DR ELLIE CANNON: How long will it be before I’m free from the pain of shingles?
I had shingles a few months ago and was given tablets. The blisters have gone but I still have pain across the side of my ribs where they were. Will it go away?
Something I noticed, during lockdown was a larger-than-usual number of my patients getting shingles.
It’s a nasty condition caused by the same virus as chickenpox, which lives, dormant, in our bodies after we first get it as youngsters.
It can, for a variety of reasons, become reactivated.
Most people will suffer for a few weeks but for some it may go on as long as a year and it is hard to say why it persists, writes Dr Ellie Cannon (file photo)
No one knows for sure why it happens but it’s thought it’s linked to a lowered immunity.
Stress, sun exposure, illnesses or medicines that suppress the immune system, and simply older age, are also thought to raise the risk.
The virus – varicella zoster – lives in the nerves and so the blisters usually appear along a line the nerve supplies.
Most commonly, they’ll wrap around one side of the body but they can appear anywhere.
We usually prescribe an anti-viral tablet, aciclovir, which helps clear up the rash faster.
The pain with shingles is known as neuralgia and it’s quite debilitating: patients say it feels like burning, pin pricks or little electric shocks.
Stress, sun exposure, illnesses or medicines that suppress the immune system, and simply older age, are also thought to raise the risk of getting shingles (file photo)
When this continues, even after the rash has gone, we call it post-herpetic neuralgia.
Most people will suffer for a few weeks but for some it may go on as long as a year and it is hard to say why it persists.
Normal over-the-counter painkillers do not really help. For severe cases we prescribe medication that specifically targets nerve-related pain.
This includes amitriptyline, pregabalin and gabapentin, and they do not suit everyone due to side effects.
Relieve the economy…by opening public toilets!
Many businesses, while open, are leaving their loos firmly shut, writes Dr Ellie Cannon
One thing I would suggest to help boost the economy and get people back in the shops: open the toilets!
There is a significant lack of public toilets in the UK – councils have essentially privatised conveniences by stealth, as many of us now rely on being able to pop into the loo at Pret or a local cafe while out and about.
But now many businesses, while open, are leaving their loos firmly shut – I presume because it’s just one area fewer to have to constantly clean.
Meanwhile, I know some public parks are keeping their toilets closed and actively fining people who are spotted nipping into the bushes.
In all honesty, large numbers of people will be put off leaving the house by all this. It’s horrendous, being caught short, and is a particular concern not only for those who’ve had bowel or bladder problems, but also for older people and families with young children.
You can make yourself more comfortable by wearing loose, soft clothes over the ribs and keeping cool. Cold packs can be good for neuralgia and some use a non-irritant plastic wound dressing to cover the area, preventing contact or irritation.
There is also a prescription cream containing capsaicin, derived from a chemical found in chillis, that some people find effective for nerve pain.
I think I may be suffering from ‘long Covid’. I had it in March but I still can’t smell anything. Will I have to learn to live with this?
Typically, it takes people two or three weeks to recover fully from Covid-19. But it appears that for an unknown reason, some have protracted illness and this, although not yet an official diagnosis, is being called by some doctors and patients Long Covid, or Covid long tail.
From early data it looks as if this could affect as many as one in ten people who’ve had the virus, and we cannot say how long this may last.
Long Covid seems to be taking many different forms: for some it is an ongoing tiredness and fatigue, for others a specific symptom such as a loss of smell, chest pain, or breathlessness.
This is something we see with other viruses: we have long known about post-viral fatigue. Infections, such as flu, can lead to a long-lasting loss of smell. A chronic loss of smell has a major impact on how we feel.
Not being able to enjoy or sense smell from food or pleasant things can be distressing but also a risk. Without smell you cannot detect smoke, a gas leak or whether food has gone off.
It is important you recognise this for your own safety.
There is a charity, Fifth Sense (fifthsense.org.uk), providing support to those with smell and taste disorders.
They may recommend ways to go about smell training, a kind of therapy where patients ‘rehabilitate’ the smelling nerves by sniffing pungent aromas such as eucalyptus.
NHS England this month are set to launch an online service for people suffering with Long Covid to get advice from nurses, physiotherapists and mental health teams, and fellow sufferers.
My son missed out on his first HPV jab in April. Will they be rescheduled, and is there any downside to the delay?
As well as missing out on lessons, school closure resulted in children missing vaccinations, including HPV vaccines for boys and girls, in addition to the teenage 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 for boys to be included in the HPV vaccination programme, run by school nurses and local council immunisation teams, rather than GPs.
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They’re planning a catch-up programme, starting later this year when schools reopen.
Children who have missed their first will receive one. But, normally, we give two jabs, a number of months apart – and children waiting for a second dose may not get that.
One dose does offer good protection against HPV, and therefore 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 reduce how effective the vaccination is.
The delay of a few months or even a year for those waiting for their first dose means protection against HPV will start only once the vaccination has been given.
All children should receive a letter and a consent form via their school for the catch-up.
Not all skin cancers are urgent
Very urgent skin problems, such as a possible melanoma, are prioritised over less-concerning lesions such as basal cell carcinomas which tend to grow very slowly (file photo)
I wrote two weeks ago about how useful photos and tech are for examining skin problems remotely – and that they allow us to spot, and refer, patients with suspected skin cancer for rapid assessment.
These systems are fast but are still reserved for those very urgent skin problems, such as a possible melanoma.
These issues are prioritised over less-concerning lesions such as basal cell carcinomas which, while they are classed as skin cancer, tend to grow very slowly and affect only the surface of the skin. It’s still worth seeing a GP promptly to have it looked at and have a referral arranged, but there may be a wait at the moment.
It can be unsettling, I know, but these kinds of cancer are almost never life-threatening, which should offer some reassurance.
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