Your Health Matters
By Claudia Parks, R.N.

What a SHOCK! What a PAIN! Dealing with the unwelcome surprise of a case of the Shingles! One million Americans each year over the age of 50 who have had chickenpox will develop herpes zoster, also known as shingles, a viral infection easily identified by the telltale blisters that usually appear on one side of the body. About one in five people who have had chickenpox will develop shingles sometime in their lifetime. Shingles equally affects all races and both sexes, and can occur throughout all seasons of the year and is not limited to the older age group.

After initial infection, the varicella virus (chickenpox) remains dormant in the nerve roots in the spinal or cranial ganglia, where it may reactivate and emerge as a shingles outbreak. What causes the varicella zoster virus to reactivate? Scientists do not know exactly, however they do know more cases are seen in patients over 50. Weakened immune system, certain medical treatments such as radiation and steroids, stressful conditions, malnourishment and even the common cold can trigger an outbreak of shingles.

The incidence of shingles is expected to increase as baby boomers age. But as children who received the varicella vaccine reach adulthood, the incidence is expected to decline because the vaccine has been found to be 94.4% to 98.3% effective in protecting against initial varicella infection that must precede shingles. People who are vaccinated may still develop shingles, but much less often than those who have experienced chickenpox.

Typically, an episode of shingles begins with an unusual skin sensation- itching or a burning, tingling, or shooting pain. Shingles appear on only one side of the body, usually somewhere on the torso, face, neck and lower part of back. Flu-like symptoms, such as fever, headache, upset stomach and malaise, may also be present. Within a few days, the affected area of skin reddens or swells, and a rash of fluid-filled blisters develops. The blisters usually crust over within a week or two and eventually heal. Other symptoms may remain, such as intense, debilitating pain in areas where the blisters occurred- this condition is referred to as post-herpetic neuralgia (PHN). The pain from PHN can be so severe it leads to insomnia, weight loss, depression, and total preoccupation with finding relief. It's difficult to treat and does not respond well to traditional medications prescribed for arthritis or orthopedic pain.

While shingles itself is not contagious, close exposure can pass the varicella virus to others, causing an initial episode of chickenpox. The virus can be transmitted until scabs have formed over all the blisters. Develop good hand washing hygiene as open blisters can transmit virus from hands to eyes or mucous membranes.

See your doctor immediately if you suspect you have shingles. He/she can write a prescription for an antiviral medication, such as Zovirax®, Valtrex®, or Famvir®, and give a pain medication to help your discomfort. Also, the temptation to scratch may be great; try not to scratch! You could cause a bacterial infection. When lesions are open, soothing oatmeal baths, painted-on topical lotions (such as calamine or diphenhydramine 'Benadryl') may help. Compresses soaked with Domeboro® astringent and gel from the aloe vera plant may also relieve itching and pain

. The GOOD NEWS is that the FDA has approved, as of May 26, 2006, a vaccine that has been under development for a number of years to prevent shingles outbreaks. ZOSTAVAX®, is Merck's new vaccine for prevention in adults age 60 and older. The BAD NEWS is that getting a dose of vaccine just may be expensive and somewhat complicated. Because the vaccine must be kept frozen- this makes it is very expensive to keep on hand by doctors and pharmacies- cost ranging around $175 - $200 a dose. The pharmacies order it as needed. Therefore, you will need to follow a procedure to get your shot!

You must get a prescription from your doctor and take it to your pharmacy (some pharmacies are not permitted to sell the vaccine) and they will check to see if your insurance will pay toward the cost. Many drug insurance companies will pay a portion of the amount and some will not pay anything! If your insurance doesn't pay, you may be asked to make a deposit toward the cost. When the drugstore contacts you that your vaccine has arrived- they will keep it frozen- you will need to take an insulated bag to place it in and immediately go to your doctor's office to have it administered. It must be given within 30 minutes of removal from the freezer.

The Union County Health Department will also administer the shingles vaccine. They keep a small amount on hand and the cost is $175.00. You can reach UCHD at 706- 745-6292 for more details or if an appointment is necessary.

Consult with your family doctor about the vaccine. To learn more visit www.cdc.gov/nip or call 1-800- 232-4636 and shinglesandyou. com for photos of the rash.

Claudia Parks, RN, is a former doctor's office and emergency room nurse and retired as an educator from Fulton County Schools. She writes Your Health Matters as a public service; the information here is designed to help you make informed choices about your health. It is not intended as a substitute for the advice of your physician. Claudia can be reached at yhm@windstream.net