Any experience of Shingles?
 

I am busy exploring the many, many delights of shingles. Started about 5 days ago and it apparently has wandered down the C2 spinal nerve. It is having a gentle dig at muscles around my clavicle and has also decided to make an appearance on the side of my face (most of it is at the back of my head and hidden by thin stubble).

Has anyone got any experience regarding Class 1 medical and flying? Any ideas how long it is before I would be well enough to fly? At the moment, discomfort and lack of sleep preclude it absolutely.

I have been given aciclovir, but as this was started a bit too late, it doesn't appear to have halted the merry march of my pox.

Ouch !

You're fit to fly......when you're fit to fly.

Best case scenario, when the lesions settle, aprox 7-21 days, (AME can advise you best.)

Post herpetic problems (usually pain) can affect patients for many months, the agents (drugs) used to control the symptoms are probably more of a problem, in terms of flying, than the pain. Sometimes the odd twinge can be controlled with regular paracetamol, which doesn't seem to cause many problems for pilots.

Thanks, gingernut.

It really is a voyage of discovery. I can plot the advance of the pustulance over hours, though some element of digging in rather than further gains now seems to be happening.

Of greater surprise is the neuralgia. It seems to be strolling around different districts, like a tourist, before returning to main base overnight. Yesterday, it strolled down my arm to my thumb, overnight an eyelid, then this morning, teeth!

Of greater concern to anyone else who gets this, is the undulating nature of it. Can feel fine for a few hours, then quickly deteriorate to zombie status pretty quickly. Short hair is a bugger. Lying on it in bed is like having hundreds of pins simultaneously inserted.

Who knows what's next. :ooh:

Oh Boy. I feel for you. I've never had it but I'm a microbiologist by trade (can I say that when I'm unemployed??) and I can only imagine what it actually feels like.

Acyclovir and the like works best if you take them early. They're significantly less effective when the pox has already taken-hold again. Not that this is useful information to you at this point I suppose. (Eh... wouldn't be the first time I've been called a "barn-door expert".)

misterblue I am some sort of weirdo that has had chickenpox three times now. The last time when I was 30 was particularly not pleasant.

I am now particularly switched on about spotting kids with it before I get anywhere near them.

Some times I am legging it and the parent isn't even aware they have it yet.

I have even denied boarding to pax with it.

That was a major argument with the parent. They don't understand what it can do to adults.

mad_jock, You can't "catch" chickenpox a 2nd time. Shingles, which is a reappearance of chickenpox, comes from "latent" virus hiding in your cells from when you first got chickenpox.

Shingles is terribly unpleasant, but avoiding people with chickenpox doesn't help. Shingles comes back from latent virus re-emerging, so the best you can do is to keep your immune system strong, and to go on anti-virals as soon as you suspect it's coming back up.

(This is a separate issue from adults catching chickenpox for the first time. That's terribly unpleasant too, but there's a vaccine to guard against it now.)

mate you bloody can cause I have


I can even give you the names of the little brats that gave it to me the last two times.

And that's exactly what the quacks said as well, "but you can't get it more than once".

Both had to admit it was chicken pox and gave me a 14 day sick line from work, I even managed to give it to a kid that was staying on the 3rd infection.

It may go completely against medical theory but if I spot chicken pox I keep well away from it. I am not having chicken pox blisters on my nuts ever again if I can help it if that means off loading pax from my aircraft so be it.

mad_jock, that's... weird...

You know, you can ask your doctor for a bit more information. Ask for an antibody titre test. It's just a bit of blood you have to give. It should show a normal titre for someone who's been previously exposed to chickenpox. If it's low, you're probably right in that you're still susceptible. You can discuss trying the vaccine anyway with your GP. You have no other immune issues, right?

BTW, anyone with chickenpox or shingles is infectious and can give it to children who haven't had it yet. mad_jock, you can consider it payback if you wish. :E

No problems at all on that front. Very rare I get anything and when I do its sleep for 24hours and then back to normal.

Second time I got it the Doc was a bit sceptic that it was CP the first time. And the third was down right unbelieving until he read my medical records.

He was going to do more tests while it was active but the practise nurse chucked me out as soon as the receptionist told her that I was in the building with CP. He got a right mouth full from her for even taking me into his office. I had to wait outside for my doctors line which was all I was in for anyway.

misterblue, the post lesion pain can be a real pain for some patients.

We're not allowed to give specific advice on here, and of course, see the doc ame blah blah, but generally speaking, don't forget the simple stuff, paracetamol etc. Paracetamol is an extremely underrated drug, we use it very successfully in cancer care - the key is to get patients to have faith in it, and to use it regularly.

However, nerve pain often requires a different approach - the nerve pain agents, (amitriptyline, gabapentin etc) seem to work extremely well, but I'm guessing would mean a no no to flying. Having said that, would have thought uncontrolled pain would be a no no too, guess it's something you'll have to chat with your ame about.

I've heard that capsaicin cream (chilli) has been used, but I have no experience of it's use. I'm guessing it works by forming a counter irritant to the pain, 'bit like accupuncture and TENS. May be worth ago, certainly less invasive than the other agents.

Wishing you a speedy and uneventful recovery. :)

paracetamol dosage to be effective needs to be prescribed by someone that knows what they are doing.

I helped out a friend doing her Phd on it as a lab rat . And its dosage is quite sensitive to get a max effect but not overdose.

Most people that take it never overload the liver and for it to be any use. But its quite a fine band between beneficial and overdose with damage.

The dosage on me was upped on a series of weeks and tests and there was a tip point when it actually started working in the manner intended. This dosage to me seemed remarkably high. I am not going to give numbers because its all linked to body mass. But it was significantly different to the dosage on the retail packets.

She was definitely in the mind that it should be a prescribed drug.

I must admit I haven't taken it since those tests, but apart from prescribed post op pain killers I haven't take anything else either.

I thought this was a slightly dyslexic thread about how many engines....

Playing the odds with paracetamol is an extremely dangerous game, that involves no-return, mad-jock.

I wouldn't advocate playing around with the dose. Unfortunately, have seen death in as little as 7.5gms/24 hrs.

And it's not a particularly good way to go :-(

Could I respectfully suggest that you delete your post mad jock ?

gingernut, if anything, I think most people are unaware of the liver damage that can be caused by paracetamol/acetaminophen. I don't think it's a bad thing to point it out.

My concern is that people may tip the balance.

come on my advice was to consulate a doctor before taking it.

I Also warned that the dosage of it is particularly individual.

I didn't give any numbers which people might think would work for them but are particular to a 100kg rugby player.

The fact is until you over load the liver paracetamol just gets metabolised then there is a very fine individual band when its full effects come into play. Screw that up and you 3-5 days in agony dying.

But you really need to be in the hands of a knowledgeable professional for it to be of any real use. And that doesn't include most of the doctors and dentists who advise people to take it.

Personally I consider it to be a high risk pharmaceutical to have in the house and I just don't process it. And I avoid any over the counter medications that contain it for colds etc.

So to me advising anyone to take the stuff without warning them of the potential overdose issues is a bit naughty.

I will admit I might have just been scared away from the stuff by a highly intelligent Pharmacologist and consultant Anaesthetist but even to a thick engineer for the little I saw of the data its bloody nasty stuff to get the dosage right on and self administered via over the counter medicines its a bit of a Russian roulette in respect to accidently overdosing. Which if you do its either a liver transplant or death.

Thanks again, gingernut for the concerns.

So far, codeine, aspirin, paracetomol (at the packet suggested dose) and naproxen, all taken on different days I hasten to add, have had no effect.

Haven't tried alcohol yet. I don't think it would dull the pain, but maybe I would care less about it. Bring on the 'two-hat' cure.

go speak to your doctor and see if he thinks co-dynomol would help.

Buy its then into the no-fly range of drugs.

Strangely enough I was using a anti dandruff shampoo called selsun for a skin fungus infection at the time of the last time I got CP. And it seemed to help with the itching.

But I will bow to those that know if this was just a random fact that my nuts stopped itching after I used it.

Misterblue - you have my deepest sympathy. I had a full on "half moon" attack around my chest in 2003, the scars are still visible & the resulting pain was horrendous - I reckon I slept for about 30mins in 2 weeks. Thank heavens I have a loving & understanding wife.
Initially my doc just prescribed over the counter drugs, but after 2 days when I was screaming in agony I was prescribed some really whacky opiate based pain killers & other drugs to kill the virus. I also attended a pain clinic & was given an industrial sized TENS machine (note to self - be careful with the power control - I knocked the control accidentally once to full power & was jumping around the room as if I was getting jolts from the electric chair before I could turn it down :uhoh:
Although not a commercial pilot, I was off work for a month & off (private) flying for 3 months while the drugs dispersed out of my body. Even now there are times when the itching returns (I liken it to having ants crawling around my body then suddenly stinging en-mass).
Good luck

Thanks chaps.

Rocket, don't worry about the ants for the moment - I seem to be looking after them for you.

I'd normally give a :) at that comment Misterblue but I realise its more like a :{
Get well soon chap

As the entertainment continues, am I supposed to inform the UK CAA if/when this lasts more than 21 days?

It used to be the case, but I can't find a definitive answer on their website.

EASA Regs
 

http://easa.europa.eu/system/files/d...bin%20crew.pdf

Page 5 of this document states:

AMC1 MED.A.020 Decrease in medical fitness
If in any doubt about their fitness to fly, use of medication or treatment:
(a) holders of class 1 or class 2 medical certificates should seek the advice of an AeMC or AME;

If in doubt, contact your AME :)

Have had this twice. First in the early 70s, and had to front the military doc each day for about 10 days where an injection of a substance that had the consistency of axle grease was made into the upper arm. Over the course of the day the enormous lump in the arm would dissipate.

Second time was in about 78. Civilian doc said "no body gets it twice" and "there is no known remedy/treatment". His advice was go to the pub for a pint.

"...have seen death in as little as 7.5gms/24 hrs..."

MAX rec. dosage of paracetamol is 6gm/24hrs for an adult so that is not "little", it's well over the top. 12-15gm in one shot will likely lead to hepatotoxicity

(I'm not knocking paracetamol - it is a really good drug with a very acceptable safety profile so long as you don't go crazy)

:ooh:

When I was a medical houseman, the use of iv acetylcysteine to prevent fatal liver damage in paracetamol OD para-suicides had not been discovered. Treatment was messy, complicated and not particularly effective - people died, and took a long time about it.

[IV acetylcysteine is almost 100% effective in preventing liver damage when given within 8 hours of the OD]

Just revisiting my post, the girl who died taking 7.5grams was an adolescent, so perhaps I need to take that into account.

As a prescriber, I advocate paracetamol most days. It's a well tolerated, and mostly, effective medicine.

I'd never recommend any dose over the 4gms/24 hours recommended by the BNF. (and they are usually spot on.) If the pain isn't controlled then, it's time for an adjunct. Pilots, need to let there prescribers know they are pilots.

In the UK, we can only sell 8 grams at a time. This is a pain in the +rse if you get a lot of tooth ache, but the last figures I've seen suggest that about 200 lives a year are saved by this measure.

That's very different from here in Canada. I can't imagine 16 capsules at 500 mg each being the maximum!

Over here, 200+ capsules per container at 500 mg each (100 grams) is easily available, including at most supermarkets. You can get 250+ capsules in big-box-stores such as Costco.

I had the dreading shingles at 62,one side of face and down left arm. Serious pain! Could not sleep,and after 36 hours of no sleep,gave up trying to sleep,watched daytime T.V.(in the U.K.),and slowly drank a full bottle of Jack Daniels. Slept like a baby for about 15 hours when the bottle was finished. Woke up and the shingles was gone. Can't promise it will work for you,but not an unpleasant medical trial.:)

No, it became a bit of a pain here, when it was introduced a few years ago. It was a measure designed to reduce the so called "para-suicides" converting to actual suicide.

I was skeptical, when I first tried to buy three packets of paracetamol from ALDI, and was refused, my initial comment to the cashier was , "why, do I look suicidal ?"

I've tried to rationalise this and reckon I probably have. Suicide is the biggest cause of death for our young people. (More so for blokes). Make no doubt about it, it has to be taken seriously. If a person is determined, then it can sometimes be difficult to identify and prevent serious attempts.We are now trained to identify these patients at an earlier stage, sometimes it's just a matter of asking someone if they are suicidal, patients generally are very honest. The level of violence involved in an attempt, can sometimes be directly related to the level intent. I've had more success with those who want to take all their tablets, than those who choose to jump in front of a train.

My very personal own opinions on this issue: Suicide is an illness. Suicide is dreadful. It has dreadful consequences. It can sometimes be preventable. If you can draw someone back from that moment of illness when they think of hurting themselves, then generally, it's a good move. (And, in the long term, a successful one.)

So, if every time I get a sore knee/tooth/throat/ear, I have to go and visit Aldi 10,000 times to save some poor kid shrivelling up from liver failure, then I'll continue the journey.

I wish I had a more sophisticated understanding of mental illnesses. (I'm a molecular biologist, so, anything bigger than small animals are out of my range of knowledge.)

I find it interesting that you say there's a correlation between the level of violence and the level of intent. It seems like there's more suicide prevention efforts on more violent means, such as BASE jumping without equipment, than less violent means. (I say that somewhat casually as my way of dealing with it. Came across a fresh one at night on a highway. Couldn't find a radial pulse. Couldn't find the carotid because the neck was so far displaced. Messy.) They spend millions putting up anti-jump barriers only to have them go to a different bridge. Seems like if the violence is high, and thus intent is high, the money is better spent on other forms of prevention than temporarily delaying them.

Which is the pain killer that they can put the antidote in but they refuse to?

I think we're getting way off topic here.

Point taken:ooh:

is that such a bad thing?

Pretty much standard in the other forums.

We aren't discussing an individual case.

paracetamol overdose is a particularly stupid way to go.

Anything which stops it must be a good thing.

Sure, but has little to do with shingles and its aeromedical implications.

Some really good threads have come from thread drifts onto different topics.

My favourite one ended up with three test pilots and the chief pilot of the concorde fleet discussing mach vortexes shedding off delta wings. Absolutely nothing to do with the 16 year olds initial question for his school work.

Already I have learned from this thread that 4mg/24hours is the max dosage.

Its just like when I teach my CRM courses every time we do case study's we end up somewhere different. Its not a problem because we want people to think and analysis.

Pilots aren't linear thinkers, we are trained to be multi directional with significant subject overlaps. And stuff we know gets taken home as well.

And to be honest self administered medication by pilots is one of the big ones for any management pilot. If a thread heads off in that direction and people can learn from it, that can only be a good thing.

But its your train set and you will run it how you like but the whole point of forums like this is to learn from a diverse skill group, the medics being one group that most don't go near if they can help it.

Shingles moving to pain control is a logical progression for a thread drift on the subject. Pain control drugs to there abuse is again quite logical.

In fact I will be using the information from this thread in the next cycle of CRM course I am developing under the human performance section.

So the OP has had some advise and now 55 pilots are going to get the benefit of the advice as well in there yearly CRM training from me. Maybe resulting in a kid not getting rushed to hospital with an OD.

This sort of stuff worries me...

Shock figures show extent of self-harm in English teenagers | Lorenza Bacino | Society | The Guardian

Back on thread

The treatment is early antivirals and symptomatic pain relief.

The best analgesia is more than one drug. Paracetamol as one gram 6 hourly is the only dose you can take, except an initial single dose of 2 grams has been shown to be reasonably safe after operations

Non steroidals such as nurofen or voltarol is a good combination as long as you don't have kidney problems or stomach issues. It MUST be taken regularly and will take possibly five days to have maximum effect. Miss a dose and the clock starts again

Codeine compounds have been widely used, but we are increasingly worried about unexpected deaths and many hospital doctors have ditched them. Both the US and UK regulators have issued warnings. There is little evidence codeine and paracetamol is better than paracetamol alone so I wouldn't use it

We then get onto more potent drugs such as tramadol which blocks the pain signal at a spinal level. Oral opiates, once thought dodgy, are now widely used after operations and can be considered

Pain clinics can also offer support with TENS or other drugs and techniques. Most are so busy that sufferers only get to the, if the pain is chronic

Hope this helps

Somebody has edited my original post heading to include the paracetamol overdose bit. Whilst I accept the thread creep as being a part of the forum, I do not think it acceptable to change the original posting.

I did not put anything about overdoses in my original post. :=

Shingles
 

There may have been a stigma around shingles before discovery that the origin is dormant chickenpox virus.


I'm of the age that parents knew mumps could cause infertility in adult males, and deliberately exposed children to others with it...not sure about the deliberate exposure with measles and chickenpox. I did have chicken pox as a child.


A couple years ago, I was finishing up an evening dog run in a forest in the spring, and some people at a campfire beside a hunting camp offered a beer and then a look inside what turned out to be an old tight moldy trailer filled with beer and tobacco fumes of people playing beer pong. The dogs indicated a desire to terminate this visit rather quickly.


Within 2 days I had a rare sore-throat to chest cold type flu. This resolved fairly quickly without medication and some blisters formed on the right side of my waist and started to spread both ways around. It looked like poison ivy or a second degree burn, but there was no surface pain.


What worried me was MRSA, because a bad case was in the media headlines at the time. And, I didn't think shingles, because of heavy TV advertising citing "burn and itch." (Never was much burn, and itch didn't start until spreading had stopped, blisters were breaking, and I knew I was going to live.) Only treatment whatsoever was one comfrey tea rinse before a bath, just before spreading had stopped, with no obvious effect one way or the other. Contact was somewhat uncomfortable in bed, but I could sleep on the other side.


There was a deep pain in my right hip, which had a resolved running injury decades earlier. (At one point, I got some relief by half laying at one end of a couch, with my foot slightly tensioned by a sling to the arm at the other end of the couch.)


I was relieved when I finally checked shingles descriptions to find that abdomen, from centerline front to centerline rear, is the most common location. I did not find anything residual harmful about it except some reference to if an eye is involved.


I'm happy to have had this chickenpox booster the natural way. The blisters left white areas like "road rash" from a bicycle crash, but these have disappeared. There are indications that antibiotics and antivirals disrupt a very complex, important and natural gut biome, increasing the risk of cancer and auto-immune diseases.


Two possible connections with vaccination--It is possible that a near absence of chickenpox infected children to challenge post-infected adults is the reason we see shingles at the current rate; and, it is unknown how shingles will effect children vaccinated for chickenpox.