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Shingles (transcript)
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ANNOUNCER:

 

MAJOR FUNDING FOR

"SECOND OPINION" IS PROVIDED

BY THE BLUE CROSS AND

BLUE SHIELD ASSOCIATION, AN

ASSOCIATION OF INDEPENDENT,

LOCALLY OPERATED, AND

COMMUNITY-BASED BLUE CROSS AND

BLUE SHIELD COMPANIES.

FOR MORE THAN 80 YEARS,

BLUE CROSS AND BLUE SHIELD

COMPANIES HAVE OFFERED HEALTH

CARE COVERAGE IN EVERY ZIP CODE

ACROSS THE COUNTRY AND SUPPORTED

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AND WELLNESS OF INDIVIDUAL

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THE BLUE CROSS AND BLUE SHIELD

SSOCIATION'S MISSION IS TO MAKE

AFFORDABLE HEALTH CARE AVAILABLE

TO ALL AMERICANS.

NEWS ABOUT OUR INNOVATIONS IS

ONLINE AT BCBS.COM AND ON

TWITTER, @BCBSASSOCIATION.

 

 

 

"SECOND OPINION" IS PRODUCED

IN ASSOCIATION WITH THE

UNIVERSITY OF ROCHESTER

MEDICAL CENTER, ROCHESTER,

NEW YORK.

 

SALGO:

 

WELCOME TO "SECOND OPINION,"

WHERE YOU GET TO SEE FIRST-HAND

HOW SOME OF THE COUNTRY'S

LEADING HEALTH CARE

PROFESSIONALS TACKLE HEALTH

ISSUES THAT ARE IMPORTANT TO

YOU.

I'M YOUR HOST, DR. PETER SALGO,

AND TODAY I'M HAPPY TO WELCOME

OUR "SECOND OPINION"

PRIMARY CARE PHYSICIAN,

DR. LISA HARRIS,

DR. ANNE LOUISE OAKLANDER,

NEUROLOGIST FROM

MASSACHUSETTS GENERAL HOSPITAL,

DR. MARK SHELLY FROM

UNIVERSITY OF ROCHESTER

MEDICAL CENTER,

AND LAURIE HOLMES, WHO IS HERE

TO SHARE HER PERSONAL STORY.

NOW, OUR PANELISTS ALONG WITH

YOU AT HOME WILL BE HEARING THIS

STORY FOR THE VERY FIRST TIME,

SO LET’S GET RIGHT TO WORK.

LAURIE, THANKS FOR JOINING US.

THANK YOU.

THIS ALL BEGAN FIVE YEARS

AGO.

YOU WERE ON A BOATING TRIP WITH

YOUR HUSBAND IN CANADA.

 

 

HOLMES:

 

RIGHT.

 

 

SALGO:

 

AND YOU WERE HAVING A GREAT

TIME.

BUT SINCE YOU'RE ON A MEDICAL

SHOW, SOMETHING HAPPENED.

WHAT WAS THAT?

 

 

HOLMES:

 

WELL, IT BEGAN WITH A

HEADACHE.

IT WAS VERY STRANGE AND IT WAS

UP HERE IN MY HEAD AND IT FELT

LIKE LIGHTNING STRIKES, IS THE

WAY I WOULD DESCRIBE IT.

AND I JUST DIDN'T FEEL GREAT.

 

 

SALGO:

 

OKAY.

 

 

HOLMES:

 

AND THEN I GOT ON THE INSIDE

OF MY MOUTH AND MY GUMS ON BOTH

SIDES, IT FELT LIKE CANKER SORES

THAT EXPLODED ONCE IN A WHILE,

AND IT WAS JUST GETTING WORSE,

SO WE WENT TO THE HOSPITAL.

 

SALGO:

 

IN CANADA.

 

 

HOLMES:

 

IN CANADA.

 

 

SALGO:

 

AND WHAT DID THEY TELL YOU

THERE?

 

 

HOLMES:

 

WELL, THEY THOUGHT THAT I HAD

THE CHILDREN'S DISEASE THAT

IS -- YOU GET IT IN YOUR MOUTH

AND YOUR FEET.

 

 

HARRIS:

 

HAND, FOOT, AND MOUTH

DISEASE.

 

 

HOLMES:

 

HAND, FOOT, AND MOUTH

DISEASE, AND THEY GAVE ME A

PRETTY HEAVY NARCOTIC AND SAID,

"YOU'LL BE OKAY," AND SENT ME

BACK TO THE BOAT.

 

 

SALGO:

 

ALL RIGHT, SO STOP

RIGHT THERE.

HAND, FOOT, AND MOUTH DISEASE.

FIRST OF ALL, IT HURTS LIKE

EVERYTHING.

IT'S REALLY A BAD DISEASE.

SPECIFICALLY, YOU -- AND ADULTS

CAN GET IT, RIGHT?

 

 

HARRIS:

 

RIGHT, RARELY, BUT THEY CAN.

 

 

SALGO:

 

WHAT ARE YOU THINKING AT THIS

POINT?

 

 

HARRIS:

 

WELL, I WASN'T THINKING HAND,

FOOT, AND MOUTH, PARTICULARLY

NOT WITH ANY LESIONS ON HER

HANDS OR HER FEET NOR EVIDENCE

OF FEVER OR BEING AROUND

CHILDREN, FROM WHAT SHE'S

DESCRIBED.

CERTAINLY WHEN SOMEONE PRESENTS

INITIALLY WITH THAT TYPE OF A

SHOCKING HEADACHE, THEN WE START

THINKING ABOUT VIRAL SYNDROMES

THAT CAN CAUSE HEADACHES,

MIGRAINE, AND, YOU KNOW, SOME

OTHER MORE COMMON THINGS, BUT

SHE'S TELLING US A COUPLE THINGS

THAT MIGHT LEAD US IN A SLIGHTLY

DIFFERENT DIRECTION.

 

 

SALGO:

 

SOMETHING ELSE JUMPED OUT AT

ME.

WE CAN ALL JOIN IN ON THIS.

THIS PAIN WAS SEVERE ENOUGH THAT

THEY GAVE YOU SOME REALLY

POWERFUL PAINKILLERS AND THEN

THEY SENT YOU OUT THE DOOR.

WOULD YOU HAVE DONE THAT?

 

 

OAKLANDER:

 

WELL, SHE HAD LESIONS, AND SO

I THINK --

 

 

SALGO:

 

LESIONS ARE THOSE

CANKER SORES.

 

 

OAKLANDER:

 

SHE HAD SORES SHE DESCRIBED

ON HER MOUTH, SO I THINK THE

DIFFERENTIAL DIAGNOSIS OF A

SEVERE HEADACHE ON ONE SIDE

OF -- OR FACIAL PAIN ON ONE SIDE

IS VERY DIFFERENT IN A PATIENT

WHO HAS SORES THAN IN A PATIENT

WHO DOESN'T HAVE ANY.

 

 

SHELLY:

 

I WAS WONDERING, YOU

DESCRIBED IT ON BOTH SIDES OF

YOUR INSIDE OF YOUR MOUTH, BUT

THAT WAS BOTH SIDES, ON ONE SIDE

UP AND DOWN.

 

 

HOLMES:

 

ONE SIDE, UP AND

DOWN, I'M SORRY, UP AND DOWN.

 

 

SALGO:

 

OKAY, BUT NOT ACROSS THE

MIDLINE.

 

 

HOLMES:

 

NO, NOT ACROSS THE MIDLINE.

 

 

SALGO:

 

SO THEY PUT YOU ON NARCOTICS.

 

 

HOLMES:

 

YES.

I TOOK ONE AND THEN I DIDN'T

TAKE ANY MORE BECAUSE IT MADE

ME VERY SICK --

 

 

SLAGO:

 

WHEN YOU SAY "SICK,"

WHAT DO YOU MEAN?

 

 

HOLMES:

 

SICK TO MY STOMACH, JUST

NAUSEOUS, AND IT DIDN'T DO

ANYTHING FOR THE HEADACHE OR THE

SORES IN MY MOUTH.

 

 

SALGO:

 

THEN WHAT HAPPENED?

 

 

HOLMES:

 

WELL, THEN I GOT VERY HAPPY.

I STARTED SINGING, I WAS -- I

WAS -- MY PERSONALITY CHANGED

QUITE A BIT, 'CAUSE I DON'T

USUALLY SING SHOW TUNES, AND I

WAS JUST HAPPY.

I JUST LOVED EVERYBODY, AND I

GOT VERY SLEEPY.

 

 

SALGO:

 

OKAY, SO LET'S STOP THERE.

NOW WE'RE HEARING SOMETHING THAT

TO ME IS WORRISOME.

HAPPY PATIENTS WORRY DOCTORS.

WHERE'S THE DISCONNECT HERE,

LISA?

 

 

HARRIS:

 

WELL, THE CONCERN IS THAT YOU

HAVE A GROUP OF SYMPTOMS WHERE

SOMEONE PRESENTS WITH A

HEADACHE, NOW ALSO HAS SOME

LESIONS ON ONE SIDE OF THEIR

MOUTH, AND NOW HAS PERSONALITY

CHANGES, SO YOU'RE THINKING THAT

THERE'S SOMETHING OCCURRING

WITHIN THE BRAIN, AND THAT WOULD

BE IMMEDIATE EMERGENCY ROOM,

LUMBAR PUNCTURE --

 

 

SALGO:

 

THAT'S A SPINAL TAP.

 

 

HARRIS:

 

 A SPINAL TAP.

I AM WORRIED ABOUT AN INFECTION

ON THE BRAIN.

 

 

SALGO:

 

NOW, WHAT'S HAPPENING TO THE

LESIONS ALL THIS TIME?

ARE THERE MORE OF THEM, FEWER OF

THEM, WHAT?

 

 

HOLMES:

 

THEN I BEGAN TO GET THEM ON

THE SIDE OF MY FACE, RIGHT HERE

ON THE SIDE OF MY FACE.

AND THEY WERE VERY, VERY

PAINFUL.

 

 

SALGO:

 

OKAY, AND, AGAIN, YOU'RE NOT

TAKING NARCOTICS FOR IT.

 

 

HOLMES:

 

NO, BECAUSE IT WASN'T DOING

ANYTHING.

 

 

SALGO:

 

AND, AGAIN, I'M STRUCK --

YOU'RE HAPPY.

 

 

HOLMES:

 

YEAH, I WAS.

IN THE BEGINNING, I WAS VERY

HAPPY.

 

 

OAKLANDER:

 

LAURIE, WHAT TIME PERIOD ARE

WE TALKING ABOUT?

WAS ALL OF THIS DURING ONE DAY,

TWO DAYS, A WEEK?

 

 

HOLMES:

 

IT DEVELOPED OVER A WEEK'S

TIME.

 

 

OAKLANDER:

 

A WEEK'S TIME.

 

 

HOLMES:

 

YES.

 

 

OAKLANDER:

 

THAT'S USEFUL TO KNOW.

 

 

SALGO:

 

AND YOU'RE ON A BOAT.

AND I'M ON A BOAT IN CANADA.

WITH YOUR HUSBAND.

 

 

HOLMES:

 

YES.

 

 

SALGO:

 

WHO HAPPENS TO BE A DOCTOR.

 

 

HOLMES:

 

YES, HE IS.

 

 

SALGO:

 

SO WHAT DID HE DO?

 

 

HOLMES:

 

WELL, ONCE THE LESIONS CAME

HERE, HE SAID, "OH, THAT'S

SHINGLES."

 

 

SALGO:

 

SHINGLES.

 

HOLMES:

 

MM-HMM.

 

 

SALGO:

 

OKAY. AND?

 

 

HOLMES:

 

AND HE PUT ME ON MEDICINE

THAT YOU USE TO HELP THE

SHINGLES GO AWAY.

 

 

SALGO:

 

AN ANTIVIRAL MEDICATION.

 

 

HOLMES:

 

YES.

 

 

SALGO:

 

ALL RIGHT, WHAT'S SHINGLES?

 

 

OAKLANDER:

 

IT'S AN INFECTIOUS DISEASE

THAT SHOWS UP ON THE SKIN, SO A

LOT OF PEOPLE THINK IT'S NOT

SERIOUS.

THEY LUMP IT IN WITH POISON IVY

OR ECZEMA, AND WHAT THEY DON'T

REALIZE IS THAT IN FACT IT'S A

NEUROLOGIC DISEASE, AND A

PROPORTION OF PATIENTS SUCH AS

LAURIE HERE END UP WITH SERIOUS

NEUROLOGIC ILLNESS AND

COMPLICATIONS.

 

 

SALGO:

 

SO LET'S NAIL A FEW POINTS

ABOUT SHINGLES.

WHAT'S THE AGENT?

WHAT CAUSES SHINGLES?

 

 

SHELLY:

 

WELL, THERE'S A VIRUS,

HERPES VARICELLA ZOSTER VIRUS.

 

 

SALGO:

 

IT'S CHICKENPOX.

 

 

SHELLY:

 

IT'S THE SAME ONE THAT CAUSES

CHICKENPOX, AND IN THE CASE OF

SHINGLES, IT WAS THERE WHEN

THERE WAS CHICKENPOX AND STAYED

SILENT FOR A LONG PERIOD OF

TIME.

 

 

SALGO:

 

SO LET ME SEE IF I UNDERSTAND

THAT.

YOU GET CHICKENPOX AS A KID, AND

IT WENT AWAY BECAUSE IT'S A

SELF-LIMITED DISEASE AMONG

CHILDREN FOR THE MOST PART.

BUT YOU'RE TELLING ME THE VIRUS

DIDN'T GO AWAY.

WHERE IS IT?

 

 

SHELLY:

 

IT STAYS DORMANT IN A NERVE

ROOT AND THAT LATER ON IN LIFE

FOR WHATEVER REASON, THERE'S

A -- THE GUARD IS LET DOWN

ENOUGH FOR IT TO COME OUT AND

CAUSE LESIONS ALONG THE

DISTRIBUTION OF THAT NERVE.

 

 

SALGO:

 

OKAY, SO SHINGLES IS THE SAME

VIRUS THAT CAUSES CHICKENPOX,

WHICH HAS BEEN HIDING OUT 20,

30, 40 --

 

 

OAKLANDER:

 

DECADES.

WHICH IS

REMARKABLE.

 

 

SALGO:

 

JUST HIDING, WAITING

TO CAUSE TROUBLE, AND THEN IT'S

HIDING IN NERVES, SO IT SHOWS

UP WHERE THE NERVES GO.

 

 

HARRIS:

 

THAT'S CORRECT, WHERE

THE PERIPHERAL NERVES GO.

 

 

SALGO:

 

YEAH, WHERE THE

PERIPHERAL NERVES GO.

 

 

OAKLANDER:

 

YES, AND THIS IS A

VERY CHARACTERISTIC SHINGLES

RASH.

THIS IS THE CLASSIC SHINGLES

RASH AND IT'S GOT SOME UNUSUAL

FEATURES THAT ARE WORTH KNOWING

ABOUT BECAUSE THIS DISEASE IS SO

COMMON, IT'S ESTIMATED THAT

ALMOST HALF OF AMERICANS WILL

HAVE THIS AT SOME POINT DURING

THEIR LIFE.

SO THE CHARACTERISTIC OF

SHINGLES IS THAT UNLIKE MOST

RASHES, IT ONLY AFFECTS HALF THE

BODY IN ALMOST ALL PATIENTS.

 

 

SALGO:

 

DOESN'T CROSS THE

MIDLINE.

 

 

OAKLANDER:

 

THIS APPEARANCE THAT YOU SEE

HERE WHERE THERE'S A SIGNIFICANT

RASH, BUT IT STOPS ABRUPTLY AS

WE GET TO -- THAT'S THE PERSON'S

BELLY BUTTON IN THAT PHOTO

THERE, AND ALSO THAT IT'S A

LOCALIZED RASH, AND SO IN A WAY,

IT'S PAINTING WHAT WE CALL A

DERMATOME, THE TERRITORY OF ONE

NERVE, WHICH YOU CAN SEE HERE.

 

 

SALGO:

 

NOW, THIS IS A LITTLE ONE.

DOESN'T LOOK SO BAD TO ME.

IS IT A PROBLEM?

 

 

OAKLANDER:

 

YES, AND SO MOST

PEOPLE WHO HAD THE FIRST RASH

WOULD REALIZE SOMETHING SERIOUS

IS WRONG AND WOULD GO TO AN

EMERGENCY ROOM.

THE SECOND RASH MAY BE MORE

TYPICAL, AND SO IT CAME OUT IN A

VERY LARGE STUDY ON THE VACCINE

THAT WAS PUBLISHED IN

THE NEW ENGLAND JOURNAL OF

MEDICINE THAT THERE ARE MANY

MORE SHINGLES RASHES SUCH AS

THIS ONE THAT ARE MILD,

SELF-LIMITED, THE PERSON MAY NOT

EVEN RECOGNIZE OR THEIR

PHYSICIAN MAY NOT EVEN RECOGNIZE

THIS AS SHINGLES, AND SO THIS

PATIENT MAY NOT GET THE

TREATMENT THAT THEY URGENTLY

NEED, WHICH CAN LESSEN THE RISK

OF COMPLICATIONS.

AND THERE ARE SOME PEOPLE WHO

HAVE SHINGLES AND THEY DON'T

EVEN HAVE THE MILD RASH, AND SO

I THINK PATIENTS WHO HAVE -- OR

PEOPLE WHO HAVE THE SYNDROME

WHERE OUT OF NOWHERE THEY'RE

DEVELOPING PAIN, ODD SENSATIONS,

TINGLING, NUMBNESS, ON ONE SIDE

OF THE BODY, EVEN WITHOUT A

RASH, THEY SHOULD STILL GO TO

THE EMERGENCY ROOM, BECAUSE IT'S

POSSIBLE THAT IT MIGHT BE A FORM

THAT HAS NO RASH OR IT COULD BE

THE PRODROME, AND SO THE RASH

MAY NOT HAVE COME OUT YET.

 

 

SALGO:

 

LAURIE, ON A SCALE OF

ONE TO TEN, HOW MUCH DID IT

HURT?

 

 

HOLMES:

 

TEN.

 

 

SALGO:

 

THAT'S WHAT I'VE HEARD FROM

EVERYBODY WHO'S HAD SHINGLES.

IT HURTS.

 

 

HARRIS:

 

AND I THINK WE NEED

TO ALSO JUST THROW A LITTLE

CAVEAT IN.

NOT EVERYONE WHO PRESENTS WITH A

SHINGLES RASH NEEDS TO GO

RUNNING FOR THE EMERGENCY ROOM.

CERTAINLY, YOU KNOW, FOR MOST OF

THEM YOU CAN SEE YOUR PRIMARY

CARE PROVIDER WITHIN THE FIRST

THREE OR FOUR DAYS.

THE THINGS THAT YOU WORRY ABOUT

IS IF IT'S ON THE FACE, IF IT'S

AROUND -- IN THE EYE.

 

 

SALGO:

 

WHO GETS SHINGLES?

WHO'S THE TYPICAL PATIENT?

 

 

HARRIS:

 

OVER 50, CAUCASIAN,

IMMUNOCOMPROMISED, SO ANYBODY

THAT'S HAD A PREVIOUS CANCER,

MALIGNANCY, DIABETES, ANYTHING

THAT SUPPRESSES YOU OR AFFECTS

YOUR IMMUNE SYSTEM.

 

 

SALGO:

 

NOW, WE SAY THAT IT'S THE

SAME VIRUS THAT CAUSES

CHICKENPOX.

LET'S NARROW THIS ONE DOWN.

IF YOU'VE NEVER HAD CHICKENPOX,

CAN YOU GET SHINGLES?

 

 

OAKLANDER:

 

ABSOLUTELY, BECAUSE --

 

 

SALGO:

 

EXPLAIN THAT.

 

 

OAKLANDER:

 

IN THE U.S., VIRTUALLY

EVERYONE, MORE THAN 95% OF

PEOPLE BY THE AGE OF ABOUT 25,

ARE SEROPOSITIVE FOR THIS VIRUS,

MEANING THAT THEY HAD IT OR

THAT THEY'VE ENCOUNTERED IT,

AND THUS IS AT RISK FOR CATCHING

SHINGLES.

 

 

SALGO:

 

ALL RIGHT, LAURIE.

YOU'RE ON A BOAT.

 

 

HOLMES:

 

MM-HMM.

HALF YOUR FACE NOW IS

INVOLVED IN THIS RASH, AND, IN

FACT, I THINK WE'VE GOT A

PHOTOGRAPH, WE CAN SHOW YOUR

RASH.

THAT'S AN OUCHIE.

 

 

HOLMES:

 

YEAH, IT WAS OUCHIE.

 

 

SALGO:

 

IT HURTS.

AND NOW YOUR HUSBAND THINKS YOU

HAVE SHINGLES, APPROPRIATE.

HE PUTS YOU ON AN ANTIVIRAL.

DID YOU HEAD FOR SHORE?

HOLMES:

 

WELL, NO, BECAUSE WE THOUGHT

IT WAS UNDER CONTROL WITH THE

ANTIVIRAL, BUT ABOUT TWO DAYS

LATER, IT WAS CLEAR THAT IT

WASN'T, BECAUSE I WAS SLEEPING

MORE AND I COULDN'T WALK

STRAIGHT, I COULDN'T -- BUT WHEN

YOU'RE ON A BOAT, YOU CAN HIDE

THAT PRETTY WELL, AND SINCE I

THOUGHT EVERYTHING WAS SO FUNNY,

I WASN'T TELLING THEM.

 

 

SALGO:

 

IF SOMEBODY'S MENTAL STATUS

IS BECOMING A LITTLE LOOPY, YOU

MAY NOT TELLING PEOPLE BECAUSE

YOU'RE NOT PROCESSING ANYTHING.

SO WHAT HAPPENED NEXT?

 

 

HOLMES:

 

WELL, THE DECISION WAS MADE

TO GO HOME, WHICH MEANT THAT WE

HAD TO CROSS THE LAKE, AND WHEN

WE GOT HOME, MY HUSBAND HAD

ALREADY CALLED AHEAD TO SEE MY

PRIMARY, AND WE WENT IN THE NEXT

MORNING AND SHE -- HER NURSE

TOOK MY BLOOD PRESSURE, WHICH

WAS EXTREMELY LOW, AND THEY

SAID, "WE'RE CALLING AN

AMBULANCE," BUT MIKE SAID, "NO,

WE'LL DRIVE YOU," AND THEY -- I

DROVE TO THE EMERGENCY ROOM.

 

 

SALGO:

 

AND WHAT DID THEY TELL

YOU IN THE EMERGENCY ROOM?

 

 

HOLMES:

 

WELL, BY THAT TIME, I HAD

GOTTEN ANOTHER HEADACHE, A

REALLY BAD HEADACHE.

I COULDN'T HAVE ANY LIGHT.

 

 

SALGO:

 

PHOTOPHOBIA.

RIGHT?

 

 

HOLMES:

 

RIGHT.

 

 

SALGO:

 

SO WHAT'S GOING ON HERE?

 

 

SHELLY:

 

WELL, YEAH, I THINK THAT AT

THIS POINT THERE'S EVIDENCE THAT

IT'S NOT JUST INVOLVING THE

SKIN, BUT IT'S GONE -- GONE, IF

YOU WILL, ALONG THE SAME NERVE

ROOTS, BUT GOING IN AROUND THE

BRAIN AND CAUSING SOME ELEMENT

OF MENINGITIS OR ENCEPHALITIS.

 

 

SALGO:

 

MENINGITIS, AN INFLAMMATION

OF THE LINING AROUND THE BRAIN,

ENCEPHALITIS, AN INFECTION IN

THE BRAIN ITSELF, BOTH OF THEM

NASTY.

 

 

SHELLY:

 

YES.

 

 

SALGO:

 

ALL RIGHT, SO WHAT DO

YOU DO?

 

 

SHELLY:

 

I THINK THAT AT THIS POINT

YOU HAVE WHAT YOU NEED TO KNOW,

THAT IS VARICELLA ZOSTER YOU'RE

DEALING WITH, SHINGLES YOU'RE

DEALING WITH, THAT IT'S AN

ENCEPHALOPOTHY, SO YOU'RE GOING

TO GO WITH INTRAVENOUS THERAPY.

I DON'T THINK THERE'S ANY WAY

YOU WON'T IMAGE THE BRAIN.

 

 

SALGO:

 

IMAGING MEANS GET AN

MRI OR A CT OR --

 

 

SHELLY:

 

SO TO LOOK AT THAT

FROM THAT STANDPOINT.

 

 

SALGO:

 

WHAT ARE YOU LOOKING FOR, BY

THE WAY?

 

 

OAKLANDER:

 

I'D ALSO DO SOME

DIRECT FLORESCENT TESTS FROM

ONE OF THE LESIONS ITSELF.

I AGREE WITH YOU THAT THE

DIAGNOSIS IS ALMOST CERTAIN, BUT

IT IS WORTHWHILE, I THINK,

PUTTING IT INTO CULTURE.

 

 

SALGO:

 

HOW IMPORTANT, THEN, IS TO

GET TREATMENT GOING EARLY WITH

THIS, IF YOU'VE GOTTEN A VIRUS

IN THE BRAIN?

 

 

SHELLY:

 

WITH A VIRUS, WE WANT

TO BE TREATING WITH THE

ANTIVIRAL MEDICATIONS WHEN

THERE'S VIRAL REPLICATION, WHICH

MEANS EARLY IN THE DISEASE.

LATER ON, WHEN SOMEBODY'S

RECOVERING, THERE MAY NOT BE

MUCH VIRUS AND IT MIGHT NOT HELP

MUCH, SO THE SOONER WE CAN GET

THAT STARTED, THE BETTER.

IT SOUNDS LIKE IT WAS STARTED,

AT LEAST IN PART, WITH THE ORAL

THERAPY, BUT WE'RE GOING TO BE

USING -- WE'RE GOING TO USE MUCH

HIGHER DOSES WHEN WE WANT TO GET

IT INTO THE BRAIN.

 

 

SALGO:

 

THIS GOES TO YOUR

COMMENT, THOUGH, RIGHT?

IT'S NOT JUST A RASH.

 

 

HARRIS:

 

THAT'S RIGHT.

 

 

SALGO:

 

IT'S NOT JUST A LITTLE SKIN

THING.

THIS IS BIG-TIME MEDICINE, ISN'T

IT?

 

 

OAKLANDER:

 

IT IS, AND I DO THINK, AS

MARK MENTIONED, TIME IS OF THE

ESSENCE.

IN THE BEST CASE, THE DIAGNOSIS

CAN BE MADE EVEN BEFORE THE FULL

BLOSSOMING OF THE RASH, AND IF

THE PATIENT IS STARTED ON

ANTIVIRALS, YOU MAY BE ABLE TO

ABORT THIS WHOLE KIND OF

ILLNESS, SO I DO THINK IT'S

IMPORTANT TO CONTACT YOUR

PHYSICIAN OR, IF NEED BE, TO GO

TO AN EMERGENCY ROOM AS SOON AS

THAT SUSPICION COMES TO YOU

THAT IT MIGHT BE SHINGLES.

 

 

HARRIS:

 

AND UNFORTUNATELY,

THEY DIDN'T PUT THAT TOGETHER

WHEN SHE DID GO TO THE EMERGENCY

ROOM.

IT WAS PRETTY CLEAR FROM THE

ONSET THAT SHE HAD, YOU KNOW, A

UNILATERAL HEADACHE, UNILATERAL

RASH IN HER MOUTH.

 

 

SALGO:

 

YOU MEAN THE EMERGENCY

ROOM IN CANADA.

 

 

HARRIS:

 

EXACTLY. THAT'S WHEN SHE

SHOULD HAVE BEEN STARTED ON

ANTIVIRALS AND NOT NARCOTICS.

 

 

SALGO:

 

ALL RIGHT, WELL, HOW LONG

WERE YOU IN THE HOSPITAL

FINALLY, THEN?

 

 

HOLMES:

 

FIVE DAYS I THINK I -- FIVE

OR SIX DAYS I WAS IN THE

HOSPITAL.

 

 

SALGO:

 

AND YOU FELT BETTER AFTER

THAT?

 

 

HOLMES:

 

AFTER THE HOSPITAL?

OH, NO.

 

 

SALGO:

 

AFTER THE FIRST FIVE

DAYS?

 

 

HOLMES:

 

OH, NO.

THEY SENT ME HOME WITH A LINE IN

AND THEY HAD A NURSE COME.

 

 

SALGO:

 

AN INTRAVENOUS,

YOU MEAN.

 

 

HOLMES:

 

YEAH, TWICE A DAY, AND I WAS

ON ALL KINDS OF MEDICINE, ALL

KINDS OF MEDICINE.

I STILL HAD A HEADACHE, I WAS SO

WEAK AND SO -- I HAD ABSOLUTELY

NO ENERGY.

I COULDN'T BELIEVE HOW WEAK I

WAS.

JUST SITTING UP WOULD TAKE A LOT

OF ENERGY.

 

 

SALGO:

 

I KNOW THAT OUR VIEWERS,

THOUGH, ARE SITTING HERE AND

ASKING THE OBVIOUS QUESTION.

CHICKENPOX HIDING.

THE VIRUS IS DORMANT FOR X

NUMBER OF DECADES.

WHAT CAUSES THE VIRUS TO KICK

INTO HIGH GEAR AGAIN AND CAUSES

SHINGLES?

 

 

OAKLANDER:

 

THE MOST COMMON REASON IS

NORMAL AGING.

 

 

SALGO:

 

THE THEORY IS, RIGHT,

THAT AS YOU AGE, YOUR IMMUNE

SYSTEM'S NOT QUITE AS GOOD AS IT

WAS WHEN YOU WERE YOUNGER, AND

WHAT MAY BE HOLDING THIS VIRUS

IN CHECK IS AT LEAST IN PART

YOUR IMMUNE SYSTEM, SO THAT'S

ONE THING.

WHAT OTHER THINGS WOULD

PREDISPOSE YOU TO GET SHINGLES?

 

 

HARRIS:

 

 

WELL, ONE OF THE THINGS WE

DON'T REALLY UNDERSTAND IS THE

ETHNIC PREDOMINANCE AND WHY WE

TEND TO SEE IT MORE IN

CAUCASIANS THAN OTHER ETHNIC

GROUPS.

THAT'S NOT CLEARLY UNDERSTOOD.

WE CERTAINLY KNOW THAT

IMMUNOCOMPROMISED PATIENTS ARE

MUCH MORE LIKELY, SO WE KNOW

THAT GROUP OF PATIENTS.

WE'RE WATCHING FOR THEM.

IT'S THE ONES THAT PRESENT OUT

OF THE BLUE, LIKE LAURIE DID.

 

 

SALGO:

 

I WAS ALWAYS TAUGHT IT

WAS STRESS, TOO.

STRESSFUL EVENTS IN YOUR LIFE,

MEDICAL STRESS -- YOU'VE HAD A

BAD INFECTION, SOMETHING, AND

BOOP.

 

 

OAKLANDER:

 

ON OCCASION, I

SEE ZOSTER COME OUT IN THE AREA

WHERE A PERSON HAS HAD SURGERY

OR TRAUMA, AND SO THAT HAS BEEN

DESCRIBED GOING BACK MORE THAN A

HUNDRED YEARS AS SOMETHING THAT

CAN THEN ALLOW THE SHINGLES TO

COME OUT IN THAT SAME SEGMENT.

 

 

SALGO:

 

LET'S PAUSE FOR JUST A

MINUTE.

I WANT TO SUM UP WHAT WE'VE BEEN

DISCUSSING, AND THEN WE'RE GOING

TO LAUNCH BACK INTO YOUR STORY,

LAURIE.

SHINGLES IS A VIRAL INFECTION

THAT CAN VARY IN SEVERITY.

EARLY TREATMENT CAN SHORTEN THE

INFECTION AND IT CAN ALSO

DECREASE THE CHANCE OF

COMPLICATIONS.

SO, LAURIE, FIVE DAYS IN THE

HOSPITAL.

YOU WENT HOME.

AS MY GRANDMOTHER WOULD SAY,

YOU'RE FEELING SHVACH.

 

 

HOLMES:

 

YES.

 

 

SALGO:

 

TELL ME ABOUT IT.

WHAT WAS IT LIKE?

 

 

HOLMES:

 

I WAS IN BED MOST OF THE

TIME, OR IN A CHAIR.

I STILL COULDN'T WALK STRAIGHT.

I HAD TROUBLE THINKING THROUGH

THINGS SOMETIMES.

I COULD GET TO THE THOUGHT, BUT

IT JUST SEEMED IT WAS SO SLOW.

IT WAS VERY FRUSTRATING.

COMING UP WITH WORDS.

IT WAS JUST VERY FRUSTRATING FOR

ME.

 

 

SALGO:

 

THIS WAS A SEVERE CASE.

 

 

HARRIS:

 

NOW, DID THEY TELL

YOU IF YOU HAD ENCEPHALITIS OR

MENINGITIS OR --

 

 

HOLMES:

 

ENCEPHALITIS.

 

 

HARRIS:

 

ENCEPHALITIS, THAT'S WHAT IT

SOUNDS LIKE.

 

 

HOLMES:

 

AND THEY KEPT ME ON LOTS OF

MEDICINES, AND MY FIRST DOCTOR

SAID TO ME THAT I WAS LUCKY, I

WAS VERY LUCKY, THAT MOST OF THE

PATIENTS THAT GET WHAT I HAD

WHERE I HAD IT END UP IN THE

NURSING HOME OR DEAD, AND I

THOUGHT, WELL, HE WAS BEING A

LITTLE DRAMATIC.

HE WANTED ME TO TAKE THIS

SERIOUSLY.

 

 

SALGO:

 

WAS HE?

WAS HE BEING DRAMATIC?

 

 

OAKLANDER:

 

NO, HE WAS BEING REALISTIC.

ENCEPHALITIS IS ONE OF THE MOST

SEVERE FORMS OF INFECTION THAT

PATIENTS CAN GET.

THERE'S ANOTHER VERY SERIOUS

NEUROLOGIC COMPLICATION WHICH

YOU DIDN'T GET, FORTUNATELY, AND

THAT'S STROKE.

MANY PEOPLE DO NOT REALIZE THAT

SHINGLES CAN ALSO TRIGGER

STROKE.

 

 

SALGO:

 

THIS IS A BAD, BAD INFECTION.

 

 

HARRIS:

 

SO YOU WERE VERY LUCKY.

 

 

SALGO:

 

YOU DIDN'T HAVE

GARDEN-VARIETY SHINGLES.

THE PEOPLE WHO HAVE COMMON

SHINGLES -- THAT IS, A

DERMATOME, THAT LITTLE NERVE

THING, A RASH, A LOT OF PAIN --

HOW LONG DOES THAT USUALLY TAKE

TO JUST GO AWAY?

 

 

OAKLANDER:

 

IT'S VERY

VARIABLE.

THERE ARE EVEN PEOPLE WHO DON'T

HAVE SEVERE PAIN DURING THE

RASH.

MOST PEOPLE DO, AND THEN THE

PAIN IMPROVES AS THE RASH HEALS

UP.

IF THE PAIN LASTS MORE THAN

THREE MONTHS AFTER THE RASH, WE

CALL THAT

POSTHERPETIC NEURALGIA, OR PHN.

 

 

SALGO:

 

TELL ME ABOUT THAT.

THAT JUST SOUNDS BAD.

 

 

OAKLANDER:

 

WELL, IT IS.

ANYTHING WITH THE WORD

"NEURALGIA" IN IT MEANS NERVE

PAIN, SO IT'S A FORM OF CHRONIC

PAIN THAT'S IN THE AREA WHERE

YOU HAD THE SHINGLES RASH, IN

AND AROUND THAT AREA, AND WITH

NEURALGIA, THERE'S UNDERLYING

NERVE DAMAGE AND THE PAIN CAN GO

ON AND LAST FOR MONTHS, FOR

YEARS, OCCASIONALLY FOR THE

REST OF YOUR LIFE.

 

 

SALGO:

 

NOW, AS I UNDERSTAND

THE MECHANISM OF THAT, TELL ME

IF I'M WRONG, BUT AT LEAST ONE

THEORY IS THAT THE MECHANISM IN

THE NERVE TO REGULATE WHETHER

IT'S ON OR OFF AND CAUSE PAIN OR

NOT CAUSE PAIN, THAT MECHANISM

GETS DAMAGED AND THE OFF SWITCH

GOES AWAY.

 

 

SHELLY:

 

WELL, WHEN THE SHINGLES

BREAKS OUT, THAT NERVE DOES

SCAR, AND SO THAT ESSENTIALLY

THERE'S NERVE DAMAGE THAT'S

HAPPENING AT THAT POINT, AND THE

QUESTION IS WHETHER OR NOT IT'LL

BE LEFT STILL PERCEIVING A LOT

OF THE PAIN THAT'S THERE.

 

 

SALGO:

 

NARCOTICS DON'T WORK

VERY WELL ON IT, DO THEY?

 

 

SHELLY:

 

NERVE PAIN IS HARD TO BLOCK

OUT.

I WANTED TO SAY THAT THE RASH

USUALLY LASTS FOR ABOUT TWO

WEEKS, YOU KNOW, THAT SOMEWHERE

IN THERE IT'LL COME ON IN ABOUT

A WEEK AND IT STARTS GOING AWAY

IN A WEEK, IT CRUSTS AND

GRADUALLY COMES OFF.

BUT WHAT YOU'RE LEFT WITH IS THE

SENSATION OF THE PAIN IN THAT

AREA.

 

 

HARRIS:

 

THE OTHER THING TO

REALLY POINT OUT IS THAT WHILE

PEOPLE ARE BREAKING OUT IN THOSE

RASHES, THEY ARE CONTAGIOUS,

SO IF YOU'RE EXPOSING PEOPLE WHO

HAVE NOT HAD CHICKENPOX,

PARTICULARLY INFANTS AND OTHER

IMMUNOCOMPROMISED FOLKS, THEY'RE

CHICKENPOX.

 

 

OAKLANDER:

 

BUT THERE ARE

PEOPLE WHO SHOULD BE AROUND

PEOPLE WHO HAVE SHINGLES OR

CHICKENPOX, AND THAT'S ADULTS

OUR AGE, BECAUSE IT TURNS OUT

THAT ONE OF THE WAYS THAT OUR

BODY KEEPS THIS SUPPRESSED IS BY

EXPOSURE TO THIS VIRUS AGAIN,

LIKE A BOOSTER, AND SO FOR

PEOPLE OUR AGE, BEING EXPOSED TO

SOMEONE WITH SHINGLES OR

CHICKENPOX CAN ACTUALLY LESSEN

THE CHANCES THAT WE'LL GET IT

OURSELVES.

 

 

SALGO:

 

NOW, THAT BRINGS UP A REAL

INTERESTING POINT, BECAUSE THERE

IS A VACCINE FOR SHINGLES, AND

IT SOUNDS AS IF THE VACCINE'S

ACTING IN THE SAME WAY THAT YOU

SAY NATURAL EXPOSURE TO MORE

ZOSTER VIRUS WOULD BE ACTING.

IS THAT FAIRLY ACCURATE?

 

 

SHELLY;

 

WELL, WHEN YOU'RE GETTING A

VACCINE, YOU'RE GETTING IT

INJECTED, AND SO YOU'RE BEING

EXPOSED IN A MORE SIGNIFICANT

WAY.

IT TURNS OUT THAT COMPARED TO

CHICKENPOX, ZOSTER'S MINIMALLY

CONTAGIOUS, IF YOU WILL, BECAUSE

IT'S OFTEN ON A TORSO, COVERED

WITH CLOTHING.

LOOKS GROSS, SO IT'S HIDDEN FROM

THAT STANDPOINT.

SO FOR THAT POINT, THERE'S NOT A

LOT OF TRANSMISSION, EVEN THOUGH

WE KNOW IF YOU REALLY TRY TO,

YOU CAN TRANSMIT IT.

WITH THE INJECTION, YOU'RE

REALLY GETTING A HUGE JOLT TO

THE IMMUNE SYSTEM, SAYING, "THIS

IS WHAT YOU WANT TO REMEMBER NOT

TO LET OUT."

 

 

SALGO:

 

SO, NATURAL EXPOSURE,

GOOD, VACCINE, BETTER.

 

 

OAKLANDER:

 

MUCH BETTER.

 

 

SALGO:

 

NOW, I KNOW THE VACCINE HAS

BEEN RECOMMENDED FOR PEOPLE 60

YEARS AND OLDER, NOW MAYBE FOR

YOUNGER PEOPLE?

 

 

OAKLANDER:

 

50 YEARS AND

OLDER.

 

 

SALGO:

 

YEAH, THEY'VE MOVED IT

DOWN TEN YEARS.

 

 

OAKLANDER:

 

THEY REALLY DID, AND CERTAIN

PEOPLE WHO ARE IN HIGH-RISK

GROUPS, WHICH WE DISCUSSED

BEFORE, MAY EVEN NEED TO BE

IMMUNIZED UNDER THE AGE OF 50.

 

 

SALGO:

 

AND THE VACCINE IS,

WHAT?

IT IS BASICALLY THE CHICKENPOX

VACCINE, IS IT NOT?

OR IS IT DIFFERENT?

 

 

SHELLY:

 

IT'S A WEAKENED

STRAIN.

IT'S A LIVE VIRUS, IT'S A

WEAKENED STRAIN.

IT IS A MORE CONCENTRATED

VERSION OF THE VARICELLA VACCINE

THAT'S GIVEN TO CHILDREN IN TWO

DIFFERENT FORMS, BUT IT'S

BASICALLY TEN -- TWO TO TEN

TIMES AS MUCH ACTUAL VIRUS TO

WAKE UP THE IMMUNE SYSTEM AT

THAT POINT.

 

 

SALGO:

 

AND ALTHOUGH THIS

VACCINE EXISTS AND YOU WOULD NOT

LIKE TO GET SHINGLES -- AND, BY

THE WAY, WE DIDN'T EVEN TALK

ABOUT EYE INJURY, BECAUSE IF YOU

GET SHINGLES AROUND YOUR EYES,

IT CAN CAUSE BLINDNESS.

 

 

HARRIS:

 

YES.

 

 

SALGO:

 

YOU DON’TT WANT SHINGLES, AND

THE VACCINE HAS BASICALLY

BEEN -- REALLY BEEN SHOWN TO BE

HARMLESS.

LOCAL SIDE EFFECTS AT THE

INJECTION SITE.

THAT'S ABOUT IT, RIGHT?

 

 

OAKLANDER:

 

YES.

 

 

SALGO:

 

YET PEOPLE AREN'T GETTING IT.

 

 

OAKLANDER:

 

IT'S A BIG PROBLEM IN PUBLIC

HEALTH, BECAUSE THIS VACCINE,

WHICH IS A WONDERFUL ADVANCE OF

MODERN MEDICINE, HIGHLY

EFFECTIVE AT PREVENTING THIS

SERIOUS NEUROLOGIC DISEASE, NOT

ENOUGH PEOPLE ARE GETTING IT.

 

 

SALGO:

 

THE POINT IS, WHAT,

50% REDUCTION IN SHINGLES

ALTOGETHER, AND IF YOU GET

SHINGLES, IT'S MUCH LESS SEVERE

IF YOU'VE HAD THE VACCINE.

 

 

OAKLANDER:

 

THE MILDER THE CASE, THE LESS

LIKELY YOU ARE TO BE LEFT WITH

POSTHERPETIC NEURALGIA.

 

 

SALGO:

 

HOW BAD WAS IT?

 

 

HOLMES:

 

WELL, I STILL

HAVE IT -- I STILL TAKE

NEURONTIN DAILY.

 

 

SALGO:

 

OH, BOY.

I HAVE CUT DOWN ON THE AMOUNT

THAT I TAKE, BUT WHEN IT GETS

BAD, IT'S LIKE HAVING A HORRIBLE

TOOTHACHE, AND THEN, LIKE, WHEN

YOU GET -- YOU GO TO THE DENTIST

AND YOU GET THE SHOTS SO YOU CAN

HAVE YOUR TEETH OPERATED ON, AND

THEN WHEN IT WEARS OFF, THAT

TINGLING.

IT JUST -- IT'S --

 

 

SALGO:

 

AND NEURONTIN IS

SPECIFIC FOR NEURALGIA.

 

 

HOLMES:

 

AND IT WORKS -- IT

REALLY WORKS.

IF I TAKE IT --

 

 

HARRIS:

 

SO ONE OF THE

THINGS YOU DON'T WANT TO DO IS

CUT DOWN YOUR DOSE, BECAUSE YOU

REALLY HAVE TO MAINTAIN THE --

AND IT'S VERY HIGH DOSE OF

NEURONTIN WHEN YOU'RE TALKING

ABOUT CHRONIC PAIN SYNDROME,

AND OFTENTIMES, PEOPLE WILL BE

UNDERDOSED AT 300, 600

MILLIGRAMS A DAY, AND WE'RE

TALKING ABOUT 1,800 TO 2,700

MILLIGRAMS A DAY TO REALLY

PREVENT THE CHRONIC PAIN OF THE

NEUROPATHY, SO...

 

 

SALGO:

 

ALL RIGHT.

LET'S PAUSE FOR A MINUTE AGAIN.

LET'S SUM UP WHERE WE'VE BEEN

AND THEN WE CAN LAUNCH BACK INTO

OUR DISCUSSION.

WHILE SHINGLES IS NOT

NECESSARILY LIFE-THREATENING, IT

CAN CAUSE LIFE-THREATENING

COMPLICATIONS AND ALSO

POSTHERPETIC NEURALGIA, WHICH

CAN LEAVE YOU IN PAIN FOR MANY

YEARS.

THE BEST WAY TO PREVENT EVER

GETTING SHINGLES IS TO GET THE

SHINGLES VACCINE.

IT WORKS, VERY FEW SIDE EFFECTS.

MAKES SENSE TO ME.

LAURIE, HOW ARE YOU DOING NOW?

I KNOW YOU'VE GOT THE PAIN.

YOU SAY IT'S GETTING LESS?

 

 

HOLMES:

 

WELL, IT'S UNDER CONTROL.

IF I TAKE MY NEURONTIN AND I

DON'T GET OVER-TIRED, IT'S

OKAY.

I ALWAYS FEEL THE TINGLING.

 

 

SALGO:

 

I'M SORRY, YOU STILL HAVE THE

TINGLING.

 

 

HOLMES:

 

YEAH.

 

 

SALGO:

 

AND YOU'RE FIVE YEARS OUT.

 

 

HOLMES:

 

THEY'VE TOLD ME I'LL PROBABLY

ALWAYS HAVE IT.

 

 

OAKLANDER:

 

ACTUALLY, IN

ALMOST ALL CASES, IT CONTINUES

TO IMPROVE OVER TIME, SO GIVEN

YOUR RELATIVE YOUTH, I THINK

THAT YOU PROBABLY WILL CONTINUE

TO IMPROVE TO THE POINT WHERE

IT'S NOT A MAJOR ISSUE FOR YOU,

BUT AS WE CAN SEE, IT'S TAKEN

YEARS.

 

 

SALGO:

 

NOW, YOU'RE BACK AT

WORK, RIGHT?

 

 

HOLAMES:

 

YEAH, I JUST -- I'M A

FIGHTER.

I WAS BOUND AND DETERMINED I WAS

GOING TO GET BACK TO WORK, AND I

DID.

 

 

SALGO:

 

WELL, THAT'S JUST

GREAT.

I'M SO GLAD YOU JOINED US HERE

TODAY.

IT'S NOT EASY TO COME UP AND

TALK TO A TELEVISION AUDIENCE

ABOUT YOUR VIRUS IN YOUR MOUTH

AND THE PAIN YOU STILL HAVE.

I THANK ALL OF YOU FOR JOINING

US AS WELL, AND AS YOU MAY HAVE

GUESSED FROM THIS KIND OF

SUMMATION, WE'RE OUT OF TIME,

BUT I HOPE YOU CONTINUE THE

CONVERSATION ON OUR WEBSITE.

THERE YOU'RE GOING TO FIND THE

ENTIRE VIDEO OF THIS SHOW AS

WELL AS THE TRANSCRIPT AND LINKS

TO RESOURCES.

THE ADDRESS IS...

THANKS FOR WATCHING.

THANK YOU AGAIN, ALL OF YOU, FOR

BEING HERE.

I'M DR. PETER SALGO.

I'LL SEE YOU NEXT TIME FOR

ANOTHER "SECOND OPINION."

 

 

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FOR MORE THAN 80 YEARS,

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ACROSS THE COUNTRY AND SUPPORTED

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