Dusty Graham and Ruth Thompson sat in the waiting area of Home Care Pharmacy at Hager Park on a recent Thursday morning while the area filled and emptied with people.
Graham, 60, and Thompson, 65, both of Hagerstown, met for the first time that morning and found they had two things in common — their love of knitting and wanting to keep themselves in good health.
Both ladies had taken part in a shingles vaccine clinic on Jan. 19, at Home Care Pharmacy, and were taking the 15 minutes after they each had their shot to get some knitting in.
What is shingles?
Dr. Allen Ditto, family practitioner at Potomac Family Medicine, said shingles — known as herpes zoster — is a rash that is caused by the chickenpox virus.
“It’s the result of having chickenpox when you were a kid,” he explained. “If you had chickenpox when you were a kid — and you get over it — the chickenpox virus never actually leaves the body.”
What happens, he said, is that the virus remains in a place along the spinal column known as the dorsal nerve root ganglia, which are like substations on the nervous system.
“For the most part, they just leave you alone, just like moss on a tree trunk on the bark leaves the tree alone,” Ditto said.
And for some unknown reason — although it often correlates with age and stress — “the virus is activated and wakes up from its suspended animation,” he said.
After waking, the virus travels down the nerve root and comes out on the skin, causing a rash, he said.
As it comes down the nervous system, Ditto said, it short circuits the nerves, disrupting the nerves’ insulation and causing pain.
“Sometimes that person might have an odd sensation, sometimes a prickly feeling, an itchy feeling, a burning feeling or a tingly feeling,” he said. “It’s actually quiet painful before the rash starts.”
Because the pain for some is intense, Ditto said doctors might think that the shingles are presenting as something else.
“I’ve already had a patient who we thought was having chest pains, broke out into a rash,” he said.
When shingles actually appear, Ditto said it’s a red rash with blisters, often appearing on the chest or back. Shingles can also appear on the face, scalp or eye. An eye doctor would care for any possible infection of the eye, Ditto said.
A person at any age can get shingles, but Ditto said it’s more likely to affect someone older, noting that 6 to 20 percent of those 60 and older are going to get shingles.
Ditto said eventually the rash and blisters will go away, but it’s the pain that often lasts.
There is no drug to treat shingles specifically, he said. The medications that a person receives are to treat the pain. And for some, the pain can be debilitating, with even the weight of a shirt skimming the area causing pain.
JoAnn Litten, 71, of Hagerstown was getting her first shingles shot during the clinic. She said her mother had shingles about 15 years ago and her doctor suggested that Litten get a shot.
Litten said she’s hoping that the vaccine will prevent her getting the virus.
The vaccine is the best bet to prevent shingles, but is not 100-percent effective, Ditto said.
“The vaccine is 50 percent effective at completely preventing it,” he said.
The other 50 percent, he said, will probably get shingles, but won’t have as much problem with the pain.
“It’s doesn’t cure the pain,” he said. “Time only cures the pain.”
Ditto said the Advisory Council on Immunization Practices, which is under the Centers for Disease Control, recommends that anyone 60 and older should get the vaccine shot. Although, he said, the FDA has the virus licensed for those 50 or older, most doctors go with ACIP’s recommendations.
The ACIP or FDA have advised only one shot at this time.
The only real prevention for shingles itself is never having chickenpox. And for those who are about age 25 and younger, Ditto said, they have already received the chickenpox vaccine.
Graham said she came to the clinic to get her vaccine simply to be proactive. “It’s an ounce of prevention,” she said.
She said she had heard shingles could be painful, so as soon as she turned 60 she asked her doctor about getting the vaccine.
Doctor offices don’t administer the vaccine in this area mainly because of the special handling the virus require, according to Susan Higgins, pharmacist manager at Home Care Pharmacy.
“We receive it frozen and it has to be kept frozen,” Higgins said.
The vaccines are administered by registered nurses, who then reconstitute the live virus before administering vaccines.
A patient must first receive a prescription from his or her doctor, which is sent to the clinic. The pharmacy calls the person back and sets up an appointment.
Higgins said Home Pharmacy has been hosting shingles vaccine clinics since 2007. The clinic hosts a clinic every month to six weeks. On average, she said, they see about 60 patients per clinic.
“We probably have done around 2,500 vaccines since the clinic has opened,” Higgins said.
As for Thompson, a retired registered nurse, said she had shingles twice and decided that she didn’t want to get it again.
Thompson said she talked about the vaccine with her doctor, who gave her a prescription to get the shot. She said she was supplied with a list of risks before she had the vaccine.
Higgins said in her pharmacy’s experience, few side effects with the shingles vaccine have been reported. Side effects are often reported as redness, itching, rash and swelling in the site of the vaccination, she said.
“In the past, of the 2,500 shots, we’ve only had three report to me that they had any kind of rash,” she said.
Ditto said he has only had one person with a small rash that lasted only a few days.
Although Higgins said many insurances cover the vaccine, including Medicare Part D, copays will vary. She said other insurance companies will only cover it if administered by a doctor’s office. The problem with that, she said, is the doctor writes a prescription, and then the patient picks up the vial and has only two days to return to his or her doctor’s office to receive the shot.
For some, like Graham, her insurance doesn’t cover the $200-plus pricetag. But she doesn’t look at it as a waste of money.
“I don’t care. I see it as an investment in my health,” she said.
If you go ...
WHAT: Shingles clinic
WHEN: 9 a.m. to 3 p.m. Thursday, March 15
WHERE: Home Care Pharmacy at Hager Park
MORE: In order to receive a vaccine, patients must first get a prescription from his or her doctor.
Photos by Yvette May/Staff Photographer
Nurse Jo Zimmerly administers the shingles vaccine to JoAnn Litten. Litten said her mother had shingles about 15 years ago, and Litten's doctor suggested that she get a shot.
Jo Zimmerly draws the shingles vaccine into a syringe. The vaccine has to be kept frozen and is administered by a registered nurse who reconstitutes the live virus before administering it.