By Ann L. Rappoport
Shingles and its agonizing aftermath rank as the third most-painful condition (after kidney stones and childbirth), according to Dr. Susan Moyer, a geriatrician and internal medicine specialist with Albert Einstein Healthcare Network.
Unfortunately, about 25 percent of the population gets shingles. The likelihood increases dramatically as we age.
Shingles (herpes zoster) and post-herpetic neuralgia disrupt quality of life “on a par with congestive heart failure, diabetes and depression,” note researchers from the Centers for Disease Control and Prevention (CDC). The acute illness typically lasts for a month or so, and for many patients, the pain and dysfunction may endure longer or even permanently.
Zostavax, a vaccine designed to prevent shingles and reduce the incidence and severity of the after-effects came onto the market in 2006, produced by Merck. But only about 2 percent of the people who could be getting it are doing so, says pharmacist Jim Vickery. Vickery operates Chalfont Immunization (soon to be called FastVax), a mobile vaccination clinic that works with pharmacies in providing the shots. To find a schedule of clinic locations and times: www.fastvax.com.
Why no demand?
So why aren’t folks rushing to prevent the scourge of shingles and its lingering debilitation?
Experts count the whys: Some Medicare Part D plans do not cover Zostavax, Moyer notes, and those in the 60-65 age range may be confused over whether private insurance covers it. If you pay out of pocket, the fee is generally over $200.
Thomas Lake, a former Merck employee partnering with Vickery in FastVax, says there are “economic disincentives” and hassles for physicians, too. The vaccine is usually sold in lots of 10, translating into an up-front investment of approximately $1,500. Unlike most vaccines, Zostavax must be kept frozen at a very low temperature, requiring a special freezer that most medical offices don’t have. Filing for reimbursement after administering the shot is time-consuming, adds Lake, and for many doctors, not cost-effective. Also, many people are unaware of the prevalence of shingles, its seriousness or the vaccine’s availability. Some may be hesitant because of drug recalls and adverse effects.
Check with your doctor
CDC and FDA Vaccine Adverse Event Reporting System (http://vaers.hhs. gov) collects data about side effects, although such reports don’t necessarily mean the symptoms are caused by the vaccine. So far, more than 350 cases of herpes zoster have been reported after receiving this vaccine. Such information hasn’t stopped the Advisory Committee on Immunization Practices (ACIP) from advising CDC to recommend Zostavax. But the vaccine is not yet included in the National Vaccine Injury Compensation Program. When considering the shingles vaccine, as with any healthcare product, you should consult your personal healthcare professional. Those allergic to gelatin, those who use steroids (such as prednisone) or who have compromised immune systems are generally not candidates for the Zostavax vaccine. But for those who qualify, the vaccine “can really benefit people,” says Moyer. Moyer knows personally, as well as professionally; her brother suffered a terrible case of shingles.
Outgrowth of chicken pox
Research indicates that the vaccine prevents shingles in 51 percent of the population, reduces severity of symptoms of those who do get it, and reduces incidence of post-herpetic neuralgia by 67 percent. Perhaps those odds don’t motivate you, but Moyer says, “If you’ve ever seen the illness, you know it’s very painful. I strongly recommend the vaccine.” Shingles is a reactivation of the virus of the chicken pox we had as youngsters. It lies dormant in nerve endings, and may be reactivated as our immune systems begin to weaken. It is often triggered by physical or mental stress.
Research indicates that the vaccine is most effective among people between 60 and 69. If you do contract the shingles virus, with or without the vaccine, don’t delay treatment, Moyer urges. Rather than wait several days for the telltale blisters to blossom and spread, go to your doctor as soon as the pain and first blemish appear. Medicines are available that help many people get through the disease if started within hours of onset.
The Philadelphia Department of Public Health has authorized its physicians to write prescriptions for patients to get the shot at one of five pharmacies (you must call for appointment): the Savon Pharmacies in the Acme stores at 920 Red Lion Road, 215-676-6279, in Clifton Heights, 610-284-6803, and at 8200 Roosevelt Blvd., 215-338-4967; Franklin Drug Center, 828 Spruce St., 215-923-7070; and Rite Aid Pharmacy, 338 E. Allegheny Ave., 215-634-4397.
For information: the Philadelphia Department of Health, Division of Disease Control, Immunization Program, at 215-685-6854; or the website of the Centers for Disease Control and Prevention, www.cdc.gov; or your healthcare professional.
‘Distractibility’ can be frustrating, but it may be ‘useful’.
Can’t remember a name at a cocktail party? Don’t panic; it’s not a sign you’re “losing it.” It may be just the opposite.
Researchers have found that although some brains do deteriorate with age (with Alzheimer’s disease, for example), more likely the aging brain is simply taking in more data and trying to sift through a clutter of information, often to its long-term benefit.
For most aging persons, the focus of attention is gradually widening, which makes it more difficult to latch onto just one fact, like a name, but this “distractibility is not, in fact, a bad thing.”
So says Shelley H. Carson, a Harvard psychology researcher, in the book, Progress in Brain Research. Frustrating as it may be, she says, it is often useful because “it may increase the amount of information available.”
Because you have retained all this extra data, adds University of Toronto psychology professor Lynn Hasher, you are now “the better problem solver” since you “can transfer the information from one situation to the other. “
A broad attention span may enable older adults to ultimately know more about a situation … than their younger peers. This may play a significant role in why we think of older people as wiser.
A family of commonly prescribed medications may cause you to “slow down” in your daily physical activities.
Researchers at Wake Forest University School of Medicine reported to the American Geriatrics Society that anticholinergic drugs — which treat a variety of conditions, including acid reflux, Parkinson’s disease and urinary incontinence — may cause the elderly to lose thinking skills more quickly.
They were found to make the patient more likely to walk more slowly and to need help in some daily activities.
Drugs included the blood pressure medication nifedipin (Adalat or Procardia), the stomach antacid ranitidine (Zantac) and tolterodine for incontinence (Detrol).
In another study, published in the Journal of the American Geriatrics Society, researchers found that older nursing home residents who take anticholinergics for incontinence, along with medicines for dementia, declined in function faster than those treated only for dementia.
Older Americans’ risk of receiving an inappropriate drug or dosage is much lower if the prescribing physician is a geriatrician, researchers conclude.
A national review of men seeking care at VA facilities concluded that about one in four were inappropriately prescribed medications, but those who had seen a geriatrician had reduced exposure to such mistakes.
The study, published in Medical Care, indicates that “geriatric care seems to help protect patients receiving prescription medications,” says Mary Jo V. Pugh, a research health scientist with the South Texas Veterans Health Care System, in San Antonio.
Geriatrics professor James S. Goodwin noted, “Patients accumulate medicines as they grow older … a geriatrician [will probably] discover those drugs the patient no longer needs.”
Experts agree that exercise is a successful intervention in preventing falls, which represent the leading cause of death for people over 65, but have differing views of the exact form of exercise that’s preferable.
More and more medical professionals are recommending tai chi, an ancient Chinese martial art that has been found to accelerate blood circulation, strengthen and mobilize joints and muscles, and improve physical fitness and mental relaxation.
According to a study led by Dr. Fuzhong Li of the Oregon Research Institute, tai chi improves functional balance, thus reducing the chance of falling.
Whatever heath problems caffeine may contribute to, there may also be an upside to it.
A study, reported in the Journal of Neuroinflammation, indicates that a daily dose of caffeine blocks the disruptive effects of high cholesterol that have been linked to Alzheimer’s disease.
Just one cup of coffee a day can protect the blood-brain barrier (BBB) from damage that occurs with a high-fat diet, University of North Dakota researchers have concluded. BBB leakage occurs in a variety of neurological disorders, such as Alzheimer’s disease.
Caffeine appears to protect BBB breakdown, a researcher notes, and may be a “safe and readily available drug [which] could have an important part to play in therapies against neurological disorders.”
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