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Shingles: A Painful and Debilitating Virus that Strikes the Elderly 
 
by Mary M. Alward August 08, 2005

Shingles is a painful disorder that usually strikes the elderly, but can and does strike people of middle age. It is caused by the same virus that causes chickenpox. Those who suffer from shingles aren't free of the pain after the rash and blisters vanish. Pain can continue for weeks, months and even years. Find out more about this this debilitating affliction.

What is Shingles?

Shingles is an infection that is localized; usually to one half of the body. It is caused by the varicella virus, which is the same virus that causes the childhood disease, chickenpox. Shingles only strikes those who have had chickenpox. The varicella virus lays dormant in nerve endings and if it is reactivated, that is when shingles occur. It is not known why the dormant virus suddenly becomes active.

Who is Susceptible?

Shingles is primarily a disease of the elderly, but can and does strike people of middle age. It affects both genders and all ethnic groups equally and can occur at any time of the year.

Is Shingles Contagious?

If you have had chickenpox, you are susceptible to shingles. Shingles cannot be spread from one person to another, nor can contact with someone suffering from shingles cause another person’s dormant varicella virus to reactivate. However, the varicella virus in a shingles sufferer can cause chickenpox in people who have never had the childhood disease.

Shingles Symptoms

The first symptoms of shingles are a tingling sensation, extreme itchiness or pain much like the prick of a pin. Several days later a rash will appear in the form of a band or a cluster of raised, red dots. Shingles usually appear on the trunk of the body or the face. The rash progresses into small blisters that are filled with fluid. Often they overlap each other similar to the shingles on a roof. Once the blisters have formed, they begin to dry up and within a week they’re crusted over. At its peak, symptoms can range from itching to excruciating pain. Shingles usually run their course in four to six weeks, but can strike again at any time. The varicella virus can lie dormant in nerve endings for years before reactivating. The virus is present only in the area of the rash and can spread chickenpox to those who have never had it for seven days after the appearance of blisters.

Early Diagnosis

Early diagnosis and treatment can shorten the duration of shingles and also prevent complications, such as continuing pain, which can be present long after the shingles have vanished.

Symptoms

The first symptoms of shingles are often mistaken for other ailments. A rash follows closely behind other vague symptoms such as tingling or a feeling of being poked by a pin. Some refer to this as a stabbing pain. Flu-like symptoms can occur and some people get quite ill having fever, chills, nausea and headache.

Shingles occurs in two stages. The first stage is the prodromal stage and then the eruptive stage follows.

The Prodromal Stage

The prodromal stage begins two to four days after the shingles rash breaks out. Symptoms may include numbness on one side of the face or body, fever, chills, nausea, headache as well as burning, tingling and stabbing pain, which can be constant or intermittent. Itching is another symptom, but it usually affects only area within the boundaries of the shingles rash.

The Eruptive Stage

The eruptive stage brings redness and swelling to the shingles site, as well as pain and fluid-filled blisters. New blisters will continue to appear for up to a week. Blisters may be clustered or form a band. Shingles look very similar to chickenpox. They may be irritating, itchy or excruciatingly painful. Within two weeks they become filled with pus, then dry out and scab-like crusts are formed. When shingles crust over, they no longer contain the varicella virus. The rash usually lasts between three and six weeks. Blisters leave no scars, but skin may continue to be discolored for weeks, months or even years, depending on the severity of the outbreak.

Where Do Shingles Break Out?

Most often shingles only break out on one side of the body. They may appear on an arm, leg, one side of the buttocks, one side of the body trunk, the torso or face.

Pain

Shingles pain can range from moderate to excruciating. If you think you have the symptoms of shingles, see your doctor immediately. He can prescribe medication that will reduce shingles symptoms and pain and encourage blisters to heal more quickly. Medications for shingles must be started within three days of when the rash appears to be effective.

Though shingles can be very painful, it is not usually life threatening to healthy people. Some people do experience prolonged excruciating pain after the blisters disappear. This condition is known as post herpetic neuralgia and can be unbearably painful. This pain can last for weeks, months or even years.

Diagnosing Shingles

Shingles are very hard for your doctor to diagnose before the rash breaks out. The symptoms can be so excruciatingly painful that it may be mistaken for appendicitis, gallstones, kidney stones, pleurisy or a heart attack. The misdiagnosis depends on where the affected nerves are located on the body.

Doctors and other health care professionals can differentiate shingles from chickenpox and other rashes by the way the blisters appear on the body. Shingles always forms a band or cluster, and appear only on one side. In addition to the placement and appearance of the rash, doctors often take a swab or scraping from the blisters and send it to a laboratory to be tested.

Treatment

Goals of Treatment

Your doctor will try his best to prescribe medications that will shorten the duration of the eruptive stage, relieve you of pain and discomfort, shorten the duration of the postherpetic neuralgia stage and speed the healing of shingles blisters.

Medications

Prescription and over-the-counter pain relievers, antidepressants, anti-inflammatory drugs and anti viral drugs may be given to the shingles patient. It’s important to keep the sufferer as comfortable as possible and reduce the risk of infection. Symptoms and pain of shingles can be largely reduced by the prescribing of anti-viral medications.

Tips

  • When shingles are in the eruptive stage, ask your doctor how to get lots of rest and a good night’s sleep. As quickly as possible, continue daily activities.

  • Reduce pain by applying a cool cloth or compress to blisters and take a cool bath at least once a day. Do not rub shingles. Avoid warm or hot baths and exposure to the sun, as heat can cause shingles to itch severely and incessantly.

  • Cover the shingles site with a sterile gauze bandage after cleansing the site or bathing.

  • Wear loose fitting clothing to reduce the irritation of blisters.

  • Trim fingernails as short as possible to avoid scratching, which may cause a bacterial infection.

Postherpetic Neuralgia

The most common complication of shingles is postherpetic neuralgia. It is a condition where shingles pain lasts for weeks, months or even years after the shingles blisters and rash have disappeared. The cause of postherpetic neuralgia is damaged nerve fibers. The nerve fibers continue to send messages to the brain from the skin area that was affected. When shingles damage the nerve endings, they can’t send proper messages to the brain. The brain deciphers these confusing messages as pain.

Ramsay Hunt Syndrome

Ramsay Hunt Syndrome is the result of the herpes zoster virus spreading to facial nerves. This causes severe ear pain. Shingles may break out on the face, neck, and scalp, the roof of the mouth, outside the ear, around the mouth or inside the ear canal. If the shingles virus strikes facial nerves, the result can be loss of hearing, facial paralysis and/or dizziness. This is usually temporary but can be permanent. If you have an outbreak of shingles on your face, ear, neck or scalp, see your doctor as soon as possible.

Hutchinson’s Sign

Hutchinson’s Signs is a condition that occurs when shingles breaks out on the end of the nose. It is a definite sign that the herpes zoster virus has penetrated the ophthalmic nerve of the eye. The eye then swells and becomes excruciatingly painful. The invasion of the herpes zoster virus into the ophthalmic nerve can cause vision loss and temporary blindness.

Skin Infection

Shingles are usually extremely itchy. If the sufferer scratches, the skin can be damaged, which can inadvertently introduce a bacterial infection from the fingernails. If shingles blisters and rash is not healing, this could indicate they are infected. If you suspect you have a bacterial infection, or notice that the rash site has worsened, contact your doctor as soon as possible.

Infected Internal Organs

When a shingles outbreak occurs the immune system weakens. If you have had an organ transplant or suffer from HIV or cancer, your immune system is not working to its highest potential. This means an outbreak of shingles is dangerous for you, as the herpes zoster virus could spread through your body and strike vital organs. If this happens you are susceptible to a secondary bacterial infection and/or viral pneumonia, which could be fatal if not treated immediately.

More about Postherpetic Neuralgia

Living with the aftermath of shingles is not easy. After-effects are long lasting and debilitating. Postherpetic neuralgia can cause overwhelming emotions, including depression, irritability, mood swings and frustration. There is no cure for postherpetic neuralgia, but there is treatment available.

Treatment of Postherpetic Neuralgia

Nerve damage that is caused by the shingles virus can’t be reversed. Treatment will not improve healing of nerves. Different types of therapy work for each individual. Some therapies cause side effects for some sufferers, while others experience no side effects at all. Ask your doctor to try a range of medications in order to help you find relief from postherpetic neuralgia.

Anti-viral Therapy

There are a wide variety of anti-viral medications available on today’s market. However, these medications must be started within three days of a shingles outbreak in order for them to work effectively.

Caregivers

It is very difficult to care for those who suffer from shingles. Unless the caregiver has had an outbreak themselves, it’s hard to imagine the intense and excruciating pain that comes with the condition. The shingles victim is in constant pain and his personality can change drastically. If you are caring for someone who has shingles, ask the doctor who is caring for the patient questions. Consider making a list to give to the doctor on the next visit. A study of postherpetic neuralgia will help you better understand the lasting pain that follows an outbreak.

Caring for the Caregiver

Remember, if you are caring for someone with shingles, you need to take care of yourself. You may be having problems adapting to your role as a caregiver. This can cause a high stress level, anxiety, and depression, a sense of guilt, anger, sadness and frustration. These are normal feelings felt by most caregivers. It these emotions get out of control, contact a health care professional who can teach you how to cope. In the meantime, here are a few tips to guide you:

  • Do something you enjoy; read a book, listen to your favorite music, watch TV, go for a walk, indulge in a bubble bath or participate in a hobby.

  • Take time out to interact with family and friends. Don’t allow yourself to become isolated. Continue with normal activities when possible.

  • Keep a journal. Writing down your emotions is good therapy.

  • Exercise. This relieves anxiety, stress and tension and eases your mind.

  • If you are overwhelmed, talk about your feelings with a family member or friend. Join a support group or seek out a health care professional who teaches coping strategies.


 




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