Podcasts about shingrix

Folge 299: PTA-Vertretung, Shingrix, L-Thyroxin & das Rauchen

Dr. Margarita Fedorova discusses whether a vaccine ingredient is quietly protecting the brain.  Show citation:  Taquet M, Todd JA, Harrison PJ. Lower risk of dementia with AS01-adjuvanted vaccination against shingles and respiratory syncytial virus infections. NPJ Vaccines. 2025;10(1):130. Published 2025 Jun 25. doi:10.1038/s41541-025-01172-3 Show transcript:  Dr. Margarita Fedorova:  Welcome to Neurology Minute. My name is Margarita Fedorova, and I'm a neurology resident at the Cleveland Clinic. Today we're exploring a study that raises a compelling question. Could a vaccine ingredient be quietly protecting the brain? A recent study by Taquet et al., published in npj Vaccines in 2025, investigated whether vaccination with an AS01-adjuvanted vaccine is associated with a lower risk of dementia. You might know it as the immune-boosting ingredient in Shingrix, the shingles vaccine, and Arexvy, the new RSV vaccine. We already know from prior work that the Shingrix vaccine was associated with a reduced risk of dementia, but the question this paper asks is why. Is it because preventing shingles itself protects the brain, or is there something specific about the adjuvant that's doing the work? To answer this, the researchers used a large US electronic health record database comparing over 35,000 people who received the AS01-adjuvanted RSV vaccine, over 100,000 who received the AS01-adjuvanted shingles vaccine and over 78,000 who received both. Each matched against individuals who got the seasonal flu vaccine instead. The findings were interesting. People who received the RSV vaccine had a 29% lower risk of new dementia diagnosis over the following 18 months. Those who received the shingles vaccine had an 18% increase in time without dementia, and those who received both had a 37% increase in dementia-free time. Here's a key insight. Both vaccines target completely different viruses, but both contain the same adjuvant. The fact that a similar protective signal was seen with both suggests the benefit may not be about which virus is prevented, and it may be about the AS01 itself. Why might an adjuvant protect the brain? AS01 contains two active components, monophosphoryl lipid A, known as MPL, and QS21. Together they activate macrophages and dendritic cells, triggering cascade that includes a production of interferon gamma. In animal models, stimulation of a receptor called toll-like receptor 4, which MPL activates, has been shown to reduce Alzheimer's-like pathology. The authors also point out that the protective effect appears within just a few months of vaccination, which is hard to explain purely by prevented infections and may point instead to a direct immunological mechanism. Very important caveat. This is an observational study, not a randomized trial, so we can't prove causation. There was also uncertainty about which brand of RSV vaccines some patients received, which could affect the strength of the AS01-specific conclusion. And with all of the dementia studies, it's unclear whether the vaccines prevent dementia or delay its onset. Though even a delay would be clinically meaningful given how few tools we have. What does this mean for clinical practice? For now, it doesn't change your vaccination recommendations. Both Shingrix and Arexvy already indicated in appropriate patients for the primary purposes, but it adds an intriguing possible benefit when counseling patients who ask about vaccines. And it opens the door to a genuinely exciting question. If AS01 has neuroprotective properties, could it be studied in a therapeutic target in its own right? That's the Neurology Minute for today. Keep exploring and we'll see you next time. If you want to read more, please find the paper by Maxime Taquet, et al., titled Lower Risk of Dementia with AS01-Adjuvanted Vaccination Against Shingles and Respiratory Syncytial Virus Infections, published in npj Vaccines in June 2025. 

Broadcast from KSQD, Santa Cruz on 5-21-2026: This is the second show featuring Mira Achilles, a UCSC graduate working on her masters in epidemiology. Dr. Dawn and Mira open with a Harvard study showing OpenAI's o1 reasoning model reached correct diagnoses 67% of the time versus 50-55% for physicians, and scored 89% versus 34% on treatment plans. The AI advantage shrinks when doctors get more data and time, suggesting its greatest value is in fast-moving triage. Dr. Dawn cautions that over-reliance on AI during residency could undermine the clinical reasoning neurologic pathways doctors must develop, and emphasizes the "zebra paradox"— rare diseases remain rare even when symptoms match the textbook. Dr. Dawn shares a personal case of a patient with throat shingles, leading her to use a medical AI (OpenEvidence) to investigate Shingrix risks. An Australian study found an elevenfold increase in shingles within 21 days of the first Shingrix dose in adults over 65, though dose two reduced overall risk by 73%. She explains this could be one of several things such as immune reconstitution inflammatory syndrome (IRIS), or that the AS01B vaccine adjuvant's strong activation may transiently reactivate latent virus, and recommends valacyclovir prophylaxis for high-risk patients for their first Shringrex shot.. Mira discusses AI in education, noting the shift from professors threatening plagiarism charges to teaching students how to critique AI output, emphasizing taking summaries "with a grain of salt." Dr. Dawn describes Chinese research scanning 1,154 children that identified a third ADHD subtype—severe emotional dysregulation—showing 45 abnormal brain regions versus 26 in the inattentive and hyperactive-impulsive types, with standard stimulants working poorly for this group. She connects this to traditional psychiatric personality disorder classifications and A discussion of vagus nerve stimulation's emerging applications for autoimmune conditions. Dr. Dawn and Mira discuss menstruation and bodily autonomy, then describe the Somedays period pain simulator that uses electrical impulses to let men experience menstrual cramps, highlighting differing pain thresholds. An emailer references a Radiolab episode about deliberate hookworm infection to treat asthma and allergies. Dr. Dawn explains parasites release immunosuppressants to survive, including anti-inflammatory protein-2 (AIP) now in drug development, which stimulates T-regulatory cells and IL-10 while "alarmins" inhibit lung inflammation—though this increases vulnerability to new infections. A caller with H. pylori and frequent viral infections asks whether S. boulardii and reuteri probiotics are safe given her low immunity. Dr. Dawn explains immunosuppression warnings target transplant-level drug suppression, not a tendency toward viruses like hers. Dr. Dawn thinks that her near-zero natural killer cells explain frequent infections, and suggests that the H. pylori test given her absence of symptoms, may be an incidental bystander rather than the cause of her low ferritin, which suggests bleeding. In medical news of the weird, Dr. Dawn describes Baby Cassian, diagnosed in utero with congenital high airway obstruction syndrome (CHAOS), who was partially removed from the womb at 25 weeks for airway surgery, returned, and born again at 31 weeks—leading to a discussion of microsurgery and how specialties partition by the physical scale of the surgery rather the location or type of structure.

Can a shingles vaccine cut your dementia risk by 20%? A series of landmark studies — published in Nature, Cell, and JAMA — say yes. In this episode, Tommy unpacks the research: how natural experiments in four countries produced one of the most compelling signals in dementia prevention, what might explain the effect beyond infection prevention, and what it means for your own vaccination decisions. In this episode: 00:00 — Introduction 00:52 — The new data on shingles vaccination and Alzheimer's risk 01:48 — The Stanford group and their regression discontinuity methodology 03:15 — How birthday-based eligibility creates a natural experiment (Wales, Canada, Australia) 05:28 — Results: a ~20% reduction in dementia diagnoses across all countries 06:52 — The Cell paper follow-up: benefits at every disease stage (unimpaired → MCI → dementia) 07:55 — Shingrix vs. Zostavax: the US natural experiment and a potentially larger effect 09:08 — Why does it work? Preventing illness, avoiding bed rest and disuse, immunomodulation 11:29 — Neuroinflammation and possible immune system "tuning" effects 12:27 — The sex difference: greater benefit in women in most (but not all) studies 15:52 — Summary of the evidence and what it means for dementia prevention strategy 17:36 — Josh's take: number needed to treat analysis 19:15 — Heterogeneous pathways to dementia and why vaccination fits the toolkit 21:13 — Practical advice: when to get vaccinated, repeat dosing, and personal risk assessment 25:36 — Wrap-up and how to submit questions Links & Resources: Shingles vaccine and dementia studies: Nature (Wales, 2025), Cell (Wales follow-up), JAMA/Lancet (Canada, Australia, US) Flu vaccine and dementia: Neurology (2026) Tommy's book: The Stimulated Mind To submit a question for us to answer on the podcast, go to brainjo.academy/question. To subscribe to the free Better Brain Fitness newsletter, join us when we record live, and get our Guide and Checklist to essential blood tests and nutrients, go to: betterbrain.fitness. To learn more about how you can boost brain fitness with neuroscience-based musical instruction, head to brainjo.academy.  Intro and Outro music composed and produced by Julienne Ellen.   

Broadcast from KSQD, Santa Cruz on 4-30-2026:>/p> Dr. Dawn opens with a bike safety public service message, noting a 34% increase in bicycle use in Santa Cruz alongside rising e-bike accidents. She urges drivers to stay vigilant and calls for education and enforcement of helmet laws, particularly for riders under 18. A University of Michigan researcher discovered that standard nitrile, latex, and vinyl gloves shed stearate particles indistinguishable from polyethylene under spectroscopy, contaminating microplastics research with approximately 2,000 false positives per square millimeter. Only clean-room gloves avoided this problem, throwing years of microplastics studies into question. Dr. Dawn explains skin's three-layer structure and the stratum corneum's ceramide-based moisture barrier. She warns against stripping natural oils with astringents and hot showers, notes that UV disrupts proteins holding skin cells together, and cites a 2019 study showing moisturing treatment reduced circulating inflammatory cytokines in older adults. Making music coordinates sound, vision, motor control, and imagination across the brain. Studies show musicians have more gray matter, better executive function, sharper memory, and even reduced pain sensitivity. A 2010 paper found musicians who began before age seven have a larger corpus callosum, and a 2024 study showed pianists had better working memory while woodwind players did best at executive function. Stanford researcher Pascal Geldsetzer analyzed populations in Australia, New Zealand, Wales, and Ontario, finding the Shingrix vaccine reduces dementia risk by up to 20%. Dr. Dawn hypothesizes that even "dormant" varicella triggers low-level inflammation affecting brain microglia, and recommends spacing Shingrix three months apart from the second dose rather than one month to avoid side effects. A Nature study of 175 people watching movies found that observing someone being touched activates the same brain regions as being touched yourself—your brain experiences sensations in corresponding body parts. This vision-touch link could enable less invasive sensory testing for autistic individuals. Princeton and Flatiron Institute researchers identified four distinct autism phenotypes: broadly affected (10%), mixed with developmental delay (19%), moderate challenges (33%), and social/behavioral (37%). A second Nature study confirmed genetically distinct forms unfold on different timelines, with post-age-six diagnoses showing different genetic profiles than early childhood cases.

I've read your book on Mitral Valve Prolapse, and it helped to reduce panic attacks...but I'm still depressedThe Singulair debacle What are your thoughts on the Shingrix vaccine?Is essential tremor causing unsteadiness and balance problems when I'm walking?Can kidney stones be controlled with probiotics?What are your thoughts on bone broth?

This week, Dr. Kahn addresses a topic gaining attention in the media: whether taking the shingles vaccine (Shingrix in the USA) may reduce the risk of heart events and dementia. Multiple studies suggest this could be true, although no randomized trials have been performed to confirm it. Furthermore, most of these studies focus on a version of the vaccine that was discontinued in the U.S. in 2020 (Zostavax), making the assumption that Shingrix provides the same benefits somewhat speculative. This is a topic worth discussing with your primary care team. Other topics include controversies in nutrition, B vitamins and stroke risk, and the impact of medications for mild dementia.  This episode is sponsored by the Fresh Pressed Olive Oil Club at getfreshdrkahn.com, featuring a limited $1 offer on high-quality olive oils.

Encore Presentations of Dr. Kelly & Steve House HOUR 1 from February 19, 2026 Hour 1 of https://RushToReason.com opens with a bold challenge: are we being told the full truth about our health—or just the convenient version? John Rush is joined by Dr. Kelly Victory, an independent physician and nationally recognized public health expert, for a wide-ranging and provocative conversation. Should some prescription drugs—like antibiotics—be available over the counter? Would it lower costs and restore patient freedom, or create new risks? Then the discussion pivots to hormone replacement therapy. Is declining testosterone or estrogen just “normal aging,” or are people suffering unnecessarily? And how do you pursue hormone therapy safely—without falling for clinic hype? The hour turns more intense as they examine rising cancer rates, particularly in younger adults. Is it a coincidence, lifestyle, COVID itself, or the mRNA shots? Dr. Kelly outlines concerns about immune disruption, lipid nanoparticles, and batch inconsistencies. What can people do now? Are antibody tests and certain supplements worth considering? If you've ever felt like key details are missing from the mainstream narrative, this episode asks the hard questions—without apology. Websites Mentioned * https://LabCorp.com * https://howbadismybatch.com HOUR 2 from March 12, 2026 Hour 1 of Rush to Reason delves into a wide-ranging, provocative discussion of health, vaccines, and the unanswered medical questions many Americans are asking. John Rush is joined by Dr. Kelly Victory and Steve House as they explore reports that severe cardiac events among younger Americans are rising. What exactly is driving the increase? And why are doctors and policymakers seemingly reluctant to investigate the issue more aggressively? The conversation examines the difference between traditional heart attacks and sudden cardiac death, along with growing concerns about myocarditis, spike proteins, and the long-term effects of mRNA technology. Listeners ask whether an “off switch” for mRNA might exist—and what testing options are available for those who want to know their risk. From antibody testing and D-dimer blood tests to supplements that may reduce spike proteins, the panel tackles listener questions head-on while urging caution about online medical claims. The hour also explores the safety of vaccines like flu shots and Shingrix, the integrity of the blood supply, and whether hormone replacement therapy could help aging men and women regain vitality. Are Americans getting the full story from the medical establishment—or are critical questions still going unanswered? Website Mentioned https://www.labcorp.com/

Encore Presentations of Dr. Kelly & Steve House HOUR 1 from February 19, 2026 Hour 1 of https://RushToReason.com opens with a bold challenge: are we being told the full truth about our health—or just the convenient version? John Rush is joined by Dr. Kelly Victory, an independent physician and nationally recognized public health expert, for a wide-ranging and provocative conversation. Should some prescription drugs—like antibiotics—be available over the counter? Would it lower costs and restore patient freedom, or create new risks? Then the discussion pivots to hormone replacement therapy. Is declining testosterone or estrogen just “normal aging,” or are people suffering unnecessarily? And how do you pursue hormone therapy safely—without falling for clinic hype? The hour turns more intense as they examine rising cancer rates, particularly in younger adults. Is it a coincidence, lifestyle, COVID itself, or the mRNA shots? Dr. Kelly outlines concerns about immune disruption, lipid nanoparticles, and batch inconsistencies. What can people do now? Are antibody tests and certain supplements worth considering? If you've ever felt like key details are missing from the mainstream narrative, this episode asks the hard questions—without apology. Websites Mentioned * https://LabCorp.com * https://howbadismybatch.com HOUR 2 from March 12, 2026 Hour 1 of Rush to Reason delves into a wide-ranging, provocative discussion of health, vaccines, and the unanswered medical questions many Americans are asking. John Rush is joined by Dr. Kelly Victory and Steve House as they explore reports that severe cardiac events among younger Americans are rising. What exactly is driving the increase? And why are doctors and policymakers seemingly reluctant to investigate the issue more aggressively? The conversation examines the difference between traditional heart attacks and sudden cardiac death, along with growing concerns about myocarditis, spike proteins, and the long-term effects of mRNA technology. Listeners ask whether an “off switch” for mRNA might exist—and what testing options are available for those who want to know their risk. From antibody testing and D-dimer blood tests to supplements that may reduce spike proteins, the panel tackles listener questions head-on while urging caution about online medical claims. The hour also explores the safety of vaccines like flu shots and Shingrix, the integrity of the blood supply, and whether hormone replacement therapy could help aging men and women regain vitality. Are Americans getting the full story from the medical establishment—or are critical questions still going unanswered? Website Mentioned https://www.labcorp.com/

Hour 1 of Rush to Reason explores a wide-ranging discussion of health, vaccines, and medical questions many Americans are asking. John Rush is joined by Dr. Kelly Victory and Steve House to examine reports that severe cardiac events among younger Americans may be rising. What could be driving the increase, and why are doctors and policymakers reluctant to investigate it more aggressively? The conversation looks at the difference between traditional heart attacks and sudden cardiac death, along with concerns about myocarditis, spike proteins, and possible long-term effects of mRNA technology. Listeners ask whether an “off switch” for mRNA might exist and what testing options are available for those who want to understand their risk. From antibody testing and D-dimer blood tests to supplements that may reduce spike proteins, the panel answers listener questions while urging caution about online medical claims. The hour also examines the safety of vaccines such as flu shots and Shingrix, the integrity of the blood supply, and whether hormone replacement therapy could help aging men and women regain vitality. Are Americans getting the full story from the medical establishment—or are critical questions still going unanswered? Website mentioned https://www.labcorp.com/ HOUR 2 Hour 2 of Rush to Reason dives into Colorado politics, election strategy, and internal battles shaping the Republican Party's future. John Rush begins with Zach Kraft of the Republican National Committee, discussing a controversial Colorado congressional candidate whose policies could threaten industries such as oil, gas, and ranching in the state. The discussion expands to national politics, including a government shutdown fight tied to Department of Homeland Security funding and ICE, raising questions about how political gridlock affects everyday workers. The hour then shifts into an unfiltered look at why Republicans continue losing elections in Colorado. Are voting systems really the issue—or are weak candidates, poor campaign strategy, and party infighting to blame? Rush argues the real problems lie within the party itself, including the caucus system, fractured campaigns, and limited voter outreach. Listeners call in to debate election integrity, messaging, and candidate viability. The hour ends with a warning: if conservative votes remain divided—including unaffiliated runs—Democrats could easily maintain control. Can Republicans unite and build a winning strategy, or will internal divisions continue to cost them elections? Timestamps 1:08 — Zach Kraft — Central Regional Communications Director. https://gop.com HOUR 3 Hour 3 of Rush to Reason begins with a powerful personal story before turning to Colorado politics. Author Katie Asher discusses her book The Book of Heaven, sharing how her non-speaking autistic son eventually learned to communicate—revealing intelligence and perceptions that challenge common assumptions about severe autism. Could society be misunderstanding what autism really is? The conversation then shifts to Colorado politics as listeners call in to discuss party unity, grassroots involvement, and the resignation of Colorado GOP Chair Britta Horne. Rush argues that internal factions—particularly those connected to Dave Williams and the “Davidians” movement—have fractured the party and weakened its ability to compete statewide. Rush warns that without structural reform and stronger leadership, the Republican Party may struggle to compete in a state trending increasingly blue. Can the party rebuild trust with voters and unify its base—or will internal divisions continue shaping Colorado's political future? Timestamps 1:12 — Katie Asher — Author of The Book of Heaven. https://www.asher.house

Hour 1 of Rush to Reason explores a wide-ranging discussion of health, vaccines, and medical questions many Americans are asking. John Rush is joined by Dr. Kelly Victory and Steve House to examine reports that severe cardiac events among younger Americans may be rising. What could be driving the increase, and why are doctors and policymakers reluctant to investigate it more aggressively? The conversation looks at the difference between traditional heart attacks and sudden cardiac death, along with concerns about myocarditis, spike proteins, and possible long-term effects of mRNA technology. Listeners ask whether an “off switch” for mRNA might exist and what testing options are available for those who want to understand their risk. From antibody testing and D-dimer blood tests to supplements that may reduce spike proteins, the panel answers listener questions while urging caution about online medical claims. The hour also examines the safety of vaccines such as flu shots and Shingrix, the integrity of the blood supply, and whether hormone replacement therapy could help aging men and women regain vitality. Are Americans getting the full story from the medical establishment—or are critical questions still going unanswered? Website mentioned https://www.labcorp.com/ HOUR 2 Hour 2 of Rush to Reason dives into Colorado politics, election strategy, and internal battles shaping the Republican Party's future. John Rush begins with Zach Kraft of the Republican National Committee, discussing a controversial Colorado congressional candidate whose policies could threaten industries such as oil, gas, and ranching in the state. The discussion expands to national politics, including a government shutdown fight tied to Department of Homeland Security funding and ICE, raising questions about how political gridlock affects everyday workers. The hour then shifts into an unfiltered look at why Republicans continue losing elections in Colorado. Are voting systems really the issue—or are weak candidates, poor campaign strategy, and party infighting to blame? Rush argues the real problems lie within the party itself, including the caucus system, fractured campaigns, and limited voter outreach. Listeners call in to debate election integrity, messaging, and candidate viability. The hour ends with a warning: if conservative votes remain divided—including unaffiliated runs—Democrats could easily maintain control. Can Republicans unite and build a winning strategy, or will internal divisions continue to cost them elections? Timestamps 1:08 — Zach Kraft — Central Regional Communications Director. https://gop.com HOUR 3 Hour 3 of Rush to Reason begins with a powerful personal story before turning to Colorado politics. Author Katie Asher discusses her book The Book of Heaven, sharing how her non-speaking autistic son eventually learned to communicate—revealing intelligence and perceptions that challenge common assumptions about severe autism. Could society be misunderstanding what autism really is? The conversation then shifts to Colorado politics as listeners call in to discuss party unity, grassroots involvement, and the resignation of Colorado GOP Chair Britta Horne. Rush argues that internal factions—particularly those connected to Dave Williams and the “Davidians” movement—have fractured the party and weakened its ability to compete statewide. Rush warns that without structural reform and stronger leadership, the Republican Party may struggle to compete in a state trending increasingly blue. Can the party rebuild trust with voters and unify its base—or will internal divisions continue shaping Colorado's political future? Timestamps 1:12 — Katie Asher — Author of The Book of Heaven. https://www.asher.house

Hour 1 of Rush to Reason explores a wide-ranging discussion of health, vaccines, and medical questions many Americans are asking. John Rush is joined by Dr. Kelly Victory and Steve House to examine reports that severe cardiac events among younger Americans may be rising. What could be driving the increase, and why are doctors and policymakers reluctant to investigate it more aggressively? The conversation looks at the difference between traditional heart attacks and sudden cardiac death, along with concerns about myocarditis, spike proteins, and possible long-term effects of mRNA technology. Listeners ask whether an “off switch” for mRNA might exist and what testing options are available for those who want to understand their risk. From antibody testing and D-dimer blood tests to supplements that may reduce spike proteins, the panel answers listener questions while urging caution about online medical claims. The hour also examines the safety of vaccines such as flu shots and Shingrix, the integrity of the blood supply, and whether hormone replacement therapy could help aging men and women regain vitality. Are Americans getting the full story from the medical establishment—or are critical questions still going unanswered? Website mentioned https://www.labcorp.com/ HOUR 2 Hour 2 of Rush to Reason dives into Colorado politics, election strategy, and internal battles shaping the Republican Party's future. John Rush begins with Zach Kraft of the Republican National Committee, discussing a controversial Colorado congressional candidate whose policies could threaten industries such as oil, gas, and ranching in the state. The discussion expands to national politics, including a government shutdown fight tied to Department of Homeland Security funding and ICE, raising questions about how political gridlock affects everyday workers. The hour then shifts into an unfiltered look at why Republicans continue losing elections in Colorado. Are voting systems really the issue—or are weak candidates, poor campaign strategy, and party infighting to blame? Rush argues the real problems lie within the party itself, including the caucus system, fractured campaigns, and limited voter outreach. Listeners call in to debate election integrity, messaging, and candidate viability. The hour ends with a warning: if conservative votes remain divided—including unaffiliated runs—Democrats could easily maintain control. Can Republicans unite and build a winning strategy, or will internal divisions continue to cost them elections? Timestamps 1:08 — Zach Kraft — Central Regional Communications Director. https://gop.com HOUR 3 Hour 3 of Rush to Reason begins with a powerful personal story before turning to Colorado politics. Author Katie Asher discusses her book The Book of Heaven, sharing how her non-speaking autistic son eventually learned to communicate—revealing intelligence and perceptions that challenge common assumptions about severe autism. Could society be misunderstanding what autism really is? The conversation then shifts to Colorado politics as listeners call in to discuss party unity, grassroots involvement, and the resignation of Colorado GOP Chair Britta Horne. Rush argues that internal factions—particularly those connected to Dave Williams and the “Davidians” movement—have fractured the party and weakened its ability to compete statewide. Rush warns that without structural reform and stronger leadership, the Republican Party may struggle to compete in a state trending increasingly blue. Can the party rebuild trust with voters and unify its base—or will internal divisions continue shaping Colorado's political future? Timestamps 1:12 — Katie Asher — Author of The Book of Heaven. https://www.asher.house

This week we bounce from weddings with questionable video evidence to universal vaccines, rogue dubstep artists named after shingles shots, and a time-loop story that left us… conflicted. Let's get into it. Real Life Ben officiated a wedding. It was beautiful. It was meaningful. It was legally binding. There may or may not be video proof. Somewhere, there's a phone with 3% battery and a shaky clip of vows. Or maybe not. Either way, two people are married and that's what counts. If you're going to officiate a wedding, here's the lesson: double-check the recording situation. Memory is not a backup drive. Ben also discovered that in newer versions of iOS, you can type to Siri. This is huge for anyone who has ever whispered a text into their phone in public and immediately regretted it. We are slowly evolving into silent thumb-typers talking to machines. The future is polite and awkward. Devon talked about how he uses ChatGPT — not casually, but intentionally. He uses it for work. He uses it to rewrite drafts, fix spelling, tighten arguments. Think of it as a second-pass editor that doesn't get tired. He went deeper into why he chose to pay for it and what "professional analysis" even means in an AI context. If you're billing by the hour, clarity matters. He also raised the question: does LexisNexis have AI baked in now? (Short answer: of course they do. Long answer: it depends how you define AI, which is half the battle in 2026.) Ben uses "AI" differently — mostly for data sifting. Large piles of information. Pattern spotting. Less magic robot, more extremely fast intern. Steven admitted he uses ChatGPT to help generate episode notes and images. If you're creating consistently, tools matter. The question isn't "Is this cheating?" The question is: "Are you using the tool to think better or to think less?" Big difference. We also watched The First Minute of Demi Adejuyigbe Is Going To Do One (1) Backflip — and yes, he does the backflip. Watch the full clip on YouTube and the full special on Dropout. Demi Adejuyigbe (pronounced DEM-ee ə-DIJ-oo-EE-bay) is sharp, chaotic, and there's a killer Marge Simpson joke in the full show. https://www.youtube.com/watch?v=_kveA4wgIhI  Speaking of Marge — Marge Simpson is not dead. The French voice actress passed away. RIP. The character remains immortal yellow. Ben also plugged his ekphrastic poetry workshop — Write Poems with Me — happening Saturday 3/7 at the Beacon Art Show or online. If you've been waiting for a sign to try poetry, this is it. Show up. Make weird art. https://buttondown.com/penciledin/archive/write-poems-with-me-saturday-37-at-the-beacon-art/  Future or Now Steven brought in a wild one: a possible "universal" vaccine from researchers at Stanford Medicine. Instead of targeting a specific virus, this nasal spray supercharges the lungs' immune defenses. In mice, it reduced viral load, prevented severe illness, and even blocked allergic reactions. COVID. Flu. Pneumonia. Allergens. If this holds up in humans, that's not incremental. That's foundational. https://www.sciencedaily.com/releases/2026/02/260222092258.htm  Ben followed with research suggesting shingles vaccines might lower dementia risk. Studies around the shingles vaccines Zostavax and Shingrix have shown reduced dementia incidence in vaccinated older adults. There's also data suggesting the vaccine may slow biological aging markers, including inflammation. https://arstechnica.com/health/2026/02/could-a-vaccine-prevent-dementia-shingles-shot-data-only-getting-stronger/  This is where Steven held his jokes until the very end. Zostavax and Shingrix are dubstep artists. "Twenty Year Window" is their debut collaboration. "Dementia" is their first single. Sometimes you need the bit. But seriously — if preventing viral reactivation reduces neuroinflammation and long-term cognitive decline, that's massive. It's early. It's correlation-heavy. But it's promising. Pay attention to this space. Book Club This week: All You Zombies by Robert A. Heinlein (1958). https://lecturia.org/en/short-stories/robert-a-heinlein-all-you-zombies/19420/  Time travel. Identity loops. Paradoxes stacked on paradoxes. There are also… problems. Ben had major issues with the problematic elements. And they're not small issues. The story reflects the era it was written in, and not in a flattering way. Devon didn't love the no-stakes feeling. When a story collapses into inevitability, tension can evaporate. If everything always already happened, what are we gripping onto? Steven's take: the story is valuable as a historical artifact. It shows where science fiction was. You can see the mechanics. The ambition. The blind spots. You don't have to endorse it to learn from it. That's maturity in reading: understanding context without pretending flaws don't exist. Next week, we're reading Presence by Ken Liu, published in Uncanny Magazine. Ken Liu tends to blend emotional precision with speculative ideas, so expect something thoughtful. https://www.uncannymagazine.com/article/presence/  Read it. Come ready. Final Thought This episode circled one big theme whether we meant to or not: Tools. AI tools. Medical tools. Narrative tools. Historical tools. The question isn't whether tools change the world. They do. The question is whether we're using them deliberately. So here's your small challenge this week: Pick one tool you're already using — AI, writing software, research databases, even your phone — and ask yourself: Am I using this to sharpen my thinking? Or to avoid it? Be honest. We'll see you next week.

In this podcast, experts Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH; Ruth Carrico, PhD, DNP, FNP-C, FAAN; and Dalilah Restrepo, MD, discuss improving shingles vaccine uptake. Topics covered include: The Burden of ShinglesCare Coordination Between Primary and Specialty CarePromoting Shingles Vaccine Series CompletionAddressing Disparities in Shingles Vaccine Access and Uptake Presenters:Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPHAssociate Professor of Clinical PharmacyUniversity of California, San DiegoDepartment of Pharmacy Practice and Sciences, Skaggs School of Pharmacy and Pharmaceutical SciencesDivision of the Black Diaspora and African American StudiesLa Jolla, CaliforniaRuth Carrico, PhD, DNP, FNP-C, FAANSenior PartnerCarrico & Ramirez PLLCProfessor, AdjunctDivision of Infectious DiseasesUniversity of Louisville School of MedicineLouisville, KentuckyDalilah Restrepo, MDInfectious Diseases SpecialistUniversity of California, IrvineLos Alamitos HospitalOrange County, California Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Broadcast from KSQD, Santa Cruz on 1-01-2025: An emailer asks about omega-3 supplementation for memory at age 72. Dr. Dawn advises checking that fish oil capsules contain adequate DHA—at least 1,000 mg—since many omega-3 products have low DHA levels. She notes Medicare covers the same testing at standard labs as proprietary labs like OmegaQuant that charge patients directly. Beyond omega-3s, she emphasizes glucose control (hemoglobin A1c below 5.6) since the enzyme that breaks down insulin also clears beta-amyloid, and weight training to raise brain-derived neurotrophic factor (BDNF), which promotes new synapse formation essential for memory. Dr. Dawn reviews Popular Science's top 2025 health innovation: eye drops from Lens Therapeutics containing aceclidine that correct age-related farsightedness for 10 hours. The drops shrink the pupil to increase depth of field, improving near vision by three or more lines on eye charts within 30 minutes without affecting distance vision. Side effects include eye irritation, dimmed night vision, and headache. She describes Duke University's breakthrough allowing heart transplants from circulatory death donors using an on-table reanimation technique. This could expand the pediatric donor pool by 20%—critical since up to 20% of children die waiting for transplants. Dr. Dawn celebrates CAR-T immunotherapy for multiple myeloma, which saved her husband's life. Of 97 heavily pretreated patients, 38% achieved complete remission still present at five years, with over 50% total survival. The therapy removes T-cells, uses CRISPR to add receptors targeting cancer cell antigens, then reinfuses the modified cells. She highlights a UC Davis study showing remote blood pressure monitoring with home technology, education, and coaching dropped patients' average blood pressure from 150/80 to 125/74 in months—low-tech with high impact. Dr. Dawn explains the Nano Knife for prostate cancer, which uses localized electrical pulses delivered through thin wires to destroy tumors while sparing surrounding nerves. This minimally invasive approach could reduce erectile dysfunction and incontinence common with traditional surgery. She describes Gilead's Sunlenca, a twice-yearly injection for HIV prevention that's 99% effective. At $14,000 per injection in the US, proceeds help fund access in resource-limited countries where it can be distributed like a vaccination. Dr. Dawn discusses Journavx (suzetrigine), a new non-opioid pain medication working on sodium channels to block pain signals before reaching the brain. At $30 for 50 pills on GoodRx, it offers an alternative for surgical pain in patients with addiction history or genetic vulnerability to opioid dependence. She details the landmark case of Baby KJ, the first person to receive personalized CRISPR gene therapy. Born with a CPS1 enzyme deficiency causing toxic ammonia buildup, KJ was too small for liver transplant. Scientists identified his specific mutation and used CRISPR base editing delivered via lipid nanoparticles to correct a single DNA letter—changing an A to G—in his liver cells which restored enough function to be discharged home. Dr. Dawn reports surprising findings that COVID mRNA vaccines amplify cancer immunotherapy. Lung cancer patients who received COVID vaccination within 100 days of checkpoint inhibitor treatment had 56% three-year survival versus 31% for unvaccinated patients. The mechanism is unknown but may involve mRNA generally alerting the immune system. She revisits research showing Zostavax shingles vaccination reduced dementia risk by 20% over seven years. A natural experiment in Wales—where an age cutoff created comparable vaccinated and unvaccinated groups—provided strong evidence that preventing herpes zoster inflammation protects brain health. Dr. Dawn concludes with Huntington's disease breakthrough: microRNA therapy delivered by virus directly into the brain slowed disease progression by 75% over three years. The microRNA binds to Huntington protein mRNA, preventing ribosome translation and toxic protein production. Some patients returned to work; others expected to need wheelchairs are still walking.

Broadcast from KSQD, Santa Cruz on 12-04-2025: Dr. Dawn opens with an experimental vaccine that prevents severe allergic reactions by targeting IgE antibodies. The vaccine could eventually replace current monoclonal antibody treatments like omalizumab that require injections every two weeks. She explains how adjuvants work in vaccines as additives that irritate the immune system enough to notice the vaccine target. Aluminum hydroxide is s common adjuvant. Modern vaccines use small pathogen fragments rather than whole organisms, requiring adjuvants to trigger adequate immune response. Dr. Dawn expresses concern about the US Advisory Committee on Immunization Practices reviewing aluminum adjuvants this week. A Danish study of over one million children finding no connection between aluminum with autism and ADHA contradicts RFK,Jr's public claims.She worries that removing aluminum could devastate vaccine effectiveness and children's health, noting that whenever vaccination rates drop, diseases like measles return to native circulation. She recounts pertussis vaccine history—when Japan stopped vaccination due to rare adverse reactions (approximately one death per million doses), they lost about 5,000 children to whooping cough in the first year. The newer acellular vaccine using pathogen fragments plus adjuvants is safer but only lasts 4-5 years versus lifetime immunity from the older whole-cell version, necessitating "cocooning" strategies where everyone contacting newborns must be recently vaccinated. Dr. Dawn describes a vaccine to prevent fentanyl from reaching the brain now starting clinical trials in the Netherlands. It pairs a fentanyl-like molecule with a carrier protein large enough to trigger antibody production. Once primed, the immune system attacks any fentanyl entering the blood, preventing highs and overdoses—potentially helping people in addiction recovery and those accidentally exposed through contaminated drugs. She reports the first documented death from alpha-gal syndrome. Alpha-gal is a meat allergy triggered by Lone Star tick bites; the tick essentially vaccinates humans against the alpha-galactosidase protein found on beef and pork. Cases have increased since 2010 as climate change expands the tick's range northward, yet a 2023 survey found 42% of doctors had never heard of the condition. Dr. Dawn highlights research from Edith Cowan University showing that blood drawn after exercise suppresses cancer cell growth when added to tumor cultures. In breast cancer survivors, plasma from high-intensity interval training or weight lifting caused cancer cells to stop growing or die; blood drawn before exercise had no effect. The key mechanism involves myokines, particularly IL-6, released by contracting muscles. A Stanford study found colon cancer survivors who exercised were 37% less likely to experience recurrence. A caller asks about pig-to-human heart transplants and mask recommendations. Dr. Dawn clarifies that newer xenotransplant pigs have more genes edited to reduce rejection compared to the 2022 case. For masking, she recommends context-dependent use—especially in public restrooms where toilet flushing aerosolizes COVID-containing particles, transportation hubs, and hospitals, noting that COVID vaccination prevents death but not infection or long COVID. She advises the same caller about spacing vaccines because adjuvant loads stack. Most vaccines can be combined safely, but she recommends against pairing COVID and Shingrix vaccines due to their heavy adjuvant content—wait at least ten days between them. She suggests inducing a sweat the night of vaccination through hot baths, saunas, or exercise to reduce adjuvant-related discomfort without diminishing antibody response. Dr. Dawn discusses seasonal affective disorder. She recommends 5,000 units of vitamin D3 and morning light exposure. She suggests that sun avoidance advice may have gone too far. A UK study of 3.36 million people found 12-15% lower mortality with greater UV exposure even accounting for skin cancer risk. A Swedish study following 30,000 women for 20 years found sun-seekers had half the mortality risk. Benefits may involve nitric oxide production lowering blood pressure, with each 1,000 km from the equator correlating with 5 mmHg higher blood pressure. Lack of bright outdoor light also contributes to childhood myopia, with rates exceeding 80% in some Asian cities. Dr. Dawn concludes with Danish microbiologists at Copenhagen's Alchemist restaurant reviving an old Bulgarian practice of fermenting milk with live red wood ants. The resulting yogurt, cheese, and ice cream contain far more beneficial microbes than commercial products, with a complex lemony acidity. Only live ants work, and wild ants may carry parasites dangerous to humans.

Vidcast:  https://www.instagram.com/p/DQdknrnjVnr/For nearly the first time in the history of American public health, there is mass confusion and lack of credible information coming from our usual public health channels about which vaccines adults should receive. I want to arm all of you you with the latest immunization recommendations from the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.  These guidelines are all based on the latest scientific information which demonstrates that these vaccines are safe and very, very effective at preventing and/or minimizing the effects of sometimes deadly diseases. For Pregnant Women since you are immunizing for yourself and your new baby:TDap, in 3rd trimester; Influenza, anytime during flu season; CoVid, anytime; RSV, late 3rd trimester during RSV season.Adults, 18 through 64 year of age: Td/TDap, every 10 years; MMR, if not immune, 1-2 doses; Varicella, if not immune; HPV, through age 26 or 45 if never immunized; Influenza, annually late October; CoVid, 2-3 times a year with latest vaccines; Hepatitis A/B, as needed for travel or chronic illness; Meningitis, as needed for high risk, travel, outbreak, complement deficiency; Pneumococcal, if never immunized, high risk, immunodeficient; RSV,  if never immunized, high risk, immunodeficient.Seniors, 65 years and older: Influenza, yearly, high dose or adjuvated; CoVid: high potency mNEXSPIKE (Moderna) or equivalent Twice yearly, regular potency 2-3 times a year; RSV, single dose ? Every 2 years; Pneumococcal, PCV20 or PCV15+PCV23; Shingles, RZV or Shingrix, 2 dose series at 50 years or more, 19 years or more if immunocompromised; TDap, every 10 years.These are the vaccines that each of us should have. Look at this as a scorecard for you to follow along with your medical team. These days, so many of us are mobile, vaccination records may be scattered and not up to date in any single medical record, electronic or otherwise. Your own checklist, digital or paper, should be the most complete. When you do get a vaccine, let's say at your local pharmacy, be certain to text or email your medical team so that the information can be added to your electronic medical record.I have posted the American Academy of Family Physicians summary chart of all adult immunizations on my website at drhowardsmith.com/adult-immunizations-2025-6.https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules/adult-immunization-schedule.htmlhttps://www.drhowardsmith.com/adult-immunizations-2025-6#adults #pregnancy #seniors #immunizations #vaccines

TWiV reviews continuing US measles outbreak, host and genetic variations that regulate antibody responses to hepatitis C virus, and varicella-zoster reactivation and the risk of dementia. Hosts: Vincent Racaniello, Alan Dove, Brianne Barker, and Angela Mingarelli Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode Support science education at MicrobeTV Mass firings at CDC (Time) Measles cases continue to climb in US (NPR) Immune 100 at The Incubator (Eventbrite) Viral and host variations modulate antibody responses against HCV (Cell Rep) VZV reactivation and risk of dementia (Nature Med) Taking a shot at dementia (TWiV 1207) Demented and crass (TWiV 1249) Letters read on TWiV 1263 Timestamps by Jolene Ramsey. Thanks! Weekly Picks Angela – ‘Am I redundant?': how AI changed my career in bioinformatics Brianne – OpenSpace and their YouTube Channel Alan – Coral City Camera – live view of a reef in Biscayne Bay, FL (and NPR story on it). Vincent – Neck pain relief exercises with Dr. Adam Fields Listener Pick Greg – AI: What could go wrong? and An AI System With Detailed Diagnostic Reasoning Makes Its Case Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content in this podcast should not be construed as medical advice.

Plötzlich auftretende Nervenschmerzen, brennende Hautausschläge und monatelanges Leiden – das kann Gürtelrose (Herpes Zoster) sein. Die Erkrankung wird durch eine Reaktivierung des Windpockenvirus ausgelöst und betrifft jedes Jahr hunderttausende Menschen in Deutschland. Viele unterschätzen das Risiko – dabei kann Gürtelrose schwerwiegende Folgen haben.Im ERCM Medizin Podcast erklärt Dr. med. Georg Friese, Facharzt für Innere Medizin mit Schwerpunkt Infektiologie und Prävention:- wie Gürtelrose entsteht und warum sie oft erst spät erkannt wird,- welche Risikofaktoren das Virus reaktivieren können (höheres Alter, Stress, geschwächtes Immunsystem),- welche typischen Symptome frühzeitig auf Gürtelrose hinweisen,- wie eine moderne Schmerztherapie das Leiden lindern kann,- warum die STIKO-Impfempfehlung gegen Gürtelrose so wichtig – jedoch die Impfquote in Deutschland noch immer zu niedrig ist.Besonders bewegend: Eine Patientin schildert eindrücklich ihre persönlichen Erfahrungen mit Gürtelrose – von wochenlangen Schmerzen bis zu massiven Einschränkungen im Alltag.Dr. Friese betont: Gürtelrose ist keine harmlose Erkrankung. Neben quälenden Nervenschmerzen und anhaltenden Beschwerden kann sie auch das Risiko für Herzinfarkt und Schlaganfall in der Akutphase deutlich erhöhen. Erfahren Sie in dieser Episode alles über Ursachen, Symptome, Risikofaktoren und die Rolle der Gürtelroseimpfung (Shingrix) in der Prävention. "Der ERCM Medizin Podcast" Social & Webseite:Instagram: https://www.instagram.com/ercm.podcast/TikTok: https://www.tiktok.com/@ercm.podcast?lang=de-DEX (Twitter): https://twitter.com/ERCMPodcastWebseite: www.erc-munich.comKontakt: podcast@erc-munich.comDr. med. Georg FrieseWebseite: https://www.cseke-friese.de/LinkedIn: https://de.linkedin.com/in/georg-friese-dr-med-3230b4131Instagram: https://www.instagram.com/friesegeorg/Zeitangaben:00:00:00 - Intro00:01:39 - Was ist Gürtelrose und wie hängt sie mit Windpocken zusammen?00:02:54 - Wie das Virus im Körper überlebt und sich im Nervensystem versteckt00:03:47 - Die Auslöser: Wann und warum bricht die Gürtelrose aus?00:05:15 - Gibt es angeborene Risikofaktoren?00:05:49 - Kann man ein erhöhtes Risiko für Gürtelrose vorab testen?00:07:21 - Die ersten Symptome: Woran erkennt man eine Gürtelrose?00:09:29 - Kann man Gürtelrose mehrfach bekommen?00:10:09 - Patientenbericht: Kerstins 8-wöchiger Leidensweg00:14:03 - Analyse eines schweren Verlaufs trotz Impfung00:15:19 - Die Behandlung starker Nervenschmerzen (Post-Zoster-Neuralgie)00:19:41 - Chronische Verläufe: Warum manche Patienten jahrelang leiden00:22:02 - Rückfall-Prävention: Was kann man selbst tun? (Schlaf, Sport & Ernährung)00:25:13 - Besonders schwere Verläufe an Auge, Gesicht und Gehirn00:29:16 - Die Impfung gegen Gürtelrose: Für wen und ab wann wird sie empfohlen?00:30:00 - Warum die Impfquote in Deutschland so niedrig ist00:32:57 - Nebenwirkungen der Impfung: Was man wissen sollte00:37:51 - Erhöhtes Herzinfarkt- & Schlaganfallrisiko nach Gürtelrose00:38:48 - Der wichtigste Faktor zur Vermeidung einer Gürtelrose#ERCM #ERCMPodcast #Gürtelrose #HerpesZoster #GürtelroseImpfung #STIKO #Shingrix #MedizinPodcast #Gesundheit #Prävention

New indication for Kerendia; investigational therapy shows promise for hypertension; Novolog interchangeable biosimilar gets approval; trial results for hormone-free contraceptive; Shingrix now supplied in a prefilled syringe.

Dr. Mindy talks about her 4th of July. And then she answers questions about UTIs, no libido after kids, herniated discs, leg knots, semaglutides, Vyvanse, large mass, rolling your ankle, ureaplasma, six year-old with nightmares from allergy meds, shingles and Shingrix and reaction from doxycycline. Dr. Mindy - YouTubeSee omnystudio.com/listener for privacy information.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Broadcast from KSQD, Santa Cruz on 6-05-2025: Dr. Dawn answers an email about Dupuytren's contracture treatment, explaining her clinic experience using acupuncture anesthesia combined with Traumeel injections directly into palm nodules. She describes how this anti-inflammatory homeopathic compound, when injected into tendon sheaths, can break the cycle of fibrosis formation. Dr. Dawn explores fascinating quantum physics concepts involving collagen microstructure, water molecules, and hydrogen ion movement that may explain how acupuncture and homeopathy work through crystalline formations in collagen tubules. She discusses vitamin A's critical role in measles complications, explaining how deficiency dramatically increases risks of encephalitis and cardiac damage. Dr. Dawn covers two forms of dietary vitamin A - beta carotene from plants requiring enzymatic conversion, and vitamin A from animal products. She warns about vitamin A toxicity risks, particularly birth defects in pregnancy, while noting that typical American diets are adequate unlike vitamin D. Dr. Dawn examines vitamin D deficiency affecting 68% of children in a South Florida study, linking inadequate levels to bone health, immune function, and gut barrier integrity. She explains how vitamin D receptors throughout the body regulate cell differentiation, insulin secretion, and tight junction formation that prevents leaky gut syndrome. There are higher deficiency rates in darker-skinned populations and the historical context of rickets during industrialization when urban environments blocked sunlight exposure. She highlights revolutionary medical technology, the world's smallest pacemaker for newborns, half the size of a rice grain. This injectable device dissolves naturally after hearts self-repair, controlled by light-emitting patches communicating through the baby's skin. This breakthrough eliminates risky surgical removal procedures that caused complications, such as Neil Armstrong's death from pacemaker wire infections. Dr. Dawn discusses research showing shingles vaccination reduces dementia risk by 20%, particularly in women. She explains the natural experiment in Wales where universal healthcare created clear vaccination cutoff dates, allowing researchers to compare dementia rates. Dr. Dawn hypothesizes that cross-immunity against herpes viruses may protect brain tissue, noting even stronger protection with newer Shingrix vaccines compared to older Zostavax. She covers alarming increases in invasive Group A Streptococcus infections, with cases more than doubling from 2013 to 2022. Dr. Dawn explains how flesh-eating bacteria secretes enzymes that dissolve epithelial barriers in throats and lungs, allowing systemic spread that destroys tissue. She links rising cases to increasing diabetes and obesity rates that compromise immune function, noting devastating mortality rates approaching 10,000 deaths nationwide. Dr. Dawn celebrates a breakthrough antibiotic discovery of Lariocidin which works against highly drug-resistant bacteria through novel protein synthesis inhibition. She explains how antibiotic resistance spreads between bacterial species just like social media memes, emphasizing the urgent need for new treatments as 4 million people die annually from resistant infections. Dr. Dawn advocates for public funding since pharmaceutical companies avoid antibiotic development due to poor profit margins. She answers an email about Epstein-Barr virus detection, explaining its role in mononucleosis, Burkitt's lymphoma, and chronic fatigue syndrome. Dr. Dawn describes how EBV can remain dormant and reactivate during stress or immunocompromise, potentially triggering autoimmunity. She discusses similarities between EBV reactivation, Lyme disease, and long COVID, suggesting they may represent variations of the same inflammatory syndrome with different triggers. She explores the nocebo effect - how negative expectations worsen outcomes - and its amplification through social media. Dr. Dawn cites studies showing people warned about erectile dysfunction or altitude headaches experience these symptoms more frequently. She discusses recent phenomena like TikTok-induced tics and vaccine side effect amplification, warning that online health information creates dangerous nocebo loops that spread faster than traditional word-of-mouth.

Broadcast from KSQD, Santa Cruz on 6-05-2025: Dr. Dawn answers an email about Dupuytren's contracture treatment, explaining her clinic experience using acupuncture anesthesia combined with Traumeel injections directly into palm nodules. She describes how this anti-inflammatory homeopathic compound, when injected into tendon sheaths, can break the cycle of fibrosis formation. Dr. Dawn explores fascinating quantum physics concepts involving collagen microstructure, water molecules, and hydrogen ion movement that may explain how acupuncture and homeopathy work through crystalline formations in collagen tubules. She discusses vitamin A's critical role in measles complications, explaining how deficiency dramatically increases risks of encephalitis and cardiac damage. Dr. Dawn covers two forms of dietary vitamin A - beta carotene from plants requiring enzymatic conversion, and vitamin A from animal products. She warns about vitamin A toxicity risks, particularly birth defects in pregnancy, while noting that typical American diets are adequate unlike vitamin D. Dr. Dawn examines vitamin D deficiency affecting 68% of children in a South Florida study, linking inadequate levels to bone health, immune function, and gut barrier integrity. She explains how vitamin D receptors throughout the body regulate cell differentiation, insulin secretion, and tight junction formation that prevents leaky gut syndrome. There are higher deficiency rates in darker-skinned populations and the historical context of rickets during industrialization when urban environments blocked sunlight exposure. She highlights revolutionary medical technology, the world's smallest pacemaker for newborns, half the size of a rice grain. This injectable device dissolves naturally after hearts self-repair, controlled by light-emitting patches communicating through the baby's skin. This breakthrough eliminates risky surgical removal procedures that caused complications, such as Neil Armstrong's death from pacemaker wire infections. Dr. Dawn discusses research showing shingles vaccination reduces dementia risk by 20%, particularly in women. She explains the natural experiment in Wales where universal healthcare created clear vaccination cutoff dates, allowing researchers to compare dementia rates. Dr. Dawn hypothesizes that cross-immunity against herpes viruses may protect brain tissue, noting even stronger protection with newer Shingrix vaccines compared to older Zostavax. She covers alarming increases in invasive Group A Streptococcus infections, with cases more than doubling from 2013 to 2022. Dr. Dawn explains how flesh-eating bacteria secretes enzymes that dissolve epithelial barriers in throats and lungs, allowing systemic spread that destroys tissue. She links rising cases to increasing diabetes and obesity rates that compromise immune function, noting devastating mortality rates approaching 10,000 deaths nationwide. Dr. Dawn celebrates a breakthrough antibiotic discovery of Lariocidin which works against highly drug-resistant bacteria through novel protein synthesis inhibition. She explains how antibiotic resistance spreads between bacterial species just like social media memes, emphasizing the urgent need for new treatments as 4 million people die annually from resistant infections. Dr. Dawn advocates for public funding since pharmaceutical companies avoid antibiotic development due to poor profit margins. She answers an email about Epstein-Barr virus detection, explaining its role in mononucleosis, Burkitt's lymphoma, and chronic fatigue syndrome. Dr. Dawn describes how EBV can remain dormant and reactivate during stress or immunocompromise, potentially triggering autoimmunity. She discusses similarities between EBV reactivation, Lyme disease, and long COVID, suggesting they may represent variations of the same inflammatory syndrome with different triggers. She explores the nocebo effect - how negative expectations worsen outcomes - and its amplification through social media. Dr. Dawn cites studies showing people warned about erectile dysfunction or altitude headaches experience these symptoms more frequently. She discusses recent phenomena like TikTok-induced tics and vaccine side effect amplification, warning that online health information creates dangerous nocebo loops that spread faster than traditional word-of-mouth.

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma and Biotech world.President Trump has nominated Susan Monarez as the new head of the CDC, facing challenges such as a measles outbreak that has already resulted in two deaths. Merck commits nearly $2 billion for an oral lipid-lowering drug, joining other companies targeting lipoprotein(a). GSK is studying the impact of their shingles vaccine, Shingrix, on reducing dementia risk. Cassava has ended their Alzheimer's program for Simufilam after years of controversy. The average life sciences salaries have increased by 9% in 2024, but bonuses and equity values have dropped. Trump has doubled down on the threat of tariffs on pharmaceuticals. In other news, Opthea and Unity have failed to unseat Regeneron's Eylea in vision disorders, while Alector will be laying off 13% of its workforce. AstraZeneca is making a potential $10 billion commitment to China despite political pressure. Opportunities in the life sciences industry are available at companies like Oncothera, Dyne Therapeutics, Amgen, and Novo Nordisk.

Highlights from Dr. Hoffman's trip to LithuaniaIs there a brand of Boswellia you recommend?I would like to start cooking with coconut oil. What do you recommend?What is the guide to taking strontium for bone health safely?Should I get the Shingrix vaccines after 4 covid shots and the annual flu shot?I've always had my T3 and T4 checked for my thyroid but never T2. How does it work? 

Are you worried about developing dementia or concerned about the risk for a loved one? In today's video, I'm excited to share a groundbreaking study published in Nature in July 2024 that reveals a potentially new way to reduce dementia risk!

On today's MJ Morning Show: Tesla recall Creepy story - 12-year-old found with 34-year-old Morons in the news Shingrix helps more than just shingles Hotel room A/C makes woman sick Baby naming laws by state Chloe's experience on her Uber ride Fester walked out of a restaurant... was he right? Top 10 fast food burgers according to USA Today Photo of Olympic surfer in the air The US gymnastics team has a nickname Cheap mid-week and brunch weddings K-Mart under fire for denim shorts for toddlers Lululemon pulls pants off market Rob Lowe says 'St. Elmo's Fire' sequel in early stages Rays stadium approved Tampa Airport construction incident Oscar Mayer Wienermobile crash Someone put Britney Spears' house on the market MJ gave in... updating his notebook to Windows 11 during show Justin Timberlake's drinking buddy took car after arrest Pitt/Jolie adopted son crashed his electric bike... hospitalized Christina Applegate has had only one plastic surgery in her life... Norah O'Donnell is leaving CBS Evening News

The latest episode of the DDW Highlights podcast is now available to listen to below. DDW's Megan Thomas narrates five key stories of the week to keep DDW subscribers up-to-date on the latest industry updates. There have been some interesting developments in neuroscience this week. Perhaps most note-worthy, shingles vaccines Shingrix has been shown to reduce the risk of dementia by 17%, and TikoMed's ALS drug caused a long-term slowing of ALS progression in a Phase II trial. You can listen below, or find The Drug Discovery World Podcast on Spotify, Google Play and Apple Podcasts. 

Dr. David Liew discusses abstract POS0620 at Eular 2024 in Vienna, Austria.

Global health care company, GSK, during their recent earnings report, outlined the company's progression in the areas of innovative vaccines and specialty medicines. During the investor call, CEO Emma Walmsley, addressed the earnings, speaking optimistically but realistically about the strategic developments of GSK. Walmsley mentioned that there is firm confidence in GSK's RSV vaccine, Arexvy, seen through market research figures and professional confidence levels.GSK's Performance This QuarterGSK has shown steady performance in Q1 of 2024, with stable growth in its principal areas of operation. The company has seen a 13% rise in sales equating to £7.4 billion. This was accompanied by an increase in core operating profit to £2.4 billion, a 35% growth from last year. GSK's core earnings per share have also risen by 37%. This performance can be attributed to the increasing acceptance of the company's innovative products in the market.The key to this performance is the strategic products, as acknowledged by GSK on its earnings call. These include Arexvy, Shingrix, Ojjaara, and Jemperli, which have been central to the company's growth. Also contributing to the company's stable performance is an ongoing commitment to research and development, facilitating a link between innovation and growth.GSK's Alignment with Consumer Trends and Future PlansMeeting emerging consumer trends, GSK is aligning its product offerings towards innovative vaccines and treatments for complex health conditions. This alignment allows for strategic planning concerning future growth. As the company affirmed on the earnings call, plans for investment into the vaccine portfolio are underway, including the regulatory submission of a new 5-in-1 meningococcal vaccine candidate.In terms of geographic strategy, GSK plans to focus on U.S. for Arexvy, and China for Shingrix. In addition to this, a focus on expanding GSK's HIV portfolio and investing in respiratory therapies is clear, suggesting broadening and strengthening its product range.During the earnings call, Walmsley also discussed the potential impact on the GSK's HIV business from a Part D redesign, aimed at reducing out-of-pocket costs for Medicare beneficiaries. However, GSK was clear that they will not provide specific guidance on the impact at this time and would continually evaluate the situation to adapt their strategies.In summary, the recent performance of GSK in Q1 2024 shows steady growth facilitated by strategic product launches. The company's strategy towards meeting emerging consumer demands and a constant focus on innovation puts it in good stead for the future. However, as with all business performance predictions and evaluations, these assertions require constant review and verification as market conditions continually evolve. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.theprompt.email

Using common case scenarios, Robert H. Hopkins, Jr., MD, MACP, and Laura P. Hurley, MD, MPH, discuss strategies for optimizing shingles vaccine uptake, including:The pathophysiology of shingles to better understand risk and burdenCDC guidelines and ACIP shingles vaccine recommendations, including considerations for those who are immunocompromised Strategies for optimizing shingles vaccine uptake no matter the clinical settingHow to address shingles vaccine‒related adverse events Addressing insurance-related concerns Presenters:Robert H. Hopkins, Jr., MD, MACPProfessor of Internal Medicine and PediatricsChief, Division of General Internal MedicineUniversity of Arkansas for Medical SciencesSchool of MedicineLittle Rock, ArkansasLaura P. Hurley, MD, MPHGeneral Internist and Health Services ResearcherAssociate Professor of MedicineDepartment of General Internal MedicineUniversity of Colorado Anschutz Medical CampusAurora, ColoradoLink to downloadable slides:https://bit.ly/4aWn6jhLink to full program:https://bit.ly/4aWBiJ0Get access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

Dr. Lisa Law and Dr. Randy Taplitz share the latest evidence-based recommendations from ASCO on vaccines in adults with cancer. They discuss recommended routine preventative vaccinations, additional vaccinations and revaccinations for adults undergoing HSCT, CD19 CAR-T treatment, or B cell-depleting therapy, guidance for adults with cancer traveling outside the U.S., and recommendations for vaccination of household and close contacts of adults with cancer. Dr. Law and Dr. Taplitz also share their insights on the guideline, including the importance of this guideline for adults with cancer and their clinicians, future advances in research, and current unmet needs. Read the full guideline, “Vaccination of Adults with Cancer: ASCO Guideline” at www.asco.org/supportive-care-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/supportive-care-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.24.00032       The ASCO Specialty Societies Advancing Adult Immunization (SSAAI) Project is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award to the Council of Medical Specialty Societies (CMSS) (with 100 percent funded by CDC/HHS). The contents are those of the authors and do not necessarily represent the official views of nor endorsement, by CDC/HHS or the U.S. Government. Brittany Harvey: Hello, and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.  My name is Brittany Harvey, and today, I am interviewing Dr. Lisa Law from Kaiser Permanente and Dr. Randy Taplitz from City of Hope Comprehensive Cancer Center, authors on “Vaccination of Adults with Cancer: ASCO Guideline.” Thank you for being here, Dr. Law and Dr. Taplitz. Dr. Lisa Law: Thank you. Dr. Taplitz: Thank you, Brittany. Brittany Harvey: Before we discuss this guideline, I'd like to take note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Taplitz and Dr. Law, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes.  So then, to dive into the content, here first, Dr. Taplitz, can you provide a general overview of both the scope and purpose of this guideline on vaccination of adults with cancer? Dr. Randy Taplitz: Yes, so people with cancer often experience a compromised immune system due to a variety of factors. This includes chronic inflammation, impaired or decreased function of the hematopoietic system, and treatments that compromise their immune function. Because of this, people with cancer are at a higher risk for infection, including with vaccine-preventable diseases. Also, response to vaccines in patients with cancer may well be affected by this underlying immune status, and their anticancer therapy, as well as the severity of the underlying malignancy. The purpose of vaccination in this group of patients is to prevent infection or to attenuate the severity of the disease when infection cannot be fully prevented.   This ASCO review builds on a 2013 guideline by the Infectious Diseases Society of America, or IDSA, and uses what's called a systematic literature review of 102 publications between 2013 and 2023. This includes 24 systematic reviews, 14 randomized clinical trials, and 64 non-randomized studies. The largest body of evidence in these studies, not surprisingly, addresses COVID vaccines on the efficacy and safety of vaccines used by adults with cancer or their household contacts. ASCO convened an expert panel to review this evidence and formulate recommendations for vaccinations in this population. Brittany Harvey: Understood. I appreciate that context, Dr. Taplitz. So then, next, Dr. Law, I'd like to review the key recommendations of this guideline. The guideline addresses four overarching clinical questions. So starting with the first question, what are the recommended routine preventative vaccinations for adults with cancer? Dr. Lisa Law: Thank you, Brittany. Before I start, I just want to wholeheartedly thank the first author of this paper, Dr. Mini Kamboj, Dr. Elise Kohn from the NCI, as well as the ASCO staff in putting this publication and guideline together. It is a very, very important guideline, and I echo everything Dr. Taplitz just said.  So going back to your question, what are the recommended routine preventative vaccines for adults with cancer? As per this guideline, there are about 7 to 8 based on patient age and risk. Namely, they are: seasonal flu, RSV for those aged 60 or above, COVID-19, Tdap, Hepatitis B, Shingrix, Pneumococcal vaccine, and the HPV vaccine. These vaccines should ideally be given two to four weeks before therapy. However, non-live vaccines can be given anytime during or after chemo, immunotherapy, hormonal treatment, radiation, or surgery. Brittany Harvey: Excellent. Thank you for reviewing those vaccinations and the timing of them as well. So then, following those recommendations, Dr. Taplitz, what additional vaccinations and revaccinations are recommended for adults undergoing hematopoietic stem cell transplantation, CD19 CAR-T treatment, or B-cell depleting therapy?  Dr. Randy Taplitz: Many studies have shown that stem cell transplant recipients essentially lose immunity from childhood immunizations, and we know that these individuals are very vulnerable to infection, particularly in the first year after transplant. Revaccination is critical to help restore their immunity. The optimal timing of vaccination is based on our understanding of adequate immune reconstitution with B and T-cell recovery so that the individual can mount a response to the vaccine. We know that a lot of factors influence this immune reconstitution, including the age of the stem cell transplant recipient, the source of the donor, the time from transplant, graft-versus-host disease prophylaxis, the treatment and severity of graft-versus-host disease, and the vaccine type and antigens used.   There are a number of bodies throughout the world, IDSA as I mentioned, CDC, American Society for Transplant and Cellular Therapy, European Society for Blood and Marrow Transplant, and European Conference for Infections and Leukemia. All of these bodies have guidelines that approach vaccination in stem cell transplants. However, variation does exist in the use of a variety of things including whether to use immune predictors to help guide vaccination, and there is really not consensus on whether this immune predictor guided vaccination is more likely to produce a protective immune response versus a standardized schedule. In addition, the duration of protection is incompletely understood.  The bottom line in these guidelines is that they recommend complete revaccination starting for most vaccines at 6 to 12 months after stem cell transplant, in order to restore vaccine-induced immunity. And I just want to go through a few of the particulars. For COVID-19, which is a three-dose series in the primary series, influenza - generally high-dose influenza - and pneumococcal vaccine, PCV20 in general, ultimately four doses, can be administered, starting as early as three months after transplant. Although there is really not much data to guide the use of the recombinant zoster vaccine in allogeneic stem cell transplant, the vaccine can be administered after the end of antiviral prophylaxis, which in general is 12 to 18 months after allogeneic and 3 to 12 months after autologous stem cell transplant. Some of the other vaccines, such as hepatitis B, Tdap, meningococcal vaccines, and HPV revaccination in those less than 45 are also recommended.   I want to also spend the moment talking about the two recently licensed RSV vaccines, which were essentially studied in less compromised hosts and really without any immunogenicity data in stem cell transplant, and thus, there is no recommendation in this guideline for the use of these vaccines after transplant. Live vaccines, such as MMR and varicella – varicella would be in varicella-seronegative patients without a prior history of varicella – should be delayed for at least two years and only given in the absence of active graft-versus-host disease or immunosuppression.  Moving briefly to CAR T, which is an immunotherapy that involves adoptive cell therapy, given the available data and after a review by the group, it was recommended that adults with hematopoietic malignancies receiving CAR T therapy directed against B-cell antigens should receive influenza and COVID-19 vaccines either two weeks before lymphodepletion or no sooner than three months after the completion of therapy. Administration of non-live vaccines preferably should occur before CAR T treatment or at least 6 to 12 months after, following the same timing as what we recommend for stem cell transplant. There is really little data to guide the safety and timing of administration of live vaccines after CAR T therapy.   In terms of adults receiving B-cell depleting therapy, they are generally unable for time to mount an effective humoral response but may have at least partially intact cellular immune responses. They are encouraged to be revaccinated for COVID-19 no sooner than six months after completion of B-cell depleting therapy, and they should receive influenza vaccine approximately four weeks from the most recent treatment dose for patients on chronic therapy. For other non-seasonal immunizations, vaccines ideally should be given two to four weeks before commencing anti-CD20 therapy or delayed until 6 to 12 months after completion, except for the recombinant zoster vaccine, which can be given one month after the most recent dose of B-cell depleting therapy. Brittany Harvey: I appreciate you reviewing each of those vaccinations and when they should be given, and reviewing the available data – albeit, limited data – in these situations.  So beyond these routine preventative vaccinations and revaccinations that you've both just described, Dr. Law, what additional vaccinations does the expert panel recommend for adults with cancer traveling outside the United States? Dr. Lisa Law: Good question. As per these ASCO guidelines, adults with solid or blood cancer traveling outside of the United States should follow the CDC standard recommendations for their destination. For the 2024 CDC Yellow Book, travel vaccines, in general, should be delayed until three months from the last chemotherapy or, and for those with solid tumors, ideally when the disease is in remission. Of note, hepatitis A, typhoid, inactivated polio, Hep B, rabies, meningococcal vaccine, and Japanese encephalitis vaccines are considered to be safe. In all cases of travel, patients should be counseled by their healthcare provider about the travel timing, with the additional attention to the regional seasonality of infections, for instance, influenza is more common in late summer in Australia, and also with attention to any outbreaks that may be occurring globally at the time of travel. Brittany Harvey: Absolutely. Those are key points for clinicians to discuss with their patients as they consider upcoming travel.  So then, the final clinical question that the panel addressed, Dr. Taplitz, what vaccinations does the panel recommend for household and close contacts of adults with cancer?  Dr. Randy Taplitz: Thank you. Yes, it is recommended that all household members and close contacts, when possible, be up to date on their vaccinations. And the only further thing I would say is that there are some special considerations for the use of live vaccines in household contacts, particularly in stem cell transplant recipients. Contacts of people who receive stem cell transplants should preferably receive inactivated influenza vaccines. As was mentioned, MMR and varicella vaccines are both safe to administer to close contacts. Vaccine strain transmission to immunocompromised hosts has not been associated with MMR use in family members.   Eleven cases of the varicella vaccine strain transmission are described in the published literature, but none occurred in compromised hosts. Because the vaccine strain can cause severe and fatal varicella in profoundly immunocompromised people, precautions are advised to avoid close contact with a person with a vaccine-induced rash. For household contact travelers, MMR and yellow fever vaccines are considered safe. Oral cholera should be avoided. For smallpox vaccines, the second-generation ACAM2000 has rarely been associated with vaccinia transmission and should be avoided because of this. But the live replication-deficient MVA-based JYNNEOS vaccine is felt to be safe for household contacts of immunocompromised individuals. Brittany Harvey: I appreciate you reviewing the importance of vaccination for household and close contacts, and some of those precautions that individuals should take. I appreciate you both for reviewing all of these recommendations.  So then in your view, Dr. Law, what is the importance of this guideline, and how will it impact both clinicians and adults with cancer? Dr. Lisa Law: In my opinion, this is a very important guideline that is long overdue in the oncology community and will have a huge impact on both clinicians and adults with cancer. Over the years, I have often been asked by my colleagues and patients, “Can I have the flu vaccine, and if so, when?” So this guideline really is going to be helpful. More importantly, our cancer patients are living much longer. They may have years of quality of life even with third or fourth line of treatment, especially, for instance, like CAR T for myeloma and lymphoma. However, we know that with additional treatment, that carries a substantial risk of infection complication among these immunocompromised patients. So it is of paramount importance to inform our patients and colleagues to be proactive in advocating preventive therapy ahead of time, meaning trying to get the patients appropriately vaccinated as early as possible to generate immunity.  Another case in point is the Shingrix vaccine. I used to see lots of shingles, but ever since we have the recombinant Shingrix, I have fewer encounters. And this is huge because post-herpetic neuralgia robs a patient's quality of life. So, again, it is very important to recommend appropriate vaccines for our cancer patients.  Brittany Harvey: Absolutely. It is key to ensure patients receive these preventative vaccines, and we hope that this guideline puts an emphasis on that for clinicians and patients.  So finally, to wrap us up, Dr. Taplitz, what are the current gaps in knowledge regarding the vaccination of people with cancer? Dr. Randy Taplitz: There are a number of really important gaps in knowledge and really critical unmet needs that require research and other dedicated efforts. Among these are, and I think paramount, are really the participation of people with cancer with varied types of immunocompromise in vaccine trials. Where vaccine trials are only for cancer patients, obviously is ideal, testing vaccines in the appropriate population. But when that's not feasible, pre-existing cancer should not preclude eligibility, and inclusion of cohorts of people receiving anticancer treatment should be incorporated prospectively. So that's really critical because the quality of our guidelines is based upon the data. We use the data for developing guidelines and gathering more data in the particular patient population is really, really critical.  Secondly, work for creating more immunogenic vaccines and research to understand the immune response to vaccines after immuno-depleting therapies, particularly with newer therapies such as CAR T and newer B cell therapies, bispecific antibodies, etc. is really critical. We need to really understand the immune response and have the most potent vaccines available to these people who may have impaired immune responses.  Switching gears a little bit, we really need mechanisms to promote institutional commitment to integrate and sustain immunization best practices for people with cancer. This will largely be through multidisciplinary, team-based approaches, protocol-based vaccination standing orders, and leveraging data sharing so that we can all be on the same page with giving vaccines to these individuals. We also need education and evidence-based decision-making tools, emphasizing preventive care through immunization, the availability of educational resources to clinicians and patients to address commonly asked questions and also misconceptions about vaccination, that's absolutely critical.  And finally, I think we need to develop strategies for addressing unique challenges and factors contributing to vaccine hesitancy during cancer therapy. We need to focus on patient and clinician communication, and very importantly, we need to consider health equity considerations in the development and approach to vaccines in these compromised patients. Brittany Harvey: Definitely, we'll look forward to research and advances in these areas that you've just described to support these guidelines and increase vaccine uptake.  So I want to thank you both so much for your work on this important guideline, and thank you for your time today, Dr. Law and Dr. Taplitz. Dr. Lisa Law: Thank you.  Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Do you have Medicare Part B and Medicare Part D? Vaccinations are covered. Toni discusses what vaccinations are covered by each Medicare Part. Toni discusses the shingles - Shingrix vaccine coverage, and how to best afford your vaccinations.  Need more information? Want to be prepared for  Take advantage of Toni's brand new video series now a available at  www.tonisays.com Remember - with Medicare it's what you don't know that will hurt you!  There's so much good information in this podcast, please be sure to share this podcast with your friends! Recognized by feedspot.com as one of the best Medicare Podcasts in the nation! Write Toni - info@tonisays.com. Toni's book is available at www.seniorresource.com and www.tonisays.com You can call Toni at 832-519-8664 Toni welcomes all Medicare questions. Toni now offers informative Medicare Webinars for all of your Medicare needs at www.Tonisays.com You can find Medicare Moments wherever you find your favorite podcasts, such as: Apple: https://apple.co/44MoguGSpotify: https://open.spotify.com/show/7c82BS4hb145GiVYfnIRsoAmazon Music: https://music.amazon.com/podcasts/884c1f46-9905-4b29-a97a-1a164c97546b/medicare-moments?refMarker=null Toni's new book: Maze of Medicare is now available at www.tonisays.com Combining Scripture with Medicare, it is the only book of its kind.  Toni's columns appear weekly in about 100 newspapers across America. If you would like Toni's column to appear in your local paper, or if you would like Toni to speak at an event - contact Toni King at 832-519-8664 Thank you for listening and be sure to tell your friends about Medicare Moments!  Blessings! Toni King See omnystudio.com/listener for privacy information.

Loại vắc-xin mới Shingrix vượt trội hơn so với vắc-xin cũ Zostavax trong việc ngừa bệnh giời leo và các biến chứng liên quan. Cần lưu ý điều gì để tiêm phòng hiệu quả?

KSQD 11-22-2023: Supplements and other advice to combat the side effects of the Shingrix vaccine for shingles; Surge in monkeypox during the summer; The many applications of AI in medicine, from drug interaction help to reading mammograms; Are calcium supplements for osteoporosis affecting my Hashimoto's thyroiditis treatment? Using computational science to improve maternal mortalities during childbirth; New research shows how cadmium, an estrogen mimic, contributes to endometriosis; Fusobacterium levels in the uterus are probably another contributing factor for endometriosis; Kombucha drinks lower blood sugar levels, which is good for diabetes; Irregular sleep patterns affects your microbiome; Irregular sleep patterns affects your microbiome and hence health

KSQD 11-22-2023: Supplements and other advice to combat the side effects of the Shingrix vaccine for shingles; Surge in monkeypox during the summer; The many applications of AI in medicine, from drug interaction help to reading mammograms; Are calcium supplements for osteoporosis affecting my Hashimoto's thyroiditis treatment? Using computational science to improve maternal mortalities during childbirth; New research shows how cadmium, an estrogen mimic, contributes to endometriosis; Fusobacterium levels in the uterus are probably another contributing factor for endometriosis; Kombucha drinks lower blood sugar levels, which is good for diabetes; Irregular sleep patterns affects your microbiome; Irregular sleep patterns affects your microbiome and hence health

KSQD 11-08-2023: Go to Santa Cruz Cancer Benefit group (sccbg.org) for Pancreatic Cancer information and awareness event in Santa Cruz on Nov. 19; The physiology of the pancreas; Prognosis for pancreatic cancer is poor; Genetic mutations, smoking, obesity and diabetes are major risk factors; The difficulties of early or any diagnosis of pancreatic cancer; Jaundice is an indicator, but only one out of 5 have the cancer; Lab tests are not very predictive, but circulating tumor DNA holds hope for detection; Can shingles vaccination help prevent dementia?More about genetic influences such as Brca1, Brca2 and KRAS genes; Can shingles vaccination help prevent dementia?

KSQD 11-08-2023: Go to Santa Cruz Cancer Benefit group (sccbg.org) for Pancreatic Cancer information and awareness event in Santa Cruz on Nov. 19; The physiology of the pancreas; Prognosis for pancreatic cancer is poor; Genetic mutations, smoking, obesity and diabetes are major risk factors; The difficulties of early or any diagnosis of pancreatic cancer; Jaundice is an indicator, but only one out of 5 have the cancer; Lab tests are not very predictive, but circulating tumor DNA holds hope for detection; Can shingles vaccination help prevent dementia?More about genetic influences such as Brca1, Brca2 and KRAS genes; Can shingles vaccination help prevent dementia?

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in the Pharma and Biotech world. ## Health AI startup Olive is shutting down. The company, once valued at $4 billion, has struggled due to high costs and the failure to secure new funding. This news is a blow to the digital health industry, which has seen a boom in funding recently. ## On another note, Doctors' Management Services has settled claims with the US Department of Health and Human Services (HHS) regarding a ransomware attack that exposed patient information. This settlement marks the first time HHS has taken action against a company for failing to comply with breach notification rules under HIPAA. ## President Joe Biden has issued an executive order for HHS to collect reports on the safety of healthcare AI. This move is part of a larger effort to ensure "safe, secure, and trustworthy" artificial intelligence in healthcare. ## Lastly, Kaiser Permanente has reached a tentative contract deal with a labor union in Washington, preventing a strike by 3,000 workers scheduled for November 1.## In other news, British biopharmaceutical company GSK has reported a 10% increase in sales in the third quarter. This growth can be attributed to strong sales of their respiratory syncytial virus shot Arexvy and shingles vaccine Shingrix. As a result, GSK has raised its outlook for the year.## The US Food and Drug Administration's advisory committee has determined that the off-target analysis for Vertex Pharmaceuticals and CRISPR Therapeutics' sickle cell disease candidate, ExA-Cel, is sufficient.## Astrazeneca has invested $245 million in French biotech firm Cellectis as part of their ongoing efforts to advance cell and gene therapy development. This investment caused Cellectis shares to increase by over 180% in premarket trading.## And finally, a webinar will be held to discuss the optimization of biomarker assays to bridge the gap in clinical trial participation. The use of multiplexed patient-centric assays could help reduce the burden on patients.That's all for today's episode. Stay tuned for more important news in the Pharma and Biotech world.

The pain from shingles has been described as aching, burning, stabbing or shock-like. It's painful, comes with a number of complications and is extremely common. - Rasa sakit akibat herpes zoster digambarkan sebagai rasa sakit terbakar, menusuk, atau seperti syok. Ini menyakitkan, disertai sejumlah komplikasi dan sangat umum terjadi.

Good morning from Pharma and Biotech Daily, the podcast that gives you only what's important to hear in the Pharma and Biotech world. Here are the key points from today's news:GSK has partnered with Chongqing Zhifei Biological Products to expand sales of its shingles vaccine, Shingrix. The company aims to double sales of the vaccine by 2026.Apellis Pharmaceuticals reports steady demand for its new eye drug, Syfovre, despite safety concerns. Prescriptions for the drug have increased in August after a period of side effect investigations.Amgen has completed its $28 billion acquisition of Horizon, despite challenges from the FTC. The deal was delayed due to concerns about product "bundling," but Amgen agreed to requirements to address these concerns.Merck has released data showing a survival benefit for early treatment with its immunotherapy drug, Keytruda, in the perioperative setting. An approval decision is expected later this month.The medtech sector is facing several financial challenges, including declining stock prices, mergers and acquisitions, investment, and revenues, according to a report from consulting firm EY.Walgreens has announced that Tim Wentworth, a former executive at Cigna and Express Scripts, will become its new CEO starting from October 23.Novo Nordisk has ended a Phase III kidney outcomes study of its drug semaglutide early due to strong efficacy signals. The positive results suggest that semaglutide may have a beneficial impact on kidney function.Biotech bankruptcies have been on the rise in 2023, with a record high of 28 bankruptcies in the sector so far this year.Roche's subcutaneous version of its multiple sclerosis drug Ocrevus has shown promise in a Phase III trial. The subcutaneous formulation performed comparably to the intravenous version of the drug.Biotech company Sana has announced staff layoffs and a refocus on its ex vivo cell therapy platform. The company will be reducing its workforce by 29% and reallocating resources to prioritize its hypoimmune platform.These developments highlight both positive and challenging trends in the Pharma and Biotech industry. Stay tuned for more updates on the latest news.

Good morning from Pharma and Biotech Daily, the podcast that gives you only what's important to hear in the Pharma and Biotech world. Today we have some exciting news to share with you.## Bristol Myers Squibb Acquires Mirati TherapeuticsBristol Myers Squibb has announced its plans to acquire Mirati Therapeutics, a developer of drugs for Kras-mutant cancers, for $4.8 billion. This acquisition is part of Bristol Myers' strategy to expand its oncology portfolio and strengthen its position in the field of precision medicine. The deal also includes an additional $1 billion payment if an experimental cancer drug being developed by Mirati gains approval from US regulators.## GlaxoSmithKline Partners with Chongqing Zhifei Biological ProductsIn another deal, GlaxoSmithKline (GSK) has partnered with Chinese pharma company Chongqing Zhifei Biological Products to expand sales of its shingles vaccine, Shingrix, in China. GSK aims to double the sales of Shingrix by 2026. This partnership will help GSK tap into the growing demand for vaccines in China and strengthen its presence in the country's healthcare market.## FDA Rejects Alnylam's Application for Expanded ApprovalThe US Food and Drug Administration (FDA) has rejected Alnylam's application for expanded approval of its RNA drug Patisiran for the treatment of a rare heart condition. This setback delays Alnylam's plans to expand the use of Patisiran and highlights the challenges faced by biotech companies in gaining regulatory approval for new drugs.## Resurgence in Mergers and Acquisitions ActivityThe biotech industry is seeing a resurgence in mergers and acquisitions (M&A) activity, with nearly $7 billion in deals announced in the first nine days of October. This increase in M&A activity follows a relatively quiet third quarter and indicates a renewed interest in consolidation and strategic partnerships within the industry. Several FDA decisions to watch out for in the fourth quarter, including verdicts on drugs from Vertex, Bristol Myers, Amgen, Pfizer, and Alnylam, could impact the future growth and profitability of these companies.## HLTH Conference AnnouncementsMoving on to the HLTH conference in Las Vegas, there were several notable announcements. Venture capital firm General Catalyst is planning to buy a health system as part of its new health business, called the Health Assurance Transformation Corporation. Amazon Clinic is considering partnering with physical providers for care referrals, recognizing that some aspects of care are better done in person. Uber has partnered with Optum to add benefits cards to its health platform, making Uber a "patient entry point" into the health benefits system.## Updates in the Health IndustryThe recent three-day strike at Kaiser Permanente has ended, but unions and the health system have not reached an agreement on a new contract for over 75,000 workers. Best Buy is venturing into prescription-based medical device sales by selling continuous glucose monitoring systems. The Drug Enforcement Administration and the Department of Health and Human Services have extended telehealth prescribing rules for controlled substances virtually through the end of 2024. There was also a strike by healthcare workers at St. Francis Medical Center in Los Angeles and the introduction of a buy now, pay later card for medical expenses by PayZen.## Tune Therapeutics' Epigenetic Editing TherapiesTune Therapeutics, a biotech company, is developing epigenetic editing therapies as a potentially safer alternative to CRISPR-style gene therapies. While CRISPR-based treatments hold promise for curing chronic conditions, they also come with safety risks due to potential off-target effects. Tune Therapeutics aims to overcome these risks by "tuning" genes up or down using epigenetic editing. This approach could provide a safer and more precise method of gene editing.## FDA Advisory Committee to Discuss Sickle Cell Disease ApplicationThe FDA adviso

Vidcast:  https://www.instagram.com/p/CwcEazygKFZ/ Getting vaccinated against shingles, pneumonia, tetanus, diphtheria, and even the flu is associated with a 25-30% up to a 40% lower risk of developing the dementia of Alzheimer's Disease.  Biomedical informatics researchers at the University of Texas followed about 1,652,000 initially dementia-free subjects over an 8 year period. The numbers revealed that shingles vaccination was associated with a 25% overall lower incidence of Alzheimer's, pneumococcal vaccination a 27% lower risk, and tetanus combo vaccination a 30% lower risk. Those who received the latest recombinant shingles vaccine, Shingrix, had a 73% lower risk.  The same research group reported last year a 40% lower risk of Alzheimer's in those receiving influenza vaccination.  These apparently protective effects of routine vaccines compare favorably with those reported for the latest anti-amyloid antibody therapies which slow Alzheimer Disease progression by 25-35%. It appears that routine adult vaccinations stimulate the immune system in a way that either prevents buildup of damaging proteins in the brain or interferes with their toxic effects. This study suggests yet another reason to keep your vaccination status up-to-date. https://content.iospress.com/articles/journal-of-alzheimers-disease/jad221231 https://www.sciencedaily.com/releases/2023/08/230816170628.htm #alzheimers #vaccinations #shingles #shingrix #pneumococcalvaccine #tdap #tetanus #influenza

In this episode of the Matter of Vax podcast, host Steph O'Connell discusses shingles and vaccines with guest Dr. Paul Van Buynder, a public health physician and professor in the School of Medicine at Griffith University. Shingles is a common and painful condition that affects a large number of Australians each year, especially those over the age of 50. Dr. Van Buynder explains the long-term consequences of shingles, including postherpetic neuralgia and eye complications He discusses two vaccines available in Australia, Zoster and Shingrix, highlighting the benefits and drawbacks of each and ways to protect oneself against shingles.  Visit Immunisation Foundation of Australia for more information Host Steph O'Connell is a public health advocate with 25 years' experience in strategic communications. She became a public voice for vaccinations when her daughter, Lily (23), narrowly survived W strain of Meningococcal on Christmas Day, 2017. Nine months later her sister, Grace, donated a kidney that has since transformed Lily's life.  Steph's advocacy for immunisation awareness and vaccination became a collaboration in 2018 with Meningococcal Australia and resulted in Meningococcal vaccination campaigns by the Australian Government Department of Health and NSW Health. Lily's story quickly resonated with audiences and became a national and international appeal for awareness, education and vaccination.  Steph's work expanded during the pandemic and today she continues to advocate for improved access to vaccines, public education for lifelong vaccination behaviour and policy reform. MatterofVax, in collaboration with Immunisation Foundation of Australia takes a look at topical immunisation issues on video and podcast.  Matter of Vax is produced by Ampel, for Immunisation Foundation of Australia. See omnystudio.com/listener for privacy information.

10/16/22The Healthy Matters PodcastEpisode - 23 - Community Immunity - Let's Talk Vaccines!Shingrix, PCV-15, PCV-23, Flu Shots, Bivalent....From Shingles, to Pneumonia, to Influenza, and even a little thing called COVID-19 - there's a lot to know when it comes to vaccines.  Most of us have been living with them our entire lives, and there are likely more ahead!  Join us for Episode 23 of the podcast where we chat with Dr. Kate Hust, Medical Director of the Internal Medicine Clinic at Hennepin Healthcare, to get an overview of the wide world of vaccines and their importance for you and your community.Got a question for the doc?  Or an idea for a show?  Contact us!Email - healthymatters@hcmed.orgCall - 612-873-TALK (8255)Twitter - @drdavidhildenFind out more at www.healthymatters.org