Shingles

You’re a woman in your mid-forties, generally healthy but under some stress with work and your family.  Going about your business every day as usual, you wake up one morning with the right side of your neck feeling stiff and sore.  No worries, probably just slept wrong, right?

Nope.  As the day goes on the pain gets worse.  Then the outer side of your shoulder starts to hurt, and the pain spreads into your upper back and then into the upper chest, which makes you a little nervous.  That evening you find what looks like an insect bite on your back.

After a restless, uncomfortable night in which Tylenol and Motrin are of NO help at all, you get up the next morning and find this:

Credit: www.zostavax.ca

You’ve got shingles.  And you’re miserable.

So what is shingles anyway?  Shingles, known as herpes zoster, is an illness caused by latent chickenpox virus.  Chickenpox is a herpesvirus, like the viruses that cause genital herpes, cold sores and infectious mono.  When a chickenpox infection clears up, the virus doesn’t go away completely but lies dormant in the cells of a particular part of the spinal cord.

When you’re under stress, sleep deprived or nutritionally depleted, or your immune system is depressed for any other reason (like old age or chemotherapy), the virus can reactivate.

Shingles is found on one side of the body, in a stripe of skin that is served by one or two spinal cord levels.  This is what’s known as a “dermatomal distribution.”  In the picture above, the affected skin is all served by one spinal nerve.  This is the nerve that is sick and being attacked by the reactivated chickenpox/shingles virus.

Shingles hurts.  It is a burning, electric pain.  The combination of pain and a blistering rash should make any medical person think of herpes and specifically shingles.  There’s no test needed to make the diagnosis of shingles, it is based on symptoms and the presence of a typical rash.  Sometimes if the rash is located in the area of the body covered by a pair of shorts, a culture needs to be done to distinguish shingles from genital herpes, because the treatment is different.

Treatment for shingles consists of a week of antiviral medicine to stop the virus from replicating.  Unfortunately, stopping the virus doesn’t make the rash or pain go away – they will slowly subside over several weeks.  We don’t have good treatment to relieve the pain of shingles.  Narcotics don’t work, and medication that relieves nerve pain can be very sedating in the doses needed to relieve the pain of a shingles outbreak.

Is shingles contagious?  In general the answer is no.  If someone who has never had chickenpox or been vaccinated against it touches the shingles rash, they can catch chickenpox.  Keeping the rash covered is all that is needed to protect loved ones if they are not immune to chickenpox.

We have a vaccine to decrease the risk of shingles, called Zostavax.  It is given at age 60 or thereabouts to adults who have had chickenpox.  If you have had shingles, you still benefit from the vaccine to boost your immunity.  If you are in your 60s and haven’t had the vaccine, talk to your doctor about whether this vaccine is right for you.

One of the biggest benefits of the shingles vaccine is that it really decreases the risk of permanent nerve pain after a shingles outbreak.  Yes, that’s right, this severe electric burning pain can be permanent.  This is called postherpetic neuralgia and it is a horrible problem that is so difficult to treat.  Much better to prevent it.

It is estimated that at least 25% of adults will have had shingles by the time they reach age 85.  YOU can decrease your risk of this terrible disease that can leave you in permanent pain.  Ask your doctor about the vaccine.

If you get shingles, what can you do to help it heal as quickly as possible?  The first thing to do is see your doctor as quickly as you can.  If you can’t see your doctor within 48 hours, go to the urgent care, because the antiviral medicine needs to be started within 48 hours of the rash starting.

As with other illnesses, you want to do everything possible to support your immune system.  This means getting plenty of sleep, eating healthy food and drinking plenty of fluids.  In addition, there is evidence that micronutrient deficiencies play a role in not only shingles outbreaks but in increasing the risk of postherpetic neuralgia, particularly zinc, calcium and vitamin C.  So taking a high-quality multivitamin is a good idea.

Shingles is common, it is serious and can have severe long-term consequences.  Recognizing it, getting it treated quickly, and taking steps to prevent it are important ways to protect your health from this major medical problem.

QUESTION: Have you or a family member had shingles?  What was your experience?

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