Tuesday, August 05, 2008

Who needs a shingles shot? Part II

I wrote some time ago about who needs a shingles shot. Here is a summary of the last 4 people I've seen in the office, all in the past 2 weeks, who wished they'd had the shingles shot before their leftover chickenpox (herpes zoster virus) staged a comeback.

The first patient was down on my schedule as 'bug bite.' I'm always suspicious, even in summer, that a 'bug bite' appointment will actually be shingles. Indeed, this 38 year old man's painful 'bite' was, in fact, a cluster of herpetic blisters on his left shoulder. He is too young to have been offered a shingles shot as they are approved for persons sixty and over. The shot would doubtless work on younger patients, but they are quite expensive, and insurance companies would be disinclined to pay for the vaccine in this low risk population.

The second patient complained of a 'bee sting.' This theoretical bee had gotten her on her left buttocks, an area not commonly at risk for a bee attack. At 62, she could've had a shingles shot instead of this stinging red circle of blisters.

The third patient, only 52, is undergoing chemotherapy for cancer. Her shingles were extensive, painfully covering most of her buttocks. She is at risk for a recurrence of herpes zoster as her treatment has compromised her immune system.

The fourth patient--age 49 and therefore too young for the shot-- came in with back pain which she described as a strip both numb and painful from her lower back around to the middle of her front at the level of her lowest rib. She had no rash...yet. I don't know for sure, but her presentation was typical of the pain that precedes a shingles outbreak.

I actually saw one other person this week who could've used a shingles shot, but he needed it 12 years ago when he was 81. Now at 93, he continues to have a painful itch over his left eye up onto his forehead from his remote encounter with his resident zoster virus. He really should re-up his immunity now against another potential attack, but he's not fond of shots.

Who is?


kenju said...

My insurance will not pay for that shot, otherwise I'd have had it. I had shingles about 18 years ago and I have no desire to experience that again!

Cilicious said...

I had a 40-something Denver friend who suffered with shingles for weeks on end. She was miserable. I wish I could get that shot. If I ever get better insurance, I might take a stab at it. (please forgive horrid pun.)

Ruth said...

How expensive is the shot? Some things are worth paying for even if your insurance doesn't. I have seen people very debilitated for months by post herpetic pain. They would pay anything to to get rid of it. My daughter had a very bad time with shingles last year. She was 24, has Type 1 diabetes, and her blood sugars were out of control for a couple of weeks. She required narcotics for the pain.

Femail doc said...

The shot is $180. I'm with you Ruth, I think I'd go for it anyway. I had another lady in yesterday with recent shingles in her groin. She was miserable, virtually sick, with stinging pain in the area.

I was dismayed KJ to learn that your insurance wouldn't pay. I thought (you'd think I'd no longer be so naive) that once Medicare hopped on board a therapeutic strategy that other insurance carriers generally followed suit.

I read an interesting abstract from the Archives of Dermatology recently that family members of persons with shingles were more likely to contract the problem than those with no family history of same. If multiple blood relatives were reported with shingles, the risk increased almost 14-fold.

Mauigirl said...

I'll be sure to ask for that shot as soon as I am eligible. I also wonder whether I should request a Heptatitis B shot. Seems like a good precaution; in my youth they did not require it but it seems like a no-brainer to get one since they are available.

TRS said...

Hmmm. Thinking, thinking here.

My dad recently suffered from a shingles outbreak that lasted more than a year. It must be horribly painful and irritating because he said he eyed the gun cabinet more than once! Scary.

But I'm curious about that itch over the left eye that you described with that last elderly patient.
I have a funny itch on my left eye. It gets puffy... red... the eyelid gets itchy and feels a bit scale-y (made up word) sometimes.
I had associated with use of Retin-A Micro, prescribed by my dermatologist... but I haven't used it in over a week, maybe two - and now you have me wondering.

I'm 38 - female.