of the New Blood Pressure 3 Making Healthy Habits Stick 5 “Care team” – what is that? Guidelines and the Hypotensive Effects of Exercise 4 Measles Outbreak 8 Two new Baylor Scott & White Lunch & Learn Signature Medicine Practices “Care team” – what is that? Paul D. Wade, MD As I was going through one of the many items listed in the patient’s electronic record, I came to an entry entitled “care team”. The patient saw this and asked me “Am I so sick that I need a team? I thought you said that I was in pretty good shape.” I assured the patient that she was in good general health, but as we age, we usually start seeing specialists for certain specific issues. Some examples would be the physician you saw for your colonoscopy, the ophthalmologist you saw for your eye exam and the dermatologist you see periodically for your skin exam. Almost all patients over the age of 50, even those in good health, will see some, if not all of the specialists I just mentioned. Above and beyond that, if the patient has a significant heart or other organ problem, she most likely will also be seeing a cardiologist or another specialist, as appropriate to her condition. All of these people comprise the care team. One of the most important functions for your internist (or other primary care physician) to do is to make sure you’re up-to-date with all the physicians whom you see and that your care is “coordinated” as much as possible. This involves open communication and sharing of information between the doctors, which generally results in better overall quality of care at a lower cost. One example of this is by reducing redundancies in the healthcare system, such as sharing lab and x-ray reports between members of the team. As time goes by, new problems may well develop which perhaps may require adding another specialist to the team. Generally, your primary care physician will coordinate this function, usually by adding a new specialist with whom he or she has worked in the past. This usually provides a smooth and cooperative effort between the primary care physician, the new specialist and the patient. Also, the care team may also include social workers as well as home health care professionals (nurses, coordinators and various therapists- speech, occupational and physical- to name a few) who become involved in the patient’s care during and after hospitalization. These professionals strive to ensure a smooth transition between being hospitalized and going home or, perhaps, to a transitional situation such as a rehabilitation facility. They also function to maintain open lines of communication between the primary care physician and the other physicians involved and to provide Thus the goal of the entire care team is to attempt to provide seamless the patient the appropriate follow-up care needed after a hospitalization care for the patient, no matter what new circumstances come into play. has occurred. This is a very important time in the continuation of care. The team is just that-a group of health care professionals who strive to If this transition is not handled appropriately, re-hospitalization or other provide continuous care for the patient at all times and in all situations. adverse situations may arise which could affect the patient’s care. The information provided is for general information and patients should not rely on the information as medical advice. 5 A Review of the New Blood Pressure Guidelines and the Hypotensive Effects of Exercise Madison Ryals, M. Ed., ACSM-CPT As a new calendar year is underway, a majority of the population is on a beneficial. Exercises that can also help lower blood pressure include aerobics, mission, working towards making themselves better. For the first time in swimming, biking, and jogging1. There is a need for more research, however, over a decade, there have been changes published, by the American Heart resistance training has even shown evidence to lower blood pressure Association and the American College of Cardiology, to high blood pressure immediately, as well as over time if consistency is kept. Especially when guidelines. Blood pressure ranges in the new guidelines are as follows: training with large muscle groups2. The important thing to remember here is that you do not have to “get in shape” in order to gain blood pressure • Normal: Less than 120/80 mm Hg benefits from exercise. This is because blood pressure lowers immediately • Elevated: Systolic pressure (top number) between 120-129 and diastolic after a single session of exercise for up to 24 hours. This could mean that (bottom number) less than 80 30 minutes of exercise a day could keep the medicines away6. The habit of improving vascular health begins a domino effect of positive benefits on • Stage 1: Systolic between 130-139 or diastolic between 80-89 mm Hg blood pressure.