Shingles Phn

[khazaddoom]

just recovering from the shingles rash on my face, thought I was getting better. Now I know I have post-herpetic neuralgia(PHN). It's really bloody painful I've been to e few doctors, clinics but they just trying to give me overpriced paracetamol. Does anyone know a pharmacy in Bangkok or a clinic that might be able to help me. I've been looking for lignocaine patches too but just get confused looks from every pharmacist. Any help would be really appreciated.

In agony

Steve

[ronnight]

need to try something like gabapentin

[popshirt]

gabapentin is available under the brand name Neurontin by Pfizer. I buy it directly from my local pharmacist at 190 baht for 100 capsules (100mg).

It works well for the pain although taking too much of it causes dizziness. I have found that one capsule two or three times a day does it for me.

Incidentally it has been one year since my shingles attack and I am left with PHN in one quadrant of my foot. It can be quite painful and the numbness is very annoying, it feels as if my sock is bunched up under the sole of my foot, but I am getting used to it............slowly. The pain usually is worst at night, then is when I pop a Neurontin, but only about once or twice a month now. The sad thing is that the numbness is not getting any better. I will see a neurologist this week again to check progress, but not much can be done.

[Familyonthemove]

yes - I remember the pain well .... sorry to hear you are suffering.

Just remember that strong pain killers often cause constipation .... so to avoid extra suffering drink plenty of fluids and eat tons of fruit and veg.

[ukdog]

I have just suffered an attack of shingles on the left side of my face and head. I treated it aggressively with Vilerm 800 mg Tablets (Acyclovir) 1 Tablet every 3 hours. (No problem through the night as I couldn't sleep due to the pain). I also washed and then applied Vilerm cream to the whole area every 3 hours.

I am now 8 days into the attack, 5 days into starting medication and the area is crusting over, no new lesions are appearing and the pain reducing. I spoke with a doctor friend in UK and then read up on the Internet;

I have taken nothing other than the Vilerm and the discomfort is now at a level where I am able to sleep at night, waking with the occasional deeper shooting pain. The Vilerm was not cheap and I bought two boxes of it due to the levels I intended to take. So far it has been very successful, virtually all swelling has gone and all areas are crusted or skin finally flacking away.

Internet:

Acyclovir, valacyclovir, or famciclovir can be used to treat acute herpes zoster and to reduce the severity and duration of viral replication. Through this inhibition of viral replication, acyclovir decreases the appearance of new lesions and accelerates crusting of the lesions.12 Despite this highly therapeutic effect of acyclovir in acute herpes zoster, many previously published studies demonstrated that acyclovir had no benefit in reducing the duration or incidence of PHN. However, more recent meta-analysis studies of all placebo-controlled trials with acyclovir for herpes zoster established that there is a significant reduction in zoster-associated pain in patients who received acyclovir.13,14

Similar results have also been observed with valacyclovir, as it, like acyclovir, minimizes the severity and duration of the acute herpes zoster outbreak.12 In addition, valacyclovir is more effective than acyclovir at reducing the duration of PHN. Studies have shown an average reduction of the duration of pain from 60 days, as seen with acyclovir, to 40 days with valacyclovir. Similar reductions in pain were also noted at 6 months after healing of the rash, as only 19% of patients taking valacyclovir reported pain, compared to the 26% of patients taking acyclovir.15

Famciclovir also promotes cutaneous healing and reduces the duration of acute pain. Patients who receive famciclovir have PHN resolve two times faster than those who receive placebo, resulting in a 3.5 month reduction in the average duration of pain.16 When comparing famciclovir to valacyclovir, both drugs equally hasten the resolution of zoster-associated pain and PHN.17

All three antiviral agents are approved for the treatment of herpes zoster. The most beneficial effects of the drugs are seen if they are used within the first 72 hours of the onset of the rash. Therefore, early clinical diagnosis and treatment of the disease results in faster cutaneous healing and reduced duration of PHN.

[glyph]

"Zostavax" (a single-dose vaccination) will prevent a shingles outbreak. Unfortunately, it is not available in Thailand.

[ukdog]

"Zostavax" (a single-dose vaccination) will prevent a shingles outbreak. Unfortunately, it is not available in Thailand.

Do you mean permanently or once an attack has started?

[Sheryl]

Neither. It will prevent (more accuratelt, greatly reduce the risks of) a person who has previously been exposed to chickenpox subsequently developing shingles in the first place. It is not useful once a person has contracted shingles.Currently recommended for persons aged 60 and abovee as that age group will usually have been exposed to chicken pox and it is after age 60 that shingles is most common.

For the pain, have you tried NSAIDs? (take with food only and not if any history of ulcer or bleeding disorder, or taking anticoagulants). Will give more relief than paracetemol.

[ukdog]

Ok thanks for that,

I took nothing but the Acyclovir at 5600mg a day (800mg every 3 hours). I am now virtually pain free and have some red areas left but they will fade I am sure. I suspect that at this rate i will be free within 2 weeks of the outbreak.

All I want to know now is will it keep coming back, or is that it. As it was far from comfortable.

[Sheryl]

Ok thanks for that,

I took nothing but the Acyclovir at 5600mg a day (800mg every 3 hours). I am now virtually pain free and have some red areas left but they will fade I am sure. I suspect that at this rate i will be free within 2 weeks of the outbreak.

All I want to know now is will it keep coming back, or is that it. As it was far from comfortable.

it can recur but it usually doesn't. More than 90% of people suffer only the one outbreak. But a minority of unfortunate folk do have it more than once.

It is most likely to recur at times when your immune system is run down for one reason or aniother...lack of sleep, inadeuqate diet, other infection.

Hopefully no need, but if it should recuir PROMPT treatrment is the key.

Good luck

[geriatrickid]

For those of you that have had shingles in Thailand, how long did it take you to recover? Is it a faster or longer recovery time than if you were in the EU or USA? Is there more discomfort in a colder climate or in a hotter climate? Thanks

[Thanyaburi Mac]

"Zostavax" (a single-dose vaccination) will prevent a shingles outbreak. Unfortunately, it is not available in Thailand.

I got that shot while in Oregon this past June, $204 at Bi-Mart, a tad expensive, but having googled "shingles" beforehand figured it'd be a good idea to have it.  Do hope my med insurance covers it, have already sent in the claim.

Mac

[Pushit]

For those of you that have had shingles in Thailand, how long did it take you to recover? Is it a faster or longer recovery time than if you were in the EU or USA? Is there more discomfort in a colder climate or in a hotter climate? Thanks

I had shingles in right side of my face, lugkily early diagnosed at Bangkok Christian Hospital. Treated with Acyclavir and cleared up in about 10 days. What lesions I had were quite painful.

Early diagnosis is key.

[ukdog]

For those of you that have had shingles in Thailand, how long did it take you to recover?

12 days total, 9 days after starting medication. I say clear but still have some red areas which are fading swiftly. No pain, new lesions, or scabbing now.

Edited August 22, 2008 by ukdog

[popshirt]

For those of you that have had shingles in Thailand, how long did it take you to recover?

12 days total, 9 days after starting medication. I say clear but still have some red areas which are fading swiftly. No pain, new lesions, or scabbing now.

One year this month and counting........still residual pain and post herpatic neuralgia (numbness)

[Zpete]

I was in Chiang Mai last Aug, 07.

When I had a shower one morning, I saw this monstrous red/purple rash ranging from navel to mid small of my back.

Initially thought it was insect bites, so treated it accordingly.

Three days later, back in BKK, I went to a pharmacist as it was not responding.

He told me it was shingles, a virus.

He sold me a cream, VIROGON, which when applied eventually lessened the red and scabby patches.

For Kiwis and Auzzies, Virogon is same as ZOVIRAX, but costs 80 baht, about 3 bucks, against Zovirax, over 20 bucks, and contains 50% more. Works for cold sores of course. Next trip, I bought half a dozen tubes home.

Anyway, the shingles lessened and was just a purplish rash when I returned to NZ. My doc confirmed it was shingles.

I had no pain or itch wotsoeva.

My wife had shingles on a shoulder, many years back, was in agony.

Guess, no sense, no pain........LOL

[Thanyaburi Mac]

QUOTE (glyph @ 2008-08-19 10:44:33) "Zostavax" (a single-dose vaccination) will prevent a shingles outbreak. Unfortunately, it is not available in Thailand.

I got that shot while in Oregon this past June, $204 at Bi-Mart, a tad expensive, but having googled "shingles" beforehand figured it'd be a good idea to have it. Do hope my med insurance covers it, have already sent in the claim.

Mac

Posts here two years ago say that the vaccine "is not available in Thailand." How about now??

Following article from the New York Times.

Mac

Doctor and Patient - An Important Vaccine Few Patients Are Getting - NYTimes.com

DOCTOR AND PATIENT

Why Patients Aren’t Getting the Shingles Vaccine

By PAULINE W. CHEN, M.D.

Published: June 10, 2010

Four years ago at age 78, R., a retired professional known as much for her small-town Minnesotan resilience as her commitment to public service, developed a fleeting rash over her left chest. The rash, which turned out to be shingles, or herpes zoster, was hardly noticeable.

But the complications were unforgettable.

For close to a year afterward, R. wrestled with the searing and relentless pain in the area where the rash had been. “It was ghastly, the worst possible pain anyone could have,” R. said recently, recalling the sleepless nights and fruitless search for relief. “I’ve had babies and that hurts a lot, but at least it goes away. This pain never let up. I felt like I was losing my mind for just a few minutes of peace.”

Shingles and its painful complication, called postherpetic neuralgia, result from reactivation of the chicken pox virus, which remains in the body after a childhood bout and is usually dormant in the adult. Up to a third of all adults who have had chicken pox will eventually develop one or both of these conditions, becoming debilitated for anywhere from a week to several years. That percentage translates into about one million Americans affected each year, with older adults, whose immune systems are less robust, being most vulnerable. Once the rash and its uncomfortable sequel appear, treatment options are limited at best and carry their own set of complications.

While the search for relief costs Americans over $500 million each year, the worst news until recently has been that shingles could happen to any one of us. There were no preventive measures available.

But in 2006, the Food and Drug Administration approved a new vaccine against shingles. Clinical trials on the vaccine revealed that it could, with relatively few side effects, reduce the risk of developing shingles by more than half and the risk of post-herpetic neuralgia by over two-thirds. In 2008, a national panel of experts on immunizations at the Centers for Disease Control and Prevention went on to recommend the vaccine to all adults age 60 and older.

At the time, the shingles vaccine seemed to embody the best of medicine, both old school and new. Its advent was contemporary medicine’s elegant response to a once intractable, age-old problem. It didn’t necessarily put an end to the spread of disease, in this case chicken pox; but it dramatically reduced the burden of illness for the affected individual. And, most notably, its utter simplicity was a metaphoric shot-in-the-arm for old-fashioned doctoring values. Among the increasingly complex and convoluted suggestions for health care reform that were brewing at that moment, here was a powerful intervention that relied on only three things: a needle, a syringe and a patient-doctor relationship rooted in promoting wellness.

Not.

In the two years since the vaccine became available, fewer than 10 percent of all eligible patients have received it. Despite the best intentions of patients and doctors (and no shortage of needles and syringes), the shingles vaccine has failed to take hold, in large part because of the most modern of obstacles. What should have been a widely successful and simple wellness intervention between doctors and their patients became a 21st century Rube Goldberg-esque nightmare.

Last month in The Annals of Internal Medicine, researchers from the University of Colorado in Denver and the C.D.C. surveyed almost 600 primary care physicians and found that fewer than half strongly recommended the shingles vaccine. Doctors were not worried about safety — a report in the same issue of the journal confirmed that the vaccine has few side effects; rather, they were concerned about patient cost.

Although only one dose is required, the vaccination costs $160 to $195 per dose, 10 times more than other commonly prescribed adult vaccines; and insurance carriers vary in the amount they will cover. Thus, while the overwhelming majority of doctors in the study did not hesitate to strongly recommend immunizations against influenza and pneumonia, they could not do the same with the shingles vaccine.

“It’s just a shot, not a pap smear or a colonoscopy,” said Dr. Laura P. Hurley, lead author and assistant professor of medicine at the University of Colorado in Denver. “But the fact is that it is an expensive burden for all patients, even those with private insurance and Medicare because it is not always fully reimbursed.”

Moreover, many private insurers require patients to pay out of pocket first and apply for reimbursement afterward. And because the shingles vaccine is the only vaccine more commonly given to seniors that has been treated as a prescription drug, eligible Medicare patients must also first pay out of pocket then submit the necessary paperwork in order to receive the vaccine in their doctor’s office. It’s a complicated reimbursement process that stands in stark contrast to the automatic, seamless and fully covered one that Medicare has for flu and pneumonia vaccines.

Despite this payment maze, some physicians have tried to stock and administer the vaccine in their offices; many, however, eventually stop because they can no longer afford to provide the immunizations. “If you have one out of 10 people who doesn’t pay for the vaccine, your office loses money,” said Dr. Allan Crimm, the managing partner of Ninth Street Internal Medicine, a primary care practice in Philadelphia. Over time, Dr. Crimm’s practice lost thousands of dollars on the shingles vaccine. “It’s indicative of how there are perverse incentives that make it difficult to accomplish what everybody agrees should happen.”

Even bypassing direct reimbursement is fraught with complications for doctors and patients. A third of the physicians surveyed in the University of Colorado study resorted to “brown bagging,” a term more frequently used to describe insurers who have patients carry chemotherapy drugs from a cheaper supplier to their oncologists’ offices. In the case of the shingles vaccine, the study doctors began writing prescriptions for patients to pick up the vaccine at the pharmacy and then return to have it administered in their offices. However, the shingles vaccine must be frozen until a few minutes before administration, and a transit time greater than 30 minutes between office and pharmacy can diminish the vaccine’s effectiveness.

Dr. Crimm and the physicians in his office finally resorted to what another third of the physicians in the study did: they gave patients prescriptions to have the vaccine administered at pharmacies that offered immunization clinics. But when faced with the added hassles of taking additional time off from work and making a separate trip to the pharmacy, not all patients followed through. “Probably about 60 percent of our patients finally did get the vaccine at the pharmacy,” Dr. Crimm estimated. “This is as opposed to 98 percent of our patients getting the pneumonia and influenza vaccines, immunizations where they just have to go down the hall because we stock it, roll up their sleeves then walk out the door.”

With all of these barriers, it comes as no surprise that in the end only 2 percent to 7 percent of patients are immunized against shingles. “There’s just so much that primary care practices must take care of with chronic diseases like obesity and diabetes and heart disease,” Dr. Hurley noted. “If a treatment isn’t easy to administer, then sometimes it just falls to the bottom of the list of things for people to do.”

“Shingles vaccination has become a disparity issue,” Dr. Hurley added. “It’s great that this vaccine was developed and could potentially prevent a very severe disease. But we have to have a reimbursement process that coincides with these interventions. Just making these vaccines doesn’t mean that they will have a public health impact.”

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[CobraSnakeNecktie]

BHT which is Butylated Hydroxytoluene has been shown very effective for people with herpes and other cold sores from breaking out and also after an outbreak.

BHT is effective against lipid walled virus like herpes and cold sores etc. Many people with herpes use BHT of about 1000 mg a day and don't have outbreaks until after they discontinue the BHT. BHT is a powerful antioxidant that is traditionally used as a preservatives for food products that have fat(lipids). It's approved as safe for foods by the US FDA.

Shingles is a similar lipid walled virus to herpes.

BHT is available at hospital supply stores in Thailand. It usually comes as a coarse powder. It's not so effective unless it's dissolved in an oil like coconut, olive etc. A dose can be added to heated oil and it will dissolve in 10 minutes or so. Some people dissolve a lot of BHT in a large amount of oil without heat but it takes a lot longer to dissolve. BHT is somewhat heat sensitive so it should not be excessively heated but gentle heat is fine.

Some people acquire BHT capsules in western countries and take them with fatty meals but the BHT will uptake better when dissolved first.

Google it

[PMNL]

Yes, it is available at most hospital and clinic.