ArcaMax

DEAR DR ROACH: I'm 60 years old now. I never had chicken pox as a child but was tested as an adult, and I do have the antibodies. I've been on a standard dose of acyclovir for 15 years after I had a severe neurological reaction to a potential but unconfirmed herpes simplex infection.

My doctor said there is evidence that maintenance acyclovir appears to prevent shingles from developing. I believe she also said that I would have to stop taking acyclovir around the time of the vaccine, and this is a very scary thought, given the severity of my reaction 15 years ago. (I still have significant neuropathy with lesions on my spinal cord.)

So, we decided against giving me the shingles vaccine. Do you agree with this approach? How strong is the evidence that maintenance acyclovir prevents shingles outbreaks? -- A.G.

ANSWER: I found a handful of studies that showed a benefit to the prevention of shingles; however, the dose was much higher than what would normally be used for herpes simplex -- 800 mg every six hours. The dose commonly used for preventing herpes simplex (commonly 400 mg twice daily or 200 mg five times daily) isn't likely to be high enough to prevent the zoster virus, which is substantially more resistant to acyclovir and related drugs.

When it comes to whether acyclovir needs to be stopped, I assume your doctor was thinking of the old shingles vaccine, Zostavax. It was a live vaccine, and acyclovir did have to be stopped before receiving the vaccination. This is not the case with the new recombinant vaccine, Shingrix, which I strongly recommend for you.

Another reader asked whether the Shingrix vaccine would make genital outbreaks more likely. I found one study that showed some protection from genital herpes outbreaks following a vaccination for zoster, but most studies showed neither benefit nor harm. There is no reason to suspect that there would be harm, so I recommend that people with genital herpes get vaccinated for shingles just the same way as the general population.

DEAR DR. ROACH: I had whooping cough as a child, despite being vaccinated. I seem to have a really deep cough whenever I get the flu. As an elderly adult, I now have a problem of coughing, so much so that at times, I have trouble catching my breath. If I passed out, would my regular breathing return? It's concerning if this can happen while I'm alone or driving. -- L.W.L.

ANSWER: Some people have a robust cough reflex with nothing particularly wrong with them, but frequent coughing can indicate a lung problem. A severe lung infection, especially at an early age, can lead to some degree of lung injury, so it may be worthwhile getting your lungs evaluated. Both X-rays or CT scans and lung testing by breathing tests (pulmonary function testing) provide valuable information.

In the rare case that people pass out from breathing, the brain has mechanisms to restart normal breathing. However, it's still not a good idea to pass out while driving!

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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