Shingles. Really?

ACUTE HERPES ZOSTER-SHINGLES

I am so sorry you are going through this right now.

I am a Nurse Practitioner in the States. I have had Herpes Zoster-Shingles in my right ear, mouth, and throat every three to five weeks for the past twenty-two years and twice in my right eye. It has now escalated to include my entire right scalp, as well, just to keep me doing more headstands, I am certain.

This is a summary of the stages, signs and symptoms of Herpes Zoster-Shingles, and medical management of the disease.

During the Pre-eruptive Phase, you may have some of the following symptoms:

Duration 1-10 Days, but the rash occasionally takes much longer to appear

Headache

Photophobia

Generalized Aches and Pains

Fever, Chills, and Sweating

Enlarged Lymph Nodes near the pain and rash

Fatigue and Exhaustion

Pain usually preceding the rash, but not always

Itching

Description of pain: deep burning or aching pain, or electric shock–like pains.

Acute Eruptive Phase

Rash of grouped vesicle-blisters in a dermatomal pattern.

Occurs in waves or crops over a period of 5-7 days.

Vesicle-blisters look dissimilar and are of different sizes.

The rash is on a red base.

The pain may continue to increase into the second and third week.

The clear vesicle-blisters cloud over, look like pustules, scab over, and turn black. This process may take between 2-4 weeks. Once every vesicle-blister has scabbed over, you are no longer infectious!

You are considered infectious (contagious) if your rash is open to the air, ie not covered, to anyone who has not had chickenpox. This includes all pregnant women! Remember, not all women know they are pregnant!

Chronic Phase (Post Herpetic Neuralgia PHN)

30 days after onset of rash. Definition varies

Duration may last months or years after initial episode of Herpes Zoster-Shingles.

The resolution of the scars can take up to a year to heal.

Management and Medications

ANTIVIRALS: THE CORNERSTONE OF TREATMENT

Famciclovir 500 mg 3x daily 7-10 days, sometimes 14 days.

Smallest Tablet

Convenient dosing

Least Resistance

Valcyclovir 1000 mg 3x daily 7-10 days

Large Tablets difficult to swallow for some

Based on Acyclovir

Acyclovir 800 mg 5x daily 7-10 days

Inconvenient Dose Schedule

Growing Resistance to Varicella Virus

Acyclovir is the antiviral most often prescribed in the UK

What dosage of the medication are you on? Sometimes, the Physician places the patient on a lower dose, but needs to increase it to help with the pain-itching.

Sometimes, you need to be placed on a cocktail of medications, as they will work synergistically to help you. These are all by prescription. I have grouped them according to class. A clinician would start with one from the Anticonvulsant class, taper the dosage up, then one from the Antidepressant Class, etc. This list is by no means complete.

ANALGESICS

NSAIDS

Ibuprofen

Naprosyn

Acetominophen

OPIOIDS

Oxycodone

Hydrocodone

Codeine

CBD

ANTI-CONVULSANTS

Gabapentin-Neurontin

Pregabalin-Lyrica

ANTI-DEPRESSANTS

SNRIs

Cymbalta

Effexor-Venlafaxine

Heterocyclics

Nortriptyline

Amitriptyline

2. I would find 100% cotton knit clothing. Make sure there are no seams to irritate your skin. The cotton knit is the most breathable, least irritating cloth to most individuals.

3. Use Lidocaine Cream or Spray OTC topically to help with the pain- itching, eg, Solarcaine with Aloe or Bactine. Many on this forum feel either Lidocaine or Benzocaine help with the pain-itching. The cream might soothe the inflamed nerve endings better and last longer on the skin. You can only use Lidocaine 12 hours on and 12 hours off, as the usefulness will extinguish itself.

4. Use ice or cool compresses. Do not take hot showers, as it will only increase the pain-itching

5. You need to rest and sleep. You cannot power through this disease. Do not go back to work! This virus is way stronger than you are, and you will only get more pain, the more exertion you do.
6. Most Importantly, get the Shingrex Immunization. It is a two phase vaccine, two months apart. It is given intramuscularly. It is highly efficacious in stopping Post Herpetic Neuralgia PHN and recurrent episodes of Herpes Zoster-Shingles.

Shingrex is available in the US at the pharmacy and covered by insurance if you are over 50 years of age. If you are younger than 50, and have had a documented case of shingles, it is still covered.

If you are in the UK/Canada/Australia/NZ, I know it has been distributed there, but the national health insurance may not cover it until age 70, which is ridiculous. It is expensive, but I would have paid thousands not to have recurrent shingles.

Best Wishes

Merry Juliana

I to was diagnosed three months ago and I am 72 years old, I of the worse illness I have ever experienced , I am now on Versatis Patch and Pregabalin tablets plus two 500 mg of paracetamol four times a day, they help but still get the after effects of shingles even with all these, I hope you don't have to go through this, every day I tell myself maybe tomorrow things will be beutter.

ask for a rx for topical lidocane and always keep anti virals rx filled to have on hand for future use. very important to reduce the chances of getting recurant and serious outbreaks- rashes in the future. the Shingrex immunization shot will provide you with protection against and future issues and protect against nerve damage . . shingrex has a booster in 3-6 months . your very early in the shingles journey and very lucky no rashes. hopefully you may head it off at the pass and once this current bout is over you will run not walk to the nearest center for SHINGREX. it is very effective protection even once after a shingles outbreak. there is a shortage in the US so be advised to be on a list to be called as soon as shingrex is made available. i dont know if your in the UK , US, ... in the US we dont need a docs approval for these shots and they are available at pharmacies everywhere.

GOOD luck.. STAY shingles free if and when possible. protect yourself with the immunization. i am one of the lucky ones that has not experienced serious rashes at diagnosis of shingles i was advised to obtain the shingles immunization. i received the first immunization 7 years ago and then was advised that the shingrex is more effective and long term protection because the initial dose from 7 years ago losses its effectiveness after time. the new immunization -shingrex is more effective and does not require future immunization updates.

A Week later and the rash isn't so red looking. And still no itching etc! The bowel cancer nurse delayed my appt for two weeks and the radiation for prostate cancer will be some time in January. Maybe I missed the worst of the shingles symptoms...