While examining my rash, the nurse practitioner asked whether I had had chickenpox as a child — yes, I responded. She called the doctor in to take a look. “Shingles,” the doctor said.
Hearing this, my heart sank because I knew this was a very painful nerve condition. She explained that the same varicella-zoster virus that causes chickenpox never completely leaves your body and can reactivate years or decades later and cause shingles.
I was surprised to hear the nurse practitioner say that a new shingles vaccine was available. The Food and Drug Administration had approved Shingrix (zoster vaccine recombinant) in 2017 as a more effective vaccine than Zostavax, which had been approved in 2006. If I had known about the vaccine earlier, I might have been spared the overwhelming pain, fatigue and worry about how long the suffering would last.
But since it was too late for prevention, we focused on treatment and managing the pain. The nurse practitioner prescribed an oral antiviral medication called valacyclovir (Valtrex) for seven days, which I took twice a day, and gabapentin (Neurontin) for pain relief, which I took three times a day initially. Gabapentin is an anticonvulsant used to treat epilepsy that also works for nerve disorders by changing the way that nerves send messages to your brain.
After a week on Valtrex, most of the liquid-filled blisters had scabbed over, which the nurse practitioner told me indicated that they were no longer infectious.
Until that point, I avoided hugging people because the infection is spread through direct physical contact with blisters.
Pritish Tosh, an infectious disease physician and researcher at the Mayo Clinic in Rochester, Minn, also suggests keeping the lesions covered in public, washing hands after changing the bandages or dressings, and not sharing towels. If you have children at home who have not had chickenpox or not been vaccinated, Tosh recommends talking to your pediatrician for guidance.
Meanwhile, I was taking gabapentin and getting frustrated that my pain wasn’t lessening.
Desperate for relief, I read online about a topical ointment with lidocaine that acts as a local anesthetic by temporarily blocking the nerves from signaling pain. The ointment with 5 percent lidocaine required a prescription, which my doctor provided. I started applying the ointment directly on my rash and, thankfully, that worked and the pain lessened within minutes. I used the lidocaine ointment daily for about 15 days until the pain significantly lessened. Later, I discovered another option, an over-the-counter ointment patch with 4 percent lidocaine.
Amid the pain, I tried to make myself more comfortable by wearing loosefitting cotton clothes (I wore large T-shirts a lot), taking cool showers with my back facing the nozzle and just letting the water drip over my front, and meditating daily to stay calm because the pain was stressful. I was extremely tired for the first few weeks I had shingles and took naps. I also went for short walks, watched movies to distract myself and talked to friends for support.
About 1 in 3 people in the United States will develop shingles during their lifetime, and nearly 1 million cases of shingles occur annually, according to the Centers for Disease Control and Prevention (CDC). Most cases of shingles occur in people 50 and older, and 1 in 2 people 80 and older will have shingles, according to the Mayo Clinic.
Age and illnesses can weaken your immune system and cause the chickenpox virus to reemerge from the nerve tissue into the cells again, Tosh said. Having HIV, cancer or cancer treatment may also weaken people’s immune systems.
Most experience similar symptoms to mine, but they may also have chills, numbness or a fever. Not everyone develops a rash, although they typically have the pain and other symptoms. If you’re unfamiliar with the signs of shingles as I was, it’s easy to mistake them for other conditions.
One lesson learned: Don’t diagnose your own symptoms. See a trained medical professional. I wasted three or four days going down the “insect bite” rabbit hole only to learn that it was shingles.
Most primary care doctors can diagnose shingles based on the symptoms and signs. The exception may be people without the rash or who “have widespread lesions due to compromised immune systems,” Tosh said. “If there’s any question about the diagnosis, the lesions can be tested by a lab using polymerase chain reaction [PCR] which is a highly sensitive and specific test for the shingles virus.”
Another reason to seek treatment early is that antiviral medications, which include acyclovir (Zovirax) and famciclovir (Famvir), work best within 72 hours of the symptoms appearing.
“Antivirals prevent the virus from expanding or replicating and reduces the degree of nerve inflammation and intensity of pain,” said Robert Bolash, assistant professor of anesthesiology and interventional pain physician at the Cleveland Clinic in Ohio.
Without antiviral medications, shingles takes anywhere from three to five weeks to resolve, according to the National Institute on Aging.
When I later asked the nurse practitioner why she only offered gabapentin, she mentioned that patients with shingles have told her they can’t tolerate lidocaine on their rash because the skin is so hypersensitive.
I would have also liked to have known when the rash would disappear so I didn’t expect it to clear up when the antiviral medication stopped. It took another three weeks to recede. Even two months later, I can still see pink traces of the rash that look like teardrops.
In the past few weeks, I have noticed an on-and-off again mild burning sensation in the same area where the rash was. I worry about developing a painful complication of shingles called postherpetic neuralgia (PHN). “The pain may disappear entirely and return or just persist in the form of hypersensitivity,” Bolash said.
Bolash recommended seeing your primary care doctor for PHN, and if the pain doesn’t lessen, seeing a pain specialist, which can include physicians and alternative medicine practitioners (acupuncturists and naturopaths).
Physicians who are board-certified in pain medicine/management include neurologists, anesthesiologists and physiatrists (physical medical rehabilitation). They would treat PHN with gabapentin, analgesic skin patches, low doses of antidepressants or steroid injections. If those fail to provide relief, a device can be implanted surgically beneath the abdominal skin to deliver pain medication to the area around the spinal cord.
Unfortunately, having shingles once doesn’t prevent you from having it again, especially if you are older, have PHN and/or a compromised immune system.
The CDC recommends that healthy adults 50 and older be vaccinated with Shingrix, the new vaccine — even if you have had shingles, have received Zostavax, the older vaccine, or are unsure you have had chickenpox. Shingrix is more than 90 percent effective when you receive two separate shots given two to six months apart, according to the CDC.
The demand for Shingrix has exceeded the supply in some states. You may have to call around to find a pharmacy with it or you can get on a waiting list. I will get vaccinated this summer.