The past two mornings I have awakened to outside temperatures of 50 degrees. Soon on goes the gas log fireplace in the living room – a sure sign of things to come.
I started to experience pain in my right breast last week, followed in a few days by an accompanying pain in my upper right back. The oncology nurse in me went to the internet to review information of male breast cancer. Did I or did I not perceive a certain lumpiness right of the nipple? Afterall this is my first attempted self-breast exam. The pains remained pretty constant, even increasing in intensity. Then after a few more days I experienced pain under my arm, like a band connecting the pains in my back and breast.
At bedtime I decided to take a look at this new area of tenderness. Looking in the bathroom mirror, I saw a cluster of angry, red raised lesions. When I turned my back just so to the mirror, I noticed similar lesions near my spine. Back to the computer a second time to confirm my new suspicions. It looked like “shingles” to me. I became anxious immediately. The same type of infection destroyed vision in my left eye four years ago. I only have one eye left.
I went to bed with a plan – to call my dermatologist and transplant doctor in the morning, and, this being Friday morning, to go to whoever could see me first. Called the skin doc first as he was closest. They said they could see me within the hour. A quick shower and off I went. Dr. Terry took one look and confirmed my diagnosis. He assured me that it was unlikely to disseminate and travel to my face (and my good eye). He started me on an antiviral, Valacyclovir, and strangely, Neurontin, an anti-convulsent, to mitigate the pain experience.
The virus Varicella zoster causes both chicken pox and shingles. The infection can only cause one episode of chicken pox. It then remains sequestered and dormant at the nerve roots for decades. It can reemerge as a shingles infection later in life when the host becomes immunocompromised by stress, aging, chemotherapy, etc. That is why it is more commonly seen in older people (like me) and in bone marrow transplant survivors (me again). Zoster is related to the herpes virus. Before they crust over, the lesions can be contagious, especially to pregnant women, other immunocompromised persons, and people who have never had chicken pox or the chicken pox vaccine.
The pain can be mild to excruciating. During my last infection, which involved the left side of my face, I remember that it was the worst pain I had ever felt, worse even than bone marrow biopsies. So far this time I have only experienced the dull throbbing pain with occasion strong stabs in the back. Because the nerves are involved, pain can be felt all along the nerve pathway or dermatome not just at the site of the lesion. Some people suffer a condition called post-herpetic neuralgia, nerve pain continuing months or years after the initial infection.
The pain from my first bout eventually subsided, although the area of my left forehead has continued to itch daily four years after the infection. I seem to recall the doctors saying that it was unlikely that I would develop shingles a second time. Oh, well… At least this is something else to add to my disability review.