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Friday, October 22, 2010

Fear of Shingles

My mom lives alone in an "over 55" apartment.  A big topic of conversation there this year has been related to shingles (no, not the kind on the roof).

Periodically one of neighbors or friends will suffer from a break out.  Most, being elderly, suffer significantly from it.  Recently a close friend of hers had shingles - she's in her 90's.   Unfortunately she ended up in the hospital for a brief time.

Apparently this took a significant toll on her friend - to the point where she was never quite the same.  "Never quite the same" is a code word for "have to go to the nursing home" or "have to go to assisted living".

This is a big fear where my mother lives.   One day the ambulance pulls up, wheels someone out, and they never come back.  Its frightening and depressing.

Shingles, herpes zoster, can do this to someone over night.  Her and her friends fear it.

So, when the local pharmacy and newspapers pop up with "get your shingles vaccine" there is cause for concern.

Concern you ask?  Why?  Doesn't the vaccine cure shingles?

No, it does not.  In fact, I think it may trigger it.  The vaccines themselves also make my mother worried.  The usual sites like WebMD are all "rah rah" for vaccines and traditional treatments - which is always suspicious in and of itself - even to her.

So I did some research and found this link:

"If you had chicken pox as a child, then you're at risk of developing a case of shingles. Long after the chicken pox is gone, the virus that caused it (varicella zoster virus, VZV) lies dormant in nerve roots. VZV may rest quietly there for all your days. But for certain people whose immune systems are compromised by immunity-suppressing drugs or stressful events, VZV may suddenly come roaring back as a case of shingles.

Obviously, no one wants that. So: To vaccinate or not to vaccinate? When I put this question to HSI Panelist Allan Spreen, M.D., he said that although he doesn't know exactly what the vaccine contains, he wouldn't take it for a king's ransom. Why? Dr. Spreen: "Because ALL vaccinations are suspect until they've been monitored for decades (for long-term dangers), and this vaccine obviously could not fall in that category"

Needless to say everyone in her apartment complex is constantly bombarded with the "get the shingles vaccine" chorus from doctors, friends, and family.  But, as you can see from the above quote, perhaps this is not such a good idea.

My mom doesn't like to take new medications for a variety of reasons.  So the idea of this vaccine does not appeal to her.  Nor does the long list of potentially nasty side effects that is provided with it.  Being the oldest child I am often asked "what should I do".

I don't have all the answers but I certainly can research these types of problems.  In this case I discovered the above link and the notion that shingles can be held in check by Vitamin B-12.

The article goes on:

"I had shingles once...and badly: Zoster ophthalmicus affects the eyes and can even cost you your vision. I was working on a ship (enclosed, recirculated air environment), and had had some poor dental work in port. From that I got the flu, had to stay up late treating patients, and that led to shingles. I was one miserable guy, but I had the nurse give me B- 12 shots everyday for 3 days and that was the end of it (though my vision was foggy for a week before clearing)."

Bumping the ratio

When I asked Dr. Spreen about preventing shingles with vitamin B-12, he suggested that 500 mcg per day would probably be a good insurance policy because B-12 protects the nerves. Supplementing with lysine (anessential amino acid) is a little more complicated.

Dr. Spreen: "With lysine you have to be more careful, as you're playing with something called the lysine/arginine ratio. Lysine competes with arginine in the body, and arginine is a stimulant of growth hormone, so you don't want to drive that down unless you have a real reason. And an arginine supplement isn't a solution because you're trying to alter the ratio to make it less favorable to the virus.

"That said, if you GET shingles, then 3 grams (3,000 mg) of lysine daily can do a lot (a LOT) to shorten the duration and lessen the pain/itch right off). Given that a person has developed shingles (or, rather, gets them fairly often), at that point I'd go on 500 mg of lysine daily (between meals) as insurance after kicking the previous outbreak. But I wouldn't take lysine just because I had chicken pox as a kid."

In supplement form, high doses of lysine may raise cholesterol levels and increase the risk of gallstones, so lysine supplementation should be monitored by a nutritionally oriented physician. Dietary sources of lysine include meat, fish, dairy products, legumes and brewer's yeast."

After reading this you get the idea that perhaps the cause of a case of shingles might be nutritionally related.  Then there is this final note in the article:

"The main reason I would not get the shingles vaccine is that it is manufactured by Merck. I do not trust most pharmaceutical companies, anyway, but Merck tops the list, especially after they got in trouble for making up research studies and articles and then paying respected scientists to put their names on them.

Here are the ingredients of the shingles vaccine (as put forth by Merck):

ZOSTAVAX is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella-zoster virus (VZV). ZOSTAVAX, when reconstituted as directed, is a suspension for subcutaneous administration. Each 0.65-mL dose contains a minimum of 19,400 PFU (plaque-forming units) of Oka/Merck strain of VZV when reconstituted and stored at room temperature for up to 30 minutes.

Each dose contains 31.16 mg of sucrose, 15.58 mg of hydrolyzed porcine gelatin, 3.99 mg of sodium chloride, 0.62 mg of monosodium L-glutamate, 0.57 mg of sodium phosphate dibasic, 0.10 mg of potassium phosphate monobasic, 0.10 mg of potassium chloride; residual components of MRC-5 cells including DNA and protein; and trace quantities of neomycin and bovine calf serum. The product contains no preservatives. (Source)

Just out of curiosity, is there a reason why this vaccine contains a flavor enhancer (monosodium glutamate, MSG)? Is it so the sucrose tastes better to the live herpes zoster virus?

Zostavax was licensed in 2006 by Merck, the same year Gardasil (Merck's HPV vaccine) was also licensed. Zostavax is recommended for people 60 and older, and it only protects half of those vaccinated. The attenuated virus (which means it's still alive, just "weakened") is 14 times as potent as the chickenpox vaccine. (Source)

Basically, if you have any health problems and your immune system is weak, this vaccine could cause a whole lot of harm."

The elderly are, for the most part, shoved off into medicare for this type of thing.  Everything is "by the book or the doctor doesn't get paid" - so there is little margin to make adjustments.  If you don't take the vaccine your doctor may choose not to keep you as a patient.  If you want a more holistic or natural approach medicaid probably does not cover it.  So you're left with towing the party line, as it were, or venturing off into the wilderness on your own.

Clearly no one wants shingles.  But do you want the potential side effects of the vaccine?  Vitamins, on the other hand, pose less risk.

Another concern I have is that most elderly people eat very poor diets.  Sure, there are vitamins, but vitamin absorption may be low.

At any rate I am suspicious of vaccines at this point - particularly when off-the-shelf vitamins may do as good a job.

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