Welcome back to our weekly column Ask D'Mine, the first of 2014 -- in what we hope will be an exciting New Year! Sadly, our featured columnist and advice-giver Wil Dubois (veteran type 1 and community D-educator), is under the weather. Actually, he's learned that the yuck he's experiencing is his very first brush with chicken pox... Yikes!
So, while we let Wil rest and ring in the New Year with some healing power, we are revisiting some of his sage advice from the past regarding illness with diabetes -- potentially quite apropos to the combination of diabetes and chicken pox too.
This question from Sept. 2011 is right on point:
Dusty from Alabama, type 2, writes: I have a question about getting the flu, pneumonia and shingles shots. I've heard it's important for diabetics to get a flu shot every year, and I personally always ask for a pneumonia shot, too, because I used to get these respiratory infections that settled into pneumonia. But what about a Shingles shot? Is that important too? I'm not sure my insurance covers it, and I have read that Shingles shots are terribly painful, but the disease would be worse. Do you know if Shingles shots are ever covered for diabetics? Is it a one-time vaccination? How long does it last? And is there anything else I should do to prepare to stay healthy for the winter season?
Wil@Ask D'Mine answers: Great questions! Flu first. Anyone with diabetes or anyone who spends much time kissing someone with diabetes should get an annual flu shot. 'Tis the season right now. Flu season usually starts in October and it takes your body about two weeks to develop the immune response after getting the shot. So get to your doc, your Walgreens (love 'em or hate 'em) or your public health office right now, today, before flu season starts.
Getting your flu shot (or nasal spray immunization) is probably the number one thing you can do as a PWD to get ready for winter. The CDC flu page says this year's vaccine will protect us from three strains expected to be the most common this year, including the over-hyped H1N1 of a few years ago.
Depending on the year, flu strikes between 5-20% of the U.S. population, sending more than 200,000 people a year to hospitals. As many as 49,000 of them never go home again. Most of those deaths are in the elderly, the young, the pregnant, and "people with certain health conditions."
That would be us.
Everyone, just get your damn flu shots.
Dusty, you're Big Time over-immunized on the pneumonia front. A pneumonia shot isn't an annual event. It's a twice-in-a-lifetime event. You should get one sometime in your first year of diabetes, or if you haven't had one ever, get one now. Then you should get a second shot once you are 65 years old. Oh, unless you were 62 when you got your first one. The two shots should be at least 5 years apart. So I don't know how old you are, but I'm thinking you're set for a loooooooooooooong time at this point. I poked around the net a bit and talked to several docs. No one seems to know what the risks are of being over-immunized, but the consensus seems to be: He'll probably be fine, but tell him to quit getting the shot every year! (Along with a few snide comments about your medical team letting you get so many.)
Pneumonia shots do two things: they absolutely prevent pneumonia in some people, and reduce the severity of it in just about everyone else.
Mortuary trivia for those of you who don't believe in preventive medicine: More than 52,000 Americans die of pneumonia every year. It's the sixth leading cause of death in our country.
As to shingles shots, this is an early senior-set immunization. Shingles, a.k.a. herpes zoster is simply chickenpox reborn. But even if you've had chickenpox (and who hasn't?) you can get shingles. Here's what happens: When you get over chickenpox, you don't rid yourself of the virus. It goes into hibernation deep in your spine where it sleeps for years and years and years. If it wakes up, as it does in about one million folks a year, it causes PAINFULL skin rashes that generally make people pray for a speedy death. The shingles attack lasts for about three weeks and is generally a once-in-a-lifetime event, but, pain in the area of the rash can last for many months after the rash is gone. Sometimes for years. The fancy-pants name for this particular brand of suckage is postherpetic neuralgia. Oh. And you could go blind — that actually happened to my wife's grandmother — or deaf.
No one knows why the virus wakes up in some folks but not in others. It could be cosmic rays, too many TV dinners, or wearing polyester. Your guess is as good as anyone else's. It's waaaaay more likely north of 60, and more likely if your chickenpox encounter was at a very young age. Other than that, it's roulette. I saw one statistic that said if you live to be 85, you have a 50% chance of getting shingles. Bummer. The shingles part, not the living to 85 part. I saw another study that showed that shingles is on the rise, up 64% over the last thirty years.
I think the bottom line here is that no one in their right or left mind would want shingles. Right? So, science to the rescue! In 2006 Merck's Zostavax shingles vaccine was FDA approved and now the CDC recommends that all folks over 60 get it.
Insurance coverage varies, although it's covered by all Medicare Part D plans, for all persons over 60, not just PWDs. The out-of-pocket cost for the shot if you're not covered is around $200. I've been surprised by how many un-covered seniors have ponied up the money without blinking an eye at the clinic where I work. Oh. Right. Most of them knew someone who had just had shingles. Go figure. No one ever said anything to me about it being painful, and I didn't find many people bitching about that online, so either the pain is worth the gain, or it's not too bad for most people.
The feds report that the shot is 50% effective in preventing shingles and cuts the risk of that nasty neuralgia pain we talked about earlier by almost 2/3 in those unlucky 50% that still get shingles anyway.
Oh, and Dusty, this is a once-in-a-lifetime shot. Please don't get one every year.
Note: one day after my 60th birthday (approx... 4,381 days from now), I'm getting my shingles shot.
Other winter stuff... you might want to talk to your medical team about what's called a sick-day plan. In a nutshell, when you're sick (flu or garden variety cold) your blood sugars will tend to go wacky. Being sick is bad enough. Being sick and hyperglycemic is double-sucky. You can have a plan in place about how it's safe to increase your meds as needed, and be sure you keep properly hydrated and all of that.
And lastly, for all of you office heroes out there: Just stay the f— home when you are sick. OK? I just hate those people who "never miss a day of work, no matter how sick I am." You know what? You're not heroic. You're idiotic. You're spreading your germs, and making the rest of us sick.
If you get sick, stay at home and get well. Don't spread the "love."
This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.