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Episode 51
The Doctor's Farmacy: House Call

Treating & Preventing Shingles From A Functional Medicine Perspective

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For anyone who has experienced shingles, or been around someone who has, you know this can be an incredibly painful condition. Symptoms include rash, hives, and nerve pain. Shingles are caused by the varicella-zoster virus, which is the same virus that causes chickenpox. This virus tends to hide, or almost hibernate, in nerve cells long after someone has recovered from chickenpox, and can re-emerge as shingles down the line. In this episode, Dr. Hyman sits down with Dr. George Papaicolaou to discuss why supporting the immune system is so critical when it comes to preventing and treating shingles, and much more.

George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency, he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care, Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health – a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017.

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In this conversation, Dr. Hyman and Dr. Papanicolaou discuss:

  • The shingles-chicken pox connection
  • Symptoms associated with shingles, and why they are so painful
  • The role of the immune system in the development of shingles
  • The conventional vs. functional medicine approach to treating shingles
  • The shingles vaccine
  • Patients suffering from shingles who Dr. Papanicolaou has treated
  • How meditation and sleep hygiene supports the immune system

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. George Papaicolaou

Dr. Papaicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital, Abington, Pennsylvania. He is also an Institute for Functional Medicine Certified Practitioner. Dr. Papnicolaou established his own practice: Cornerstone Personal Health dedicated to the Functional Medicine Model. Dr. Hyman invited him to bring his expertise and twenty years of experience to the UltraWellness team. He specializes in treating the root causes of many conditions including Neurodegenerative disorders, ADHD, PANDAS/PANS, gut and hormone health.

Show Notes

  1. The New Science Of Immuno-Rejuvenation
  2. The Secrets To Creating A Healthy Immune System
  3. How to Protect Yourself from COVID-19: Supporting Your Immune System When You May Need It Most
  4. Why Meditation Is The New Medicine
  5. My 4-Week Celery Juice Challenge

Transcript

Dr. George Papanicolaou:
Bacteria and viruses have their own circadian rhythm. And the immune system can then establish a circadian rhythm that will allow it to fight and suppress infection. Fascinating.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman, and that is Farmacy with an F. F-A-R-M-A-C-Y, a place for conversations that matter. And if you’ve ever suffered from shingles or know anybody who has you better listen up to this podcast because we’re having a special episode of our House Call podcast with none other than our Dr. George Papanicolaou from The UltraWellness Center in Lenox, Massachusetts, one of our incredible team there. And we are going to talk about what to do if you have shingles from a functional medicine perspective. So welcome George,

Dr. George Papanicolaou:
Mark, thank you for having me. It’s always a pleasure to talk to you about anything.

Dr. Mark Hyman:
Anything? Okay, here we go. We’ve had some good talks. So let’s just jump in here. What is shingles? Why should we care? And how big of a problem is it anyway?

Dr. George Papanicolaou:
Shingles, it’s a pretty big problem. And it’s something that I think everybody’s more aware of than they think of. It’s really chickenpox. Most everybody’s had chicken pox. Now we have fewer cases because we have a vaccine for it, but chicken pox is caused by varicella-zoster. And when you have chicken pox, that varicella-zoster is going to actually stay in your body as many viruses do, and it’s going to hide in a nerve root in your spine. And it’s going to stay there for a very long time.

Dr. George Papanicolaou:
Unfortunately, as we get older, it’s possible that our immune systems may wane and this virus can then move back out of its hiding place along a nerve root, where it creates an enormous amount of inflammation and destruction. It finally escapes onto the skin and you get this blistering rash. And if you’ve ever seen it, it gets pretty nasty looking. And it happens usually one side of your body. It’s usually arms or torso most commonly, and it can be very uncomfortable. Big problem. About 30% of Americans will develop zoster in their lifetime. That’s about 1 million people per year, and it has an enormous amount of morbidity and costs associated with it.

Dr. Mark Hyman:
Yeah, it’s pretty bad. Basically what happens is you get chickenpox when you’re a kid. Now when I was a kid, we used to go to chickenpox parties, where your mom would take you to a party with the other kids with chickenpox, so you’d get the chicken pox and get it over with. And I still have the chicken pox scar on my head. And what happens is that viruses tend to live in you forever. They’re hard to get rid of, and basically the chicken pox goes to sleep for 60 years. And then things happen that trigger the re-emergence of the chicken pox, which is actually sleeping in your nerves, which is why it’s so painful. When you get this rash on your skin, it’s really the virus traveling through the nerves that causes this horrible pain and burning and inflammation. And the blisters are just the end result of that. So what is the driver of the emergence of chicken pox into shingles as we get older? Because not everybody who has chicken pox when they’re younger gets shingles.

Dr. George Papanicolaou:
Right. So I know when we talk about getting older and the issue is it’s your immune system. So your immune system begins to be suppressed. It doesn’t work as well. As we know during this time of COVID, we’ve talked about the immune system a great deal. I think people are more understanding of epidemiology and immunology than any other time in the history of mankind. And I can’t go to a party. I don’t go to parties. There aren’t any parties. But I can’t talk to people having a conversation. So it’s really, we say as we age there are things that happen that will cause our immune system to wane, but what does aging mean? We’re getting older.

Dr. George Papanicolaou:
But as we’re getting older, I think what’s happening is things that we’ve been doing for years begin to catch up. And I think a podcast of yours I listened to recently, you were actually answering questions on your one podcast. You brought up the concept of long latency deficiency disease. And I think over time when we’re not eating foods that have nutritious value, we’re not eating foods that have those nutrients and minerals that support our immune systems, then our immune systems begin to suffer. And that happens as we age, but it’s not an aging problem. It’s a food problem. It’s a stress problem. It’s those things that we understand in functional medicine.

Dr. Mark Hyman:
I think you were talking about at some point, it’s this whole idea of immuno-aging, that our immune systems age. And we should talk about how to rejuvenate our immune system, particularly now in the face of COVID. We’ll get into it, but keep going about shingles.

Dr. George Papanicolaou:
Yeah. And so when you asked me to put the connection between aging and shingles, it’s hard for me just to say it’s aging. I think it’s the processes. I think it’s our lifestyle, our nutrition that accumulates over years that results in disease and particularly in suppression of our immune system. What really drives conventional medicine to address shingles as aggressively, and I say aggressively because we have vaccines for it. So millions and millions of dollars go into the research and development of vaccines, because you think a disease is creating such a epidemiologic, social, and health problem that you need to stamp it out. And so then you have this mass immunity. Why?

Dr. George Papanicolaou:
Well, because although it sounds like a simple problem that goes away. It’s a skin rash and is about 14 days, and it’s mild for most people. It can have some severe adverse outcomes. It can actually travel to your eye. It can travel to your ear. You can actually get meningitis encephalitis as a complication of shingles. Now, very rare, but it can happen. And the cost of treating shingles is enormous. So there’s a lot of emphasis put on it in terms of a vaccine to prevent it. And that’s how conventional medicine works, prevent it with the vaccine or treat the symptom once it happens, or the disease once it happens. But focusing on what I just mentioned earlier and preventing through lifestyle nutrition and other factors that we can alter is what we need to be thinking about.

Dr. Mark Hyman:
Yeah. And I think, I think we are suffering not just from shingles as we get older, but we’re suffering from all of the age-related diseases. They’re all related to the decline of our immune system. We call it immunosenescence. But we can be old at 35 too, right?

Dr. George Papanicolaou:
Yeah. Oh, absolutely.

Dr. Mark Hyman:
If we’re eating a crappy diet, I mean, biologically I’ve seen people who are 20 but their biological age was 45. And I’m 61, my biological age is 39. So I think we have-

Dr. George Papanicolaou:
I knew you were going to bring that up. [inaudible 00:07:55].

Dr. Mark Hyman:
I got some new tests. I got to see what they show. There’s new tests for immune aging too, which has to do with DNA methylation. But-

Dr. George Papanicolaou:
Yeah. When I see it on paper, I’ll believe it. So-

Dr. Mark Hyman:
I’ll send it to you.

Dr. George Papanicolaou:
But going back to the shingles, I don’t want to underestimate the effect it can have. Because when we treat people with shingles, it’s extraordinarily uncomfortable and painful. And when you are older and you have a declining immune system, you are at much higher risk for those adverse reactions I talked about. And one of the ones I didn’t mention, the most important thing, is something called postherpetic neuralgia. So, as I said, as I was talking about it, the virus comes out and as it’s coming along that nerve root, it’s creating a lot of damage on that nerve. And you may or may not recover. And if you don’t recover, that nerve can then emanate pain in a chronic fashion for months to years. And I’ve treated patients unfortunately that have had it for years, and it’s extraordinarily uncomfortable. It disrupts sleep. It creates a lot of stress. And it just leads to a lot of disability.

Dr. Mark Hyman:
Right. So basically even after the rash goes away, the nerve endings continue to be inflamed and cause pain. Well, conventional medicine, isn’t that great with shingles, right? What do we got to offer from conventional medicine? And then we’re going to get into what’s different about functional medicine and how we treat it with functional medicine.

Dr. George Papanicolaou:
Yeah. So the two things that in conventional medicine is … the first thing is that they’re really treating the symptoms. But what I wanted to mention is is that there is a vaccine. There is a vaccine. I think it was called Zostavax, and it came out in early 2000s. And it actually only had a 50% efficacy rate. And by the time … after eight years, it has declined about 35%. It was actually taken off the market in 2020, but it did limit potentially your chance of getting it. And if you did get it, it decreased the severity of the illness.

Dr. George Papanicolaou:
And then a new vaccine came out in 2017 called Shingrix, and it has a 97% efficacy rate in keeping you from getting shingles. So it’s a much, much better vaccine. The issue with the vaccines and this particular vaccine is it does have some adverse reactions, and you need to get the second shot. And the concern is that not enough people are going to get it and that not enough people are going to get the second shot. So it’s not a panacea to solve that problem, but it’s what conventional medicine does. It doesn’t look at how can we make your immune system better so you have overall improved health so that your immune system can fight off all types of infections, not just one single infection called varicella-zoster, because that’s all that vaccine is good for.

Dr. George Papanicolaou:
So that’s what they offer. They offer a vaccine. And then if you do get it, they offer antivirals. You have 72 hours to get your antiviral. And then it’s going to decrease the length of your illness and the severity, but the length by just about two to three days. That’s it. [inaudible 00:11:38]

Dr. Mark Hyman:
Yeah. That’s not so impressive. So basically you’ve got steroids, you’ve got Advil, you’ve got topical creams and anesthetic creams, but none of that stuff really solves the problem that much. So let’s talk about our approach with functional medicine. How do we think differently about it? What can we do with these people who are suffering? And how do we actually get these people better over the long-term using an approach that looks at root causes and also looks at the other side of the equation? Because traditional medicine is basically shutting down something, right? Steroids shut down inflammation. NSAIS, or Advil, shut down inflammation. Narcotics shut down the pin. But it doesn’t do anything to deal with the virus itself or actually fixing your immune system or rejuvenating your immune system. We’re working on only one side of the scale here.

Dr. Mark Hyman:
And functional medicine is the science of creating health, which means how do you create a healthy immune system? One, so you don’t get shingles activated. And two, if you do get it, how do you build a more resilient immune system so you can minimize the effects of it, recover faster, and actually get over the problem without being too miserable?

Dr. George Papanicolaou:
Where would you like to start?

Dr. Mark Hyman:
Just go in. Just dive in, man.

Dr. George Papanicolaou:
Yeah, because we could go into … But I was going to start where you start, and it’s food is medicine. And I really think that it really begins with what we’re eating over the long term. We have our food system, and you’ve talked about this, you write about it. It’s your baby. But I’m going to jump in on it, we have a food system that’s supplying food that is calorie-rich, nutrient-poor, minerals are gone. And why do I bring that up? Because it’s those key nutrients and minerals that we get what we need to support a healthy immune system. We need zinc. We need vitamin A. We need vitamin C. We need vitamin D. We need selenium. And we’re finding that a lot of her foods are just missing these and a lot of those foods that we need to get aren’t readily available in our supermarkets. And if they are, they are grown in such a way that they don’t have the concentration of those minerals and nutrients that we need.

Dr. George Papanicolaou:
So in functional medicine, we see supporting your overall health starts by choosing really good, healthy foods from a wide range of vegetables and fruits and fish and healthy grass fed, grass finished beef and getting nuts and seeds and berries because they’re all going to carry the nutrients that we need to support the healthy immune system. So it starts with really your nutrition.

Dr. Mark Hyman:
So really upgrading the quality of your food you’re eating and using both anti-inflammatory foods, basically spices, herbs, all the colorful phytochemicals in food, ginger and all these wonderful things that we can use to upgrade our immune system. And at the same time, getting rid of the foods that drive a disturbed immune system, for example, sugar and starch suppress your immune system. So if you’re eating tons of processed food and sugar and starch, which is the bulk of our calories, about 60% of our calories, that’s going to drive a suppressed immune system and make you more likely to get into trouble.

Dr. Mark Hyman:
And then you also mentioned the nutrients, which are critically important because they’re not just making expensive urine. These are regulating all the functions of your body, particularly your immune system. So you mentioned zinc. You mentioned vitamin A. You mentioned vitamin D. You mentioned vitamin C. These are really important. Even amino acids like lysine can be very helpful in regulating viral infections. So I think these are the things we use in functional medicine. And often we can get really tremendous benefit with people helping to reduce the course of the illness to shorten it and also to reduce any long-term side effects.

Dr. Mark Hyman:
So tell us about this 42 year old patient you had with shingles who kept coming back and back. She also had hives, yeast problems and was a vegetarian. So what was the story with her and what did you do to fix her? And how did you identify the issues? Because typically in traditional medicine, we just use conventional tests. We don’t really look under the hood. And someone said that using traditional medicine is like trying to diagnose what’s wrong with your car by listening to the noises it makes instead of looking under the hood. And functional medicine is really about looking under the hood. So how do we do that?

Dr. George Papanicolaou:
Right. So this is a case of a woman, as you said. She was a 42 year old female. So you’re immediately starting to, as they’re giving you their symptoms, you’re starting to think about the systems that are involved. And so when I’m hearing that she’s a vegetarian, I’m immediately starting to think about some of the possible deficiencies she may have. So I’m thinking about that. I’m thinking about how that will impact her overall health. I’m thinking about how it will impact the health of her gut. So I’m starting to think about her gut and what makes me think more about her gut is the hives and the yeast infections. They start to make me think that that’s an unhealthy gut. There’s a good chance that she has a bacterial imbalance that we call dysbiosis, and that it might be being driven by candida. Or the dysbiosis was there and the candida then grew. And candida can cause hives and yeast. So I’m thinking now that her gut’s involved, that she has some nutritional deficiencies, maybe not enough A, maybe not enough zinc, maybe not enough C.

Dr. George Papanicolaou:
So I did a stool analysis, a complete diagnostic stool analysis. And indeed I found that she had significant dysbiosis and candida overgrowth. Additional testing I did included what we call an organics acid test, and I looked at her overall amino acids. And what I found was that she was low in zinc and she was low in amino acids, which again, I wasn’t totally surprised because vegetarians, if they’re not really careful, may not be getting enough protein. And indeed she wasn’t, when we looked at her diet and her amino acids were low.

Dr. George Papanicolaou:
So what does that all add up to? It adds up to this. She wasn’t getting some of the key nutrients she needed to support her immune system. She wasn’t getting enough protein to give the amino acids she needs to make those proteins that are important for the immune system to function. And she had the candida in her gut and that all caused her immune system to tank. And she developed shingles, and this was happening repeatedly. She had recurrent episodes. By the time she came to see me, she had four episodes. She’d been treated four times and she was being put on a suppressant. She was taking an antiviral every day. And she was breaking through on the antiviral. So that’s why she came. She said, I don’t know what else to do.

Dr. George Papanicolaou:
So having put all that together, I started her on lysine and vitamin C. I put her on a mushroom compound called turkey tail because of its benefits for boosting the immune system. And then I treated her gut. We treated her candida with caprylic acid. And I used another compound called Biocidin to help with the overall general dysbiosis. And we cleared up her gut. And I talked to her about her diet. She had leaky gut by the way, which means that that [inaudible 00:19:36] membrane that’s responsible for filtering out the bad guys and letting in the good guide to these gates. We treated that with quercetin and some L-glutamine. And so as these things improved, one thing, she just felt generally overall better. And so her shingles, that case of shingles improved.

Dr. George Papanicolaou:
And the other thing that we needed to address was she was under an enormous amount of stress. And so I had her start meditating. And what’s really interesting is that there was a recent study that showed that meditation actually will alter the function of genes that will improve immune function, particularly those genes involved in fighting viruses. So meditation, we started her meditating. And six months later, she hadn’t had another outbreak. And she had been on pretty much up to that point an every three to five, six month cycle. So that’s how we treated her, and she did really well.

Dr. Mark Hyman:
That’s really amazing George, because we really often don’t think of how do we strengthen our immune systems? Not just in terms of shingles, but in terms of everything and in terms of COVID. And if you go to your doctor and say, what do I do to boost my immune system? They’re like I don’t know. Come to me when you got a problem and there’s inflammation. I can give you drugs to shut it off. But if you say, well, where is the inflammation coming from? And why is my immune system not working well? And how do I upregulate it? How do I rejuvenate my immune system? Well, it’s all the things you’re talking about. It’s eating the right foods with immuno rejuvenating properties is taking the right nutrients. It’s fixing your gut, which is a big part of your immune system. It’s using various herbs and nutrients actually that can be antiviral or immune regulating like the adaptogenic mushrooms, reishi, chaga, cordyceps, lion’s mane, shiitake, all of these. Maitake mushrooms. These are powerful adaptogenic mushrooms that help with the polysaccharides and using food as medicine to upregulate immunity.

Dr. Mark Hyman:
So we have this incredible arsenal of tools at our disposal that are completely ignored by traditional medicine. And that’s really what we do with The UltraWellness Centers. We help people dig down into one, finding what the root causes are and two, actually helping people to rejuvenate their health in a very specific way. It’s very personalized. And that’s really what’s so gratifying for the work we do, because we literally get to see people’s lives changed and transformed by doing some very simple things.

Dr. Mark Hyman:
You mentioned protein. And I think people don’t understand. Like a lot of people may be trying to eat less meat or not eat protein. And if you want to be a vegetarian or vegan, it’s okay, but you have to be on top of the protein. We don’t need as much protein we can get. We can get it all from greens. It’s just nonsense. Your immune system is driven by protein. You need protein to build the immunoglobulins, the antibodies. And so I’ve seen many patients, and we test them. We don’t just guess. We test. Right?

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
And so we see at The UltraWellness Center really dramatically low levels of amino acids, protein insufficiencies. And it’s not like they’re having protein calorie malnutrition, like in the third world or developing world. They’re having dysregulated immunity and overall health. I mean, one woman she’s like her hair was falling out. She was tired all the time. She had all these health issues. And she had like zero meat. She just was a vegan who only ate sugar and vegetables. And so it wasn’t really a healthy diet. And so we need to do those things. So that’s great. So what happened when you started to do these things with this patient?

Dr. George Papanicolaou:
Yeah, she got better. I mean, her shingles went away obviously. But what was most important was that her hives stopped. She didn’t have another yeast infection. She was getting yeast infections monthly. And at the six month mark-

Dr. Mark Hyman:
Like vaginal yeast infections?

Dr. George Papanicolaou:
Yes. Vaginal yeast infections. And so once we cleaned up her candida, that resolved, her hives resolved. And at six months out, she was off of her viral suppressant medication, and she hasn’t had an episode. And so what was interesting, I want to mention this. I did get her to eat more protein and it wasn’t because I convinced a vegetarian to start eating meat. I just went over with her all the foods and made sure that she was really focusing on getting her tofu, her tempeh, her lentils, her chickpeas, her beans. I had her start using some nutritional yeast. So I just reminded her if you’re going to be vegetarian, because she really wanted to be, these are the foods you need to eat. I reestablished her protein needs and how to really be careful about making sure, I think I calculated her out to needing about 50 grams, 48 to 50 grams. I said, you really need to get that every day.

Dr. George Papanicolaou:
And so I helped her be a better vegetarian. And she was really grateful, and it really worked out well. What was really helpful to her too and she told me this, was that when I told her about the meditation piece, she was like, what’s meditation going to do for my shingles? And I explained to her that it impacts the immune system. So she bought it. She did it. And she said, George, of all the things I’ve done, meditation had the biggest impact on my life. She said I just am more relaxed every day. I function better at work. I communicate better with my children. My sex life with my husband’s actually better. Sleep, actually …

Dr. George Papanicolaou:
As I was just reading about the immune system in prep for this, sleep, we talk about how sleep is so important for our overall health. But sleep in the bigger context of establishing a healthy circadian rhythm. So there’ve been recent studies that show that it’s the circadian rhythm, establishing a good circadian rhythm actually sets the immune system up because bacteria and viruses have their own circadian rhythm. And the immune system can then establish a circadian rhythm that will allow it to fight and suppress infection. Fascinating.

Dr. George Papanicolaou:
So working on making sure that we’re getting our circadian rhythm in place, sleep is a big part of that. And from the moment you wake up in the morning to the time you go back to bed, you’re actually preparing yourself for sleep. And one of the best things you can do in the morning is wake up, open a window, open a door, go outside, get some fresh air and look into the sky because that light hits your brain. There’s a certain nucleus that sets your circadian rhythm for the day. And it’s going to now start preparing for 12 to 14 hours later when you go to sleep to have you completely ready to sleep in a comfortable and restorative way.

Dr. Mark Hyman:
That’s great.

Dr. George Papanicolaou:
Lifestyle.

Dr. Mark Hyman:
So really what you’re saying, George, is that with functional medicine, whether it’s shingles or any other viral issue or preventing infections, she had yeast infections, all the host of things, that we have a lot we can offer from the perspective of functional medicine to one, identify the imbalances that are driving immune dysregulation, immune aging, and immunosenescence as well as identify very specific interventions from lifestyle, supplements, herbs, and other therapies that can actually help.

Dr. Mark Hyman:
And one of the things we didn’t talk about, which is interesting is ozone therapy, which we do at The UltraWellness Center and has been studied is published in the online National Library of Medicine database, looking at, for example, the use of ozone therapy with postherpetic neuralgia and found that it was more effective than any other treatment. It can also be used topically for shingles. So there’s a lot of options that we use in functional medicine that are not typically available with functional medicine.

Dr. George Papanicolaou:
Absolutely. Yes.

Dr. Mark Hyman:
So, George, thank you for joining us on this podcast on this special episode of House Call on The Doctor’s Farmacy, where we dive deep into healthcare issues and medical problems that many people suffer from that aren’t getting good answers. And here at The UltraWellness Center in Lenox, Massachusetts, we are now doing virtual consults and we can see people from anywhere. It’s pretty wonderful. It’s one of the silver linings of COVID for us being able to really increase our reach and help so many more people. So if you’ve been listening to this podcast and you love what you heard, please share with your friends and family. Subscribe wherever you get a podcast. Leave a comment. Maybe you’ve had shingles, how have you found a way to get through it? We’d love to learn from you and hopefully we’ll see you next week for another episode of The Doctor’s Farmacy.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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