By Dr Zeba Hisam
TEN days ago I started feeling a peculiar pain in the scapular region of my back. It was localised at one point and was constant. It didn’t seem to be the routine muscular pain that I get after vigorous home chores. I took an analgesic but it didn’t go away. I was perplexed as to what it could be.
The mystery was solved after four days when some papular rashes appeared in a line at the same site. I made my diagnosis. It was Herpes Zoster which is termed Shingles in popular parlance. Yet I went to the skin ward of the Karachi Civil Hospital to confirm my diagnosis. And the doctors there endorsed it and put me on antiviral acyclovir tablets five times a day.
I am not going to college where I teach. Neither do I attend my clinics at the hospital where I work.What is Herpes Zoster (shingles)?
After the primary infection of varicella ( chicken pox), generally in childhood, the virus remains dormant in the cranial nerve sensory ganglia and spinal dorsal root ganglia. In about 10-30 per cent of persons affected by chicken pox, the latent varicella zoster virus reactivates itself as Herpes Zoster (shingles). Herpes zoster usually occurs in adults, but cases have also been reported in children. Skin lesions resemble those of chicken pox. Pain is severe and commonly precedes the appearance of the rash. Lesions follow a dermatomal distribution, with thoracic and lumbar roots being the most common. But lesion can also occur on the face, eye and ear involving cranial nerve roots.
It is more severe in people above 60 years. Its treatment is with antiviral drug. Therapy should start within 72 hours of the onset of the lesions and be continued for 7 days or until the lesions crust over. Antiviral therapy reduces the duration of herpetic lesions and associated episodes of acute pain. So it is very important to consult a doctor urgently if any skin lesion arises on the body.
Secondary bacterial superinfection can occur as a complication and post herpetic neuralgia (severe nerve pain persisting after shingles are over) occurs in 60-70 per cent of patients needing prolonged treatment with drugs that reduce nerve pain (not the usual pain killers)!
For shingles contact precautions are sufficient (not like chicken pox, which is airborne and contact isolation is recommended). In shingles only the lesions are contagious and so direct contact with the areas affected by lesions should be avoided.
Health care workers with Herpes Zoster should be withdrawn from work until lesions are crusted.
Herpes Zoster can be prevented by a vaccine which should be given to healthy adults because it reduces the incidence of the disease and post herpetic neuralgia.
I am experiencing severe constant sharp pain with itching and burning sensations but I restrain myself from scratching. I am happy that it gives me a better comprehension of how my patients suffer from aches and pains when they are not well. Correct diagnosis is also a blessing that enables us to provide the appropriate treatment.
I remember an elderly female patient who came to me once with chest pain. She had consulted many doctors who advised an ECG and chest X-rays but she got no relief from any medication. When she came to me with piles of her test reports and prescriptions, I examined her on the couch where I asked her to lie down. When I exposed the area of her pain I found papular rashes of Herpez Zoster under her right breast.
I have seen a patient with abdominal pain who was advised an ultrasound of the entire abdomen. The physician did not even examine the site of the pain which had full blown rashes of Herpes Zoster!
I thank God that my diagnoses was made early! I was just wondering what a miraculous blessing it is to have my old mother with me. She is here to look after me when I am myself over 50 years of age! She applies acyclovir ointment on the lesions on my back with gloves on without being scared that it is contagious! She suggested to me to get branches of the Neem tree that I have kept in a bucket filled with water in the bathroom. I take one Neem twig daily and rub it lightly on my lesions and I find it so soothing and comforting to relieve my pain temporarily!
I do all my household work per routine. I wake up early at the same time as I have done all my working life. I do not consider myself sick as I have no fever or other complaints. I am able to work at home. Many activities that I had no time to do due to my hospital and college routine are now being attended to. So here is a golden opportunity to catch up on what I had always planned to do. I have made an album of Eid photos yesterday. I organised my drawers, documents, cupboards and cabinets before that. I enjoy going through the beautiful collection of books in my library. I enjoy listening to wonderful music by Beethoven and Mozart! Right now I am listening to Ghalib’s poetry and Ammi is knitting a sweater for Mustafa (my niece’s son)!
The other blessing I am grateful for are my loving brothers, bhabis and sisters who bring me cooked food every now and then. So I have a lot of cooked food in the fridge and I don’t have to cook! I had an urge to eat some sweet dish and I asked my bhabis and two of them brought my favourite pudding and sewiyyan! Ammi says that she would have scolded me for eating these but she feels I am suffering so she does not argue and let me eat everything! As soon as I am fine again, I will take care of my diet and exercise! But right now I feel justified in indulging in eating! So it’s nice to be treated like that!
1 October 2016
The writer is a consultant physician at Zubaida Medical Center and Head of Department of Physiology at Fatima Jinnah Dental College, Karachi.