DR. Larry A 60 y/o pilot laying over in Bangkok recently contacted me via email. He wanted to discuss an intensifying pain on the top and side of his head which had been present for a few days. In the thirty-six hours preceding our meeting on Skype, he developed a red, raised, bumpy tender rash on his forehead. The usual remedies of Tylenol or Advil weren’t helping the pain and he wondered if he should be worried. It wasn’t affecting his vision or his ability to fly however, it wasn’t pretty and it was keeping him from sleeping.
He was in a bit of a panic, thinking he may have contracted something during his trip to SE Asia. After I had a visual of the problem, the easy part was diagnosing a case of shingles, Herpes Zoster. The hard part was telling him it wasn’t going away anytime soon and it was likely to get worse. In fact, it did get worse. The rash spread and caused his eyelid to become swollen. Fortunately, it didn’t affect his cornea or his vision.
The treatment, an anti-viral medication called Valtrex, wasn’t available to him in Bangkok. Once he got home, he started therapy and over a number of days, the rash started to recede. The pain predictably took a few weeks to diminish to the point he didn’t need prescription pain medication for relief and sleep.
He was relieved to know he did not contract this overseas. He came to learn he developed shingles because he had chickenpox growing up. Simple as that. Why him? That remains a mystery.
After having chickenpox, the herpes zoster virus lays dormant in the nerves of the once affected body. It can re-activate years and decades later to a particular nerve to the skin, thus explaining the way it affects a clearly demarcated band of skin only.
We explain its resurgence as due to a decrease in the body's natural resistance, which may come through other infections, stress, being generally run down, or occasionally, when the body's immune defenses are affected by certain drugs or other immune deficiencies. You might think if this were the case, then everyone someday would develop shingles because everyone at some point is stressed or run down beyond healthy. It actually is common with a lifetime incidence of 10% to 20% , and for those over 85 years of age, at least 50%. We used to believe once a person had an outbreak, they were protected. We now know the recurrence rate is over 5% within the following 8 years.
Shingles wouldn’t garner much attention if the rash were the only problem. Pain is the nasty culprit which brings people to their knees. It’s typically intense, often searing and unremitting in nature and people can't bear clothes touching the affected area. To make matters worse, the pain usually lingers long after the rash recedes. We call this pain, Post-Herpetic Neuralgia, or PHN and it’s not uncommon for PHN to last for weeks, months and in some cases, years. There are therapies for PHN however, many of them are not compatible with flying.
To combat shingles and its disability amongst an aging population, a vaccine was created called, Zostavax. This vaccine reduces the risk of an outbreak by up to 50%. While not perfect, it is something to seriously consider for those at risk. Talk to your health care provider to find out if this is something you might benefit from for one never knows when or where this might pop out.
To your good health,
Dr Larry.
For further information: HERE
Enjoy the Journey!
XOX Karlene
I can't imagine being stuck in a foreign country without the medication needed to treat one's ailment! Thanks for the great advice Dr. Larry!
ReplyDeleteI am going to talk to my dr. about this vaccine. I've known people with horrible cases of shingles, and it's pretty darned awful. One question for Dr. Larry: is there any correlation between how severe a case of chicken pox a person had as a child and the likelihood of developing shingles as an older adult?
ReplyDeleteLinda, there is no association between the severity of a chickenpox infection and the likelihood of developing shingles later on in life. Luck of the draw one might say, since acquiring the virus at all creates the risk.
ReplyDeleteMany providers only recommend the shingles vaccine for people over 65 since that is when it becomes more common and it's how the original studies were set up. With time, I'm sure we'll be giving it earlier and earlier as more people decide they want to minimize their risk of developing the disease and ramifications. Thanks for asking!
Heather, there is nothing worse than getting stuck in a foreign country when you're ill. We definitely appreciate what we have here.
ReplyDeleteLinda, excellent question and Dr. Larry, thanks for the response. Ah... I'm the anti-vaccine person... I'll have to think on this one. But... I have few years until I'm 65.
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