Friday, 28 December 2012

Shingle hell, shingle hell, shingle hell pop!

My weakened immune system, courtesy of the antibody treatment, is what led me to today's topic: My butchering of the well-known Christmas song lyrics used as the title for this post.  That's probably about as much Christmas spirit as I'll managed to muster-up this year, which you'll probably start to appreciate once you've read a bit more about the joy that is shingles.

A few days after the fifth antibody treatment, whilst visiting some of the family, I started to find it was uncomfortable sitting down.  At first, I just assumed that spending a few hours sat on a hard chair was the cause of the problem, and that soon enough I'd feel fine again, but when it still felt uncomfy the next day I started to think that I had maybe been bitten by a mosquito or something instead, hence the recovery process would be that bit longer.  However, by the next evening, there were a few other nearby places that were also red, raised and tender, so I decided to ring the hospital about it, as it was now starting to look more like a rash.  I couldn't describe it very well over the phone, as it was hard for me to see it, so the hospital suggested going to see my G.P. the day next.  The next day I managed to get a late afternoon appointment, where the G.P. took a quick look and said that seems like early shingles to me, as there are some blisters.  My G.P. prescribed some antiviral medication, but suggested getting in touch with the hospital to check whether they advised doing anything else, given they are much better placed to understand this issue in the wider context of my other treatment etc.

Once I got home, I spoke to the hospital and they said to start taking the antiviral medication as prescribed, but to come and see them early the next morning.  I had to go early, before other patients arrived, as if it was shingles, then I would be contagious, so avoiding contact with other patients was clearly desirable, especially given such patients would likely have weakened immune systems.  The next morning, when I arrived at the hospital, one of the receptionists guided me to a consultation room that was out of the way, and I'd imagine was probably not going to be used for anything else that day.  Shortly afterwards, one of the nurses put a warning sign on the door, so that everybody knew that I might have a contagious virus - The nurse explained why the sign was being put up, as I guess some people might panic if they saw a medical professional doing this, but I didn't really think anything of it - If the nurse had been wearing a hazmat suit, it would have been a different story!

It wasn't long before another nurse came in to collect blood samples and do the weekly flushing of my Hickman line.  Shortly after that nurse left, a doctor and yet another nurse came in to see me.  They took a look at the rash and agreed with my G.P. that it seemed like shingles.  The doctor really just suggested taking a different antiviral medication, which is both stronger and required less doses per day (is more practical), and said that I'd need to wait around for the blood test results just in case anything else was required.  Once the blood test results arrived, the doctor could see that my immune system was low, which was no great surprise, so I was also prescribed some Filgrastim injections to administer over the next week (on alternate days).  Yet another nurse picked-up my prescription for me, just to avoid me having to wait at the pharmacy where I might spread the virus; It did amuse me that my prescription seemed to be handed to me at arm's length - held by just a thumb and one finger.

I'd imagine some of you are probably now thinking: So, what exactly is shingles?  Well, shingles is what someone gets when the chickenpox virus reactivates.  When someone gets chickenpox, their body builds-up an immunity to it, but never completely gets rid of the virus, i.e. it is merely kept under control by their immune system.  The virus actually lays dormant in nerve cells, until such time that it is reactivated, e.g. when the carrier has a weakened immune system.  Once someone has shingles, the affected areas of their skin are contagious to the touch, but can only give someone chickenpox, and even then only if they've never had it previously (or have a weakened immune system); i.e. it's not actually possible to give someone shingles itself.  Shingles is most common in people aged over fifty (about one in four of us get it in our lifetime), it's unusual to get it more than once, it tends to occur on the upper body, and it can take a few weeks before the rash disappears.

Note: I actually got the rash a little further south than the norm, and after nearly two weeks of sitting on it, I'll definitely be glad once it has gone.  If you're now thinking, when you said "a little further south", I thought you were meaning somewhere else for a minute; Unfortunately, I got it there too!

The use of antiviral medication can reduce the duration and severity of the symptoms, but it's really important to start taking them as soon as possible, i.e. within at most three days of the rash starting to appear, as otherwise their effectiveness is significantly reduced.  In other words, it's definitely worth going to visit your G.P. sooner rather than later, especially if the rash is on your face; The blisters can actually result in permanent blindness and/or deafness in any eyes and/or ears that are affected, respectively.  The only other medication that might prove useful is painkillers, as the blisters can really hurt; They feel like a mixture of tenderness and soreness, a burning sensation, and occasional sharp stabbing pains.

Note: I tried taking some paracetamol for the pain, but for me they were pretty much like sneezing on an inferno, so after a couple of days of taking them, I never bothered with them any more.  I did find that minimising any contact with the blisters (even just the slightest of touches from clothing) helped; Also, in contrast to my recent run-in with an infection resulting in several days of diarrhea, I actually found that I was most comfortable when sat on the toilet, as the seat was cool, which seemed to ease the soreness and burning sensation, and I could sit down without putting any pressure on the blisters.

Shingles itself looks quite similar to chickenpox in that it presents as a red (usually itchy) rash, which ultimately results in blisters that eventually dry-out/scab-over; However, unlike chickenpox, shingles rarely appears in more than one dermatome (area of skin supplied by an individual nerve), as the virus normally works its way (from the spine) along a single nerve until it eventually forms blisters on the associated area of the skin - That's also why it normally only appears on one side (left or right) of the body, and the blisters are quite concentrated, i.e. form in clusters.  The blisters can leave scars once healed, and can also be extremely painful.  The pain can last for weeks, months and even years after the rash itself has gone, and can also prove to be particularly tricky to treat.  In fact, even before the rash appears, the area can be tingly, itchy or even painful, as the virus works its way down the nerve.

Note: For about a week, each day I have taken a picture of the rash at the top of my right leg, as the hospital told me to let them know if it didn't seem to be getting any better (or was spreading), because it might be necessary for me to have additional treatment; However, due to the location and the sheer number of blisters, it was kind of hard to tell just by looking and remembering, hence that's where the digital camera (in my phone) came in handy.  If you are lucky/unlucky (delete as appropriate), I might even upload them in a later blog post, so that you can appreciate the true horror just that little bit more!

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