What is this skin-pain condition? Is it related to shingles?
May 10, 2018 9:31 PM Subscribe
A friend (80 y.o.) has had some severe shingles episodes in recent years, and I've been helping his son keep this log of I-wonder-if-this-is-shingles-related stuff, in the hopes that it is helpful for asking Metafilter, in case someone here has any input. He's concerned about having to go through the same thing his father has. Is this kind of thing related to shingles? He's concerned that it is, and wonders if he should do anything about it. YANMD, etc.
This friend's son said he went into a pharmacy a few years back to ask about shingles vaccine, and they practically laughed him out the door and said the vaccine was only for the elderly (he's in his 30s). He did also say he can't remember ever having a visible rash at the site of the pain. Thanks!
This friend's son said he went into a pharmacy a few years back to ask about shingles vaccine, and they practically laughed him out the door and said the vaccine was only for the elderly (he's in his 30s). He did also say he can't remember ever having a visible rash at the site of the pain. Thanks!
Not everyone gets a giant amount of pain. Mr. Nat (mid 30s) had it recently, but we caught it pretty early because the rash was very characteristic. He got in to urgent care, got antivirals, and consequently things lasted a couple weeks and not longer, and he had very little pain.
I do think it is easy to recognize, but I agree with the last poster that likely your friend would do better with some anxiety help than they would knowing more details about how to recognize shingles.
posted by nat at 12:10 AM on May 11, 2018 [1 favorite]
I do think it is easy to recognize, but I agree with the last poster that likely your friend would do better with some anxiety help than they would knowing more details about how to recognize shingles.
posted by nat at 12:10 AM on May 11, 2018 [1 favorite]
I'm having shingles RIGHT NOW and my (and my wife's) docs both suggest we get the vaccine after I'm no longer active. I made it into urgent care on the road just before antivirals would no longer have been effective. I did not recognize it as shingles because I have an existing skin-and-joint-pain condition, psoriatic arthritis, and I took the shingles flare as a newly involved joint with extremely florid psoriasis - so as a voice of experience, I have to say you sure as shit can mistake it for something else.
I've been told it should resolve in two weeks, and that's about where I am today... but it's not particularly resolved. It's less leaky, less painful, and less itchy, but it leaks, it makes my clothes stink, and I can't sleep well due to pain and itch. So i gather my recovery is a bit slow, likely reflecting my immunosuppressed biology stemming from the psoriatic arthritis and treatment thereof.
I'm 52. I have mildly elevated blood pressure, take meds for that, and normally run 3 miles a day but am waiting until I no longer leak to resume.
posted by mwhybark at 1:14 AM on May 11, 2018
I've been told it should resolve in two weeks, and that's about where I am today... but it's not particularly resolved. It's less leaky, less painful, and less itchy, but it leaks, it makes my clothes stink, and I can't sleep well due to pain and itch. So i gather my recovery is a bit slow, likely reflecting my immunosuppressed biology stemming from the psoriatic arthritis and treatment thereof.
I'm 52. I have mildly elevated blood pressure, take meds for that, and normally run 3 miles a day but am waiting until I no longer leak to resume.
posted by mwhybark at 1:14 AM on May 11, 2018
I'm not a doc, so take this with a grain of salt—your friend seems unnecessarily worried abt something that may never be a huge issue for him.
More anecdata re my experience with shingles a couple of years ago: I had very minor pain in my leg for a couple of weeks before I noticed a quarter size rash by my knee. Had the rash been on the back of my knee/out of sight, the whole episode would likely have passed without a doctor visit and diagnosis.
posted by she's not there at 1:47 AM on May 11, 2018
More anecdata re my experience with shingles a couple of years ago: I had very minor pain in my leg for a couple of weeks before I noticed a quarter size rash by my knee. Had the rash been on the back of my knee/out of sight, the whole episode would likely have passed without a doctor visit and diagnosis.
posted by she's not there at 1:47 AM on May 11, 2018
If the son has never had chickenpox or chickenpox vaccine (or isn’t sure whether he has), it wouldn’t be a bad idea for him to get vaccinated, because he could get chickenpox from his dad’s shingles if not immune, although you’d sort of expect that if he were going to get it that way, he would have done so by now. People who get their immunity to chickenpox via vaccination are considered unlikely to be able to develop shingles later on.
posted by lakeroon at 3:52 AM on May 11, 2018
posted by lakeroon at 3:52 AM on May 11, 2018
Yes, your friend seems anxious about something that is not likely to affect him.
I disagree with previous posters, you don’t always *know* when it’s shingles. It can be very mild or, you know, not.
5 years ago there was a time when 4 of my acquaintances had it within a couple months of each other. All 25-45. Severity varies by site.
posted by OrangeVelour at 3:54 AM on May 11, 2018
I disagree with previous posters, you don’t always *know* when it’s shingles. It can be very mild or, you know, not.
5 years ago there was a time when 4 of my acquaintances had it within a couple months of each other. All 25-45. Severity varies by site.
posted by OrangeVelour at 3:54 AM on May 11, 2018
I was about 30 when a doctor diagnosed my rash and shoulder pain as shingles. Long before a vaccine. I worked at a dime store, exposed to kids and old folks. He should get vaccinated.
posted by Carol Anne at 4:43 AM on May 11, 2018
posted by Carol Anne at 4:43 AM on May 11, 2018
I'm not a doctor, but looking at that log the things that make me think "not shingles" are that the pain occurs on both sides of the body, the episodes are months apart, and there is no mention of bumps or blisters.
I had shingles in my 30's. It was very mild - an area that felt a little sensitive, as if I had a bruise there, and some itchy bumps that could have been mistaken for bug bites. It's not always a big deal.
posted by Redstart at 4:47 AM on May 11, 2018
I had shingles in my 30's. It was very mild - an area that felt a little sensitive, as if I had a bruise there, and some itchy bumps that could have been mistaken for bug bites. It's not always a big deal.
posted by Redstart at 4:47 AM on May 11, 2018
I had shingles before age 30. I’ve had it three times, never with intense pain (more like itching). It did not take months to resolve - the first time was probably a month, the second time a couple weeks and the third time mere days because I caught it early and took medication.
What I always experienced: redness and bumps. Outbreak always confined to one dermatome (single nerve area).
Shingles is most likely to present on the side of the body/rib cage and second most commonly on the forehead. I’ve also had it on a wrist.
I recommend your friend find a good doctor to talk to about this, one who takes seriously the possibility of younger adults getting shingles.
posted by mai at 5:48 AM on May 11, 2018
What I always experienced: redness and bumps. Outbreak always confined to one dermatome (single nerve area).
Shingles is most likely to present on the side of the body/rib cage and second most commonly on the forehead. I’ve also had it on a wrist.
I recommend your friend find a good doctor to talk to about this, one who takes seriously the possibility of younger adults getting shingles.
posted by mai at 5:48 AM on May 11, 2018
If your friend has not had chicken pox, they may be able to get vaccinated, avoiding the issue, probably(could have had a quite mild case). My insurance doesn't pay for the new shingles vax, which the pharmacist says is dramatically better than the older one. Most insurance won't cover the shingles vax before age 60. Friend can still get a prescription for the vax and get it at his own cost. I have known several people who had shingles at young and young-ish ages.
It's my understanding that there can be post-shingles pain at the site, even with no blisters or rash. I have known numbers of people with severe shingles pain, so his concern is valid, up to a point. I'd get the vax, then worry about something else.
posted by theora55 at 6:34 AM on May 11, 2018 [1 favorite]
It's my understanding that there can be post-shingles pain at the site, even with no blisters or rash. I have known numbers of people with severe shingles pain, so his concern is valid, up to a point. I'd get the vax, then worry about something else.
posted by theora55 at 6:34 AM on May 11, 2018 [1 favorite]
I had shingles at 46. I think one pharmacy’s approach should not define years of worry. Your friend should talk to a doctor or another pharmacy and get the vaccine -what’s the down side? Then he can keep investigating if necessary.
posted by warriorqueen at 7:35 AM on May 11, 2018
posted by warriorqueen at 7:35 AM on May 11, 2018
It's really not clear why exactly your friend thinks this is shingles rather than like... anything else that could cause transient irritation and pain. If he's worried that his dad's experience means he's genetically predisposed, it doesn't really work like that - his dad being 80 is sufficient reason to explain why he got shingles, any 80 year old is at risk because your immune system doesn't work as well at that age. And the symptoms he's listing would be a very unusual way for shingles to present, honestly - as others have noted, they're on different sides, with no eruption, and usually resolve in hours.
As for getting the vaccine, it might help him to understand a bit how it works. I'm not a doctor or an immunologist, but I am interested in this stuff and I'll try to explain it the way I understand it. When you get chickenpox, your immune system kills all the virus cells it can reach, but the infection will usually 'retreat' to a nerve - or rather, some nerve cells that are infected with the virus are overlooked by the immune cleanup squad. While it's there it's effectively under house arrest, though. It only remains undetected in those nerve cells because it's for the most part stopped doing Virus Stuff like making the cell replicate its Virus Genes - if it did, the antibodies you made during and after the initial infection will immediately set off a red alert and the rest of your immune system will come in guns blazing.
However, just occasionally it manages to sneak past the armed guard - the antibody isn't there at the exact right time, and so when the virus cells decide to Try Something your immune system is behind the game and by the time it's in gear the virus has already made a huge mess, cells turned into virus factories, damage to the nerves, no way to clean it up without inflammation and fighting on the streets and destroying a load of your own cells that the virus has coopted. Sometimes this kind of sneaky escape happens by chance, but rarely. It gets more and more likely when the armed guard have got tired or lazy and their eye's off the ball - ie if you're immunosuppressed, which can be for a number of reasons ranging from powerful drugs that knock everything out to the mild tamping down of the immune response that can be a result of stress. Age is a big factor here - as you get older your immune system just doesn't work as well.
One way to counteract this is to give the chickenpox virus's personal armed guard a very specific kick up the arse. The shingles virus is just a deactivated but still live chickenpox virus - your immune system will see it and goes Oh Shit, I remember chickenpox, it fuckin sucked and now it looks like it's Around, better make a load of extra antibody. This doesn't help all stages of the process - just the one that allows your immune system to 'see' when the virus infected cells start playing up. Interestingly, it's also pretty effective to be around someone who's shedding virus, like someone with chickenpox - far from 'causing' shingles this is actually somewhat protective. (Public health tidbit: his is why the UK government doesn't vaccinate children against chickenpox - it would result in a load more shingles in older people who would otherwise get 'passively vaccinated', and shingles is more likely to lead to disabling consequences than childhood chickenpox.) Now, people with shingles don't breathe out huge quantities of virus like people with chickenpox do, but it's still possible that if your friend was exposed to uncovered rash on his dad that may have given him a tiny bit of protection. Maybe that'll comfort him, I don't know.
The reason it's not recommended in younger people is because if you're younger you're pretty likely to be already making plenty enough antibody to keep the virus in check - if it sneaks out it's probably going to be a chance event, the kind that viruses would make an Exciting Action Film about if they could make films, which luckily they can't. It's really crappy if you're on the wrong side of the Plucky Action Hero Virus that beats all the odds to give you a painful and unpleasant time, but it's also not something that will happen to most people, and the consolation is that your youthful immune system will hopefully help you to make a quicker and more complete recovery than you might otherwise have had (which: it doesn't always work out this way, we're talking about statistics here). There's a few circumstances when a doctor might recommend a vaccine, but if your immune system's working well it's not going to be something you really need. The effectiveness of the vaccine as a kick up the arse also wanes with time (your immune system 'forgets' about it and gets complacent again), so if you get it at 30 you'd need multiple boosters to still be protected at 60+, which is when the risk of shingles, particularly of a bad attack, starts to get much higher. You also don't want to leave it too late - after 80 your immune system doesn't seem to respond much to the vaccine, it's just like 'whatever, throw what you like at me, just going to keep doing what I'm doing'. Ageing sucks :(
Also, just to address something several commenters have brought up, it says in the linked document that the OP's friend had chickenpox as a child. So not a concern there.
posted by Acheman at 9:12 AM on May 11, 2018 [1 favorite]
As for getting the vaccine, it might help him to understand a bit how it works. I'm not a doctor or an immunologist, but I am interested in this stuff and I'll try to explain it the way I understand it. When you get chickenpox, your immune system kills all the virus cells it can reach, but the infection will usually 'retreat' to a nerve - or rather, some nerve cells that are infected with the virus are overlooked by the immune cleanup squad. While it's there it's effectively under house arrest, though. It only remains undetected in those nerve cells because it's for the most part stopped doing Virus Stuff like making the cell replicate its Virus Genes - if it did, the antibodies you made during and after the initial infection will immediately set off a red alert and the rest of your immune system will come in guns blazing.
However, just occasionally it manages to sneak past the armed guard - the antibody isn't there at the exact right time, and so when the virus cells decide to Try Something your immune system is behind the game and by the time it's in gear the virus has already made a huge mess, cells turned into virus factories, damage to the nerves, no way to clean it up without inflammation and fighting on the streets and destroying a load of your own cells that the virus has coopted. Sometimes this kind of sneaky escape happens by chance, but rarely. It gets more and more likely when the armed guard have got tired or lazy and their eye's off the ball - ie if you're immunosuppressed, which can be for a number of reasons ranging from powerful drugs that knock everything out to the mild tamping down of the immune response that can be a result of stress. Age is a big factor here - as you get older your immune system just doesn't work as well.
One way to counteract this is to give the chickenpox virus's personal armed guard a very specific kick up the arse. The shingles virus is just a deactivated but still live chickenpox virus - your immune system will see it and goes Oh Shit, I remember chickenpox, it fuckin sucked and now it looks like it's Around, better make a load of extra antibody. This doesn't help all stages of the process - just the one that allows your immune system to 'see' when the virus infected cells start playing up. Interestingly, it's also pretty effective to be around someone who's shedding virus, like someone with chickenpox - far from 'causing' shingles this is actually somewhat protective. (Public health tidbit: his is why the UK government doesn't vaccinate children against chickenpox - it would result in a load more shingles in older people who would otherwise get 'passively vaccinated', and shingles is more likely to lead to disabling consequences than childhood chickenpox.) Now, people with shingles don't breathe out huge quantities of virus like people with chickenpox do, but it's still possible that if your friend was exposed to uncovered rash on his dad that may have given him a tiny bit of protection. Maybe that'll comfort him, I don't know.
The reason it's not recommended in younger people is because if you're younger you're pretty likely to be already making plenty enough antibody to keep the virus in check - if it sneaks out it's probably going to be a chance event, the kind that viruses would make an Exciting Action Film about if they could make films, which luckily they can't. It's really crappy if you're on the wrong side of the Plucky Action Hero Virus that beats all the odds to give you a painful and unpleasant time, but it's also not something that will happen to most people, and the consolation is that your youthful immune system will hopefully help you to make a quicker and more complete recovery than you might otherwise have had (which: it doesn't always work out this way, we're talking about statistics here). There's a few circumstances when a doctor might recommend a vaccine, but if your immune system's working well it's not going to be something you really need. The effectiveness of the vaccine as a kick up the arse also wanes with time (your immune system 'forgets' about it and gets complacent again), so if you get it at 30 you'd need multiple boosters to still be protected at 60+, which is when the risk of shingles, particularly of a bad attack, starts to get much higher. You also don't want to leave it too late - after 80 your immune system doesn't seem to respond much to the vaccine, it's just like 'whatever, throw what you like at me, just going to keep doing what I'm doing'. Ageing sucks :(
Also, just to address something several commenters have brought up, it says in the linked document that the OP's friend had chickenpox as a child. So not a concern there.
posted by Acheman at 9:12 AM on May 11, 2018 [1 favorite]
Sorry, I missed the edit window there - in paragraph 4 I meant to say that the shingles VACCINE is just a live chickenpox virus.
posted by Acheman at 9:47 AM on May 11, 2018
posted by Acheman at 9:47 AM on May 11, 2018
Not about whether it's shingles but about getting the vaccine:
I am 29 and take a medication that suppresses my immune system, so my doctor told me I needed this and other vaccines. I only had trouble with getting this one, but it was a mess. I got a weird and infuriating run-around (especially bad because the shingles vaccine is live and so I had to be off my medication for weeks) that ultimately resulted in me needing a prescription and to pay nearly $300 out of pocket despite having excellent insurance. They are serious about it being a vaccine for the elderly, whether or not it makes any sense.
posted by hollyholly at 12:34 PM on May 11, 2018 [1 favorite]
I am 29 and take a medication that suppresses my immune system, so my doctor told me I needed this and other vaccines. I only had trouble with getting this one, but it was a mess. I got a weird and infuriating run-around (especially bad because the shingles vaccine is live and so I had to be off my medication for weeks) that ultimately resulted in me needing a prescription and to pay nearly $300 out of pocket despite having excellent insurance. They are serious about it being a vaccine for the elderly, whether or not it makes any sense.
posted by hollyholly at 12:34 PM on May 11, 2018 [1 favorite]
FWIW both my wife and I are immunosuppressed (I am on Humira and she is a childhood-onset insulin-dependent diabetic) and our docs have communicated that we should (in my case) or could (in her case) get the 'new' shingles vax, which was just recently approved (I think I heard one of the docs say in February) for immunosuppressed people. No mention was made to me about going off Humira for the shot, although my rheumie did say that had I seen here before my regular shot day she would have asked me to skip the Humira for a round as I recover. I suppose I should check in with her about that this week since my next shot is coming up.
Both sets of docs indicated that the percentile of multi-incident shingles patients is quite small, but also that immunosuppressed people are more likely to have multiple incidents. My wife has had it one time when she was eighteen. I definitely intend to get the vaccination once my symptoms are gone, although I must admit to being curious about how the vaccination might benefit me if I have just recently had a weeks long immune system battle with the virus.
posted by mwhybark at 2:55 PM on May 11, 2018
Both sets of docs indicated that the percentile of multi-incident shingles patients is quite small, but also that immunosuppressed people are more likely to have multiple incidents. My wife has had it one time when she was eighteen. I definitely intend to get the vaccination once my symptoms are gone, although I must admit to being curious about how the vaccination might benefit me if I have just recently had a weeks long immune system battle with the virus.
posted by mwhybark at 2:55 PM on May 11, 2018
This thread is closed to new comments.
Actual shingles will hurt like hell and it be unmistakable and it will last for a LONG TIME. Like months. And even if you don't know if it is shingles you will be going to the ER to find out what this excruciating pain and terrifying rash is and they will diagnose it in like 5 seconds.
So if that hasn't happened I'm going to say definitely no.
#2. I got shingles in my mid-to-late 40s (I had chicken pox at 12 or so), so cases at younger than 50 are quite possible. If you think you're more susceptible somehow I might wait until turning 40 or 45 and then talk to your personal physician about it rather than random folks at a pharmacy. Or what the heck, even do it now (if you could document that a relative developed shingles in say the late 30s or early 40s, that might help). Keep in mind that current vaccines have to be renewed every 5 years and have some pretty significant downsides in terms of allergic reactions etc.
#3. It sounds to me like your friend is obsessing about this one particular thing quite a bit and maybe needs to find treatment for that obsessive behavior even more so than a shingles vaccine.
posted by flug at 11:00 PM on May 10, 2018 [1 favorite]