Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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9:56 AM
December 20th, 2016

Shingles ~ What You Need to Know

What Is Shingles?

Shingles is the return of an infection long forgotten from childhood. Current medical thinking is that when a childhood case of chickenpox resolves, the virus causing it does not vanish. Instead, it migrates from the skin, along the path of nerves, to a collection of nerve cells called a ganglion, which resides close to the spinal cord or brain. Then, when the immunity containing the virus in the ganglia diminishes, the virus reemerges along the distribution of the nerve causing an outbreak.

 

What Are the Symptoms?

Symptoms usually begin with an unusual feeling in a broad localized area called a dermatome. The feeling can be a sensation of tingling, itching, or, more usually, pain. Thereafter the area may become reddened and very slightly swollen. Small blisters then form in the area and the sensation may change to burning, throbbing, or stabbing. The blisters may enlarge and coalesce and the contained fluid changes from clear to cloudy. The blisters then rupture, scab over, and gradually resolve.

 

Often, this ends the episode entirely; but, sometimes there are sequelae. The most frequent of these are scars in the area and pain long after the resolution of the blisters.

 

Who Gets Shingles?

Shingles can afflict anyone who has previously been infected with chickenpox. However, certain risk factors substantially increase the possibility of being afflicted. Common risk factors include immunosuppressive therapy either for autoimmune diseases or for transplant rejection prevention, and TNF (Tumor Necrosis Factor) inhibitors such as are used in the treatment of rheumatoid disease.

 

Diseases that pose risk factors for shingles are inflammatory bowel disease, rheumatoid arthritis, chronic obstructive pulmonary disease, asthma, chronic kidney disease, lymphoma, multiple myeloma, HIV, acute lymphocytic leukemia, and depression.

 

However, the most common risk factor is age. The probability of shingles increases with age and reaches 50% in those over 85 years old. Only 10% of shingles patients are younger than 20 years old.

 

Incidence of shingles is also reported to be higher in whites by 75% and in females. 

 

Since the introduction of widespread chickenpox vaccination in 1995, the incidence of shingles may decrease as the vaccinated population ages.

 

Can You Get Shingles Without Ever Having Been Infected with Chickenpox?

Technically, no. But, practically, one may forget ever having had chickenpox, especially if the case was mild. The US Centers for Disease Control (CDC) estimates that 99.5% of those born in the US and over 40 years of age have been infected with chicken pox.

 

Additionally, shingles is possible in persons who have been exposed to the attenuated virus by chicken pox vaccination. However, the likelihood of shingles here is much less than in those exposed to the wild virus in community- acquired chickenpox.

 

Finally, children have gotten shingles because their mother contracted chickenpox when she was pregnant with them.

 

Can Shingles Recur?

Yes, shingles recurs in about 4% of shingles sufferers.

 

What Are the Consequences of Shingles?

The most common complication of shingles is post-herpetic neuralgia (PHN). It is a continuation, or sometimes reappearance after a brief respite, of the pain that accompanies the shingles episode. Occasionally the quality of the pain or discomfort changes somewhat. PHN may last for months or years. Like shingles itself, PHN also increases in likelihood with age. 50% of shingles victims over the age of 60 develop PHN.

 

A less serious complication from a shingles episode is localized bacterial infection from scratching the skin lesions. More serious but rare complications are meningo-encephalitis, ischemic stroke, spread of shingles far beyond the original restricted distribution, paralysis, and blindness, deafness, or facial weakness from shingles of the face.

 

Is There a Test for Shingles?

Although laboratory tests for shingles virus exist, they are generally used only in unusual circumstances as in cases in which the typical symptoms do not appear or cases in which an early recognition of the attack is needed because of a patient’s low immunity.

 

The physician typically diagnoses shingles from the appearance of the involved skin and the history provided by the patient.

 

What Is the Treatment for Shingles?

 

The most specific treatment for shingles is one of the antiviral drugs. These are most effective when begun within 72 hours of appearance of the rash, but they have some effect even when given later. These drugs can both shorten and soften the attack and reduce the risk of subsequent PHN.

 

Nonspecifically, there are numerous options for the treatment of the pain associated with shingles and PHN. These involve analgesics such as ibuprofen or sometimes stronger, anti-seizure medications, antidepressants, and sometimes corticosteroids. Nerve injection is also used. Sometimes a capsaicin cream or lidocaine path is helpful.

 

Of course, the best way to approach a problem is not to have it, so let us go on to discuss prevention.

 

Shingles Prevention - Chicken Pox Vaccination

 

Since shingles is reactivation of a childhood chickenpox infection, an effective approach is the two-dose vaccination against chickenpox. It will prevent chickenpox in about 90% of those vaccinated and will shorten and reduce the severity of the chickenpox infection in the rest. By herd immunity, it also reduces the community frequency of chickenpox, thus protecting those who cannot be vaccinated.

 

Shingles Prevention - Shingles Vaccination

 

Those who have already had chickenpox can also be vaccinated but with the single-dose shingles vaccine. Because the incidence of shingles, and, in those afflicted by shingles, the incidence of PHN increases substantially with age, the CDC recommends shingles vaccination for all those 60 years of age and older. The Infectious Disease Society of America is more aggressive and recommends shingles vaccination for those 50 years of age and older.

 

The shingles vaccine is not perfect, but it reduces the incidence of shingles by 70% in those aged 50-59, by 64% in those aged 60-69, and by a somewhat lesser amount in those 70 years of age and older.

 

Testing for a previous chicken pox infection is not required for shingles vaccination. Even those with a past attack of shingles can be vaccinated, since a subsequent attack of shingles is still possible. Of course, the shingles vaccination is not a treatment for a current attack of shingles or PHN.

 

Since the virus in the shingles vaccine is severely weakened, but still live, it is contraindicated in pregnancy and in those with immunodeficiency states, leukemia, lymphoma, HIV, tuberculosis, or those on immunosuppressive therapy, chemotherapy, or radiation therapy.

 

Conclusion

 

Shingles is a disease that eventuates in a great deal of pain, suffering, and disability. Further, treatments are only partially effective in many and ineffective in some. We are fortunate to live at a time when there are vaccines to substantially reduce the frequency and severity of chickenpox, shingles, and post-herpetic neuralgia. All who are candidates for these vaccinations are well advised to take advantage of them to keep our lives and senior years free of disability and pain.

 

-Thomas Falasca, DO

Shingles ~ What You Need to Know

Shingles is a disease that eventuates in a great deal of pain, suffering, and disability. Further, treatments are onl ...See More


Shingles ~ What You Need to Know

What Is Shingles?

Shingles is the return of an infection long forgotten from childhood. Current medical thinking is that when a childhood case of chickenpox resolves, the virus causing it does not vanish. Instead, it migrates from the skin, along the path of nerves, to a collection of nerve cells called a ganglion, which resides close to the spinal cord or brain. Then, when the immunity containing the virus in the ganglia diminishes, the virus reemerges along the distribution of the nerve causing an outbreak.

 

What Are the Symptoms?

Symptoms usually begin with an unusual feeling in a broad localized area called a dermatome. The feeling can be a sensation of tingling, itching, or, more usually, pain. Thereafter the area may become reddened and very slightly swollen. Small blisters then form in the area and the sensation may change to burning, throbbing, or stabbing. The blisters may enlarge and coalesce and the contained fluid changes from clear to cloudy. The blisters then rupture, scab over, and gradually resolve.

 

Often, this ends the episode entirely; but, sometimes there are sequelae. The most frequent of these are scars in the area and pain long after the resolution of the blisters.

 

Who Gets Shingles?

Shingles can afflict anyone who has previously been infected with chickenpox. However, certain risk factors substantially increase the possibility of being afflicted. Common risk factors include immunosuppressive therapy either for autoimmune diseases or for transplant rejection prevention, and TNF (Tumor Necrosis Factor) inhibitors such as are used in the treatment of rheumatoid disease.

 

Diseases that pose risk factors for shingles are inflammatory bowel disease, rheumatoid arthritis, chronic obstructive pulmonary disease, asthma, chronic kidney disease, lymphoma, multiple myeloma, HIV, acute lymphocytic leukemia, and depression.

 

However, the most common risk factor is age. The probability of shingles increases with age and reaches 50% in those over 85 years old. Only 10% of shingles patients are younger than 20 years old.

 

Incidence of shingles is also reported to be higher in whites by 75% and in females. 

 

Since the introduction of widespread chickenpox vaccination in 1995, the incidence of shingles may decrease as the vaccinated population ages.

 

Can You Get Shingles Without Ever Having Been Infected with Chickenpox?

Technically, no. But, practically, one may forget ever having had chickenpox, especially if the case was mild. The US Centers for Disease Control (CDC) estimates that 99.5% of those born in the US and over 40 years of age have been infected with chicken pox.

 

Additionally, shingles is possible in persons who have been exposed to the attenuated virus by chicken pox vaccination. However, the likelihood of shingles here is much less than in those exposed to the wild virus in community- acquired chickenpox.

 

Finally, children have gotten shingles because their mother contracted chickenpox when she was pregnant with them.

 

Can Shingles Recur?

Yes, shingles recurs in about 4% of shingles sufferers.

 

What Are the Consequences of Shingles?

The most common complication of shingles is post-herpetic neuralgia (PHN). It is a continuation, or sometimes reappearance after a brief respite, of the pain that accompanies the shingles episode. Occasionally the quality of the pain or discomfort changes somewhat. PHN may last for months or years. Like shingles itself, PHN also increases in likelihood with age. 50% of shingles victims over the age of 60 develop PHN.

 

A less serious complication from a shingles episode is localized bacterial infection from scratching the skin lesions. More serious but rare complications are meningo-encephalitis, ischemic stroke, spread of shingles far beyond the original restricted distribution, paralysis, and blindness, deafness, or facial weakness from shingles of the face.

 

Is There a Test for Shingles?

Although laboratory tests for shingles virus exist, they are generally used only in unusual circumstances as in cases in which the typical symptoms do not appear or cases in which an early recognition of the attack is needed because of a patient’s low immunity.

 

The physician typically diagnoses shingles from the appearance of the involved skin and the history provided by the patient.

 

What Is the Treatment for Shingles?

 

The most specific treatment for shingles is one of the antiviral drugs. These are most effective when begun within 72 hours of appearance of the rash, but they have some effect even when given later. These drugs can both shorten and soften the attack and reduce the risk of subsequent PHN.

 

Nonspecifically, there are numerous options for the treatment of the pain associated with shingles and PHN. These involve analgesics such as ibuprofen or sometimes stronger, anti-seizure medications, antidepressants, and sometimes corticosteroids. Nerve injection is also used. Sometimes a capsaicin cream or lidocaine path is helpful.

 

Of course, the best way to approach a problem is not to have it, so let us go on to discuss prevention.

 

Shingles Prevention - Chicken Pox Vaccination

 

Since shingles is reactivation of a childhood chickenpox infection, an effective approach is the two-dose vaccination against chickenpox. It will prevent chickenpox in about 90% of those vaccinated and will shorten and reduce the severity of the chickenpox infection in the rest. By herd immunity, it also reduces the community frequency of chickenpox, thus protecting those who cannot be vaccinated.

 

Shingles Prevention - Shingles Vaccination

 

Those who have already had chickenpox can also be vaccinated but with the single-dose shingles vaccine. Because the incidence of shingles, and, in those afflicted by shingles, the incidence of PHN increases substantially with age, the CDC recommends shingles vaccination for all those 60 years of age and older. The Infectious Disease Society of America is more aggressive and recommends shingles vaccination for those 50 years of age and older.

 

The shingles vaccine is not perfect, but it reduces the incidence of shingles by 70% in those aged 50-59, by 64% in those aged 60-69, and by a somewhat lesser amount in those 70 years of age and older.

 

Testing for a previous chicken pox infection is not required for shingles vaccination. Even those with a past attack of shingles can be vaccinated, since a subsequent attack of shingles is still possible. Of course, the shingles vaccination is not a treatment for a current attack of shingles or PHN.

 

Since the virus in the shingles vaccine is severely weakened, but still live, it is contraindicated in pregnancy and in those with immunodeficiency states, leukemia, lymphoma, HIV, tuberculosis, or those on immunosuppressive therapy, chemotherapy, or radiation therapy.

 

Conclusion

 

Shingles is a disease that eventuates in a great deal of pain, suffering, and disability. Further, treatments are only partially effective in many and ineffective in some. We are fortunate to live at a time when there are vaccines to substantially reduce the frequency and severity of chickenpox, shingles, and post-herpetic neuralgia. All who are candidates for these vaccinations are well advised to take advantage of them to keep our lives and senior years free of disability and pain.

 

-Thomas Falasca, DO

Know Your Risk Factors

Get to know your heart better. Take it for a little walk. Just the right amount of exercise can benefit your heart en ...See More


Know Your Risk Factors

A Valentine present for your heart! Why not? Your faithful little friend would love some attention from you this February. How about a nice review of the things that keep your little buddy safe and happy?

 

Your tireless little ticker beats 100,000 a day against the pressure of your arteries. Your doctor calls it afterload, or more simply, blood pressure. Reduce the load on your heart, control your blood pressure. Your cardiac companion will love you for it.

 

Your feisty friend supplies your body with 1800 gallons of blood a day. But, like other parts of the body, it needs blood itself. Blood supplies this miraculous little muscle through arteries that narrow gradually or obstruct suddenly when blood cholesterol levels are elevated. You can visit your doctor to learn your cholesterol level and reduce it if it is elevated. What a wonderful Valentine favor for your heart.

 

Diabetes is the dextrose demon that damages the blood vessels feeding your precious heart. Worst of all, your heart may feel the effects before you do. But the dextrose demon can be caged. You can visit your doctor to learn your blood sugar level, and if it is elevated, you can act to reduce it. You can defend your heart from the dextrose demon.

 

Your heart and many other organs are sensitive to the effects of smoking, which is responsible for nearly 1 in every 5 deaths in the US annually. One of the best gifts you can give your heart this Valentine Day is to go smoke-free. You can visit your doctor this month to find out how going smoke-free is easier than ever.

 

Get to know your heart better. Take it for a little walk. Just the right amount of exercise can benefit your heart enormously. Your doctor can approve the appropriate exercise for you and your little bosom buddy. So you can recreate and benefit your heart all at once!

 

Another weighty issue is BMI, Body Mass Index. Your heart needs a healthy BMI for it’s best longevity. You can keep your heart beating longer by learning your BMI and maintaining it within range. Visit the link below to learn your BMI and keep your heart happy.

 

Learn Your BMI

 

So Happy Valentine Day to you and your heart and be sure to visit us soon for more useful health information.

 

-Thomas Falasca, DO

Cataract Precautions

Although the cause of cataracts is not completely clear, it seems there may be measures you can take to at least post ...See More


Cataract Precautions

Although the cause of cataracts is not completely clear, it seems there may be measures you can take to at least postpone the occurrence of so-called senile cataracts. Don’t be discouraged if you do develop a cataract because it is an inevitable part of life if you live long enough.

 

Eye Exams. As a general principle, eye exams are recommended for all persons over 65 years old at least every two years, and more often for some patients. Ask your physician how often you should have an eye exam.

 

Sun Protection. Ultraviolet light may contribute to cataract formation. You can reduce this exposure by wearing broad-brimmed hats outdoors and by wearing sunglasses that block ultraviolet B (UVB) rays.

 

Be Smoke-Free. Some studies relate smoking to earlier cataract formation. This is yet another reason not to start smoking or to see your doctor about a program for quitting.

 

Control Other Health Problems. Health problems such as diabetes and collagen vascular diseases can accelerate the development of cataracts. You can reduce this risk by partnering closely with your doctor in controlling these related health problems.

 

Medications. There are a number of medications known to induce cataracts. The primary culprits are the steroids. Certainly the anabolic steroids illegally uses by some athletes are linked to cataracts. But all steroids from oral prednisone to some asthma inhalers can induce cataract formation. Even patients under the age of 40 have developed cataracts from some of the drug companies’ most heavily advertised asthma inhalers. Nevertheless, if you have been prescribed these medications, do not discontinue them without your doctor’s knowledge.

 

Eat Healthily. Fruits and vegetables are a pleasant and convenient path to good health. Additionally, there is even some weak evidence that the antioxidants in fruits and vegetables retard the development of cataracts.

 

Cataract Related Diseases. In addition to impairing vision, cataracts have many insidious effects. Cataracts can effect a change in eyeglass prescription. Usually cataracts necessitate a stronger prescription; but, surprisingly, they sometimes necessitate a weaker one. Finally, cataracts can cause certain types of glaucoma which may produce permanent blindness.

 

Cataracts Obstruct Detection of Other Eye Diseases. Just as a cataract may impair your vision out of the eye, it impairs the doctor’s view into the eye to examine structures behind the cataract. Thus, diseases of the retina and optic nerve such as diabetic retinopathy, age-related macular degeneration, retinal detachments, glaucoma, and papilledema can avoid detection because of cataracts. Cataracts may also deprive you of the benefits of high-tech diagnostics by interfering with your doctor’s use of such techniques as fluorescein angiogram and optical coherence tomography (OCT).

 

If You Do Develop a Cataract. Many cataracts are mild and do not require surgery initially, but there is no medication to eliminate the cataract. Surgery is the only option when the cataract blurs your vision or prevents the detection of other serious eye diseases. How[ever, recent years have seen great advances in cataract surgery. Although there are risks with any surgery, cataract surgery is one of the safest and most effective of all surgeries performed.

 

Cataract Surgery Is Now Refractive Surgery (LASIK and PRK). A huge advancement in cataract surgery has been the development of intraocular lens implants that can now correct near-sightedness, far-sightedness, and astigmatism. After cataract surgery, many patients do not need glasses for distance vision and some do not need them for distance or near vision because the lenses are accommodative or multifocal. In some patients cataract surgery can be combined with laser in-situ keratomileusis (LASIK) for better vision. Nevertheless, vision correcting lenses and LASIK are not covered by health insurance or Medicare so the patient should expect an additional cost.

 

Summary. You can take precautions to help reduce some of the risks of cataracts, but if vision-impairing cataracts do occur, surgery achieves excellent results in restoring vision.

 

-Robert Haverly, MD

-Thomas Falasca, DO

What Is Autism?

The incidence of diagnosed autism and autism spectrum disorders has substantially increased in recent years. It is un ...See More


What Is Autism?

The incidence of diagnosed autism and autism spectrum disorders has substantially increased in recent years. It is unclear how much of this is from true disease increase and how much is from improved diagnosis.

 

Autism is a more specific term than autism spectrum disorder. Autism refers to (1) impaired social interaction, (2) impaired communication, and (3) restricted, repetitive behaviors. Autism spectrum disorder refers only to (1) impaired social interaction and (2) restricted, repetitive behaviors.

 

So what do these terms mean? (1) Impaired social interaction means that affected children may totally ignore the presence of a parent, sibling, or pediatrician. (2) Impaired communication means that these children may have delayed and limited use of language. (3) Restricted, repetitive behaviors means they may engage in repeated finger movements, postures, or utterances.

 

Of course, all behaviors must be taken in context. Further, there is no x-ray or laboratory test to detect autism. Only a well-trained, experienced clinician can make the diagnosis of autism or autism spectrum disorder. However, some elements do raise concerns and should be followed up with such a specialist.

 

First is the absence of protodeclarative pointing. Normally, when a small child is asked, “Where is (for example) the teddy bear?” the child will point with the index finger while looking at the questioner’s face. A child’s inability to do this should be investigated.

 

Second is the abence of normal gaze monitoring. Typically when an adult speaks a child’s name and points to an object across the room while saying, “Oh look, there’s a …,” the child looks at the object indicated. Again, regular failure at this gaze monitoring can be a cause for further examination.

 

Third is the absence of pretend play. The usual actions of a child presented with a toy object, such as a car, is to simulate the actions associated with the real object. A child may consistently fail to wheel the car across a surface, but instead seem fixated on the color or texture of the object or incessantly spin one of the car’s wheels. Consistent actions of this type warrant specialist consultation.

 

The prevailing professional opinion is that children with autism can be helped with behavioral therapy and special education programs. Speech and language therapy, social skills therapy, and occupational therapy are also deemed useful. While no medications exist to treat the core problem of autism, medications may help other problems often associated with autism.

 

-Thomas Falasca DO

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