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DEAR DR. ROACH: I was reading your recent column about shingles. Several years ago, I contracted shingles, even after getting the shingles vaccine. It hit me in my left eye, so I went to my eye doctor. (I wasn’t sure what the problem was.) He took one look at my eye and diagnosed me with shingles.
He gave me an antibiotic that cleared up the problem. At no time was I in any pain, which I attributed to my getting the vaccine. Do you concur with my observation? I’m aware that getting shingles can be very painful. -- L.J.
ANSWER: Shingles is caused by a reactivation of the chicken pox virus, which most older adults acquired as children with chicken pox. But it can also be acquired through the chicken pox (varicella) vaccine. Usually, shingles is painful as it grows in the nerve, causing inflammation and nerve damage. The vaccine helps reduce the risk of getting shingles; however, it isn’t perfect, and people can still get shingles despite the vaccine.
Fortunately, the vaccine has two additional benefits. The first is that, as you correctly surmised, it reduces the pain of acute shingles. It also reduces pain medication use by 40% and the duration of the pain meds by 50%. I think you’re relatively fortunate to have no pain at all. The second benefit is that vaccination reduces, by about 90%, the likelihood of getting continued pain for weeks and months after the infection -- a condition called post-herpetic neuralgia.
Shingles is sometimes so obvious that any experienced clinician can make the diagnosis at a glance. However, it can be misdiagnosed as herpes simplex (and vice versa), other viruses, or even bacterial infections. The laboratory can be very helpful when the diagnosis isn’t clear.
Antiviral medicines, such as valacyclovir (Valtrex), are effective at reducing pain and inflammation, and it’s best to begin them as soon as possible (ideally within 24 hours but certainly within 72 hours of onset of the rash).
Shingles of the eye should be urgently seen by an ophthalmologist, who has equipment and expertise that primary care clinicians do not. There are complications of the eye that may require intravenous antiviral medicine. All adults over 50 and immunocompromised adults of any age should get the shingles vaccine, unless there’s a good reason for them not to get it.
DEAR DR. ROACH: Should one get the COVID vaccine when they suspect that they have active long COVID? How can one rebuild a good immune system after long COVID? -- C.B.
ANSWER: Yes, a COVID vaccine is indicated. The vaccine is safe in people with persistent symptoms after a COVID infection, which is commonly called “long COVID.” Most people don’t see a change in their symptoms. About 20% of people experience improvement, while an equal number experienced a (usually temporary) worsening of their symptoms. The vaccine helps protect people against getting long COVID with future COVID infections.
Regaining normal strength, vitality and resilience after long COVID takes time. The recommended interventions include a tailored exercise program, as people with long COVID have a reduced ability to exercise, and standard recommendations may be too strenuous. At least one study found a benefit for six months with probiotics and prebiotics helping people to recover. Proper sleep hygiene with a goal of 6-8 hours may help. Stress management and psychological support may also play important roles.
There’s not a magic bullet when it comes to recovering from long COVID. I have several patients who continue to struggle after getting a severe COVID infection during the beginning of the pandemic, which was more than six years ago now.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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