Shingles Shots

[Ianab]

I love it when I get such a definitive answer from a health care professional...

What usually happens is that one dose is maybe 90% effective in preventing the disease. Useful, unless you are in the 10%, They can't increase the dose of vaccine because that might make the side effects worse. But if you get 2 shots, you get up to 99% prevention. So even 2 shots isn't a 100% guarantee, but you have to be pretty unlucky to be in the 1%. 

[dougtrr2]

I love it when I get such a definitive answer from a health care professional...

But sometimes I would rather get an honest "I don't know" rather than some BS.  I had rotator cuff surgery on both my shoulders (not at the same time).   My left side hurt WAY more than the right side.  I asked my doctor why.  His response, "Darned if I know, by the MRIs your right shoulder was much worse."  I preferred that honest non answer to some made up story.

Doug in SW IA

[Southside]

Selling two units and two office visits instead of one, yea there is "some benefit" to it, at least to "someone".

[B.C.C. Lapp]

Ding ding ding, we have a winner.   Southside beat me to it.

[doc henderson]

Jim, cmon.  most doc offices and pharmacies get whatever your insurance pays for the labor to give the shot and pay (if not provided by the government) for the shot.  I think in practice we made 14 bucks for giving a shot.  I can tell you for most of us, it is a service and not a money maker.  i.e  a pain in the ash when staff is low.  My wife just resigned due to not enough staff to be safe.  If you do not want a shot, then do not get it.

[John Mc]

Selling two units and two office visits instead of one, yea there is "some benefit" to it, at least to "someone".

None of the doctors in my area have any need to drum up extra business. Many are not taking new clients as it is. Further, they have no input as to the recommended frequency of vaccinations.

[doctorb]

One dose is 90% effective.  The second dose pushes this to 99% effective.

You can get these at CVS or other pharmacies.  They don't charge an office visit and insurance covers the costs of the vaccine. The Shingryx vaccine is a real advance over what we had previously.  The need for a second dose is a common part of certain vaccine regimens and may become more common as we better understand and attempt to optimize our immune systems.  

If you are going to make the effort to get the first shot, basically eliminating your risk of getting shingles with the second dose makes a lot of sense.  If you know an adult who has suffered with the disease, you know what I mean.  I have never had one of them tell me, after months of Shingles pain, that they are glad they didn't get the shot.  

[SwampDonkey]

My grandfather had the shingles, like I said earlier. It was no pleasure experience. Back and shoulders. Mom had  a mild case and took the antibiotics, then the shots a few weeks later. She only had a rash around the belt line, pills cleared it up quick.

I also had a co worker with shingles, she was in her late 50's. This was 25 years ago. She never had any fun either.

[doc henderson]

In med school we got hep B vaccine.  three shots, and then a titer to see if we responded.  there were a handful out of 200 that did not respond.  they ended up taking a second round. It was a small enough number that it could be confirmed.  It was uncurable back then, so deemed important for health care folk.  In the gen. pop. you do not confirm but do the number that gets the vast majority of people protected.  there would have been some that were fine after a single dose, but may not last forever, and some that are not protected even after 2 doses.  that gets to the 99%.   I never got covid that I can prove.  8 inches from the faces of the critically ill covid patients.  but corona virus is a common cold in kids, and I have 40 years of being in their faces.  I prob. had some natural immunity.

[Southside]

Well Doc the "someone" is also big pharma, the insurance companies, hospitals, etc.  Case in point. My wife had to have a minor surgery two years back.  While she was out the surgeon decided to administer something, I don't recall what it was, anyway we get a $2,500 bill for this part, in addition to the rest of the bills, that insurance refuses to pay.  Claimed it was "medically un-necessary".  Hospital and the surgeon said - "pay the bill or else". Someone want to explain to me how she was supposed to make an informed decision and consent to that part of the procedure?  I don't want to hear a peep about the "poor down trodden" medical industry after all the events of the past few years.  I am not saying either of you two are bad people or doctors, but your industry has some significant work ahead of it if it ever wants the trust of the population again. 

[Ianab]

I never got covid that I can prove.  8 inches from the faces of the critically ill covid patients.  but corona virus is a common cold in kids, and I have 40 years of being in their faces.  I prob. had some natural immunity.

Kids are fantastic carriers of viruses however. Lil being a kindy teacher has probably been exposed to pretty much every virus in circulation, similar to yourself. And with our 2 kids at different schools I suspect every bug in town finds it's way here at some point. 

Lil did test positive for Covid, but only had "cold" symptoms for maybe 2 days, Only actually stayed home because of the test. The other 3 of us had no symptoms, so didn't test. Maybe we had asymptomatic infections? Who can say. 

It's interesting that Shingles is actually caused by the chickenpox virus. Chickenpox was always considered to be just a nuisance disease for kids, but once you recover your body doesn't eliminate all the virus, and it can lurk and flare up again later on, as your immune system ages and gets weaker. Chickenpox vaccine is now part of kids regular vaccination schedule, hopefully that will reduce the incidence of shingles in years to come?

As for side effects? One is you hope they are a lot less than the disease you are trying to prevent. Most would agree a sore arm of a couple of days is better than an outbreak of shingle. But if you've taken young kids for their routine shots, you know they are often a bit "upset" for a couple of days after. Tired / grumpy etc. No reason a vaccine won't have the same effect on an adult, maybe more because we know how quick a 3 year old bounces back from having a cold virus. 

[doc henderson]

actually, our hospital lost millions of dollars this past year, and everyone fired in the C suite.  the company I work for lost 10 times that amount and was pleased that we lost less than many of the other ED staffing companies, some of whom are now bankrupt.  The last pharmacy my wife worked at could not hire any more Pharmacists, and she felt unsafe.  Left late every night and still 500 prescriptions to fill.  a week behind. Now 2 weeks retired.   I am hiring docs to work I do not know.  It is a poo show for sure, and there isn't a dang thing I can do about it.  

[doc henderson]

It will be interesting to see if the CP vaccine confers the same long-lasting immunity as having had the disease.  
Jim I am sure the open-ended consent made some reference to things in the operation, but you would have needed a lawyer to figure that out.  I would want a detail of what it was and why it was needed.  whether it was not needed, or the doc needs to document medical necessity to get paid.  Sometime the insurance just makes it so hard to collect that we give up and take a loss. or it gets passed on to the patient.  
The business plan I was taught in medical school, was take good care of the patient and the money will follow.  I have only turned one patient to collections in my career and used to waive deductibles and copays for any employee of the hospital worked at, till insurance said we could not do that for those patients unless we did it for all including all their patients.
 

[Ianab]

The US medical system is a source of bemusement to most the developed world. 

It costs 2 or 3 times more than any other 1st World country, but doesn't realy deliver any better over all health care.  I think Southside is right with blaming the overall drug / insurance / legal /. hospital  system. But that's not something front line medical staff have any control over. 

So not faulting the front line Docs, as they are some of the best, and have the high tech tools and training. But the crazy billing and insurance system is just mind-boggling. Politics / lawyers / insurance? What % of "health spending" goes into that, vs actual health care, as in Drs pay and needed drugs / operations? 

If I get a script from my Doc, they email to my local pharmacy, and I pick it up next day. There is NO quibbles about cost and what's covered or not. If it's on the "approved drug" list, a Dr can prescribe it. If you NEED  hospital care, you get it. 

And I know it's not "free health care". We all pay for it via taxes. Just it seems cheaper and less gotchas that come back and bill you later .

[SwampDonkey]

My family doctor has been out of commission for awhile with illness. So I go to the ER at a small hospital and get processed in no time. I don't wait more than 5 mins to get on with it. This is not the same everywhere in ER's. If I was to go to the regional I could wait hrs. The advantages of small hospitals. I have to get BP meds every 3 months since this summer. Hard to believe that, bad genes I guess. Never smoked, not overweight and get all kinds of exercise and the right kind of food. Go figure. :D

[doctorb]

If you can, please share what was administered to your wife.  Your recounting is disturbing to me, and I'm sorry to hear it.

While I believe your wife's story regarding her surgery, some of it makes little sense to my understanding of how things work.  Your insurance pays the bills, and determined that some form of treatment wasn't medically indicated.  So they balked.  The hospital is the person responsible here, not your wife.  As you said, she didn't consent to this treatment, and they apparently didn't contact you for permission either.  I agree with doc H that they used something in the global consent for surgery to assume they had permission to administer it.  There is a pre-authorization process with elective procedures.  This treatment undoubtedly wasn't included in that.  This sounds like the insurance company interpreted the treatment as outside of the surgical procedure, and thus unauthorized. You should not be responsible for this charge.  Have you sat down with the hospital and tried to hash this out?  My bet is that it can be resolved.  I have seen this type of thing before, and sitting down with a person from the finance office usually straightens it out.  Listening only to the bill-collector side of the hospital finance department won't get you anywhere but angry.

While I am sympathetic to your side in this dispute, I don't think your wife's example really correlates well with the discussion about one or two shot vaccines.  As you said, you have distrust, and distrust can flow everywhere.

[YellowHammer]

I get flu shots every year, this year I didn't even get a sore arm. Covid vaccines were virtually unnoticeable but the first chicken pox vaccine hit like a ton of bricks, worst reaction I've ever had. Fever for a couple nights, aching muscles. I didn't get anything done for day 2 and 3 and then started feeling better day 4.  So it's time for my second shingle shot and I go to CVS and ask if that was "normal" and the answer was yes, and the second will be noticeably worse.  So seeing as how I couldn't take three or four days for feeling like a truck had run me over, I passed that day.  So now I have basically until the end of the year to carve out a time to feel sick for a week.  Not an easy thing to volunteer for.  However I do know folks who have had shingles and I don't want that, either. So I'll do it, but I have to get into the right "zen" frame of mind step in front of that speeding truck again.  

[doc henderson]

It is good to set that expectation, and plan for it.  I hope you are pleasantly surprised and have min. side effects.  that is also possible.

[Southside]

Doc - I just asked her, she recalls the matter but not exactly what it was, but she knows where the paperwork is so will pull it up.  At the time I recall she made a number of calls to the insurance, the hospital, and the surgeon and at the end of the day we were told to pay or it would go to collections.  Yes, maybe we could have hired a lawyer, but what if that didn't gain us any ground?  Then I have to pay the shark and the bill.  They got paid, and if it was me and not my wife paying the bill it would have been via wheelbarrow and pennies. I will get you the info after she pulls it up. 

[doc henderson]

Well, I am sorry.  our hospital has a policy of transparency.  i will help anyway I can, but prob. water under the bridge anyway.  If the insurance deems it unnecessary, that may be true, or poss. they are trying to get out of paying, or the Doc and hospital did not document enough.  I am not part of the billing other than being asked to add to the document if it is lacking.  the medical records people look at what is needed for billing but are not allowed to come right out and say it.  That would be considered padding the bill. some docs are good and other still scratch 3 lines on a form like the good Ol days.  I would be in the latter category if it were up to me.  Just give me a couple chickens or some eggs!  

[Magicman]

My second Shingles shot was a non event compared to the first.  Even after the soreness of the first shot, I was not going to forego the second shot.  

I have friends who have gone through the misery of Shingles and I wanted all of the protection possible.

[Southside]

Doc - no apology necessary, like I said that was not directed at either doc here, but the industry as a whole has lost a lot of faith over the past few years with a lot of folks. The move toward larger corporate entities with golden parachute CEO's as the top is part of the problem.  

Our little electric co-op CEO makes $1.3MM a year, I met the last guy, he was Mr Potato Head at best.  They sent me a quote to install a service meter to power a well last week.  Simple meter off the service line, single phase,  40' of underground cable to the meter box, just over $5K.  Umm - nope I can do a solar set up for $1,500 and never pay a monthly bill, but that won't help the CEO now will it?  

[WV Sawmiller]

   I got my second shingles shot last Tuesday and it made my arm sorer than the first one. I don't know if it helped or hurt that I sawed lumber the next day and kept lifting heavy board and scrap slabs and such. Its finally much better now.

[doc henderson]

I am a proponent of working through most pain (not broken bones) and feeling better than if you shut down and sit and think about.  Pain is pain but it is made worse with and emotional psychological component.  use gets blood flow to the area and may help reduce swelling.  a sprain to the ankle needs ICE.  Ice, compression (ace wrap) and or elevation.

[Ed_K]

 If you haven't got the shots, trust me you don't want the other. I layed on the couch for 9 day not daring to move unless I really had too.