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Q: I am 65 years old, fairly healthy, and have never had shingles. Should I receive the shingles vaccine?
A: I get asked this question a lot. Anybody who has had shingles can tell you it is not a fun thing to get, and we have a vaccine to prevent it. As you probably know, shingles is a painful skin rash caused by the same virus that causes chickenpox (Varicella Zoster virus). After causing chicken pox, this virus is never cleared from the body, but remains dormant in the nerve tissues. When the body’s immune system is weakened due to any reason, this virus can get activated and cause herpes zoster (common name is shingles). Shingles often appears as a blistery rash along the course of a nerve, on one side of the body.
The shingles vaccine contains a weakened chickenpox virus. The shingles vaccine can help in several different ways:
Reduces the risk of getting shingles in people aged 60 and older (by about 50%).
Reduces post herpetic neuralgia (nerve pain associated with shingles).
The shingles vaccine also works to stop the spread of the virus.
Who Should Get the Shingles Vaccine?
The CDC recommends a single dose of the shingles vaccine for people aged 60 and older, even if they’ve already had a bout of shingles. At this time, CDC does not have a recommendation for routine use of shingles vaccine in persons 50 through 59 years old. However, the vaccine is approved by FDA for people 50 and older.
Who Should not Get the Shingles Vaccine?
According to the CDC, the following groups of people should not get the vaccine:
Those who have a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine.
HIV/AIDS or another disease that affects the immune system
Treatment with drugs that affect the immune system, such as steroids
Cancer treatment such as radiation or chemotherapy
A history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma
Active, untreated tuberculosis
Pregnancy (or might be pregnant). Please note that women should not become pregnant until at least three months after getting shingles vaccine.
FAQs about the Vaccine:
What are the side effects from the vaccine?
The vaccine is given in the back of the arm. It may cause some redness or soreness at the site of injection. Other side effects are uncommon.
Can I get the vaccine if I have a cold?
It is OK to get the vaccine if you have a minor cold, but wait if you have a serious respiratory illness such as pneumonia.
Should I Get the Vaccine if I’ve already Had Shingles?
Yes, the shingles vaccine should be given regardless of a history of shingles.
Can I Get the Shingles Vaccine if I’m under 50?
The CDC does not recommend getting the vaccine before 50 years of age.
Will the vaccine prevent Genital Herpes?
No. Even though shingles is caused by a “herpes” virus, it is a different virus, and the vaccine will not protect against other forms of herpes including genital herpes.
This information is strictly an opinion of Dr Prakash and is not intended to replace the advice of your doctor. Dr. Chris Prakash is a contributing columnist and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology-Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children. He can be reached at (903)785-0031 or Sucharu.firstname.lastname@example.org.
You may have seen or heard about e-cigarettes. They appear harmless enough. They may even seem glamorous. But what is the real truth behind these products, and should we trust that they are an effective way to quit smoking?
We know that these devices are popular. The Tobacco Vapor Electronic Cigarette Association (yes, there is such an association) estimates about 4 million Americans now use e-cigs. They project sales to cross the 1 billion mark by the end of this year. Currently there are more than 250 different brands of e-cigarettes available in different flavors and colors!
What are e-cigarettes?
E-cigarettes are battery operated inhalers that look like regular cigarettes, that consist of a rechargeable lithium battery, a cartridge called a cartomizer and an LED that lights up at the end when you puff on the e-cigarette. The cartomizer is filled with a liquid that typically contains the chemical propylene glycol along with nicotine, flavoring and other additives. When you puff on the device, a heating element boils the liquid until it produces a vapor. The user gets a puff of hot gas that feels a lot like tobacco smoke. When the user exhales, there’s a cloud of vapor that looks like smoke.
How much do they cost?
According to the Tobacco Vapor Electronic Cigarette Association, starter kits usually run between $30 and $100. The estimated cost of replacement cartridges is about $600, compared with the more than $1,000 a year it costs to feed a pack-a-day tobacco cigarette habit.
Are e-cigarettes regulated?
No. These devices are not controlled by any agency. The FDA has the authority to regulate e-cigarettes under existing tobacco laws rather than as a medication or medical device. The agency has hinted it will begin to regulate e-cigs soon!
The biggest potential advantage of e-cigarettes is in helping people quit smoking. But the jury is out on that. In fact, The WHO has asked marketers not to make that claim.
For smokers who don’t plan to quit tobacco, some point to e-cigarettes as a way to “smoke” in smoke-free environments such as airplane lounges, restaurants, and workplaces.
Nicotine addiction of any kind is bad, and people with the habit need help quitting, not help continuing their habit in more socially acceptable ways (which e-cigarettes may provide).
Long term effects of e-cigarettes are unknown. Studies have shown that e-cigs contain some hazardous compounds in addition to nicotine.
Rather than quit, e-cigarettes might worsen users’ nicotine habits. Do e-cigarettes help tobacco smokers quit?
Theoretically, e-cigs may help people quit smoking by preserving the hand to mouth ritual of smoking, but this is based on the notion that e-cigarettes are less harmful. As of yet, though, little evidence exists to support this theory.
In a recent study published in the medical journal Lancet, researchers compared e-cigarettes to nicotine patches and other smoking cessation methods and found them statistically comparable in helping smokers quit. So, experts consider e-cigarettes promising but not fool proof.
E-cigarettes are being advertised in a rather glamorous portrayal of smoking or “vaping”. Many experts worry that this may entice youngsters, especially since many popular brands come in flavors and colors that seem designed to appeal to a younger generation of smokers.
There are no federal age restrictions to prevent kids from obtaining e- cigarettes. Most e-cigarette companies voluntarily do not sell to minors, yet “vaping” among young people is on the rise.
A Center for Disease Control and Prevention study found nearly 1.8 million young people had tried e-cigarettes and the number of middle and high school student e-smokers doubled between 2011 and 2012.
By Dr. Chris Prakash, eParisExtra
This information is strictly an opinion of Dr. Prakash and is not intended to replace the advice of your doctor. Dr. Chris Prakash is a contributing columnist and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris and board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children. You can reach him at (903) 785-0031 or Sucharu.email@example.com.
Texas is currently fighting a whooping cough epidemic, and even though cases have slowed down, the state is on pace to have the highest number of cases recorded in over 50 years.
According to the Texas Department of State Health Services, there have been almost 2400 cases of whooping cough, and two deaths, in the state this year.
What is whooping cough?
Whooping cough (or pertussis) is a respiratory infectious disease caused by the bacterium Bordetella pertussis. The hallmark symptom is uncontrollable, violent coughing which makes it hard for the patient to breath and elicits a whooping sound (gives the disease it’s name).
Is it contagious?
Yes, whooping cough is highly contagious. Patients with pertussis can spread it to others in the first 3 weeks of coughing if not treated with antibiotics. After they have been on antibiotics for 5 days, they can no longer spread the disease. Although the cough can last longer than 3 weeks, a person is no longer contagious after the third week.
What are the symptoms of whooping cough?
Early symptoms, which last about one to two weeks, are similar to a cold, and include a runny nose, low-grade fever, and cough. Later, patients can exhibit the uncontrollable cough and high pitched “whoops”, vomiting and exhaustion after coughing.
How do you test for whooping cough?
If you have symptoms suggestive of pertussis, a nasal swab is obtained and tested for the pertussis bacteria.
How can you prevent pertussis?
The Texas State Department of Health recommends the pertussis vaccination as the number one preventative measure against the disease. The recommended vaccine in the U.S. for whooping cough is DTaP, which is a combination vaccine that protects against diphtheria, tetanus and pertussis. The protection is delivered as a series of five shots, which are given at 2, 4 and 6 months of age, between 15 and 18 months, and then before a child enters school at 4 to 6 years old.
Can you get pertussis even if you’ve had the vaccine?
Yes! The vaccination protection can fade over time, so you can get pertussis even if you were vaccinated against it. Therefore, it is recommended that preteens get a booster dose of another pertussis vaccine known as Tdap around 11 or 12 years old. Adults who did not get Tdap when they were younger, pregnant women not previously vaccinated with Tdap and adults over 65 who are often near infants are also recommended to get the Tdap shot.
Anyone of any age can get pertussis. However, it can be more serious in infants and people with suppressed immunity. The Texas State Department of Health recommends keeping infants and other people at higher risk of contracting the disease away from the ill.
This information is strictly an opinion of Dr. Prakash and is not intended to replace the advice of your doctor. Dr. Chris Prakash is a contributing columnist and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology and lives in Paris, TX with his wife and two children. You can reach him at (903) 785-0031 or Sucharu.firstname.lastname@example.org.
First Lady Michelle Obama recently launched a campaign to encourage people to drink more water. She said that drinking water was the single best thing we could do to improve our health. She also stated that “water is the best energy drink.”
Is it true? Are her recommendations based on facts?
Forty-three percent of Americans drink less than four cups of water daily, and 25 percent of children do not drink any water daily (federal statistics).
Drinking more water makes intuitive sense. We all know the 8 by 8 rule – drink 8 glasses (8 oz) of water a day. But is this based on hard data? Let’s examine.
There are no good scientific studies to support this recommendation; however, there are a number of observational trials that support the notion that water is an essential ingredient for our health.
Let us look at the guidelines set by the Institute of Medicine: Total water intake should be 91 ounces for women and 125 ounces for men (from all food and beverages combined). Usually, about 25 percent of water comes from our food. Also note that all fluids count, even caffeinated beverages. So, an average female needs to consume approximately 70 ounces of fluids, and an average male requires about 90 ounces of fluids every day. Of course, these figures are approximate, and fluid requirement can be highly individualized.
Most of us get enough water in the foods and liquids that we consume on a daily basis. Our kidneys have a sophisticated filtration mechanism regulated by hormones (mainly ADH) that regulates fluid (and electrolyte) balance. Most healthy people can let thirst be a guide of water intake. Also look at the color of your urine – if dark and concentrated, you might need to increase your water intake.
Can we drink too much water?
Although uncommon, it is possible to drink too much water. This could be the case if you have congestive heart failure or an underlying condition involving the kidneys or liver, predisposing you to fluid overload. It is advisable to check with your doctor regarding this. Rarely, drinking too much water can cause hyponatremia/low sodium in blood (some patients with disease of the adrenal glands, or endurance athletes, such as marathon runners, who drink large amounts of water). In general, though, drinking too much water rarely causes any problems in healthy adults.
Switch out Soda for Water!
According to the Harvard School of Public Health: Two out of three adults and one out of three children in the United States are overweight or obese, and the nation spends an estimated $190 billion each year treating obesity-related health conditions. Rising consumption of sugary drinks has been a major contributor to the obesity epidemic. A typical 20-ounce soda contains 15 to 18 teaspoons of sugar and upwards of 240 calories. A 64-ounce fountain cola drink could have up to 700 calories. People who drink this “liquid candy” do not feel as full as if they had eaten the same calories from solid food and do not compensate by eating less.
Even though the First Lady’s campaign may not be based on scientific data, drinking more water is healthier for most people, especially if they switch out soda consumption with water. Tap water vs. bottled water is a whole different debate, and I will leave that for some other time.
Contributed by Dr. Chris Prakash
This information is strictly an opinion of Dr. Prakash and is not intended to replace the advice of your doctor. Dr. Chris Prakash is a contributing columnist and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology and lives in Paris, Texas with his wife and two children. Dr. Prakash can be reached at 903.785.0031 or Sucharu.email@example.com.
Q: I see “gluten free diet” advertised in magazines and online, as a healthier option, and even grocery aisles are full of gluten free products. Is this a fad, or is gluten free diet really healthier?
A: I agree. Gluten free diet is everywhere, and it is a relatively recent phenomenon. It is very important to know what a gluten free diet is, and who would really benefit from this diet.
What is Gluten?
Gluten is a protein in wheat, rye, and barley that is commonly found in bread, beer, pasta and a wide range of other processed foods containing these grains.
Can gluten cause disease?
Yes, for about 1% of the population, gluten causes celiac disease (CD). This is an acquired autoimmune disease that occurs in genetically predisposed individuals. Patients with celiac disease, who ingest gluten, will develop intestinal inflammation that causes destruction of the villous structures and malabsorption of nutrients. Common symptoms include diarrhea, bone pain, anemia and skin rash. Patients with untreated CD are also at increased risk of certain cancers, such as non-Hodgkin’s lymphoma.
Celiac disease is diagnosed through blood tests, but a duodenal biopsy is the gold standard test for diagnosis.
People with Celiac Disease get tremendous relief from a gluten free diet.
What is “non-celiac gluten sensitivity”?
This is a relatively new disease making its way through the medical literature. This includes patients who just feel better on a gluten free diet, but do not have celiac disease. The symptoms that patients describe are vague, and include diarrhea, abdominal cramping, bloating, headaches, fatigue (similar to those of irritable bowel syndrome, fibromyalgia or chronic fatigue syndrome). Once these patients start on a gluten free diet, their symptoms improve; however, the jury is still out on the exact cause of Non Celiac Gluten Sensitivity. It has been postulated by some that many symptoms attributed to gluten may actually be caused by sensitivity to other components of wheat flour or other ingredients found in wheat-based foods.
The true prevalence of gluten sensitivity is not known.
Can Gluten free diet be Dangerous?
Gluten free diet is a specific nutritional therapy for people with celiac disease and gluten sensitivity. For everyone else, it may not make a lot of sense.
In fact, gluten free packaged products (breads, cakes, pasta etc) have a higher glycemic index, and can induce insulin resistance and weight gain. They also have less fiber than wheat based flours, and may lack important vitamins and minerals.
Gluten free products are more widely available than ever, and that is great for people with celiac disease. But, patients need to make smart choices. The basis of a healthy gluten-free diet, as with any diet, should be natural foods. Lean meats, chicken and fish, fruits and vegetables, nuts and low-fat dairy products are all safe for people with celiac disease.
This information is strictly an opinion of Dr. Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, Texas with his wife and two children, and can be reached at 903.785.0031, or Sucharu.firstname.lastname@example.org