Is it a spider bite? A burn? Did your dog cuddle up after running through poison ivy?
Shingles causes a special kind of pain, and it's always interesting to see what it gets confused with.
Even more interesting is the life cycle of the virus that causes shingles. You can blame it on the childhood illness "chicken pox." That virus, varicella zoster, goes dormant only to erupt out of a nerve root later in life. The immune system normally keeps the virus under control.
But when immunity is weakened from another sickness or stress, for example, the virus is able to make its comeback. The manifestation is called shingles or herpes zoster.
In so many cases, the irony is that when one needs their health to be on their side; instead, they have a new painful illness to deal with. Shingles is more associated with patients over age 50, but I've seen it even in 20 year olds.
So, anyone over 20 would be wise to have some concept of shingles. Recognizing it early can allow better outcomes. New prevention methods are available too.
The pain will often precede the rash. The skin of the affected nerve feels very sensitive.
Sometimes people feel achy or feverish. When the rash comes, it's poetically described as "dew drops on red roses" (although those suffering wouldn't give it such nice terms) because it has a red base with fluid-filled blisters.
Each nerve comes out of the spine as a set, one extending to each side of that spinal level. So, you will see the rash only on one side of the body as it follows the nerve in the same general area. The rash won't cross the middle of the body.
It's important to be familiar with shingles because treating it early provides the best outcome. Part of treatment is to limit the virus and stop the spread.
For this, antivirals are prescribed, but their effect is better the sooner they are started. The medication options called acyclovir (Zovirax), famcyclovir (Famvir), or valcyclovir (Valtrex).
These are the same medications used for herpes or cold sores. Sometimes steroids are used. Their effect is more for pain. Trials show they don't reduce the complication of long-term pain. They can be helpful if the rash is on the face.
The other part of treatment is controlling the pain. Nerve pain feels different than other types of pain people are more used to experiencing. People describe it as burning, itching, tingling or numbness.
Anti-inflammatory pain medications like ibuprofen (Advil) or naproxen (Aleve) are a good start if you can tolerate those medications. Some get relief from topical Benadryl ointment. Cool compresses or a mixture of baking soda and water may also give some relief. Sometimes people will need to meet with their healthcare provider to discuss other pain medication.
Even with an early start on the antivirals, the pain and rash may last about two weeks. Without treatment, rash and symptoms could be present around a month.
Most people fully recover from shingles. However, a condition in which the nerve continues to be damaged after the rash has healed can occur. It is called post-herpetic neuralgia (PHN). Only 10 percent of shingles cases will lead to PHN. Pain medications targeting nerve pain are useful in these cases.
When the virus affects the nerve in the area of the eye, serious care must be taken to ensure the eye is not damaged permanently. If the rash presents anywhere near the eye, it is important to also see an eye specialist.
Is it contagious?
No one can catch shingles from you. But the virus can be spread to someone who has never had the chicken pox. Until the blisters are scabbed over, it would be good to take care around infants under a year old, pregnant women and anyone with a compromised immune system.
For the older generation, you may have heard of the vaccine Zostavax. This was offered for adults over 60 to help prevent shingles.
Although any chance of reducing shingles is a good thing, this vaccine didn't show effectiveness much more than 50 percent. As of this January, there is a new vaccine called Shingrix that has a much better chance of prevention. It is given as two shots. Pharmacies in town that give vaccines now carry this new, improved vaccine. Those over 50 years of age can get the vaccine covered by their insurance. Even those who have had shingles can get the vaccine to prevent another episode in the future.
To find out more about the shingles vaccines and possible side effects, see the Center for Disease Control website bit.ly/2BUIeVU.
Erika Lucero is a physician assistant working at Taos Urgent Care for the past three years after previously working in Española. She lives in Embudo with her husband and twins, enjoying life on the river.