DEAR DR. ROACH: I am in my 60s. About 40 years ago, I had a case of shingles. Can shingles reoccur, or having once had it am I protected from having it again? I’ve been given conflicting information about whether I need to be vaccinated. — M.F.
DEAR DR. ROACH: I heard a report from a recent study that said a person who has shingles early in life is more likely to suffer a stroke. Would you please explain why? — A.L.R.
ANSWER: Shingles is a disease caused by the reactivation of varicella zoster virus, the virus for chickenpox, which lays dormant in the body for years or even decades. Shingles itself is painful, but the most feared complication has been postherpetic neuralgia, which can be horrifically painful and can last for months, especially in older people.
In January 2014, researchers in the UK found an increased risk of stroke and other vascular disease, including heart attack, in people who’d had shingles before the age of 40. The study could not answer why, but previous research has shown that blood vessels in the brain can be affected by the virus that causes shingles. There may be a role for the antibodies produced by the body as well.
It is clear that people with shingles at an early age should be even more careful about other risk factors for stroke, especially smoking, blood pressure and cholesterol. A previous history of shingles does not guarantee against further episodes, so the vaccine is recommended at age 60 with or without a history of shingles in the past. The recommendation for shingles vaccine may change: The vaccine has a Food and Drug Administration indication for ages 50- 59, but is not recommended by the Advisory Committee.
Shingles questions are among the most frequently asked. The booklet on the shingles virus answers many of them. Readers can obtain a copy by writing: Dr. Donohue — No. 1201W, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: My great-niece is 9 years old. She saw her doctor for a bad complexion, and was told that she is stage 3 for puberty. What does this mean, and how many stages are there? — F.N.
ANSWER: Puberty is a process, not an event. It goes on normally for several years. There are five stages of puberty, usually called Tanner stages. There are specific criteria for development that correspond to each stage. Nine years old is on the younger side for Tanner stage 3, but puberty starts at different times for different people, with significant differences that run in families and by ethnic background.
Your great-niece’s complexion issue probably relates to high levels of adrenal hormones, which start increasing even before puberty. Very high levels early in puberty should raise concern for a condition called congenital adrenal hyperplasia, although most cases of acne in early puberty are quite normal. If the gynecologist is worried, some simple blood and urine tests can tell you more.