By Dr. Jim Ferguson
Sometimes, it’s hard for me to remember whether I’ve written about something or just thought about it. As a result, I have a new project putting my previous five hundred and thirteen Focus essays in a computer file which I can then easily search. If I had realized ten years ago that I would still be writing for The Focus, I would have been organizationally more proactive.
This week I’ve been thinking about vaccinations, after several of my patients asked me about the new shingles vaccine. I’ve written previously about vaccines, how they work and shingles prevention in particular. I know this because Mr. Computer and his assistant Mr. Search Engine were able to find these topics in my newly formatted computer file, aptly entitled Knoxville Focus essays!
Shingles is a reactivation of the herpes zoster virus which most of us acquired in childhood when we had chickenpox. The immune system controls the primary chickenpox infection, but the herpes virus remains dormant in spinal nerve roots forever. Then, as the immune system ages and becomes less vigilant, the virus reactivates to produce the characteristic shingles rash and pain.
I wrote about shingles and the vaccine, Zostavax, after it was marketed in 2006. This vaccine uses a weakened (live-attenuated) herpes zoster virus to stimulate the immune system. Zostavax lessens the chance of having shingles by two thirds and reduces the chance of after-shingles neuralgia by half. Vaccination is also used to prevent primary herpes zoster infection (chickenpox) in children.
Given the fact that the incidence of shingles increases as we age, vaccination is recommended to boost the immune system for adult patients over sixty years old. Unfortunately, the protective effects of shingles vaccination wan after five to eight years. Furthermore, since Zostavax is produced with a weakened but live virus, it can’t be given to patients with a damaged immune system, despite their high risk of shingles disease.
Recently, a new vaccine (Shingrix) has been developed which uses a herpes surface protein (glycoprotein E), rather than a live virus, to boost the immune system. Shingrix is significantly more effective (>90%) at preventing shingles than the older, Zostavax vaccine. Furthermore, the new vaccine can be given to patients with damaged immune systems, though it may be less effective in these patients.
Perhaps, because it is more effective, the new vaccine causes significantly more side effects such as arm pain at the site of the injection and sometimes fever. The new vaccine also requires two intramuscular injections two to six months apart, whereas the old vaccine requires just one subcutaneous injection. Shingrix is also more expensive ($350) than Zostavax ($250), though Medicare and most private insurance companies are covering the vaccines with variable copay costs. Choosing between the two vaccine may be moot, because Zostavax may soon be deemed obsolete and no longer be available. Knoxville Kroger pharmacies have already sent their supply of the older vaccine back to their corporate warehouse.
There is also a newer pneumonia (pneumococcal) vaccination called Prevnar. It’s complicated because the older vaccine Pneumovax is actually best used in tandem with Prevnar because both have unique properties, and together expand protection against the most common type of bacterial pneumonia.
There are some things I miss from my previous life of traditional medical practice. Most notably, I miss the patients I once cared for. As a semi-retired doc, I now care for about eighty folks, but in the old fashion “hands on” way. In fact, going over previous essays while organizing my Focus file, brought two patient’s stories to mind.
The first story I’ve told before, but it’s so good it merits a retelling. MC arrived as my last patient on the last day of my traditional medical practice. Unbeknownst to me, she had collected every essay I’d written for The Focus in scrapbooks which she gave me as a retirement and Christmas present. In a 2013 Focus essay I compared her gift to one described in the beautiful short story by O. Henry called “The Gift of the Magi.” I have honored my former patient by continuing to collect my essays in now more than a half dozen scrapbooks. However, I needed a better way to search five hundred plus essays than leafing through scrapbooks, so I’ve created a computer collection of “The Doctor Is In.”
I’ve never shared the second reminisce, because it involves a tragedy. LP was an attorney, an accomplished poet and like me a migraineur. But, unlike me she was devastated by her refractory headaches which ultimately destroyed her ability to practice her profession and then opioids took her life. I thought of her when I recently reviewed an essay called “The Rat Park” I write about two years ago. But I think of her even more often since Becky and I moved to our new home. You find lots of things when you move, and I found a poem LP once gave me. Using a Google search, I could not find evidence that this poem was ever published. So, my homage to LP is to share “The Faith Healer” with you.
Hands on, in the way of the old folks,
A healer with science at his fingertips
Must know still that the path to health
Is paved with compassion.
For a great healer must enter
The heart of his patient;
Must hear even the unspoken language of pain,
The unwritten vocabulary of striving,
The quiet yearnings
That lie beneath the skin,
Under the tendons, under the bones.
These elements show
On no MRI, on no X-ray.
The true healer must listen to the heart
Without a stethoscope,
And when even science offers
No answers, no hope,
Must give dignity to suffering
And even to death,
Through the small yet colossal acts of love
That come, in the end, only through faith.
When I someday “shuffle off this mortal coil,” and my essence transcends to another reality, I hope to find MC and LP and to thank my old friends for their kindness and lingering reminisces.
