If you were born before 1976, you probably have a strain of the herpes virus living inside you. That is according to Dr. Brenda Field of Barefoot Bay Internal Medicine who says, “For those that are of a certain age, let’s say over forty, it’s assumed that everybody had chickenpox.”
That matters because the varicella-zoster or herpes-zoster virus that causes chickenpox and lingers in the body after the disease runs its course also causes the painful skin and nerve condition known as shingles: a nasty, itchy rash of fluid-filled blisters.
In part because so many people had chickenpox as children and partly for other unknown reasons, incidents of shingles in the United States appear to be on the upswing. Especially among seniors.
“When they looked at the number of people over age 65 in the early 1990s who were getting shingles and then looked at it again in 2010, there was a big increase,” says Dr. Field. “It’s not clear what’s going on with that. Nobody’s got a very good theory why that is, but it seems shingles is becoming more common.”
In fact, shingles has become so common that the pharmaceutical giant, Merck and Company, is currently paying for a multi-million dollar nationwide television advertising campaign on “shingles awareness” starring former Super Bowl winning quarterback, Terry Bradshaw.
Not coincidentally, Merck also manufactures and sells a shingles vaccine known as Zostavax.
Anyone who has ever had chicken pox can develop shingles.
The Mayo clinic reports that, “Shingles is most common in people older than 50 and the risk increases with age. Some experts estimate that half the people 80 and older will have shingles.”
After the initial chickenpox symptoms have gone, the varicella-zoster virus can lay dormant inside the nerve tissue of the spinal cord or brain and live there for decades before re-activating itself and causing an outbreak of shingles.
No one really knows what triggers that re-activation. It may be due to lowered immunity brought on by age or it may be a result of stress, chronic diseases or other factors.
While rarely life-threatening, shingles can pack quite a wallop with pain, nerve damage or post-herpetic neuralgia, skin infections, vision loss and even inflammation of the brain or encephalitis along with facial paralysis and balance problems.
One positive – given the level of pain shingles can inflict, most people don’t need to be advised to see their physician right away, as is advised. Victims of the disease almost always call on their doctor to seek some relief.
Field, who has seen more than her fair share of shingles cases in Barefoot Bay, is a big advocate of shingles vaccinations and even has her own best case scenario when she talks about the timing of those vaccinations.
“For me,” the down-to-earth Field explains, “if I can grab the folks between sixty-five and seventy and get them vaccinated, that’s perfect. Those are exactly the ones I want. We’re going to get the most bang for our buck, so to speak, in that age group. If we do it before then they’ll still get a good immunity, but that immunity may start to tail off before their risk it at its highest level.”
As the conversation continues, Field discounts down the often-heard claim that a shingles vaccine shot can actually cause a shingles outbreak. “The [weakened, live-virus] vaccine is only given to people whose immune systems are judged to be in good working order,” she says. “We don’t give it to people whose immunity is being affected by cancer, cancer treatments or certain medications.”
With shingles increasing nationwide, it’s only reasonable to ask “what’s new” in treatment.
The answer is, “nothing.”
The Centers for Disease Control says, “Several antiviral medicines – acyclovir, valacyclovir and famciclovir – are available to treat shingles. These medications will help shorten the length and severity of the illness but to be effective, they must be started as soon as possible after the rash appears.”
That said, all three of those antivirals have been available for years and none of them make the shingles rash disappear overnight.
The sympathetic Field offers her advice for dealing with the rash: “I always tell people, you have to baby your skin and baby the blisters. Don’t do anything to the blisters. People have an almost irresistible urge to start messing with and popping the blisters.
“Use very mild soaps, wear loose clothing so nothing is binding,” Field continues, “The skin is going to be very sensitive so really baby that skin.”
For the pain Field suggests starting with acetaminophen or ibuprofen but if necessary she can prescribe something stronger. In this case, newer isn’t always better. Field points out that while gabapentin or Lyrica is frequently advertised these days, an older and much less expensive drug, amitriptyin, which she says, “isn’t advertised anymore,” may be every bit as effective.
It’s probably of little consolation to today’s seniors that a vaccine for chickenpox was finally introduced in 2006 or that the CDC now reports a near 90 percent vaccination rate among today’s children.
Despite that vaccination rate, a final word of caution is in order.
According to the U.S. Libraries of Medicine at the National Institutes of Health, while you can’t “catch” shingles from someone else, you can pass the virus on to someone who has never had chickenpox – typically a child or grandchild – who would then come down with chickenpox, (rather than shingles), and the whole dormant varicella-zoster virus cycle would begin all over again in another generation.
Dr. Brenda Field is at Barefoot Bay Internal Medicine, 8000 Ron Beatty Blvd., Suite A-3 in Barefoot Bay. The phone number is 772-664-1388.
