A Young Shingle Gal  

(Len Spoden - For The Washington Post)

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By Terri Sapienza
Washington Post Staff Writer
Tuesday, October 4, 2005

After the sores broke open and I got a pain in my chest -- not on my chest, but deep inside my chest -- I knew it was time to call the doctor.

The episode had started a week earlier, as seven bumps appeared on the right side of my chest running in a crooked, vertical row. I assumed I'd been bitten by something. A few days later the bumps sprouted white tops and then multiplied -- another patch of bumps emerged under my right arm. The itching got worse. Poison ivy, I figured. I used cortisone cream and willed myself not to scratch.

But chest pain has a way of getting your attention, as did the headaches and a burning sensation under my arm. I headed for the doctor.

My physician, Peter J. Ouellette of Georgetown University, took one look, asked a few questions and announced his diagnosis: shingles.

I repeated it, to make sure I had heard correctly. Shingles.

I had heard of shingles, but had no idea what it was or what it meant. "It's one of the adult forms of chickenpox," Ouellette said, reassuringly. "You'll be fine."

He told me it would take a couple weeks for the blisters to go away and (probably) a couple of weeks more for the pain to dissipate. He also told me that my waiting had cost me: At this point in the disease, medication wouldn't help. I simply had to let the virus run its course.

Though I didn't verbalize it at the time, I had in my head the same question my sister asked me later that day: "Isn't shingles an old person's illness?"

And if it is, how in the world did I get it at age 35?

After a person recovers from chickenpox, the virus that caused the illness does not completely go away; it lies dormant in the nerve cells that run parallel to the spine. For reasons not fully understood, the virus can become reactivated after a long period, sometimes decades. When that happens, you've got shingles, also called herpes zoster.

The biggest risk factors for reactivation are increasing age and a weakened immune system, which explains why the disease is most commonly seen in older people. However, plenty of younger people come down with shingles when -- for sometimes no apparent reason -- their immunity is low. Infants of women infected with chickenpox during pregnancy can get shingles, too. People of any age who are severely immunosuppressed (anyone undergoing radiation or chemotherapy treatments for cancer, those who are HIV-positive or who have had a transplant operation) also have an elevated risk of the disease.

Though shingles cannot be transmitted to another person, someone with shingles can transmit the virus to a person who has never had chickenpox. That person will get chickenpox, not shingles. The virus is transmitted by contact with fluid from the blisters. The contagious stage lasts until the rash crusts over, usually 10 to 14 days.

When the virus reactivates, it damages nerve cells (which is what creates the pain), then travels to the skin's surface and produces a rash.

Early signs of shingles can include a slight temperature, headache and upset stomach. There can also be pain, itching, burning, tingling, numbness and general discomfort in the area of the skin where a rash will eventually appear. Even so, shingles is often difficult to diagnose in its beginning stages.

"Unfortunately, the early symptoms of shingles are not distinctive or specific enough to alert a doctor to what is exactly going on," said Myron J. Levin, professor of pediatrics and medicine at the University of Colorado School of Medicine. Only after the rash appears are doctors able to really know what they are dealing with.

Four or five days after the first symptoms, a rash will usually develop. It begins as a small cluster of bumps, commonly as a band around one side of the waist, chest or face. The distinctive distribution of the rash helps doctors diagnose the illness and explains its odd-sounding name, which is derived from the Latin "cingulum," meaning belt or girdle.

At this stage, burning sensations and sharp, severe pains can begin.

After two or three days, the bumps become fluid-filled blisters, which will burst open, then crust over, forming scabs. The blisters typically heal 10 to 14 days after the start of the rash. In some instances, scarring occurs. Viruses latent in other nerve cells can cause shingles again, usually in a different place, but Michael Oxman, infectious disease specialist at the VA San Diego Healthcare System says this is rare, since one case of singles usually boosts immunity against the virus.

Antiviral medication, such as acyclovir, famcyclovir and valacycilovir, can be taken to reduce pain and accelerate the healing process, but as my doctor had pointed out, it's most effective if taken within 72 hours of the onset of the rash.

Except for my age, I'd had a classic case so far.

Shingles Classic

After the rash has healed, shingles can get really nasty. Pain can persist or reappear. This is known as postherpetic neuralgia (PHN), or leftover pain. People with PHN -- usually those who are older and sicker -- no longer have the virus multiplying and affecting nerves; instead, they are suffering from damage to their nerve tissue.

PHN can make everyday activities difficult and daily stimuli -- the touch of clothing on skin, the feel of a breeze -- unbearable. It can be debilitating and last for months or years. It can also lead to depression.

PHN is "uncomfortable and disabling," said Phillip Brunell, a special volunteer at the National Institute of Allergy & Infectious Diseases (NIAID), a branch of the National Institutes of Health (NIH). "People can't sleep, some can't work and they're in constant pain. It's a condition that's difficult to manage."

Pain can often be reduced, though usually not eliminated, through a combination of drugs including steroids, painkillers, antidepressants and anti-seizure medications.

Tough Bullet to Dodge

Not every young shingles sufferer is as lucky as I was.

Eric Zoellner, 43, a home builder from Annapolis, recently felt intense pressure behind his eye. He figured it was the start of a sinus infection.

When he went to his doctor, he learned he had shingles with a particularly troublesome complication: herpes zoster ophthalmicus (HZO). Zoellner developed bumps underneath the eyebrow, around the eye socket and on one side of his nose.

He dealt with the virus and its resulting pain for eight weeks, suffering from pressure in his eye, sensitivity to light, blurred vision, headaches and loss of sleep and appetite. At one point, the pain was so bad his head would hurt when the wind blew.

"It's excruciatingly painful," said Zoellner. "And a slow and frustrating recovery."

Katie Dowling, 29, a speech therapist from Chevy Chase, came down with shingles at age 16. Dowling recalls "a small patch of scaly, itchy bumps" that appeared on the top left side of her chest and ran over her shoulder and down her arm. She thought it was a simple skin rash. Then a friend's father, a dermatologist, took a look and told her she had shingles.

Dowling doesn't recall feeling ill before the rash appeared, only "dealing with typical high school stresses at the time" -- balancing schoolwork, studying for SATs and handling several extracurricular sports activities. Her case was mild. It took only a couple weeks for the blisters and itchiness to subside, and she suffered no lingering pain.

The Good News

The good news for people who have suffered from shingles is that fewer than 5 percent will get a second case.

Other good news: A vaccine may be coming. The Shingles Prevention Study, a clinical trial led by the Department of Veterans Affairs (VA) in collaboration with NIAID and Merck & Co., found that an experimental vaccine cut the risk of developing shingles in people 60 and over by half and reduced the chance of developing PHN by two-thirds. If approved by the Food and Drug Administration, the vaccine could prevent 250,000 cases of shingles in the United States each year and significantly reduce the severity of the disease in another 250,000. (It would offer no benefit to those who already have the condition.)

"Even if the vaccine is approved, it does not mean the elimination of the virus entirely," cautions Oxman. "It will still be important for physicians and patients to be aware and alert and recognize the characteristics and symptoms of shingles so they can seek treatment. The sooner you initiate antiviral therapy, the better off you are."

Shortly after my visit to the doctor, my blisters healed. I experienced some lingering pain accompanied by minor burning sensations and headaches, but only for a short time.

Three and a half months after my first symptoms, the only reminder of the virus that remains is the faint imprint of tiny scars upon on my chest.

My four-week encounter with shingles was uncomfortable but mild compared with the months and years of discomfort that many others experience. I had no PHN. No pain at the touch of a gentle breeze.

When I spoke with Ouellette recently, I asked him why I had gotten the disease as a young and healthy person. He told me possible culprits could include: fatigue, stress or a recent bout of strep throat that had taxed my immune system. We'll never really know.

But he said my age helped me recover quickly. "Younger patients have smaller rashes, less pain and quicker recoveries," he said.

So even though I didn't realize it when I was diagnosed, I got lucky with my case of shingles.

If luck stays with me, it will be my last. ·

E-mail:sapienzat@washpost.com


© 2005 The Washington Post Company

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