I haven't done this in a long time.
Yeah I know.
All right.
I have to get really close, right?
Yeah.
Is that a good level?
Do you need to be lower or higher?
No, I need to be lower.
Okay.
And then you can just angle it up.
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.
Oh yeah.
What do you want to do?
And then you do when you know the notes to sing.
You can sing most anything.
Yeah.
Okay.
That was good.
Okay.
Well, hey y'all.
Welcome back to another episode of Your Mom on Drugs featuring me, Josh Klaus.
And me, Jennifer Seltzer.
Yes, we are a mother and son pair who like to talk about the world of medicine, pharmaceuticals,
biology, things that can be taken when you're not feeling so hot.
And today we are going to be talking about chicken pox and shingles.
And you're probably thinking what are those two things have to do with one another?
Well, that's what this episode is all about.
Just to give you a little background on ourselves if you're a first time listener to us, my
name is Josh and I have a master's in public health and a bachelor's in biology from the
University of Texas.
And I'm also the son to this wonderful lady right across from me who I will let introduce
herself.
My name is Jennifer Seltzer and I am Josh's mom.
And I have a bachelor's in pharmacy, but I also have a doctor of pharmacy degree as well
too.
I've been a pharmacist and taught pharmacy students for several decades.
I'm now retired, but primarily my focus was drug information and helping students learn
how to acquire information about medicines and disease states and also evaluate clinical
trials.
And fun, you know, growing up with my mom, I always thought that what she had was just
general mom knowledge.
I had no idea that she was so trained and knowing about all the things drug related.
It wasn't until I was about 15 where I saw a letter addressed to Dr. Seltzer and I thought
it was like, who's Dr. Seltzer?
And then my mom's like, that's me.
And so it reflects poorly on my curiosity of my mother's career.
But now that she's retired, I wanted to pull her out of retirement and talk about drugs
and diseases that affect humans.
So I figured we could just jump right into it and talk about shingles and chickenpox.
And it's a viral disease that causes that, right?
Do you want to give an overview of?
Sure.
And so we can't really talk about shingles without first talking about chickenpox or
chickenpox is known as varicella zoster.
That's the varicella zoster virus.
And it used to be before 1993 that all of us would get the chickenpox.
And if you remember, it was a disease state that was very contagious and it had a generalized
itchy rash that was usually covered the whole body.
You usually have symptoms for four to seven days.
And usually it was an exposure to someone who also had the chickenpox or the varicella
zoster rash.
You would incubate about two weeks before you'd start seeing evidence of that particular
rash.
Sometimes as parents, you'd have like chickenpox parties so that your kids would, everybody
would get the chickenpox and get it over with and stuff.
So usually adults will get a little sicker if they got the chickenpox, if they didn't
get it as a kid.
They may get fever and kind of just feel kind of sick before the rash develops.
Whereas kids usually break out with the rash.
They may have a day or so of fever and then just feel kind of yucky.
They can have a fever.
I mean, they can feel kind of yucky for a couple of days.
And then it takes about a week or so for all of those little vesicles that have caused
itchy and developed the rash to crust over.
And once they've all crust over, especially after they've crust over, then you're considered
not contagious anymore.
You do spread the chickenpox primarily by direct person contact.
You can inhale, like even the bacteria, I'm sorry, the viruses can be emitted from the
lesions themselves.
So you could breathe that in potentially and get it.
Or certainly if you, also if somebody's infected and they cough or whatever, you could also
potentially get it from them as well that way.
And then after that fact, so a lot of times we get viruses and then they're gone.
But this particular virus stays, when you're done with the chickenpox virus, then it stays
what we call dormant or it's kind of asleep in your basal root ganglia, which is inside
your nervous system near your spinal cord.
And it stays there for years.
And so we're going to then now turn our attention from that point on to talking about shingles
because shingles is the reactivation of that virus in your nervous system.
And it primarily occurs in adults, but it can also occur in kids, but kids don't seem
to develop as many of the big symptoms like adults do when they get shingles.
Yeah.
So before we head into shingles, can we stop and maybe talk a little bit about chickenpox
and maybe just basic viruses real quick?
Of course.
All right.
I think viruses are really interesting because they're one of the smallest things on planet
Earth that kind of act like an organism, even though they're technically not alive.
That's a whole nother debate.
But just to give everybody a concept of what a virus is and kind of what my mom was talking
about going from that dormant state to the active state.
So all a virus is, and we'll post a picture on our Instagram just so you have a good idea
of what it looks like, but it's good to picture a virus kind of like a house.
Like if you look at a house, it's got an outside structure, but there are ports of entry.
There are doors, there are garage doors, there are windows.
And with the right combination of tools, whether that be a key or even some mechanical force
like lifting up a window, sometimes you could even break a window.
Don't do that.
And you can get into the house.
But also remember inside of the house, there are also doors that might lead to closets
or bathrooms or bedrooms and things like that.
So the cell is a similar way.
And the virus is basically trying to trick the cell into getting inside of it so that
it can make more of itself.
A virus is incapable of making more of itself.
So it actually has this really cool coating on the outside that it has all of these proteins
on it that we call antigens.
And then they will try to bind with a cell.
And if it fits just in the right way, it'll trick the cell into letting it inside of itself.
Now a virus is just composed of this outside coating, basically just almost like it looks,
but in this case with varicella, it's actually a herpes virus.
So not the herpes that you probably know from sexually transmitted diseases.
Herpes is just a big family of viruses, actually over 100 types of herpes viruses.
And they come in, I think it's alpha, beta, and gamma, I think just based on their protein
subunits.
So varicella actually falls under alpha and it's just one type of herpes virus.
So basically it has this really cool, almost looks like a basketball, like a shell-like
virus.
And then it dumps its genetic material inside of the cell and its genetic material is actually
DNA.
You might have heard this because all of your cells have DNA and that's how your cells know
how to make protein.
So it actually puts its DNA inside of your own cell and then your cell just sees that
DNA and incorporates that into its own genome, which we call basically the library of all
of the DNA inside of your cell.
And then it just starts to make copies of this virus just without knowing it.
And it will just make copy after copy after copy after copy.
And then soon there are so many viruses inside of the cell that it literally explodes.
And then that's just one cell.
And now you have so many other viruses then going out to each other cell and doing the
exact same thing.
But if you know anything about your body, and hopefully in a little bit, there's this
thing called the immune system that's kind of sniffing around to see if any funny businesses
going on.
And if enough of this virus goes around causing enough trouble, your immune system goes, hang
on, wait a minute.
And then they actually bind to these basically these viruses using a lot of different mechanisms.
We won't go into in detail here, but they will basically try to gobble them up and degrade
them before they can cause any more damage.
So when mom is mentioning when you get something like the chickenpox and you get a fever and
tiredness, that's not really the symptom of chickenpox.
It's actually partially the symptom of your immune system attacking this virus.
And the fever is actually raising your temperature in your body to actually reduce the ability
of the virus to move as quickly because actually the temperature affects the biochemistry of
certain foreign pathogens.
And so a lot of times when you feel feverish or malaise or any of these symptoms when you
get infected with something, it's actually your own body fighting against it.
And then the secondary symptoms, things like the pustules and rashes on your body, are
what's actually specific to the virus itself.
So just to remember that all a virus is, is just a protein coat with genetic material
inside of it.
It's trying to get inside of your cells, make more of it, and then move on and do the same
exact thing.
So and last thing I'll say, because I'm going on a virus diatribe here, is that my mom was
talking about this dormant phase.
So viruses do this really cool thing where they can go from something called the lytic
cycle and the lysogenic cycle.
So the lytic cycle is what I describe where the viruses are just going crazy and they're
trying to replicate.
But then they come to a risk of like, well, if I do that, I'm going to get found out by
the immune system.
And they're not consciously thinking this.
This is just something that happens.
So every now and then a virus will just insert its genetic material into a cell.
And as my mom said, in the case of varicella, it inserts its DNA into nerve cells associated
with your spinal column and it will just stay asleep, meaning that it won't replicate itself.
Your cell will just think that's a part of its genetic code and it'll just stay there.
And it lies dormant, almost kind of like a monster waiting to come out at the perfect
time.
And when that perfect time comes out, which is what we're going to talk about with shingles,
and we still don't really know the environmental trigger that causes this, then it re-emerges
in these ganglion cells and then you get shingles.
So I think this would be a perfect segue to then talk about shingles.
And it's the same exact virus, but just in a different location, correct?
That is correct.
So it is interesting, Lisa, when you look in the literature with the chickenpox virus,
they'll call it varicella zoster, but with shingles, a lot of times you'll see it as
herpes zoster.
But as Josh said, it's the same exact virus.
It's just a way to differentiate from the fact that it's not chickenpox anymore, but
now it's shingles.
And what happens is, is that at some point, as Josh said, that virus has been sleeping
around in your ganglion cells in your nervous system for years, decides to awaken and activate.
And then it will then start producing the symptoms of shingles.
Let me just give you just a little bit of just kind of background information about
shingles.
So shingles is not a seasonal infection, like some viruses that we know about, like the
flu, for example.
So anyway, it can happen at any time during the year.
It also is that for all of us that were born before 1980, almost all of us are infected
with this wild type of, we would call the wild type varicella zoster virus, and we're
all at risk for shingles.
And about 1.2 million cases of shingles happen each year in the United States, where about
one in three people will develop shingles in their lifetime.
And usually most people only have one episode, but you can have a repeat episode of shingles.
More often we see that in people who are immunocompromised.
That means people whose immune systems may not be working at optimum levels due to either
a disease or medication that they're having to take.
So that means that you said from 1980, so almost the majority of people born from before
1980 or have been infected by the wild type varicella.
So there's probably, I mean, I was born after 1980, but I know I had the chickenpox because
you told me I did.
And you were born before 1980, correct?
Yes, I was.
Rev it in.
Well, I hope so.
But so, man, it makes you think, wow, like a lot of us are just walking around with this
virus inside of us and we don't even know it.
Right.
And it's just lying dormant.
Right.
Exactly.
So interestingly, so we're going to so the so I'll get back to that point in just a minute.
But so the risk of developing shingles increases as you get older.
And one of the reasons that it's one of the speculated reasons that this happens is because
again, as you get older, your immune system is not working at the capacity it was when
you were a 10 year old or a 20 year old.
So it starts.
It doesn't work quite as well.
So it could be that you don't have your immune system that's going to target that varicella
zoster virus working as well as it used to.
And so that's one reason.
That's a good point.
Yeah.
One of the best analogies I heard was from a physician, his name's Peter Atiyah.
And I highly recommend folks listening to his podcast called The Drive.
It's really good medical information, but he likened the immune system kind of being
like an arm using the house analogy that I used earlier.
The immune system is kind of like an army going around to each person's house to kind
of show proof that nothing nefarious is happening on the inside of that house.
And if that house can show the proof that nothing nefarious is going on inside, basically
they show their protein contents, they see no virus here, then the immune system moves
on.
But if there is any evidence of virus activity, or even if the cell can't even produce any
activity, the immune system will kill that cell.
So even if it's jumping out of that lytic to lysogenic cycle, or from lysogenic to lytic,
if your immune system is young and healthy and robust, obviously you're not going to
notice that you have symptoms, even if one of these varicella viruses comes out.
But as my mom was saying, amongst elderly people and immunocompromised people, if your
immune system starts to, you know, if your military starts to dwindle a bit and it gets
a little aged, and over time, then the virus might get a little more adventurous and might
actually go out and start to copy itself.
And as we know with certain viruses, they usually grow exponentially, because if one
cell can explode and make a hundred viruses, and then that hundred viruses infects a cell,
and then it creates 10,000, so it's an exponential growth thing.
So just keep in mind, your immune system is doing a lot of work in the background, and
you don't even know it.
And it's an amazing feat of biology that you can keep a lot of these things at bay.
Right.
And I wanted to clarify for our audience, Josh, I think that you might have missed defining
what the lysogenic stage is.
So lytic is more like the viruses collect inside of a cell and it explodes, but lysogenic
is more that they kind of go dormant.
Yes, it's that dormant stage.
Sorry, I forgot to mention that.
Yeah.
Okay, so as Josh said, there's a couple of reasons why our immune system may be declining.
One is, especially they've seen that happen in people who are beyond 50 years of age.
It started to kind of decline more than when you were younger than that.
That doesn't mean that if you're younger than 50, you can't get the shingles, but it's
less common.
And also to people that are immunosuppressed, either you've got a medical condition that
suppresses your immune system, like if you have cancer or a human immunodeficiency virus,
or you are taking immunosuppressive medications, steroids, some drugs like for rheumatoid arthritis
that can suppress your immune system.
If you're a bone marrow or a solid organ transplant patient, you're going to have a lower immune
system.
So those kinds of things would make you more susceptible to getting the shingles.
And interesting too, in the literature that I read, it talked about the fact that there
seemed that more women developed shingles than men, and more whites compared to blacks.
But the reasons for this aren't really well understood.
And so I think that, again, it's just collecting data over time just to see how that really
pans out.
Interestingly too, most patients with shingles have no history of being exposed to somebody
with a herpes zoster virus infection, unlike the chickenpox vaccine.
Because remember, the shingles is already there inside of you.
So it's not that you got exposed to somebody else.
It just decides to wake up for the fact that your immune system might not be working as
well, or it decides to replicate.
Yeah, that's a good point.
So it's almost like people who had the chickenpox might know that they might get shingles in
the future, but there are people who are infected with varicella who might not have gotten the
chickenpox, but then could develop shingles in the future.
Right?
Like if you're infected with this virus, there is a chance, even if you didn't develop chickenpox,
that you could develop shingles?
I think that if you didn't, I don't know how you could get that virus without having had
been exposed.
Maybe you had chickenpox and you had, I don't even know how you could have chickenpox without
even having any symptoms.
I guess what I mean is like, could you have gotten such a low level of virus inside that
it didn't present symptoms?
I did not read anything like that.
That doesn't mean that it's not possible, but that would be, I think, pretty unusual
and stuff.
So it seems more likely that if you'll have enough of a viral load to cause chickenpox.
I'd say that if you, by chance as an adult, let's say you're adult my age and somehow
you skated through not ever getting chickenpox as a kid and you get exposed to that varicella
zoster virus, the first thing that's going to happen is you're going to get chickenpox.
Yeah, because from what I read, it goes into the areas of the body that are more associated
with the epidermis, like the mucosal linings, which is what causes the pox, the chickenpox.
And then it migrates just because your body is composed of blood and fluid and the stuff
moves around.
So the virus eventually finds a home.
It's like, oh, I really love these ganglia.
I'm going to nestle down here and stay a while.
Why it resides there, that's a good question, but maybe it just has the right receptors
to reside there.
Just for those out there, ganglia just means a collection of nerve cells.
So it's like a bunch of them combined together.
So a single nerve cell is called a neuron and then a bunch of them together is called
a ganglion.
So it's just a massive of those nerve cells.
So I think I detracted you from your point, but you were talking about, yeah, essentially
with people who get shingles, they have to have an event before, correct?
Right.
And so let's talk a little bit.
So we talked about chickenpox and how chickenpox presents, while shingles presents differently.
There is, so again, we talked about the fact that this virus kind of lays low in your ganglion
cells, which are nerve cells, and they kind of line your spinal cord.
And your spinal cord has nerve, different types of nerves that go out to different parts
of your body to make things work for you to feel things, for you to move, all that type
of stuff.
So there is a patterned picture of how our nervous system kind of talks to the other
parts of our body, and it's called a dermatome map.
And so basically it shows how our nervous system or the nerves that come from our spinal
cord talk to the different areas of our body.
And our spinal cord is broken up into separate sections.
There's the cervical section, which is at the top.
Then the thoracic section was kind of your midsection, and then the lumbar section, which
is at the bottom.
And so when your shingles gets activated and it does its thing, primarily we're seeing
it have activity in that thoracic area, which is in your chest, kind of mid area to the
lower part of your back as well, too.
And the reason this is important for somebody to understand this is that when you get the
symptoms of shingles, they are going to be located in a specific dermatome, which is
going to just line up.
And it always goes just on one side of your body.
It doesn't cross what we call the midline of your body.
Really?
So it's always one side of the body.
One side of the body.
That's so interesting.
And like the chickenpox, where it goes all over the place.
When you get a shingles infection, it follows a dermatome.
And the symptoms start out, first of all, with maybe feeling some tingly or burning
pain.
And it can be throbbing, because it's following along this dermatome.
And I can give Josh this picture, and he can also post this picture of the dermatomes on
our Instagram as well, too.
Is a good analogy to think about a dermatome is like, if you're thinking about like your
spine is the trunk of a tree, and then each one of the branches off of a tree is essentially
like the nerves going off of that.
And essentially, the shingles would just be affecting one side of the tree.
Is that a good analogy?
Yeah, one limb on one side of the tree.
Exactly.
That's a great picture.
And so what happens, so you've got this little tingling burning pain that you feel, and you
may have some associated systemic symptoms as well.
You can have headache or malaise or a fever.
But then with that burning pain, then a few days after that, then you're going to see
this vesicle eruption.
You'll get like a red kind of rash, and then it becomes then a pustule, like it's a bump
filled with pus, kind of.
And then after that, it is called...
So it's a pustule vessel first, and then it ulcerates.
So it may be kind of like the pus thing bursts, and it's kind of like a whole kind of thing.
We've all had that kind of stuff happen to us before.
And then it crusts over.
And so it takes about...
And usually we'll see that pustulating and ulcerating event happen three to five days
after the rash has started and stuff.
And it usually takes about two to four weeks for that rash to heal.
So that's two to four weeks.
And you may have some pain associated with it as well.
And you could have some systemic symptoms as well too.
So it's a fairly uncomfortable and kind of nasty looking kind of rash and stuff.
So it's not a very pleasant experience at all.
And it doesn't seem like there's any warning signs.
It just kind of... for some reason, the virus just decides to break out of that lysogenic
or dormant phase into the lytic phase in this specific dermatome in your thoracic portion
of your spine.
Or your lumbar.
Or in your lumbar.
Now, most of the time it happens there.
And I'd say probably the warning symptoms of it are going to be that prodrome where
you start feeling that burning pain that's really weird.
It's just kind of following a path along a nerve either in your back or your lower back.
Is it always just one side of the body?
Meaning it's always going to be the right side or does it depend on the curse?
No, it can be on either side and any of the dermatomes, but it's not going to cross over
to the other side.
Got you.
If you've got a matching dermatome on the other side, it doesn't cross to the midline.
Does that make sense?
It does.
Yeah.
Wow.
What an interesting virus.
It is.
It's quite fascinating.
Like I said, you can have fatigue, fever, feeling kind of sick, just kind of that malaise
accompanying along with it.
Most of the time this virus gets diagnosed clinically so that you're not doing a blood
test per se to test it.
The only time you would usually do that is if you happen to be someone who ended up with
the pain.
But there's a small percentage of patients that can get the pain associated with the
shingles virus, but don't get the rash.
And so then you've got to figure out, because you've got to do a diagnosis.
And so there are some tests that can be run at that point and stuff.
So again, so we talked about the fact that this virus as shingles causes a nasty kind
of rash that starts out red first and then turns into pustules and then ulcerates and
then crusts over and is associated with some pain.
And so it usually takes, like I said, about two to four weeks for it to heal.
There are some complications that can be associated with this virus.
One of the most common ones is what we've heard of as called post-herpetic neuralgia.
And basically that is pain that persists after that rash has gone away.
It's almost like phantom pain.
It almost is.
And it can continue for, it's usually it's any pain that happens and lasts for about
anything, anything that lasts greater than four weeks, you know, after the rash is gone.
And I mean, I don't know if I'm saying that right.
If the rash lasts and heals over at four weeks and you still have pain after that, then we're
going to call that post-herpetic neuralgia.
Because it doesn't seem that there's an apparent cause for the pain.
It's just almost like the remnants of the nervous system kind of over firing.
Because it was in that ganglionic type cell, you know, because it's in the nervous system
and stuff.
Yeah.
And just as a refresher, a lot of sensations that you feel inside of your body or due to
your nervous system firing, it's a way to process sensory information.
Just, this is a really brief side tangent, but I, when I took some neurobiology classes
in college, there's this, we learned about this surgeon, his name was Wilder Penfield.
He was this Canadian surgeon and he was one of the first surgeons to do open like brain
surgery while somebody was conscious.
In fact, your brain has no nerve endings, meaning that you can poke it and you will
not feel that your brain is being poked.
It's your central nervous system.
But the crazy thing is that he took a electrode, which is basically provides electric current
and he would stimulate different portions of the brain and then ask the patient while
they were awake, like, hey, what are you feeling right now?
And sometimes they would feel somebody touching their arm if he was touching a portion of
their brain or sometimes he would do it and they would hear music.
And so there's this really cool idea that your brain is responsible for getting signals
from the periphery of your body, like your fingers and your toes, like you're experiencing
the world through your digits.
And then your brain has to make sense of that information.
So if you have this virus that is essentially sensing quote unquote phantom signals because
it's causing inflammation to these nerve cells or these ganglion cells, then your brain is
just thinking, oh, we're experiencing pain.
And so it's just going to keep delivering that symptom even though the cause, quote
unquote, the rash is gone.
So it's just like this nasty little trick that unfortunately that varicella is playing
long after it has caused its initial damage.
So just a fun little side tangent.
Yeah, thanks, Josh.
Well, it's not that fun.
Yeah, yeah.
But it's a good picture of what's going on.
And this post-herpetic neuralgia or PHN can happen in up to a third of the patients.
It can go anywhere from as low as 5% of patients up to about a third of the patients can have
this hanging on after they have the shingles rash.
And the risk of getting post-herpetic neuralgia does increase as you get older.
The other thing is that although a lot of shingles viruses occur in those thoracic and
lumbar pathways from the dermatomes in that area, you can also have it affect other dermatomes.
And one in particular is one that affects your eyes.
It's called the trigeminal nerve.
And so it's going to be in the upper part of your spinal cord.
And if you get ocular complications with shingles, it becomes almost a medical emergency because
you can lose your vision if somebody does not take care of it very quickly.
I think we learned about the trigeminal nerve in our migraine episode too, right?
Because I think the trigeminal nerve is affected within migraines with the aura, correct?
Yes.
Okay.
So when the trigeminal nerve is affected by the shingles virus, you can get things like
a conjunctivitis, which is kind of like a pink eye.
Another episode?
Yes.
Or it can cause glaucoma, which is increased pressure in your eye.
Or again, like I said, blindness if you don't treat it.
So you want to get to an ophthalmologist right away if you ended up with eye complications
or eye symptoms associated with your shingles virus.
Okay.
That's really good to know.
Other complications of the shingles virus include the fact that it could disseminate
or spread throughout the whole body.
That's not very common only in about one to two percent of patients.
And then you can also have sometimes a bacterial over infection or super infection.
But that again, it's not very common as well too.
We talked about the fact that chickenpox is very transmittable and about chickenpox parties
in the old days and stuff and all.
But also the shingles virus can also be transmitted to other people if they have not had the chickenpox
or they've not had a vaccine and have never had the chickenpox.
So again, it's the virus can be transmitted to other people and people who have never
had the virus before.
Gotcha.
Okay.
So we're going to like now transition into the treatment modalities for shingles because
if you get it, then you're going to want somebody to help you with some of the different things
that go along with it.
The first thing that has been prescribed or recommended for use in shingles vaccine and
shingle in the shingles virus disease infection is our antivirals.
So there's there's several antivirals that that are recommended.
They should be used as early as possible in the disease state in the first 72 hours.
So the first three days and you what what the reason for the antiviral is is to you
want to hopefully speed up the lesion or those vesicle them getting better and resolving.
You want to decrease the number of new lesions that develop.
You want to also reduce viral shedding so that it doesn't spread as much.
And you also want to hopefully decrease some of the severity of the acute pain.
It also may help to prevent ocular complications or the eye complications.
And it may help to decrease that post herpetic neuralgia risk.
So the antivirals are important to give if you do get shingles in those first 72 hours.
The most common ones that are used are acyclovir, valacyclovir and vancyclovir.
And I assume that these are either prescribed by a doctor.
You probably get their prescription.
No, you know, you can get an oral prescription for them.
They're all oral medications so you can get a prescription for them and get it filled
in your pharmacy and take it.
Usually you take them for about seven, seven days.
If you have really serious symptoms associated with your shingles infection, then you you
might have to be hospitalized and receive some IV therapy.
Yeah.
And because was either chickenpox or shingles with with time you're getting them taking
antiviral, it's probably better to send somebody else to get the antivirals just because you
don't because it can be spread via these openings in your mucosal lining or even in droplets.
If they get out, it might be good to send somebody else to also to get it relatively
quickly because viruses, as we know, spread or they replicate really quickly.
An antiviral is actually meant to slow down that replication process for viruses.
So your immune system has time to catch up to the load that the viruses are causing inside
of the body.
It's like, you know, you remember that story, like when the Dutch boy, you know, putting
his finger in the in the dike.
And you're essentially that's essentially what antivirals are.
You're trying to stop the flow so that you have time to repair because you don't want
that dam to break because then it takes a lot of energy and effort for your immune system
to clean up after that.
That's a great picture as well, too, Josh.
So and so the other thing, so you're going to want to try to address the actual virus
itself.
But you may want to take some some medications for pain relief because the pain can be I've
not had shingles myself personally, but I hear that it can be quite uncomfortable.
You can take over the counter pain relief medications such as Tylenol or Advil or Motrin.
Sometimes they work and sometimes they don't.
They can help off for sure help you if you have a fever or just the malaise part of the
of the virus that they can help with that.
The other things that are used to help with the pain of shingles are there's a topical
cream called capsaicin that can help with the with the pain of shingles.
And also you can get lidocaine patches, which is kind of an anesthetic or not kind of, but
it is an anesthetic and it can help with the pain as well, too.
In fact, capsaicin is the molecule associated with spicy food.
That's right.
It is.
That you can also use that topically to actually soothe the pain because I hate spicy food.
It gives me so much pain.
But if I imagine putting it on the outside of your body has a different effect.
It's amazing context matters when you're putting molecules in places.
That's right.
Other things that are used to manage the pain that's associated with the shingles virus
infection are some patients actually do need narcotics.
So things like opiates, oxycodone, morphine and stuff, because the pain can be pretty
severe.
Other things that have been used to manage the pain associated with shingles are gabapentin
and pregabalin.
They are actually anti-seizure medications, but they have mechanisms that have been proposed
anyway to have some chemical interference with the pain mechanisms that are going on
in your nervous system.
So that's why they could potentially work.
And then they've also used antidepressants to manage the pain associated with shingles.
And patients that are kind of resistant to these effects, there also have been some studies
where they use botulinum toxin injections to help with the pain as well too.
So that's not going to be the first line therapy.
That's going to be kind of towards the end and stuff.
Yeah, because imagine having something like PHN is dealing with chronic pain.
It's just got to be awful.
So you're kind of like, wow, I know I've been in pain for a long time and it affects your
mood.
So I imagine sometimes maybe it's not even just about the pain.
It's about learning how to bear the pain because that can be really tough.
So you just want it to end.
And it's like, well, can I bear it not ending knowing that this has happened?
Right.
And that's a good point.
I neglected to mention this, but this post-herpetic neuralgia pain can last for months.
And I've even read that in some patients it could last for years.
So it's bad.
So in that 30% or so of patients that get it, it's a bum deal.
And on a lighter note, one of the other great treatments for shingles or chicken pox is
oatmeal.
Oatmeal baths.
Are you just about to get to that?
I was just about to get to that.
So yeah.
So there are some other things that can be used to help reduce it.
It's primarily to help reducing the itching that might be associated with it and stuff
or just to just bring just some relief.
I can remember when Josh and his brother had the chicken pox.
They had their oatmeal bath and they stuck them in there and somehow they felt good while
they were taking that bath.
So I actually looked up the history of this because I was really curious about why oatmeal
of all things.
And actually it's been used since like 2000 BC in the Egyptian times.
It's just been kind of known to kind of cause this soothing effect.
And long story short, this is just a side little food chemistry thing.
When you boil oats, very much like when you boil fruit, this is how you make jelly or
jam.
When you boil fruit, you release these things inside of the fruit.
It's called pectin.
It essentially keeps the binding of the cell walls because plants are made of these things
that are a little bit different than animal cells and that really helps them stick together.
And so you basically get this kind of, we call it a colloid.
It's a colloidal solution, which is almost kind of this gel like solution where things
are just kind of suspended animation.
I've ever seen jello before and things suspended in that jello.
That's a colloid.
And so very much like when you boil fruit and you kind of get these together.
And actually that's the difference between jelly and jam is that one has pectin and one
doesn't, which is why jam is more spreadable and jelly isn't.
I might have that backwards, please correct me.
I think that's correct.
Because the jam has the actual pieces of fruit in it.
And so same with oats.
So like when you boil them, actually a lot of these properties get leached out and they
go into the water and they kind of into this colloidal solution.
And so when you apply them to the skin, they have this anti-poritic, that was a fun word
that you taught me, pruritic, which basically just means itchy.
It's P-R-U-R-I-T-I-C.
Yeah, pruritic.
You can impress people with that next time.
And so it has this kind of soothing quality.
And when they found this out, now they put it in a lot of cosmetics.
They put it in shampoos and lotions because they found out this property of oatmeal not
only is anti-itch, but it also makes your skin feel a little creamier and smoother.
And so it's also now probably in a lot of products you use to make yourself feel nice
and vibrant and young.
So yeah, I thought that was really interesting.
There you go.
In addition to taking an oatmeal bath, the other things that you could use potentially
to help yourself feel better, you could put some wet compresses on the area of the rash
or where the pain is to just help it feel better.
You don't want to use the wet compresses if you've also put a cream or a patch on at the
same time.
You could either wipe it off or just reduce the effect of the cream or the patch.
So again, they're used separately.
There's an old time favorite.
It's like in the pink bottle, the calamine lotion.
You can use that for reducing itching or just apply some comfort to that area.
And then also wearing loose clothing because can you imagine if you're in pain and then
you've got like leggings, then that would not feel very good.
So you're going to want to use that light loose clothing to help feel better and stuff.
You want to make sure you keep that rash clean and dry.
You don't want to put topical antibiotics or adhesives on it.
You don't want to close it up because that's not going to be good for it and stuff.
So you don't need to use topical antibiotics and stuff because that's not going to help
it get better because an antibiotic does not treat a virus.
Yeah, and biotics are for bacteria and unfortunately this is not a bacterial infection.
So those are mechanisms for when you have shingles.
Needs to treat the actual virus itself.
So now we're going to move into, well, is there anything we can do to prevent the virus?
And obviously what's been developed is a vaccine.
Yeah, and we are very aware that vaccines are a little bit of a hot topic nowadays.
And we understand if you're listening to us might have a different view of vaccines.
We are just kind of under the view that when we read the literature that we are making
the assumption that these are developed in a safe and effective way that have been evaluated
by organizations like the FDA.
And we are just basically, we're not experts.
We're trained in a certain field and we are kind of going into the medical literature
and just reporting what we find.
And we want y'all to make the best health decisions that you can make based on the information
that we find.
But not every condition out there is preventable.
So it's kind of cool that we have a technology that can at least provide some type of preventative
strategy.
Because certain things like cardiovascular disease or cancer, there are behaviors that
you can do to maybe reduce the risk.
And that's another thing I want to talk about too is the idea of risk.
So risk, a lot of times when we deal with the medical literature, we're dealing in things
called probability.
And probability is the idea that there is a certain likelihood of something happening
to you.
So for example, if you have, let's say you're driving in a car and there is a 90% chance
that you are going to make it to your destination safe.
That is not guaranteed that you're going to be safe.
There is a 10% chance that you could not arrive safely at your destination.
And it is up to, I'm making up these figures by the way.
I think it's much safer than that.
But there is a chance that you could not make it safely.
But it's up to you to see if am I going to get in the car today?
And then if you get in a car accident, should I wear my seatbelt or not?
To prevent major injury.
And you could arrive at your destination without your seatbelt on and be safe.
But you could also get in a car accident and if you don't have your seatbelt on, you'll
have an adverse outcome.
Will you die?
There is a chance you might.
And so when we talk about probability, we're just talking about likelihood of events because
unfortunately we're humans and we don't have perfect information.
And so probability basically comes into light when we have imperfect information.
We say based on these assumptions and these things that we do, this is the outcome.
This is the likely outcome, whatever that percentage may be.
But there could be a percentage of people where that outcome is not favorable and that
could be for myriad factors.
And when we're talking about vaccines, if you got vaccinated and you still got the shingles,
for example, it could be because the vaccine was bad.
It could be that your immune system didn't respond as favorably to it.
It could be the fact that the certain type of shingle, the varicella virus just overtook
your immune system.
So when we talk about adverse events, even when you get a health intervention, just like
people who've never smoked a day in their life can still get lung cancer, there's still
a probability there even though it's very low.
So I just wanted to kind of give that as a caveat.
I don't know if you want to add anything on to that.
I know I think you covered most everything I think that needs to be said about that.
So, okay.
Yeah.
We're here to provide information.
You're your own person, make your own choices and we love you.
So on that note, I'm going to talk about the shingles vaccine because the shingles virus,
I mean, the effects of that dormant shingles virus is preventable with a vaccine.
There was a vaccine that came out initially against the shingles virus in 2006.
That was the first one that came out and it was a single dose virus.
I mean, I'm sorry, a single, I am not doing well with words today.
Words are hard.
It was a single dose vaccine.
It came out in 2006, but then since that time it was shown that it was not as effective
and that was a big deal.
You know, it was a single dose, but it wasn't effective as effective.
And so it has since been replaced.
I think it was at what 68% effective.
And it dropped to 40% effectiveness in people over 70 and 15 or 18% effectiveness in people
over 80.
So again, it was like almost like you had, it didn't provide a lot of benefits and stuff
as the older you got.
So that was a bummer, you know?
So yeah, I just want to start to do another tangent, but I feel like maybe it might be
a good idea to just do a basic overview of what a vaccine actually is or what it does
because we haven't talked about it yet.
Sure.
So the theory, and please fill in my gaps if I've forgotten, but your immune system
when it encounters a pathogen that it's never seen before.
And a pathogen is bacteria or a virus.
Yeah, fungus.
Something that's not welcome in your body.
Yeah, that's going to cause some type of disease.
And if it's never seen it before, it doesn't know how to respond to it.
Remember with our house example, it's like if it's showing a key that you don't have
a lock to, there's no way to get that door to open up.
So if there is a virus or a bacteria that's in your body, your immune system can't identify
it.
So it'll essentially just run rampant, cause a disease, and then your body learns if you
survive that, okay, this thing caused a bad thing inside of us.
Let's learn next time it comes inside of us to sniff it out really, really quickly.
So your body has this whole host of tools to be able to fight against this, things like
antibodies and white blood cells and macrophages and T cells.
And that's beyond the scope of my knowledge and understanding, because there are immunologists
out there.
Mine too.
Yeah, who are great at this.
I would highly recommend listening to a podcast called TWIV this week in Virology, who are
amazing at just talking about viruses and they are so awesome.
And they just really do a great job of talking about this.
So the goal with a vaccine is like, well, what if we give a small portion of the virus
so that your body kind of knows what to expect prior to being infected.
And this technology can take many different forms.
And we're going to talk about that.
My mom just talked about a lot.
You can give people an attenuated version of a virus, meaning that it's actually the
whole virus is inside of it, but it's been killed.
So it shouldn't be active or alive.
But now our vaccine technology has gotten much more sophisticated.
We can even take some of just the genetic material that was inside of the virus and
say, well, this is the part that seems to be good that the immune system can sniff out.
And we call those subunit vaccines or recombinant DNA vaccines.
And you've probably heard about maybe in the coronavirus pandemic, we've also had mRNA
vaccines.
We won't get into that as well.
But there are many different ways to try to get your body to become prepared for a pathogen
coming inside of your body.
So yeah, going back to what we were talking about with the initial shingles vaccine, what
my mom is saying is that the first version, I believe you said it was a attenuated virus.
The first one was a live virus.
It was a live virus.
Okay.
So it was even a risk maybe of, yeah, even getting some live virus inside of you as well.
But I think the assumption there was that the dose would be low enough that it wouldn't
cause pathogenicity.
Correct?
That's correct.
No, I'm good.
I'm good.
So going back towards that vaccine, were you done talking about that, the first one that
we came out with?
I wasn't going to really spend a whole lot of time on that vaccine because it has been
taken off the market in 2020.
And so it's not even an option for people to get anymore.
So then to move on from that, so a newer version of that shingles vaccine was created in 2017.
And it's called Shingrix, S-H-I-N-G-R-I-X, Shingrix.
And it's a recombinant varicella zoster glycoprotein E antigen.
So this glycoprotein E antigen is a main target of what we call the CD4 plus cells, which
is, it's a T cell.
It's just part of your immune system.
So that helps to generate that immune response.
And so they've picked out this piece of the varicella or the herpes zoster virus to create
the vaccine.
Yeah.
On the picture that we'll post on our Instagram with a picture of a herpes virus, the glycoprotein
is essentially the shell on the outside of the virus.
So it's essentially the thing that will eventually, it uses to get inside of your cells in the
first place.
So we're just taking those proteins on the outside of the shell of the herpes virus.
And then you just make a whole bunch of those proteins by putting the DNA inside of a yeast.
And then the yeast basically turns out a bunch of those proteins.
And then you essentially supply those with the people.
And so with that, with giving this, injecting this part into your body, this part of this
virus into your body, it stimulates your immune system and you start having active immunity.
So it kicks in your immune system and it helps to protect against zoster disease because
it now starts to recognize this virus and it's going to have the army and it's going
to be on guard for attacks so that if they see any parts of it, that it'll get knocked
out.
And this virus, I mean, oh my gosh, this vaccine, the Shingrix vaccine is approved for use in
people who are 50 years of age and older.
And it's also approved, it's just got a recent approval for use in immunocompromised patients
19 years of age and older.
So again, remember those patients with a immune system that's not working correctly are definitely
much more at risk of developing shingles.
And so this virus, this vaccine is approved for use in those patients as well.
There is, so a question would be, well, tell me again who all can get the Shingrix vaccine?
And so it's going to be, in addition to people who are over 50 years or people who are immunocompromised
and over 19 years of age, you also want to get it if you've actually had the shingles
because you can get the shingles again, even though it's not as likely, but if you've had
it once, you probably never want to get it again.
You want to make sure if you're going to get the Shingrix vaccine after you've had the
shingles that you want to make sure that your rash has completely healed over before you
get the virus, the vaccine.
Yeah, because probably the varicella virus is still inside of your cells.
It's just lying dormant again.
Right.
And so if it does come out of that dormant phase again, you want to have an active defense
towards it.
And the other thing we mentioned, the older shingles vaccine, which was called Zostavax.
If you happen to be a person between 2006 and 2018 that got Zostavax and it again, we
talked about the fact that it's that its activity dropped over time.
And so it was not as effective.
Then you can you can get the Shingrix vaccine.
You need to wait at least eight weeks after your last Zostavax dose.
But again, that's that's kind of a moot point now because Zostavax hasn't been around for
three years.
So anybody who had Zostavax in the past is eligible to get the Shingrix vaccine now.
And then also if you've had the chicken box vaccine, there is actually a chicken pox vaccine.
I'm not mistaken that I was trying to look that up, but I just I forgot to write it down
in my notes.
I think it was an attenuated live vaccine.
I think the chicken pox vaccine is that.
But it doesn't protect against shingles.
It protects against chicken pox.
I know that's weird.
I think it has to do with the amount of virus that's in those different vaccines.
I think that the amount in the chicken pox vaccine was lower than the one that's in the
shingles vaccine.
So I think that I think that's the difference.
But it can also be a timing thing because I'm thinking because there was a paper I read
for this lecture or for this podcast where we were talking about.
So they were analyzing basically there was this there was a study done and it was an
observational study of like basically looking at six million kids who there were some who
had gotten vaccinated against chicken pox and then some who had not gotten vaccinated
against chicken pox.
And I think the vaccine came out what 96 was it 93 93 93.
And so there were people like me who was born in 87 who didn't didn't get vaccinated, but
I did get the chicken pox.
So I had some type of natural immunity.
I imagine that will wane over time.
I don't probably want to get the shingles vaccine or whatever the variation is.
But the more I think about it, the closer I'm getting to 50.
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
15 years away.
But they followed this population of children who had gotten the vaccine versus ones who
didn't.
And they noticed a 72 percent reduction in herpes zoster incidence, which they basically
defined as they didn't define it as shingles because I think it was either kids either
getting chicken pox or if they had had chicken pox, they had some less inversion of shingles
because remember, kids, their immune systems are just better.
So they will actually keep some of these diseases that bear.
They won't be as severe.
We saw we saw this term covid as well.
You know, there's just it mainly affected older people just due to kids being a little
bit more on average, you know, their immune systems being more robust.
So I it was interesting to see that that reduction had happened in that population.
And I think we were talking about in context with, you know, getting this chicken pox vaccine,
it does seem to reduce the incidence of shingles in adolescence.
Right.
Because that study went up to 17 years of age.
And yes, and so that chicken pox vaccine, you know, works well to prevent chicken pox
or it's sure if if if a kiddo gets chicken pox after they've gotten the vaccine, it's
a really mild version of the chicken pox compared to other kids and stuff.
So I should also mention in this study, it was like there were six million kids, but
the incidence of shingles is so they had to use a big population because shingle looks
amongst kids is so rare, so rare.
And so you have to do a large sample size to try to find to see if it was effective.
Because remember, this vaccine has only been around since 1993.
So kids haven't gotten old enough yet to really see if this is going to be protective against
shingles.
It seems to be the case in young kids.
But I don't know if that'll be the case, you know, as they get older, because again, their
immune systems will wane just like everybody else.
Because we were all kids once.
So I'd love and you know, even you, even me.
Oh my gosh.
And let me this this is before we talk a little bit more about the shingles vaccine, let me
just tell you another little fun fact about chicken pox and shingles.
So before 1993, most everybody got the chicken pox.
Not everybody, but a large percentage of people got the chicken pox.
And so with all of us as you know, old, you know, as parents or older people that had
gotten the chicken pox in the past, because kids, grandkids, great grandkids would get
the chicken pox.
So we continually activate your immune system against the varicella zoster virus.
So you would stay kind of immunized or protected against the varicella zoster virus.
It wasn't didn't mean that you couldn't get shingles, but you had this activation because
you were constantly around kiddos in just living life that had either had chicken pox
or just getting over chicken pox or whatever.
When the when the vaccine came out.
So far fewer kids have active chicken pox.
So then as the older adults or adults, older adults are not exposed as much to that virus
anymore.
So our immune systems as an older adult don't get stimulated as much.
So our our our so our immunity against that varicella zoster virus can go down because
of the fact that younger kids got vaccinated against the chicken pox.
So it's going to be very interesting.
And as Josh said, we do not have the data yet with the younger kids that have gotten
vaccinated against chicken pox.
If in fact, their incidence of varicella will be lower because they may be the the amount
of virus that was generated in their body didn't wasn't enough to to house enough in
the dormant and in the ganglion cells.
We just that's we have no idea.
We just don't know yet.
And so so that's true.
It's like the pros and cons of I remember when I was a school teacher and just like
the first week of school, I would just always get sick because the kids would come back
and then kids are disgusting.
And so they just they're not.
Well, what I mean by that is that they just they carry disease.
They get into everything.
You know, and then obviously you get sick because probably during the summer, you know,
when I was on break, I wasn't around as many people as I am when I'm enclosed in a school
environment.
So you kind of take for granted, like a lot of the pathogens that you're exposed to when
you're around a bunch of people.
Obviously, you can get a little bit sick, but, you know, maybe that baseline is kind
of keeping your immune system on track, which is why, you know, you should always have a
bunch of friends, you know.
So if you're feeling alone and just go out and hang out with people, it's not only good
for your social life, it's good for your immune system, too.
There you go.
Just be careful.
Yeah.
So actually, there's no there's no maximum age for getting the Shingrix vaccine either
and stuff.
So it is a two dose series.
So that means that you have to get two doses of this vaccine.
You get the first dose and then you're going to get the second dose two to six months after
you get the first dose.
It's administered intramuscularly in your arm, in your top of your arm, you know, and
you can get it in your doctor's office.
But you know, a lot of, you know, most pharmacies have a pharmacist that can administer your
vaccines now as well, too.
So that's one that they can give.
It does cause some adverse effects.
The ones that many patients complain about with this vaccine are it does cause pain,
redness and a little swelling in your arm at the actual injection site.
You can take Tylenol for a day or two after you get it.
And and it does go away.
You could you might feel a little feverish or just kind of just not feeling well after
you get it.
You could get in.
You know, that usually happens in about half of the patients.
You can get a headache.
You know, you can feel a little sick to your stomach.
But it doesn't really last for very long.
And it's so and again, those like I said, those symptoms don't last for very long.
You could take some Tylenol to relieve that symptom.
But it's so much better than getting the shingles itself because the shingles will last definitely
longer than a day or two.
As a pharmacist, what we've told patients when they are going to plan to get their shingles
vaccine, if you have a Monday through Friday job or you know, whatever your schedule is,
get it on a day when the next day you know you don't have a lot going on.
So you can anticipate that you might not feel well for a day.
You can, you know, and then and then accommodate that and stuff.
So you can get that advice.
And also just it's my understanding that when you do get those kind of feverish symptoms,
that is your immune system kind of kicking in.
It is.
And obviously, some people's immune systems are more robust than others just due to humans
being different from one another.
So you're going to get a different response depending on who you are.
Right.
So this that this vaccine is very effective.
The shingles, the new one.
The new shingles two dose vaccine is, but you have to get both doses to get the really
effective that's really effective result.
And in the data that they've collected after they studied this vaccine, I believe it, correct
me if I'm wrong, Josh, I think it was 30,000 patients that did one study.
And the effectiveness overall effectiveness was 97 percent, 94 percent up there.
And that was that and that was the around, you know, around a five year time period.
And that effect has been sustained over at least eight years.
But as time has gone on, the effect has not dropped that much.
And that's the cool thing that was makes this this newer vaccine, this shingles vaccine
better than the older Zostavax vaccine is that the effects are maintained in the different
age groups.
And again, remember, older patients are going to be more likely to get shingles.
So we're looking at those that are older, you know, the 50 to 59, the 60 to 69, the
70 to 79 and those over 80.
And it's effective in all of those age groups.
I believe that it may dump down a little bit or drop down a little bit to maybe 85, 86
percent of efficacy in those older than 80.
But that's still really effective for a vaccine.
So that and it's likely with you if you get so again, you get this this vaccine when you
turn 50 or close after 50.
And it's likely that the that the effectiveness of this vaccine will last, you know, for the
rest of your life.
There may be, you know, in years to come that you might have to get a booster dose, but
that hasn't been shown yet.
Yeah.
But it hasn't been out long enough yet really to know whether or not that's really what
we need to be 2017.
So yeah.
So we don't know that yet.
So but again, right now they know that it probably lasts for at least 10 to 15 years.
And yeah, let's just revisit probability again.
So we have a patient sample size of 30000 people.
Right.
Let's just assume that that's the number of people who got the dose of the vaccine.
Let's just assume it's 95 percent effective at reducing the incidence of shingles, meaning
that you won't show the symptoms that we talked about earlier.
That still means that there are about 1500 people out of that 30000 who will show symptoms,
you know, so it doesn't mean.
So when we say the vaccine is effective, we're meaning it's effective against non treatment
or like if you don't get the vaccine.
So but there's still a chance that you could get it.
So you were all we're doing is evaluating risk.
So there is a possibility that you could be vaccinated and you could still get the shingles.
And it just means that for you, for some reason, the vaccine wasn't it just didn't take the
way it did for the majority of the population.
And then you have to move to other treatments like we talked about antivirals and pain medications
and maybe a nice oatmeal bath, you know, to make you feel better.
Yeah.
So so, yeah.
So the other thing that I want to mention, too, is that you're like thinking, how can
it be good for 10 years and the vaccine only came out in 2017?
And researchers can project into the future when they've got certain data as to how it's
like a trajectory.
It's kind of like how how is something going to do over this time period based on what
it's done in these first five years?
And so that's how they can anticipate that it's going to still be effective five years
from now because it's doing so good right now and there's no evidence that it's abruptly
dropping off in efficacy.
Yeah, I think that's that's really well said.
And it's also also good to keep in mind, like weather forecasts, like weather forecasts
are really accurate, I think three days out.
But if they get two weeks out, I think the reliability is maybe a 50 50.
It's like a coin flip of what is if you're looking two weeks out and a weather forecast,
that's basically saying based on the conditions that we think the weather is going to do,
we think it's going to be like this.
And obviously, the further you go into the future, it's going to be hard to predict.
But the closer you are in your timestamp, the more accurate your forecasting will be,
depending on how much information, how good your models are.
So anytime we model these things, it's always making certain assumptions, just like with
weather forecasting.
So this could change over time, you know, but the information we have right now based
on the first five years that well, it's been six years now since 2017.
Yes, then it's we see no reason to a DVA.
But that could always change.
It could change.
So again, that's why you've got researchers that are always collecting data.
So are there folks out there who you would caution against either?
I was just going to do that.
I was just going to wow.
It's just too cool.
It's like we share genetic material.
So so there are a couple of populations that are not going to want to get this shingles
vaccine for sure because of the data that have been have been found or the lack of data.
One is if you obviously and this goes with it, taking any medication, any vaccine, if
you've had a significant allergic reaction to that particular vaccine or if you have
severe allergic reaction to any vaccine, you're not going to want to get this vaccine because
it could a lot of vaccines use the same types of fillers, you know, and extra things in
them and stuff.
And so you're not going to want to get it if you've had an allergic reaction to a vaccine.
You don't want to use it if you're pregnant and primarily because we don't have enough
data to know whether or not it's it's safe or not.
And also, as I mentioned earlier, you don't want to get it if you currently have the shingles.
You need to wait until the virus, the disease is over and then you can get the vaccine.
Gotcha.
Yeah.
And I feel that with the pregnancy, that's going to be a pretty small cohort of people,
right?
Because it's so people over 50.
Right.
I don't know when women go through menopause.
It just depends.
I mean, there have been some women that have been pregnant, you know, the late 40s, maybe
50 and stuff, but maybe for immunocompromised women as well who are earlier than 50.
Right.
That's fair.
Right.
So so again, I think that's just about it as far as what I've got to say about the shingles
virus and shingles vaccine.
I think that, as we mentioned, it's going to be really interesting to follow this through
the next several decades to see how the kiddos that were vaccinated with the chickenpox vaccine,
how they fare in the future as far as the development of shingles.
So that's just something to stay tuned for.
So I agree.
And the the wow thing is too, is that there are so many other than varicella, there's
just viruses inside of your body that you just don't even know about and are waiting
to come about and do their thing at a later course in time.
It's pretty interesting to think that probably everyone is walking around now with varicella
or Epstein-Barr virus or some of these virus that don't have obvious pathogenicity.
And at some point it comes out.
So when that happens, we hope that you've listened to this episode to learn about some
treatments that you can take.
And hopefully you all will go out and if you're 50 or older, get the Shinglet vaccine and
to protect yourself because shingles is no walk on the beach.
It is a pretty awful condition.
Like Josh said, the vaccine is, and people, it varies as to the effect, but like most
people, the adverse events associated with the vaccine are gone within a couple of days.
And it's just so worth it not to have that fear of getting shingles or the posterpatic
neuromalgia.
Keep that varicella at bay.
So with that being said, thank you all so much again for joining us.
If you like what we do, please share this podcast with somebody else you think would
be interested in learning about biology and drugs and all that fun stuff.
Like our Instagram page so that you can follow us.
But until next time, my name is Josh Klaus.
And I'm Jennifer Seltzer.
This has been another episode of Your Mom on Drugs.
We'll see you all next time.