(Photos above are images of my sorry back taken by my partner on November 6, 2013 with his iPhone 5…who needs a real camera anymore? Top is closeup–note blisters known as vesicles; bottom is from a distance)
Andrew Siegel, MD Blog #128
My internist had suggested that at some point I should get the shingles vaccination and it truly was on my list of things to do—eventually do—you know that list that we all have. Also on that list of mine is to get my bicycle serviced, to get my tennis racquet restrung, and to read The Rise and Fall of the Third Reich.
Well, I finally did get vaccinated, but it was the hard way, by way of an outbreak of shingles! People, this is NOT the smart way to get inoculated…this is yet another example of me foolishly not listening to my own advice (Blog #94—Vaccinations Are Not Just For Kids).
Shingles—aka herpes zoster—results from the very same virus that causes chickenpox. After exposure to chickenpox, the virus never quite completely leaves one’s system, living dormant in nerve cell bodies. For most people, the antibodies manufactured by the body keep the virus in check for many, many years. However, when one’s immunity becomes compromised by age or other factors, the virus can be re-activated and break out of its home within nerve cell bodies and travel down a nerve to cause a viral infection of the skin in the region of the nerve known as a dermatome, causing a painful (often agonizingly so) skin rash known as shingles. A one-time vaccination for shingles can prevent the occurrence of this painful condition. The FDA has approved the vaccine for adults 50 or older, although some insurance companies will not cover it until age 60.
As a physician, I have insight into many disease processes, both through academic knowledge acquired in medical school and clinical knowledge acquired through years of experience in taking care of patients. However, there is no better teacher than the school of “hard knocks,” when one personally suffers with the disease process! In this narrative, I wish to share that experience with you.
My story: In retrospect it all started with vague symptoms of a head cold a bout of insomnia. Upon arising one morning, my upper back muscles on my left side hurt in a strange way when I stood erect. I then developed a strange sensation—it felt raw and irritated, somewhere between what a rug burn and what getting struck with a bullwhip would feel like. The symptoms temporally followed getting a massage, so my immediate thought was that I was having a reaction to the massage oil or to the vigorous sports massage I had had with the massage therapist digging her elbows deep into my knotty back muscles. I had my wife check my back out, but she saw nothing. The following day I experienced tingling, pain and burning that rapidly increased in intensity and when I gazed in the mirror, I witnessed the ugliest looking bright red rash with blisters, completely confined to my left side, starting near the midline of the upper back and extending towards my underarm. It looked like shingles to me, but I had my doubts because it didn’t hurt excessively, and most of my patients whom I observed with shingles had severe and disabling pain. I thought it might even be poison ivy. I smeared some hydrocortisone ointment on and tried to forget about it. The next day at work, I peeled off my OR scrubs and showed my progressive rash to my partner who took the two photos that are attached. The unequivocal diagnosis was shingles. He prescribed Valtrex for one week, which I started immediately and I took Ibuprofen before sleeping to help the discomfort. The shingles continued to progress with the burning feeling extending down my left arm towards my fingers, although there was no rash in this area. Within a few days the rash improved dramatically and the blisters ruptured, crusted and started healing. Ten days later, the rashes are scabbed and continue to heal and the burning has improved significantly, but is still present.
Half of Americans will develop shingles, aka varicella-zoster, by age 80, and although most cases develop in people over 60, it can occur at any age. Essentially it is a painful, blistering skin rash and debilitating disease caused by reactivation of the chickenpox virus (herpes) that lies dormant for years in nerves and becomes activated at times of stress, decline in immunity, or other unknown reasons. It is a unique disease as it develops only on one side of the body. It characteristically causes waves of burning pain, insomnia, and a significant interference with one’s ability to pursue activities of daily living.
The term shingles is derived from the Latin cingulum, meaning belt, because of the girdle-like pattern of distribution of the rash along the line of a nerve fiber’s course, usually a narrow band from the spine extending around the abdomen or chest. Similarly, the word zoster is derived from the Greek zoster, meaning belt. The word herpes is derived from the Greek herpein, meaning to creep, because of the recurrent and latent infections of this viral group.
My shingles involved my upper back and extended to my underarm and down my arm. There are much worse locales for shingles to occur, particularly the face, eyes, mouth and ears, where it can cause visual and hearing deficits. When shingles involves the lumbar area, it can affect urinary and bowel function. I had a recent patient with lumbar shingles causing an inability to urinate, requiring the temporary placement of a bladder catheter. In addition to the painful skin rash, shingles can often cause systemic symptoms including malaise, fevers and chills, headache, joint pain and specific symptoms depending on the nerves involved.
Shingles is not contagious to those who have had chickenpox. However, if one has not had chickenpox, exposure to anyone with shingles at the stage at they have open blisters may be infectious, potentially causing chickenpox and not shingles. It is for pregnant women to avoid exposure to those infected with shingles because of the potential for transmitting the virus to the fetus.
Shingles is treated with an anti-viral medicine that combats the virus, reduces the pain, shortens the course of the outbreak and helps prevents complications. For really bad outbreaks, steroids and narcotics may be necessary. I was able to suffice with Ibuprofen because I’m tough as nails (absolutely not the truth!). Topical lotions containing calamine may be soothing. After the resolution of shingles, which typically occurs within 2-3 weeks, there is the possibility of permanent pain known as post-herpetic neuralgia. The good news is that for most people, after shingles resolves, it will never resurface.
Bottom Line: Shingles is now a largely avoidable infection so getting the vaccine deserves to be put on your active to-do list! I seriously regret not regarding my internist’s advice, because the long and the short of it is that shingles is not fun at all and can potentially have devastating long-term consequences. The shingles vaccine—Zostavax—is the most effective means of reducing the incidence of herpes zoster and post-herpetic neuralgia, as well as reducing the severity of an outbreak if it occurs.
Andrew Siegel, M.D.
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