DEAR DR. GOTT: In your recent column, you said that the shingles vaccine should not be given to former cancer patients. I am in remission from large B cell non-Hodgkin’s lymphoma. I have Wegener’s granulomatosis, which although in remission, is still there. The Wegener’s is the reason that a shingles vaccine is recommended. I will be having CD19 level blood testing before any vaccination, but with my history, should I still have the vaccine?

DEAR DR. GOTT: I read your recent article regarding the shingles vaccine with much interest. My doctor recommended the vaccine for me; however, I am reluctant to get it. My concern is that I understand the vaccine is formulated with live virus and my white blood count is below normal. Neither my doctor nor a pharmacist was able to comment on this.

DEAR DR. GOTT: I read your article that the shingles vaccine is not right for everyone. I am 65 now and I had ovarian cancer 25 years ago with chemotherapy on weekends once a month for a year. Your article said I shouldn’t have the vaccine because I had cancer. Does this hold true for me even though I had cancer so long ago? Also, I can’t remember if I had chickenpox. Please advise.

DEAR DR. GOTT: I am a white male, age 58-1/2. I had chickenpox as a child and suffered with a classic case of shingles in February 2010. I received a prescription at a cost of about $300 for 21 pills, seven days’ worth, that helped tremendously.

I asked my doctor at that time about the vaccine, and he said he had not studied the vaccine enough yet, as it was new in February 2010. Could you please enlighten me about new information regarding this vaccine or where to go for new information about it because I don’t want the discomfort again?

DEAR DR. GOTT: I read your column on the shingles vaccine with interest. However, I am wondering why you stated that those undergoing radiation for cancer or with a history of cancer should not have it.

In 2009, I was diagnosed with breast cancer and underwent surgery, chemotherapy and radiation. I also turned 60 that year and asked my oncologist about having the shingles vaccine. He said I could have it as long as I waited one month after I finished chemotherapy. I was undergoing radiation at the time when I had the vaccine and seem to have no issues as a result.

Have I done myself harm or is the vaccine or effective? Also, if the vaccine only lasts six years, should I have another when I am 66 or avoid it owing to my cancer history?

DEAR READERS: Thank you all for writing. When I wrote this article, I acquired the information from reputable sources to include the Centers for Disease Control and Prevention that specifically indicates people with a weakened immune system because of HIV/AIDS or another disease that affects the immune system, treatment with drugs that affect the immune system, cancer treatment such as radiation or chemotherapy, a history of cancer affecting the bone marrow or lymphatic system such as leukemia or lymphoma, and women who are or might be pregnant should not get the vaccine.

The U.S. Food and Drug Administration mirrors this and states conditions such as cancer of the lymph, bone or blood and those with a weakened immune system caused by treatments such as radiation should not be immunized.

Drugs.com indicates if a person has leukemia or lymphoma (or other cancer affecting bone marrow) or a weakened immune system caused by disease or by receiving medication such as steroids or chemotherapy, they should not take the vaccine.

The Mayo Clinic indicates the vaccine isn’t recommended if a person has a weakened immune system due to HIV/AIDs, lymphoma or leukemia or is receiving immune system-suppressing drugs such as steroids, radiation or chemotherapy and more.

The website www.Zostavax.com indicates that patients should not get the vaccine if they have a weakened immune system.

MedlinePlus indicates a person who has a weakened immune system because of treatment with drugs that affect the immune system such as prolonged use of high-dose steroids, cancer treatment such as radiation or chemotherapy, cancer affecting the bone marrow or lymphatic system such as leukemia or lymphoma should not get the vaccine.

Therefore, I stand by my original March statement that indicated there are some people who should not receive the vaccine. However, that said, I defer to each reader’s oncologist, hematologist or other specialists who may have a different view on the subject. Thank you all for writing.

He has been further advised that there is a simple test his doctor should administer before giving him the shingles shot if he (my husband) is unsure as to whether he ever had chickenpox or not. Please advise. Thank you.

DEAR READER: Once a person acquires chickenpox, the virus lives in a dormant state in specific nerve roots within the body. If it becomes active later in life, it is known as shingles.

Zostavax (the shingles vaccine) for people 60 and older was designed to prevent shingles. The older a person is, the more severe the effects of shingles can be, so it is likely he should get the injection that will protect him for about six years. According to the Centers for Disease Control and Prevention, this recommendation is made regardless of whether he remembers having the disease. It’s not uncommon for people as they age to forget whether they had chickenpox.

The probability of getting shingles rises at around age 50; however, the vaccine is recommended for people 60 and older because the safety and effectiveness of the vaccine has been studied only within that age bracket. There is no specific time a person should wait after having shingles before receiving the vaccine; however, it is recommended he or she wait until the rash is completely cleared following an attack.

That said, there are definitely some people who should not receive the vaccine. They include those on chemotherapy, radiation or other treatment for cancer; those with a history of cancer; those on steroids because of the effect the steroids may have on a person’s immune system; those with HIV/AIDS; and women who are pregnant.

The most common side effects of the vaccine are slight pain, swelling, itching or a rash at the site of the injection.

For most people, the pain associated with shingles lessens as the rash heals. For others, shingles can lead to pain that lasts for years, a condition known as postherpetic neuralgia. Long-term nerve pain can be difficult to deal with and may require pain medication for control.

Your husband’s primary-care physician can better direct him as to whether the vaccine is right for him. There is testing to determine whether your husband had chickenpox as a child; however, if we follow the CDC recommendations, that testing becomes a moot point.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Ramsay Hunt syndrome occurs when the facial nerve to one of the ears becomes infected by the shingles/chickenpox virus.

The primary symptoms are a painful red rash with blisters in, on and around one ear associated with facial weakness or paralysis on the same side. For some, the rash or the weakness may occur before the other, and rarely for some, a rash will never present. Other symptoms may include hearing loss, change in or loss of taste, tinnitus, vertigo, ear pain and difficulty closing one eye.

Complications can include eye damage owing to improper eye closure because of facial paralysis or weakness; permanent hearing loss and facial weakness; and postherpetic neuralgia (pain caused by damaged nerves).

Treatment includes antiviral drugs, steroids and pain relievers. If vertigo is a problem, anti-anxiety drugs may be beneficial. Home remedies include over-the-counter pain relievers and cool, wet compresses. If closing the eye is difficult, try using moisturizing eyedrops and taping the eyelid shut at night to prevent drying and damage.

Unfortunately, I am not aware of any effective alternative treatments that will speed healing. The virus has to run its course. Even with antiviral medication, some damage will be done, and only time will tell whether it’s permanent.

I suggest you try whatever alternatives you like, and keep a journal of the symptoms before treatment, what type of treatment you had and how your symptoms were affected, if at all, after treatment. If you have positive results from something, stick to it. Let me know of your results, and I will print a future article to inform my readers.

To provide related information, I am sending you copies of my Health Reports “Dr. Gott’s Compelling Home Remedies” and “More Compelling Home Remedies.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

There isn’t much information on NMO/Devic’s. Do you have any idea how to treat this kind of pain? Any natural pain alleviations?

DEAR READER: Devic’s disease, also known as neuromyelitis optica (NMO), is an unusual form of multiple sclerosis (MS). The immune system attacks the optic nerve and the spinal cord. The cerebrospinal fluid in NMO sufferers is different from those with typical MS because of its large number of white blood cells and other factors. This is beneficial during the diagnosis process in differentiating the two disorders.

Symptoms can include numbness, weakness, loss of vision and bladder and/or bowel problems.

There is no cure available, and treatment is somewhat limited; however, research is ongoing. Currently, steroids and plasma exchange are the best options. For some patients, the regular use of steroids may be necessary, and relapse may occur when the steroids are tapered off and discontinued. For those not helped by steroids, plasma exchange may be considered. Imuran (azathioprine) and mitoxantrone (Novantrone) may also be helpful. Standard MS therapies have not been proven to be as effective in NMO.

You may benefit from practicing relaxation and breathing techniques, yoga, tai chi, water aerobics and other gentle, stretching exercises. Perhaps acupuncture or acupressure may be beneficial. Be sure to speak with your doctor about this before undergoing any exercise or alternative therapy. This is important because, in some cases, certain activities can cause more harm. If you experience improvement, your physician should also be aware because changes in dosages and medications may be appropriate.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Simply take this combination three times per day: one 400 IU vitamin E, two 100-milligram B-complex and four 1,000-milligram slow-release vitamin C tablets. When the shingles symptoms are gone, stop the vitamin E and B-complex and taper off the vitamin C slowly. If you have diarrhea symptoms, eat cheese.

DEAR READER: I have not heard of this and have no idea why it would work. You failed to mention how long before symptoms typically start to disappear when using this “remedy.” I would also like to mention that the tolerable upper limit for those over 19 for vitamin C is 2,000 milligrams, and for vitamin E, it is 1,500 IU. While vitamin C has a relatively low toxicity, vitamin E may cause hemorrhaging and interrupt blood coagulation when taken above recommended daily doses. I suggest everyone interested in trying this remedy do so only under physician monitoring.

I am currently taking Valtrex, and it has stopped the outbreak but not the pain. I am turning 60 this year and want to know if the vaccine will not only help me but might also get me off the Valtrex, because it is so expensive.

DEAR READER: An outbreak of shingles typically lasts only a few weeks with proper treatment. For those who go untreated, the risk of developing prolonged or permanent side effects, most notably nerve pain but also numbness and tingling, becomes greater.
Unless you are simply having repeat attacks, I highly doubt that a single outbreak could last 10 years. You are more likely experiencing some of the side effects I mentioned above. They are likely permanent if you have had them for 10 years.

The shingles vaccine is not a treatment. It will not help you with regard to your pain; however, it may prevent future outbreaks or lessen the severity and duration of any future attacks.

Because you are not yet 60, you are not a candidate for the vaccine simply because it has not been studied in those under 60. However, because you will be 60 this year, I recommend you make an appointment with your physician after your birthday to get the vaccination.

I would also like to take this opportunity to mention an error in the column to which you are referring. I stated that shingles is highly contagious and that those who have not had chickenpox can develop it after becoming infected by the person with shingles and that those who have had chickenpox could develop shingles. This is somewhat incorrect. While shingles is highly contagious, it is only so during a small window in which the blisters begin to break open and ooze. Before the rash develops and after it crusts over, the people are not contagious. The virus is not transmitted through the air; direct contact between the infected drainage and the mouth or an open sore is necessary. Also, I was mistaken that direct contact may result in the development of shingles in those who have already had chickenpox. I apologize for this error but still caution anyone in the contagious period of shingles to avoid direct contact with others, regardless of whether they had chickenpox or not, just to be on the safe side.

People who are interested in receiving the shingles vaccine should speak with a physician or pharmacist because there are special precautions that must be taken. The vaccine must be kept frozen at a specific temperature until it is reconstituted and then must to be used within 30 minutes. Because of these restrictions, most doctors do not store the vaccine in office; rather, it must be picked up by the patient at the nearest pharmacy in order to be given within the necessary time frame. I had some readers write to tell me that they received the vaccine right in the pharmacy by a nurse on staff. Not all states allow this, however. Your doctor or pharmacist is your best resource in this regard.

DEAR READER: Shingles is a viral infection. It is actually a second infection caused by the chickenpox virus. Symptoms typically begin with pain, numbness or tingling on one side of the body. It most commonly occurs on one side of the chest, wrapping around to the back. The next most common area is the face, but it can present anywhere on the body, including the eyes, which can cause permanent damage if left untreated.

Usually, within two or three days, a red rash develops that slowly turns into fluid-filled blisters that break open, ooze, and crust over. Untreated, most cases will resolve within five or six weeks. Untreated shingles carry potentially serious complications depending on the location where they appear. The open sores should never be touched, as the fluid contains high levels of the virus that can be transferred easily to others. The disorder is highly contagious and can cause chickenpox in those who have never had it and shingles in those who have.

Other symptoms include fatigue, headache, fever and chills, itching and a general achy feeling. There are also atypical cases in which patients develop shingles pain without the typical rash and blistering.

Treating shingles can speed healing, reduce the risk of complications, and ease pain. The best results are achieved if antiviral medication is started within 72 hours of the first symptoms. For those in severe pain, narcotics, tricyclic antidepressants, anticonvulsants or numbing agents may be prescribed. Mild to moderate pain may be controlled with over-the-counter pain relievers such as ibuprofen and naproxen. Antihistamines may also help. Topical anti-itch creams may be helpful if there is an accompanying itch.

Stress can worsen the pain of shingles and should be avoided. Cool compresses or baths may ease symptoms. Relaxation techniques such as meditation, tai chi or deep breathing can reduce stress levels. Even something as simple as listening to soft music or reading in a quiet room can help.

Anyone concerned about having shingles or who develops pain or itching on one side of the body should see his or her physician as soon as possible. Those over the age of 60 should also consider receiving the shingles vaccine, which reduces the risk of developing this infection and may lessen symptoms, duration and intensity should an attack occur. It may also lower the risk of developing postherpetic neuralgia (continuing nerve pain after the shingles infection is over). The vaccine is not a treatment option. People with specific health concerns should not receive the vaccine, so speak with your physician regarding whether to have it.

How long you should wait depends on your situation. There is no specific time period, but it is generally recommended that the rash be gone before receiving the vaccine. If you are under 60, you may not be able to receive it because the vaccination has been tested only in people 60 and older.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my Web site at www.AskDrGottMD.com.

First, I have a worn hearing aids for about five years. They are digital with the battery section behind, not in, the ear and a small plastic tube inside the ear. I have had itchy ears for sometime but since wearing the aids my ears flake and peel daily. I have used peroxide to make sure there is no infection and anti-itch creams, lotions and salves but nothing helps. My ears continue to peel. My doctor says it is not psoriasis but could only suggest a different cream.

The other problem I have is a persistent itch in one spot on my back by my right shoulder blade. It occasionally hurts. It seems to have started right around the time I developed shingles eight years ago.

Do you have any suggestions on either of these issues?

DEAR READER:
Itchy ears are very common. Hearing aids are one of the main causes, especially among the elderly. Some individuals may experience an allergic reaction to the plastic the aid is made from or from the polish that many companies use. Another cause may simply be that the aids are rubbing your ears causing irritation.

I suggest you try wiping the hearing aids carefully with alcohol before wearing them. It is also important to keep them clean to so they maintain good working order. Another option would be to try smaller aids that do not wrap around the ear. This will reduce fiction and may eliminate or reduce the peeling.

As for your chronic back itch, I believe you may be correct that shingles was the cause. Shingles causes inflammation and irritation of the nerves of the skin. In some instances this can cause permanent damage called post-herpetic neuralgia (PHN). Often this condition results in pain, numbness or tingling but an itchy sensation is not common.

PHN is not harmful in most instances, but if you are truly bothered, I recommend you see a neurologist who can examine and test you. He or she can determine the cause of the problem and recommend appropriate treatment.

To give you related information, I am sending you a copy of my Health Report “Ear Infections and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Shingles is an infection caused by the varicella zoster virus. Known as herpes zoster, it causes a painful rash, most commonly appearing as blisters that wrap from the middle of the back around to the middle of the chest. Other parts of the body can be affected as well, but are less common. Most rashes last a few weeks or up to a month. Those lasting longer are sometimes known as post herpetic neuralgia. The older an individual gets, the greater his or her chances are of suffering from such long-term nerve pain.

Treatment can often be difficult and may require a combination of prescriptions for pain control. While anti-virals decrease pain and promote healing, the body responds best when the drug or drugs are given within 72 hours of outbreak. Unfortunately, you are well past that stage. Following that brief time period, topical skin medications, pain relievers, corticosteroids, anti-convulsants, narcotics, and non-narcotics (or a combination thereof) may be necessary.

You don’t indicate what your primary care physician has put you on for relief of the accompanying pain and discomfort. Therefore, I recommend you return to him or her and discuss your options. You can then work together to formulate a plan to bring this problem under control. If all options have been tried, ask for a referral to a specialist who might be able to offer new ones.

I was finally able to convince my mother to get the shingles vaccine but her doctor would only give her a prescription for it. He wouldn’t administer it because of the short window in which is has to be given.

Mom and I searched for weeks to find a health care provider who administered the vaccine. A local internist would administer it BUT only if my mother was able to get the vaccine and bring it to him. As you indicated, it must be kept frozen in order for it to be effective so I made several phone calls, wrote emails and even contacted the health reporter from one of our news stations in search of a provider of the vaccine. No one was able to help.

I finally contacted AARP who suggested I write to the CDC. They, in turn, recommended that I contact Merck who developed the vaccine. I went to the Merck website and was able to find a location, only 30 minutes away where the vaccine was sold and administered. It turned out that a nationally known supermarket, which contains a pharmacy, had the vaccine in stock. Across from the supermarket was a clinic where the vaccine could be given by a health care professional. I was very impressed by the pharmacist who wouldn’t give my mother the vaccine until he was certain that there was someone available in the clinic, right then, who would be able to administer it. The entire process took less than an hour and my mother’s insurance covered most of the cost.

The website to find a location is http://www.merck.com/product/mav/home.html. You need to put in your home zip code and it will bring up locations that provide Merck vaccines. I understand how difficult it is for some people to get the vaccine and I hope that this helps make it easier for them.

DEAR READER:
When I first mentioned the shingles vaccine, I had no idea that so many people would have trouble getting it. Most physicians seem to be unwilling to administer it because it has such a small viability window.

I am printing your letter in the hopes that it will help those interested in getting the vaccine. Thanks for passing along this invaluable information.