What is Shingles?
I explain to my patients that after getting chicken pox as a child, the virus lays dormant in the nerves. If the immune system goes down from infection, stress or advanced age, then the virus flares up.
Quickcare or ER?
A few Red Flags
Shingles on the face..
It is very very dangerous when it is in the eye. Eye specialist are needed. Admission is warranted. You will need to go to the ER. Keep in mind, shingles at the tip of the nose indicates that it may flare up in the eye.
If the shingles is limited to the torso (chest and back), a clinic can handle the medical regimen and subsequent follow up
What will your doctor ask?
It is never a good idea to approach a patient with only one diagnosis in mind. It is like a horse with blinders.
Your doctor will ask of your shingles symptoms. A symptom is your description of your condition to your doctor. It is your story.
Answering the following questions will help your doctor understand.
What is the rash like?
Is it more painful than itchy?
Is there discharge (pus)?
One key component to shingles symptoms is pain. Shingles on the back many times will have a preceding pain..
A key point is to ask if any thing makes it better or worse. Most will put on a cream or lotion without any change. Hmm Why? We will get to that unique aspect of shingles in a minute.
It is very common for persons to complain of the pain 2-3 days before the rash develops.
What will your doctor look for?
Your doctor will look for signs. A sign is an objective finding discovered during the examination.
Look at the rash. Notice a few key items. The redness has an angry appearance. It is not flat but instead almost like pimples.
Look at the pattern. Notice that on the back it does not cross the midline. That is, it stops in the center of the spinal column. It stays to one side of the body. We will explain the reason later.
Notice the lack of oozing or discharge.
Key point: Shingles on the face may be very very serious. At times, nerve branch going to the eye with be affected. When this occurs, long term vision may be impaired. Eye involvement necessitates the need for an eye specialist (ophthalmologist).
What is the doctor thinking?
The outside irritants like plants or chemicals can cause a rash.
The most common plant in the US is poison oak “Leaves of three let it be”. This rash can be nasty. Angry. Lots of swelling and oozing. Itchy.
The rashes may from the inside. Your whole body is like a giant chemical reactor. The skin is a manifestation of those reactions.
So a doctor will ask himself if the rash is something that rubbed up against him or is his body reacting to something he breathed in or swallowed. In the case of shingles, it is neither.
- Shingles is flair up with the chicken pox virus that within the nerves. Nerves are outpouches of the spinal chord. So, what is unique of shingles is will follow the nerves.
- Spinal chord nerves which start on one side of the body stay on one side. No crossing over to the other side.
- A virus related to chicken pox is inside one of those nerves from the spinal column. When the herpes virus flares up within the nerve, it makes the skin rash. Thus, topical medications will not help.
What is the treatment for shingles?
# 1 shingles treatment is medication is something to control the pain. Narcotics are great.
#2 is to use an anti-viral medication such as Acyclovir.
#3 To decrease the inflammation, I prescribe Prednisone pills ( a steroid) for approximately a week as seen with a Medrol dose pack.
More and more persons are receiving the shingles vaccine. It is effective for over 50% of shingles cases and those that do get shingles have a much milder version.
Can you get Shingles more than once?
Many times my patients will have more than one flare up.
Is Shingles contagious?
Shingles comes from within a patients’ body. It is a flare-up a virus that has been sitting around for years. You don’t catch it from somebody.
How long will you be sick?
Shingles generally lasts for about a week. It gradually dries up and the pain diminishes. Some will have a lingering pain (post herpetic nueralgia) that can benefit from more pain medications or nerve blocks. Gabapentin (Neurontin) is effective for post-herpetic neuralgia. Please ask your doctor about the shingles vaccine.
Let me tell you a story
One of the unwritten rules of being a physician is being questioned outside of the clinic hours. “Doc, I got this pain and I was wondering if you can help me out…” Family members that you didn’t even know come up all the time. Even your dad calls.
“I think I have shingles. I was reading on the internet about shingles and I think that is what I have. ”
” All that is fine but I think have to ask a few questions,” says I.
In my dad’s case, the rash was only on one side of his back and radiated forward to his abdomen. Nothing made it better or worse. It was painful, red.
In my dad’s case, he still calls me about the pain three weeks later. He continued with the pain long past the rash. This is very common and is called post herpetic neuralgia. In this case, a good medication to use is Gabapentin aka Nuerontin.
I hope this helps