It’s about time for a little rant. It turns out that having lots of choice is not the end-all of freedom, as much as promoters of democracy, freedom and the American Way would like us to believe.
Take toothpaste, for example. I recently went to the drugstore to buy some toothpaste. Sounds simple, doesn’t it? I ended up walking out of the store totally frustrated.
I’ve been a loyal fan of Colgate toothpaste for easily forty-five to fifty years. I tried Crest for a while, dabbled with Tom’s, but mostly it’s been Colgate. Colgate was just fine. Simple, white, plain toothpaste with some fluoride. No problem. I’ve watched with trepidation over the years, the introduction of different looking boxes with the Colgate logo on them, but bypassed them completely, knowing where to direct my eyes on the shelf, to the red and white box of the regular brand. I think I must have loaded up last year during a sale.
Then, this year the plain red and white box with the plain white toothpaste became extinct, replaced by some twenty different varieties on the shelf. Now Colgate makes TOTAL; PROCLINICAL WHITE PASTE (in the blue box); PROCLINICAL GEL; ADVANCED WHITENING; ADVANCED CLEAN; GUM DEFENSE; ENAMEL STRENGTH; MINT STRIPE; MAX WHITE (with mini bright strips); MAX CLEAN WITH SMART FOAM [[[smart foam?]]]; MAX FRESH with mini breath strips; LUMINOUS CRYSTAL CLEAN MINT—Ahhhhhhh!!!—SENSITIVE MULTIPROTECTION; SESITIVE ENAMEL PROTECTION; SENSITIVE WHITENING; SPARKLING WHITE MINT ZING—God help us!!!!—SPARKLING WHITE CINNA MINT; TARTAR PROTECTION WHITENING CRISP MINT PASTE or CRISP MINT GEL; ULTRABRITE ADVANCED WHITENING. And those don’t include the brands for kids.
What marketing MBA did Colgate hire to come up with all those registered and trade-marked brands? Please! Let’s 'up' the lithium dose a bit. It’s like, how many different models of a VW bug do we need? Is this what the world of facebooking tweeters want?
Okay, I'm finished with the rant.
Way down that list, I discovered CAVITY PROTECTION GREAT REGULAR FLAVOR. Eureka! Might that possibly be a re-branded version of what I was hoping to find in the first place? I’ll give it a try if I can find it on the shelf, buried beneath the other varieties.
Thursday, April 28, 2011
Friday, April 22, 2011
SHINGLES (Herpes Zoster): New Progress in Prevention!
see also: IT'S YOUR SKIN: Treat it Well!, at http://www.itsyourskintreatitwell.blogspot.com/
Shingles is a household term these days. The medical term is Herpes Zoster. Take anyone older than sixty and that person likely knows someone who has had a case of Shingles. An estimated 500,000 Americans per year get Herpes Zoster, and up to one per hundred adults per year if you are older than 65. Worldwide, it's a huge problem that, while usually non-fatal, can cause terrible suffering.
The amazing development is that advances have been made in the vaccine arena that could almost make Herpes Zoster a thing of the past. See end of this posting.
In my 25-plus years in dermatology, I’ve consistently been impressed by the fact that Herpes Zoster (Shingles) is often misdiagnosed, even by dermatologists, and is often treated too late to have any benefit, which leads to protracted and debilitating pain. The pain and suffering that comes from Herpes Zoster is underappreciated by doctors and patients alike (except those who have it). Furthermore, patients with suppressed immune systems (AIDS, organ transplant patients, certain malignancies) can develop life-threatening illness from Herpes Zoster when it spreads throughout the body.
Fortunately, if caught early enough, there are excellent treatments for Herpes Zoster. Diagnosing it early is not always easy. In addition to treating the ‘rash’ after it starts, there is a new vaccine that promises to prevent cases of Herpes Zoster. For us aging baby boomers, that is a real advance.
So, what is Herpes Zoster and how can it be recognized, treated, and prevented?
Herpes Zoster comes from the reactivation of the chickenpox virus, called Varicella-Zoster Virus (VZV). After childhood chickenpox, the Varicella viruses (probably millions of them) become dormant and retreat to nerves in the spinal cord where they remain for the rest of our lives. With aging, or in the setting of certain diseases, immunity against VZV weakens, and the virus can become reactivated. When it does, instead of reactivating throughout the entire body, it reactivates in one nerve ‘root’ only. This single nerve root reactivation is what causes Herpes Zoster.
DIAGNOSIS: Because only one nerve root is involved, the rash of Herpes Zoster happens on one side of the body along the path of a nerve, hence, one side of the face, across one side of the trunk, down one side of the arm, etc. In dermatology, we learn that with any new rash on one side of the body, we MUST consider Herpes Zoster as a possible diagnosis. Even with new-onset of pain without a rash along the path of one nerve, we have to think about early Herpes Zoster. The reverse is also true: any new skin rash involving both sides of the body or multiple limbs is probably NOT Herpes Zoster. Typically in Herpes Zoster, pain/burning/tingling usually comes first, followed in 24 to 48 hours by small red bumps and fluid-filled blisters where the nerve branches up to the skin.
TREATMENT: Early treatment limits the severity of Herpes Zoster in most cases. Once the rash of blisters and pain are established, it is too late, and treatment can only be directed toward reducing pain, not preventing it.
Three anti-viral drugs exist to treat Herpes Zoster: acyclovir, valacyclovir, and famciclovir. The latter two achieve much higher blood levels orally and are the treatments of choice. The first drug, acyclovir, has excellent anti-viral activity against the other Herpes virus called Herpes Simplex, but is less effective as an oral drug against Herpes Zoster. Patients with poor kidney function require lower doses.
The key to successful treatment is to treat early. This means patients need to seek help early and doctors need to have a high index of suspicion and institute treatment based on probability, not proof of the diagnosis. There is little to no risk to patients in treating in this manner, but delaying treatment can lead to months or even years of misery, pain, and disability. Doctors who see emergency or walk-in patients are the ones best able to help patients with evolving Herpes Zoster.
In severe or untreated cases, patients are often left with protracted pain called ‘postherpetic neuralgia’. Although it usually improves slowly over time, it can be excruciatingly painful for weeks to months, sometimes years. Treatments can be helpful, but often require sophisticated combinations of pain killers, gabapentin-like drugs, anti-depression drugs, and occasional use of nerve blocks.
In patients with suppressed immune systems for any reason, Herpes Zoster can trigger a more wide-spread illness throughout the body that can be life-threatening. Again, early diagnosis and treatment with anti-viral drugs is life-saving.
PREVENTION: Back in 2006, a live vaccine against Herpes Zoster was approved in the U.S. The vaccine, called Zostavax®, is basically a larger-than-normal dose of the Chickenpox vaccine used routinely in children. Zostavax® has been shown to reduce by 50% the risk of getting Herpes Zoster. It also reduces the risk of the protracted postherpetic neuralgia by two-thirds. Every individual age 60 or older who qualifies should request and receive Zostavax®.
The new development: Shingrix® is a new vaccine made from molecular subunits of the chickenpox virus plus an immune enhancer. It has been shown to be safe (no accidental infection) and highly effective for up to three years (so far) of protection. Two doses are given a few months apart, and the injection into the deltoid can produce significant pain. The cost is around $300 but because it is so effective, it is likely that insurers will cover the cost, and countries with drug coverage will negotiate lower prices and cover the cost for their citizens. Cost savings will follow when fewer individuals will have need for medical care of their shingles.
Shingles is a household term these days. The medical term is Herpes Zoster. Take anyone older than sixty and that person likely knows someone who has had a case of Shingles. An estimated 500,000 Americans per year get Herpes Zoster, and up to one per hundred adults per year if you are older than 65. Worldwide, it's a huge problem that, while usually non-fatal, can cause terrible suffering.
The amazing development is that advances have been made in the vaccine arena that could almost make Herpes Zoster a thing of the past. See end of this posting.
In my 25-plus years in dermatology, I’ve consistently been impressed by the fact that Herpes Zoster (Shingles) is often misdiagnosed, even by dermatologists, and is often treated too late to have any benefit, which leads to protracted and debilitating pain. The pain and suffering that comes from Herpes Zoster is underappreciated by doctors and patients alike (except those who have it). Furthermore, patients with suppressed immune systems (AIDS, organ transplant patients, certain malignancies) can develop life-threatening illness from Herpes Zoster when it spreads throughout the body.
Fortunately, if caught early enough, there are excellent treatments for Herpes Zoster. Diagnosing it early is not always easy. In addition to treating the ‘rash’ after it starts, there is a new vaccine that promises to prevent cases of Herpes Zoster. For us aging baby boomers, that is a real advance.
So, what is Herpes Zoster and how can it be recognized, treated, and prevented?
Herpes Zoster comes from the reactivation of the chickenpox virus, called Varicella-Zoster Virus (VZV). After childhood chickenpox, the Varicella viruses (probably millions of them) become dormant and retreat to nerves in the spinal cord where they remain for the rest of our lives. With aging, or in the setting of certain diseases, immunity against VZV weakens, and the virus can become reactivated. When it does, instead of reactivating throughout the entire body, it reactivates in one nerve ‘root’ only. This single nerve root reactivation is what causes Herpes Zoster.
 |
| Herpes Zoster blisters along the inner arm |
 |
| cluster of blisters on the neck |
TREATMENT: Early treatment limits the severity of Herpes Zoster in most cases. Once the rash of blisters and pain are established, it is too late, and treatment can only be directed toward reducing pain, not preventing it.
Three anti-viral drugs exist to treat Herpes Zoster: acyclovir, valacyclovir, and famciclovir. The latter two achieve much higher blood levels orally and are the treatments of choice. The first drug, acyclovir, has excellent anti-viral activity against the other Herpes virus called Herpes Simplex, but is less effective as an oral drug against Herpes Zoster. Patients with poor kidney function require lower doses.
The key to successful treatment is to treat early. This means patients need to seek help early and doctors need to have a high index of suspicion and institute treatment based on probability, not proof of the diagnosis. There is little to no risk to patients in treating in this manner, but delaying treatment can lead to months or even years of misery, pain, and disability. Doctors who see emergency or walk-in patients are the ones best able to help patients with evolving Herpes Zoster.
In severe or untreated cases, patients are often left with protracted pain called ‘postherpetic neuralgia’. Although it usually improves slowly over time, it can be excruciatingly painful for weeks to months, sometimes years. Treatments can be helpful, but often require sophisticated combinations of pain killers, gabapentin-like drugs, anti-depression drugs, and occasional use of nerve blocks.
 |
| disseminated VZV |
In patients with suppressed immune systems for any reason, Herpes Zoster can trigger a more wide-spread illness throughout the body that can be life-threatening. Again, early diagnosis and treatment with anti-viral drugs is life-saving.
PREVENTION: Back in 2006, a live vaccine against Herpes Zoster was approved in the U.S. The vaccine, called Zostavax®, is basically a larger-than-normal dose of the Chickenpox vaccine used routinely in children. Zostavax® has been shown to reduce by 50% the risk of getting Herpes Zoster. It also reduces the risk of the protracted postherpetic neuralgia by two-thirds. Every individual age 60 or older who qualifies should request and receive Zostavax®.
The new development: Shingrix® is a new vaccine made from molecular subunits of the chickenpox virus plus an immune enhancer. It has been shown to be safe (no accidental infection) and highly effective for up to three years (so far) of protection. Two doses are given a few months apart, and the injection into the deltoid can produce significant pain. The cost is around $300 but because it is so effective, it is likely that insurers will cover the cost, and countries with drug coverage will negotiate lower prices and cover the cost for their citizens. Cost savings will follow when fewer individuals will have need for medical care of their shingles.
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