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DR ELLIE CANNON: How long will it take to be free from the pain of shingles?

I had shingles a few months ago and was on tablets. The blisters are gone, but I still have pain on the side of my ribs where they were. Will it disappear?

One thing I noticed was that a larger than normal number of my patients got shingles during shutdown.

It’s a nasty condition caused by the same virus as chickenpox, which lives dormant in our body after we first got it as a boy.

It can be reactivated for several reasons.

Most people will suffer for a few weeks, but for some it can take up to a year, and it's hard to say why it persists, writes Dr. Ellie Cannon (file photo)

Most people will suffer for a few weeks, but for some it can take up to a year, and it’s hard to say why it persists, writes Dr. Ellie Cannon (file photo)

No one is sure why it happens, but it is thought to be related to decreased immunity.

It is also thought that stress, sun exposure, diseases or medications that suppress the immune system, and simply age, increase the risk.

The virus – varicella zoster – lives in the nerves, which is why the blisters usually appear along a line supplied by the nerves.

Usually they will wrap around one side of the body, but they can appear anywhere.

We usually prescribe an antiviral tablet, aciclovir, which helps clear up the rash faster.

The shingles pain is known as neuralgia and it is quite debilitating: patients say it feels like burning, stinging or minor electric shock.

Stress, sun exposure, diseases or medications that suppress the immune system, and simply older age, are also thought to increase the risk of shingles (file photo)

Stress, sun exposure, diseases or medications that suppress the immune system, and simply older age, are also thought to increase the risk of shingles (file photo)

Stress, sun exposure, diseases or medications that suppress the immune system, and simply older age, are also thought to increase the risk of shingles (file photo)

If this persists even after the rash clears up, we call it postherpetic neuralgia.

Most people will suffer for a few weeks, but for some it can take up to a year and it is hard to say why it persists.

Regular over-the-counter pain medications don’t really help. For severe cases, we prescribe medication that specifically targets nerve-related pain.

This includes amitriptyline, pregabalin and gabapentin, and they are not suitable for everyone due to side effects.

Relieve the economy … by opening public toilets!

Many companies, while open, leave their loosely closed, Dr. Ellie Cannon

Many companies, while open, leave their loosely closed, Dr. Ellie Cannon

Many companies, while open, leave their loosely closed, Dr. Ellie Cannon

One thing I would suggest is to boost the economy and get people back into the shops: open the toilets!

There is a significant lack of public toilets in the UK – the councils have essentially privatized convenience through stealth, as many of us now trust that they can enter the toilet in Pret or a local cafe while on the move.

But now, while open, many companies keep their loos tightly closed – I assume because it’s just one area less to constantly clean.

Meanwhile, I know that some public parks keep their toilets closed and actively impose fines on people seen squeezing the bushes.

Frankly, large numbers of people will be put off by this. It is horrible, to be caught short and is not only a concern for people with bowel or bladder problems, but also for the elderly and families with young children.

You can make yourself more comfortable by wearing loose, soft clothes over the ribs and staying cool. Cold packs can be good for neuralgia, and some use a non-irritating plastic wound dressing to cover the area, preventing contact or irritation.

There is also a prescription cream that contains capsaicin, derived from a chemical found in chilies, which some people find effective for nerve pain.

I think I may be suffering from ‘long Covid’. I had it in March, but I still don’t smell anything. Should I learn to live with this?

It normally takes two or three weeks for people to fully recover from Covid-19. But it seems that some have long-term illness for unknown reasons and this, while not yet an official diagnosis, is called Long Covid or Covid long tail by some doctors and patients.

From early data, it seems that it can affect as many as one in ten people who have had the virus, and we can’t say how long it could take.

Long Covid seems to take many different forms: for some it is persistent fatigue and fatigue, for others a specific symptom such as loss of smell, chest pain or shortness of breath.

This is something we see in other viruses: we have known about postviral fatigue for a long time. Infections, such as the flu, can lead to long-term loss of smell. A chronic loss of smell greatly affects how we feel.

Not being able to enjoy or smell food or pleasant things can be annoying, but also a risk. Without a smell you cannot detect smoke, a gas leak or food.

It is important that you recognize this for your own safety.

There is a charity, Fifth Sense (fifthsense.org.uk), that supports people with odor and taste disorders.

They can recommend ways to do odor training, a type of therapy in which patients “rehabilitate” the smelling nerves by sniffing pungent aromas such as eucalyptus.

NHS England will launch an online service this month for people suffering from Long Covid to get advice from nurses, physical therapists and mental health teams and peers.

My son missed his first HPV shot in April. Will they be resisted and is there a downside to the delay?

In addition to missing classes, school closure led to children missing vaccinations, including HPV vaccines for boys and girls, in addition to the teen boosters of tetanus and diphtheria, and the meningitis vaccination.

There is plenty of catching up to do: it is particularly relevant, as 2020 is the first year of boys being included in the HPV vaccination program, run by school nurses and municipal immunizations, rather than general practitioners.

WRITE TO DR ELLIE

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They are planning a catch-up program, which will begin later this year when schools reopen.

Children who have missed their first receive one. But we usually give two injections several months apart – and children waiting for a second dose may not get it.

One dose provides good protection against HPV, and thus the cancers they cause, at least in the short to medium term, until a second booster dose can be given when life returns to normal.

A delay of years between the two doses will not decrease the effectiveness of the vaccination.

The delay of a few months or even a year for those waiting for their first dose means that protection against HPV will only start after the vaccination is given.

All children must receive a letter and permission form from their school for catch-up.

Not all skin cancers are urgent

Very urgent skin problems, such as a possible melanoma, take precedence over less troubling lesions such as basal cell carcinomas, which tend to grow very slowly (file photo)

Very urgent skin problems, such as a possible melanoma, take precedence over less troubling lesions such as basal cell carcinomas, which tend to grow very slowly (file photo)

Very urgent skin problems, such as a possible melanoma, take precedence over less troubling lesions such as basal cell carcinomas, which tend to grow very slowly (file photo)

I wrote two weeks ago about how useful photos and technology are to investigate skin problems remotely – and that they allow us to identify and refer patients with suspected skin cancer for quick review.

These systems are quick, but are still reserved for those very urgent skin problems, such as a possible melanoma.

These issues take precedence over less troubling lesions such as basal cell carcinomas which, although classified as skin cancer, tend to grow very slowly and affect only the skin surface. It is still worth seeing a primary care physician quickly to see him and arrange a referral, but there may be a waiting period at the moment.

It can be disturbing, I know, but this kind of cancer is almost never life-threatening, which should provide some reassurance.

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