Mary-Ellen Siegel - Shingles: New Hope for an Old Disease

Mary-Ellen Siegel and Gray Williams

In loving memory of Hermine, sister, friend, and staunchest ally.

M.E.S.

To my daughters, Julie, Meredith, and Dar, who light my life.

G. W.

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hank you to all those who support my professional endeavors: my family as well as my friends and colleagues in the Department of Community and Preventive Medicine (Social Work and Behavioral Sciences) at the Mount Sinai School of Medicine in New York. I am especially grateful to Drs. Helen Rehr, Gary Rosenberg, Susan Blumenfeld, and Penny Schwartz. -M.E.S.

Thanks to the many friends and relations who generously shared their own experiences with me, and helped me to gain a more personal perspective concerning this painful medical disorder. -G. W.

We greatly appreciate the many professionals who gave of their time and expertise to us to provide readers with the most up-to-date information:

Physicians: Brian Blakely, Christina Y. Chan, Seymour M. Cohen, Seymour Gendelman, Anne Gershon, Michael A. Goldsmith, Joseph E. Herrara, Albert Lefkovits, Myron Levin, Jacqueline Lustgarten, Franco Muggia, Michael Rowbotham, Parag Sheth, and Charles B. Stacy.

Pharmacists: Michael Morelli and staff at Arrow Pharmacy in New York.

Thank you to the late Richard Perkin, founder of the VZV Research Foundation, and Louis Gary, the current chairman of the VZV Research Foundation, for their encouragement and for providing us with much useful information.

A special thank you to the late Mike Cohn, who brought us together on this project. And thank you to Rick Rinehart, editorial director of M. Evans.

ntil recently, physicians had little to offer patients suffering from a reactivation of the chickenpox virus, the condition called herpes zoster, more commonly known as shingles. In the past, physicians could only offer palliative therapy and home remedies. When antiviral drugs were introduced, the picture changed, and now more effective treatment is available.

Today physicians are seeing many more patients with shingles because there has been a growth in the population most vulnerable to developing this viral disease. This includes the aged, patients treated with radiation or chemotherapy for cancer, transplanted-organ recipients, people who are HIV positive, and anyone else whose immune system has been weakened by disease or treatment, or even excessive stress.

Physicians can now offer patients with herpes zoster effective therapy with antiviral agents if the condition is diagnosed early. If the painful condition known as post-herpetic neuralgia develops later, judicious use of carefully selected antidepressants, antiseizure medications, and palliatives can be helpful in ameliorating the resulting discomfort.

Anyone who suspects that he or she might have shingles should be examined promptly by a physician, since early diagnosis is crucial for effective therapy. The first seventy-two hours after symptoms appear offer a brief "window of opportunity" during which treatment can dramatically decrease the severity and duration of the disease. If a patient's primary physician is not experienced in treating shingles, there should be a prompt referral to a physician who is. Most family or internal medicine physicians and dermatologists are able to treat shingles effectively.

Most importantly, the recent introduction of the herpes zoster vaccine, approved by the FDA and recommended by the CDC for administration to patients over sixty, offers a safe and effective method of preventing shingles in patients whose age puts them at risk for developing this disease.

The authors of Shingles have researched their subject very carefully and have provided a great deal of information that should help make patients, their relatives, and their friends able to cope with this common illness. The authors stress that prompt treatment is important and that treatment is an art as well as a science. They offer hope for the present as well as the future in minimizing and even eradicating this condition once referred to as "the devil's grip."

ark Singer is an avid gardener who spends much of his free time working in his yard. A year ago, when he was fifty five, an itchy reddish rash appeared on the fingers of his left hand. At first he thought that he had once again come into contact with poison ivy. But he was annoyed that the usual remedies he used for poison ivy didn't work very well, and that the rash persisted longer than usual. Still, the itching wasn't serious enough to make him seek medical help. It was only because he had a regular checkup scheduled two weeks after the rash appeared that he mentioned it to his doctor.

The doctor examined the rash closely. "That's not poison ivy," he said. "I'm pretty sure you have shingles. Those little blisters are quite distinctive. A mild attack, fortunately. You're already getting over it."

Susan MacDonald was an active, seventy-six-year-old widow who had always enjoyed good health. One morning she got up feeling slightly feverish, queasy in her stomach, and sore on the left side of her upper chest and back. Within a few hours a slight blotchy rash began to appear in the sore area. From friends who had suffered from shingles, she knew what the symptoms were. She called her doctor's office to report her suspicions and was given the first appointment for the following morning.

By that time, some of the small bumps of her rash had swelled into blisters. "It's shingles, all right," her doctor told her. "We could have some tests run on fluid from those blisters to make sure, but it really isn't necessary. Besides, it's more important to start treatment right away. Fortunately your case appears to be only moderately severe."

As Fred Weintraub celebrated his eightieth birthday, he was thankful that he had no serious health problems other than mild arthritis in his hands and knees. One summer weekend, he noticed an odd, cramping feeling in his left chest, rather like a muscle spasm. Over the next two days, the cramping feeling became a burning pain which spread from his chest to his back. By the evening of the fourth day, a broad band of reddish rash covered the area. Thinking that this outbreak might be some form of skin disease, he went the next morning to a dermatologist who had treated him the year before for a severe rash from poison ivy. The doctor promptly diagnosed Fred's condition as shingles.