Oct 27, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Last week was busy and interesting at the pharmacy. We intentionally lit a fire in the board room, ate stuff pulled out of a swamp and were braiding grandmother's hair, and that was just on Thursday night. Fred Stevens, an aboriginal herbalist from Mafeking, came down and gave us a talk about the plants he uses to help people who come see him. We started with a smudge and then smelled and touched everything from wild mint to cranberry bark to sage. We even tasted green flag or rat root which has to be dug out of quite wet areas. Fred uses it to help people with cough and colds. He told us it would even taste a little like Buckley's cough syrup. I hate the taste of Buckley's, so honestly, I'd use rat root any day of the week, because I think it tastes better. Morris and Andy Amyotte and Rod Young from Dauphin also shared their knowledge. Andy and Morris were especially helpful teaching several of us how to braid sweet grass, which is also known as grandmother's hair.

Last week I was also at the Arthritis Society's Pain Busters Forum. It was a great group at the Lion's Den, but interestingly, I seemed to get as many questions about the shingles vaccine than I did about arthritis medications. Then at an MS meeting, the shingles vaccine came up again, so maybe its time to discuss Zostavax.

What is Shingles? Shingles is a condition caused by the same virus that causes chickenpox, varicella-zoster. This virus does not leave your body when the red itchy spots of chickenpox go away. Instead, it becomes inactive in the nerve cells of your body. It just sits there for 30,40, or 50 years. In some people, the virus then reactivates and causes a rash. This time though, instead of being itchy like chickenpox, the rash is usually painful. This condition is known as shingles. The medical term for it is herpes zoster.

Doctors talk about two main things when they talk about shingles or herpes zoster. They talk about the reinfection of nerve cells by the virus and its accompanying rash, and they talk about postherpetic neuralgia. Postherpetic neuralgia is nerve damage pain that remains after the shingles rash is gone. In Canada each year, there are 130 000 new cases of shingles, 17000 cases of postherpetic neuralgia and 20 deaths. Postherpetic neuralgia can result in severe pain. Common sites of postherpetic neuralgia pain are the torso and the face. Sometimes the pain is so severe patients are unable to wear clothing that comes in contact with the lesions or to be outside in the wind because of the sensitivity of the skin on the torso and face. There have even been cases of loss of vision and facial scarring. Shingles and postherpetic neuralgia will probably increase as the population ages. The number of people with shingles who get postherpetic neuralgia rises from 10% among the general population to as high as 40% among those over 50.

Should I get the shingles vaccine? I'll start with a strong answer and then I'll get wishy-washy. If you are over 50, you should probably get the shingles vaccine, Zostavax. However, it is not quite as simple as saying, yes everyone should get a measles shot. A measles shot is about 95% effective, inexpensive and the cost is usually covered by Manitoba Health, not the patient. Zostavax is 50-70% effective, costs almost $200 and the patient has to pay. So the decision to get the shingles shot should be thought over carefully and discussed with your doctor.

At the Pain Busters Forum someone asked how long the protection from the shingles vaccine lasts. The answer is we dont know. Protection from shingles does seem to decrease over time. The studies seem to say that protection lasts at least 4 years. However, it could be longer, the studies just havent been done yet as Zostavax is still a relatively new medication. At the moment there is no indication for getting a booster shot of Zostavax done the road.

How well does the shingles vaccine work? Zostavax is the shingles vaccine that been approved in Canada for people 50 years of age and older. It prevents the shingles infection in 50% of the people who get it and postherpetic neuralgia in 67% of the people who receive the vaccine. These numbers are still being debated by the experts. A recent Cochrane review seems to show the Zostavax vaccine only prevents post herpetic neuralgia by preventing shingles. That means if you get the vaccine and still get shingles, you are just as likely to get post herpetic neuralgia as someone who didn't get the shot.

I was surprised to learn that, if you have had shingles before, it is still reasonable to get the shingles vaccine. In fact there is no evidence that having shingles once will reduce the chance you will get it again. If you have active shingles right now, your doctor will wait until the current rash and pain go away before they give you the shingles vaccine.

Zostavax is a live attenuated vaccine. So whereas you can't get influenza from a flu shot, because there is no live virus in the vaccine, Zostavax is different. Zostavax has weakened live virus in it. This makes no difference to most people, but if a patient has a weakened immune system, we have to be careful. People who have HIV, had an organ transplant or who are on high dose steroids shouldn't get Zostavax. It is more of a gray zone for people who have their immune system somewhat suppressed. These include people on low dose steroids, methotrexate and newer arthritis treatments like etanercept (Enbrel). It might be reasonable for them to get Zostavax, but they should discuss their immune function with their doctor first.

At an MS conference I was at in Brandon during the last over scheduled week, a Harvard trained Neurologist, Dr. Allan Bowling, spent a lot of time talking about how diet, positive attitude, spirituality and alternative medicines can help people with MS if used properly under the care of someone who knows what they are doing. I'm sure this is old news to Fred Stevens, Morris and Andy Amyotte and Rod Young. I really enjoyed their teachings about what they do to keep people healthy inside and out. Meegwetch.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional

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