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August 10, 2006
Shingles attack
Q My husband has had shingles for almost one year. Not only is he going out of his mind, but I think I am, too, because I cannot find anything to help him. He is up all night. Whatever help you can offer would be deeply appreciated.
A
The varicella-zoster virus causes two distinct illnesses. One is chickenpox, which usually happens in childhood. The other is shingles, which usually happens later in life. This virus becomes a permanent guest in the body after chickenpox, one that refuses to leave – ever. As years go by, it wakens, travels down nerve roots to the skin and causes the typical skin rash and pain of shingles.
Your husband doesn’t have shingles. He has postherpetic neuralgia – nerve damage that the virus brought on when it travelled down his nerves to his skin. (Don’t let the "herpes" name throw you; this is not the herpes of herpes genital infection or the herpes of cold sore infections. The name adds confusion to a confusing topic.)
When the shingles rash first appears, prompt treatment with Famvir, Valtrex or Zovirax can shorten the course of shingles and might, for some, lessen the chances for getting postherpetic neuralgia.
Your husband’s condition is one that calls for pain eradication. Amitriptyline, an anti-depressant medicine, in low doses can sometimes bring pain relief. Gabapentin, a seizure medicine, is another drug used to control this kind of pain. Lidocaine skin patches have helped many. If pain relief is not forthcoming then a step up to the more powerful opioids can often ease discomfort. Morphine, OxyContin and fentanyl patches are examples.
At this point, if success still has not been obtained, then visiting a pain clinic could be the answer. Such clinic (or other doctors) can provide nerve blocks, spinal cord stimulators or devices that deliver analgesics directly to the spinal cord for pain control.
Q
A large welling has appeared on my neck under the chin. It was diagnosed as a thyroglossal duct cyst. It is not painful. My doctor advised me not to have anything done about it.
My niece works for an oncologist. She asked him, and he told her it should be removed soon. I need help in deciding which direction to take.
A In the early stages of foetal life, the thyroid gland lies at the base of the tongue. As the foetus matures, the gland migrates to its permanent position in the lower neck. Along the path of its migration, it can leave pieces of thyroid gland that, after birth, can become thyroglossal ("glossa" for "tongue") duct cysts.
The usual place for this cyst is at or slightly below the crease where the head and neck join. During childhood, most of these cysts create no symptoms and can be simply watched.
Later in life, however, such cysts can undergo changes that, in rare instances, evolve into cancer. A warning sign of trouble is a cyst that suddenly gets bigger. In those cases, everyone – doctor and patient – must know beyond the shadow of a doubt if cancer changes have occurred. Usually that information can be obtained only by examining the tissue with a microscope. Therefore, I favour the oncologist’s recommendation.
Q My blood pressure fluctuates in its readings. I am on numerous medicines, which I take throughout the day. My home readings are lower than the office readings. When I was hospitalised, I got my pills all at once, and my readings were low. Is it all right for me to continue to do that?
A I don’t see any reason why you can’t, except for the pill you take twice a day. Why not bring your blood pressure machine to the doctor’s office and see if your machine and the doctor’s register the same reading? If they do, the doctor will be inclined to accept your home readings as your official blood pressure.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P .O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com
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