Another public service announcement on shingles
[NOTE: A while back I wrote this post to warn readers to be on the alert for the rash of shingles, because the illness can be devastating and early detection and treatment can help avoid the worst of the complications. Doctors and sufferers seem to often not recognize the first signs, so I am moved to post a warning again because of the following event.]
A while back I was talking on the phone to a friend of mine and she happened to mention that she had a small rash on her face. It looked like little blisters or pimples, and was really disturbing to her because, after all, wasn’t adolescence supposed to be over now that she was in her 50s? From whence came this foul acne resurgence?
Because of certain previous events in my life, I’ve become shingles-vigilant, and so I asked her whether she’d thought of shingles as a possibility. “It can be on the face, you know,” I said. And since I was at my computer anyway, I sent her some photos of facial shingles for comparison to her affliction.
No, she said, it didn’t really look like what she had. Well, maybe a little. Maybe just one or two of the pictures. And then she read a link I sent her about shingles in general, and she didn’t think it quite fit.
We didn’t see each other for a while (busy, busy, busy!) and I promptly forgot about our exchange. And then a couple of days ago I got a call from that same friend.
She sounded distraught. No, forget distraught: she sounded absolutely dreadful, as though she were being squeezed in a vise.
“For the last four days I’ve had the world’s worst headache,” she said, her voice barely recognizable, so tight with pain it was. “And I’m terribly nauseated and haven’t been able to sleep.”
This was alarming. It sounded to me like status migrainosis, where a migraine gets locked in and just goes on and on and on.
I encouraged her to go to the doctor again (she’d been two days earlier and they’d said she had a sinus headache and had given her antibiotics). It didn’t sound like any sinus headache I’d ever heard of, nor did it sound like she was being a wimp. It sounded dreadful and perhaps even dangerous.
I didn’t hear from her for a couple of days, despite my leaving several messages on her phone with mounting concern. And then I got the news: she’d been in the hospital. She was still there. And they now were saying it was herpes zoster: shingles, with its sequel of neuralgia.
But when I went to visit her I discovered the news was even worse: the diagnosis was actually herpes zoster ophthalmicus. In other words, shingles of the eye.
I’ll skip some of the details except the most salient ones: it can damage vision. It can cause long-lasting, intractable, and extremely severe pain that is very difficult to treat. It can (as you already know from this story) be hard to diagnose at first, and difficult to distinguish from more ordinary rashes.
My friend is still in the hospital. Right now the only thing that seems to control her pain is to knock her out. They’re trying to get the right combination of drugs to help her so that she can be released. I hope that her pain will ultimately resolve and her vision will be unaffected, as is true of most sufferers. But in the meantime her anguish is profound, and this could go on for a long, long time.
So what’s the point of this post? Simply this: please be aware of what shingles looks like [link warning: upsetting photos] and how it works. And even if your rash doesn’t seem to quite match the photos or your symptoms the descriptions, hie yourself to a doctor immediately and let him/her take a look.
And if you’re in your 50s or 60s, consider getting the vaccine.
Walgreens offers the vaccine in our town and Medicare Part D covers part of it in some cases.
Thanks for posting this. I just happened to get the vaccine yesterday. My grandmother had a bad bout of it and I just didn’t want to take a chance on getting it.
One day I discovered that one of my lymph glands at the top of my leg was swollen. Upon examining the nearest cheek (not facial) and discovered a constellation of little pustules.
I went to the doc, showed him, and he pronounced it a case of shingles. Thing is, I felt zero pain, and had the gland not been swollen, I’d have written off the little pustules as zits.
Nevertheless, they ran tests to verify the virus strain, and a few weeks later ran it again to make sure it was subsiding.
It was, else I’d have needed that shot, too.
I was ten flavors of lucky to not feel any pain (both my father and sister got the painful variety), but that just goes to show that things can be more serious than they seem.
Thanks for bringing attention to this. I came down with shingles a few years ago and it put me out of action for three months. It’s a serious disease.
I’m reminded of an article in The New Yorker from a few years back:
http://www.newyorker.com/reporting/2008/06/30/080630fa_fact_gawande
The article’s focus was on how itch is not actually the firing of pain neurons but of special “itch” neurons.
The case study is of a woman’s scalp shingles, the neuropathy having killed the pain sensors but leaving her with an itch so terrible and relentless that she managed to scratch right through her skull and into her brain.
Yeah.
So, no small matter, this shingles thing.
Thanks for the heads up, and I hope your friend gets better quickly!
Thanks for the reminder. I’ve been putting off getting vaccinated. I’m off to get it today.
Every time I go into Walgreen’s, I think I should get the shingles vaccine. I haven’t. Will do tomorrow. Thanks for the warning.
I had that when I was on my first sub. It was a black patch of rashes on my back. Now, we only had a medic on board. Further, he told me I had herpes zoster, but he wasn’t sure. The whole time out I thought I had… herpes, I guess it would be what, complex 3 or something? I kept meaning to ask him to clarify, but being busy (I qualified on that first three month run, something they allow two years to do), and I was a bit afraid to ask. When we returned to dock I finally found out it was just some silly infection. Sorry, don’t mean to downplay it, but other than being a bit itchy and sore, lasting 4 months give or take, it mostly wasn’t an issue for me. I just thought it might have been.
H. zoster is eminently treatable with an antiviral (an antibiotic against a virus) such as Acyclovir (aka Zovirax). Works best if started early. The vaccine will not prevent shingles 100%. The virus is within us all already if we have had the chicken pox; it resides inside cells, so is sheltered from the immune system.
Don Carlos: yes, the links talk about that.
When I had shingles, about seven years ago, I realized that’s what I had and I raced to the emergency room at 3 AM because I knew time was of the essence. I walked in and said, “I’ve got shingles, and I want those anti-viral drugs!” and they said wait a minute, let’s examine you first. I got the drugs, and for that reason or just luck, I had a mild case and no post-herpetic pain.
The problem for my friend (and several other friends of mine, actually) is that they didn’t realize what they might have and didn’t go to the doctor in time. Or they actually went to the doctor in time and were misdiagnosed.
I am recovering from shingles right now. It is very painful and unpleasant. I was fortunate that the doctor recognized them for what they were immediately, and prescribed an antiviral. They are healing, albeit very slowly.
I developed a case of shingles when I was 33, that the doctor said was probably brought on after having experienced two of the worst sunburns of my life over the summer of that year. Didn’t have a widespread rash, but there were a number of blisters all in a nice, neat horizontal line across my chest and back. The whole episode lasted about 3 – 4 weeks, but after it was all over, there were no lingering effects.
But at the height of the ailment, the pain, it felt like nails were being driven into my back and chest, and I didn’t get much sleep and didn’t eat much all that time.
I got shingles on my head about 15 years ago. I describe shingles as the meanest illness I have every had. It is just punishing.
At the time, I was in landscaping and when the pustules appeared on my forehead, I thought that I had just gotten into some poison ivy. But, they didn’t itch like poison ivy and it didn’t get better. Finally went to the doctor and he noted that the pustules were only on the left side of my head and told me I had shingles. It almost got into my eye and to this day I’m not so sure that it didn’t get into my brain. When it first hit, I could barely stay awake.
Anyway, after a nice bout with neuralgia, I haven’t had any further issues. You can bet that I am on the alert for it, though!
Shingles tracks the course of a single nerve, thus does not cross the midline. A useful clue. Helps if you know anatomy!
Don Carlos: unfortunately, some doctors don’t seem to know anatomy. Several of my misdiagnosed friends had rashes that tracked the course of a nerve root on one side but their doctors still did not recognize that it was shingles.
My rash was very small and tracked only part of a nerve root, so it was harder to tell. And my friend who’s in the hospital now had an atypical rash that erupted in segments, not all at once so it was hard to see the distribution.
Left hand pointer finger and thumb. I just thought they were viscous bug bites, terrible burning itch, finally saw Doc and he immediately recognized it but I was too late for antivirals. Had to wear lidocaine patches on it for weeks. It’s been nearly 10 years and I still can’t leave my seatbelt on normally for more than 1/2 hour.
I’m beginning to wonder if I attract an unusually shingley readership.
Then again, they say 1 out of 3 people will get shingles in his/her lifetime.
I had shingles 5 years ago across the front and back of the left side of my body. I thought I was too young for shingles, that it must be something else. I got the the anitvirals after the rash started spreading and it was clear that it was only on one side. Even though I started taking them after my skin looked like chunks of raw hamburger, the drugs knocked it down in several days. I still have scars underneath my skin that look like busted veins and they still hurt after 5 years.
I gather the young lady at the pharmacists must have thought I needed the antiviral drugs for something else because she tried to tease me about them. I think the same drugs are perscribed for certain STDs.
I count myself lucky, one of my former co-workers got it in his eye. He can’t work, or do much of anything any more.
One of the AOSHQ moron linked you, but I’ve been here occasionally before.
Good luck to your friend with the eye. That really scared me when I was reading up on shingles.
My mother had shingles, and the pain was so great that I think it destroyed her will to live.
Seriously, this is a serious threat to those who may have other issues too.
Get your shingles shots.
The pain of shingles can be devastating and not mitigated by any painkillers. Begin to use anti-viral drugs as early as possible. They work, if applied early enough and in adequate dosage. As for vaccines, they hardly can help much because neural tissue is well isolated from immune system action. Vaccines are good only in prophylactic, to attack virus in bloodstream. But most people already have herpes virus infection when they are born, it is called “vertical transmission”. And shingles can be symmetric, too. Quite often both ganglions on both sides of backbone are affected. Assymetry is nevertheless a sure symptom of shingles.
Shingle can be easely confused with migraine when cranial nerves are affected. If usual painkillers do not work or pain lasts longer than few hours, begin to use antiviral drugs.
Recently my wife felt unusually strong headache but she was accustomed to such pain and ignored it. Only when orbital pains began, I guessed that it could be shingles, 4 days after onset of headache. She took Acyclovir in maximal recommended dosage, and in a day or two she was OK. Be aware of orbital pains or rigidity of backside of head muscules: they are early signs of shingles.
Young people can get shingles, too, when their immune system is temporally weakened by flu, common cold or host of other conditions. It it is more prevalent in 50- or 60- year old, when their immune system deteriorates from aging and dormant infection get out of control. But nobody should suppose that they are “too young” for it.
It must be true that this is an unusually shingly crowd. I’ve had it twice. Both times I recognized it immediately, with help from a nurse in the family, and got on drugs pronto, so it was not too bad.
On the other hand, my mother recently developed severe one-sided pain in her head, jaw and neck and an odd red bump on the temple. What we initially thought might be shingles or cellulitis (which she had previously had on her scalp after an insect bite) turned out to be something we’d never heard of but needs to be watched for vigilantly in older folks: temporal arteritis. This is an inflammation of the artery walls that is very painful, made my doughty mother as ill as I’ve ever seen her, and can result, if not promptly treated with prednisone, in irreversible blindness. She’s fine now, but it was quite an ordeal. I guess the moral of this story is that sudden unusual symptoms, especially painful ones, really are worth that trip to the doctor, no matter how independent and tough we may like to think we are.
Serious as this thread is, it’s making me laugh as I picture us all crowded around some virtual table comparing our ailments!
neo, i’ve had two comments swallowed here. Don’t know why.
I was lucky. My shingles were very mild and some Valcyclover knocked it out pretty quickly. Gave me a good scare, though.
I tell people it’s way to easy to become a nurse, or a doctor, or a lawyer, relative to the complexity of the work that they all do. Nurses’ mistakes, just don’t get me started. For the doctors and lawyers: suing the wrong guy, misdiagnosing a deadly bowel cancer, in a coworker’s husband, or my diabetes. As Mad-Eye Moody said, “Constant vigilance!”
Obama paid for my shingles shot! Not really, but Obamacare made it so my insurance had to pay for it. I paid for it up front before I found out.
Yay.
Good for you for highlighting this Neo.
My wife had shingles on her head and face, and it did get into her eye. It was terrible at the time and the after-effects, neuralgia and light sensitivity, plagued her for decades.
Sadly, most of the after-effects could have been avoided if the Physicians she saw had taken aggressive action. They did not. Hopefully, times have changed and MDs are more knowledgeable now, but folks need to be pro-active if they aren’t.
BTW, hers started with an ear ache, and she went to the Dr for a potential ear infection. She did not have obvious visible manifestations until a couple of days later. One Dr recognized the problem but did nothing. To be fair, the effective medications were probably new at the time. Her Opthamologist sent her to another MD who started her on anti-viral Rx, but too late. I also had a case of shingles, fortunately mild, just a few years before and the DR sent me home with no treatment, but the admonishment that it would not kill me, but I might wish I were dead before it was over.
One more point. Ignorance about this condition abounds. My “superiors” told me not long after my outbreak that they thought I needed to take a break from a stressful position since I had already suffered a nervous disorder. (I was only too happy to take a permanent break from that crowd not long after.)
In fairness to docs who may be charged by implication with failure to diagnose, as with Neo’s friend, one must recognize that the pain of shingles, whether mild or severe, can precede any skin lesion by days.
Don Carlos: what puzzles me, though, is that in several of my friends’ cases (not the one described here, though), the rash was obviously shingles and still the doctors failed to diagnose. I diagnosed one of these people over the telephone by asking him to describe the rash. It wasn’t rocket science–or brain surgery.
kolnai: my son had it when he was in his late teens or his 20s (I forget which) when he was at school. He thought it was a spider bite, and went to the doctor at the health service, who fortunately diagnosed it and gave him antivirals. He had pain for a couple of weeks but then it went away.
What can I say, Neo? How’s about “Sh*tty Docs”? To attribute facial neuralgia to ‘sinusitis’ is pretty crappy, too, since one would have to have an outrageous sinusitis, accompanied by other obvious findings thereof, to get any serious pain.
Unfortunately, too many ‘PCPs’ are little more than traffic cops. Chest pain? turn right for the cardiologist. Facial pain? maybe it’s your sinus, turn left for ENT.
Don Carlos: agreed.
I had just read an article recently (don’t know where) about how sinus infections are relatively rare compared to the number of times people think they have them. Usually, it’s a regular headache or a migraine instead. In my friend’s case, I could understand (and I shared) the idea that she had a migraine, because her symptoms were quite consistent with that. But sinus infection? Not.
My opinion of GPs, family practitioners, PCPs, whatever you want to call them, is that they’re fine for treatment of the usual but I would not rely on them for diagnosis for anything serious or out of the ordinary. The problem is that sometimes serious and/or out of the ordinary things masquerade as ordinary things. But in this case, sinus infection seems a very poor choice of diagnosis, any way you look at it.
I had shingles a decade ago.I do not recall precisely which medicine the MD prescribed, but it was a much smaller dose of a medication used for psychiatric patients.
When I was out of town on a business trip, I missed one of my evening doses. The next morning, I naively thought that to compensate, I should double my meds to compensate for the one I missed the night before. Bad mistake. I was drowsy all day. The PDR said that drowsiness was one side effect of the med. I am glad that my ordinary dosage was too small to feel drowsy.
My GP correctly diagnosed me. He was quite open with me about consulting a reference book for the diagnosis and/or the prescription. I appreciated his honesty in this case, instead of trying to appear to be omniscient. He was simply omniscient as a problem solver. 🙂
Thanks for the tip about Walgreen’s. It is worth the expense.
“I was lucky. My shingles were very mild and some Valcyclover knocked it out pretty quickly.”
That describes my case. I got it when I was 27. It was on my leg (which I think is less common) and sort of looked like poison ivy and that’s what my friends told me it was. But I’d had poison ivy several times before and this didn’t itch nearly as much as poison ivy. It felt more tingly and mildly painful than itchy, although it did itch a bit. Since I didn’t have health insurance at the time, I wasn’t eager to run off to the doctor but when I became convinced after a day or two that it wasn’t poison ivy (and it started to spread towards my knee) then I went. He diagnosed it right away and gave me the drugs. I don’t think I knew anything about it besides the name before that. It was somewhat painful for about two to three weeks but nothing intolerable. I just had to minimize brushing my pants against it. I still have some small white scars on my leg from the heavier spots, although mine didn’t cover a large area like in some of those pictures. I was told that it’s usually milder when you’re young.
Gringo’s diagnosis might have been correct, but his GP’s prescription was decidedly not.
…one must recognize that the pain of shingles, whether mild or severe, can precede any skin lesion by days.
What I felt before the blisters appeared was a slight tingling in my chest, with sensitivity to being touched on the right side of my midsection. It was enough that just the rubbing of clothing across the sensitized area would really bug me.
Don Carlos: it worked, as the pain/itching was put under control. Perhaps I should go back to the MD office and check to see what precisely I was prescribed.
Gringo:
Since you desribed it as a psychiatric med that sedated except at low dose, it was likely amytriptyline. That is most definitely not an anti-viral. That it helped the symptoms is nice; kinda like taking Advil for a bacterial pneumonia, which lowers the fever but doesn’t touch the infection.
Don Carlos: amytriptyline is the treatment of choice, as far as I know, for the pain of post-herpetic neuralgia. Not, of course, for shingles itself, and it doesn’t change the course of the illness.
My friend is home from the hospital, by the way. Her pain is still there although reduced, and she’s taking a lot of meds. I will probably go see her again tomorrow.
Coincidentally, just happened to get my shot a few weeks ago. Luckily my health plan paid in full for the shot, but Costco, where i got my shot, listed a retail price for it as $185.44, which seems quite high to me.
Neo @12:39 am:
My point exactly.
I did have post-herpetic neuralgia, and took medication for that until some 6 weeks after the initial diagnosis of shingles. I took the business trip about 4 weeks after I was diagnosed, which would have been in the post-herpetic neuralgia stage. Most likely the medication which got me drowsy was amytriptyline.
I have a vague memory of a getting a prescription for post-herpetic neuralgia, which implies that there was a different drug that the GP initially prescribed for shingles- most likely an antiviral. Whatever he initially prescribed, worked.
The fault was not with the GP, but with interpreting my memory.
I still feel some numbness when I blink my left eye, a residue of the shingles attack.
If before my attack with shingles I took for granted the accomplishments of our pharmaceutical R&D, I am now very grateful to have taken advantage of those accomplishments.
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