DR. HOOK- Hang it up: Nail down shingles cure

Steve Carell has a hard life. I'm sure he got seasick on the Ark while filming Evan Almighty in Crozet. In his NBC show The Office, he's as clueless as Alicia Silverstone in Clueless. In Anchorman, he had only three– at best four– brain cells. 

But in reality he's very well educated. He went to my college! He graduated from Denison University in 1984 just as I was preparing to matriculate that fall. I missed him by that much!

   In The 40 Year Old Virgin, Carell decides to have his body hair waxed. Funny how today many men are trimming, cutting, and waxing their hair. When I grew up in Ohio, the other guys made fun of me for not having much body hair. I just told them I lost it all in a nuclear accident– which didn't work because they didn't know what nuclear meant.  

Anyway, when Carell is having the waxed hair yanked out, he curses and insults the poor lady performing the procedure. Needless to say, he doesn't let her finish and walks out with five separated strips of smooth skin in a field of hair on his chest and abdomen. To me, it looked like dermatomes that can be involved in herpes zoster (shingles). Why does everything remind me of medicine?

Shingles cover your roof, but here I'm talking about another kind of shingles, herpes zoster. Ninety percent of Americans get chicken pox, which is caused by varicella zoster virus (VZV). (Get out the calamine lotion!)

Unfortunately, the zoster virus can hide and thrive in the nervous system in a nerve root by the spinal cord or in the brain. Years later, in 10-20 percent of adults, VZV can re-activate and recreate the red blisters of chicken pox, except this time they appear only along the nerve root distribution: the dermatom– a la Steve Carell. 

Eight percent of cases will develop a chronic painful condition called postherpetic neuralgia (PHN). PHN is about as much fun as having a grease fire in the kitchen– with you in the fire! When shingles break out, medications can reduce the risk of PHN, but there is no guarantee.

If herpes zoster affects the eye or ear, a person can become blind, lose hearing, or have hyperacusis– painful sensitivity to sound. Hyperacusis makes listening to Judy Garland sing, "Clang, clang, clang went the trolley" feel like a bullet going off in the ear– bang, bang, bang went the...

Shingles in the eye? Very painful, and light makes it even worse. When a patient came to my LA office wearing dark sunglasses, I just figured it was Cher or some other famous personage. Here in Charlotttesville, I figure it's or shingles. (Or maybe a black eye.)

People most at risk include those 60 years or older, those with HIVand/or AIDS, kidney transplant patients, or people on chronic steroids or immuno-suppressants. The theory about shingles is the immune system against VZV starts to decline, and during a time of stress, VZV takes advantage of the situation to flare up.

Now a new vaccine is finally available to boost the immune system against VZV: zostavax. (Sounds like a beer.) This mercury-free vaccine contains live attenuated (weakened) VZV to increase immunity. In the New England Journal of Medicine 2004, zostavax was shown to be about 51 percent effective in preventing shingles after three to four  years. As a person gets older, it isn't as effective, but it does appear to reduce the severity of shingles and complications such as painful PHN.

Is zostavax for you? (Do I sound like a dreadful pharmaceutical commercial?) Talk to your doctor and check out my web page, cecats.com.  It's time to hang up your shingle.