Dear Dr. Roach: I am in my 60s. About 40 years ago, I had a case of shingles. Can shingles reoccur, or having once had it am I protected from having it again? I've been given conflicting information about whether I need to be vaccinated.
M.F.
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Dear Dr. Roach: I heard a report from a recent study that said a person who has shingles early in life is more likely to suffer a stroke. Would you please explain why?
A.L.R.
Shingles is a disease caused by the reactivation of varicella zoster virus, the virus for chickenpox, which lays dormant in the body for years or even decades. Shingles itself is painful, but the most feared complication has been post-herpetic neuralgia, which can be horrifically painful and can last for months, especially in older people.
In January 2014, researchers in the U.K. found an increased risk of stroke and other vascular disease, including heart attack, in people who had had shingles before the age of 40. The study could not answer why, but previous research has shown that blood vessels in the brain can be affected by the virus that causes shingles. There may be a role for the antibodies produced by the body as well.
It is clear that people with shingles at an early age should be even more careful about other risk factors for stroke, especially smoking, blood pressure and cholesterol. A previous history of shingles does not guarantee against further episodes, so the vaccine is recommended at age 60 with or without a history of shingles in the past.
The recommendation for shingles vaccine may change: The vaccine has a Food and Drug Administration indication for ages 50-59, but is not recommended by the Advisory Committee.
Dear Dr. Roach: I am interested in your input regarding the commonly prescribed metroclopramide (Reglan). I researched possible side effects of this medication prior to taking the first dose. I was horrified to find tardive dyskinesia (and its irreversible complications) cited. As a speech pathologist, my patients have included those afflicted with Huntington's disease. The uncontrollable facial and body contortions are heartbreaking to observe, and for the patients to suffer. Tardive dyskinesia鈥檚 manifestations profoundly alter quality of life that any risk of developing irreversible tardive dyskinesia would far outweigh any benefit.
P.C.
Tardive dyskinesia is a late side effect of some medications, especially antipsychotic medications, usually used for schizophrenia, and also including metoclopramide.
Tardive dyskinesia manifests through abnormal movements, especially of the mouth and face, but may also include limbs, neck and trunk. Chewing movements of the mouth, tongue protrusion and smacking of the lips are very common. As you point out, once it occurs, it may stay forever; however, if it is recognized early and the offending medication stopped immediately, 50 to 90 per cent of patients may remit.
