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Miscellaneous thoughts and ramblings
Tuesday, March 29, 2005
Zoster Disaster (or Tingles From Shingles)
Yesterday I got a little red patch on the small of my back, just to the right of my spine. It was very tender, like a pimple that’s deep under the surface. As the day went on, I kept expecting a pimple to pop up, but the little patch stayed red and got more and more tender. It developed what doctors call hyperesthesia, which is abnormally increased sensation, so that the brush of my shirt across my back became unpleasantly noticeable. That’s when I started suspecting shingles, or what us doctor types call herpes zoster. It has nothing to do with herpes virus; it’s caused by the virus that causes chicken pox. Today, more painful red patches appeared. Having better judgment than to treat myself, I actually saw my doctor who agreed with the diagnosis of shingles and prescribed an antiviral medicine. It usually resolves completely after a few days, but in the meantime, it hurts like hell.

Even a casual glance at today’s headlines demonstrate that there a lot of people much worse off than me, but my few minutes on the other side of the patient gown was a good reminder of the pain and the worrisome uncertainty involved in being sick.
Actually, the conversation went something like this.
Bean: "Should I just prescribe myself some acyclovir?"
Me: "Are you crazy? You have to see a doctor. The spots are on your back and you know what they say about a doctor who treats himself."
Bean: Made doctor's appointment.
For the record, I should also say that I dismissed Bean's claim that he had shingles, mostly by laughing at him. Sorry, hon.
For the docs out there: From the fact that my jeans feel like they're stiking needles in my right anterior thigh and medial knee, I'm guessing that it's my right L3 dermatome that's affected. Not that it matters.
Hey, you've got shingles...and we've got a really, really tall and a large,weird-roofed house that could stand to have a new roof. Could you get over here and put your shingles to good use?
Sorry for that momentary lapse in good judgement. What I really meant to say was "Refuah Shlema" --a speedy and complete recovery. I've heard how painful an ailment it can be...
One more "pearlie" for you. You could also name this post:
A Roster of Zoster
Torontopearl: two puns in two comments! Thank you. And thanks also for the get-well wishes.

Refua shlema: [Hebrew] literally, complete healing.
Have you not yet figured out that I can be very punny if there's a call-out for punny people -- and even if there's not?

I've noticed your trend to translate foreign terms, so I made sure that I also did in my earlier comment, but I guess it doesn't stand out, getting lost amongst my text. Your "way with words" is definitely more on the ball. (-and-chain!) Ooohhh, guess I'd better quit now while I still can.
Doctor Bean... I'm sorry you're going through this. At least you have the [very] small comfort of having an in-depth understanding of what is going on to cause you so much discomfort.

For those of us who don't have a physician [like you] with the willingness/ability to explain things properly, we tend to leave the Dr.'s office with only a prescription and a vague idea of what the hell our bodies are going through.

Refuah Shelaima my friend.

Torontopearl: Your translation was fine, I just try to make it very obvious, so that it's clear that the Coffeehouse is to be enjoyed by English readers of all persuasions.

David: You’re very sweet. Thanks.

Actually, the reason I feel almost fine is that I understand shingles much better than I understand mortality and the number of friends I’ve lost recently is zero. You’re very sweet to wish me refuah. The comforting wishes should go entirely in the opposite direction.
Here's a very weird epilogue to the story.

This morning a 70-something year-old patient of mine calls me. Her name is not Edna, so that's what I'll call her.

Edna: Dr. Bean, thanks for calling me back. I think I have a rash from one of my blood pressure pills so I stopped taking them.
Me: [OK. Good luck. I'll see you in the hospital after your stroke.] When did you notice the rash?
Edna: This morning.
Me: Your chart shows that we haven't changed your medicines for over a month, so I don't think it's your pills. Where's the rash?
Edna: Between my breasts.
Me: Why don't you come in this morning and let me try to figure it out? And go ahead and take whatever pills you normally take in the morning.
Edna: OK. Also, I think I pulled a muscle two days ago in my back. Can I take Tylenol with all the other medicines I'm on?
Me: Sure.

She comes in and points out about a 2 cm patch of red blistered skin on the middle of her chest. The rest of the skin on her chest is fine. I peek at her back, there's a bright red blistered horizontal stripe to the right of her spine on her upper back. I kid you not.

Me: Have you looked at your back in the last couple of days?
Edna: No.
Me: When did you say your back started hurting?
Edna: About two days ago.
Me: Can you point to where it hurts?

She points to the red stripe.

She's got shingles, of course. Too weird. I see maybe a case or two a year. What are the odds?

[cue Twilight Zone theme music]
refuah shelema. there are a bunch of medications that may help with the pain. email me if you need a list.(no, not narcotics). what are we supposed to say, physician heal thyself?
Thanks, dilbert. For now, I'm taking Bextra, and I'm not that miserable. The discomfort is mild; it's just very distracting, and I don't need anything that makes it harder for me to concentrate.

For the post-herpetic neuralgia*, I know that Neurontin and other anti-convulsants are useful and even SSRIs, but I hope none of that becomes an issue.

* post-herpetic neuralgia - permanent pain that sometimes results from shingles, usually in older patients
I love shingles. Well, as a doctor. It's the one disease where I can just walk into the room and say, "Hi, did you know you have shingles?"

Seriously, refuah shelaima. Reminds me of the time I went to work with a stiff neck and had to sit through 3 other people complaining about theirs.
Thanks, Psycho. Whining and moaning about it here feels really good. I think suffering silently is overrated.
We should start a doctor's whining group. It's like when my patients ask me how I am. I say, "I can't complain. Well I could, but nobody wants to listen." Nobody wants to hear doctors complaining. Except maybe other doctors.

While we're at it, I've been chasing this pain around my body. It started in my back, then went to my thumbs, now it's in my neck...
Psycho Toddler: Ouch! Do you want to talk about it?

My wife would probably say something unsympathetic like "It's probably lupus. Or malingering."
Wow, shingles really seems to be an attraction to comment on. Go figure...

I've noticed that people hit a certain age, see reality around them, and start to talk medicalese and ailmentese, comparing notes.

And I don't mean a certain age of 50 and 60; we fortysomethings (not me, of course, unless the topic is already out there) and thirtysomethings do it too. I guess the moans and groans catch up with everybody at some point or another.

Re. shingles: too bad it's not like a dermatitis or a heat rash and you can just apply good ol' calamine lotion, blow cool air on the area and...problem be gone!

Hope you continue to feel better with your treatment.
Refuah sheleima. Sorry for the late comment - the comment section wasn't working for some reason. Maybe the Blogger has got the shingles, too. Oh well, misery loves company. Anyway, feel better soon!
Is it too late to rename this thread "Too Much Information"?
Ralphie: (a) “Too much information” doesn’t have that cool rhyming thing I’ve got going on in the title. (b) Really? I wasn’t particularly graphic. I didn’t mention any naughty body bits. No potty humor. Is just mentioning that I have shingles too personal? Sorry.
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