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I haven't done this in a long time.

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Yeah I know.

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All right.

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I have to get really close, right?

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Yeah.

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Is that a good level?

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Do you need to be lower or higher?

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No, I need to be lower.

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Okay.

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And then you can just angle it up.

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Do re mi fa sol la ti do do re re fa sol la ti do mi mi fi sol sol re fa fa la ti ti.

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Oh yeah.

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What do you want to do?

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And then you do when you know the notes to sing.

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You can sing most anything.

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Yeah.

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Okay.

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That was good.

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Okay.

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Well, hey y'all.

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Welcome back to another episode of Your Mom on Drugs featuring me, Josh Klaus.

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And me, Jennifer Seltzer.

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Yes, we are a mother and son pair who like to talk about the world of medicine, pharmaceuticals,

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biology, things that can be taken when you're not feeling so hot.

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And today we are going to be talking about chicken pox and shingles.

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And you're probably thinking what are those two things have to do with one another?

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Well, that's what this episode is all about.

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Just to give you a little background on ourselves if you're a first time listener to us, my

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name is Josh and I have a master's in public health and a bachelor's in biology from the

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University of Texas.

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And I'm also the son to this wonderful lady right across from me who I will let introduce

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herself.

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My name is Jennifer Seltzer and I am Josh's mom.

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And I have a bachelor's in pharmacy, but I also have a doctor of pharmacy degree as well

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too.

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I've been a pharmacist and taught pharmacy students for several decades.

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I'm now retired, but primarily my focus was drug information and helping students learn

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how to acquire information about medicines and disease states and also evaluate clinical

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trials.

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And fun, you know, growing up with my mom, I always thought that what she had was just

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general mom knowledge.

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I had no idea that she was so trained and knowing about all the things drug related.

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It wasn't until I was about 15 where I saw a letter addressed to Dr. Seltzer and I thought

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it was like, who's Dr. Seltzer?

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And then my mom's like, that's me.

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And so it reflects poorly on my curiosity of my mother's career.

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But now that she's retired, I wanted to pull her out of retirement and talk about drugs

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and diseases that affect humans.

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So I figured we could just jump right into it and talk about shingles and chickenpox.

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And it's a viral disease that causes that, right?

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Do you want to give an overview of?

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Sure.

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And so we can't really talk about shingles without first talking about chickenpox or

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chickenpox is known as varicella zoster.

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That's the varicella zoster virus.

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And it used to be before 1993 that all of us would get the chickenpox.

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And if you remember, it was a disease state that was very contagious and it had a generalized

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itchy rash that was usually covered the whole body.

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You usually have symptoms for four to seven days.

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And usually it was an exposure to someone who also had the chickenpox or the varicella

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zoster rash.

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You would incubate about two weeks before you'd start seeing evidence of that particular

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rash.

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Sometimes as parents, you'd have like chickenpox parties so that your kids would, everybody

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would get the chickenpox and get it over with and stuff.

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So usually adults will get a little sicker if they got the chickenpox, if they didn't

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get it as a kid.

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They may get fever and kind of just feel kind of sick before the rash develops.

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Whereas kids usually break out with the rash.

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They may have a day or so of fever and then just feel kind of yucky.

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They can have a fever.

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I mean, they can feel kind of yucky for a couple of days.

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And then it takes about a week or so for all of those little vesicles that have caused

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itchy and developed the rash to crust over.

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And once they've all crust over, especially after they've crust over, then you're considered

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not contagious anymore.

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You do spread the chickenpox primarily by direct person contact.

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You can inhale, like even the bacteria, I'm sorry, the viruses can be emitted from the

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lesions themselves.

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So you could breathe that in potentially and get it.

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Or certainly if you, also if somebody's infected and they cough or whatever, you could also

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potentially get it from them as well that way.

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And then after that fact, so a lot of times we get viruses and then they're gone.

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But this particular virus stays, when you're done with the chickenpox virus, then it stays

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what we call dormant or it's kind of asleep in your basal root ganglia, which is inside

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your nervous system near your spinal cord.

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And it stays there for years.

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And so we're going to then now turn our attention from that point on to talking about shingles

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because shingles is the reactivation of that virus in your nervous system.

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And it primarily occurs in adults, but it can also occur in kids, but kids don't seem

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to develop as many of the big symptoms like adults do when they get shingles.

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Yeah.

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So before we head into shingles, can we stop and maybe talk a little bit about chickenpox

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and maybe just basic viruses real quick?

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Of course.

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All right.

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I think viruses are really interesting because they're one of the smallest things on planet

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Earth that kind of act like an organism, even though they're technically not alive.

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That's a whole nother debate.

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But just to give everybody a concept of what a virus is and kind of what my mom was talking

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about going from that dormant state to the active state.

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So all a virus is, and we'll post a picture on our Instagram just so you have a good idea

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of what it looks like, but it's good to picture a virus kind of like a house.

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Like if you look at a house, it's got an outside structure, but there are ports of entry.

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There are doors, there are garage doors, there are windows.

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And with the right combination of tools, whether that be a key or even some mechanical force

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like lifting up a window, sometimes you could even break a window.

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Don't do that.

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And you can get into the house.

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But also remember inside of the house, there are also doors that might lead to closets

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or bathrooms or bedrooms and things like that.

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So the cell is a similar way.

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And the virus is basically trying to trick the cell into getting inside of it so that

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it can make more of itself.

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A virus is incapable of making more of itself.

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So it actually has this really cool coating on the outside that it has all of these proteins

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on it that we call antigens.

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And then they will try to bind with a cell.

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And if it fits just in the right way, it'll trick the cell into letting it inside of itself.

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Now a virus is just composed of this outside coating, basically just almost like it looks,

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but in this case with varicella, it's actually a herpes virus.

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So not the herpes that you probably know from sexually transmitted diseases.

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Herpes is just a big family of viruses, actually over 100 types of herpes viruses.

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And they come in, I think it's alpha, beta, and gamma, I think just based on their protein

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subunits.

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So varicella actually falls under alpha and it's just one type of herpes virus.

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So basically it has this really cool, almost looks like a basketball, like a shell-like

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virus.

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And then it dumps its genetic material inside of the cell and its genetic material is actually

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DNA.

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You might have heard this because all of your cells have DNA and that's how your cells know

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how to make protein.

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So it actually puts its DNA inside of your own cell and then your cell just sees that

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DNA and incorporates that into its own genome, which we call basically the library of all

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of the DNA inside of your cell.

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And then it just starts to make copies of this virus just without knowing it.

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And it will just make copy after copy after copy after copy.

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And then soon there are so many viruses inside of the cell that it literally explodes.

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And then that's just one cell.

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And now you have so many other viruses then going out to each other cell and doing the

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exact same thing.

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But if you know anything about your body, and hopefully in a little bit, there's this

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thing called the immune system that's kind of sniffing around to see if any funny businesses

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going on.

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And if enough of this virus goes around causing enough trouble, your immune system goes, hang

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on, wait a minute.

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And then they actually bind to these basically these viruses using a lot of different mechanisms.

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We won't go into in detail here, but they will basically try to gobble them up and degrade

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them before they can cause any more damage.

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So when mom is mentioning when you get something like the chickenpox and you get a fever and

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tiredness, that's not really the symptom of chickenpox.

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It's actually partially the symptom of your immune system attacking this virus.

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And the fever is actually raising your temperature in your body to actually reduce the ability

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of the virus to move as quickly because actually the temperature affects the biochemistry of

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certain foreign pathogens.

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And so a lot of times when you feel feverish or malaise or any of these symptoms when you

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get infected with something, it's actually your own body fighting against it.

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And then the secondary symptoms, things like the pustules and rashes on your body, are

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what's actually specific to the virus itself.

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So just to remember that all a virus is, is just a protein coat with genetic material

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inside of it.

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It's trying to get inside of your cells, make more of it, and then move on and do the same

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exact thing.

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So and last thing I'll say, because I'm going on a virus diatribe here, is that my mom was

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talking about this dormant phase.

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So viruses do this really cool thing where they can go from something called the lytic

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cycle and the lysogenic cycle.

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So the lytic cycle is what I describe where the viruses are just going crazy and they're

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trying to replicate.

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But then they come to a risk of like, well, if I do that, I'm going to get found out by

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the immune system.

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And they're not consciously thinking this.

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This is just something that happens.

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So every now and then a virus will just insert its genetic material into a cell.

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And as my mom said, in the case of varicella, it inserts its DNA into nerve cells associated

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with your spinal column and it will just stay asleep, meaning that it won't replicate itself.

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Your cell will just think that's a part of its genetic code and it'll just stay there.

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And it lies dormant, almost kind of like a monster waiting to come out at the perfect

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time.

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And when that perfect time comes out, which is what we're going to talk about with shingles,

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and we still don't really know the environmental trigger that causes this, then it re-emerges

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in these ganglion cells and then you get shingles.

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So I think this would be a perfect segue to then talk about shingles.

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And it's the same exact virus, but just in a different location, correct?

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That is correct.

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So it is interesting, Lisa, when you look in the literature with the chickenpox virus,

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they'll call it varicella zoster, but with shingles, a lot of times you'll see it as

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herpes zoster.

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But as Josh said, it's the same exact virus.

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It's just a way to differentiate from the fact that it's not chickenpox anymore, but

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now it's shingles.

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And what happens is, is that at some point, as Josh said, that virus has been sleeping

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around in your ganglion cells in your nervous system for years, decides to awaken and activate.

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And then it will then start producing the symptoms of shingles.

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Let me just give you just a little bit of just kind of background information about

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shingles.

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So shingles is not a seasonal infection, like some viruses that we know about, like the

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flu, for example.

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So anyway, it can happen at any time during the year.

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It also is that for all of us that were born before 1980, almost all of us are infected

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with this wild type of, we would call the wild type varicella zoster virus, and we're

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all at risk for shingles.

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And about 1.2 million cases of shingles happen each year in the United States, where about

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one in three people will develop shingles in their lifetime.

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And usually most people only have one episode, but you can have a repeat episode of shingles.

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More often we see that in people who are immunocompromised.

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That means people whose immune systems may not be working at optimum levels due to either

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a disease or medication that they're having to take.

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So that means that you said from 1980, so almost the majority of people born from before

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1980 or have been infected by the wild type varicella.

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So there's probably, I mean, I was born after 1980, but I know I had the chickenpox because

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you told me I did.

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And you were born before 1980, correct?

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Yes, I was.

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Rev it in.

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Well, I hope so.

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But so, man, it makes you think, wow, like a lot of us are just walking around with this

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virus inside of us and we don't even know it.

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Right.

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And it's just lying dormant.

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Right.

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Exactly.

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So interestingly, so we're going to so the so I'll get back to that point in just a minute.

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But so the risk of developing shingles increases as you get older.

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And one of the reasons that it's one of the speculated reasons that this happens is because

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again, as you get older, your immune system is not working at the capacity it was when

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you were a 10 year old or a 20 year old.

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So it starts.

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It doesn't work quite as well.

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So it could be that you don't have your immune system that's going to target that varicella

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zoster virus working as well as it used to.

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And so that's one reason.

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That's a good point.

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Yeah.

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One of the best analogies I heard was from a physician, his name's Peter Atiyah.

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And I highly recommend folks listening to his podcast called The Drive.

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It's really good medical information, but he likened the immune system kind of being

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like an arm using the house analogy that I used earlier.

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The immune system is kind of like an army going around to each person's house to kind

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of show proof that nothing nefarious is happening on the inside of that house.

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And if that house can show the proof that nothing nefarious is going on inside, basically

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they show their protein contents, they see no virus here, then the immune system moves

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on.

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But if there is any evidence of virus activity, or even if the cell can't even produce any

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activity, the immune system will kill that cell.

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So even if it's jumping out of that lytic to lysogenic cycle, or from lysogenic to lytic,

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if your immune system is young and healthy and robust, obviously you're not going to

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notice that you have symptoms, even if one of these varicella viruses comes out.

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But as my mom was saying, amongst elderly people and immunocompromised people, if your

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immune system starts to, you know, if your military starts to dwindle a bit and it gets

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a little aged, and over time, then the virus might get a little more adventurous and might

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actually go out and start to copy itself.

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And as we know with certain viruses, they usually grow exponentially, because if one

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cell can explode and make a hundred viruses, and then that hundred viruses infects a cell,

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and then it creates 10,000, so it's an exponential growth thing.

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So just keep in mind, your immune system is doing a lot of work in the background, and

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you don't even know it.

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And it's an amazing feat of biology that you can keep a lot of these things at bay.

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Right.

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And I wanted to clarify for our audience, Josh, I think that you might have missed defining

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what the lysogenic stage is.

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So lytic is more like the viruses collect inside of a cell and it explodes, but lysogenic

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is more that they kind of go dormant.

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Yes, it's that dormant stage.

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Sorry, I forgot to mention that.

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Yeah.

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Okay, so as Josh said, there's a couple of reasons why our immune system may be declining.

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One is, especially they've seen that happen in people who are beyond 50 years of age.

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It started to kind of decline more than when you were younger than that.

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That doesn't mean that if you're younger than 50, you can't get the shingles, but it's

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less common.

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And also to people that are immunosuppressed, either you've got a medical condition that

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suppresses your immune system, like if you have cancer or a human immunodeficiency virus,

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or you are taking immunosuppressive medications, steroids, some drugs like for rheumatoid arthritis

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that can suppress your immune system.

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If you're a bone marrow or a solid organ transplant patient, you're going to have a lower immune

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system.

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So those kinds of things would make you more susceptible to getting the shingles.

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And interesting too, in the literature that I read, it talked about the fact that there

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seemed that more women developed shingles than men, and more whites compared to blacks.

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But the reasons for this aren't really well understood.

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And so I think that, again, it's just collecting data over time just to see how that really

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pans out.

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Interestingly too, most patients with shingles have no history of being exposed to somebody

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00:19:14,720 --> 00:19:20,680
with a herpes zoster virus infection, unlike the chickenpox vaccine.

286
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Because remember, the shingles is already there inside of you.

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So it's not that you got exposed to somebody else.

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It just decides to wake up for the fact that your immune system might not be working as

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well, or it decides to replicate.

290
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Yeah, that's a good point.

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So it's almost like people who had the chickenpox might know that they might get shingles in

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the future, but there are people who are infected with varicella who might not have gotten the

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chickenpox, but then could develop shingles in the future.

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Right?

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00:19:51,440 --> 00:19:56,520
Like if you're infected with this virus, there is a chance, even if you didn't develop chickenpox,

296
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that you could develop shingles?

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I think that if you didn't, I don't know how you could get that virus without having had

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been exposed.

299
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Maybe you had chickenpox and you had, I don't even know how you could have chickenpox without

300
00:20:10,160 --> 00:20:11,160
even having any symptoms.

301
00:20:11,160 --> 00:20:15,960
I guess what I mean is like, could you have gotten such a low level of virus inside that

302
00:20:15,960 --> 00:20:17,960
it didn't present symptoms?

303
00:20:17,960 --> 00:20:20,600
I did not read anything like that.

304
00:20:20,600 --> 00:20:22,120
I did not read anything like that.

305
00:20:22,120 --> 00:20:26,920
That doesn't mean that it's not possible, but that would be, I think, pretty unusual

306
00:20:26,920 --> 00:20:27,920
and stuff.

307
00:20:27,920 --> 00:20:34,360
So it seems more likely that if you'll have enough of a viral load to cause chickenpox.

308
00:20:34,360 --> 00:20:39,480
I'd say that if you, by chance as an adult, let's say you're adult my age and somehow

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00:20:39,480 --> 00:20:45,880
you skated through not ever getting chickenpox as a kid and you get exposed to that varicella

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00:20:45,880 --> 00:20:50,080
zoster virus, the first thing that's going to happen is you're going to get chickenpox.

311
00:20:50,080 --> 00:20:58,000
Yeah, because from what I read, it goes into the areas of the body that are more associated

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with the epidermis, like the mucosal linings, which is what causes the pox, the chickenpox.

313
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And then it migrates just because your body is composed of blood and fluid and the stuff

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moves around.

315
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So the virus eventually finds a home.

316
00:21:15,600 --> 00:21:17,600
It's like, oh, I really love these ganglia.

317
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I'm going to nestle down here and stay a while.

318
00:21:21,280 --> 00:21:25,760
Why it resides there, that's a good question, but maybe it just has the right receptors

319
00:21:25,760 --> 00:21:28,640
to reside there.

320
00:21:28,640 --> 00:21:32,240
Just for those out there, ganglia just means a collection of nerve cells.

321
00:21:32,240 --> 00:21:35,480
So it's like a bunch of them combined together.

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00:21:35,480 --> 00:21:39,680
So a single nerve cell is called a neuron and then a bunch of them together is called

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a ganglion.

324
00:21:40,680 --> 00:21:44,760
So it's just a massive of those nerve cells.

325
00:21:44,760 --> 00:21:50,040
So I think I detracted you from your point, but you were talking about, yeah, essentially

326
00:21:50,040 --> 00:21:54,880
with people who get shingles, they have to have an event before, correct?

327
00:21:54,880 --> 00:21:55,880
Right.

328
00:21:55,880 --> 00:21:57,320
And so let's talk a little bit.

329
00:21:57,320 --> 00:22:05,080
So we talked about chickenpox and how chickenpox presents, while shingles presents differently.

330
00:22:05,080 --> 00:22:12,080
There is, so again, we talked about the fact that this virus kind of lays low in your ganglion

331
00:22:12,080 --> 00:22:16,960
cells, which are nerve cells, and they kind of line your spinal cord.

332
00:22:16,960 --> 00:22:21,420
And your spinal cord has nerve, different types of nerves that go out to different parts

333
00:22:21,420 --> 00:22:25,920
of your body to make things work for you to feel things, for you to move, all that type

334
00:22:25,920 --> 00:22:26,920
of stuff.

335
00:22:26,920 --> 00:22:35,040
So there is a patterned picture of how our nervous system kind of talks to the other

336
00:22:35,040 --> 00:22:38,020
parts of our body, and it's called a dermatome map.

337
00:22:38,020 --> 00:22:44,180
And so basically it shows how our nervous system or the nerves that come from our spinal

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00:22:44,180 --> 00:22:46,680
cord talk to the different areas of our body.

339
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And our spinal cord is broken up into separate sections.

340
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There's the cervical section, which is at the top.

341
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Then the thoracic section was kind of your midsection, and then the lumbar section, which

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00:23:00,520 --> 00:23:02,120
is at the bottom.

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And so when your shingles gets activated and it does its thing, primarily we're seeing

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it have activity in that thoracic area, which is in your chest, kind of mid area to the

345
00:23:14,640 --> 00:23:17,040
lower part of your back as well, too.

346
00:23:17,040 --> 00:23:22,720
And the reason this is important for somebody to understand this is that when you get the

347
00:23:22,720 --> 00:23:28,520
symptoms of shingles, they are going to be located in a specific dermatome, which is

348
00:23:28,520 --> 00:23:29,960
going to just line up.

349
00:23:29,960 --> 00:23:33,200
And it always goes just on one side of your body.

350
00:23:33,200 --> 00:23:36,120
It doesn't cross what we call the midline of your body.

351
00:23:36,120 --> 00:23:37,120
Really?

352
00:23:37,120 --> 00:23:38,120
So it's always one side of the body.

353
00:23:38,120 --> 00:23:39,120
One side of the body.

354
00:23:39,120 --> 00:23:40,120
That's so interesting.

355
00:23:40,120 --> 00:23:43,940
And like the chickenpox, where it goes all over the place.

356
00:23:43,940 --> 00:23:47,960
When you get a shingles infection, it follows a dermatome.

357
00:23:47,960 --> 00:23:53,720
And the symptoms start out, first of all, with maybe feeling some tingly or burning

358
00:23:53,720 --> 00:23:55,400
pain.

359
00:23:55,400 --> 00:24:00,800
And it can be throbbing, because it's following along this dermatome.

360
00:24:00,800 --> 00:24:05,480
And I can give Josh this picture, and he can also post this picture of the dermatomes on

361
00:24:05,480 --> 00:24:07,600
our Instagram as well, too.

362
00:24:07,600 --> 00:24:12,400
Is a good analogy to think about a dermatome is like, if you're thinking about like your

363
00:24:12,400 --> 00:24:18,960
spine is the trunk of a tree, and then each one of the branches off of a tree is essentially

364
00:24:18,960 --> 00:24:21,840
like the nerves going off of that.

365
00:24:21,840 --> 00:24:25,520
And essentially, the shingles would just be affecting one side of the tree.

366
00:24:25,520 --> 00:24:26,520
Is that a good analogy?

367
00:24:26,520 --> 00:24:28,400
Yeah, one limb on one side of the tree.

368
00:24:28,400 --> 00:24:29,400
Exactly.

369
00:24:29,400 --> 00:24:30,400
That's a great picture.

370
00:24:30,400 --> 00:24:31,400
That's a great picture.

371
00:24:31,400 --> 00:24:35,800
And so what happens, so you've got this little tingling burning pain that you feel, and you

372
00:24:35,800 --> 00:24:39,200
may have some associated systemic symptoms as well.

373
00:24:39,200 --> 00:24:42,520
You can have headache or malaise or a fever.

374
00:24:42,520 --> 00:24:49,040
But then with that burning pain, then a few days after that, then you're going to see

375
00:24:49,040 --> 00:24:52,680
this vesicle eruption.

376
00:24:52,680 --> 00:24:59,960
You'll get like a red kind of rash, and then it becomes then a pustule, like it's a bump

377
00:24:59,960 --> 00:25:01,960
filled with pus, kind of.

378
00:25:01,960 --> 00:25:05,880
And then after that, it is called...

379
00:25:05,880 --> 00:25:10,800
So it's a pustule vessel first, and then it ulcerates.

380
00:25:10,800 --> 00:25:16,080
So it may be kind of like the pus thing bursts, and it's kind of like a whole kind of thing.

381
00:25:16,080 --> 00:25:18,080
We've all had that kind of stuff happen to us before.

382
00:25:18,080 --> 00:25:19,960
And then it crusts over.

383
00:25:19,960 --> 00:25:22,160
And so it takes about...

384
00:25:22,160 --> 00:25:30,400
And usually we'll see that pustulating and ulcerating event happen three to five days

385
00:25:30,400 --> 00:25:35,080
after the rash has started and stuff.

386
00:25:35,080 --> 00:25:41,600
And it usually takes about two to four weeks for that rash to heal.

387
00:25:41,600 --> 00:25:43,360
So that's two to four weeks.

388
00:25:43,360 --> 00:25:47,000
And you may have some pain associated with it as well.

389
00:25:47,000 --> 00:25:50,620
And you could have some systemic symptoms as well too.

390
00:25:50,620 --> 00:25:55,560
So it's a fairly uncomfortable and kind of nasty looking kind of rash and stuff.

391
00:25:55,560 --> 00:26:01,040
So it's not a very pleasant experience at all.

392
00:26:01,040 --> 00:26:03,240
And it doesn't seem like there's any warning signs.

393
00:26:03,240 --> 00:26:09,120
It just kind of... for some reason, the virus just decides to break out of that lysogenic

394
00:26:09,120 --> 00:26:16,400
or dormant phase into the lytic phase in this specific dermatome in your thoracic portion

395
00:26:16,400 --> 00:26:17,400
of your spine.

396
00:26:17,400 --> 00:26:18,400
Or your lumbar.

397
00:26:18,400 --> 00:26:19,400
Or in your lumbar.

398
00:26:19,400 --> 00:26:21,400
Now, most of the time it happens there.

399
00:26:21,400 --> 00:26:26,480
And I'd say probably the warning symptoms of it are going to be that prodrome where

400
00:26:26,480 --> 00:26:29,200
you start feeling that burning pain that's really weird.

401
00:26:29,200 --> 00:26:35,760
It's just kind of following a path along a nerve either in your back or your lower back.

402
00:26:35,760 --> 00:26:37,960
Is it always just one side of the body?

403
00:26:37,960 --> 00:26:40,960
Meaning it's always going to be the right side or does it depend on the curse?

404
00:26:40,960 --> 00:26:45,740
No, it can be on either side and any of the dermatomes, but it's not going to cross over

405
00:26:45,740 --> 00:26:46,740
to the other side.

406
00:26:46,740 --> 00:26:47,740
Got you.

407
00:26:47,740 --> 00:26:50,480
If you've got a matching dermatome on the other side, it doesn't cross to the midline.

408
00:26:50,480 --> 00:26:52,080
Does that make sense?

409
00:26:52,080 --> 00:26:53,080
It does.

410
00:26:53,080 --> 00:26:54,080
Yeah.

411
00:26:54,080 --> 00:26:55,080
Wow.

412
00:26:55,080 --> 00:26:56,080
What an interesting virus.

413
00:26:56,080 --> 00:26:57,080
It is.

414
00:26:57,080 --> 00:26:58,080
It's quite fascinating.

415
00:26:58,080 --> 00:27:05,960
Like I said, you can have fatigue, fever, feeling kind of sick, just kind of that malaise

416
00:27:05,960 --> 00:27:07,840
accompanying along with it.

417
00:27:07,840 --> 00:27:14,760
Most of the time this virus gets diagnosed clinically so that you're not doing a blood

418
00:27:14,760 --> 00:27:18,040
test per se to test it.

419
00:27:18,040 --> 00:27:22,880
The only time you would usually do that is if you happen to be someone who ended up with

420
00:27:22,880 --> 00:27:24,360
the pain.

421
00:27:24,360 --> 00:27:29,800
But there's a small percentage of patients that can get the pain associated with the

422
00:27:29,800 --> 00:27:33,000
shingles virus, but don't get the rash.

423
00:27:33,000 --> 00:27:37,640
And so then you've got to figure out, because you've got to do a diagnosis.

424
00:27:37,640 --> 00:27:41,600
And so there are some tests that can be run at that point and stuff.

425
00:27:41,600 --> 00:27:49,440
So again, so we talked about the fact that this virus as shingles causes a nasty kind

426
00:27:49,440 --> 00:27:55,920
of rash that starts out red first and then turns into pustules and then ulcerates and

427
00:27:55,920 --> 00:28:01,040
then crusts over and is associated with some pain.

428
00:28:01,040 --> 00:28:06,320
And so it usually takes, like I said, about two to four weeks for it to heal.

429
00:28:06,320 --> 00:28:11,560
There are some complications that can be associated with this virus.

430
00:28:11,560 --> 00:28:16,640
One of the most common ones is what we've heard of as called post-herpetic neuralgia.

431
00:28:16,640 --> 00:28:22,440
And basically that is pain that persists after that rash has gone away.

432
00:28:22,440 --> 00:28:24,120
It's almost like phantom pain.

433
00:28:24,120 --> 00:28:25,200
It almost is.

434
00:28:25,200 --> 00:28:32,320
And it can continue for, it's usually it's any pain that happens and lasts for about

435
00:28:32,320 --> 00:28:39,080
anything, anything that lasts greater than four weeks, you know, after the rash is gone.

436
00:28:39,080 --> 00:28:41,840
And I mean, I don't know if I'm saying that right.

437
00:28:41,840 --> 00:28:47,320
If the rash lasts and heals over at four weeks and you still have pain after that, then we're

438
00:28:47,320 --> 00:28:49,600
going to call that post-herpetic neuralgia.

439
00:28:49,600 --> 00:28:52,920
Because it doesn't seem that there's an apparent cause for the pain.

440
00:28:52,920 --> 00:28:56,960
It's just almost like the remnants of the nervous system kind of over firing.

441
00:28:56,960 --> 00:29:01,520
Because it was in that ganglionic type cell, you know, because it's in the nervous system

442
00:29:01,520 --> 00:29:02,520
and stuff.

443
00:29:02,520 --> 00:29:03,520
Yeah.

444
00:29:03,520 --> 00:29:07,340
And just as a refresher, a lot of sensations that you feel inside of your body or due to

445
00:29:07,340 --> 00:29:12,560
your nervous system firing, it's a way to process sensory information.

446
00:29:12,560 --> 00:29:19,000
Just, this is a really brief side tangent, but I, when I took some neurobiology classes

447
00:29:19,000 --> 00:29:23,720
in college, there's this, we learned about this surgeon, his name was Wilder Penfield.

448
00:29:23,720 --> 00:29:29,560
He was this Canadian surgeon and he was one of the first surgeons to do open like brain

449
00:29:29,560 --> 00:29:32,680
surgery while somebody was conscious.

450
00:29:32,680 --> 00:29:38,920
In fact, your brain has no nerve endings, meaning that you can poke it and you will

451
00:29:38,920 --> 00:29:41,120
not feel that your brain is being poked.

452
00:29:41,120 --> 00:29:44,040
It's your central nervous system.

453
00:29:44,040 --> 00:29:49,600
But the crazy thing is that he took a electrode, which is basically provides electric current

454
00:29:49,600 --> 00:29:54,440
and he would stimulate different portions of the brain and then ask the patient while

455
00:29:54,440 --> 00:29:57,600
they were awake, like, hey, what are you feeling right now?

456
00:29:57,600 --> 00:30:01,160
And sometimes they would feel somebody touching their arm if he was touching a portion of

457
00:30:01,160 --> 00:30:05,560
their brain or sometimes he would do it and they would hear music.

458
00:30:05,560 --> 00:30:12,760
And so there's this really cool idea that your brain is responsible for getting signals

459
00:30:12,760 --> 00:30:18,520
from the periphery of your body, like your fingers and your toes, like you're experiencing

460
00:30:18,520 --> 00:30:20,720
the world through your digits.

461
00:30:20,720 --> 00:30:23,360
And then your brain has to make sense of that information.

462
00:30:23,360 --> 00:30:29,400
So if you have this virus that is essentially sensing quote unquote phantom signals because

463
00:30:29,400 --> 00:30:34,800
it's causing inflammation to these nerve cells or these ganglion cells, then your brain is

464
00:30:34,800 --> 00:30:37,660
just thinking, oh, we're experiencing pain.

465
00:30:37,660 --> 00:30:43,120
And so it's just going to keep delivering that symptom even though the cause, quote

466
00:30:43,120 --> 00:30:44,720
unquote, the rash is gone.

467
00:30:44,720 --> 00:30:50,360
So it's just like this nasty little trick that unfortunately that varicella is playing

468
00:30:50,360 --> 00:30:53,440
long after it has caused its initial damage.

469
00:30:53,440 --> 00:30:54,880
So just a fun little side tangent.

470
00:30:54,880 --> 00:30:55,880
Yeah, thanks, Josh.

471
00:30:55,880 --> 00:30:56,880
Well, it's not that fun.

472
00:30:56,880 --> 00:30:57,880
Yeah, yeah.

473
00:30:57,880 --> 00:31:01,840
But it's a good picture of what's going on.

474
00:31:01,840 --> 00:31:09,600
And this post-herpetic neuralgia or PHN can happen in up to a third of the patients.

475
00:31:09,600 --> 00:31:14,280
It can go anywhere from as low as 5% of patients up to about a third of the patients can have

476
00:31:14,280 --> 00:31:18,640
this hanging on after they have the shingles rash.

477
00:31:18,640 --> 00:31:25,320
And the risk of getting post-herpetic neuralgia does increase as you get older.

478
00:31:25,320 --> 00:31:32,800
The other thing is that although a lot of shingles viruses occur in those thoracic and

479
00:31:32,800 --> 00:31:42,120
lumbar pathways from the dermatomes in that area, you can also have it affect other dermatomes.

480
00:31:42,120 --> 00:31:45,720
And one in particular is one that affects your eyes.

481
00:31:45,720 --> 00:31:47,160
It's called the trigeminal nerve.

482
00:31:47,160 --> 00:31:51,080
And so it's going to be in the upper part of your spinal cord.

483
00:31:51,080 --> 00:31:57,880
And if you get ocular complications with shingles, it becomes almost a medical emergency because

484
00:31:57,880 --> 00:32:02,600
you can lose your vision if somebody does not take care of it very quickly.

485
00:32:02,600 --> 00:32:07,080
I think we learned about the trigeminal nerve in our migraine episode too, right?

486
00:32:07,080 --> 00:32:12,120
Because I think the trigeminal nerve is affected within migraines with the aura, correct?

487
00:32:12,120 --> 00:32:13,120
Yes.

488
00:32:13,120 --> 00:32:14,120
Yes.

489
00:32:14,120 --> 00:32:15,120
Okay.

490
00:32:15,120 --> 00:32:21,880
So when the trigeminal nerve is affected by the shingles virus, you can get things like

491
00:32:21,880 --> 00:32:24,560
a conjunctivitis, which is kind of like a pink eye.

492
00:32:24,560 --> 00:32:25,560
Another episode?

493
00:32:25,560 --> 00:32:26,560
Yes.

494
00:32:26,560 --> 00:32:31,040
Or it can cause glaucoma, which is increased pressure in your eye.

495
00:32:31,040 --> 00:32:33,160
Or again, like I said, blindness if you don't treat it.

496
00:32:33,160 --> 00:32:38,240
So you want to get to an ophthalmologist right away if you ended up with eye complications

497
00:32:38,240 --> 00:32:41,800
or eye symptoms associated with your shingles virus.

498
00:32:41,800 --> 00:32:42,800
Okay.

499
00:32:42,800 --> 00:32:44,440
That's really good to know.

500
00:32:44,440 --> 00:32:50,480
Other complications of the shingles virus include the fact that it could disseminate

501
00:32:50,480 --> 00:32:52,040
or spread throughout the whole body.

502
00:32:52,040 --> 00:32:56,120
That's not very common only in about one to two percent of patients.

503
00:32:56,120 --> 00:33:00,720
And then you can also have sometimes a bacterial over infection or super infection.

504
00:33:00,720 --> 00:33:04,640
But that again, it's not very common as well too.

505
00:33:04,640 --> 00:33:10,080
We talked about the fact that chickenpox is very transmittable and about chickenpox parties

506
00:33:10,080 --> 00:33:12,600
in the old days and stuff and all.

507
00:33:12,600 --> 00:33:20,760
But also the shingles virus can also be transmitted to other people if they have not had the chickenpox

508
00:33:20,760 --> 00:33:24,400
or they've not had a vaccine and have never had the chickenpox.

509
00:33:24,400 --> 00:33:29,120
So again, it's the virus can be transmitted to other people and people who have never

510
00:33:29,120 --> 00:33:31,040
had the virus before.

511
00:33:31,040 --> 00:33:32,040
Gotcha.

512
00:33:32,040 --> 00:33:33,040
Okay.

513
00:33:33,040 --> 00:33:39,600
So we're going to like now transition into the treatment modalities for shingles because

514
00:33:39,600 --> 00:33:44,520
if you get it, then you're going to want somebody to help you with some of the different things

515
00:33:44,520 --> 00:33:46,160
that go along with it.

516
00:33:46,160 --> 00:33:52,400
The first thing that has been prescribed or recommended for use in shingles vaccine and

517
00:33:52,400 --> 00:33:59,320
shingle in the shingles virus disease infection is our antivirals.

518
00:33:59,320 --> 00:34:03,940
So there's there's several antivirals that that are recommended.

519
00:34:03,940 --> 00:34:08,800
They should be used as early as possible in the disease state in the first 72 hours.

520
00:34:08,800 --> 00:34:14,760
So the first three days and you what what the reason for the antiviral is is to you

521
00:34:14,760 --> 00:34:23,160
want to hopefully speed up the lesion or those vesicle them getting better and resolving.

522
00:34:23,160 --> 00:34:27,720
You want to decrease the number of new lesions that develop.

523
00:34:27,720 --> 00:34:33,040
You want to also reduce viral shedding so that it doesn't spread as much.

524
00:34:33,040 --> 00:34:38,480
And you also want to hopefully decrease some of the severity of the acute pain.

525
00:34:38,480 --> 00:34:44,120
It also may help to prevent ocular complications or the eye complications.

526
00:34:44,120 --> 00:34:47,580
And it may help to decrease that post herpetic neuralgia risk.

527
00:34:47,580 --> 00:34:54,060
So the antivirals are important to give if you do get shingles in those first 72 hours.

528
00:34:54,060 --> 00:35:00,440
The most common ones that are used are acyclovir, valacyclovir and vancyclovir.

529
00:35:00,440 --> 00:35:04,480
And I assume that these are either prescribed by a doctor.

530
00:35:04,480 --> 00:35:05,480
You probably get their prescription.

531
00:35:05,480 --> 00:35:08,460
No, you know, you can get an oral prescription for them.

532
00:35:08,460 --> 00:35:13,240
They're all oral medications so you can get a prescription for them and get it filled

533
00:35:13,240 --> 00:35:15,020
in your pharmacy and take it.

534
00:35:15,020 --> 00:35:18,720
Usually you take them for about seven, seven days.

535
00:35:18,720 --> 00:35:25,280
If you have really serious symptoms associated with your shingles infection, then you you

536
00:35:25,280 --> 00:35:28,400
might have to be hospitalized and receive some IV therapy.

537
00:35:28,400 --> 00:35:29,400
Yeah.

538
00:35:29,400 --> 00:35:34,340
And because was either chickenpox or shingles with with time you're getting them taking

539
00:35:34,340 --> 00:35:40,160
antiviral, it's probably better to send somebody else to get the antivirals just because you

540
00:35:40,160 --> 00:35:45,480
don't because it can be spread via these openings in your mucosal lining or even in droplets.

541
00:35:45,480 --> 00:35:49,480
If they get out, it might be good to send somebody else to also to get it relatively

542
00:35:49,480 --> 00:35:53,920
quickly because viruses, as we know, spread or they replicate really quickly.

543
00:35:53,920 --> 00:36:00,000
An antiviral is actually meant to slow down that replication process for viruses.

544
00:36:00,000 --> 00:36:06,440
So your immune system has time to catch up to the load that the viruses are causing inside

545
00:36:06,440 --> 00:36:07,640
of the body.

546
00:36:07,640 --> 00:36:14,600
It's like, you know, you remember that story, like when the Dutch boy, you know, putting

547
00:36:14,600 --> 00:36:17,240
his finger in the in the dike.

548
00:36:17,240 --> 00:36:20,400
And you're essentially that's essentially what antivirals are.

549
00:36:20,400 --> 00:36:25,480
You're trying to stop the flow so that you have time to repair because you don't want

550
00:36:25,480 --> 00:36:29,280
that dam to break because then it takes a lot of energy and effort for your immune system

551
00:36:29,280 --> 00:36:30,880
to clean up after that.

552
00:36:30,880 --> 00:36:32,800
That's a great picture as well, too, Josh.

553
00:36:32,800 --> 00:36:38,800
So and so the other thing, so you're going to want to try to address the actual virus

554
00:36:38,800 --> 00:36:39,800
itself.

555
00:36:39,800 --> 00:36:46,760
But you may want to take some some medications for pain relief because the pain can be I've

556
00:36:46,760 --> 00:36:51,720
not had shingles myself personally, but I hear that it can be quite uncomfortable.

557
00:36:51,720 --> 00:36:59,000
You can take over the counter pain relief medications such as Tylenol or Advil or Motrin.

558
00:36:59,000 --> 00:37:01,640
Sometimes they work and sometimes they don't.

559
00:37:01,640 --> 00:37:05,760
They can help off for sure help you if you have a fever or just the malaise part of the

560
00:37:05,760 --> 00:37:08,800
of the virus that they can help with that.

561
00:37:08,800 --> 00:37:12,720
The other things that are used to help with the pain of shingles are there's a topical

562
00:37:12,720 --> 00:37:17,640
cream called capsaicin that can help with the with the pain of shingles.

563
00:37:17,640 --> 00:37:22,840
And also you can get lidocaine patches, which is kind of an anesthetic or not kind of, but

564
00:37:22,840 --> 00:37:26,600
it is an anesthetic and it can help with the pain as well, too.

565
00:37:26,600 --> 00:37:30,240
In fact, capsaicin is the molecule associated with spicy food.

566
00:37:30,240 --> 00:37:31,240
That's right.

567
00:37:31,240 --> 00:37:32,240
It is.

568
00:37:32,240 --> 00:37:36,360
That you can also use that topically to actually soothe the pain because I hate spicy food.

569
00:37:36,360 --> 00:37:37,920
It gives me so much pain.

570
00:37:37,920 --> 00:37:41,360
But if I imagine putting it on the outside of your body has a different effect.

571
00:37:41,360 --> 00:37:45,080
It's amazing context matters when you're putting molecules in places.

572
00:37:45,080 --> 00:37:46,080
That's right.

573
00:37:46,080 --> 00:37:47,080
That's right.

574
00:37:47,080 --> 00:37:51,160
Other things that are used to manage the pain that's associated with the shingles virus

575
00:37:51,160 --> 00:37:55,280
infection are some patients actually do need narcotics.

576
00:37:55,280 --> 00:38:00,440
So things like opiates, oxycodone, morphine and stuff, because the pain can be pretty

577
00:38:00,440 --> 00:38:01,540
severe.

578
00:38:01,540 --> 00:38:07,200
Other things that have been used to manage the pain associated with shingles are gabapentin

579
00:38:07,200 --> 00:38:08,760
and pregabalin.

580
00:38:08,760 --> 00:38:16,400
They are actually anti-seizure medications, but they have mechanisms that have been proposed

581
00:38:16,400 --> 00:38:24,920
anyway to have some chemical interference with the pain mechanisms that are going on

582
00:38:24,920 --> 00:38:26,160
in your nervous system.

583
00:38:26,160 --> 00:38:29,800
So that's why they could potentially work.

584
00:38:29,800 --> 00:38:38,160
And then they've also used antidepressants to manage the pain associated with shingles.

585
00:38:38,160 --> 00:38:42,780
And patients that are kind of resistant to these effects, there also have been some studies

586
00:38:42,780 --> 00:38:47,340
where they use botulinum toxin injections to help with the pain as well too.

587
00:38:47,340 --> 00:38:49,440
So that's not going to be the first line therapy.

588
00:38:49,440 --> 00:38:52,080
That's going to be kind of towards the end and stuff.

589
00:38:52,080 --> 00:38:58,560
Yeah, because imagine having something like PHN is dealing with chronic pain.

590
00:38:58,560 --> 00:39:00,200
It's just got to be awful.

591
00:39:00,200 --> 00:39:06,960
So you're kind of like, wow, I know I've been in pain for a long time and it affects your

592
00:39:06,960 --> 00:39:07,960
mood.

593
00:39:07,960 --> 00:39:10,840
So I imagine sometimes maybe it's not even just about the pain.

594
00:39:10,840 --> 00:39:15,280
It's about learning how to bear the pain because that can be really tough.

595
00:39:15,280 --> 00:39:17,080
So you just want it to end.

596
00:39:17,080 --> 00:39:22,360
And it's like, well, can I bear it not ending knowing that this has happened?

597
00:39:22,360 --> 00:39:23,360
Right.

598
00:39:23,360 --> 00:39:24,360
And that's a good point.

599
00:39:24,360 --> 00:39:31,080
I neglected to mention this, but this post-herpetic neuralgia pain can last for months.

600
00:39:31,080 --> 00:39:34,520
And I've even read that in some patients it could last for years.

601
00:39:34,520 --> 00:39:36,720
So it's bad.

602
00:39:36,720 --> 00:39:44,000
So in that 30% or so of patients that get it, it's a bum deal.

603
00:39:44,000 --> 00:39:49,680
And on a lighter note, one of the other great treatments for shingles or chicken pox is

604
00:39:49,680 --> 00:39:51,240
oatmeal.

605
00:39:51,240 --> 00:39:52,240
Oatmeal baths.

606
00:39:52,240 --> 00:39:53,240
Are you just about to get to that?

607
00:39:53,240 --> 00:39:54,240
I was just about to get to that.

608
00:39:54,240 --> 00:39:55,240
So yeah.

609
00:39:55,240 --> 00:39:58,320
So there are some other things that can be used to help reduce it.

610
00:39:58,320 --> 00:40:02,280
It's primarily to help reducing the itching that might be associated with it and stuff

611
00:40:02,280 --> 00:40:05,720
or just to just bring just some relief.

612
00:40:05,720 --> 00:40:08,520
I can remember when Josh and his brother had the chicken pox.

613
00:40:08,520 --> 00:40:12,360
They had their oatmeal bath and they stuck them in there and somehow they felt good while

614
00:40:12,360 --> 00:40:13,360
they were taking that bath.

615
00:40:13,360 --> 00:40:18,000
So I actually looked up the history of this because I was really curious about why oatmeal

616
00:40:18,000 --> 00:40:19,000
of all things.

617
00:40:19,000 --> 00:40:26,400
And actually it's been used since like 2000 BC in the Egyptian times.

618
00:40:26,400 --> 00:40:31,160
It's just been kind of known to kind of cause this soothing effect.

619
00:40:31,160 --> 00:40:39,160
And long story short, this is just a side little food chemistry thing.

620
00:40:39,160 --> 00:40:44,840
When you boil oats, very much like when you boil fruit, this is how you make jelly or

621
00:40:44,840 --> 00:40:47,840
jam.

622
00:40:47,840 --> 00:40:53,560
When you boil fruit, you release these things inside of the fruit.

623
00:40:53,560 --> 00:40:54,560
It's called pectin.

624
00:40:54,560 --> 00:40:59,640
It essentially keeps the binding of the cell walls because plants are made of these things

625
00:40:59,640 --> 00:41:04,520
that are a little bit different than animal cells and that really helps them stick together.

626
00:41:04,520 --> 00:41:07,020
And so you basically get this kind of, we call it a colloid.

627
00:41:07,020 --> 00:41:11,920
It's a colloidal solution, which is almost kind of this gel like solution where things

628
00:41:11,920 --> 00:41:13,680
are just kind of suspended animation.

629
00:41:13,680 --> 00:41:17,480
I've ever seen jello before and things suspended in that jello.

630
00:41:17,480 --> 00:41:19,280
That's a colloid.

631
00:41:19,280 --> 00:41:22,840
And so very much like when you boil fruit and you kind of get these together.

632
00:41:22,840 --> 00:41:26,240
And actually that's the difference between jelly and jam is that one has pectin and one

633
00:41:26,240 --> 00:41:30,080
doesn't, which is why jam is more spreadable and jelly isn't.

634
00:41:30,080 --> 00:41:31,560
I might have that backwards, please correct me.

635
00:41:31,560 --> 00:41:32,560
I think that's correct.

636
00:41:32,560 --> 00:41:33,560
I think that's correct.

637
00:41:33,560 --> 00:41:36,720
Because the jam has the actual pieces of fruit in it.

638
00:41:36,720 --> 00:41:38,520
And so same with oats.

639
00:41:38,520 --> 00:41:42,160
So like when you boil them, actually a lot of these properties get leached out and they

640
00:41:42,160 --> 00:41:46,520
go into the water and they kind of into this colloidal solution.

641
00:41:46,520 --> 00:41:53,080
And so when you apply them to the skin, they have this anti-poritic, that was a fun word

642
00:41:53,080 --> 00:41:55,720
that you taught me, pruritic, which basically just means itchy.

643
00:41:55,720 --> 00:41:56,720
It's P-R-U-R-I-T-I-C.

644
00:41:56,720 --> 00:41:57,720
Yeah, pruritic.

645
00:41:57,720 --> 00:42:01,680
You can impress people with that next time.

646
00:42:01,680 --> 00:42:05,560
And so it has this kind of soothing quality.

647
00:42:05,560 --> 00:42:08,080
And when they found this out, now they put it in a lot of cosmetics.

648
00:42:08,080 --> 00:42:13,560
They put it in shampoos and lotions because they found out this property of oatmeal not

649
00:42:13,560 --> 00:42:18,560
only is anti-itch, but it also makes your skin feel a little creamier and smoother.

650
00:42:18,560 --> 00:42:23,660
And so it's also now probably in a lot of products you use to make yourself feel nice

651
00:42:23,660 --> 00:42:25,440
and vibrant and young.

652
00:42:25,440 --> 00:42:28,000
So yeah, I thought that was really interesting.

653
00:42:28,000 --> 00:42:29,000
There you go.

654
00:42:29,000 --> 00:42:33,160
In addition to taking an oatmeal bath, the other things that you could use potentially

655
00:42:33,160 --> 00:42:39,400
to help yourself feel better, you could put some wet compresses on the area of the rash

656
00:42:39,400 --> 00:42:42,680
or where the pain is to just help it feel better.

657
00:42:42,680 --> 00:42:48,000
You don't want to use the wet compresses if you've also put a cream or a patch on at the

658
00:42:48,000 --> 00:42:49,000
same time.

659
00:42:49,000 --> 00:42:53,520
You could either wipe it off or just reduce the effect of the cream or the patch.

660
00:42:53,520 --> 00:42:56,280
So again, they're used separately.

661
00:42:56,280 --> 00:42:58,520
There's an old time favorite.

662
00:42:58,520 --> 00:43:00,800
It's like in the pink bottle, the calamine lotion.

663
00:43:00,800 --> 00:43:06,480
You can use that for reducing itching or just apply some comfort to that area.

664
00:43:06,480 --> 00:43:10,680
And then also wearing loose clothing because can you imagine if you're in pain and then

665
00:43:10,680 --> 00:43:14,240
you've got like leggings, then that would not feel very good.

666
00:43:14,240 --> 00:43:21,240
So you're going to want to use that light loose clothing to help feel better and stuff.

667
00:43:21,240 --> 00:43:24,680
You want to make sure you keep that rash clean and dry.

668
00:43:24,680 --> 00:43:30,920
You don't want to put topical antibiotics or adhesives on it.

669
00:43:30,920 --> 00:43:34,160
You don't want to close it up because that's not going to be good for it and stuff.

670
00:43:34,160 --> 00:43:37,680
So you don't need to use topical antibiotics and stuff because that's not going to help

671
00:43:37,680 --> 00:43:41,400
it get better because an antibiotic does not treat a virus.

672
00:43:41,400 --> 00:43:46,780
Yeah, and biotics are for bacteria and unfortunately this is not a bacterial infection.

673
00:43:46,780 --> 00:43:51,760
So those are mechanisms for when you have shingles.

674
00:43:51,760 --> 00:43:54,880
Needs to treat the actual virus itself.

675
00:43:54,880 --> 00:44:01,520
So now we're going to move into, well, is there anything we can do to prevent the virus?

676
00:44:01,520 --> 00:44:05,760
And obviously what's been developed is a vaccine.

677
00:44:05,760 --> 00:44:14,040
Yeah, and we are very aware that vaccines are a little bit of a hot topic nowadays.

678
00:44:14,040 --> 00:44:21,360
And we understand if you're listening to us might have a different view of vaccines.

679
00:44:21,360 --> 00:44:27,240
We are just kind of under the view that when we read the literature that we are making

680
00:44:27,240 --> 00:44:31,560
the assumption that these are developed in a safe and effective way that have been evaluated

681
00:44:31,560 --> 00:44:36,480
by organizations like the FDA.

682
00:44:36,480 --> 00:44:41,120
And we are just basically, we're not experts.

683
00:44:41,120 --> 00:44:45,880
We're trained in a certain field and we are kind of going into the medical literature

684
00:44:45,880 --> 00:44:49,920
and just reporting what we find.

685
00:44:49,920 --> 00:44:55,440
And we want y'all to make the best health decisions that you can make based on the information

686
00:44:55,440 --> 00:44:57,360
that we find.

687
00:44:57,360 --> 00:45:01,720
But not every condition out there is preventable.

688
00:45:01,720 --> 00:45:06,120
So it's kind of cool that we have a technology that can at least provide some type of preventative

689
00:45:06,120 --> 00:45:08,520
strategy.

690
00:45:08,520 --> 00:45:11,880
Because certain things like cardiovascular disease or cancer, there are behaviors that

691
00:45:11,880 --> 00:45:14,040
you can do to maybe reduce the risk.

692
00:45:14,040 --> 00:45:17,600
And that's another thing I want to talk about too is the idea of risk.

693
00:45:17,600 --> 00:45:22,380
So risk, a lot of times when we deal with the medical literature, we're dealing in things

694
00:45:22,380 --> 00:45:23,800
called probability.

695
00:45:23,800 --> 00:45:30,080
And probability is the idea that there is a certain likelihood of something happening

696
00:45:30,080 --> 00:45:31,080
to you.

697
00:45:31,080 --> 00:45:39,320
So for example, if you have, let's say you're driving in a car and there is a 90% chance

698
00:45:39,320 --> 00:45:42,600
that you are going to make it to your destination safe.

699
00:45:42,600 --> 00:45:44,640
That is not guaranteed that you're going to be safe.

700
00:45:44,640 --> 00:45:49,200
There is a 10% chance that you could not arrive safely at your destination.

701
00:45:49,200 --> 00:45:51,760
And it is up to, I'm making up these figures by the way.

702
00:45:51,760 --> 00:45:54,200
I think it's much safer than that.

703
00:45:54,200 --> 00:45:58,200
But there is a chance that you could not make it safely.

704
00:45:58,200 --> 00:46:01,840
But it's up to you to see if am I going to get in the car today?

705
00:46:01,840 --> 00:46:06,640
And then if you get in a car accident, should I wear my seatbelt or not?

706
00:46:06,640 --> 00:46:09,480
To prevent major injury.

707
00:46:09,480 --> 00:46:14,200
And you could arrive at your destination without your seatbelt on and be safe.

708
00:46:14,200 --> 00:46:18,000
But you could also get in a car accident and if you don't have your seatbelt on, you'll

709
00:46:18,000 --> 00:46:20,160
have an adverse outcome.

710
00:46:20,160 --> 00:46:21,160
Will you die?

711
00:46:21,160 --> 00:46:22,680
There is a chance you might.

712
00:46:22,680 --> 00:46:29,240
And so when we talk about probability, we're just talking about likelihood of events because

713
00:46:29,240 --> 00:46:33,180
unfortunately we're humans and we don't have perfect information.

714
00:46:33,180 --> 00:46:36,840
And so probability basically comes into light when we have imperfect information.

715
00:46:36,840 --> 00:46:43,720
We say based on these assumptions and these things that we do, this is the outcome.

716
00:46:43,720 --> 00:46:47,060
This is the likely outcome, whatever that percentage may be.

717
00:46:47,060 --> 00:46:50,680
But there could be a percentage of people where that outcome is not favorable and that

718
00:46:50,680 --> 00:46:52,040
could be for myriad factors.

719
00:46:52,040 --> 00:46:56,600
And when we're talking about vaccines, if you got vaccinated and you still got the shingles,

720
00:46:56,600 --> 00:47:00,240
for example, it could be because the vaccine was bad.

721
00:47:00,240 --> 00:47:03,560
It could be that your immune system didn't respond as favorably to it.

722
00:47:03,560 --> 00:47:08,780
It could be the fact that the certain type of shingle, the varicella virus just overtook

723
00:47:08,780 --> 00:47:09,880
your immune system.

724
00:47:09,880 --> 00:47:15,360
So when we talk about adverse events, even when you get a health intervention, just like

725
00:47:15,360 --> 00:47:20,000
people who've never smoked a day in their life can still get lung cancer, there's still

726
00:47:20,000 --> 00:47:22,640
a probability there even though it's very low.

727
00:47:22,640 --> 00:47:24,240
So I just wanted to kind of give that as a caveat.

728
00:47:24,240 --> 00:47:26,720
I don't know if you want to add anything on to that.

729
00:47:26,720 --> 00:47:31,320
I know I think you covered most everything I think that needs to be said about that.

730
00:47:31,320 --> 00:47:32,320
So, okay.

731
00:47:32,320 --> 00:47:33,320
Yeah.

732
00:47:33,320 --> 00:47:34,320
We're here to provide information.

733
00:47:34,320 --> 00:47:39,440
You're your own person, make your own choices and we love you.

734
00:47:39,440 --> 00:47:44,120
So on that note, I'm going to talk about the shingles vaccine because the shingles virus,

735
00:47:44,120 --> 00:47:54,040
I mean, the effects of that dormant shingles virus is preventable with a vaccine.

736
00:47:54,040 --> 00:48:00,800
There was a vaccine that came out initially against the shingles virus in 2006.

737
00:48:00,800 --> 00:48:03,680
That was the first one that came out and it was a single dose virus.

738
00:48:03,680 --> 00:48:07,560
I mean, I'm sorry, a single, I am not doing well with words today.

739
00:48:07,560 --> 00:48:08,680
Words are hard.

740
00:48:08,680 --> 00:48:10,800
It was a single dose vaccine.

741
00:48:10,800 --> 00:48:16,520
It came out in 2006, but then since that time it was shown that it was not as effective

742
00:48:16,520 --> 00:48:19,160
and that was a big deal.

743
00:48:19,160 --> 00:48:22,960
You know, it was a single dose, but it wasn't effective as effective.

744
00:48:22,960 --> 00:48:24,680
And so it has since been replaced.

745
00:48:24,680 --> 00:48:29,760
I think it was at what 68% effective.

746
00:48:29,760 --> 00:48:37,360
And it dropped to 40% effectiveness in people over 70 and 15 or 18% effectiveness in people

747
00:48:37,360 --> 00:48:38,480
over 80.

748
00:48:38,480 --> 00:48:43,480
So again, it was like almost like you had, it didn't provide a lot of benefits and stuff

749
00:48:43,480 --> 00:48:45,120
as the older you got.

750
00:48:45,120 --> 00:48:47,480
So that was a bummer, you know?

751
00:48:47,480 --> 00:48:51,480
So yeah, I just want to start to do another tangent, but I feel like maybe it might be

752
00:48:51,480 --> 00:48:55,680
a good idea to just do a basic overview of what a vaccine actually is or what it does

753
00:48:55,680 --> 00:48:57,360
because we haven't talked about it yet.

754
00:48:57,360 --> 00:48:58,360
Sure.

755
00:48:58,360 --> 00:49:03,240
So the theory, and please fill in my gaps if I've forgotten, but your immune system

756
00:49:03,240 --> 00:49:06,880
when it encounters a pathogen that it's never seen before.

757
00:49:06,880 --> 00:49:09,840
And a pathogen is bacteria or a virus.

758
00:49:09,840 --> 00:49:10,840
Yeah, fungus.

759
00:49:10,840 --> 00:49:13,680
Something that's not welcome in your body.

760
00:49:13,680 --> 00:49:16,400
Yeah, that's going to cause some type of disease.

761
00:49:16,400 --> 00:49:19,280
And if it's never seen it before, it doesn't know how to respond to it.

762
00:49:19,280 --> 00:49:26,480
Remember with our house example, it's like if it's showing a key that you don't have

763
00:49:26,480 --> 00:49:30,360
a lock to, there's no way to get that door to open up.

764
00:49:30,360 --> 00:49:36,280
So if there is a virus or a bacteria that's in your body, your immune system can't identify

765
00:49:36,280 --> 00:49:37,280
it.

766
00:49:37,280 --> 00:49:43,400
So it'll essentially just run rampant, cause a disease, and then your body learns if you

767
00:49:43,400 --> 00:49:48,280
survive that, okay, this thing caused a bad thing inside of us.

768
00:49:48,280 --> 00:49:53,320
Let's learn next time it comes inside of us to sniff it out really, really quickly.

769
00:49:53,320 --> 00:49:59,360
So your body has this whole host of tools to be able to fight against this, things like

770
00:49:59,360 --> 00:50:03,320
antibodies and white blood cells and macrophages and T cells.

771
00:50:03,320 --> 00:50:08,560
And that's beyond the scope of my knowledge and understanding, because there are immunologists

772
00:50:08,560 --> 00:50:09,560
out there.

773
00:50:09,560 --> 00:50:10,560
Mine too.

774
00:50:10,560 --> 00:50:11,560
Yeah, who are great at this.

775
00:50:11,560 --> 00:50:15,920
I would highly recommend listening to a podcast called TWIV this week in Virology, who are

776
00:50:15,920 --> 00:50:20,520
amazing at just talking about viruses and they are so awesome.

777
00:50:20,520 --> 00:50:22,920
And they just really do a great job of talking about this.

778
00:50:22,920 --> 00:50:30,460
So the goal with a vaccine is like, well, what if we give a small portion of the virus

779
00:50:30,460 --> 00:50:37,880
so that your body kind of knows what to expect prior to being infected.

780
00:50:37,880 --> 00:50:39,680
And this technology can take many different forms.

781
00:50:39,680 --> 00:50:40,920
And we're going to talk about that.

782
00:50:40,920 --> 00:50:42,280
My mom just talked about a lot.

783
00:50:42,280 --> 00:50:47,480
You can give people an attenuated version of a virus, meaning that it's actually the

784
00:50:47,480 --> 00:50:50,700
whole virus is inside of it, but it's been killed.

785
00:50:50,700 --> 00:50:53,440
So it shouldn't be active or alive.

786
00:50:53,440 --> 00:50:57,720
But now our vaccine technology has gotten much more sophisticated.

787
00:50:57,720 --> 00:51:02,200
We can even take some of just the genetic material that was inside of the virus and

788
00:51:02,200 --> 00:51:07,600
say, well, this is the part that seems to be good that the immune system can sniff out.

789
00:51:07,600 --> 00:51:11,920
And we call those subunit vaccines or recombinant DNA vaccines.

790
00:51:11,920 --> 00:51:18,000
And you've probably heard about maybe in the coronavirus pandemic, we've also had mRNA

791
00:51:18,000 --> 00:51:19,000
vaccines.

792
00:51:19,000 --> 00:51:20,000
We won't get into that as well.

793
00:51:20,000 --> 00:51:29,400
But there are many different ways to try to get your body to become prepared for a pathogen

794
00:51:29,400 --> 00:51:31,960
coming inside of your body.

795
00:51:31,960 --> 00:51:38,040
So yeah, going back to what we were talking about with the initial shingles vaccine, what

796
00:51:38,040 --> 00:51:43,440
my mom is saying is that the first version, I believe you said it was a attenuated virus.

797
00:51:43,440 --> 00:51:45,000
The first one was a live virus.

798
00:51:45,000 --> 00:51:46,000
It was a live virus.

799
00:51:46,000 --> 00:51:47,000
Okay.

800
00:51:47,000 --> 00:51:53,800
So it was even a risk maybe of, yeah, even getting some live virus inside of you as well.

801
00:51:53,800 --> 00:51:57,240
But I think the assumption there was that the dose would be low enough that it wouldn't

802
00:51:57,240 --> 00:51:58,240
cause pathogenicity.

803
00:51:58,240 --> 00:51:59,240
Correct?

804
00:51:59,240 --> 00:52:00,240
That's correct.

805
00:52:00,240 --> 00:52:01,240
No, I'm good.

806
00:52:01,240 --> 00:52:02,240
I'm good.

807
00:52:02,240 --> 00:52:13,520
So going back towards that vaccine, were you done talking about that, the first one that

808
00:52:13,520 --> 00:52:14,520
we came out with?

809
00:52:14,520 --> 00:52:19,240
I wasn't going to really spend a whole lot of time on that vaccine because it has been

810
00:52:19,240 --> 00:52:20,960
taken off the market in 2020.

811
00:52:20,960 --> 00:52:27,080
And so it's not even an option for people to get anymore.

812
00:52:27,080 --> 00:52:41,540
So then to move on from that, so a newer version of that shingles vaccine was created in 2017.

813
00:52:41,540 --> 00:52:47,400
And it's called Shingrix, S-H-I-N-G-R-I-X, Shingrix.

814
00:52:47,400 --> 00:52:56,440
And it's a recombinant varicella zoster glycoprotein E antigen.

815
00:52:56,440 --> 00:53:04,600
So this glycoprotein E antigen is a main target of what we call the CD4 plus cells, which

816
00:53:04,600 --> 00:53:06,160
is, it's a T cell.

817
00:53:06,160 --> 00:53:07,880
It's just part of your immune system.

818
00:53:07,880 --> 00:53:10,240
So that helps to generate that immune response.

819
00:53:10,240 --> 00:53:17,720
And so they've picked out this piece of the varicella or the herpes zoster virus to create

820
00:53:17,720 --> 00:53:18,720
the vaccine.

821
00:53:18,720 --> 00:53:19,720
Yeah.

822
00:53:19,720 --> 00:53:23,440
On the picture that we'll post on our Instagram with a picture of a herpes virus, the glycoprotein

823
00:53:23,440 --> 00:53:28,200
is essentially the shell on the outside of the virus.

824
00:53:28,200 --> 00:53:33,560
So it's essentially the thing that will eventually, it uses to get inside of your cells in the

825
00:53:33,560 --> 00:53:34,560
first place.

826
00:53:34,560 --> 00:53:40,120
So we're just taking those proteins on the outside of the shell of the herpes virus.

827
00:53:40,120 --> 00:53:46,600
And then you just make a whole bunch of those proteins by putting the DNA inside of a yeast.

828
00:53:46,600 --> 00:53:49,840
And then the yeast basically turns out a bunch of those proteins.

829
00:53:49,840 --> 00:53:53,440
And then you essentially supply those with the people.

830
00:53:53,440 --> 00:54:00,080
And so with that, with giving this, injecting this part into your body, this part of this

831
00:54:00,080 --> 00:54:06,300
virus into your body, it stimulates your immune system and you start having active immunity.

832
00:54:06,300 --> 00:54:11,780
So it kicks in your immune system and it helps to protect against zoster disease because

833
00:54:11,780 --> 00:54:17,620
it now starts to recognize this virus and it's going to have the army and it's going

834
00:54:17,620 --> 00:54:24,120
to be on guard for attacks so that if they see any parts of it, that it'll get knocked

835
00:54:24,120 --> 00:54:26,400
out.

836
00:54:26,400 --> 00:54:33,200
And this virus, I mean, oh my gosh, this vaccine, the Shingrix vaccine is approved for use in

837
00:54:33,200 --> 00:54:36,480
people who are 50 years of age and older.

838
00:54:36,480 --> 00:54:41,800
And it's also approved, it's just got a recent approval for use in immunocompromised patients

839
00:54:41,800 --> 00:54:44,680
19 years of age and older.

840
00:54:44,680 --> 00:54:49,680
So again, remember those patients with a immune system that's not working correctly are definitely

841
00:54:49,680 --> 00:54:52,180
much more at risk of developing shingles.

842
00:54:52,180 --> 00:54:57,600
And so this virus, this vaccine is approved for use in those patients as well.

843
00:54:57,600 --> 00:55:06,960
There is, so a question would be, well, tell me again who all can get the Shingrix vaccine?

844
00:55:06,960 --> 00:55:13,980
And so it's going to be, in addition to people who are over 50 years or people who are immunocompromised

845
00:55:13,980 --> 00:55:19,240
and over 19 years of age, you also want to get it if you've actually had the shingles

846
00:55:19,240 --> 00:55:24,800
because you can get the shingles again, even though it's not as likely, but if you've had

847
00:55:24,800 --> 00:55:27,600
it once, you probably never want to get it again.

848
00:55:27,600 --> 00:55:30,760
You want to make sure if you're going to get the Shingrix vaccine after you've had the

849
00:55:30,760 --> 00:55:35,440
shingles that you want to make sure that your rash has completely healed over before you

850
00:55:35,440 --> 00:55:36,960
get the virus, the vaccine.

851
00:55:36,960 --> 00:55:40,960
Yeah, because probably the varicella virus is still inside of your cells.

852
00:55:40,960 --> 00:55:42,640
It's just lying dormant again.

853
00:55:42,640 --> 00:55:43,640
Right.

854
00:55:43,640 --> 00:55:48,480
And so if it does come out of that dormant phase again, you want to have an active defense

855
00:55:48,480 --> 00:55:49,480
towards it.

856
00:55:49,480 --> 00:55:57,040
And the other thing we mentioned, the older shingles vaccine, which was called Zostavax.

857
00:55:57,040 --> 00:56:04,440
If you happen to be a person between 2006 and 2018 that got Zostavax and it again, we

858
00:56:04,440 --> 00:56:08,920
talked about the fact that it's that its activity dropped over time.

859
00:56:08,920 --> 00:56:11,280
And so it was not as effective.

860
00:56:11,280 --> 00:56:14,520
Then you can you can get the Shingrix vaccine.

861
00:56:14,520 --> 00:56:22,240
You need to wait at least eight weeks after your last Zostavax dose.

862
00:56:22,240 --> 00:56:26,200
But again, that's that's kind of a moot point now because Zostavax hasn't been around for

863
00:56:26,200 --> 00:56:27,240
three years.

864
00:56:27,240 --> 00:56:33,400
So anybody who had Zostavax in the past is eligible to get the Shingrix vaccine now.

865
00:56:33,400 --> 00:56:40,000
And then also if you've had the chicken box vaccine, there is actually a chicken pox vaccine.

866
00:56:40,000 --> 00:56:45,480
I'm not mistaken that I was trying to look that up, but I just I forgot to write it down

867
00:56:45,480 --> 00:56:46,480
in my notes.

868
00:56:46,480 --> 00:56:48,720
I think it was an attenuated live vaccine.

869
00:56:48,720 --> 00:56:51,640
I think the chicken pox vaccine is that.

870
00:56:51,640 --> 00:56:54,040
But it doesn't protect against shingles.

871
00:56:54,040 --> 00:56:56,160
It protects against chicken pox.

872
00:56:56,160 --> 00:56:57,480
I know that's weird.

873
00:56:57,480 --> 00:57:02,560
I think it has to do with the amount of virus that's in those different vaccines.

874
00:57:02,560 --> 00:57:08,720
I think that the amount in the chicken pox vaccine was lower than the one that's in the

875
00:57:08,720 --> 00:57:10,280
shingles vaccine.

876
00:57:10,280 --> 00:57:12,360
So I think that I think that's the difference.

877
00:57:12,360 --> 00:57:17,240
But it can also be a timing thing because I'm thinking because there was a paper I read

878
00:57:17,240 --> 00:57:23,840
for this lecture or for this podcast where we were talking about.

879
00:57:23,840 --> 00:57:28,080
So they were analyzing basically there was this there was a study done and it was an

880
00:57:28,080 --> 00:57:35,000
observational study of like basically looking at six million kids who there were some who

881
00:57:35,000 --> 00:57:39,680
had gotten vaccinated against chicken pox and then some who had not gotten vaccinated

882
00:57:39,680 --> 00:57:40,680
against chicken pox.

883
00:57:40,680 --> 00:57:46,240
And I think the vaccine came out what 96 was it 93 93 93.

884
00:57:46,240 --> 00:57:53,200
And so there were people like me who was born in 87 who didn't didn't get vaccinated, but

885
00:57:53,200 --> 00:57:54,660
I did get the chicken pox.

886
00:57:54,660 --> 00:57:57,440
So I had some type of natural immunity.

887
00:57:57,440 --> 00:57:59,480
I imagine that will wane over time.

888
00:57:59,480 --> 00:58:03,420
I don't probably want to get the shingles vaccine or whatever the variation is.

889
00:58:03,420 --> 00:58:06,000
But the more I think about it, the closer I'm getting to 50.

890
00:58:06,000 --> 00:58:10,320
So I'm like, you know, maybe it'll still be around when I'm when I'm 50 when I'm 50, that's

891
00:58:10,320 --> 00:58:13,140
15 years away.

892
00:58:13,140 --> 00:58:17,880
But they followed this population of children who had gotten the vaccine versus ones who

893
00:58:17,880 --> 00:58:19,040
didn't.

894
00:58:19,040 --> 00:58:24,600
And they noticed a 72 percent reduction in herpes zoster incidence, which they basically

895
00:58:24,600 --> 00:58:30,800
defined as they didn't define it as shingles because I think it was either kids either

896
00:58:30,800 --> 00:58:35,920
getting chicken pox or if they had had chicken pox, they had some less inversion of shingles

897
00:58:35,920 --> 00:58:39,180
because remember, kids, their immune systems are just better.

898
00:58:39,180 --> 00:58:42,460
So they will actually keep some of these diseases that bear.

899
00:58:42,460 --> 00:58:45,400
They won't be as severe.

900
00:58:45,400 --> 00:58:47,440
We saw we saw this term covid as well.

901
00:58:47,440 --> 00:58:52,040
You know, there's just it mainly affected older people just due to kids being a little

902
00:58:52,040 --> 00:58:56,040
bit more on average, you know, their immune systems being more robust.

903
00:58:56,040 --> 00:59:06,480
So I it was interesting to see that that reduction had happened in that population.

904
00:59:06,480 --> 00:59:13,140
And I think we were talking about in context with, you know, getting this chicken pox vaccine,

905
00:59:13,140 --> 00:59:18,480
it does seem to reduce the incidence of shingles in adolescence.

906
00:59:18,480 --> 00:59:19,480
Right.

907
00:59:19,480 --> 00:59:22,240
Because that study went up to 17 years of age.

908
00:59:22,240 --> 00:59:27,520
And yes, and so that chicken pox vaccine, you know, works well to prevent chicken pox

909
00:59:27,520 --> 00:59:32,160
or it's sure if if if a kiddo gets chicken pox after they've gotten the vaccine, it's

910
00:59:32,160 --> 00:59:37,360
a really mild version of the chicken pox compared to other kids and stuff.

911
00:59:37,360 --> 00:59:42,640
So I should also mention in this study, it was like there were six million kids, but

912
00:59:42,640 --> 00:59:47,340
the incidence of shingles is so they had to use a big population because shingle looks

913
00:59:47,340 --> 00:59:49,800
amongst kids is so rare, so rare.

914
00:59:49,800 --> 00:59:54,240
And so you have to do a large sample size to try to find to see if it was effective.

915
00:59:54,240 --> 00:59:58,480
Because remember, this vaccine has only been around since 1993.

916
00:59:58,480 --> 01:00:03,360
So kids haven't gotten old enough yet to really see if this is going to be protective against

917
01:00:03,360 --> 01:00:04,360
shingles.

918
01:00:04,360 --> 01:00:06,600
It seems to be the case in young kids.

919
01:00:06,600 --> 01:00:11,040
But I don't know if that'll be the case, you know, as they get older, because again, their

920
01:00:11,040 --> 01:00:14,280
immune systems will wane just like everybody else.

921
01:00:14,280 --> 01:00:15,560
Because we were all kids once.

922
01:00:15,560 --> 01:00:18,320
So I'd love and you know, even you, even me.

923
01:00:18,320 --> 01:00:19,320
Oh my gosh.

924
01:00:19,320 --> 01:00:24,000
And let me this this is before we talk a little bit more about the shingles vaccine, let me

925
01:00:24,000 --> 01:00:29,280
just tell you another little fun fact about chicken pox and shingles.

926
01:00:29,280 --> 01:00:34,880
So before 1993, most everybody got the chicken pox.

927
01:00:34,880 --> 01:00:38,580
Not everybody, but a large percentage of people got the chicken pox.

928
01:00:38,580 --> 01:00:44,440
And so with all of us as you know, old, you know, as parents or older people that had

929
01:00:44,440 --> 01:00:49,480
gotten the chicken pox in the past, because kids, grandkids, great grandkids would get

930
01:00:49,480 --> 01:00:50,760
the chicken pox.

931
01:00:50,760 --> 01:00:57,460
So we continually activate your immune system against the varicella zoster virus.

932
01:00:57,460 --> 01:01:04,180
So you would stay kind of immunized or protected against the varicella zoster virus.

933
01:01:04,180 --> 01:01:08,200
It wasn't didn't mean that you couldn't get shingles, but you had this activation because

934
01:01:08,200 --> 01:01:15,560
you were constantly around kiddos in just living life that had either had chicken pox

935
01:01:15,560 --> 01:01:18,120
or just getting over chicken pox or whatever.

936
01:01:18,120 --> 01:01:21,000
When the when the vaccine came out.

937
01:01:21,000 --> 01:01:26,860
So far fewer kids have active chicken pox.

938
01:01:26,860 --> 01:01:35,160
So then as the older adults or adults, older adults are not exposed as much to that virus

939
01:01:35,160 --> 01:01:36,160
anymore.

940
01:01:36,160 --> 01:01:40,520
So our immune systems as an older adult don't get stimulated as much.

941
01:01:40,520 --> 01:01:46,720
So our our our so our immunity against that varicella zoster virus can go down because

942
01:01:46,720 --> 01:01:50,740
of the fact that younger kids got vaccinated against the chicken pox.

943
01:01:50,740 --> 01:01:53,120
So it's going to be very interesting.

944
01:01:53,120 --> 01:01:57,260
And as Josh said, we do not have the data yet with the younger kids that have gotten

945
01:01:57,260 --> 01:01:59,300
vaccinated against chicken pox.

946
01:01:59,300 --> 01:02:05,920
If in fact, their incidence of varicella will be lower because they may be the the amount

947
01:02:05,920 --> 01:02:12,040
of virus that was generated in their body didn't wasn't enough to to house enough in

948
01:02:12,040 --> 01:02:14,560
the dormant and in the ganglion cells.

949
01:02:14,560 --> 01:02:16,240
We just that's we have no idea.

950
01:02:16,240 --> 01:02:17,240
We just don't know yet.

951
01:02:17,240 --> 01:02:18,720
And so so that's true.

952
01:02:18,720 --> 01:02:23,680
It's like the pros and cons of I remember when I was a school teacher and just like

953
01:02:23,680 --> 01:02:28,320
the first week of school, I would just always get sick because the kids would come back

954
01:02:28,320 --> 01:02:30,960
and then kids are disgusting.

955
01:02:30,960 --> 01:02:32,520
And so they just they're not.

956
01:02:32,520 --> 01:02:35,640
Well, what I mean by that is that they just they carry disease.

957
01:02:35,640 --> 01:02:36,640
They get into everything.

958
01:02:36,640 --> 01:02:40,800
You know, and then obviously you get sick because probably during the summer, you know,

959
01:02:40,800 --> 01:02:45,280
when I was on break, I wasn't around as many people as I am when I'm enclosed in a school

960
01:02:45,280 --> 01:02:46,280
environment.

961
01:02:46,280 --> 01:02:51,320
So you kind of take for granted, like a lot of the pathogens that you're exposed to when

962
01:02:51,320 --> 01:02:52,840
you're around a bunch of people.

963
01:02:52,840 --> 01:02:57,120
Obviously, you can get a little bit sick, but, you know, maybe that baseline is kind

964
01:02:57,120 --> 01:03:02,240
of keeping your immune system on track, which is why, you know, you should always have a

965
01:03:02,240 --> 01:03:03,800
bunch of friends, you know.

966
01:03:03,800 --> 01:03:08,280
So if you're feeling alone and just go out and hang out with people, it's not only good

967
01:03:08,280 --> 01:03:10,960
for your social life, it's good for your immune system, too.

968
01:03:10,960 --> 01:03:11,960
There you go.

969
01:03:11,960 --> 01:03:12,960
There you go.

970
01:03:12,960 --> 01:03:13,960
Just be careful.

971
01:03:13,960 --> 01:03:14,960
Yeah.

972
01:03:14,960 --> 01:03:19,620
So actually, there's no there's no maximum age for getting the Shingrix vaccine either

973
01:03:19,620 --> 01:03:20,620
and stuff.

974
01:03:20,620 --> 01:03:22,720
So it is a two dose series.

975
01:03:22,720 --> 01:03:26,160
So that means that you have to get two doses of this vaccine.

976
01:03:26,160 --> 01:03:30,600
You get the first dose and then you're going to get the second dose two to six months after

977
01:03:30,600 --> 01:03:32,840
you get the first dose.

978
01:03:32,840 --> 01:03:38,320
It's administered intramuscularly in your arm, in your top of your arm, you know, and

979
01:03:38,320 --> 01:03:40,280
you can get it in your doctor's office.

980
01:03:40,280 --> 01:03:45,800
But you know, a lot of, you know, most pharmacies have a pharmacist that can administer your

981
01:03:45,800 --> 01:03:47,400
vaccines now as well, too.

982
01:03:47,400 --> 01:03:49,160
So that's one that they can give.

983
01:03:49,160 --> 01:03:52,840
It does cause some adverse effects.

984
01:03:52,840 --> 01:03:58,840
The ones that many patients complain about with this vaccine are it does cause pain,

985
01:03:58,840 --> 01:04:03,320
redness and a little swelling in your arm at the actual injection site.

986
01:04:03,320 --> 01:04:08,520
You can take Tylenol for a day or two after you get it.

987
01:04:08,520 --> 01:04:11,880
And and it does go away.

988
01:04:11,880 --> 01:04:17,280
You could you might feel a little feverish or just kind of just not feeling well after

989
01:04:17,280 --> 01:04:18,280
you get it.

990
01:04:18,280 --> 01:04:19,280
You could get in.

991
01:04:19,280 --> 01:04:22,320
You know, that usually happens in about half of the patients.

992
01:04:22,320 --> 01:04:24,120
You can get a headache.

993
01:04:24,120 --> 01:04:26,840
You know, you can feel a little sick to your stomach.

994
01:04:26,840 --> 01:04:29,440
But it doesn't really last for very long.

995
01:04:29,440 --> 01:04:33,200
And it's so and again, those like I said, those symptoms don't last for very long.

996
01:04:33,200 --> 01:04:36,720
You could take some Tylenol to relieve that symptom.

997
01:04:36,720 --> 01:04:41,320
But it's so much better than getting the shingles itself because the shingles will last definitely

998
01:04:41,320 --> 01:04:43,400
longer than a day or two.

999
01:04:43,400 --> 01:04:47,320
As a pharmacist, what we've told patients when they are going to plan to get their shingles

1000
01:04:47,320 --> 01:04:54,200
vaccine, if you have a Monday through Friday job or you know, whatever your schedule is,

1001
01:04:54,200 --> 01:04:57,500
get it on a day when the next day you know you don't have a lot going on.

1002
01:04:57,500 --> 01:05:00,760
So you can anticipate that you might not feel well for a day.

1003
01:05:00,760 --> 01:05:03,760
You can, you know, and then and then accommodate that and stuff.

1004
01:05:03,760 --> 01:05:05,480
So you can get that advice.

1005
01:05:05,480 --> 01:05:09,860
And also just it's my understanding that when you do get those kind of feverish symptoms,

1006
01:05:09,860 --> 01:05:12,080
that is your immune system kind of kicking in.

1007
01:05:12,080 --> 01:05:13,080
It is.

1008
01:05:13,080 --> 01:05:17,520
And obviously, some people's immune systems are more robust than others just due to humans

1009
01:05:17,520 --> 01:05:19,040
being different from one another.

1010
01:05:19,040 --> 01:05:22,560
So you're going to get a different response depending on who you are.

1011
01:05:22,560 --> 01:05:23,560
Right.

1012
01:05:23,560 --> 01:05:28,400
So this that this vaccine is very effective.

1013
01:05:28,400 --> 01:05:29,400
The shingles, the new one.

1014
01:05:29,400 --> 01:05:35,520
The new shingles two dose vaccine is, but you have to get both doses to get the really

1015
01:05:35,520 --> 01:05:42,280
effective that's really effective result.

1016
01:05:42,280 --> 01:05:48,800
And in the data that they've collected after they studied this vaccine, I believe it, correct

1017
01:05:48,800 --> 01:05:53,280
me if I'm wrong, Josh, I think it was 30,000 patients that did one study.

1018
01:05:53,280 --> 01:06:01,360
And the effectiveness overall effectiveness was 97 percent, 94 percent up there.

1019
01:06:01,360 --> 01:06:07,480
And that was that and that was the around, you know, around a five year time period.

1020
01:06:07,480 --> 01:06:12,640
And that effect has been sustained over at least eight years.

1021
01:06:12,640 --> 01:06:15,760
But as time has gone on, the effect has not dropped that much.

1022
01:06:15,760 --> 01:06:20,920
And that's the cool thing that was makes this this newer vaccine, this shingles vaccine

1023
01:06:20,920 --> 01:06:28,360
better than the older Zostavax vaccine is that the effects are maintained in the different

1024
01:06:28,360 --> 01:06:29,360
age groups.

1025
01:06:29,360 --> 01:06:33,640
And again, remember, older patients are going to be more likely to get shingles.

1026
01:06:33,640 --> 01:06:38,360
So we're looking at those that are older, you know, the 50 to 59, the 60 to 69, the

1027
01:06:38,360 --> 01:06:41,080
70 to 79 and those over 80.

1028
01:06:41,080 --> 01:06:43,480
And it's effective in all of those age groups.

1029
01:06:43,480 --> 01:06:49,000
I believe that it may dump down a little bit or drop down a little bit to maybe 85, 86

1030
01:06:49,000 --> 01:06:51,680
percent of efficacy in those older than 80.

1031
01:06:51,680 --> 01:06:54,900
But that's still really effective for a vaccine.

1032
01:06:54,900 --> 01:06:59,600
So that and it's likely with you if you get so again, you get this this vaccine when you

1033
01:06:59,600 --> 01:07:02,120
turn 50 or close after 50.

1034
01:07:02,120 --> 01:07:06,080
And it's likely that the that the effectiveness of this vaccine will last, you know, for the

1035
01:07:06,080 --> 01:07:07,920
rest of your life.

1036
01:07:07,920 --> 01:07:13,120
There may be, you know, in years to come that you might have to get a booster dose, but

1037
01:07:13,120 --> 01:07:14,560
that hasn't been shown yet.

1038
01:07:14,560 --> 01:07:15,560
Yeah.

1039
01:07:15,560 --> 01:07:18,480
But it hasn't been out long enough yet really to know whether or not that's really what

1040
01:07:18,480 --> 01:07:20,400
we need to be 2017.

1041
01:07:20,400 --> 01:07:21,400
So yeah.

1042
01:07:21,400 --> 01:07:22,400
So we don't know that yet.

1043
01:07:22,400 --> 01:07:29,040
So but again, right now they know that it probably lasts for at least 10 to 15 years.

1044
01:07:29,040 --> 01:07:31,340
And yeah, let's just revisit probability again.

1045
01:07:31,340 --> 01:07:36,520
So we have a patient sample size of 30000 people.

1046
01:07:36,520 --> 01:07:37,520
Right.

1047
01:07:37,520 --> 01:07:43,440
Let's just assume that that's the number of people who got the dose of the vaccine.

1048
01:07:43,440 --> 01:07:48,400
Let's just assume it's 95 percent effective at reducing the incidence of shingles, meaning

1049
01:07:48,400 --> 01:07:52,360
that you won't show the symptoms that we talked about earlier.

1050
01:07:52,360 --> 01:07:59,640
That still means that there are about 1500 people out of that 30000 who will show symptoms,

1051
01:07:59,640 --> 01:08:03,240
you know, so it doesn't mean.

1052
01:08:03,240 --> 01:08:07,960
So when we say the vaccine is effective, we're meaning it's effective against non treatment

1053
01:08:07,960 --> 01:08:10,080
or like if you don't get the vaccine.

1054
01:08:10,080 --> 01:08:12,680
So but there's still a chance that you could get it.

1055
01:08:12,680 --> 01:08:16,120
So you were all we're doing is evaluating risk.

1056
01:08:16,120 --> 01:08:22,760
So there is a possibility that you could be vaccinated and you could still get the shingles.

1057
01:08:22,760 --> 01:08:27,840
And it just means that for you, for some reason, the vaccine wasn't it just didn't take the

1058
01:08:27,840 --> 01:08:30,800
way it did for the majority of the population.

1059
01:08:30,800 --> 01:08:34,760
And then you have to move to other treatments like we talked about antivirals and pain medications

1060
01:08:34,760 --> 01:08:38,440
and maybe a nice oatmeal bath, you know, to make you feel better.

1061
01:08:38,440 --> 01:08:39,440
Yeah.

1062
01:08:39,440 --> 01:08:40,440
So so, yeah.

1063
01:08:40,440 --> 01:08:46,480
So the other thing that I want to mention, too, is that you're like thinking, how can

1064
01:08:46,480 --> 01:08:51,200
it be good for 10 years and the vaccine only came out in 2017?

1065
01:08:51,200 --> 01:08:58,360
And researchers can project into the future when they've got certain data as to how it's

1066
01:08:58,360 --> 01:08:59,560
like a trajectory.

1067
01:08:59,560 --> 01:09:04,040
It's kind of like how how is something going to do over this time period based on what

1068
01:09:04,040 --> 01:09:06,360
it's done in these first five years?

1069
01:09:06,360 --> 01:09:10,720
And so that's how they can anticipate that it's going to still be effective five years

1070
01:09:10,720 --> 01:09:15,560
from now because it's doing so good right now and there's no evidence that it's abruptly

1071
01:09:15,560 --> 01:09:17,000
dropping off in efficacy.

1072
01:09:17,000 --> 01:09:19,560
Yeah, I think that's that's really well said.

1073
01:09:19,560 --> 01:09:23,880
And it's also also good to keep in mind, like weather forecasts, like weather forecasts

1074
01:09:23,880 --> 01:09:27,600
are really accurate, I think three days out.

1075
01:09:27,600 --> 01:09:32,320
But if they get two weeks out, I think the reliability is maybe a 50 50.

1076
01:09:32,320 --> 01:09:36,160
It's like a coin flip of what is if you're looking two weeks out and a weather forecast,

1077
01:09:36,160 --> 01:09:41,360
that's basically saying based on the conditions that we think the weather is going to do,

1078
01:09:41,360 --> 01:09:43,280
we think it's going to be like this.

1079
01:09:43,280 --> 01:09:47,640
And obviously, the further you go into the future, it's going to be hard to predict.

1080
01:09:47,640 --> 01:09:52,080
But the closer you are in your timestamp, the more accurate your forecasting will be,

1081
01:09:52,080 --> 01:09:54,920
depending on how much information, how good your models are.

1082
01:09:54,920 --> 01:09:59,820
So anytime we model these things, it's always making certain assumptions, just like with

1083
01:09:59,820 --> 01:10:01,640
weather forecasting.

1084
01:10:01,640 --> 01:10:06,320
So this could change over time, you know, but the information we have right now based

1085
01:10:06,320 --> 01:10:10,240
on the first five years that well, it's been six years now since 2017.

1086
01:10:10,240 --> 01:10:14,860
Yes, then it's we see no reason to a DVA.

1087
01:10:14,860 --> 01:10:15,860
But that could always change.

1088
01:10:15,860 --> 01:10:16,860
It could change.

1089
01:10:16,860 --> 01:10:20,120
So again, that's why you've got researchers that are always collecting data.

1090
01:10:20,120 --> 01:10:23,840
So are there folks out there who you would caution against either?

1091
01:10:23,840 --> 01:10:25,080
I was just going to do that.

1092
01:10:25,080 --> 01:10:26,080
I was just going to wow.

1093
01:10:26,080 --> 01:10:27,080
It's just too cool.

1094
01:10:27,080 --> 01:10:31,240
It's like we share genetic material.

1095
01:10:31,240 --> 01:10:35,800
So so there are a couple of populations that are not going to want to get this shingles

1096
01:10:35,800 --> 01:10:41,320
vaccine for sure because of the data that have been have been found or the lack of data.

1097
01:10:41,320 --> 01:10:46,720
One is if you obviously and this goes with it, taking any medication, any vaccine, if

1098
01:10:46,720 --> 01:10:53,680
you've had a significant allergic reaction to that particular vaccine or if you have

1099
01:10:53,680 --> 01:10:56,880
severe allergic reaction to any vaccine, you're not going to want to get this vaccine because

1100
01:10:56,880 --> 01:11:02,600
it could a lot of vaccines use the same types of fillers, you know, and extra things in

1101
01:11:02,600 --> 01:11:03,600
them and stuff.

1102
01:11:03,600 --> 01:11:08,440
And so you're not going to want to get it if you've had an allergic reaction to a vaccine.

1103
01:11:08,440 --> 01:11:12,440
You don't want to use it if you're pregnant and primarily because we don't have enough

1104
01:11:12,440 --> 01:11:16,320
data to know whether or not it's it's safe or not.

1105
01:11:16,320 --> 01:11:21,260
And also, as I mentioned earlier, you don't want to get it if you currently have the shingles.

1106
01:11:21,260 --> 01:11:26,600
You need to wait until the virus, the disease is over and then you can get the vaccine.

1107
01:11:26,600 --> 01:11:27,600
Gotcha.

1108
01:11:27,600 --> 01:11:28,600
Yeah.

1109
01:11:28,600 --> 01:11:32,200
And I feel that with the pregnancy, that's going to be a pretty small cohort of people,

1110
01:11:32,200 --> 01:11:33,200
right?

1111
01:11:33,200 --> 01:11:34,200
Because it's so people over 50.

1112
01:11:34,200 --> 01:11:35,200
Right.

1113
01:11:35,200 --> 01:11:36,680
I don't know when women go through menopause.

1114
01:11:36,680 --> 01:11:37,680
It just depends.

1115
01:11:37,680 --> 01:11:41,560
I mean, there have been some women that have been pregnant, you know, the late 40s, maybe

1116
01:11:41,560 --> 01:11:46,360
50 and stuff, but maybe for immunocompromised women as well who are earlier than 50.

1117
01:11:46,360 --> 01:11:47,360
Right.

1118
01:11:47,360 --> 01:11:48,360
That's fair.

1119
01:11:48,360 --> 01:11:49,360
Right.

1120
01:11:49,360 --> 01:11:53,880
So so again, I think that's just about it as far as what I've got to say about the shingles

1121
01:11:53,880 --> 01:11:55,960
virus and shingles vaccine.

1122
01:11:55,960 --> 01:12:01,480
I think that, as we mentioned, it's going to be really interesting to follow this through

1123
01:12:01,480 --> 01:12:08,920
the next several decades to see how the kiddos that were vaccinated with the chickenpox vaccine,

1124
01:12:08,920 --> 01:12:13,160
how they fare in the future as far as the development of shingles.

1125
01:12:13,160 --> 01:12:15,080
So that's just something to stay tuned for.

1126
01:12:15,080 --> 01:12:16,240
So I agree.

1127
01:12:16,240 --> 01:12:20,600
And the the wow thing is too, is that there are so many other than varicella, there's

1128
01:12:20,600 --> 01:12:25,560
just viruses inside of your body that you just don't even know about and are waiting

1129
01:12:25,560 --> 01:12:30,760
to come about and do their thing at a later course in time.

1130
01:12:30,760 --> 01:12:36,000
It's pretty interesting to think that probably everyone is walking around now with varicella

1131
01:12:36,000 --> 01:12:41,280
or Epstein-Barr virus or some of these virus that don't have obvious pathogenicity.

1132
01:12:41,280 --> 01:12:43,880
And at some point it comes out.

1133
01:12:43,880 --> 01:12:48,280
So when that happens, we hope that you've listened to this episode to learn about some

1134
01:12:48,280 --> 01:12:51,440
treatments that you can take.

1135
01:12:51,440 --> 01:12:59,480
And hopefully you all will go out and if you're 50 or older, get the Shinglet vaccine and

1136
01:12:59,480 --> 01:13:03,640
to protect yourself because shingles is no walk on the beach.

1137
01:13:03,640 --> 01:13:06,880
It is a pretty awful condition.

1138
01:13:06,880 --> 01:13:13,240
Like Josh said, the vaccine is, and people, it varies as to the effect, but like most

1139
01:13:13,240 --> 01:13:20,720
people, the adverse events associated with the vaccine are gone within a couple of days.

1140
01:13:20,720 --> 01:13:27,200
And it's just so worth it not to have that fear of getting shingles or the posterpatic

1141
01:13:27,200 --> 01:13:28,200
neuromalgia.

1142
01:13:28,200 --> 01:13:30,120
Keep that varicella at bay.

1143
01:13:30,120 --> 01:13:33,440
So with that being said, thank you all so much again for joining us.

1144
01:13:33,440 --> 01:13:37,500
If you like what we do, please share this podcast with somebody else you think would

1145
01:13:37,500 --> 01:13:43,160
be interested in learning about biology and drugs and all that fun stuff.

1146
01:13:43,160 --> 01:13:46,560
Like our Instagram page so that you can follow us.

1147
01:13:46,560 --> 01:13:49,820
But until next time, my name is Josh Klaus.

1148
01:13:49,820 --> 01:13:51,160
And I'm Jennifer Seltzer.

1149
01:13:51,160 --> 01:13:53,680
This has been another episode of Your Mom on Drugs.

1150
01:13:53,680 --> 01:14:20,680
We'll see you all next time.