Living Well I'll never forget the day my friend Porter told me his face was on fire.
He was on his way back home from a trip to Zurich, Switzerland, when huge, bright red blisters appeared on his cheek and ear. The lymph nodes in his neck swelled, and he was in so much pain, he passed out... twice.
When the plane landed, Porter went straight to the emergency room. As he told his Digest readers:
I was clearly an emergency case. Suddenly, half a dozen nurses surrounded me, pulling, injecting, and staring at my face the way you might look at a huge jigsaw puzzle. I knew right away they had no idea what was wrong with me. Then I passed out again.
The doctors told him he had flesh-eating bacteria and pumped him full of antibiotics and pain pills.
But as soon as I saw him, I knew it wasn't bacterial. He had shingles.
Porter became one of the 1 million cases of shingles diagnosed in Americans every year. I helped guide him to the best treatment options and he recovered in a few weeks. He's lucky he avoided the side effects – some people lose their vision, experience strokes, or feel the burning pain for months after the rash clears.
There's a lot of information out there about this horrific disease, so today we're going to answer some of the most popular questions...
What is shingles?
Shingles (or the herpes zoster virus) is an outbreak of painful redness and blisters. Herpes zoster develops from the chickenpox virus. So if you had chickenpox as a kid, that virus never left you. Some of the virus lies dormant in the nerves along your spinal column.
Later in life, that virus can wake up. When it does, it triggers excruciating blisters and redness on one side of the body. Typically it presents in a band along the torso, but it can occur anywhere. I saw a number of shingles patients in my ophthalmology practice, for example. That's because about 20% of shingles cases are in the eye (this is called herpes zoster ophthalmicus) and can lead to blindness.
It's important to remember that shingles is an inflammatory disease. As a recent study in PLOS Medicine showed, the inflammation from a shingles outbreak affects the entire body. That extra inflammation strains the cardiovascular system so much that a person with shingles will see their risk of stroke and heart attack double in the six months after the outbreak.
Is it contagious?
You can pass the virus to someone else if they come in contact with your open blisters – if that person has never had chickenpox. Basic preventive measures like handwashing and keeping your blisters covered help the virus from spreading.
What triggers a shingles outbreak?
If you've had chickenpox or had the chickenpox vaccine, the shingles virus is already inside of you. (There's some debate on the link between the chickenpox vaccine and shingles, but people who receive the chickenpox vaccine and later get shingles typically have less severe outbreaks.)
But there are some triggers that will make it more likely to activate:
1. Age. The older you are, the more likely your chance of getting shingles. One-third of Americans will get shingles at some point in their lives – and that number jumps to 50% for people over the age of 85.
2. A weakened immune system. This happens naturally as we age, but also in folks with certain diseases like irritable bowel syndrome and multiple sclerosis.
3. A stressful event. Stress is one of the biggest triggers for a shingles outbreak. Likewise, injury or even some surgeries may put enough stress on your system to trigger shingles.
4) Immunosuppressant drugs. Medications that suppress the immune system can also increase your risk for getting shingles. For instance, a study published in the journal Annals of the Rheumatic Diseases showed some evidence that rheumatoid arthritis ("RA") patients who were on immune-system-suppressing drugs like Humira and Enbrel had a higher rate of developing shingles than other RA patients.
Likewise, cancer patients going through chemotherapy or radiation also experience weakened immune systems and are at a higher risk for shingles.
What can I do to prevent shingles?
Your chances of getting shingles increase as you age. So keeping your immune system healthy by eating plenty of antioxidant-rich foods and staying active are great ways to remain healthy.
Also, use caution when you're around groups of kids. Whether or not exposure to kids with chickenpox helps or harms your own viral infection is still under debate.
Some studies of middle-aged folks show that re-exposure to kids with chickenpox provides a "booster" to their immune systems. That helps keep shingles in hibernation for a few years. But since you lose antibodies as you age, this might not help so much if you're older – people aged 60 and older should still steer clear of chickenpox-carrying kids.
Also, if you're over 50, you should get the shingles vaccine. It clearly cuts down both the pain and the actual occurrence of the disease. In a large, five-and-a-half year study of 38,500 men and women across 22 sites in the U.S. Department of Veterans Affairs system, the vaccine was found safe compared with a placebo.
The usual complaints from a vaccine occurred: redness, swelling, pain, and irritation at the site of injection. Otherwise, this vaccine appears to be quite safe, and it reduces the pain and occurrence of the disease by at least 50%.
The good news is that the vaccine costs only $190. And while not every insurance company pays for it, Medicare Part D covers it the same way it covers regular vaccinations. And even if you have to pay cash... relative to the pain and suffering this disease causes... it could be the best health care money you ever spend.
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How long does the pain last?
This is a question doctors hear all the time. Pain from shingles typically lasts about 30 days. However, in about 10%-18% of shingles cases, the affected nerves still suffer even after the skin clears. That means the pain lasts for weeks, months... even years.
Few treatments help with the pain, and they come with their own risks. We've written before about the dangers of overdosing on acetaminophen. Other medications include certain types of opioids and antidepressants, but taking these long-term leads to terrible side effects as well.
Some studies have shown promising results with a medicated patch applied to the area and left on for a short period of time. The patch contains capsaicin – the same thing in hot peppers that burns your mouth.
The downside is that the patch might cause its own pain from the capsaicin. Most patients in the study, however, said that the overall relief afterward was worth it.
If you develop shingles, see your doctor immediately. He may put you on antiviral medications to help reduce your risk of developing long-term pain from shingles.
People often refer to shingles as the most painful disease you will ever experience. I plan to do my best to avoid this horrible virus. Do what I do and get your shingles vaccine, manage your stress levels, and take care of your immune system by eating antioxidant-rich foods and staying active.
What We're Reading...
- Watch this video about shingles from the National Institutes of Health.
- One woman's experience with what she called "the dragon in my ribcage."
- Something different: Build muscle – and gray matter – at the gym.