The chicken pox vaccine was not licensed for use in the US until 1995, which means a lot of adults today may have had chicken pox. That also means that a lot of us are susceptible to developing shingles, a painful potential recurrence of the same virus that infected us with chicken pox. I remember when my great grandmother had shingles in the early 1960s. She experienced great pain and disability for at least a couple of months, and was left much less ‘able’ than before the disease. Medicine has come a long way since then.
This contribution is to share my experience with shingles and how I now am prepared for a recurrence in TEOTWAWKI. I am not a physician but a survivor of a recent case of shingles, sharing what worked for me and what did not. If you had the chicken pox vaccine and never actually got the pox, then you don’t need to read this unless you have loved ones who were not so fortunate. If, as I have experienced, your healthcare won’t cover the Shingles Zoster vaccine until you are 60 and you don’t plan to pay the $300 for the vaccine with a prescription, here’s my plan to treat a recurrence if I’m on my own in stressful times.
Herpes Zoster is the virus that brings chicken pox. Once you have the virus in your body, it’s your for life. Like many members of the Herpes family, it survives in nerve tissue and lies dormant until conditions are right. Again, as with most recurring herpes virus, H. Zoster stays in check unless your immune system is stressed. In adults, H. Zoster can recur as ‘shingles,’ a much more painful version of the active or acute viral infection. In my recent case, it was a stressful period at work, in winter and after I had slacked off on my regular exercise program. TEOTWAWKI will undoubtedly be more stressful than most work environments, so I choose to plan for the potential until I reach 60 and can get the vaccine. I probably will keep the preps after that as well.
I was 55 and tired. Work had been a bear, late nights and multiple deadlines. I had recently been moved to a building that made my allergies kick up, so that wasn’t helping. I was also preparing for a business trip, getting all the arrangements in order. On Tuesday, I just didn’t feel right. By Thursday I was at my doctor’s office because I was having disturbing abdominal pain – in the area near my appendix. Everything she suspected was ruled out. I wasn’t crazy about leaving town on Sunday, but at least I didn’t have a hot appendix. I did notice a strange almost painful sensation on my skin on the same side of my hip and abdomen as the interior abdominal pain, but it seemed insignificant compared to the internal pain. I probably didn’t mention it to the ‘doctor for fear she’d think I was a total hypochondriac. What I didn’t know then was this phase is called the ‘prodrome’ and is when the virus is starting its recurrence in your body. It occurs for usually for 5 to 7 days before the first bumps. The skin tenderness is one of the classic prodrome symptom list that includes flu-like symptoms and some localized internal pain.
Saturday morning I was dressing and found the first cluster of bumps, about an inch in diameter, on my lower back. That was a big clue, but I still didn’t believe it. I was 55 for heaven’s sake and Shingles is an old person’s disease – Gramma was almost 90 when she had it! After a quick Google search for shingles, I raced to urgent care, where I had to educate the doctor. Though skeptical, he gave me a prescription for acyclovir which I started taking immediately. I also bought some spray-on Solarcaine, which helped with the surface pain. The acyclovir is an anti-viral that helped slow the outbreak, but wasn’t the best choice of drugs. I let my boss know that I wouldn’t be traveling on Sunday.
Sunday was a blur of Solarcaine, pills every 4 hours, and trying to find some type of clothing that minimized the discomfort. Finding a comfortable position was also a challenge. Bed rest is a tall order when just the weight of the sheet hurts. Imagine if you were bugging out on foot, with a plan to wear most of you spare clothing and trying to carry a pack when a large swath of your skin feels like it’s on fire and is covered in blisters. If that’s your plan, it might help to be prepared for this little gem!
Monday, I saw my doctor. The rash was halfway around my abdomen, with some isolated spots starting below my naval. The breakout was slowed but not stopped because the acyclovir just wasn’t strong enough. She changed the anti-viral meds to Valacyclovir (Valtrex), a much better drug that could be taken less frequently. She also prescribed Percocet for pain, a week at home (some people in my office had never had chicken pox) and a return visit in a week. The Solarcaine and Percocet allowed me to rest much more comfortably. I suspect a non-narcotic pain killer would also have made a big difference in the pain, but my doctor decided not to experiment and went for the sure thing.
The new anti-viral allowed an almost complete bypass of the nastiest phase of the disease: blisters progressing to open sores and then scabs – shortening the course of the illness by at least two and possibly four weeks. Also, it reduced the potential for infecting others and for the secondary infections possible with any open sores. Instead, the rash transitioned to thin, hard skin spots until the crusts washed off in the shower after a couple of weeks. Sorry if this sounds disgusting, but it is the reality of the disease when modern medicine is not available.
On the return visit, my doctor changed the medications. Gabapentin replaced Percocet, with a primary purpose to help prevent post-herpetic neuralgia – a painful complication that can leave one suffering from pain long after the lesions have healed. She also prescribed Lidoderm patches to place over areas with healed lesions to reduce the pain. Even with these meds, I still could not tolerate conventional clothing, so I spent another two weeks at home, but was able to telecommute part time. One discovery I made was that the Lidoderm patches could be cut in half and used essentially as a nerve block by placing just above the top of the band of lesions and along my spine. (Good lesson — I now keep Lidoderm patches in my G.O.O.D. kit and my emergency med bag for non-narcotic emergency pain relief.) Before that I was uncomfortable plastered with up to 3 patches a day.
So what are my other TEOTWAWKI lessons? Beyond getting and staying in good shape, and keeping Lidoderm patches handy, I’ll get the Zoster vaccine as soon as I can. Chaos and stressful surroundings will not be conducive to best self-care. Many of us will be candidates for shingles with the disabling pain and secondary infection potential if we don’t have the specific meds to manage the disease.
Second is that with or without the vaccine, I’ll keep a shingles kit in my med supplies. I don’t know how long the Zoster vaccine works, or if it can be overcome by the virus in conditions that will be far from the current ‘normal’ life of clean water, climate control and reasonable rest and nutrition. Otherwise, coping with shingles may not be realistic in a bad or worst-case scenario. Worst case, my spouse may need it, or someone will need the ‘kit’ and will be willing to trade goods, services or goodwill for it.
My current shingles kit is small but powerful. It includes the meds above in sufficient quantities to reproduce my experience – 7 days of high doses of Valacyclovir in one pill bottle and in another pill bottle , 7 x 5mg Percocet (half-tablet twice a day for the first week after bumps start) and 30 x 100 mg Gabapentin (1 to 2 per day as long as they last). These are taped together at the bottoms so they form along tube with the open ends out for easy access, and stored with a bottle of Solarcaine gel and 5 Lidoderm patches (1/3 patch per day for 12 hours) in a plastic zipper bag in the med kit. Wish I could travel back in time and give Gramma just those few things to have helped her pain!
As I said, I’m not a physician, so what I’ve just related was hard-won personal wisdom. There are probably better Shingles kits that can be assembled.