Andrew Siegel MD 11/6/2021
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My Shingles Story
My internist suggested that I should get the shingles vaccination. It truly was on my list of things to do—eventually—you know that list that we all have. Also, on my list is to get my bicycle serviced, to declutter the basement closets that are full of toys even though my youngest is in grad school, and to reread Hamlet and Macbeth.
I finally did get vaccinated, but the hard way, via an outbreak of shingles. This is not the smart way to get inoculated!
Shingles—a.k.a. herpes zoster—is caused by the virus that causes chickenpox. After exposure to chickenpox, the virus never completely leaves one’s system, living dormant in nerve cells. Antibodies manufactured by the body keep the virus in check for many years. However, when one’s immunity becomes compromised by age or other factors, the virus can be re-activated and cause a viral infection of the skin in the region of the nerve known as a dermatome, causing a painful (often agonizingly so) skin rash known as shingles. A vaccination for shingles can prevent the occurrence of this painful condition.
As a physician, I have insight into many disease processes, both through academic knowledge acquired in medical school and clinical knowledge acquired through years of experience in taking care of patients. However, there is no better teacher than the school of “hard knocks,” when one personally suffers with the disease process. In this entry, I share my experience with you.
Upon arising one morning, my upper left-side back muscles hurt in a strange way. Later, I developed an odd sensation—a raw and irritated feeling, somewhere between what a rug burn and what getting struck with a bullwhip would feel like. My wife examined my back, but saw nothing unusual. The following day I experienced tingling, pain and burning that rapidly increased in intensity and when I gazed in the mirror, I witnessed an ugly looking, bright red rash with blisters, completely confined to my left side, starting near the midline of the upper back and extending towards my underarm. It looked like shingles to me, but I had my doubts because it didn’t hurt excessively, and most of my patients whom I observed with shingles had severe and disabling pain. I thought it might be poison ivy. I smeared some hydrocortisone ointment on the rash and tried to forget about it.
The following day at work, the burning sensation escalated and I peeled off my OR scrubs and showed the rash to my partner, who took the photograph seen above. The unequivocal diagnosis was shingles. He prescribed Valtrex for one week, which I started immediately and I also took Ibuprofen before sleeping to help the discomfort. The shingles continued to progress with the burning feeling extending down my left arm towards my fingers, although there was no rash in this area. Within a few days the rash improved dramatically and the blisters ruptured, crusted and started healing. Ten days later, the rashes scabbed and continue to heal and the burning ultimately resolved.
Shingles
The term “shingles” is derived from the Latin cingulum, meaning belt, because of the girdle-like pattern of distribution of the rash along the line of a nerve fiber’s course, usually a narrow band from the spine extending around the abdomen or chest. Similarly, the word “zoster” is derived from the Greek zoster, meaning belt. The word “herpes” is derived from the Greek herpein, meaning to creep, because of the recurrent and latent infections of this virus.
Half of Americans will develop shingles, a.k.a. varicella-zoster, by age 80, and although most cases develop in people over 60, it can occur at any age. Shingles causes a painful, blistering skin rash via reactivation of the chickenpox virus (varicella-zoster virus) that lies dormant for years in nerves and becomes activated at times of stress, decline in immunity, or for other unknown reasons. Those who have inflammatory bowel disease have an increased predilection. It is a unique disease as it develops only on one side of the body. It characteristically causes waves of burning pain, insomnia, and a significant interference with one’s ability to pursue activities of daily living.
The thoracic (chest) dermatome is the most common one affected, followed by the cervical (neck) and trigeminal (facial) dermatomes. The herpetic rash is typically distributed within a single dermatome on only one side of the body. My shingles attack involved my upper back extending to my underarm and down my arm. There are many worse locales for shingles to occur, particularly the face, eyes, mouth and ears, where it can cause visual and hearing deficits. When shingles involves the eyes because of reactivation of the virus within the trigeminal nerve, it can have particularly devastating consequences. When shingles involves the lumbar (lower back) area, it can affect urinary and bowel function. I had a recent patient with lumbar shingles causing inability to urinate, requiring the placement of a bladder catheter. In addition to the painful skin rash, shingles can cause systemic symptoms including malaise, fevers and chills, headache, joint pain and specific symptoms depending on the nerves involved.
Symptoms of shingles typically start with a prodrome (early symptoms preceding the onset of the major symptoms) including pain, itching or pins and needles sensation. Subsequently, the dermatome involved will develop a patchy, red rash with herpes vesicles (blisters) and increased intensity of pain often described as burning, throbbing or stabbing. The involved area may also be itchy and tender to touch. With time, the herpes blisters rupture, crust and heal.
Shingles is not contagious to anyone who has had chickenpox. However, if one has not had chickenpox, exposure to anyone with shingles at the stage they have open blisters may be contagious, potentially causing chickenpox and not shingles. It is important for pregnant women to avoid exposure to those with active shingles because of the potential for transmitting the virus to the fetus.
Although shingles is generally self-limited and resolves without intervention, antivirals are recommended to be initiated within 72 hours of the onset of the shingles rash. Oral acyclovir, famciclovir, and valacyclovir reduce viral shedding and accelerate symptomatic resolution, reduce the pain, shorten the course of the outbreak and help prevent complications. For bad outbreaks, steroids and narcotics may be necessary. I was able to suffice with Ibuprofen because I’m tough as nails (absolutely not the truth!). Topical lotions containing calamine may be soothing. After the resolution of shingles, which typically occurs within 2-3 weeks, there is the possibility of permanent pain known as post-herpetic neuralgia. The pain of post-herpetic neuralgia can be difficult to alleviate, even with the use of narcotics.
Bottom Line: Shingles is largely an avoidable infection, so getting vaccinated deserves to be put on your active to-do list! I seriously regret not regarding my internist’s advice, because the long and the short of it is that shingles is not fun at all and potentially can have devastating long-term consequences. The shingles vaccine—Shingrix—is the most effective means of reducing the incidence of herpes zoster and post-herpetic neuralgia, as well as reducing the severity of an outbreak if it occurs. The current CDC recommendation is that healthy adults aged 50 years or older receive two doses of Shingrix, 2-6 months apart, for the prevention of herpes zoster and post-herpetic neuralgia. This recommendation stands even if individuals previously have had shingles, received Zostavax (the previous iteration shingles vaccine), or are not sure if they ever had chickenpox.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. He is the co-founder of PelvicRx and Private Gym. His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, herpes zoster, post-herpetic neuralgia, shingles, Shingrix, varicella-zoster virus
Our Greatest Wealth Is Health 
November 6, 2021 at 8:50 AM |
Hi Andy. Thanks for sharing your story and I’m glad you’re feeling better. I received the Shingrix shots this year. I will use your story to pass the word to others .
November 6, 2021 at 8:50 AM |
Hi Andy. Thanks for sharing your story and I’m glad you’re feeling better. I received the Shingrix shots this year. I will use your story to pass the word to others .