DEAR DR. DONOHUE: I am an 83-year-old woman. I am just beginning to recover from shingles that started four months ago. A doctor told me it is possible to have shingles more than once. Please confirm the possibility. Is there a vaccine to prevent this? – L.L.

DEAR DR. DONOHUE: Shortly after we visited my daughter, our grandchildren came down with chickenpox. Soon after our visit, my husband got a bad case of shingles. People tell me that he could have caught the shingles virus from my grandchildren, who were incubating chickenpox. Is this so? – N.N.

ANSWER:
The chickenpox virus is highly contagious. Almost every adult has been infected during childhood, whether he or she can remember the infection or not.

Once the chickenpox virus infects a person, the virus stays with that person for the rest of his or her life. It lodges in nerve cells. Later in life, when there’s a temporary lapse in the immune system, the virus wakens and travels down nerve roots to the skin, where it bursts forth into the typical shingles skin rash. N.N., your husband did not catch shingles from your grandchildren. He has harbored the shingles virus ever since he had chickenpox as a child. The shingles virus and the chickenpox virus are one and the same. The first encounter with the virus is always chickenpox, never shingles.

Speedy treatment of shingles can sometimes cut short an attack. Zovirax, Valtrex and Famvir are three drugs used to fight a shingles outbreak The rash phase of shingles, bad as it is, is not the worst consequence of a shingles attack. The pain that lasts long after the rash is gone can be unmitigated torture.

L.L., I hate to be the bearer of bad news, but a person can have more than one encounter with shingles. A second encounter, however, is not common. Currently undergoing testing is a more potent version of the chickenpox vaccine specifically designed to prevent outbreaks of shingles.

Shingles is a common malady of the elderly. The shingles pamphlet details the life history of the shingles virus and treatments for it. People can order a copy by writing: Dr. Donohue – No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have been waking up during the night trying to catch my breath. If I sit up, it helps, so I generally spend the rest of the night sleeping in a chair. Can I wait for my annual exam, or should I see the doctor now? – L.J.

ANSWER:
See the doctor now. You describe paroxysmal nocturnal dyspnea – sudden attacks of breathlessness during the night.

It’s an indication that the heart can’t pump strongly. When a person is horizontal, fluid shifts from tissues into the circulation. That overloads the circulation, and a weak heart cannot handle it. Fluid backs up into the lungs and produces breathlessness. When seated in a chair, fluid oozes back into the tissues and takes the load off the heart. A person is able to breathe less laboriously.

My diagnosis is at best a guess, but your symptoms worry me, so they should worry you.

DEAR DR. DONOHUE: What is pulse pressure? It’s a term I never heard before. My doctor said mine was high-normal. Does this have anything to do with blood pressure? – P.K.

ANSWER:
Pulse pressure is the difference between the systolic (first number) and diastolic (second number) blood pressures. Systolic pressure results from the force the heart uses to eject blood to supply the body. Diastolic pressure is the pressure in circulation between beats.

Say you have a blood pressure of 120 over 80. Your pulse pressure is 40. Pulse pressures up to 50 do not raise eyebrows. Those over 60 do raise eyebrows. A large pulse pressure is evidence of artery hardening. A large pulse pressure even when systolic and diastolic numbers are low can still be a sign of artery hardening.

DEAR DR. DONOHUE: My husband has a diagnosis of skin vasculitis. We have no idea what this is, how long it lasts or where he got it. We need information to plan for the future. Please help. – T.B.

ANSWER:
Vasculitis – blood vessel inflammation – encompasses many different illnesses with many different signs and symptoms. The one thing these disparate conditions have in common is inflamed blood vessels.

One common vasculitis, one you might have heard of, is temporal arteritis. The inflamed blood vessels include the temporal arteries, the arteries at the sides of the head (hence the name). Headache is its chief symptom.

Skin vasculitis, your husband’s disorder, has the official name of “predominately cutaneous vasculitis.” The involved vessels in this vasculitis variety are small skin blood vessels.

Bruises cover the patient’s skin. The skin might also break out in flat spots, blisters (small or large) and recurring hives. The legs are the principal targets involved in the breakout. Affected people often report that the rash and their skin itch, burn or sting.

At times, this vessel inflammation can be traced to a medicine that the person takes. At other times, a background illness, such as lupus or rheumatoid arthritis, is to blame. Quite often, however, it happens without finding the instigator.

If the inflammation is not linked to some underlying illness and if internal organs are not involved in the process, then complete recovery is anticipated.

If the situation is more severe, doctors resort to one of the cortisone medicines to control it.

It appears that your husband’s involvement is limited to the skin. He should, therefore, come through this without any permanent damage. How long that might take is a question that has no pat answer.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.


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