Well, after my visit to the dermatologist, I am just maddened. After seeing my regular PCP yesterday, who took one look at the tell-tale vesicles in a linear formation, surrounded by redness, and noted that my BP was elevated (140/90), and concurred with my initial diagnosis of shingles (herpes zoster). She prescribed Valtrex 1000 mg (aka 1g), along with pain medication, and suggested that I follow the course that I mentioned to her of as much rest as possible, as little clothing as possible, staying cool (crank up the AC), and keeping the area dry. I fortunately had some topical Lidocaine 2% gel, so I am using that as well. But back to today’s source of irritation–I had made an appointment yesterday with the dermatologist, as I called both my PCP and my dermatologist’s office–thinking it better to use the shotgun approach, and see who could get me in the quickest. The dermatologist’s office was able to schedule me for a 9:00 appointment this am (not with my dermatologist, but another provider), so I took that appt., then a couple of hours later my PCP’s office called and asked if I could be there at 1:00 yesterday (so they were able to get me worked in same day!). Of course I said I would be there, but after thinking about it yesterday afternoon, I decided to keep my appt. this morning with the dermatologist as well, since I had a couple of dermatological issues that I thought I could knock out as well (the two birds with one stone theory). Also, in the back of my mind, I was curious as to whether the diagnoses would be the same. So, I arrived for my appointment this morning, had to wait much longer to get in than I did to be seen yesterday (which was a work-in, and by rights should take longer), and finally get in to see the….FNP. I have great respect for FNPs (Family Nurse Practioner), as they have to complete an extensive and rigorous educational process, but just as it is with MDs, some as better than others. My friend and former co-worker Celina–brilliant. The FNP I saw today–still reserving judgement to a point, but….I hate being given misinformation, and PLEASE PLEASE PLEASE—do not talk to me in euphemisms and avoid the hard questions or discussions. So, I tell him that I believe I have shingles, and he appears to agree, until I mention that I have had them previously (I told him that I was first diagnoses with shingles in college,) as I mentioned they were just like their herpes simplex cousin—the gift that keeps on giving. So then, he told me that once you have shingles, you can’t get them again, and that my blistered-up rash o’pain was a “cold sore” which was his euphemistic way of saying that I was suffering not from Herpes Zoster (shingles), but Herpes Simplex II (genital herpes) or HSV I (cold sores/fever blisters). Ok–first issue—misinformation–you CAN have more than one shingles outbreak! Obviously, if it lies dormant in the ganglia, and active shingles is caused by some trigger reactivating the virus, so that it reawakens in the ganglia, and travels through the nerve fibers to the skin, and then eventually subsides and becomes again dormant in the ganglia, common sense would tell you that it can be re-awakened again. I understand that you may develop antibodies, and that the majority of people who are afflicted with shingles do NOT have a recurrence, but those who are immunosuppressed or immunocompromised (the elderly, diabetic, people with HIV, cancer, lupus, etc.) frequently do have recurrences. From my research online, it appears that the general consensus is approximately 4% of people who have shingles experience recurrences. So, it makes me FURIOUS when someone tells me something that I know is incorrect, and supported by research and documentation. And if he thought it really was HSV I or II–as another dermatologist told me during last summer’s shingle/seborrheic dermatitis debacle, then why didn’t he ask me if I had ever been diagnosed with genital herpes or had suffered from cold sores? I have NEVER had a cold sore, and have been tested for genital herpes–and it was negative. If it truly was either HSV I or II, then it is your obligation as a healthcare provider to discuss that with me and give me the information I need to protect those I love (and even those I don’t), as HSV I and II are both HIGHLY contagious! NO questions, information, nothing!! So if it were HSV I or II, I would be putting those I love at risk (my boyfriend, family members–my parents, brother and sister-in-law, nephews, co-workers) because I wasn’t informed and educated about how HSV I and II can be spread and the level of contagion, since it can be spread just by touching the affected area and then touching someone else–so I could scratch the blisters on my back, forget to wash my hands, and touch one of my nephews and infect them. Also sharing towels–warm, wet, and wonderful for transmission. And don’t forget “Auto-inoculation: An infected individual can spread the virus to other parts of his or her body by touching an area shedding virus and then touching, scratching, or rubbing another susceptible part of the body. Towels are especially conducive to this.”, so I could be spreading it all over my own body, including to my eyes–which could potentially cause blindness due to keratitis among other eye infections. According to the the National Eye Institute, a division of the National Institute of Health: “Herpes simplex keratitis is a leading cause of corneal opacification in the United States, other industrialized countries, and developing nations throughout the world. An estimated 450,000 people in the United States can develop recurrent episodes of the disease and about 46,000 episodes of HSV eye infection every year. Herpetic eye disease is the most common infectious cause of corneal blindness in this country.”, . HSV is easily killed by soap and water, but the lack of appropriate care, and misinformation, and the failure to disseminate information when necessary is unfortunately not so easily treated.
Well, I guess I will wrap up this rant for now, as I need to eat some dinner, and spend some time with Scootch, but I will be back later with more updates on my progress.
