ArcaMax

DEAR DR. ROACH: I read your recent column on shingles. I am 66 years old and in fairly good health. I had both Shingrix shots about five years ago. I take hydroxyurea for polycythemia vera (PV).

Around Aug. 1, I noticed some spots on my forearm that appeared to be a spider bite. I went to my family doctor, and she immediately diagnosed me with shingles and put me on gabapentin, which didn't help much. The next month was complete misery. I never really had itching or an extensive rash, but intense pain and burning developed from the top of my neck down to my left thumb and forefinger. My wife read that hydroxyurea lowers your immune system, which is probably why I had such a bad case of shingles despite the Shingrix shots.

My cousin is a retired anesthesiologist. He recommended an epidural steroid injection (ESI) that would help me immediately. I had the injection, and within 24 hours, I had an 80% improvement in my pain level. Over the next month, the pain decreased another 10% to 15%. I went from being almost incapacitated to being able to live again in 24 hours. The outcome was life-changing.

It seems that doctors need to be brought up to date on ESIs for shingles. I understand the studies are inconclusive, but the on-the-ground results seem to show that it is effective. The pain from shingles has to be experienced to really understand how debilitating it can be. ESIs are fairly inexpensive. If they only helped slightly, they would be worth the cost. To have the improvement I found is priceless. -- Anon.

ANSWER: I often recommend the vaccine to prevent shingles, but as your case shows, the vaccine isn't perfect. I agree that your PV and its treatment with hydroxyurea may have predisposed you to the complication of shingles that you had, called postherpetic neuralgia (PHN). You are quite right that the pain can be extraordinarily severe.

I am glad you wrote because steroid injections are not a treatment that I have written about before. As you say, not all trials found a benefit, but the largest trial found that intrathecal injections (similar to epidural but found to be more effective in a small trial) led to excellent or good pain relief in 90% of people with intractable PHN, compared to 4% in people who received no treatment.

DEAR DR. ROACH: I am a healthy 50-year-old man. When I was at the pharmacy recently, they said I could get a vaccine for pneumonia. Is this something I should do? -- S.I.

ANSWER: The pneumonia vaccine at age 50 is a new recommendation by the Advisory Committee on Immunization Practices. The risk for developing severe pneumonia from the bacteria Streptococcus pneumoniae starts to increase at around age 50 and becomes much higher after 65. The new vaccines (PCV20 and PCV21, under the brand name "Prevnar") have long-lasting protection for many strains of this bacterial species.

If you haven't had this vaccine and are over 50, you should consider it at your next visit. (It's OK to get the vaccine at the same time as the flu or COVID vaccines.)

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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