T + 704 Sit Rep

Posted by raetsel at Saturday, August 21, 2010

Just a quick shingles situation report.

I went to the clinic on Wednesday 18th August and saw the registrar. He had a quick look at the shingles and confirmed the outbreak appears to be over as the lesions have crusted over and started to fade in places.

He told me to keep taking the gabapentine for four weeks for the nerve pain. He also reduced my ciclosporin to 10mg twice a day. Assuming we continue the taper as it has been at 10mg per visit then when I next attend clinic on 6th October I should be stopping ciclosporin altogether. ( I hope we don't go down to 5mg not least because that will be really fiddly to measure the liquid in my syringe. )

I was signed off work until 30th August ( though it will be 31st when I can actually go back to work as Monday 30th is a Bank Holiday).

The pain from the shingles has been quite intense at times over the last week and I've had to take some co-codamol painkillers between gabapentine doses to help relieve it. Over the last couple of days it has started to calm down a little so I hope it has gone past its peak. I do seem to have adjusted to the gabapentine better and don't have so many problems with drowsiness or fuzzy headedness.

T + 697 All that blisters..... (PG)

Posted by raetsel at Saturday, August 14, 2010

.....is not bold? Ok not a great tag line but my internal sub-editor couldn't resist the alliteration.

Oh I should say that this post is rated Potentially Gruesome for pictures of shingles.

This time last week I was blogging about my admittance to hospital with shingles. Well for those of you who have not heard by other means such as Twitter, Facebook or the Intermom (that special network of mothers that disseminates information between sons, daughters and the friends thereof far faster then the World Wide Web) I was released from hospital on Monday 9th August which was ahead of the schedule I had initially been told.

The reasoning was that we had caught the outbreak early I had had seventy-two hours of intravenous aciclovir and no new lesions had appeared anywhere for forty-eight hours. I was sent home around 14:00 with some gabapentine nerve pain tablets and a ten day course of valaciclovir tablets, which are a form of aciclovir that produce higher levels of the drug in the blood than normal aciclovir tablets.

I was signed off work until the 18th August at least, which is when I have a clinic appointment to review how things are going. I expect I'll be signed off for the rest of that week at least.

The week at home has been ok, I've had quite a bit of pain in the band around my trunk where the shingles are, the area known as dermatome T-8 R as there are eight dermatomes that cover the whole of the trunk of the body, these are the names given to the nerves that run through and "serve" the skin.

The gabapentine does a pretty good job of reducing the pain though it seems to be a universal law that the amount of relief you get from any pain killer lasts about one hour less than the minimum time you have to allow between doses. Thus first thing in the morning and last thing before bed have been the most painful.

Aside from the pain I have felt quite tired and the gabapentine has made me feel really drowsy and fuzzy headed at times during the day. Most noticeably it seems when I hold my focus at a fixed point for any length of time such as when reading. Sounds a little odd I know but having looked round a few patients' websites it seems to have happened to others.

As for the shingles themselves they have, you might say, blossomed but no new areas have appeared, they are all along T-8, but don't take my word for it, see for yourself (you can even click to embiggen and get the full HD experience):-

They still seem to have a way to go before they start crusting over which is the sign the outbreak is over, though it may take weeks for the skin to return to normal. The crusting also means I'm no longer contagious to people who haven't had chickenpox before, pregnant women and people who are immunocompromised.

I could be wrong but I get the impression the valaciclovir is holding the outbreak in check and stopping it spreading but it will have to take its normal course in the area where it started. There is a small chance I may have to go back into hospital to have more intravenous treatment if it does not clear up but I hope it won't come to that.

T + 690 When is a bad back not a bad back?

Posted by raetsel at Saturday, August 07, 2010

The answer is when it is shingles. I'm writing this blog post from Ward West 5 of the Queen Elizabeth Hospital having been admitted yesterday.

It started on Wednesday afternoon, 4th August when I felt an ache in my upper back just below the shoulder blade. Having just worked two eighteen hour days doing a disaster recovery for work, I put it down to having spent too much time sitting in front of a computer screen with my far from perfect posture.

The pain persisted throughout Wednesday and Thursday but co-codamol pain killers kept it at bay and I was able to work in the office as normal. I logged on from home on Friday morning as per my usual routine. I started to get a tender sort of burning sensation under the skin in a band around my abdomen and back on the right hand side but it wasn't until there were some spot/lesions on the side of my abdomen where the tenderness and burning was that I made the connection and realised it could be shingles.

I tried ringing my GP for an appointment but as this was 8:30 in the morning all the appointments for the day had already gone. To be honest that was just a bit of a stalling tactic on my part as I knew I would have to talk to hospital and I would have to come in.

I rang the Bone Marrow Transplant ward, explained I was nearly two years post-transplant and I thought I had shingles. The nurse said she would get a doctor to call me back as soon as possible.

I remember during a consultation about my transplant a few weeks before it took place that the subject of shingles came up. The doctor explained it was common for transplant patients to get shingles(about 30-40% of patients get them within 5 years of a transplant).

As you may know shingles is caused by a reactivation of the chicken pox virus. Once you get chickenpox the virus stays dormant in the body kept in check by your immune system. It can flare up into shingles at anytime especially if you have a weakened immune system. There is anecdotal evidence that stress can affect the immune system enough to cause an outbreak of shingles. ( So maybe my first instinct about the two long days at work being the cause of my pain was right after all).

Shingles is not pleasant for anyone but for someone like me with a naive and suppressed immune system it can be "quite nasty" if not treated quickly. I decided not to enquire into what "quite nasty" meant when the doctor mentioned it back in August 2008.

The doctor said back then to call the ward at any time I thought I might have shingles and just make sure to say "I think I have shingles" and everyone will leap into action a bit like some IRA coded warning sent to a radio station.

Sure enough 23 minutes after I called the ward I got a call back from the doctor in charge of the transplant unit. ( Yes I just checked the call log on my iPhone to get the times, so?).

The doctor asked me a couple of questions about the pain and lesions and then, somewhat to my surprise as I was just expecting her to say "come up and we'll check it out", she said there was a bed ready for me at 14:00 and I would be kept in for at least 5 days for intravenous acciclovir treatment.

So that was it, the well oiled machine was set in motion. A couple of emails to work to explain the situation and where I was on a couple of projects and then I called Dad's taxis to book a trip to the QE. I printed out my list of "things to take into hospital" and started preparing.

Before Dad came to pick me up I called NHS Direct to check it was ok for me to be in contact with him. The nurse said that for normal healthy people who have had chickenpox it was ok to be around me. I need to steer clear of pregnant women and people who have never had chickenpox, however the risk is only through physical contact with the virus (e.g. Contact with the lesions ) there was no airborne component to shingles per se.

I was admitted to a single bed side ward at the QE and the doc took one look at my abdomen and back and confirmed it was shingles even though there were only a few small spots.

As NHS direct pointed out there was no risk to normal healthy people from my shingles but as I am on a ward full of people with immune systems in various states of disarray I would be confined to the side room and that included use of the toilet, so it is the commode for me for the duration of my stay. (Oh joy of joys, unbounded. )

My treatment started immediately. The doc fitted a canula in my arm so I could have IV acciclovir. The dose is 1g in 250ml of saline given over 1 hour every 8 hours.

This means I am only connected to my old friend Ivy the drip stand for an hour, three times a day. The rest of the time I can move about unencumbered. If only I had somewhere to go.

I spent a reasonable night, interrupted only by a bag of acciclovir at around midnight. The pain from the shingles was bearable and I am now on some special pain killers that are good for nerve pain called gabapentine or something like that. I'll have to look it up.

This morning I did get a brief release from the room when I was taken down for a chest x-Ray. This is just a precaution to check I don't have a shingles on the lung. As my breathing is fine it's unlikely to be a problem.

I will finish this blog post with two apologies. Firstly I am sorry it is so long but what can I say I have time on my hands and a fully charged iPad. Secondly as I have typed this all on the iPad keyboard sorry if there are more typos than usual. Right time for a proof read.

- Posted using BlogPress from my iPhone