Deborah Howell (Host): We've all probably heard a lot about shingles, especially if you know someone who's had it. Angeline Smith, a Nurse Practitioner and Primary Care Provider at Pullman Family Medicine and Palouse Health Center, she's with us today. She's an expert here to tackle our key questions about shingles and discover what steps to take if you suspect shingles. Welcome, Angeline.

Angeline Smith, ARNP: Thank you, Deborah. Happy to be here with you today.

Host: Just a pleasure to have you. So, is it true that shingles is a reactivation of the chickenpox virus in the body?

Angeline Smith, ARNP: It is true. Shingles is also known as herpes zoster. It's caused by the same virus that causes chickenpox called varicella zoster. So when a person recovers from chickenpox, the varicella zoster virus lies dormant in the body, kind of asleep, hanging out, causing no symptoms, but it can reactivate later in life.

Host: Okay, so what causes this reactivation and what are the symptoms?

Angeline Smith, ARNP: So reactivation of the virus can be caused by several different things. It's usually like a, you know, a trauma response to the body or when the body is stressed in a certain way. So age can cause reactivation, recent physical trauma, illness, fatigue, or emotional distress even. It can also reactivate if you're taking immunosuppressive medications, if you have lymphoma or if you've undergone radiation treatment. Symptoms can start with a really weird sensation on your skin, kind of like itching, maybe a burning pain, tingling. Some people will get flu like symptoms such as fever, headache, or that overall feeling of being sick. So after a few days of that, a painful rash develops that includes clusters of fluid filled vesicles, and it usually occurs in like a band like fashion across the chest and back, but it can show up on other parts of the body such as the head or the face.

It doesn't usually cross the midline of your body, so it usually causes, it's right on one side of the body, but a couple vesicles can turn and can go across the midline. But the vesicles will eventually turn into scabs and resolve over time. So it takes a few weeks sometimes for it to go away.

Host: All right. Now, is shingles contagious, and can someone who hasn't had chickenpox contract shingles?

Angeline Smith, ARNP: Yes and no. So a person is not going to catch shingles per se, but they may catch chickenpox if they've never had chickenpox before. Or if they've not had the varicella vaccine that prevents chickenpox. So someone who has never had chickenpox that is exposed to a person with active shingles can contract the varicella zoster virus, but it will manifest as chickenpox, not shingles. So it's important to avoid contact with anyone who may have shingles if you have never had chickenpox or the chickenpox vaccine.

Host: Got it. So who's at risk for contracting shingles?

Angeline Smith, ARNP: So if you've ever had chickenpox, you have the varicella zoster virus in your body, which, as we talked about before, can reactivate under certain conditions. But people age 50 and older are more likely to contract shingles, as well as those who are immunocompromised, undergoing chemotherapy, are HIV positive or are using immunosuppressive medications for another condition such as rheumatoid arthritis, but it is possible to contract it earlier than age 50, but not as common.

And there are also certain populations of people who have a higher risk of a complicated infection should they get it, such as pregnant women who can pass that virus on to their baby via the placenta, premature babies, or people with a weaker immune system.

Host: You have all the answers, Angeline, I'm telling you, but I have a few more questions. How is shingles treated? And if you think you have shingles, what should you do?

Angeline Smith, ARNP: So we like to treat shingles as early as we can from when symptoms first start, and we usually treat with an antiviral medication called acyclovir. We usually start this medication if you've had the rash for less than three days, unless new vesicles are popping up. That's why it's so important to make an appointment to be seen by your doctor as soon as your symptoms start so we can get this medication on board.

 It's important to keep the rash clean and dry, try not to scratch it, which is why it's a good idea to keep it covered, and take any prescribed medications as directed. Again, hand hygiene, very, very important.

Host: So how do you take a shower then?

Angeline Smith, ARNP: You take a shower, you just got to get it clean, and then make it dry, and then keep it covered.

Host: Okay. So it can get wet during the shower?

Angeline Smith, ARNP: Yes, that's totally fine. Yep.

Host: Alright, anything else you'd like to add about the treatment or shingles in general?

Angeline Smith, ARNP: Yeah, there, you can prevent shingles. It's, there's a vaccine approved to prevent shingles and it's, and the related complications that you can get from it. And it's called Shingrix. It's a two dose series given approximately two to six months apart. And it's recommended for adults aged 50 and older, as well as adults 18 and older who are more at risk of catching it early, such as those who are immunocompromised. You can get your Shingrix vaccine at your local pharmacy, but we also recommend parents have their children vaccinated with the varicella vaccine to prevent chickenpox in the first place, and that will hopefully prevent shingles later in life.

The varicella vaccine is expected to give lifelong immunity. So if you have an active shingles infection, important to wash your hands frequently until your rash is scabbed over and keep the rash clean, dry, and covered. And the biggest thing I would like people to take away from today's conversation is how important prevention is as we age and to see your doctor yearly for a preventive care visit to discuss what's recommended for your age and your health issues because the complications from shingles can include blindness if it occurs close to the eyes, hearing loss, and facial paralysis if it affects the facial nerve, skin infection, and the overall nerve pain can last for months up to years after the initial infection resolves.

Host: Wow, up to years I did not know that. Yeah, very, very important because, so many of us say, oh, another vaccine, but it is a one time thing, two shots, six months apart, And then that's it, for the rest of your life, correct?

Angeline Smith, ARNP: Yep, and it's, we think, oh, it's a rash, what can it really do? But the nerve pain that comes with the rash can last for years afterward, and it's, can be debilitating with some people, depending on your, you know, current conditions you already have.

Host: Well, Yeah, for sure. Well, Angeline, thank you so much for being with us today to enlighten us about shingles and when it's time to seek help. It's been such a pleasure to have you on the podcast. Thanks for all your great answers.

Angeline Smith, ARNP: Thank you so much for having me.

Host: And you can learn more about this subject, providers and services at pullmanregional.org/PullmanFamilyMedicine. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.