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Ask Dr. Rick – June 2011

June 11, 2011

Shingles: A Quick Guide to This Painful Condition

With the advent of Tony LaRussa’s case of shingles, shingles have become a major topic in sports medicine, especially in the St. Louis area.

While it’s not a life-threatening condition, shingles can be excruciatingly painful. LaRussa’s shingles caused blisters and swelling around his right eye that forced him to miss a week of work.

So what is shingles and why do someone people get it? Here are some key facts.

Who Gets Shingles?

Shingles is a painful, generally blistering rash that is due to the herpes zoster virus. The virus normally is the cause of chicken pox and people that have shingles will generally have had chicken pox in the past.

Once someone is infected with chicken pox, the virus remains dormant but inactive in the body, and usually sits in some of the nerves of your body. People can go the rest of their lives and never suffer an episode of shingles.

Unfortunately, a certain percentage of people will develop shingles. No one really understands why the virus becomes active but it generally occurs in people who are over 60-years-old, have had chicken pox before the age of one, and may have a weakened immune system either due to medication or some type of disease.

What Are the Symptoms of Shingles?

Symptoms with shingles generally are pain on one side of the body—trunk, eye or neck—tingling, and severe burning along the chest or back. The pain is severe. There can be a rash and blisters. It can also be seen in areas like the eye, mouth and ears.

Ocular shingles can cause blindness and is a very severe condition.

Other symptoms include abdominal pain, chills, fever, pain, genital lesions, headache, hearing loss and joint pain. The diagnosis is usually made visually looking at the rash and tests include a small skin sample and/or a blood test.

How Do You Treat Shingles?

Anti-viral medications are used to treat the virus responsible for shingles: Zoster. Medicines include acyclovir and Famvir. These anti-viral medicines can reduce the duration and severity of shingles symptoms, but only if given within the first three days of an outbreak.

The rash will typically resolve on its own within two to four weeks.

Medications that should be taken immediately and treatment used upon the diagnosis: antihistamines to stop the itching, pain medications, and cold-wet compresses.

Post infectious complications can include blindness, deafness, another attack of shingles, or bacterial skin infections.

In short, shingles is common and should be treated immediately. Any sense that you may have shingles—look for conditions like headache, sensitivity to light, and flu-like symptoms without a fever—contact your doctor immediately.


Ask Dr. Rick

“Dear Dr. Rick, I have had early morning stiffness in my hands. It has taken me approximately an hour to get my fingers un-stiff. I was wondering if you could help me with this problem.”
– James, Wentzville, MO


Dear James, stiffness in the hands in the morning usually is a sign of some type of arthritic condition. This could be rheumatoid arthritis or this could possibly be an osteoarthritis condition. I would initially start by placing warm compresses on your hands in the morning, taking over-the-counter antiinflammatory and if this does not resolve in three to four weeks, you need to see your physician, maybe worked up for local or systemic arthritis. Thank you very much for her question.

“Dear Dr. Rick, I was playing tennis four days ago and felt a severe pop in my calf. I had immediate pain in my calf and had trouble walking. It seems to be better after the last two to three days, but I still have soreness and have no ability to walk up stairs. Do you have any idea what has happened?”
– Jane Z., Fairview Heights, IL


Dear Jane, this is a common formality, which is seen in racquet sports and is called tennis leg. This is usually a tear of the medial head of the gastrocnemius or the calf muscle. It is not a tear of the Achilles, generally does not need surgery, and is treated with rest and subsequent physical therapy. It takes about four to six weeks to get better. After the acute pain, it is important to try to get on some crutches for four or five days and start gentle stretching at approximately a week. I would see your physician and get started on some gentle physical therapy after one week. Again, this will take about four to six weeks to get better. Good luck.

Pearl for the Month of May: Do not eat carbohydrates after eight o’clock at night.

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