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Shingles on right arm 68 year old female, need any suggestions from knowledgeable people.

Posted , 8 users are following.

don53138
don53138

Shingles is covering at least half of arm from forefinger to high on shoulder. Slight pain for 2 days before rash started 5 days ago (couple pink spots) and has continued to expand to present along with pain. Shingles was diagnosed 4 days ago and anti-viral was prescribed, but pills were so big (1gm) they couldn’t be swallowed and now way pass 72hrs recommend time frame for start. Pain is extreme to point arm and hand cannot be used at all. Vicodin doesn’t relieve pain only allows 2-3 hours of sleep (which does help some). A melanoma was removed from forearm with 4 lymph nodes removed in arm pit 7 years ago.

All ready understand Shingles process but have questions that can’t seem to get answers about.

1)      How long does the rash normally keep spreading?

2)      At what point does the most severe pain slack off?

3)      Any recommendations for pain relief?

4)      Does anybody know if complications could happen because of lymph nodes removed?

2 likes, 73 replies

73 Replies

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  • don53138
    don53138

    Posted

    An update with few questions. Rash on wife's arm has mostly crusted over except for couple blisters near wrist. Thumb still swollen and immobile. Arm pit, right upper chest, shoulder and breast area (mostly around area where lymph nodes removed years ago) swollen with pain which is still keeping her from elevating arm completely above heart.

    Her most troubling pain is now mostly skin (surface area) which has been deep pain prior. She swears the Gabapentin has caused the surface pain to be more severe, now on 300mg 3 x daily for 900mg daily total. Realizing this may just be a stage type process or confidential timing brings up following questions.

    Does Gabapentin have any other benefit  than pain relief?

    Like does it help minimize long term effect of PHN?

    Could this just be normal for surface pain to increase prior to get better?

    We're debating stepping her down slowly and stopping Gabapentin completely. Looking for advice concerning this as it doesn't seem her PCP has a clue.

    • Merry19451
      Merry19451 don53138

      Posted

      Don,

      The Gabapentin does help with acute pain relief and also does help prevent Post Herpetic Neuralgia PHN. The pain of Herpes Zoster-Shingles gets worse often the second and third weeks before it gets better. As your wife was unable to receive more Opioids, I am certain the pain is worse, but not due to the Gabapentin, but not having any Opioids to take.

      I take Topamax, a similar anticonvulsant. I am certain I would have been suicidal with pain without the Topamax, and definitely would have Post Herpetic Neuralgia PHN without the Topamax.

      I strongly advise to stay on the Gabapentin. I am sorry to hear that she is suffering so.

      Best Regards

      Merry Juliana

  • don53138
    don53138

    Posted

    I guess shingles doesn't observe Christmas, but it does appear there may be slight improvement in pain intensity today. Blisters and rash area of entire arm has dried and crusty, skin extremely dry (cracked) looking almost like alligator skin. Hopefully a sign pain level might be heading down hill.

    Hand, elbow and front shoulder area still swollen (7+ days now) with pain. However we're now able to concentrate more on ice pack application and better elevation methods to reduce swelling as suggested by Merry along with other great advice from her. Thanks from the heart to Merry, christine76458 and hope4cure who have offered great advice to this point.

    To all here my wife and I would like to wish you all a very Merry Christmas and Happy New Year.

    Pat & Don

    • Merry19451
      Merry19451 don53138

      Posted

      Dear Pat and Don,

      As a Nurse and Nurse Practitioner, I can attest that Shingles and other diseases do not take holidays.

      I would put on a non-scented hydrating lotion or cream on the dry skin.

      A Merry Christmas to both of you, and a Joyous New Year.

      Merry Juliana

  • don53138
    don53138

    Posted

    Just an update, crusty scales has fallen off most upper arm, but reddish areas where scales came off. lower arm / hand still have scabs where blisters were, but is scaling off in other areas. Wife claims pain has continued and maybe worst at times. This is 4 weeks and 3 days since rash started to appear.

    Last thing PCP did was order an extended steroid taper of Prednisone 60mg (4 days), 40mg (4days) and 20 mg (4 days) to help with hand, elbow, shoulder swelling and hopefully reduce pain. Pat has completed the 60mg and 2 days of the 40mg, but has yet to notice any improvement with swelling or pain. I'm beginning to fear she will have an extended case of PHN, that Merry indicated might be a possibility being in arm that had lymph nodes removed (arm pit).

    Because of Gabapentin supply in a couple days we're planning a slow taper down from the present 1200mg a day over the next 3 weeks. Unless knowledgeable people here on shingles forum think we should reconsider and request a refill.

    • Merry19451
      Merry19451 don53138

      Posted

      Don and Pat,

      I am so sorry, Pat, that the excruciating pain has continued. I would request a refill on the Gabapentin, as it does reduce the neurogenic pain. I would not start a taper yet. I would also request a consultation with a Neurologist who might be able to add additional medications.

      Cymbalta or Venlafaxine, both SNRI antidepressants, are used quite successfully to help with Post Herpetic Neuralgia PHN. I am on Topiramate, an anticonvulsant (similar to Gabapentin) and Venlafaxine.

      It takes an artist in medicine to prescribe these, and other medications, meaning, one who is knowledgeable in these meds, but also excels in listening to the patient, and elicits her problems, side effects of meds, and tapers meds accordingly.

      My best wishes for a better New Year.

      Merry Juliana

    • don53138
      don53138 Merry19451

      Posted

      Merry, thanks again for the great advice. Had another PCP visit 3 days ago about Gabapentin and Percocet refills. PCP finally realized that quality of life was nonexistent refilled both, while allowing enough Gabapentin to go to 1800mg daily for another month and 10-325 on Percocet (now who was it in the beginning that said Percocet needed to be 10-325?) wink.

      After just 3 1/2 days at 1800mg of Gabapentin and excruciating pain under control, I can see a noticeable improvement. Thanks again for your advice.

      Don

  • don53138
    don53138

    Posted

    Just an update of wife’s condition and time line to this point of a bad case of Shingles that might be of interest to others dealing with it.

    Good news I hope she has turned corner from severe pain to lesser degree of pain, now at 6 weeks & 1 or 2 days after first signs of minor arm pain (thought to be sore arm muscles at that point). There is still enough pain she can not use arm but is able to move it some now and elevate to help reduce swelling. It still has some crusty areas and pinkish areas where crust has fallen off. Has only needed one Percocet in two days but still on 1800mg daily of Gabapentin and is now complaining about being bored (good sign I hope).

    Time Line:

    6 weeks & 1 or 2 days ago minor arm pain (thought to be sore arm muscles at that point).

    5 weeks & 5 days ago noticed two or three small pinkish spots on arm.

    5 weeks & 4 days ago arm mostly covered in rash, diagnosed as shingles at that point by Urgent Care. Still only minor pain at that point which extra strength Tylenol was handling.

    5 weeks & 1 day ago started Valtrex anti-viral little later than 72 hour recommended period because of prescription error and stronger old pain killer (Vicodin) on hand from previous operation.

    4 weeks & 6 days ago started Percocet to replace old Vicodin because of out of control pain.

    4 weeks & 1 day ago started 300mg daily Gabapentin, gradually increasing to present 1800mg dailey (started 1 week & 1 day ago).

    2 days ago noticeable difference of pain intensity with less pain control needed other than Gabapentin and crusty skin flanking nearing completion.

    Starting after another 19 days planning a slow 21 day taper down of Gabapentin. Hopefully it will not be needed after that.

  • don53138
    don53138

    Posted

    Wife near end of 8th week still having upper arm (bicep area), shoulder joint pain that increases to 5 pain level at times. She describes it as deeper pain not surface (skin area) pain. Thumb is still swollen and sensitive at tip (unusable) and is still shedding skin. Skin on most of arm still has pinkish areas where rash was but dead skin gone in those areas.

    Question for those that have experienced shingles. Does this sound like still active shingles or example of PHN pain at this point?

    • Merry19451
      Merry19451 don53138

      Posted

      Dear Don and Pat,

      For some reason, the forum didn't update me on your last post, but I am happy Pat, that you are doing better. Complaints of boredom sound better than complaints of pain...

      Any pain past the one month threshold is considered Post Herpetic Neuralgia PHN. As the pain has diminished elsewhere, I would be hopeful that the thumb area would also recover. The fingers have many more sensory nerves than the arm, and it makes sense that it would continue to be painful, unfortunately for you. Be careful of a Gabapentin taper, as you might need it for the thumb and shoulder, and biceps pain. If it gets too painful, please consider continue use of it. I use Topiramate for

      1. migraine prophylaxis initially

      2. Shingles pain recurrent

      3. Joint, back, and neck pain

      4. Neuropathy both feet

      You certainly married the right caring man, unlike some of us, the first time around!

      Please keep us posted!

      It cheers me up to hear you both doing better. Your husband is an honorary RN!

      Best Wishes

      Merry Juliana

    • don53138
      don53138 Merry19451

      Posted

      Merry,

      Thanks for reply, I suspected it would be considered PHN at this point even if thumb had not yet shed the crusty skin and still skin sensitive but just wasn’t sure. IIRC the thumb was last area to develop rash, so makes sense it would be last area to clear. It will be three more days before we begin the 21 day taper (at 8 ½ week mark), if pain does start to increase we’ll definitely consider continuing or requesting a switch to Topirmate as Pat doesn’t have much faith that the Gabapentin is helping.

      Can’t express enough how much your support has meant to us and many others on this forum.

      Thank You So Much!

      Don and Pat

    • Merry19451
      Merry19451 don53138

      Posted

      Don,

      She definitely will know if the Gabapentin has been helping her when she tapers down. I am by no means suggesting she switch to Topiramate. I happened to be on it for migraine prophylaxis, and realized it was helping my Herpes Zoster-Shingles Pain, and probably preventing Post Herpetic Neuralgia PHN. I used far less oxycodone during my episodes and wasn't essentially bedridden.

      Gabapentin can make some people drowsy.

      Topiramate in some people, including my twin, can cause a mental fog. It would be off label use BTW.

      Lyrica causes weight gain and mood swings.

      With medications, it is always:

      Pick your poison!

      Best Wishes

      Merry Juliana

  • christine76458
    christine76458 don53138

    Posted

    Hi Don

    so glad things are improving. 6 weeks sounds about right

    mine took that long, and another few weeks taking things easy

    w

    waiting for red marks to fade . I dont remember any pain after that

    Hopefully you are both on the home strate now

    christine

    • don53138
      don53138 christine76458

      Posted

      Christine,

      Thanks for info, it helps to hear from others with actual experience. Wife is just past 8 weeks now, we’ll definitely be looking forward to red marks fading and hopefully more pain reduction even knowing things are not the same in ever case.

      Thank You, Don

  • don53138
    don53138

    Posted

    My wife’s 10 week update: Had to delay taper down of Gabapentin and stay at 1800mg daily, because pain started to increase again couple days before taper down was started. The thumb is still painful and swollen as are elbow, upper arm and shoulder. We just can’t figure out if the swelling/pain is from nerve damage of from lymphedema she is subject to in that arm.
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