Alternate injection site needed

Dear Dr. Roach: I read your recent column on the value of the shingles vaccination. In 1991, I had a mastectomy and I had my other breast removed in 1994, with all lymph nodes removed in both arms. After my surgeries my instructions were never to have blood taken, blood pressure or injections in either arm. I followed those instructions.

I went to my local pharmacies to get the shingles shot in my butt or thigh. No one would do it! My internist does not have the vaccine. In your opinion, is it safe for me to get the shingles shot in my arm? I am so afraid of getting lymphedema. — Anon.

Lymphedema is swelling in an extremity caused by damage to lymphatic vessels. Cancer can damage the lymphatic vessels, as can surgery and radiation. A breast cancer patient with your risk factors has stage 0 lymphedema.

Because they are in danger of developing lymphedema swelling, people with a history of breast cancer and your risk factors are given the advice you were given. I imagine it must have been hard to be so meticulous for nearly 30 years. I would not recommend getting the vaccine in the arm, if there were a safe and effective alternative.

I contacted GlaxoSmithKline, the manufacturer of Shingrix, who told me that although the vaccine was only studied when administered in the deltoid (shoulder muscle), the anterior-lateral thigh is an acceptable alternate location to give the vaccine, which I also confirmed with the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

If the pharmacy staff are uncomfortable giving the vaccine there (and I can understand why), then you might arrange to get the vaccine from the pharmacy and bring it to your doctor, who can give you the dose in his or her office. I have done this for my patients.