Shingles

Or in French, “La Zona“.

I have, for the past week or so, been dealing with the adult reactivation of the chickenpox (or Herpes Zoster Varicella virus).

You probably have a vague memory (or third party experience) of chickenpox as an infection that causes pustules and severe itching in a child.

This is not that. This is something else entirely.

What is it?

After your immune system beats the HZV virus into submission and your childhood symptoms abate, the virus retreats into the nervous system, goes dormant and lies there until the day you die, safely kept in check by your immune system, which will pounce on it if ever it gets any delusions of grandeur.

Shingles is what happens when your immune system is absent without leave or otherwise distracted or subdued (hay fever combined with infant-related lack of sleep, for example), and the Herpes Zoster virus seizes the opportunity to make a late-stage comeback.

Quick clarification: It’s called Herpes Zoster because it’s from the same family of diseases as the Herpes Simplex virus, which causes cold sores and genital herpes. This is a different virus that shares the same unfortunate name.

So basically it’s chickenpox.

What are the symptoms?

Numerous and unpleasant, they come in stages.

  1. A prickling, burning, pins-and-needles-like feeling in an area of your body. Typically only on one side of the body. This is often accompanied by a slight fever and a sense of general malaise. This lasts 2 or 3 days.
  2. A rash begins to appear in the related area. It’s not really a rash, but more a collection of pustules that will gradually fill with virus-loaded lymphatic fluid. This will appear and spread in an area governed by one or two dermatomes, over a period of days. The virus is still replicating in the nervous system, causing inflammation and can cause a truly staggering amount of pain.
  3. The rash weeps, crusts over and begins to heal. The pain continues. This takes between a few days and a few weeks.
  4. Everything heals up and you very much hope that you don’t develop post herpetic neuralgia where the pain continues for a period of months or years because of the damage caused to your nerves.

If you are unlucky, the virus hits you in the face and then creeps around your eye. This results herpes zoster ophtalmicus, which starts with an itching, burning sensation in the eye and can result in all sorts of sight-threatening consequences. This is the scenario doctors are worried about because it can cause permanent damage. If it reaches your eyes, you have to go to an eye clinic or an emergency room immediately unless you already have a treatment for the eye.

How is it treated?

To tackle the virus

You take antivirals, typically Aciclovir (which is Zovirax in pill form). Five pills a day at four-hour intervals. It’s important to take them regularly and one of the biggest problems with the treatment is that people fail to adhere to the protocol. So if you are reading this because you have Shingles, set your alarm, take your pills, on time, every time.

There are alternatives – new modern antivirals – but Aciclovir is known to work. It doesn’t magically kill off the virus, that would be too good to be true. It breaks down into chemicals, one of which competes with another chemical building block for incorporation into the DNA chain of the Herpes Zoster virus, and in cases where it successfully incorporates it prevents the virus from replicating further. In other words, it messes with the replication of the virus, slowing it down and buying time for your immune system to prepare a response.

To deal with the pain

Paracetamol, one gram at a time, four times a day, at minimum four hour intervals. This one’s a problem because if you do the math, 4 times 4 hours does not cover the 24 hours in the day and when the painkillers wear off, the discomfort (as doctors like to refer to extreme pain) is quite significant.

Don’t wait for pain to arrive before taking Paracetamol, you’re better off taking it at regular intervals to ensure the right amount of analgesic is in your bloodstream over time, and until you fall asleep.

You can also take Ibuprofen, which is a relief since it allows you to cover the gaps in the daily schedule that Paracetamol cannot cover, but one doctor told me that he didn’t think taking an anti-inflammatory was a good idea when you have Shingles, because it could slow down recovery. I found no reference to this online, but he put enough doubt in my mind that I stopped taking the Ibuprofen and dealt with the pain during the nights.

In extreme cases you can get prescribed opioids (codeine and stronger). I don’t like these drugs, they make me dull, slow and senseless, so I didn’t even think to ask for them, although with hindsight it would perhaps have been helpful for the worse two days of my particular episode. It’s not like I was able to function with the pain anyway.

To deal with Shingles reaching your eyes

In my case, Zovirax ocular ointment, five times a day, in the conjunctival sac. This involves you peeling your eye open and shoving a cream directly under into the area beneath the eyeball. It’s horrid and you have to do it to the same schedule as the pills. On the other hand, the risk of impaired sight or blindness is far worse than shoving cream into your eye, so no complaints there.

To deal with risk of contagion

Don’t touch an unvaccinated child who hasn’t had chickenpox. Anyone who has had chickenpox is immune, but you can set off an infection in a child or an adult who has no immunity if they come into contact with the lesions or the fluid within them. Chickenpox in adults is no joking matter and best avoided. Shingles is not as contagious as chickenpox, but it can be spread by contact with infected lymph.

To deal with the depression

If you develop post-herpetic neuralgia and your pain continues for some considerable time (weeks to months), then the ongoing pain and its impact on your daily life can have significant effects on your mental wellbeing. Antidepressants are sometimes prescribed to help deal with this.

I’m not at this point right now, I’m waiting for the lesions to clear up, so I’m still in quite a lot of pain but that’s normal at the moment, and I’ll find out if I’m one of the unlucky ones in a couple weeks if the pain fails to abate.

Bear in mind that if you are depressed, you’re usually the least qualified person to identify the cause, so go see someone and don’t just guess that it’s nothing to do with the persistent discomfort you have after an episode of Shingles.

In conclusion

Shingles is a deeply unpleasant viral infection that causes significant physical pain because of its effects on the nerves. It’s also unsightly as it causes painful and very visible red lesions in the affected area. In almost all cases, however, it responds well to treatment and disappears rapidly once the infection has run its course.

In my case, the infection peaked after 7 days of frankly extreme pain. Paracetamol is my new best friend. I took the antivirals religiously and applied the Zovirax ointment to my eye every four hours after V’s paediatrician saw me and wrote out a prescription.

“Your daughter’s in great shape, developing physically and mentally in accordance with expectations. You, on the other hand, are in a sorry condition, and that rash is perilously close to your eye, so take this…”

I really hope you didn’t come here because you’ve got Shingles, but if you have the rash and the pain, you also have my sympathies and I hope you make a rapid recovery. The worst part of it is not being able to give your daughter a hug.

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