Shingles is herpes?


[00:00:00] All right, I'm gonna do a quick, um, shingles video. Why did that come up? Because a patient who gave me permission to post, even though I'm not gonna name her name, came in for a scheduled C-section the other day. And she had a big lesion. Lesion just means spot. She had a lesion here that initially I actually thought was a, um, an a hive, but she herself said, you know what? 

About four days ago? So let. Sunday or so, I started having tingling zinger type sensation that wrapped around and went behind her ear and her lymph nodes were a little bit swollen, and so she had this lesion that was a like circular, but a little bit irregular shaped and a spot on her eye. This was now Thursday, so four days later it hadn't become vesicular. 

Vesicles are the term that we use for those teeny little blisters. The ooze. It had not become vesicular exactly, but it definitely. Um, bumpier than just a regular hive. So we talked to infectious disease, we talked to dermatology. There was actually a little bit of controversy as to whether or not [00:01:00] people thought it was or was not shingles. 

All in all, we came to the conclusion that we would treat it as shingles because the treatment is completely benign and it would potentially decrease the progression of her having symptoms. So why do we care about shingles? Well, first of all, shingles is, and you know this, I think, but if you don't, I will reiterate to you guys what is shingles. 

The chickenpox virus that we've been exposed to when we were young for my generation. You guys, many of you if you're younger, have had the vaccine. The vaccine is live virus, but it's a small amount so the virus can live in our nerve roots, what's called the dorsal root Gang. Gland is the fancy word, um, in our spine. 

when you've been vaccinated, you actually have less likelihood of getting shingles. They think that's the data that's now coming out is that the future generations seem to have less likelihood of getting shingles, but for our generation, certainly we will have the virus that still lives, the chickenpox lives in our system forever, and then all of a sudden something will suppress our immune system. 

Fatigue, exhaustion, illness, [00:02:00] steroids, something that suppresses our immune system. Then, That chickenpox virus to climb up the spinal cord and go through, excuse me, go through one of the nerves in what are called a dermatome, which is the nerve that travels underneath our skin. So if you guys Google derma tone, D E R M A T O M E, you'll see a map of the human body's dermatome. 

And it's literally just different lines that are. That show you where each nerve in the skin is, and that's where the virus now travels back, you get pain and then you get those little bumpy, like a rash that look almost like little blisters. So why do we care about it? Well, because people who have had it will tell you it is like horribly painful. 

Um, not everyone has terrible pain. Some people have a milder symptoms, some people have more persistent symptoms. Will it last forever? Most likely not. Most patients will. A week or two, limited course. Some patients will have several weeks, some several months, rarely several years of persistent pain in what's called postherpetic neuralgia. 

Why do we call it postherpetic [00:03:00] neuralgia? It's not herpes, is it? Well, actually it is a member of the herpes virus of the, of the whole class, so, Um, chickenpox itself is vericella zoster virus, which is a herpes virus. It's part of the whole family. So it is con considered post-herpetic neuralgia if you have this, um, persistent pain there. 

So do we care because it's dangerous? Like I said, no. Do we care because we can prevent it? Well, after 50 you can get a vaccine and there are two different forms of vaccines. One is a little bit higher dose in a way of the chickenpox virus. And the other one is, I don't, I'm not sure of the details, but the newer one seems to be just a more chemically created version of it so it can help prevent. 

So it's basically giving your body more immunity to suppress the body's ability to let that chickenpox virus get re-triggered. And. Um, shingles, why did we care about it, in particularly in this patient who's had to have a baby? Because what comes outta those little vesicles is [00:04:00] actually chickenpox virus. 

It's not shingles virus. Shingles is just the name of the entity that occurs once the chickenpox virus reactivates in our nerve roots in our skin. But if we actually burst those veic, Virus would come out. Now, she happened to not really have a lot of these little blisters, but the recommendation was just to cover it with a loose claw, I mean with a loose, um, pad so that she didn't end up having any virus, because the baby will have antibodies when the baby's born that have crossed through the placenta and protected the baby, but only so much. 

It's not as much as getting a vaccine. It's not as much as having had chickenpox, and then your body creates enough antibodies against it. So the mom had to. Careful, only insofar as if there were vesicles, they had to not necessarily burst, transmit too much virus to the baby who only has so much immunity. 

Again, in her case, we didn't worry as much. The second thing is that we gave her Valacyclovir, which is the medication that we also use. For herpes. Herpes because it helps decrease the, like I said, how intense and [00:05:00] how long her symptoms will be if they come up. A funny story is when I was a resident, I was an intern, it was 1999, and we got called to the er, me and another resident to see an old woman in her nineties with like spots on her vagina. 

They told us, so we go, look, lo and behold, the poor lady had shingles on her. and she literally said to us, I will never forget. Oh my God, I can't believe I have herpes on my twt. No, sorry. She said chickenpox on my twt. She used the word twt. She was serious. It was adorable. Um, so. . Any other questions you guys can ask me, but basically it's not dangerous, but it's very painful. 

I would get a vaccine if you're over 50, which I'm about to be 50, so I'm gonna be getting my vaccine because anyone who's had it will tell you it is dreadful and can again, last days, weeks, months. Typically it won't be weeks or months, but it can be. And anyone who I've seen who's gone through that, um, really tends to have this very difficult pain. 

By the way, the post pelvic neuralgia can be [00:06:00] treated, but it's not easy. So you can use medications that work for depression even though it's not a, it's not because we think you're crazy. It's that antidepressants can work for the pain because of the way the neurotransmitters work. You can use the medication that used for restless leg syndrome called Lyrica. 

Um, they can use something called Gabapentin. So there are medications they can try, but it's not easy as you guys can guess. Okay, that is shingles. Bye.