Weird Medicine: The Podcast - 310 - Shingles Vaccine and Hypnotic Sleep Aids

Episode Date: May 1, 2018

Dr Steve discusses the merits of adult vaccination for varicella zoster (the virus that causes chickenpox and shingles). Also mortality associated with certain sleeping pills and the alternative OTC meds. STUFF.DOCTORSTEVE.COM simplyherbals.net premium.doctorsteve.com Learn more about your ad choices. Visit podcastchoices.com/adchoices

What is a pirate's favorite animal? Ark, Varks. You're listening to Weird Medicine with Dr. Steve on the Riotcast Network, Riotcast.com. I've got diphtheria crushing my esophagus. I've got Tobolovir stripping from my nose. I've got the leprosy of the heartbell, exacerbating my inflatable woes. I want to take my brain out and blast with the wave,

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Medicine, Weird Med Show, which is nothing but show. related content. Lady Diagnosis or DR. Scott W.M. Anyway, all right. Thank you for being with us today or for us. I guess that's the royal us. I'm going to have to do a quick one today. This is work-related.

And as you know, if you've listened to this show for a long time, I have a lot of wear a different, a lot of different hats. And this is one of them, one of the more important ones, as far as I'm concerned. sometimes my other jobs get in the way. So I'm going to have to make this one quick this week. We'll be back, hopefully, to a regular schedule next week or the week after. It may be the week after. I've got a kid's birthday party this week when I'm supposed to be recording,

so we may have to put it off another week. But I'll try to have something good for you. Maybe a best-up. We've got a new intern coming, and it's a cliff from the funniest person, the Tri-Cities, turns out that he, for those of you that saw that, he was one of the finalists, and he needed an intern credit, and so he's going to be our intern. So he's entertaining, and I'm going to get him to cut up some best-ofs that are theme-based for his final project, and we'll play some of those here as well.

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and the other thing that you can do with that is use that in concert with the Weird Medicine app that you can get on the iTunes store or Google Play Store, and it really integrates very well with the premium program. All right. So anyway, thank you for that. Shingles vaccine. You know, there's a lot of vaccines that are recommended for children. I'm getting this from science-based medicine.org to give credit where credit is due.

There, you know, there aren't that many vaccines just for adults, and pertussis vaccine is one that adults can get. Tentis vaccine is another one that adults must get. Tentness is a, I've only seen one case of that in my career, and they say 10 to 20 percent fatality from getting tetanus. I think it's higher than that. But that's what they say. And that's, I mean, that is a huge number. a.k.a. lock jaw. Tetanus gets its name because it causes tetany, which is a contraction or spasm of the muscles that won't let go. And so they call it lock jaw because you get tetany of the facial muscle.

They can't help your jaw. Well, usually you're so sick. That's not an issue for you at that point. It would be an issue for the person examining you because they can't open your mouth because you have tetany of the facial muscles. Anyway, so get your damn tetanus vaccine. I had somebody the other day asked me if it's a problem if they get one before 10 years, because you're supposed to get one every 10 years. And our protocol was if you get a wound and you don't know when your last tetanus shot was, go ahead and get a tetanus shot. And then write that down and then get one 10 years later. If you know when you got your tetanus shot and you get a dirty wound, five years is good. But if you get a filthy wound, in other words, you fall in a cow pasture and you put your hands straight out and you fall into a cow paddy that also has a nail that's sticking straight up and it pierces your hand and contaminates the wound with cow fecal matter.

It doesn't matter when you had your last tetanus shot. Get another one right then. And there are protocols for these things. If you're not sure, ask your primary care. But anyway, the shingles vaccine is one of those adult vaccines that, and I can't think of another one that's really only offered to adults. And there's a new shingles vaccine that's been added to the schedule for adults over the age of 50. And this is called shingricks, which is hard to say.

And the other one is Zostovacs, which was released in 2000. six. So why do you want to get a shingles vaccine? Well, let's talk about shingles for a minute. Shingles is also known as herpes zoster. So it is in the chickenpox virus, which causes shingles, is in the herpes family. And so what does herpes do? It hides in your nervous system and these things called ganglia. And then it comes out every once in a while, right? And so if you have genital herpes, those herpes simplex viruses will hide in these ganglia and then when you get stressed or whatever the other trigger is, they come out and then cause a cold sore on your mouth or they cause blisters on your dick or vagina or other places.

If it happens on your hand, what's the name? GVAC used to know this one. It is. If you got it, if you said herpetic Whitlow. Oh, shit. Let's try that again. If you said herpetic Whitlow. Give yourself a bill.

That would be correct. So this chickenpox is a herpes vaccine vaccine or a virus. It's in the herpes family. And after you get your chicken pox outbreak, your primary outbreak, you will often have chickenpox vaccine vaccine vaccine retreating to some place in the nervous system and hide until you're my age and start having a decreased immune system or whatever it is that triggers it and it will come out usually just one time and then your immune system gets revved up again and then it can't do it again. Now, people that have recurrent shingles may have actually have herpes rather than

recurrent shingles or they may have an issue with their immune system that's allowing this to come out. Anyway, so, you know, you develop immunity and this varicella virus persists in the nerve cells of the sensory ganglia and can be reactivated. And so you say, okay, well, who gives a shit? Can I transmit shingles to somebody else? The answer is no. You could give somebody else chickenpox if they've never had chicken pox before, but you can't give them shingles. So, okay, so who cares? You know why you care because this virus is a is a son of a bitch because it um as it retreats it leaves behind uh nerve cells that are damaged and they will send pain fibers to the brain and about 50% of people uh it will have what's called post herpetic neuralgia and it'll usually last a month or

two, but in about 20% of the cases, it'll last for longer than a year, sometimes for the rest of their life. And it can be painful, and particularly if you get shingles of the head. And shingles, oh, by the way, how do you recognize shingles? Well, it'll be poxy-looking blisters, red, painful, burning blisters that follow one nerve root. So it'll be, if you have it on your chest, it'll be often coming from. the nerve root that comes out of the spinal column and will wrap around the ribs and it'll follow the ribs, it kind of spread out. And it's wherever that nerve, single nerve root goes. But if it's the facial nerve, then it'll, or a trigeminal nerve, it'll be all over your face.

And sometimes these things can get in your eye. They can swell up the nerve root as it's coming out of the skull and cause Bell's palsy if it hits the facial nerve, which is a one-sided weakness of the face, can suck. So once you get post-repidic neuralgia, there's treatments for it, but there's no cure. It's just got to go away on its own. So it'd be nice to be able to prevent that. It decreases productivity and decreases quality of life for a lot of people. So doing the shingles vaccine to rev up the nervous system,

I'm sorry, the immune system so that you don't get shingles, or if you do get shingles, you get in a milder form would be a nice thing. So anyway, the incidence of shingles is about four cases per thousand people per year. But if you narrow it down to people 60 and older, it's 10 cases per thousand people per year. So it's about 0.1% of people will get it. And of those people that get that, about 1% of those will be hospitalized for complications. So 0.01 will be hospitalized. There is a fatality rate for shingles, believe it or not.

It's 0.28 per million population. It's mostly the elderly and people who are immunocompromise, meaning chemotherapy patients, patients with HIV and that kind of stuff. in a small percentage of patients, less than 5% will go on to have a second or third episode. So it sucks. So we have seen an increase in shingles, and it may be because we're not exposed to chickenpox as much as we used to be because of the chickenpox vaccine. I've never been the biggest fan of the chickenpox vaccine, mainly because of the chickenpox vaccine, mainly because, chicken pox tends not to be life-threatening, and although I'm not going to say there are never cases of life-threatening chicken pox, because there certainly are, but it tends not to be.

And we don't know what's going to happen when these adults grow up with this sort of waning immunity because they never actually had chicken pox. And if we're going to have a whole bunch of adults who are now at risk of getting chicken pox as adults, Now, when you're a kid and you get chicken pox, it's kind of no big deal. When you're an adult and you get chicken pox, it is a big deal. And if you're a pregnant adult and you get chicken pox, it can be catastrophic. So anyway, the CDC kind of determined that rates of shingles started increasing before the varicella vaccine was introduced. And they didn't accelerate after vaccine.

chickenpox vaccine was started, so that theory may not hold water, but it is interesting. Anyway, so, yeah, just get your vaccine. Schingrichs doesn't contain live virus, so immunocompromised patients can take it. You know, Zostovacs contains live varicella virus, and it can't cause full-blown chicken pox, but it creates immunity every once in a while if you have an immunocompromised patient these things can cause complications

these live attenuated viruses so we won't give them so for people who were on chemo or had immunodeficiencies of some sort they couldn't get the Singles vaccine but now with this new one because it doesn't contain live virus that can

so let's see here yeah so they recommend the shingricks for all immunocompetent adults age 50 or older, even if they've previously had shingles or Zostovacs. So guess what? I'm going to the pharmacy when I finish this show after I finished my other work that's keeping me from doing a prolonged show this week, and I'm going to go get my shingricks vaccine. But anyway, it is more effective, but it does cause more adverse effects. And let me see what they're adverse effects they're saying.

Only slightly greater than with placebo. 17% had severe local reactions that prevented normal daily activities for an average of two days. So this would have been pain or rash at the site of injection. Some people reported muscle pain and fatigue, headache. Oh, shit, maybe I won't get this today. I've got to work. 45% of people reported muscle aches. and 45% reported fatigue.

Now, these were all short-lived. So this stuff really makes an intense immune reaction, apparently, which is good. That's what you want. And so if you can get through the effects of the vaccine, then you should have good immunity. But anyway, so just get the damn thing. Shingle sucks. It really sucks really, really bad. So, all right.

Let's take a few phone calls and see what we got here. Hey, Dr. Steve, this is Matt from Connecticut. Aside from being a 38-year-old guy with a gut and shit like that, trying to be healthier. And I've noticed that my shin, basically do you have your shin and you kind of my right leg and you kind of look at the, basically go from the shin bone and go like 11 o'clock, on the dial, that's kind of numb from almost my knee down to my foot. So there's like a two inch wide section by about a foot and a half.

Or maybe I'm good for myself a little something there, but it's numb. I can feel pressure, but when I scratch it or whatever, I have nothing. Is this something I should be worried about? If you could play that on the podcast, I'd appreciate it. Thanks so much. Yeah, okay. Well, yeah, this is a nerve compression, some sort of neuropathy. There is this thing called the peronial nerve. And when you get a severe neuropathy of that, it can actually cause foot drop. But in some people, this, since it's 11 o'clock, I'm assuming that he means on the outside. So that would be on the outside of the left knee would be at 11 o'clock would be the lateral sural cutane. nerve. And that, if it's compressed, will cause numbness in that area. So most of the time this is caused by some sort of trauma. It can be musculoskeletal injury or nerve traction, compression,

laceration, stuff like that. Every once in a while, you can get a mononeuropathy from diabetes, so I would get my blood sugar checked. If this really bothers you, you know, they can do a test of the nerves to see where the compression is happening. It could even be as high as in the hip around the sciatic nerve. So, you know, that's most likely what's causing this. Those nerves can grow back. The peripheral sensory nerves can grow back. It may take six to 12 months, but you've got to stop whatever is causing the compression in the first place.

So see your primary care and tell them that you think you have a peronial nerve injury, and they can work you up if it's bothering you. Now, if you can live with it, I would still tell your primary care, but you may be able to avoid a more expensive workup if just telling you that's what. it is, but if it starts to expand, if all of a sudden you have a droopy foot or you're tripping over yourself more frequently or the numbness is starting to expand down the leg or up into the thigh, then absolutely you want to get that worked up. And the way they would do that is through an electromagnogram, which is a needle test that they stick in. A neurologist generally will do this, although physiatrist can do them as well and some other people. They stick a needle in, that's attached to an oscilloscope and they look for a fasciculation of the nerves.

In other words, twitching that shows that the nerve has been disconnected or the muscle's been disconnected from the nerve. And then they can march it back if they know the anatomy and you can see where that nerve starts to pick back up again and you can pinpoint where the compression occurs. So that's pretty cool. And, yeah, I totally get that blood sugar check, though. Every once in a while we'll see a mononeuropathy. That is a single nerve that's affected by people with diabetes.

All right. Hey, Steve, I have a couple of questions. You talk about hypnotic sleep medications. What about over-the-counter like Unisom? Are those really dangerous? are there any alternatives besides just melatonin? And also, I get a medication from a small compounding pharmacy, which is owned by the doctor.

He's always in there checking it out and makes a lot of money off of that. One of the medications is a compounded, refrigerated medication, and is there any way they could be possibly either messing up the medication or not keeping it refrigerated or they kind of make their stuff on their own? if I had some questions and concerns about the medication and maybe them not having a generator there when the fire was out here during the storm and all the stuff not working and now I'm getting screwed over by them or is that me being paranoid because the medication kind of worked and seemed like it didn't work and I got a medication that was prescribed for me the different dosage that they accidentally gave to me and it seemed like it worked a lot better. Yeah. Yes, to all of the above. Yes, you're probably being paranoid, but yes, things can happen. And it's not just compounding pharmacies. I've gotten stuff from my regular pharmacy. They even have a robot that does, you know, fills the bottles up. And every once in a while, very rarely. And I think our pharmacists pretty much ensure one of the safest drug supplies in the world, you know, make sure that our patients are getting what they're supposed to be getting, and they catch physicians' errors, and, you know, they counsel patients on their medications and those kinds

of things. So I really think that we have a very safe medication supply. But any pharmacist will tell you, heck, they can make a mistake. So it's okay to ask them. And if you get home and you look at your pills and they don't look right, it's okay to call them. And they can check the numbers every once in a while, manufacture just changes the color, but the numbers on the markings that are on those pills will clearly identify them. And you can see if they're the right thing or not. But yeah, I think it's okay. You could say, this stuff used to work.

It's not working anymore. You know, is there any possibility that I didn't get the right thing? Or if I didn't, maybe I just need, you know, them to up the dose. So the thing that we were talking about, hypnotic sleep medications is that there's an increase risk of all-cause mortality in people who take hypnotic sleep medications. And those would include the benzodiazepine-like sleep aids and the non-benzodiazepine hypnotic sleep aids like, you know, ambient and. lunesta and that kind of stuff. So I'm just reading from a journal, hypnotic drug risks of mortality, infection, depression, and cancer, but lack of benefits. The hypnotic drugs increase all-cause mortality.

It says use of hypnotic drugs is associated prospectively. You remember, prospective data is better data than retrospectively. So looking back and just looking at charts is not as good as evidence as, you know, saying we're going to start with a cohort of a thousand people and follow them over time. With greatly increased risk of all-caused mortality, some of this mortality has been documented as deaths caused by hypnotics by medical examiners attributed to respiratory arrest resulting from, quote-unquote, overdose. However, it's likely that many deaths from respiratory depression occur among patients never seen by coroners, especially when the death is caused by a combination of hypnotics with other contributing factors,

so that the lethal hypnotic dosage may by itself have been within the current customary dosage ranges. In other words, taking, you know, that 2 milligram clonopin, if you had emphysema or congestive heart failure, may have pushed you over the edge, even though that's a normal dose. In addition to respiratory depression, hypnotics appear to be causally related to serious illnesses and premature deaths from cancer, serious infections, mood disorders, accidental injuries, suicides, and homicides. So damn. So I have pledged to get off my hypnotics. I was on this medication called lunestine.

I was on three milligrams. And I thought I needed it to sleep. And I cut it down to two. And I did okay. I cut it down to one. And then I started cutting the milligram tablets in half to a half milligram, which basically at that point is a homeopath. dose. In other words, the dose is so small it probably wasn't doing anything. But I was psychologically

felt, God, I got to have that. And I still kept taking it, even though I intellectually knew it probably wasn't doing me any good. And eventually, I just said, oh, fuck it. And just didn't renew my prescription and bit the bullet. And since I didn't have it, I couldn't take it. And it was actually quite easy to stop it. So I had one sort of bad night where I think my body was still sort of looking for. it. But then after that, I was okay. So I'm really trying to stay off the hypnotics just for this reason. So that's the background behind his question. The real question he asked those, what about the over-the-counter stuff? And as far as we know, taking anticholinergic medications, which most of the over-the-counter sleep aids, with the exception of melatonin are, don't have an

increased risk of mortality. Now, if you take chronic anticholonergic medication, these are medications like Benadryl and Visturil and things like that that cause dry mouth and can cause the heart to beat faster, have been associated with an increased risk of dementia. I'm not 100% sure that it's rigorously proven, but there is an association between taking anti-colonergic medicines every night and an increased risk of dementia. So I can't just say, yeah, just do that instead. Now, Unisom is a drug that used to be called Bendectin. It's now called another thing.

It was taken off the market because they were worried that it may cause birth defects. It was actually proven not to be associated with birth defects, but was never put back on the market for pregnant women. And it's a reasonably effective medication. If you're going to do melatonin, keep the doses low. You don't need a lot. There are some studies that say 0.5 milligrams of melatonin is plenty. You can buy it as much as 10 milligrams over the counter. But a 2.5 milligram melatonin gummy, and you all know my feelings about the marketing of gummies to adults.

I don't mind the gummies themselves because I really do think, particularly in the case of melatonin, and you get good absorption of the drug because the delivery system, this sort of gel thing, just dissolves, right? You take a pill. Sometimes the drug can bind to the clay that's in there and the clay's got a big surface area and the drug just can't get out of there. But the gummies, that's not the case. So Dr. Scott and I are both convinced without any proof whatsoever other than our own experience.

that the gummies work better. I just don't like the marketing when they call them Vita Craves. Like I crave the gummy because it's so tasty and I wouldn't take a vitamin otherwise. I don't care about my health. I just wanted to taste. Oh, pisses me off. Oh, they made my vitamin in a delicious gummy and the person's holding it up like they're so excited. Stop with the marketing of the fucking gum.

gummies to adults. It's sickening. Anyway, but that's not to say that the delivery system itself is not a good delivery system. And I think even in vitamins, sometimes vitamins are poorly absorbed when you make them in capsules or pills. But when you make it in a gummy, that gummy is going to disappear, leaving the molecule behind. There's nothing for that molecule to hide behind.

So I don't think it's a bad idea. Anyway, so, but melatonin gummies, 2.5 milligrams, is a decent, starting dose. If you've been used to taking hypnotics, if you've been on Ambien for the last five years, you're going to have some withdrawal when you get off of that. So I would recommend tapering off of that. And if you just take melatonin, the first night that you didn't take your 10 milligram ambient, you're going to be pissed. It's not going to work very well for you. So talk to, if you want to get off the hypnotics, hypnotics, the hypnotics, talk to your primary care. or whoever is prescribing them for you

and just ask them to do a nice slow taper over a period of about six weeks and you should be able to get off of them without going through a big withdrawal and without a lot of pain. But I am a bigger fan of the melatonin. It appears to be safe and not associated with naughty things unlike the anticholinergics.

But in a pinch, you've taken a trip to Hawaii or you're coming back from Europe and you can't get your, your clock set and your primary care doesn't want to write you a prescription for sleep medication, taking an over-the-counter sleep aid with or without a melatonin to reset your biological clock, I think is an okay thing to do. All right. Let's do this one and we'll get out of here.

Hey, guys. Is there a limit to how many times I can call this number and ask you question? No. Because I may have exceeded that. No, just ask Stacey. There's no limit. So I have carpal tunnel, self-diagnosed myself, but I get the tingling in the fingertips and all that. But there are times when I could just be sitting there, and sometimes it seems that it has something to do with my posture, because I have really bad posture.

And if I sit up straight, it feels like it gets better. Uh-oh. So that may you think maybe I'm pinching nerves in the neck or. Yeah. So let's talk about that for a second. So carpal tunnel is a neuropathy. We call it a compression neuropathy because it's caused by compression of the nerve in the wrist, in the carpal tunnel, which is the tunnel of the wrist. If you think about it, how to look at your wrist, how are nerves and blood vessels going to get from the arm, you know, well, from the spinal cord down the arm, and into the hand, they've got to go through, and you feel it, it doesn't feel like there's any place for them to do that. Well, in that mushy place on the wrist that's on the same side of the wrist as the palm is, that's where the carpal tunnel is.

And those structures flow through there to get to the hand. And if you play piano or you type a lot and you build up the muscles in there, they can actually decrease the space that those nerves have to pass through there. you'll get numbness and tingling of the thumb, first finger, and half of the, um, no, thumb, first finger, second finger and half of the fourth finger. And then, um, you can get the same thing if you get a compression of the funny bone, which is the nerve that passes through the, uh, elbow. That's called ulnar neuropathy.

And they're actually, uh, I don't have time to go through all of this. We've got about a minute 44 before the music stops. If you'll look online and just search for exercises, for carpal tunnel or exercises for ulnar neuropathy or cupital tunnel syndrome that's what i have i've actually found those to be quite effective uh for my really really terrible uh ulnar neuropathy and um they they have a lot to do with just re uh stretching the nerves so that they're moving around in those tunnels a little bit more freely and uh i've had great results with that so you can try that but um if moving your neck changes the symptoms in your hands you've got to be thinking about

a cervical ridiculopathy or a pinch nerve in the neck because that's where those nerves come from right so you've got a nerve that starts in the bottom part of the neck that goes to the first three fingers and then a nerve that's one level down going to the fourth and fifth finger so if you pinch the nerve up there, then you'll get those symptoms in the same place. So the way that you find out which way this is going is to get that EMG and they can trace it up to your neck or to the carpal tunnel itself. And that's the test that needs to be done. So see your primary care and get that taken care of them.

Until next time, check your stupid nuts for lumps, quit smoking, get off your asses and get some exercise. We'll see you in one week for the next edition of Weird Medicine. Thank you.