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22 | James Hubbard's My Family Doctor | The Magazine That Makes Housecalls The shingles Vaccine immunizing infants against chick- enpox has provided some hope for decreasing shingles. a vaccine, Zostavax, for adults over 60 who have had chickenpox is also avail- able. it's not perfect but drastically reduces the risk of shingles and its complications. complications are few, but shingles can result in serious eye problems when it involves that area of the face. About 8 percent of people over 60 with shingles develop postherpetic neuralgia, with the risk going up if you're over 70. Q housecalls chronic disease Chickenpox All Grown Up By BRUCE KaLER, M.D. How do you get rid of shingles? —anonyMous, via www.MyFaMily- doctoRMag.coM AnSWER Shingles is the chickenpox virus that's been hanging around and decided to rear its ugly head. It usu- ally goes away on its own, but getting treatment as early as possible is best to help prevent complications. WAKE-uP CALL After chickenpox has lain dormant for decades in one of your nerve roots, something can wake it up. We think the trigger is often some form of stress that lowers your resistance, driving the immune system below a certain threshold and allowing the virus to turn on. The rash can be preceded by several days of a burning pain that varies in intensity but has a reputa- tion of being quite uncomfortable. Since the virus is trapped in a nerve, the rash appears only in the swath of skin that nerve supplies. It won't even cross over to the other side of your body because nerves start in your backbone. KICKInG IT OuT Since this is a herpes virus—though different than the ones that cause cold sores and sexually transmitted blisters—it isn't curable, just as the herpes STD and cold sores aren't. It will, however, go back into hiber- nation. If you're otherwise healthy, you'll probably fight it off like any other virus. Nonetheless, it's best to get treatment. The average shingles outbreak can last several weeks and vary in intensity considerably from one per- son to the next. Antiviral drugs such as acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex) can help relieve the pain and inflam- mation and shorten the outbreak's duration if you start them within 48 to 72 hours of when the rash begins. But most importantly, when taken early enough, these drugs can also help prevent postherpetic neuralgia, a troublesome condition in which the pain persists for months to years after the rash has subsided. Before these drugs were available, high doses of ibuprofen were—and still can be—helpful in reducing the pain's intensity. Consult your health- care provider before treating yourself. High doses can be dangerous, even life-threatening. And make sure your doctor knows beforehand if you have kidney impairment, congestive heart failure or bleeding problems. In severe cases, a steroid may provide some relief. Over-the-counter topical products like creams are of little use for this frustrating condition. PASSInG IT On People can't catch shingles from shin- gles, but they can catch chickenpox from it. If you've never had chick- enpox, you can get it through direct contact with shingles blisters or their fluid. If you have had chickenpox or been vaccinated, though, you should be immune. Consult your health-care pro- vider as soon as you see a suspicious rash to help minimize the pain and frustration. Recurrences can happen, but keeping a healthy lifestyle and managing stress are your best bets for keeping shingles from coming back. bRuce kaleR, M.d., is a family doctor and director of the U.S. Healthworks clinic in Puyallup, Wash. He wrote The Owner's Manual for Allergy Relief and the medical mystery Turnabout, both of which are avail- able at www.seattledoc.com.