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DEAR DR. ROACH: Have you ever heard of a fully vaccinated 79-year-old woman getting a repeat case of shingles? This is actually my fourth time having it. My first occurrence of shingles was when I was 26 years old, and it was on my torso. The next two occurrences were on my forehead, and I got antiviral medication for them. They subsided rather quickly, although I was left with some neurological aftereffects.

When the first vaccine came out several years ago, I received it. Then as soon as Shingrix was available, I got both of these shots. This time, I'm on antiviral medication and hoping for a mild case. I do have other possible immune-system-related conditions, including vitiligo, seborrhea, angular cheilitis and interstitial cystitis. None of my primary care physicians over all these years has ever mentioned if there could be anything that needs to be further investigated. -- D.

ANSWER: Chicken pox is a viral illness that is caused by one of the viruses in the herpes family. Shingles is a reactivation of the chicken pox virus in a specific area of the body. Getting shingles a second time is unusual but not unheard of; however, there are very few instances of shingles coming back three or more times.

The first thing I want to be sure of is whether it really is shingles, meaning that the lab should positively identify a sample of one of the lesions as varicella-zoster virus, which causes both chicken pox and shingles. Herpes simplex virus (which causes cold sores) can look a great deal like VZV, and it is sometimes mistaken for shingles. The occurrences on your forehead might have actually been HSV, not VZV.

If it is proven to be recurrent shingles, your doctor should look for something wrong with your immune system. The conditions that you mentioned, especially vitiligo, are often associated with an immune system that reacts against itself, like with an autoimmune disease. People who get recurring viral infections should be suspected of having a "hole" in their immune system, called an immunodeficiency.

By far, the most common immunodeficiency that is associated with recurrent shingles is an HIV infection, so you should also get an HIV test. I do see HIV in people in their 60s and 70s. I don't wish to alarm you with the thought of HIV, but I also have to tell you that an unsuspected cancer can also predispose you to the recurrence of shingles, as cancer can suppress the immune system.

There are rare primary immunodeficiencies (ones people are born with) that can predispose people to recurrent herpes viruses. These are out of the expertise of most primary care doctors, so an immunologist would be the expert to consult.

DEAR DR. ROACH: I'm a 76-year-old woman who's trying to adjust to changing recommendations for protein consumption. I am reading that protein isn't utilized efficiently by older bodies, so we need to increase our intake. Not long ago, the recommendation was 60 grams daily, but now I'm seeing 100 grams daily. Can you tell me if this is commercial hype or actually sound advice? -- A.B.

ANSWER: Your protein intake should be appropriate for your body size. If you weigh 60 kilograms (132 pounds), then 60-70 grams of protein is a good amount for you. If you are 80 kilograms (176 pounds), then 80-100 grams is now recommended.

I have seen much higher recommendations by some wellness influencers, but unless you are chronically ill or trying to build muscle (1.5-2 grams of protein per day per kilogram of body weight is recommended), you don't need more than the standard 1.0-1.2 grams per day per kilogram.

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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.

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