These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Shingles
Question: My neighbor is 78 and has shingles for over 1 month. His doctor has treated him with B vitamins. He still has pain and the shingles have dried up. He continues to have a loss of appetite. His doctor does not want to use cortisone. What do you recommend?
Answer: Shingles is a breakout of latent Herpes Simplex (chicken pox). The virus once in your body will “hide” in the spinal cord. Then during times of stress, immune suppression, or for random reasons it will break out again. During this second infection the virus only travels along the nerve or nerves in the spinal cord where it is “living”. This gives a characteristic band effect which almost never effects both sides of the body at the same time. The characteristic vessicles appear as little blisters. These last for about 7-10 days and then dry up and crust over. While one has active blisters,the virus is contagious to those people or pregnant women who have not had chicken pox. After the blisters dry up and fall off there tends to be a characteristic neuropathy. About 30-75% of patients will continue to experience pain in the area of the viral infection and blisters. Treatment during the actute phase with anti-viral drugs appears to have some effect in
decreasing the incidence of post-herpetic neuralgia which is the medical name for this pain syndrome. Treatment with Zostrix(capsaicin) over three to four weeks can be very effective. This drug is derived from a type of hot pepper and appears to work by working on the local nerve fibers which cause the pain. Recently, this drug has recieved a lot of use in diabetic neuropathy, arthritis and many other chronic pain syndromes.
Side Effects from Hydroco/Apap
Question: My mother is taking Verapamil and developed shingles and is now adding hydroco/apap and amitriptyline to treat shingles. Are there any side effects?
Answer: Hydroco/apap is medical short hand for hydrocodone plus acetaminophen-the side effects for this combination usually centers on the hydrocodone. Hydrocodone is a narcotic and as such has the same side effects as most narcotics;that is, constipation, nausea(especially if on an empty stomach) vertigo and difficulty concentrating. Amitriptyline was originally used as an anti-depressant. However, it is limited by its anticholinergic side effects. That is, constipation, drowsiness, dry mouth and occasionally difficulty focusing. These same anti-cholinergic side effects are what potentiate any analgesia. That is, an antihistamine or any drug with anticholingeric side effects will increase the effect of other pain medicines. Verapamil is a calcium channel blocker used for angina, hypertension and occasionally irregular heart beats. It has the side effect of constipation and swollen feet. As a consequence, your mother is likely to have severe constipation on this regimen.
