Week 5: What should I be looking for?

In order to catch shingles early, you should be educated in what to look and feel for.  We always hear of signs and symptoms, but what is the difference between the two? Signs are a condition that is visible to the patient as well as others.  Symptoms are any description the patient has of the condition in question, essentially something others can’t see.  With shingles, the most common signs and symptoms include (Mayo Clinic, 2014)…

• Pain, burning, numbness or tingling in a specific area (symptom)
• Sensitivity to touch (symptom)
• A formed red rash that begins after the pain (sign)
• Itching (symptom)

Other individuals may experience additional signs and symptoms that include…

• Fever (symptom/sign)
• Headache (symptom)
• Sensitivity to light (symptom)
• Fatigue (symptom)
• If the rash is located on the face, loss of vision may occur (symptom)

http://www.adultandpediatricdermatology.com/pics/pic046.jpg

The rash is the most prominent sign of shingles. As previously stated, the rash will form around a segment of a dermatome (see previous weeks for more information and photographs!). Once the rash appears, the blisters can open up. It is during this phase that the person is contagious since the virus lives inside the exudate. Transmission is caused by direct contact (CDC, 2014).  This means that the fluid from the blisters would need to come in contact with another individual.  From there the virus can enter the body through cracks in the skin, by mouth, and other portals of entry.  Although the other person cannot contract shingles itself, they can contract the virus. If a person has not previously had the chickenpox or the vaccine, then they may develop the chickenpox if coming in contact with the open sores (CDC, 2014). After the blisters open, a scab will begin to form over them in 7-10 days (CDC, 2014).  Once this scab has formed, you are no longer contagious.  Until this time, it is important to keep the rash covered, avoid scratching the rash, and most importantly WASH YOUR HANDS (CDC, 2014)!

Below I have listed a timeline on when these symptoms may appear, and how long it will last.

 

National Institutes of Health. (April, 2013). Shingles. NIH SeniorHealth. Retrieved from http://nihseniorhealth.gov/shingles/symptomsanddiagnosis/01.html

This link also provides additional information on the timeline of the signs and symptoms for shingles in addition to the ones listed in the reference section.

http://nihseniorhealth.gov/shingles/symptomsanddiagnosis/01.html

References:

 Centers for Disease Control and Prevention. (September, 2014). Transmission. Shingles (Herpes Zoster). Retrieved from http://www.cdc.gov/shingles/about/transmission.html

Centers for Disease Control and Prevention. (May, 2014). Signs & Symptoms. Shingles (Herpes Zoster). Retrieved from  http://www.cdc.gov/shingles/about/transmission.html

Mayo Clinic. (December, 2014). Symptoms. Diseases and Conditions: Shingles. Retrieved from http://www.mayoclinic.org/diseases-conditions/shingles/basics/symptoms/con-20019574

National Institutes of Health. (April, 2013). Shingles. NIH SeniorHealth. Retrieved from http://nihseniorhealth.gov/shingles/symptomsanddiagnosis/01.html

Week 4: How do I know if what I have is Shingles?

The diagnosis of Shingles is pretty simple in fact.  You can seek help from your primary care provider, or other health providers.  Sometimes, a provider may refer you to a dermatologist.  Dermatologists are physicians that specialize in treating conditions of the skin (DermNet NZ, 2014). 

http://www.dermnetnz.org/dermatologist.html

To diagnose shingles, the physician will most often observe your skin lesions, and ask some questions.  These questions may include… “Have you ever had the chicken pox?”  “ When did this rash first appear?”  “Describe your pain that you are feeling around the affected area.” “What have you been doing to treat this rash?”  If the provider is still uncertain about the characteristics of the rash, along with your responses to their questions, they may scrape off part of the blister to be examined under a microscope (American Academy of Dermatology, 2015). 

Individuals who are immunocompromised may have a rash that expands outside of the one dermatome.  This can throw providers off in their diagnosis of Shingles since that dermatome pattern is a hallmark sign (CDC, 2014). By looking at the sample, physicians can appropriately treat the rash if they were previously uncertain about what was causing it.  The shingles virus, a different virus, bacteria, an allergic response, or something else could cause a rash.  Diagnosis becomes more complicated if your rash has not erupted before seeking medical attention (CDC, 2014).  In these instances, a provider might perform a blood test.  With the blood test, the provider is looking to see if your body has formed antibodies to the virus.  This means your body has been previously exposed, and has built defenders to attack the virus if it enters your body again.  This is not considered the best practice since most individuals have received the vaccine (CDC, 2014). 

It is incredibly important to seek care if you are concerned about acute pain or a visible rash.  Although shingles can clear on its own, you may be left with pain, numbness, and itching for years to come (ADA, 2015).  An early diagnosis is the only thing that can save you this trouble.  With early diagnosis comes early treatment. 

Here is an overview from a Dermatologist discussing different rash distributions, what nerves are involved, and why early diagnosis is important.

References:

American Academy of Dermatology. (2015). How do dermatologists diagnose shingles? Shingles: Diagnosis, Treatment, and Outcome.  Retrieved from https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/shingles/diagnosis-treatment

Centers for Disease Control and Prevention. (May, 2014). Diagnosis and Testing. Shingles (Herpes Zoster). Retrieved from http://www.cdc.gov/shingles/hcp/diagnosis-testing.html

DermNet NZ. (December, 2014). What is a Dermatologist? What is Dermatology? Retrieved from http://www.dermnetnz.org/dermatologist.html

Photos

Oakview Dermatology. What is a Physician Assistant? Physician Assistant. Retrieved from http://www.oakviewderm.com/physician-assistant.html

Week 3: How does this happen inside of my body?

As I have stated before, the virus first enters you body as chickenpox, or as a component of the varicella vaccine.  Even though the naturally occurring infection clears on the outside, the virus remains hidden on the inside.  The virus is able to remain dormant.  Dormant means that the virus is still alive within you, however it is not causing harm to the body.  This is how shingles is able to appear tens of years later after initial infection.  When the immune system is weakened, the virus is able to rapidly multiply once again (CDC, 2014).  The virus reemerges as the Herpes Zoster virus (CDC, 2014).  The virus will thrive in your spinal nerves, or more specifically the dorsal root ganglia where it has been hiding all this time (CDC, 2012).  The virus can also sit in your cranial nerves, which surround your head. Once in large numbers, the virus can make its way to the skin (NIH, 2014). 

http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html

When the virus reaches the skin, it continues to multiply; Soon, a rash with form (NIH, 2014).  When you look at your rash, it may appear to be in one specific segment along your body.  This is because the affected area is the space that is innervated by the nerve internally.  This is more commonly known as a dermatome (CDC, 2014).  (Picture) Most often, the rash forms in the dermatomes around the abdomen and rib cage.  However, as I stated before, the virus can attack nerves on the face, which can lead to debilitating injury if the disease progresses (NIH, 2014). 

http://doctorspiller.com/herpes_zoster.htm

The body inherently understands that foreign invaders are attacking it, so the inflammation process begins (NIH, 2014).  Different mediators are sent to the location of the virus in attempt to attack the offenders.  Inflammation leads to pain, heat, redness, and swelling.  This defense mechanism is what causes the individual the most irritation.  This pain can remain even after the rash is healed, like you have been experiencing (NIH, 2014). 

So as you can see, there is a simple mechanism as to how this disease causes so much trouble in an individual’s life.  Below are some videos that break down this information again.

 

References:

Centers for Disease Control and Prevention. May, 2014. Clinical Overview: Shingles (Herpes Zoster).  Retrieved from http://www.cdc.gov/shingles/hcp/clinical-overview.html

Centers for Disease Control and Prevention. May 2012. Varicella.  Epidemiology and Prevention of Vaccine Preventable Diseases. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html

National Institutes of Health. (November, 2014). Shingles: Overview. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072808/

Photos:

Centers for Disease Control and Prevention. May 2012. Varicella.  Epidemiology and Prevention of Vaccine Preventable Diseases. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html

Spiller, M. 2000. Herpes Zoster. Retrieved from http://doctorspiller.com/herpes_zoster.htm

Week 2: You are not alone

Epidemiology is a branch of medicine that deals with the incidence, distribution, and possible control of diseases and other risk factors relating to health (Merriam-Webster, 2015).  Government organizations such as the Centers for Disease Control and Prevention, and the World Health Organization are excellent resources to research this information of whatever disease you may be interested in.  Below I have highlighted the major epidemiological data for Shingles.  If you are interested, I have also listed some additional readings on the topic. 

Who is at risk?

Some individuals like yourself Dad, are more likely to encounter this illness in your lifetime than others.  Most importantly, only individuals that have been naturally exposed to the Varicella Zoster Virus (chickenpox), or those that have received the varicella vaccine, can end up with Shingles (CDC, 2014).  For individuals over 40 years old today, about 99.5% have experienced chickenpox (CDC, 2014)! The Shingles infection often flares when your body is working hard, such as experiencing a suppressed immune system.  Individuals with cancer, HIV, those that have undergone transplants, or those taking immunosuppressant medications such as steroids are at high risk (CDC, 2014). 

What are the rates?

Every year in the US, about 4 people out of every 1,000 experience Shingles (CDC, 2014).  Those rates increase as age increases.  For example, out of people over 60 years old, it is 10 people out of every 1,000.  Adding this up, there are about 1 million cases annually in the US.  Out of those 1 million cases, about 1-4% seek hospitalized care.  Unfortunately, 96 of those people will succumb to complications of the disease (CDC, 2014). 

Path of destruction…

The general trend of cases has been gradually increasing though out the years.  The overall cause is unknown, but this could be due to the growing aging population of the baby boomers such as yourself.  It is also found that more women than men, and more Caucasians than African Americans (CDC, 2014). 

As you can see, many others are experiencing the same thing as you.  Here is a support group for shingles if you want to talk about your story, and learn more from others. http://www.dailystrength.org/c/Shingles/forum

Additional Readings

http://www.cdc.gov/shingles/hcp/clinical-overview.html

http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292851/

References

Centers for Disease Control and Prevention. May, 2014. Clinical Overview: Shingles (Herpes Zoster).  Retrieved from http://www.cdc.gov/shingles/hcp/clinical-overview.html

Merriam-Webster. 2015. Epidemiology. Retrieved from http://www.merriam-webster.com/dictionary/epidemiology