Shingles Nausea after the outbreak

Dear Robert,

I am so sorry you are suffering with this disease. Unfortunately, you can have nausea with Herpes Zoster-Shingles. Were you been prescribed any antivirals and analgesics?

I am a retired NP, and the nausea can also be caused by the severe pain, or analgesics you are taking. If the lesions are gone, I am taking an educated guess you are past the 14 day mark and off the antivirals.

If the pain is still severe, I would ask your physician to prescribe a stronger analgesic. May I ask what you were prescribed? Also, your physician could prescribe an anti-emetic for the nausea. It sounds as if shingles has hit more than one dermatome for you.

May I ask where you live? It makes a difference as to whether you are eligible for Shingrix.

I am going to send information to you in a separate posting regarding Herpes Zoster-Shingles. It is quite detailed, and hopefully it will help you. Nausea is not common, but it certainly does occur as a manifestation of shingles. It can be a side effect of a medication, and therefore, is important to rule out that as a cause.

My heart goes out to you, Robert, as I truly know how you feel.

Best Regards,

Merry Juliana

Dear Robert,

I am so sorry that you are suffering from this disease. Unfortunately, there is a lot of misinformation among health professionals. Many health care professionals are abysmally ignorant regarding the diagnosis, the signs and symptoms of the disease, and the treatment and management of the disease. They are loathe to prescribe opioids for the acute pain.

My first episode of Shingles felt like I was giving birth via my ear canal while being tased!

I have had Herpes Zoster-Shingles in my right ear, mouth, and throat every three weeks for the past 24 years. For the past 2 years it has also spread to my entire right scalp. I have had it twice in my right eye.

The third ENT finally diagnosed it correctly.

Because I suffered so much with the disease, I am extremely active on this forum. My goals are to educate, support, and advise the people. I have learned so much from many wonderful individuals on this forum. I am a retired Nurse Practitioner in the States.

There are three stages to Herpes Zoster-Shingles.

THE FIRST STAGE-ACUTE STAGE

PRE-ERUPTION

PAIN, often burning or lancinating

Itching

Patchy redness

Swelling, in the dermatomal area of involvement

Swollen Lymph Nodes, either at this stage or subsequently

Constitutional Symptoms

Headache

Photophobia

Aches and Pains

Mild Fever

Chills

Fatigue

Exhaustion

THE SECOND STAGE-ERUPTION

Grouped herpetiform vesicles-blisters developing on the red base (the classic finding)

The vesicles come in crops or waves over a period of

usually 5 days

Skin findings that typically appear unilaterally, stopping abruptly at the midline

Vesicular involution: Vesicles initially are clear but eventually cloud, rupture, crust, and involute (shrink)

After vesicular involution, slow resolution of the remaining

red plaques, typically without visible sequelae

Scarring can occur if the skin has been compromised by

excoriation, secondary infection, or other complications

Almost all adults experience pain, typically severe

A few experience severe pain without a vesicular eruption (Zoster Sine Herpete)

Symptoms tend to resolve over 10-15 days,

but can last much longer

Complete healing of lesions may require up to a month

THE THIRD STAGE PHN

POST HERPETIC NEURALGIA

Persistent or recurring pain lasting 30 or more days

after the acute infection or after all lesions have crusted (9-45% of all cases)

Pain usually is confined to the area of original

dermatomal involvement

The pain can be severe and incapacitating

Pain can persist for weeks, months, or years

Slow resolution of pain is especially common in the

elderly

PHN is observed more frequently after cases ofHerpes Zoster-Shingles Ophthalmicus (HZO)

Herpes Zoster-Shingles Oticus

(Ramsay Hunt Syndrome)

and in instances of upper-body dermatomal involvement

TREATMENT & MANAGEMENT

Antivirals

The cornerstone of treatment

Should be started within three days of onset of

symptoms or rash

Famcyclovir 500 mg 3x daily 7-10 days

Most efficacious

Newest Antiviral

Valaciclovir 1000mg 3x daily 7-10 days

Less efficacious than Famcyclovir

Large pill

Based on Acyclovir

Acyclovir 500mg 5x daily 7-10 days

Most resistance to this Antiviral

Oldest Drug

Cheapest drug- Used in the UK

Difficult schedule of 5x daily

USE THE FOLLOWING: one of each class together

Anticonvulsants

Gabapentin-Neurontin

Dosages must be tapered up and down

Effective as adjunct in acute stage and PHN

Pregabalin-Lyrica

Dosages must be tapered up and down

Effective as adjunct in acute stage and PHN

Weight Gainer

Affects moods

Difficult to wean off due to withdrawal symptoms.

Antidepressants

Dosages must be tapered up and down

Effective as adjunct in acute stage and PHN

Can be difficult to wean off due to withdrawal symptoms.

Duloxetine-Cymbalta SNRI

Venlafaxine-Effexor SNRI

Amitriptyline-Elavil Tricyclic

ANALGESICS

OPIOIDS

Oxycodone

Codeine

Hydrocodone

IF YOUR PAIN IS NOT WELL CONTROLLED WITHIN THE FIRST TWO WEEKS, GET IT UNDER CONTROL BY DEMANDING OPIOIDS.

***The pain often increases markedly the second week of the disease.

HERPES ZOSTER SHINGLES IS ONE OF THE MOST PAINFUL AFFLICTIONS OF MANKIND SECOND TO CANCER AS IT INVOLVES NERVE PAIN.

IT IS THE PHYSICIAN'S DUTY TO HELP THE PATIENT IN PAIN. OPIOIDS STILL ARE THE BEST OPTION FOR ACUTE PAIN.

Gabapentin-Neurontin or Pregabalin-Lyrica can help decrease the neurogenic pain when used in conjunction with Opioids

Topicals

Lidocaine/Benzocaine

Found in Bactine, Solarcaine, Oragel, Salonpas

Auroguard for Ramsay Hunt Syndrome etc

Numbs the skin's nerve endings

Corticosteroid Sprays Creams OTC

Decreases inflammation, soothes topical swelling,

pain

Cool Compresses/ICE.

(DO NOT USE HEAT-CAUSES MORE PAIN AND INFLAMMATION)

100% COTTON CLOTHING soft & allows the skin to breathe!!!!!

SLEEP AND REST

You will experience fatigue and exhaustion and want to sleep. Obey your body. You cannot power through this. Take off from work. If you don't, it will only get worse.

CONTAGIOUS

Remember: your exposed rash is contagious to all individuals who have not as yet had chickenpox.

This list includes all pregnant women and their unborn fetuses. Many women do not know in the early stages if they are pregnant.

If someone has been fully vaccinated, they are protected. The unborn child is never protected.

Cover your rash with clothing or a dressing.

You are no longer infectious when every last vesicle-blister has scabbed over/ dried up.

PREVENTION of SHINGLES

Get the Shingrix Vaccine, a two part injection, taken 2-6 months apart.

The efficacy is 93%

1. It is available in the US at age 50 with insurance
2. If you have had Shingles, and are in the US, Shingrix is covered by your insurance. Have your physician write a note stating you have had Shingles.
3. In the UK, it is not available until age 70.

   ADDENDUM the Shingrex vaccine has helped decrease the intensity of pain of my episodes, but not decrease the frequency of episodes.

High Lysine Low Arginine Diet

Google High Lysine Low Arginine Diet and Herpes.

The amino acid Lysine helps decrease Herpes and Arginine triggers Herpes Zoster-Shingles.

If you binge on chocolate or nuts, and find yourself getting a horrible prolonged shingles episode after,

it is due to the high amino acid content of Arginine in chocolate and nuts.

You can take Lysine supplements, but there can always be issues with drug interactions, adverse reactions, and harm to the heart, liver, and kidneys.

It is my hope that this letter has helped you in understanding your disease and how to care for yourself.

Best Wishes,

Merry Juliana

Were you put on any meds for shingles? Some of those can cause nausea. As Merry mentioned, this illness has a wide range of symptoms, not just the pain and rash. Your whole body has been sick, for some it can take a few weeks to feel back to normal. However, you can still get ill with other things too (seems unfair, doesn't it?) when you have shingles.