Greetings, Dr. Roach I am now sixty years old. Although I was tested as an adult and did not get chicken pox as a child, I do have the antibodies. Since I experienced a serious neurological reaction to a possible but unconfirmed herpes simplex infection, I have been taking acyclovir at a normal dose for 15 years.
According to my doctor, there is proof that taking maintenance acyclovir can stop shingles from coming on. I think she also mentioned that I would need to stop taking acyclovir around the time of the vaccination, which is a somewhat unsettling idea considering how badly I reacted to it fifteen years ago. (I still have spinal cord injuries and severe neuropathy.)
Therefore, we chose not to provide the shingles vaccine to me. Do you support this strategy? To what extent is there proof that acyclovir maintenance stops shingles outbreaks? — A.G.
ANSWER: I discovered a few studies that demonstrated a benefit in preventing shingles; however, the dosage was 800 mg every six hours, which is significantly greater than what is typically used for herpes simplex. Since the zoster virus is significantly more resistant to acyclovir and similar medications, the dosage often used to treat herpes simplex (400 mg twice daily or 200 mg five times daily) is probably insufficient to prevent it.
I believe your doctor was considering the old shingles vaccine, Zostavax, while deciding whether to cease taking acyclovir. Because it was a live vaccine, acyclovir had to be stopped before to vaccination. With Shingrix, a new recombinant vaccination that I highly suggest for you, this is not the case.
Whether the Shingrix vaccine might increase the likelihood of genital breakouts was a question posed by another reader. The majority of research revealed no benefit nor harm, but I did find one study that suggested some protection against episodes of genital herpes after receiving a zoster immunization. I advise genital herpes patients to have the same shingles vaccination as the general public because there is no reason to believe that there would be any risk.
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Greetings, Dr. Roach Despite being immunized, I experienced whooping cough as a youngster. Every time I get the illness, my cough seems to get incredibly deep. As an older adult, I now have a severe coughing condition that occasionally makes it difficult for me to catch my breath. Would my normal breathing return if I passed out? If this can occur when I’m driving or alone myself, that’s worrying. — L.W.L.
ANSWER: While frequent coughing may be a sign of a lung issue, other people have a strong cough reflex without any special issues. It might be beneficial to get your lungs examined because a serious lung infection, particularly when it occurs early in life, might cause some degree of lung damage. Lung testing through breathing tests (pulmonary function testing) and CT or X-ray images both yield useful information.
The brain has systems in place to resume regular breathing in the extremely unusual event that someone passes out from coughing. Still, it’s not a smart idea to faint while operating a motor vehicle!
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