Jan 28, 2014
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Dont hit the launch button! I think that was the only time I saw this running, climbing, screaming gaggle of 7 and 8 year olds stop what they were doing momentarily and listen to me. Erics hockey team was recently at a tournament in Shilo. Between games they were scrambling over displays outside the artillery museum. This particular display was a truck mounted rocket launcher. The kids happened to do very well at the tournament. They dont usually win a lot of games, but in this tournament they won 3. They dont usually score a lot of goals, but this time most of the kids got one. Eric enjoyed the hockey, but that wasnt his favorite part. If you ask Eric about the Shilo tournament, he will tell you about the waterslide in the hotel, the X-box game he played against his goalie, the rocket launcher truck and of course the bucket of candy he won in the rainbow auction.
Shingles might be the worst prize you could ever win at a rainbow auction. Shingles is a condition caused by the same virus that causes chickenpox, varicella-zoster. This virus does not leave your body when the red itchy spots of chickenpox go away. Instead, it becomes inactive in the nerve cells of your body. In some people, the virus reactivates later life and causes another rash. This time though, instead of being itchy, the rash is usually painful. This condition is known as shingles. The medical term for it is herpes zoster.
Doctors talk about two main things when they talk about shingles or herpes zoster. They talk about the reinfection of nerve cells by the virus and its accompanying rash, and they talk about postherpetic neuralgia. Postherpetic neuralgia is nerve damage pain that remains after the shingles rash is gone. In Canada each year, there are 130 000 new cases of shingles, 17000 cases of postherpetic neuralgia and 20 deaths. Postherpetic neuralgia can result in severe pain. Common sites of postherpetic neuralgia pain are the torso and the face. Sometimes the pain is so severe patients are unable to wear clothing that comes in contact with the lesions or to be outside in the wind because of the sensitivity of the skin on the torso and face. There have even been cases of loss of vision and facial scarring. Shingles and postherpetic neuralgia will probably increase as the population ages. The number of people with shingles who get postherpetic neuralgia rises from 10% among the general population to as high as 40% among those over 50.
There are three main ways to treat shingles and postherpetic neuralgia. If someone already has the painful postherpetic neuralgia, the doctor will usually start with starting with a tricyclic antidepressant like amitriptylline or a medication like gabapentin. These medications will hopefully decrease the pain signals from the damaged nerves. Sometimes the doctor will add a narcotic painkiller like codeine or morphine as well. Unfortunately, randomized controlled trials have shown only a 20%40% reduction in severity of pain.. Often the doctor will have to throw several medications from several different nerve pain categories at postherpetic neuralgia. That is one of the places the Dauphin Clinic Pharmacy shines. We can make a topical ointment with up to 4-5 different nerve pain medications in it that can help the pain quite a bit. All in all, though, postherpetic neuralgia can be very difficult and painful to treat.
If we could reduce or eliminate the initial shingles rash, that would be better, right? Well, if you get to your doctor within 72 hours of the first sign of shingles, we can do something more. The first sign of shingles is often a tingling or burning sensation in the skin. This sensation may become quite painful and accompanied by fever and headache. The skin over the burning area then begins to redden and fluid filled blisters develop after two or three days. The blisters continue to form until the rash reaches its peak in three to seven days. Gradually, the blisters will break and form small ulcers which dry to form scabs. The scabs usually fall off in about three weeks. If you see the doctor within 72 hours of that tingling, burning and reddening, the doctor can give you an antiviral like famciclovir. There is evidence that the early use of antivirals will provide relief for acute pain and hasten healing of the rash. We hope this will also reduce the chance of postherpetic neuralgia, but the evidence for using antivirals to prevent postherpetic neuralgia is weak.
The best option would be to prevent the shingles infection altogether. There is a shingles vaccine that been approved in Canada for people 50 years of age and older. It is called Zostavax and it prevents the shingles infection in 50% of the people who get it and postherpetic neuralgia in 67% of the people who receive the vaccine. It is believed that the vaccine may also make posthepetic neuralgia pain less severe in people who get the vaccine but still get shinges. Something I learned when researching this article was that you can get shingles more than once. So, even if you have had shingles before, it is still reasonable to get the shingles vaccine.
An interesting thing about the shingles vaccine, Zostavax, is its storage requirements. It has to be stored frozen (below -15C) and it has to be injected within 30 minutes of being mixed. So you need to have a pharmacy with a freezer very close to a clinc where the injection can be given. This means the Dauphin Clinic Pharmacy is the only pharmacy I know of in the Parkland that has the Zostavax shingles vaccine. If you get the vaccine it will reduce the chance that shingles will keep you from enjoying the things you love and living in the moment.
Hockey is a great game. Its fun, fast and tough. But it is just a game and when it is over, Erics team just poured their infectious energy into whatever was next. I think sometimes us hockey parents forget that. Eric happened to score his first goal this year in Shilo, but if you ask him, his goal ranks after the candy bucket, rocket launcher truck and waterslide. Maybe its time to take a page from the 7 & 8 year olds and live in the moment. Hockeys great when you are on the ice. When you come off it is time to look for the next rocket launcher!
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional
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