DEAR DR. ROACH: My son had a pacemaker placed in 2013 and got it checked every four months. He developed an ulcer on his coccyx. He was being seen every two or three weeks in a wound clinic, and I was told it was 98% healed. The visiting nurse came between visits to the doctor and sent him to the emergency room because of a bad odor.

The ER said he had a wound and blood infection. Because he had a pacemaker, they said they would check it. It was checked a week later, and he died two days after that. I was told he died because his pacemaker wires were infected. Should someone have caught this problem? I am thinking my son died due to a medical error. — Anon.

ANSWER: I am very sorry about your son. I don’t have enough information to say for sure a medical error was responsible for his death; however, the story is concerning.
An ulcer on the sacrum is usually a sign of debility and immobility, which puts a person at risk for medical complications. If the wound was deeper than the doctors realized, it could have led to bacteremia — that is, bacteria in the blood. People with ANY kind of medical hardware need to be very concerned about bacteremia, since no matter how well the device is put in, it is at risk for being infected (what we call “seeded”) by the bacteria. Bacteria can go anywhere blood goes. Infection around a pacer wire is extremely serious and usually requires surgical removal of the infection, which in turn requires great expertise.

A week seems too long, especially in hindsight, to let the pacemaker leads go without evaluation. I’m publishing your letter in hopes that other people in a situation like your son’s know to get prompt evaluation of any hardware they have that is in contact with blood, such as a pacemaker or automated implantable cardioverter-defibrillator, in a situation of bacteremia (blood infection).

DEAR DR. ROACH: I’m a 78-year-old woman with shingles. It is between the left side of my butt and my vagina. It feels like I’m sitting on broken glass. I had to go to the emergency room because of the pain. I am now on gabapentin three times a day. The doctors said they have never had a case where my shingles are.

A friend just had them on his arm. Is it just a coincidence I got them just after being in his company? I did get a shingles shot five years ago. — T.W.

ANSWER: Shingles is caused by reactivation of the varicella-zoster virus, which lays dormant in the nerve roots after a person had chickenpox as a child. Under stress, or as we get older, the virus can reactivate in a specific body location. The genital area, including the vulva and vagina, is unusual, but it’s by no means unheard of. However, I recommend being sure of the diagnosis, since genital herpes can look a lot like shingles. A laboratory can tell the two related viruses apart.

Since zoster is a reactivation of a dormant virus, getting exposed to a person with chickenpox or shingles is not the cause of your infection. Gabapentin is one effective treatment, but it may take weeks to get to adequate pain control.

The shingles shot from five years ago (Zostavax) is seldom given now. A newer vaccine (Shingrix) is more effective, although it requires two doses. I recommend the newer vaccine even for people who have had the Zostavax in the past.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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