Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: I am an 86-year-old male in excellent health, except for high blood pressure, which is well-controlled. However, a few months ago, I was hospitalized with periorbital cellulitis as well as a shingles outbreak over the eye. The rash was definitely asymmetrical and confined to the right side of my head. I started cephalexin through an IV and valacyclovir.
After six days of treatment, I was well enough to leave the hospital and directed to remain on the meds for five more days. I was also diagnosed with double vision, due to the effect of shingles on the nerves and microvascular tissues on my right eye. The physicians at the hospital had given cursory information on what the long-term prognosis would be for my vision.
Fortunately, I am now almost back to normal, but having lost 20 pounds in the hospital, I am three sizes smaller around the waist and haven’t regained the weight. Two questions remain about this experience.
The first has to do with the reluctance of my physician to recommend the shingles vaccine in the first place; whereas with all the other vaccinations, he was proactively positive. He has since retired, so I can’t question him directly.
Secondly, why isn’t double vision advertised more overtly as a possible side effect from shingles? Had I known there was even a remote possibility of double vision, I would have been first in line for the shot, especially now that I know how hard it is to overcome this hardship. — K.R.F.
ANSWER: Shingles causes a rash on a specific area and side of the body. Although yours wasn’t painful, it usually causes at least some discomfort, sometimes excruciating pain. But it’s the complications that sometimes happen with shingles that cause physicians the most worry.
The most common complication is post-herpetic neuralgia, which persists for at least 90 days after the rash begins. The older a person is, the more likely they are to have this complication — and the longer it is to last. I have had patients become bedbound from this complication, requiring inpatient rehabilitation to recover.
Other complications include eye disease. The virus can cause vision loss. The nerves can also be affected, causing double vision or other motor loss. In addition, it can cause meningitis (inflammation of the lining of the brain), encephalitis (inflammation of the brain itself) and even a stroke due to its effect on blood vessels. People who had shingles are at a significantly higher risk for a stroke at least a year after the infection.
Although most people with shingles have a painful rash that lasts a week or two, the sight-threatening and other severe complications should prompt physicians to actively promote the recombinant vaccine, Shingrix, which is very effective at preventing the disease (90% to 97%) and its complications (90% to 100%). I can only guess that your physician was thinking of the old, one-shot live vaccine, which was not as effective and whose benefit waned after eight years or so.
Even people who have already had shingles, or those who had the old vaccine, should get the new two-shot vaccine. It can be given to adults over 50 and some adults of any age with immune system disease. (Make sure to speak to your doctor about this.)
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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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