Originally published on Sept 28, 2023 in palliumindia.org

I knew my mother would die in a couple of years. What I didn’t foresee was the extent of her suffering during those two years. She battled a terminal lung condition that progressively took away her ability to breathe. In India, where she lived, relief was hard to come by. I was told multiple times that since she wasn’t a cancer patient, she couldn’t get morphine for her breathlessness, morphine was only for cancer pain. Many doctors criticized us for opting for palliative and hospice care when we could afford more aggressive treatments, failing to appreciate the patient’s own understanding that in terminal conditions, the quality of life can often outweigh the quantity of life. In a dire situation, she was put on a ventilator against our explicit wishes. As a physician, it appalled me how hard I had to fight to get her the hospice care she desired. Her passing left me both devastated and disillusioned with a healthcare system that had deeply failed her. 

This experience led me to Pallium India in February of this year. Their loving compassion empowered me to channel my grief into something positive. With their support, I embarked on a month-long journey across the state of Tamil Nadu in India this August, reaching out to hospitals, colleges, non-profit palliative care organizations, and community groups.

In that one month, I spanned 7 cities, covered 1500 miles on Indian Railways, spoke to over a thousand people and indulged in a lot of curry! Pallium’s southern regional coordinator personally made all the arrangements and accompanied me on this trip, for which I am truly thankful.

My main message to the medical community was to integrate palliative and hospice care into the healthcare system so that everyone would have access to it.  

A concerning sentiment I came across during my travels was the perception among most Indian doctors that palliative care is charitable care. Yet, the public, who would be the beneficiaries of such care, appeared quite willing to pay. The realization that palliative care could be as commercially viable as specialties like cardiology or endocrinology was an eye-opener for many. I made it clear that if we continue to view palliative care solely as charitable, its reach will remain limited. I urged business leaders and healthcare providers to see palliative care patients as deserving customers, emphasizing that the service requires substantial resources and should be funded similarly to other health services. While there’s undoubtedly a segment of society that might require it as a charitable service, a large section is both willing and capable of bearing its costs.

It is now time for the medical community in India to elevate palliative care to the same standard as other specialties, a fully integrated part of the mainstream healthcare system, and readily accessible to those in need.

I remain deeply grateful to Pallium India, both for their personal support to me and for the invaluable services they offer in India.

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Dr. Sue Royappa specializes in internal medicine and public health in the US. She runs a medical software company and a public health non-profit with her husband Andrew.

Originally published in Hideaway Lake News on April 1, 2022

While we obsess about carbs, fats and proteins, we often forget about an equally important player in our diet – fiber. I have found that if I make sure and include foods rich in fiber at every meal, I automatically eat healthier. This is because foods with high amounts of fiber are naturally low in unhealthy fats and high in vitamins and minerals.

Fiber is a type of carbohydrate that the body can’t break down and digest, which means first of all, it doesn’t have any calories! Second, this also means it helps in the regulation of our bowel movements. Although it seems counter intuitive, fiber can help with both constipation and diarrhea. This is because there are two types of fiber, soluble and insoluble, and they work together to address all bowel movement irregularities. All fruits, vegetables, whole grains and beans have a mix of soluble and insoluble fiber, some have more of one than the other.

Soluble fiber is found in oats, avocados, flax seeds, black beans, apples and others. This is the fiber that helps most if you suffer from diarrhea as it removes water and bulks up the stool.

Insoluble fiber is more plentifully found in all other vegetables, fruits, grains and legumes. Both types of fiber help with constipation by regulating the water content in the stool as well as the rate at which food moves through the gut. Ensuring you have adequate amounts of fiber is the best way to assure your gut health. Most Americans get less than half of the recommended fiber in their diet. I find it difficult to count fiber grams and such, so I just make sure I eat 1-2 servings of fiber rich foods at each meal and I automatically get the daily required amount.

If you normally eat a diet very low in fiber, which often means a highly processed one, it will take some time for your body to adjust to any added fiber. So don’t go from zero fiber to lots of high fiber foods quickly. Give your body time to adapt or you will experience terrible gas, bloating and possibly even diarrhea. Start by adding one serving of fiber rich food per day and increase by one serving every few days to weeks, depending on how you tolerate it. If you start getting stomach problems, cut back a bit and take it slower. Also make sure you drink plenty of water with your fiber rich foods to allow the fiber to work like it should.

Talk to your doctor before you start a fiber regimen if you suffer from irritable bowel syndrome, chronic constipation or gastroparesis, so they can guide you about the correct amount and type of fiber to eat in order to get the most benefit. While whole foods are the best source of fiber, some people may not be able to get all their fiber needs from regular foods. They may have to add a fiber supplement such as psyllium or inulin in the form of a powder or tablets. Again, make sure you increase these supplements slowly and take them with plenty of water, otherwise you may get gas, cramps and bloating.

Why go through all of this if your bowels are already moving fine? This is because in addition to its effects on your bowel movements, fiber also improves your cholesterol, moderates your sugar by helping you avoid rapid rises in sugar, and keeps you feeling full longer. Studies have shown that it improves heart health, helps control your weight and maybe even live longer. So the next time you sit down to a meal, pay attention to your fiber too!

Originally published in Hideaway Lake News on Mar 3, 2022

Osteoporosis is a disease where your bones become fragile and break easily. Like many other chronic diseases, it is silent, and you won’t know you have it unless you break a bone or test for it with a bone density scan. You might have heard the term osteopenia as well, that is used to describe thinning bones that are not yet so thin that they will break easily. Osteopenia is a signal that you need to build up your bone strength now so you don’t break a bone in the future.

Postmenopausal women are at higher risk of thinning bones and fractures than younger women. This makes many people assume that osteoporosis is a disease of just women. However, that is not true, men can also get osteoporosis. Small and thin older people, regardless of gender, and those who take certain long term medications like steroids and acid reducers, all have an increased chance of low bone mass which in turn makes them more likely to have a fracture.

We often think that a fall causes the fracture, but sometimes the fall is caused by the fracture! This happens when the bones are so thin, they break spontaneously and then you fall. And this may be the first and only sign that you have osteoporosis. To avoid such a nasty surprise, make sure and talk to your doctor about getting a bone density scan, also called a DEXA scan, if you are over 65. Your doctor may choose to scan you earlier if you have a family history of early osteoporosis or if you have other risk factors I mentioned above.

Incorporating a regular exercise program of strength training is one of the best ways to maintain bone density. In fact, strength training has been shown to not only help maintain but also increase bone density in those with thinning bones. You don’t have to become a bodybuilder pumping heavy weights, just simple resistance exercises using your own body weight, light weight dumbbells or weight lifting exercise machines will do the job. If you’re not already doing it, check with your doctor about how you can safely start such a program.

The next thing you can do is eat a diet which provides for your daily calcium needs. Milk, yogurt, cheese and other dairy products, canned fish bones, leafy greens, beans and nuts are all good sources of calcium. If you are vegan, you might want to consider a calcium supplement. And finally, make sure that you have enough vitamin D for strong bones. Many people are vitamin D deficient because they are indoors so much and don’t get the sunlight exposure that is essential for making vitamin D in your body. So it is generally recommended that everyone take 400 – 800 units of vitamin D daily. If you are severely deficient, your doctor may put you on a prescription strength vitamin D or ask you to take higher doses of over the counter supplements.

If you already have osteoporosis, then there are still ways to improve bone density and reduce fracture risk. Several treatments are now available, from daily, weekly and monthly pills, to monthly and yearly injections. Each has its own pros and cons and your doctor will discuss them with you so you can together choose the option that is best for you.

Regardless of your age or gender, it is never too early or too late to start taking care of your bones. Eat a healthy diet rich in calcium, take a vitamin D pill and pick up those dumbbells!

Originally published in Hideaway Lake News on Feb 4, 2022

People who ask this question fall into two groups. The first one says “I’m very healthy and I never fall sick. Why do I need to go see my doctor?”. The other one says “I’m in the doctor’s office almost every month with so many medical problems. Why do I need to go in separately for an annual visit?”. These are valid questions but I hope to convince you that both groups of people can benefit from an annual preventive health visit with their doctor.

Many conditions are “silent”, i.e. you don’t feel bad or experience any symptoms until it is too late and you have a catastrophic event like a heart attack or a stroke. The annual visit allows the doctor to monitor otherwise healthy seeming people for silent killers like high blood pressure, diabetes, high cholesterol and obesity. If these are caught early and managed with appropriate lifestyle changes and/or medications, many major problems can be avoided later in life. In addition, they discuss vitamin deficiencies, cancer screenings and immunizations depending on the age and gender. Over the years I have found many cancers in the early stages because someone came in for their annual preventive visit. This is also the time when I do a full physical exam and have found life threatening skin cancers and heart murmurs in otherwise “healthy” people. Your doctor also gets a chance to address mental and emotional health during this visit. It is essentially a time when you can get a full picture of your health, not just get treated for your stomach flu or poison ivy rash or whatever is ailing you at that point.

Similarly, for those who have so many medical problems that they are in and out of their doctor’s office every few weeks, they’re always focused on fixing the acute problem and never have a chance to address things like cancer screenings and immunizations. The annual visit is when insidious problems like excess alcohol use, domestic violence, fall risks and elder abuse are brought to attention. For older patients, the doctor can check on their memory for early signs of Alzheimer’s disease. They can talk about their social life, if they are suffering from loneliness or depression, both of which can adversely affect their physical health. These are issues that they don’t normally have time to discuss during a problem visit when your legs are swelling up because you have heart failure or you’re having yeast infections from your high blood sugars.

So a recap for the healthy – get your blood pressure, sugar, cholesterol and weight checked. Get your immunizations updated and your cancer screenings completed every year.

For those who seem to always be in the doctor’s office, the preventive visit will allow your doctor to not just update your immunizations and cancer screenings, but also watch for subtle issues like memory problems, excess alcohol use, loneliness and depression.

We are right now so hyper-focused on COVID that many people are ignoring other things that are more likely to kill them. A deluge of cancer deaths is expected from missed cancer screenings. Don’t be a part of that statistic. Once the Omicron surge is past, don’t ignore your next reminder call from your doctor’s office for your annual preventive visit. It might just save

your life. Take control of your health and set an intentional path for a healthier you in the coming years. Best of health to us all!

Originally published in Hideaway Lake News on Jan 3, 2022

Health fads come and go but the Four Pillars of Health have stood the test of time. These four pillars are food, activity, sleep and rest. This means eating nutritious foods, being physically and mentally active, getting good quality and adequate sleep, and finally, giving our bodies and minds the rest they deserve.

Many of us will make New Year’s resolutions year after year that we will eat better, be more active, sleep more and work on our mental stress, but we end up going back to our old habits soon after we decide to do otherwise. Sometimes it is because the resolutions are too complex. Other times, we don’t have a clear plan to achieve them. Then there are times when we simply don’t give them the priority and commitment they deserve. To ensure success, keep goals SMART – Specific, Measurable, Attainable, Realistic and Time Bound. These are principles from the business world that are surprisingly effective in setting and achieving health goals.

Specific – What do you want to accomplish? It should be direct, detailed and meaningful.

Measurable – How will you know when you have reached it? It should be quantifiable to track progress or success.

Attainable – Is it in your power to accomplish it? You should have the tools and resources to attain it.

Realistic – Can you realistically achieve it? Your circumstances and environment should allow you to achieve it.

Time Bound – When exactly do you want to accomplish it? It should have a deadline.

Let’s apply the SMART method to one of the Four Pillars of Health.

Food: Your goal is “I will eat healthier this year”. This is not specific – what is “healthier”? It is not measurable – how will you determine if you have eaten healthier? It may or may not be attainable or realistic since the definition of “healthier” is so vague. It is also not time bound – is it for every day for the entire year or for five days of the week?

You see how difficult it is to achieve goals that are not SMART. Let us convert the statement “I will eat healthier this year” to multiple SMART goals.

“I will eat two servings of vegetables with each lunch and dinner”.

“I will limit sugary drinks to one per week”.

“I will limit fast food restaurant meals to one every two weeks”.

The above goals are SMART – they are specific, you can measure what you’re doing, they are attainable, they are realistic and time bound.

Make a resolution for each of the Four Pillars of Health. Then convert each resolution into a set of SMART goals. Write these down, make a commitment to yourself and your family, track your progress, revel in your success. This year, be SMART about your health.

A Happy New Year to you all! And the very best of health!

Originally published in Hideaway Lake News on December 3, 2021

As I write this, my 74 year old mother is struggling to breathe with flu pneumonia in India. Her COVID test was thankfully negative. I have been trying to get her a flu shot and a pneumonia shot for the past three months, but they were unavailable in her city of 1 million people. And now she has pneumonia, which could have been prevented had she been able to get a flu shot.

COVID vaccines were initially in such short supply in India that she didn’t get fully vaccinated until just a few weeks ago. Also, she couldn’t get the mRNA vaccines that have been readily available here for months. However, she is fortunate that the hospitals there have no oxygen shortage this time around. And she’s also very lucky that she found a hospital bed.

I want to remind us all of some of the things that we take here for granted.

Most people in the world don’t have access to the safe and highly effective mRNA vaccines.

Most people in the world can’t just walk into their grocery store and get a flu shot.

Most people in the world don’t even know that there is an excellent pneumonia vaccine.

We often forget how blessed and privileged we are compared to most others around the world. It saddens me to have to beg patients to get a flu, pneumonia or COVID shot when others are desperate to get them at any cost. If you believe that COVID is a conspiracy or the vaccines are a hoax, then nothing I say will change your mind. But for those of you who usually get vaccines, but have now been swayed by misinformation, I have a personal plea: Please do not let fear keep you from doing what is right. Please get yourself and your loved ones vaccinated.

I am not one who simply takes news headlines at face value. When the news screams that a miracle vaccine/treatment has been discovered, I actually read the scientific paper that the headline was based on. I dug deep into the data before convincing myself that the mRNA vaccines were safe. The data on boosters for high risk people is now looking very strong too.

Many people feel that they should not get vaccinated because they are being forced by mandates to do so. I fully understand the terrifying prospect of being stripped of personal freedom. A family friend recently said that he is quitting his well paying job at the hospital because they were forcing him to get vaccinated. He said he would rather work 3 jobs to support his family than have his principles challenged. Safeguarding personal freedom is very important to me as well, but please don’t cut off your nose to spite your face. You’re putting your and your family’s health, finances and safety at risk when there is no need to do so.

With the holidays approaching, and the weather turning cold, most of us will be gathering indoors in larger groups than in prior months. There is a significant likelihood that cases, hospitalizations and deaths due to COVID will rise again after recent decreases. The latest data show that in Texas, the unvaccinated died at a rate 40 times higher than the vaccinated. If you’re still not convinced that you should get the vaccine, I urge you to wear surgical masks when in close proximity with others, avoid being in large crowds and open your windows to improve ventilation  

when in crowded conditions.

Many tell me, “I never get sick, so I don’t need to get vaccinated.” My mother never got the flu all these years, but she did this year. She’s now in the hospital on oxygen, possibly needing a ventilator. There is always a first time for everything. Don’t let your first flu or pneumonia kill you when you could have prevented it.

Stay safe this holiday season. Take advantage of all the benefits of living in this great country. Get vaccinated and be healthy!

Originally published in Hideaway Lake News on November 1, 2021

After months of being cooped up, many of us reached the end of our tether during the holidays last year. We met up with families and friends to share a hug, a meal and a toast. But the price we paid was steep. We went through some of the most traumatic times last holiday season as we lost record numbers of people to COVID. 

ThisThanksgiving however, things are somewhat brighter, despite the havoc wreaked by the delta variant. We lost far fewer people than we otherwise would have because of the development of multiple safe and effective vaccines. Most vaccinated people are now able to socialize with their loved ones without fear of hospitalization and death. Kids are going back to school, people are returning to work, friends are gathering for parties and families are going on vacations. It is my fervent hope that deaths will continue to decrease and our lives will continue to go towards the normal that we all took for granted in the past.

More people are getting vaccinated each day as they see the safety and benefits. Boosters are now available for those who are at high risk, which includes people 65 years and older, and younger people with one or more chronic medical conditions. Pfizer vaccine boosters are now approved and it is possible that Moderna and Johnson & Johnson will soon have boosters approved as well. Boosters help further reduce the chance that you will get infected, not just prevent hospitalization and death. Sometimes, even though the COVID infection may not put you in hospital, it could tip a high risk person over the edge if they have serious underlying medical conditions like heart failure or atrial fibrillation. So a booster can really help those people.

Check with your doctor, especially if you are younger than 30, about the safest vaccine for you. There are extremely rare but serious side effects that you should be aware of such as inflammation of the heart and blood clots depending on your age and gender. Other fears such as infertility in women have proven unfounded. Pregnant women are at much higher risk of complications from COVID, so please talk with your doctor about vaccination if you’re planning to get pregnant or currently pregnant. Overall, the vaccine continues to be a very safe preventive option for almost all of us.

Natural immunity in those who have recovered from COVID appears to provide robust protection from hospitalization and death from reinfection. However, those who have recovered from COVID, can still get reinfected and have the potential to spread the virus more than those who have been vaccinated. People who get infected after vaccination have no symptoms or mild to moderate symptoms and don’t generally require hospitalization. 

A new pill for early treatment of mild to moderate COVID is now in the works. We will have to wait and see how safe and effective it will be. Antivirals are very difficult to bring to market, so it is astonishing to have a potentially viable candidate so soon. I hope more such drugs will be developed and we will soon have not only effective vaccines but effective treatments as well.

Best of health and Happy Thanksgiving to all!

Originally published in Hideaway Lake News on October 3 , 2021

In the spring when I woke up with a stuffy nose, scratchy throat and headache, I had to ask myself – is it allergies or is it COVID? Now in the fall, when I have those same symptoms again, I need to throw in cold and flu into that mix! It is not always easy to make the distinction but it is helpful to know some key characteristics of each so you can at least decide if it is time to see your doctor.

The first step is to separate allergies from the other three which are viral infections. An easy symptom that helps you do that is fever. You do not get a fever with allergies. So if you have a fever in addition to other respiratory symptoms, it is an infection and not allergies. If you have body aches with your runny nose and scratchy throat, then again seasonal allergies are less likely, and a viral infection is more likely the culprit.

Nasal allergies generally cause sneezing, runny nose, itchy eyes, scratchy throat, nasal congestion and sometimes a cough from the nasal drainage. All these symptoms may be present with a cold, but you’re more likely to have other symptoms like fatigue, low grade fever and malaise as well. The symptoms start off relatively mild and progress over a few days in the case of a cold. Allergies frequently make you feel irritated and frustrated rather than making you want to stay in bed with a cup of soup and a warm blanket.

In the case of the flu, often you will have fairly abrupt onset of high fever, chills, body aches, headache and cough in addition to the other symptoms of a cold. If you think you have the flu, it is best to see your doctor within 72 hours. She might be able to treat you with antivirals to reduce the duration and severity of symptoms as well as keep you from going to the hospital with serious complications such as pneumonia if you are a high risk person. The antivirals work best if started early in the course of the disease.

And then of course we have the “C”! COVID is the most tricky of the lot because you may have very mild symptoms, so there is no way to know unless you get tested. Sneezing and itchy eyes are not usually seen as sole symptoms in COVID – if you just have those, it is more likely allergies. But when in doubt, call your doctor.

Remember allergies don’t cause fever and generally don’t make you feel tired and achy. If you have any of those symptoms, stay away from others until your symptoms have resolved and get tested for COVID since it is the great mimic. If you or a loved one have difficulty breathing, chest pain or confusion, please get medical attention immediately.

And of course, don’t forget to get your flu shot by October. We lose thousands of people every year to the flu. Flu shots significantly reduce your risk of death. Dead is dead whether from the flu or from COVID or from anything else.

Enjoy the cooler weather, be active outdoors and eat healthily to maintain a robust immune

system. Happy fall y’all! And best of health to us all!

Originally published in Hideaway Lake News on Aug 27 , 2021

I had hoped not to write about COVID again! But things have changed rapidly, prompting me to update you. The new delta variant is spreading fast because it is much more infectious. Hideaway cases have risen after several weeks of zero. My physician friends at Tyler hospitals are telling me that they are again inundated with new COVID patients and COVID wards are being reopened. If hospitals become overwhelmed, we would again have difficulty getting care for serious non-COVID problems. My close family member’s heart surgery in Pensacola has been postponed indefinitely due to their hospital overflowing with COVID patients. He is fully vaccinated and therefore at low risk for COVID complications but is elderly and at high risk of death from heart problems. Now he has to wait, hoping that he doesn’t die because of his heart. We don’t want something similar to happen here.

The big difference today is that COVID vaccines have been proven safe and highly effective.

I was certainly very concerned about these new vaccines when they were first introduced so quickly, but after nearly 2.5 BILLION people worldwide receiving a variety of these vaccines over the past 8 months, I am convinced that they are safe, effective and the best way to get us out of this situation.

As long as the virus continues to spread, we will have more variants – some more infectious or more lethal, others milder than the original, just like the flu every year. We will continue to have controversial mandates. If we want to stop this and get to a place similar to the flu, we need to reduce new variants by reducing spread. To achieve this, avoiding crowds, improving ventilation, washing hands, social distancing and masking are all helpful, but I must impress upon you that vaccines have proven far more effective.

For anyone who is thinking that the vaccines don’t work, all you need to know is this: about 90% of people in hospitals due to COVID are UN-vaccinated. Just think about that for a minute. It should be all the proof we need.

Yes, some vaccinated people can still get COVID, but they overwhelmingly fare much better. Those who are hesitating because the vaccine has “only” emergency approval should realize that these vaccines have now been “tested” in the real world far more than the typical controlled study. It is true that issues of concern exist, like myocarditis in young males and that is certainly something to discuss with your doctor along with any other concerns. But by and large, the general population has done amazingly well with these safe and effective vaccines.

The delta variant is causing a lot more hospitalizations among the higher-risk young, many of whom mistakenly think they are low risk. I hear comments like “I don’t have high blood pressure, it is normal with medication” or “I’m only carrying a few extra pounds”. However, if you have obesity (BMI of 30+) or are taking medications for high blood pressure, diabetes or other chronic diseases, then you are at high risk, regardless of your age. You need to be vaccinated

to protect yourself from serious COVID.

Finally, consider this: 96% of doctors are vaccinated! That should tell you how much WE believe in the safety and efficacy of these vaccines. If you trust us to treat you when you are sick, then please trust us to prevent you from getting sick. Nothing in life is 100% risk free, so no one can promise you that the vaccines, or eating, drinking, breathing and driving are risk free. All we can promise you is that the risk of vaccination is now known to be tiny compared to the risk of COVID complications.

Please protect yourself and your loved ones. Please get vaccinated. Best of health to us all.

Originally published in Hideaway Lake News on July 30, 2021

Earlier this summer I had a painful bump on my shoulder that I thought was a bug bite. Two days later there were a few blisters in the same area and I cursed myself for getting into poison ivy. Then a couple of days later, I had a band of excruciatingly painful blisters on a red base. Never once in the early days did it occur to me that I might have shingles, although I have diagnosed and treated many patients with this painful rash over the years. I was in denial – nah, I’m not old enough for shingles! It has to be the poison ivy I got into while clearing my yard!

For those of you not familiar with shingles – here it is in a nutshell. It is an extremely painful rash that appears as a band of blisters along a nerve. It is usually on one side of the body, often on the trunk or face. It occurs due to reactivation of the chicken pox virus. You cannot give shingles to another person, but if you have an active shingles rash, you can give chicken pox to someone who has not yet been vaccinated against chickenpox, such as infants. The rash can last for 2-3 weeks and some people can later develop a chronic pain syndrome called postherpetic neuralgia (PHN). PHN is the presence of sharp, stabbing and/or burning pain for months after the rash has healed. If you are unlucky enough to get shingles along the nerve close to the eye or ear, you could lose your sight or hearing. So this is pretty serious stuff.

Treatment with an antiviral drug works best if started early, preferably within 72 hours after you first notice the rash. If it has been more than 72 hours, it may still help some people reduce pain, the number of new blisters and the risk of PHN. Some people may have burning or stabbing pain even before the rash appears. If there is eye or ear involvement, then your doctor will work with the ophthalmologist or ENT and follow you very closely. She will also watch the rash for any signs of superimposed bacterial infection. All this to say, shingles is not something to be taken lightly at all.

I was scheduled to get my shingles vaccine when I turned 50 last year – but I had put it off due to the pandemic. This year, I got the rash just two weeks before I was to have my vaccine. While it is common to get shingles at an older age, you can certainly get it sooner. The shingles vaccine, Shingrix, is excellent (>90% effective) at preventing shingles after two doses which are given 2-6 months apart. It is a once in a lifetime series for people 50 and over. If you got the older vaccine Zostavax, you can still get Shingrix for better protection – make sure and talk to your doctor about it. So, if you are 50 or older, run, don’t walk to get the shots and protect yourself. I would not wish this pain on anyone else! If you recently got your COVID vaccine, then make sure and wait at least two weeks before getting Shingrix.

Next time you get a painful bump or a cluster of blisters, in addition to thinking about a bug bite, poison ivy or allergic reaction, think about shingles too. Even if you think you’re too young for it. Additionally, do protect yourself with insect repellant, gloves and lightweight clothing that fully covers your arms and legs so you don’t get bug bites, poison ivy or poison oak when you’re outdoors working in your yard.

Have a wonderful summer y’all!