By MARY JACOBS / Special Contributor to The Dallas Morning News
maryjacobs44@yahoo.com
Josh Glick missed the Cowboys’ game last Thanksgiving to go to the
emergency room. In retrospect, he’s glad he did.
Josh Glick got medication for shinglesearly during his outbreak last
year, so even though the shingles slowed him down for a while, he’s
back to his athletic self, working out at the Jewish Community Center
in Dallas. He’s now a college freshman. “>
Josh Glick got medication for shinglesearly during his outbreak last
year, so even though the shingles slowed him down for a while, he’s
back to his athletic self, working out at the Jewish Community Center
in Dallas. He’s now a college freshman.
A high school senior at the time, Josh broke out with a rash on one
side of his face, which he at first thought was just a patch of
“really gross pimples.” But he also had an unexplained toothache, and
the fluid-filled blisters were extremely painful – red flags
that spurred his grandfather, a pediatrician, to take Josh to the
hospital.
The diagnosis: shingles, a severe skin condition caused by varicella-
zoster, the same virus that causes chickenpox. Doctors started Josh on
anti-viral medication right away, with pain medication to help.
Normally athletic and active, he was exhausted and in constant pain
and missed 10 days of school.
“I never ate,” he recalls. “All I wanted was for my mom to rub my back
and give me more pain meds.”
Relatively speaking, however, Josh’s case was mild, partly because he
is young and partly because he got the medication early.
Around Christmas 2005, Ms. Emery, now 61, noticed blisters on her
back, but she assumed the cause was a heating pad she’d used for her
aching back. By New Year’s Eve, the normally energetic community
volunteer felt so horrible she could barely move.
Her doctor diagnosed shingles and started the anti-viral medications,
but it was too late. For the next four months, Ms. Emery was
miserable, exhausted and in terrible pain.
“The blisters on my back felt like a really bad toothache, where you
can feel the nerve endings,” she says. Wearing clothing on her back
was unbearably painful. When her husband would walk by, “just the
breeze when he passed by was excruciating.”
Already slim, Ms. Emery lost so much weight during the bout with
shingles that she had to buy new clothes.
“I was just skin and bones,” she says. It wasn’t until November,
almost a year after her first symptoms appeared, that she began to
regain the weight.
The lesson learned from Ms. Emery’s nightmare: Know the symptoms and
see your doctor right away if you suspect you have shingles.
Or better yet, get the vaccine. The FDA approved Zostavax, a vaccine
against shingles, in 2006 – too late for Ms. Emery.
Anybody who has had chickenpox can get shingles, and sooner or later a
significant number of them will.
“Once you’re infected with chickenpox, the virus is dormant in your
body for the rest of your life,” says Dr. Stephen Tyring, clinical
professor in the department of dermatology at the University of Texas
Medical School in Houston. But physical or emotional stress, or immune
suppression caused by disease or cancer treatment, can trigger an
outbreak.
Don’t think you had chickenpox when you were a kid? Think again. Dr.
Tyring’s research says that, while many don’t remember having
chickenpox, more than 90 percent of the population has had it.
The research, published recently in the Archives of Dermatology, also
pointed to family history as another risk factor for shingles.
“If just one blood relative has had shingles, you should get
vaccinated,” Dr. Tyring says. “Your risk is double that of someone who
has had no relatives with the virus.”
For youngsters, there’s another possible risk factor. Those who had
chickenpox in infancy, before their first birthday, have an increased
risk of pediatric shingles.
You don’t need to have a trigger or a risk factor to get shingles,
however. If you’ve had chickenpox at any time in your life, you can
get the disease.
Shingles can’t be cured, but early intervention with antiviral
medication can minimize the length and severity of the symptoms. The
key word is “early.”
“We’d like to see patients within the first 48 hours after the onset
of symptoms,” says Dr. James Luby, professor of internal medicine-
infectious diseases at UT Southwestern Medical Center. “But the sooner
the better.”
Steroids also may be prescribed to help reduce the severity of the
outbreak, but they are not usually prescribed for children with
shingles. Josh didn’t have steroids.
For those experiencing severe pain with the onset of the rash, drugs
to treat nerve pain such as Neurontin or Lyrica can help, according to
Dr. Randall Wooley, an internist at Presbyterian Hospital.
The first sign is often burning or tingling pain, or itch, followed by
a rash of fluid-filled blisters, similar to chickenpox. And usually
someone coming down with shingles will feel generally crummy, with
chills, fever, upset stomach or headache.
There’s also a distinctive pattern to the blisters. Josh’s outbreak,
on just one side of his face, was what tipped off his grandfather.
“Shingles is almost always on one side of the body,” says Dr. Joel
Steinberg, who is a professor of pediatrics at UT Southwestern. “It
always follows an exact nerve root pattern.”
Most commonly, the blisters form as a band spanning one side of the
trunk. (The disease often produces a “girdle” or belt of blisters on
one side of the waist, thus the name zoster(Greek for girdle) and the
name shingles,which comes from cingulum,the Latin word for beltor
girdle.)
The second most common location is on one side of the face around the
eye and on the forehead. However, shingles can involve any part of the
body.
Some rashes merge and produce an area that looks like a severe burn.
Other patients may have just a few scattered lesions that don’t cause
severe symptoms. In a few cases, patients have the pain but no
blisters at all.
In Josh’s case, shingles was diagnosed with a test of fluid taken from
one of the blisters. In most cases, however, it’s diagnosed by
symptoms alone.
About 1 million cases of shingles occur in the U.S. each year, about
half of them affecting people 60 or older.
“The older you are, the more likely you are to get shingles,” says Dr.
Martin Myers, professor of pediatrics and co-director of public health
policy for the Sealy Center for Vaccines at the University of Texas
Medical Branch, Galveston. “As people pass the age of 60, the risk of
developing shingles goes up with each decade.”
While shingles most often strikes after age 40, it’s common enough
that cases in young people, like Josh, are not rare.
“Shingles is an intense inflammation within the nerves,” says Dr.
Randall Wooley, an internist at Presbyterian Hospital. “It’s just
about the worst kind of pain you can have.”
Other complications can include scarring, bacterial skin infections,
muscle weakness and, depending on the location of the outbreak,
hearing loss, vision loss or paralysis on one side of the face. Some
can have long-term nerve pain (called post-herpetic neuralgia).
“The older you are when you get shingles, the greater your chance of
developing post-herpetic neuralgia,” says Andrew B. Crocker, a
gerontology health specialist for the Texas AgriLife Extension
Service.
“This pain can last for weeks, months or even years.” The agency is
working to increase awareness and encourage people 60 and older to get
vaccinated.
Shingles is not contagious – exactly. “You can’t give shingles
to someone else, but it’s possible that a person with an active
outbreak of shingles could transmit chickenpox to someone who has
never had chickenpox, or who has not been vaccinated,” says Dr.
Wooley. In other words, an unvaccinated youngster could catch the
chickenpox from a grandparent with active shingles.
The shingles left Josh Glick with no lingering problems, just memories
of the Christmas when his friends nicknamed him “Shingle Bell Rock.”
He’s working out daily and back to normal, aside from a few scars.
“When I returned to school, everybody thought I’d been in a knife
fight,” he likes to joke. “But I’m not that cool.”
“I’d recommend the vaccine to anyone,” she says. “You don’t want to go
through what I did.”
Get the vaccine: Zostavax, the vaccine against shingles, has been
approved for people 60 and older. It’s expensive (about $200) but
usually is covered by insurance. Some studies are looking at whether
people 50 and older should be vaccinated. It’s basically the same
vaccine that’s used for chickenpox, but with a different dosage.
Know the risk factors:People who have had chickenpox can get shingles.
People who have received the chickenpox vaccine, which was approved by
the FDA in 1995, are less likely to get shingles than those who have
had the disease. Other risk factors: aging, a family history of
shingles or a weakened immune system due to cancer, certain drugs,
transplants, chemotherapy, HIV or stress.
Know the symptoms: Common symptoms include burning, tingling or
numbness of the skin; chills, fever, upset stomach or headache; fluid-
filled blisters; skin that is sensitive to touch; mild itching to
strong pain. Many shingles sufferers will experience pain before the
blisters appear.
Act fast:Antiviral medications can minimize the pain and duration of a
shingles outbreak, if the medication is started early enough. Call
your doctor immediately if you suspect you have shingles.
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