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Shingles… aka Herpes Zoster

10 Jun

Originally posted July 2011

Shingles aka Herpes Zoster… Also known as chicken pox to children. We all know about the all-over itching vesicles that cover a child’s body but what isn’t as commonly known is that the same virus can affect adults who have never come into contact with chicken pox when they were younger. Of course this particular virus is more dangerous when caught at as an adult (hence the pox parties where parents take their kids purposefully to infect them). Even less known is that herpes zoster remains dormant in your system and may express themselves as shingles later on in life. So even if you’ve had chicken pox as a kid, you may still get a flare up of shingles when your immune system weakens as a result of old age.

Shingles are differentiated from other skin lesion in that the vesicles (unlike the child chicken pox version) follow a distribution corresponding to a specific peripheral nerve or dermatome. In other words, the skin lesions are in a pattern that follows the length of a nerve typically on the midback or face, but also commonly along the arms. The virus attacks the length of the particular nerve usually starting with itchiness followed by a skin lesion that is obviously different than a mosquito bite (they may be clustered together and scar and heal at different rates). As the virus travels down the length of the nerve, you may feel swelling, and sharp pain upon touching or movement of the area (especially if the virus has went down to the hands) in addition to the skin lesions.

If the pain persists over a month then you may have developed one of the side conditions associated with Shingles, called Post Herpetic Neuralgia/Neuropathy. This condition results in extreme pain and swelling, not just of one joint but the total infected area with the highest degree of pain where the virus has last traveled to (this virus like to go from one end of a nerve starting in your spinal cord and dorsal root ganglion to the distal ends, like the ulnar innervations of the hand).

The importance of this blog is that as the baby boomers reach past 60 there will be more and more cases of Shingles as they currently occur to approximately 50% of the population at one point in their lives. As you age the ability of your immune system to combat the various bacteria, viruses, and oxidative aging becomes less effective leaving you vulnerable to conditions such as pneumonia. Herpes zoster is one of those conditions that one would not know about unless you are a doctor or you had them, and if you’ve had shingles and the more painful after-effects of PHN then you would know that it is a condition to be feared and should be an impetus for to take better care of ourselves in our older age.

If you suspect you have Shingles, please note that it can be contagious to the touch to others with slightly compromised immune systems or who have never come into contact with the chicken pox virus. Please see your family physician and take the anti-viral medication as prescribed before seeing a chiropractor about alleviation of the pain symptoms.

June 9th 2012,

Returning to the subject of Shingles, I have found an increasing number of shingles cases in the past year, all from patients who are under the 50 year demographic. Cases where the nerve affect is a Cranial Nerve, like a case of shingles in the inner ear affecting the 8th Cranial Nerve can be dangerous and cause lasting health consequences becuase it may also affect other functions of the body that share nerve innervation with the affected nerve.

Let me explain that shingles aka Herpes Zoster in adults tends to start specifically in the nerve, but also like to start at the dorsal root ganglion of the nerve. The DRG (as we call the in neurologist circles) is where the nerves exit the spinal cord to give power and energy input into superficial structures like skin, muscles, joint mechanoreceptos. From here the shingles virus will travel the length of the nerve until it reaches the nerve ending like in the hands or the skin of the face.  Because of this after the virus has run its course and the antiviral medication has finished its process patients can be left with reoccurring, temporary, dermatomal pain in a pattern on the skin which is highly suggestive of the nerve root being affected. This leads to the condition described above called Post-Herpetic Neuropathy.

Treatment options: Although I have not found electrical stimulation to be affective, it in theory should work to restimulate the nerve endings through the skin to the muscles. Low level settings are required because if the patient is suffering from PHN the electrical stimulation will be more painful than it may be worth, however TENS units and E-stim units at the Sensory Level Stimulus (SLS level, meaning intensity only to where the patient can feel the pulsation and no muscle pumping, can be practical and beneficial. Acupuncture, in theory can be quite useful for the pain management and even can help to fight the virus through a boosted immune system however practitioners again should be wary of electrical stimulation of these patients. Heat as opposed to ice as a rule.

I have found the best by far is therapeutic ultrasound therapy. Herpes Zoster like to feed on the myelin sheath that protects and insulates nerves and then on the epineural components of the nerves themselves. Ultrasound therapy can help to reinvigorate these nerve cells and receptors without the customary inflammation that electrical stimulation can bring.

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