Conclusion on Shingles with Recap and Reminders

Final Important Facts, Reminders, and Recap on Shingles

            As our blog post comes to conclusion there are a few extra points that should be included. For specific management outside any medications that are used the best way to is to maintain proper hygiene. However many times proper hygiene can be overlooked during such a painful and stressful time. Important notes on hygiene would be to attempt to shower at least once per day with soap and water if possible. Sponge bathes are also another way to maintain proper hygiene if shower access is difficult. When your skin is broken up in the blistering phase there is a breach in your body’s natural defenses to ward off bacteria and other infectious agents. Soap and water is recommended as the best possible way to prevent these types of infections. In addition to soap and water you may want to try skin-soothing products as well, such as a lotion or crème that you find to be soothing. This can reduce the temptation to itch the infected site and avoid more pain and to prevent the wounded area from opening up. Cool water is also another way to attempt to improve comfort during an outbreak. Reminders about Shingles that are crucial to have include to always consult your physician if you have questions about a condition or have rashes that present and last more than a period of 7 days without going away. Shingles is a condition that one in four adults will experience during their lifetime, according to the U.S. National Library of Medicine, and that the best way for prevention over the age of 50 is the Zostavax vaccination. Lastly, it is important to remember that taking medications as directed and receiving treatment in a timely manner is the best means to stop an outbreak.

References: 

Mccoy, Krisha. "Skin Care for Shingles." EverydayHealth.com. Everyday Health. Web. 31 July 2015.

"Protecting Yourself From Shingles | NIH MedlinePlus the Magazine."U.S National Library of Medicine. U.S. National Library of Medicine. Web. 31 July 2015.

Facial Shingles and Financial Assistance

Trigeminal Neuralgia

          As we know Shingles can show up anywhere across the body due to the virus remaining dormant within the nerves in our body. We have nerves that run throughout every single part of our body; therefore it can pop up just about anywhere. As we discussed within our last posting, post hepatic neuralgia (pain within the nerves after presentation) is a consequence of untimely treatment of shingles. Now we ask what is trigeminal neuralgia and why is it important to know what it is? This condition is associated with what we call orofacial acute shingles. In general terms this means facial shingles. Facial shingles comes from the herpes zoster virus reappearing within the Trigeminal Nerve, therefore affecting the face.

Trigeminal Nerve. Digital image. Https://bdyerillustration.files.wordpress.com/2011/10/trigeminal-nerve-redone-150-dpi1.jpg. N.p., n.d. Web. 28 July 2015. <https://bdyerillustration.files.wordpress.com/2011/10/trigeminal-nerve-redone-150-dpi1.jpg>.

Above is a picture of where the trigeminal nerve innervates your face. With this picture and previous posts on how shingles behaves we can see that shingles can appear all across the face.

Orofacial Acute Herpes Zoster. Digital image.Http://www.medscape.com/content/2003/00/45/83/458361/art-sm458361.fig1.jpg. N.p., n.d. Web. 28 July 2015. <http://www.medscape.com/content/2003/00/45/83/458361/art-sm458361.fig1.jpg>.

As we can see above, shingles has appeared and is affecting the left side of the face. This identification of a single sided facial rash matches with what we know about shingles; that is only presents on one side, or unilaterally. Particular to the trigeminal presentation of Shingles, it is very important to seek medical care as quickly as possible. As we can see in the first picture, the Trigeminal Nerve innervates the eyes which can cause eye swelling, as seen above. Without timely treatment with antiviral drugs, there is a possibility for vision loss. As shingles is allowed to progress without treatment damage can be done to the nerves, which results in the conditions we have previously discussed of lingering neuralgia.

Financial Concerns

If there are concerns about finances toward treatment options there are a few routes of treatment according to SIMED Physician Dr. Muhammad, Ali, M.D. Valtrex is the most common treatment however there are cheaper options available. If finances are the primary concern, discussion with your physician about other options, such as cheaper acyclovir, are possible alternatives. There are a variety of prescription financial assistance programs available for those whom meet the requirements. Companies such as RxHope offer programs for prescription assistance. Below is a link to the requirements and steps to take to acquire Valtrex through assistance programs. Your overseeing physician can also recommend other programs for other means of financial assistance. 

Financial Assistance Programs:

https://www.rxhope.com/PAP/info/PAPList.aspx?drugid=488&fieldType=drugid

References: 

SIMED: Dr. Muhammad, Ali M.D.

 "Patient Assistance Information." Patient Assistance Information. Web. 29 July 2015.

"JCDA - Journal of the Canadian Dental Association." How to Manage Acute Herpes Zoster Affecting Trigeminal Nerves. Web. 29 July 2015.

Primary Care Physician Take on Vaccination and Essential Information

Vaccination Information

Other important information that both patients and families should be familiar with are what to expect post vaccination. In 99% of cases concerning the Zostavax vaccination, there are no notable side effects, however <1% reported episodic headaches and injection sight reactions and irritations, as reported in the Vostavax informational sheet that is contained within the Merck Vaccinations packaging. Other contraindications toward getting vaccinated include: Neomycin or gelatin allergies as this may trigger anaphalaxis, or a whole bodily reaction to drugs which results in difficulty breathing, swallowing, increased heart rate and more. Other valuable information to consider is nursing mothers. It is not known whether or not the VZV is passed through breast feeding, therefore it is crucial to consider this before any breastfeeding because of possible transmission.

Interview with SIMED’s Dr. Muhammad Ali, M.D.

In a recent interview with local SIMED primary care physician we discussed day to day management of shingles and this was the advice he provided. Blister period maintenance is essential to getting through a shingles outbreak due to the skins protective layer being exposed. With the blisters open infection is a commonality; however we can reduce this incidence via soap and water cleaning techniques. During outbreaks soap and water is the best cleaning method to prevent infection of the open wound areas. Next we discussed how shingles can commonly be confused with other skin irritations that could be due to another source. This can be differentiated through knowing that shingles presentation is unilateral, or on one side of the body. If there is bilateral presentation, both sides of your body, then it is highly unlikely that shingles is the culprit. This is due to shingles being active in the nerves.

Dermatomes. Digital image. Http://41.media.tumblr.com/tumblr_lwk8c1hSgD1r5my9jo1_1280.jpg. N.p., n.d. Web. 28 July 2015. <http://41.media.tumblr.com/tumblr_lwk8c1hSgD1r5my9jo1_1280.jpg>.

Within this picture representation it shows the areas which particular nerves innervate each region of the body. With shingles it is highly unlikely to see presentation on both sides of the body in the same position. Due to this innervation shingles can be very painful due to post hepatic neuralgia, or pain within the nerves after presentation. This is also why it is important to seek out antiviral treatment options, which have been discussed previously.

References:

"ZOSTAVAX® (Zoster Vaccine Live)." ZOSTAVAX® (Zoster Vaccine Live). Web. 22 July 2015

Interview:

Ali, Muhammad. "Shingles Virus Information." SIMED. SIMED Office, Gainesville. 1 July 2015. Lecture.

What to do as Family Members and friends of those with Shingles

What Should I know?

Shingles is a complication that can leave many members of ones’ family concerned for how they can assist someone with shingles. Information that is crucial to know about shingles is that upon first clinical presentation of the blister phase.

Blistering Phase:

"Is Shingles (Post-Herpetic Neuralgia or Herpes Zoster) Contagious?"Cure Talk. Web. 5 Aug. 2015.

 Family and friends should take care about direct contact with this person during the blistering phase due to this being the most likely stage for transmission. It is important to note that you cannot get shingles if you have not had the Chickenpox. However if you have not had the chickenpox in the past you may be susceptible to getting chickenpox after being in direct contact with a person with shingles. If there is a barrier between your skin and the shingles the likelihood of transmission is also significantly lowered. Being aware of these factors can help you limit exposure yet still be able to provide support to those with shingles.  One significant factor that can limit transmission of shingles is to identify a crusting stage.

Crusting Stage

"Shingles (Herpes Zoster Virus) Pictures Slideshow: A Collection of Photos on MedicineNet." MedicineNet. Web. 5 Aug. 2015.

 The crusting stage is the point at which shingles is no longer contagious; again contagious being for those whom have not had chickenpox in the past, shingles by its nature is not contagious to those who have not had chickenpox. In other words, YOU MUST HAVE HAD CHICKENPOX TO GET SHINGLES. Other suggestions for prevention are to wash your hands often to prevent the spread of the varicella zoster virus. One very important thing to take into consideration is pregnancy. If a person is pregnant and comes in contact with a person with shingles there is a possibility of the unborn getting chickenpox. Also maintaining immunity to the shingles virus through vaccination is the best way to avoid getting shingles, as people age you can also get “booster” shots which may help to reduce your risk of developing shingles. This is especially crucial for those over the age of 50 because of declining immunity. Maintaining immunity will provide the best chance of not getting shingles. 

Vaccination:

"Prevent Painful Shingles with FDA-approved Vaccination- Zostavax - Pain Management and Injury Relief." Pain Management and Injury Relief. 12 Oct. 2013. Web. 5 Aug. 2015.

References:

"About Shingles (Herpes Zoster)." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 1 May 2014. Web. 5 Aug. 2015.

Introduction to Shingles

Introduction to Shingles 

What is Shingles?

Shingles is a condition that can present after one has had chickenpox. The Varicella zoster virus (VZV) is the culprit that causes both. However incidence of chickenpox does not mean that you will get shingles. After chickenpox the VZV can stay within your body and goes into dormancy. The most at risk populations are the elderly, over 50 years of age, and individuals with suppressed immune systems. According to Mayoclinic, half of those over the age of 80 will get Shingles. 

Characteristics of Shingles:

• Pain, burning, numbness or tingling
• Sensitivity to touch
• Presentation of a red rash within days after pain, numbness, or tingling.
• Fluid-filled Blisters that break open and crust over.
• Itching

Below is a link to Mayo Clinic and the clinical presentation of Shingles.

Mayo Clinic Symptoms and Characteristics

How to Prevent Shingles?

Prevention is the best way to avoid getting Shingles. Vaccinations are available, which are known as the Herpes Zoster Vaccination, Zostavax, which is recommended for individuals over the age of 60. This is a similar vaccine to the Chickenpox vaccination we used for young children. This vaccination has shown to lower the rate of incidence of Shingles in both men and women by over 50%. It has also shown to dramatically reduce the symptoms associated with shingles upon incidence, which is why the CDC recommends receiving the Zostavax vaccination.  More information about the vaccine can be seen in the Video below along with a link to the CDC informational page on their stance on vaccination. 

CVS Informational on Zostavax

CDC ZostaVax Information.

So what to do now?

If you have already had concerns about the possibility of having Shingles, the best idea would be to schedule an appointment with your primary care physician or visit a local clinic to discuss treatment options. Vaccination is the best prevention we have against incidence of Shingles. One of the most important things about Shingles is that it is largely a condition of opportunity. Immuno-suppressed individuals, such as post-chemo therapy patients and those with HIV, are most susceptible to getting shingles due to their immune system. If you have had chickenpox in the past there is a possibility that undergoing procedures, such as organ transplants, can increase the risk of shingles due to immune suppression. Consult any questions you have with a PCP before making decisions that could put you in a compromised state. 

Outcomes post Shingles

The good news is that Shingles is a very treatable condition. Through anti-viral medications and pain-relievers the symptoms can be managed easiest within 72 hours of presentation. There is rarely any hospitalization due to its manageability with a timely treatment. 

References:

"Vaccination." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 25 Nov. 2014. Web. 5 Aug. 2015.

"NINDS Shingles Information Page." Shingles Information Page: National Institute of Neurological Disorders and Stroke (NINDS). Web. 5 Aug. 2015.

***All references used with be noted within this color text.