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Medical Varicella zoster virus in those over 50 ACK

  1. Jan 14, 2012 #1

    rhody

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    Just when you thought I could breathe a sigh of relief and was feeling good for a couple of weeks, Blam, shingles, son of a .....
    A quick call to my brother in law who is about ten years younger than me confirmed the symptoms. He said the best advice is to get on an antibiotic as quickly as possible to keep the spread of the virus from advancing along other nerves. It was weird too because the last few days I have been having pain above the area where my kidney stone was removed. I thought it was another one. I am glad it wasn't but this is no fun either. I have a call in to my Dr now, hopefully he will trust my symptom description, and I can get the antibiotic no later than tomorrow. My brother in law waited over a week and he got a pretty bad case and has had tingling and discomfort from time to time since then, it comes and goes. My personal belief is that stress can bring it on, but I have no absolute proof, but recent bout with kidney stones and recent work stress certainly didn't help the situation.

    Funny I was feeling especially upbeat health wise, and will try to continue that feeling despite this. The Dr just called and is calling in the prescription now, so I won't have to wait until tomorrow, that is a good thing.

    Rhody... :yuck:

    P.S. I just had a thirty minute sneezing fit, until I remembered that old trick I learned awhile ago, grab your lower lip squeeze and shake, I did it for about five minutes and it worked, then the urge to sneeze returned, more squeezing and shaking and now it has subsided. Took a couple of benadryl too to address the itching.
     
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  3. Jan 14, 2012 #2

    Evo

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    I'm really sorry to hear this, I hope that you are still going to the doctor to confirm what is wrong. My doctor would never agree to call in anything without an examination first, I'm surprised your doctor didn't insist that you be seen by a physician first.

    Hope you feel better soon.
     
  4. Jan 14, 2012 #3

    rhody

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    Evo,

    I have known my Doc for fifteen years, in all my visits I would say 95% of the time I would tell him what I thought was wrong with me and was proven correct. This is one of those circumstances where waiting would be foolish. I could suffer long term effects not pleasant for years to come by waiting. I will make an apt on Monday to confirm I was correct. I saw my brother in laws rash and mine matches it exactly. I checked online google images of it as well, same thing.

    I find it curious that the breakout site is on my right side almost parallel to my right kidney. Coincidence ? Remember my right kidney and ureter had a stinking stent in it for 9 days. Less than two weeks later, shingles.

    Rhody... :bugeye:
     
  5. Jan 14, 2012 #4

    turbo

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    Sorry to hear that rhody. My wife's uncle suffered debilitating bouts of shingles when he was in his 60's. I hope you can get it under control. I had chicken pox (bad!) when I was a kid, and I am praying that my stressed immune system doesn't lay me open to shingles. I wouldn't wish that crap on anybody. He was a cranky old guy, and the cousins used to tell their kids to call him "uncle agony" instead of "Anthony" for all his complaining, but he really did have something to complain about when the shingles kicked in.

    When someone lives on a pristine pond and loves fishing and he is in too much pain to walk out on the dock and make a few casts now and then to try to pick up a smallmouth or a brookie for supper, you know that the suffering is real. You don't give up some dearly-loved activity like that without a reason.
     
  6. Jan 14, 2012 #5

    Evo

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    Rhody, you can't treat a virus with antibiotics. Aside from the fact that it won't help, it's irresponsible for your doctor to prescribe an antibiotic for anything without seeing you first. Do you mean you requested anti-viral medication?

    http://www.webmd.com/skin-problems-and-treatments/shingles/shingles-treatment-overview
     
  7. Jan 14, 2012 #6

    rhody

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    Evo,

    I didn't tell him what to prescribe. He didn't ask, he knew. He just wanted to know how long I had the rash. I have valacyclovir, 1 gram, 3 times daily, 7 days. I checked your link, he prescribed one of the recommended meds, listed above.

    Rhody...
     
  8. Jan 14, 2012 #7

    rhody

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    Has anyone had a bout of shingles shortly after surgery, stress or trauma ?

    Rhody... :yuck:
     
  9. Jan 15, 2012 #8

    bobze

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    Shingles, like you pointed out is caused by the Varicella-Zoster virus (or VZV). As Evo points out antibiotics don't work against viruses. VZV is a herpes virus (human herpes virus 3) and like other herpes viruses (in deed like most DNA viruses) they establish latent infections.

    VZV, the first time around, causes chickenpox. HSV 1-3 have a predilection for neurons. With VZV this predilection is for dorsal root ganglia neurons. When you become immunosuppressed it is possible for the virus to reactivate and spread down the dermatome that sensory nerve innervates. This leads to that painful rash isolated to one "stretch" of your body that VZV causes.

    [Strike]The chance of developing post-shingles neuropathy is low and the exact circumstances that lead to it are not fully understood. I don't believe the number is as high as your OP states IIRC. Possibly in the elderly it is more common, but in the general population with shingles I believe it is actually pretty low. So I would try not to worry over it too much. [/Strike]

    Edit again; apparently there is not strikethrough, you'll have to use your imagination! :redface:

    Edit: Nevermind. It appears to be a pretty common complication :(. I was thinking of transverse myelitis which develops in <1% of patients post shingles. If it makes you feel any better with some anecdotal evidence: I actually had shingles while in undergrad (dirty living conditions, post-bronchitits, not eating healthy, partying a lot etc) and didn't develop it. Referring back to some of our literature from micro, less severe reactivations of the virus generally tend to have less post-shingles neuropathy complications. So here is to hoping you only had a small outbreak!

    Having just come through surgery and being older (?I'm guessing?), its not really surprising. There is (of course of little help to you now) a shingles vaccine. It doesn't actually prevent you from getting the virus (remember you acquired it when you got chickenpox--the little bastard has just been laying dormant in your neurons all this time), but will prevent reactivation of virus.


    The meds your doctor gave you are actually herpes anti-virals. Valacyclovir (VACV) is actually just the L-valyl ester of acyclovir (that popular herpes med you see commercials for on TV). Since VZV is a herpes virus and is closely related to other herpes viruses (HSV1/2, EBV, CMV, etc) valacyclovir works on it. The doses needed to treat non herpes simplex viruses are higher however, which is why we use valacyclovir a lot for non-life threatening herpes infections. It has much better oral bioavailablity than does acyclovir (same deal with ganciclovir/valganciclovir as well). Compared with the original drug, you have it easy you should be happy :P. You could be taking 5 or 6 pills a day! VACV has less side effects as well.
     
    Last edited by a moderator: Jan 16, 2012
  10. Jan 15, 2012 #9

    atyy

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    Do they still say it's only worth taking if you've had the rash for less than ~48 hours?
     
  11. Jan 15, 2012 #10

    rhody

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    Yes, atty he did, and it was just about at the limit so I said yes.
    I'll give you a dorsal root ganglia, would love to arm those structures with nano punji sticks, lol. Seriously, though, don't you both find it odd that the stress of living through kidney stone treatment, combined with work stress, and a short time later < 2 weeks then boom, here we go with shingles, and almost in the exact place of the right kidney and ureter which had to endure a stent for nine freaking days !!??

    I know we aren't getting into dispensing medical advice here, (Ryan is watching, hehe, thread lock gun is loaded, finger is on the trigger, lol), but the Doc has got me on one gram Valacyclovir three times a day for the next seven days. With such a large dose, this is a yes or no question, does that weaken me if I need this type of medication in the future ?

    I wanted to say thanks for your support bobze, atty, it is appreciated. I will post a picture of the biggest area if you wish. It feels like someone hit that area with a scrub brush from a grill. One more factor I didn't mention that me or may not be relevant. I took my beast of a motorcycle out for a twenty minute ride in 30 degree Fahrenheit weather with heated gloves that barely helped. It felt good when I got back, but chilled, then an uncontrolled sneezing fit started. I swear I must have sneezed at least two hundred times. My nose wouldn't stop running either. That couldn't have helped the situation. :redface:

    Rhody...
     
  12. Jan 15, 2012 #11

    lisab

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    Since there's a chickenpox vaccine now, kids rarely get it anymore. So they won't have the virus in their system. Does this mean they can't get shingles as an old person? Does the chickenpox vaccine last a lifetime? Will they need a booster as they approach old age?

    Is the chickenpox vaccine identical to the shingles vaccine, since it's the same virus?
     
  13. Jan 15, 2012 #12

    atyy

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    Wow, it's getting harder to be a kid - one less excuse to skip school!
     
  14. Jan 15, 2012 #13
    There is now a vaccine for this virus that you can get while you are older to boost your memory b cell population with ig's to VZV. You should look into it.
     
  15. Jan 15, 2012 #14

    rhody

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    What about a poor soul like myself, is it fruitless to have a booster shot now that I have had an outbreak of shingles ?

    Rhody...
     
  16. Jan 15, 2012 #15
    It is not fruitless because as you get older your memory b cells (immune cell that remembers Zoster) die. The Center for Disease Control is generally a reliable source of evidence based medicine and they recommend it for anyone 60 or older. Here's the paragraph from their report:

    And here is the full report:

    http://www.cdc.gov/mmwr/PDF/rr/rr57e0515.pdf
     
  17. Jan 15, 2012 #16

    bobze

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    Correct, if you are vaccinated against chickenpox--In theory you should never need the shingles vaccine or be able to get shingles. The populations of memory immune cells does tend to decrease over time--With some vaccines more than others.

    However, the chickenpox vaccine is a live attenuated virus so life-long immunity is generally very good (I think their numbers are somewhere around 80-90%). Of course people can always get a low dose or have a sub-par immune response and still get a very mild form of chickenpox though. If that were the case, in theory they could get shingles as well.

    The shingles vaccine (Zostavax) is the same strain of attenuated virus as the chickenpox vaccine (Varivax), just delivered at a much, much higher dose. Since someone getting the Zostavax has had chickenpox and has an immune response in place against VZV already, then the large dose is okay and just ramps up the production of immune response to VZV, such that it will suppress shingles. You cannot use the shingles vaccine in someone who is not immunocompetent to VZV already and you cannot use the chickenpox vaccine to create a large enough response to suppress shingles in someone with VZV latency.

    Rhody, the CDC recommends that all persons over the age of 60, regardless of having had shingles before or not, get Zostavax. Most people only ever have one bout of shingles in their lives, baring other immunosuppression complications.

    It is possible however to get shingles more than one time and having it once doesn't necessarily protect from getting again. There is no formal evidence to show having one out break is sufficient to protect against others, however that is "formal evidence". The fact that clinically, most people only ever deal with one (or less than one) outbreak of shingles suggests it obviously provides some protection against subsequent outbreaks (at least in immunocompetent individuals).

    Whether you get the shingles vaccine or not will be up to you and your doctor. I would bet that if you are normally healthy though (aside from your stone bout) and not 60 yet, then he'll recommend you just follow the guidelines for getting the vaccine (single dose at 60).
     
  18. Jan 15, 2012 #17

    Moonbear

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    This is an excellent reason to get the vaccination instead of the "chicken pox parties" some parents ignorantly use as an alternative to vaccination.

    Valacyclovir, acycolovir, etc. are antiviral medications. That's the correct thing for shingles/chicken pox, not an antibiotic. However, a doctor prescribing an antibiotic is not necessarily wrong either. The lesions produced by the virus are susceptible to secondary bacterial infection. Back before antivirals were developed, antibiotics were still prescribed simply to prevent skin infections from so many open sores.

    What I've always thought was interesting about shingles is that it doesn't affect all nerve endings, but will pick just one spinal nerve somehow and affect all areas of skin supplied by that single nerve. That's why the most common shingles symptoms occur in a "belt" of skin around the torso; that's just the area affected by one spinal nerve. I've always wondered why not all of them, or at least more than one?
     
  19. Jan 15, 2012 #18

    bobze

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    Not that I really see any difference between the two, so more just an fyi thing;


    Its probably best to use the Vaccines: Home from CDC for your most up-to-date vaccine information. They adjust and change the recommendations almost yearly. The recommendations for VZV were updated in Sep. 2011; CDC VZV recommendations, which are "more current" than the 2008 MMRW original recommendation you provided Phys. Though again, I don't think they changed much.
     
  20. Jan 15, 2012 #19
    Thanks to bobze, I found the new recommendation which includes ages 50 - 59 based on a 70% reduced risk of getting zoster.

    http://www.cdc.gov/vaccines/vpd-vac/shingles/hcp-vaccination.htm#recommendations [Broken]
     
    Last edited by a moderator: May 5, 2017
  21. Jan 15, 2012 #20

    rhody

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    Thanks for the heads up, bobze and PhysiPhile, why does the FDA recommend this and not the AMA ? I printed your post PhysiPhile and will show it to my Doc when I see him.

    Rhody... :smile:
     
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