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Dear Dr. Roach: My son is healthy and 51 years of age. He had chickenpox as a young child. My concern is if he should get the shingles vaccination now or wait until he is older.

I have heard that the vaccine wears off as you get older, and I wonder if he should wait until he is older and hope he does not get the shingles in the meantime.

L.C.P.

Dear L.C.P.: The current recommendation is to get the shingles vaccine at age 60, being the best compromise between reducing risk of shingles as quickly as possible and making sure it lasts long enough to provide benefit when it’s most necessary: as we get older.

People with or without a history of chickenpox or shingles should get the vaccine unless there is a reason not to give it.

A new subunit vaccine has completed a phase 3 trial, and the results are very encouraging. It seems to be more effective and longer-lasting than the current vaccine.

Hopefully, additional data will confirm this and it can be approved for use.

Dear Dr. Roach: Could a variation on lithotripsy (the physical destruction of hardened masses), which is used to break up kidney and gallstones, be used to disrupt calcium deposits in cardiovascular tissue?

F.M.

Dear F.M.: The calcium in blood vessels, whether they go to the heart (predisposing to heart attack), brain (predisposing to stroke) or the legs (predisposing to peripheral arterial disease) is contained within the wall of the blood vessel itself.

In the case of kidney and gallstones, the stones are within the lumen (“lumen” is a general term for any hollow tube, in this case the urinary ducts and bile ducts, respectively).

Breaking up the stones into small pieces allows the remnants to flow downstream and be excreted. In the wall of the blood vessel, there is no place for them to go.

Reversal of blockages in blood vessels can occur either with lifestyle changes (a study by Dean Ornish showed a reversal with a combination of quitting smoking, a very-low-fat diet, regular exercise and stress management) or, in some cases, with medication.

Email questions to ToYourGoodHealth@med.cornell.edu.

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