DEAR DR. DONOHUE: I hear on the local and national news that all people 60 and over should get the shingles vaccination. Do you consider it safe? – B.B.

DEAR DR. DONOHUE: I would like your opinion on the shingles immunity shot. I am a 75-year-old male and have heard many horror stories related to shingles. Would you suggest getting a shot? – E.S.

ANSWER: Zostavax, the new vaccine for shingles prevention, is quite safe, and I would not hesitate to get the shot.

The virus that causes chickenpox causes shingles. Just about every adult has been infected with the chickenpox virus, whether they remember having it or not. The virus lives in the infected person’s nerve cells for life. Later in life, when a person’s immunity dips, as it does from time to time, the virus leaves its nerve-cell home, travels down the nerve to the skin and produces the painful rash of shingles.

Shingles itself is bad. What is worse is the pain that can linger for a very long time after all signs of the rash have gone. That’s postherpetic neuralgia, and it comes from the damage done to the nerve by the virus as it makes its way down the nerve to the skin.

The vaccine has been shown to provide a 51 percent reduction in shingles outbreaks. When a vaccinated person did break out with shingles, the illness was much less severe than it would have been without the shot. Most important, it reduces the changes of postherpetic neuralgia – the dreadful complication of shingles – by two-thirds. That alone is a justification to get the vaccine.

The vaccine is costly. You have to discuss this matter with your doctor.

The shingles booklet describes this painful illness in detail. It does not discuss the vaccine. Readers can obtain a copy by writing: Dr. Donohue – No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I had surgery for a dental problem. Since I have a heart murmur, I have to premedicate with antibiotics. The antibiotic gave me thrush. This has happened before. Is there some way I can premedicate with an antibiotic shot so the medicine won’t go into my mouth and stomach? – J.M.

ANSWER: Thrush is an infection from the yeast Candida. In the mouth, the infection is seen as white patches on a red base.

Small numbers of Candida can live in the mouth without creating a disturbance. However, when a person with oral Candida must take antibiotics, the antibiotics suppress bacteria that also live in the mouth and keep the Candida population in check. Candida numbers surge, and the person comes down with thrush.

You have to take antibiotics before dental procedures that release bacteria into the blood. You have a heart valve that is a bit out of shape and produces a heart murmur. Bacteria in the blood home in on such valves and cause a dangerous infection — endocarditis.

Taking the antibiotic by shot would do no good. The antibiotic still works in the mouth, even though it is given by injection.

Your doctor could give you an alternate antibiotic to the one you usually take to see if it won’t lead to emergence of thrush. Or you could take medicine that keeps Candida in check at the same time you take the antibiotic – a pre-emptive strike.

DEAR DR. DONOHUE: I hope you can explain a saying for me. I have heard it used in autopsy reports on TV, and it was also on my mother’s record. It’s: “hearing the thunder of hoofbeats and looking for a zebra.” I think it’s a cruel expression. – A.S.

ANSWER: The expression in medicine goes more like this: “When you hear hoof beats, think of horses, not of zebras.” The meaning is: When you see common signs, think of common causes. It’s not something said in cruelty.

DEAR DR. DONOHUE: I am 78 and have essential tremor. I was on Inderal for it, and it helped me. My new doctor took me off Inderal because of my slow heart rate. My shaking is now terrible. Do you believe I should not take Inderal? – W.F.

ANSWER: You shouldn’t take it if your slow heart brought on symptoms, like feeling faint. Otherwise, I can’t see any reason to stop it. There are, however, other medicines you can take. Primidone is an example.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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