June 29, 2014

Shingles, and not the roofing kind

So, I get a shingles diagnosis to add/confirm to the feeling of getting old. Even though I guessed right on my diagnosis, I really didn't know much about it (other than it side-lined David Letterman a few years back). The quick stuff I read before heading to the doctor was not encouraging. I will dig more into it, but here is what I know so far.

Shingles is caused by the virus that gave you chickenpox as a kid. In some people, it reactivates later in life, causing shingles. From WebMD,
"Early symptoms of shingles include headache, sensitivity to light, and flu-like symptoms without a fever. You may then feel itching, tingling, or pain where a band, strip, or small area of rash may appear several days or weeks later. A rash can appear anywhere on the body but will be on only one side of the body, the left or right. The rash will first form blisters, then scab over, and finally clear up over a few weeks. This band of pain and rash is the clearest sign of shingles." 
After reading that, I went down my own list of symptoms. I definitely had the pain, red rashes and it was only affecting my right side. After clicking on a few pictures of sample rashes (I will spare you), it seemed like I was a candidate, even though the rashes more typically shows up on your torso first. Off to the doctor.

After looking me over, and asking a few questions, he confirmed that it was shingles. I don't have a regular doctor, so I wasn't sure how this guy would react to a patient coming in with his own diagnosis. I am sure with the ease of access to information, they get flooded with amateur doctors pretending to know what they are doing after ten minutes on the Internet. Unprompted, he said he appreciated how involved people are in this area in managing and researching their health. We chatted for a bit and he filled me in on what to expect.

Shingles is a viral disease. Once your bout of chickenpox runs its course, the virus remains latent in your nerve cell bodies. Years or decades later, the virus can break out of the nerve cell bodies and travel down the nerve to cause a viral infection in the skin area served by those nerves. The infection can spread within nerve cell clusters, but seems to stay to one side of the body (beyond my understanding of anatomy to know why).

The skin infection becomes painful, I assume because the infection is in the nerve. The rash eventually blisters, and this is when it could be contagious if someone were to come in contact a broken blister. From what the doctor said, though, the chickenpox virus is all around us already, so there is no need to really quarantine yourself.

He confirmed those phrases that no one wants to see connected with what they have - "we're not sure what causes it (the outbreak after dormancy)" and "there is no cure". The regimen is about trying to minimize and shorten the symptoms. I am on an anti-viral medication as well as a corticosteroid for the next week or two. The doctor said that the addition of steroids is somewhat controversial (in that the benefits are not clearly proven), but he said that on a risk/reward basis, the steroids could reduce the incidence of scarring and other long-term effects. He also said if I get snippy with someone, I can blame it on him/the steroids. I am thinking about having cards printed up.

The pain and rash typically subside within three to five weeks (your results may vary). The concern, beyond some possible scarring, is a condition called, Postherpetic neuralgia, a condition of chronic pain following a shingles outbreak. This apparently happens in one out of every five people, though more frequently in those over 60. Per Wikipedia, it affects closer to ten percent of those under 60. Postherpetic neuralgia is the damage to the nerves in the skin where the rashes appeared, causing them to send abnormal signals to the brain. "These signals may convey excruciating pain, and may persist or recur for months, years, or for life." Here's hoping I am not one of the 10%.

So, now you know as much as I do. It definitely hurts, with a lower-grade ache punctuated with some stabbing pain, and a burning sensation at the rash points. I am hoping that the anti-virals and steroids cut the time it takes for shingles to run its course, and really hoping there are not significant lingering effects. For now, since one of the hot points is in the palm of my right hand, I will work on improving those ambidextrous skills.

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