Development of shingles can be serious heath problem in seniors

By Jane Carney

Published: August 21, 2008

Did you grow up with this old wives' tale? "If shingles blisters reach all around your abdomen, you will die.” Relax, it isn't true.

But shingles can be a serious health problem.

Shingles is caused by a virus, varicella zoster, the same one that causes chicken pox. After a person recovers from chicken pox, the virus remains in nerve cells next to the spinal cord. If the virus reactivates, it causes shingles.

Shingles can occur in anyone who has had chicken pox. Since 90 percent of adults have had chicken pox, most adults are vulnerable. About 20 percent of those will develop shingles. And because the effectiveness of the body's immune system is reduced by age, older people are more likely to develop shingles. Anything that hinders the immune system increases the risk of shingles, such as:

•Chemotherapy.

•Radiation therapy.

•Rheumatoid arthritis.

•Steroid medications.

•HIV/Aids.

•Stress or emotional upset.

Although these are known risk factors, in most cases there is no known cause for the reactivation of the virus. Exposure to a person with chicken pox does not reactivate the virus. It is important to know, however, that a person who has shingles can transmit the virus to a person who has never had chicken pox. Although most children recover from chicken pox without serious complications, a person with active shingles should avoid contact with anyone who has never had chicken pox, as well as pregnant women.

The usual first symptom of shingles is burning, tingling, numbness, or extreme sensitivity in a certain part of the body. This is followed or accompanied by:

•A red rash.

•Fluid-filled blisters, which will break open and then crust over.

•Itching.

•Headache.

•Upset stomach, perhaps pain in the abdomen.

•Fever and chills.

The pain is often described as intense, with just the slightest touch or even a soft breeze causing pain. The pain may occur a few days or a week before the rash appears. Usually, only one nerve is involved, and the pain and rash will follow the path of that nerve. So, if it begins in the middle of the back, it will develop in a band around one side of the body to the breastbone. The whole process typically takes three to four weeks.

Treating the virus quickly may reduce chances of complications.

All of this is bad enough, but the possible complications are severe. If the shingles occur near the eyes, the result may be temporary or permanent loss of sight. An occurrence near the ear may cause loss of hearing. It can cause inflammation of the brain (encephalitis), and loss of facial movement also is possible. Any time shingles occurs above the neck, it is imperative to seek medical attention.

For about one of five people who develop shingles the pain does not stop after the blisters disappear. Instead, the damaged nerve fibers send confused messages from the skin to the brain, indicating pain. Just as in active shingles, the pain may be severe. This is known as postherpetic neuralgia. It can last a long time and is treated with pain medicine, antidepressants, or anticonvulsant medicines , but with no guarantee of relief. Antidepressants and anticonvulsants often are prescribed for those who, while not depressed or diagnosed with a seizure disorder, experience chronic pain, as many patients find they alleviate the pain.

In May 2006, the Food and Drug Administration approved the first vaccine for shingles in adults. The vaccine is recommended for adults 60 and older who have had chicken pox. The vaccine is not 100 percent protection, but it does reduce the chances of developing shingles by about half.

The vaccine costs about $150. Unlike the influenza vaccine, which is covered under Medicare Part B, this vaccine is covered by Medicare in Part D, the part that covers medicines. In April, Rep. Mazie Hirono, D-Hawaii, introduced a bill (H.R. 5877, Shingles Prevention Act) to have the shingles vaccine covered in Medicare Part B, like the influenza vaccine.

I have been surprised that my primary care physician has not mentioned the vaccine to me. But I am going to check my insurance coverage and put it on my list of things for discussion the next time I see my doctor.

Jane Carney retired from the faculty at Oklahoma City Community College. She can be reached at jccarney

@cox.net

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