It was six years ago, but Elmira Cox remembers it like it was yesterday -- the day she woke up in pain after experiencing a night of unusual itching and tingling that she chalked up to mosquito bites. But the morning she woke up with a burning across her back, the Acklins native knew that something was truly wrong.
Throughout the day the pain got worse even though she tried to ignore it. It was only when blisters started to appear on her back and that she took her daughter's advice to see a doctor who diagnosed her with shingles -- a skin rash that occurs as a result of the chickenpox virus being reactivated in the body due to a weakened immune system.
"I didn't know what it meant but [the doctor] said it happens sometimes to older people like me because I had chickenpox when I was a girl. I still don't know how that has anything to do with now but I never want to experience that again. It hurt so much and the pain didn't go away even after the rash went. I sometimes feel that deep pain every now and then," said the 83-year-old.
Unlike Cox, most people have never heard about shingles, but the disease was pushed into the forefront in the last few weeks with television advertisements for treatment for the disease, showing an elderly woman describing how debilitating the burning sensation characteristic of the disease was for her. She then describes how shocking it was to visit her physician to uncover the root of the problem only to be given the shocking truth that anyone who has ever had chickenpox can develop the disease decades after recovering from the infantile illness.
While many people may have seen the commercial and disregarded its message, Dr. Rashmi Unwala, a dermatologist with a sessional clinic at Doctor's Hospital said people should make themselves aware of the disease as it is a relatively common condition. And anyone who has had chickenpox before she said is susceptible to getting the painful disease as they age beyond 60 years.
"When people think of herpes zoster also known as shingles and see it on television they may feel it is not relevant to them and it's a far away illness that happens to other kinds of people, but this is not true. It's not about color, region or family history. Shingles can happen to anyone older, particularly over 60 years old. And depending on your health or if you are on any immunosuppressant medication or treatments it may even occur to people younger in some cases," she said.

Painful skin rash
According to the dermatologist, shingles is a painful skin rash associated with chickenpox that reddens and causes painful blisters on the skin in a distinctive stripe like pattern. It can also burn uncontrollably and cause throbbing pain to the area that is affected. It occurs because the chickenpox virus (Varicella zoster virus) never actually leaves the system even after someone has overcome it in their youth. As a result it can reactivate within a few nerves if the immune system weakens and the virus escapes confinement.
"The way this virus works is that once you've had chickenpox it stays within the system but the body is able to keep it under control for years and decades to come. There is no specific reason why, but once you get much older and your immune system is not the same it can reactivate within a nerve and spread along [the nerve's] path," she said.
Depending on where the virus activates, certain complications can result if treatment is not sought aggressively. Dr. Unwala said if it occurs in a nerve that connects to the ear or the eye, hearing loss and damage to eye sight may occur permanently.
"This illness is very distinctive in that when the rashes appear they only occur in one strip of the skin on one half of the body," said Dr. Unwala. "There are few diseases that work like that so it can be diagnosed right away in many cases. It appears like this because when the virus reactivates it goes along a specific nerve and that is all. Nerves end in the center of the body so the track it will follow will stop right down the middle of the front and back of the body. But the interesting thing about it is that it can reactivate in any nerve where it was once dormant so that the means it may affect the arm, leg, abdomen or anywhere."
No matter where the rash appears the dermatologist advises people to seek treatment within the first two to three days of seeing symptoms.

Symptoms
The earliest symptoms of shingles are often headaches, fever and malaise (a feeling of general discomfort or uneasiness, or being out of sorts). This can lead to people not taking the symptoms to be anything initially. But its usually when other symptoms like a burning sensation, itching, over-sensitivity of skin or a feeling of constant pins and needles or prickling feeling in an area of skin that looks normal arises that people tend to get a lot more concerned.
After treatment has been sought, and even after the
illness has healed for two to four weeks, the doctor said some people may still suffer from long term pain in the affected nerve called postherpetic neuralgia which may be the result of not treating the condition right away, or the severity of the patient's case. She also said sufferers may have scarring after their brush with the disease as well.
"People with shingles should also be careful when they have their blisters because during this time they are contagious. This means they should avoid being around other people -- particularly those [people] susceptible to catching it -- like the elderly, children under the age of one and pregnant people. They are likely to get chickenpox which may or may not develop into shingles," said Dr. Unwala.
The good news is that much like the chickenpox vaccine there is a shingles vaccine that the elderly can get administered by their primary physician. Dr. Unwala recommends that everyone over age 60 should have the shingles vaccine administered.
And even though shingles is associated with chickenpox, she said it does not appear in the same way. And that it is a virus within the herpes family, but that it's not the same as the sexually transmitted disease called herpes or the mouth sore also from the herpes family. She said it is a distinct disease that should not be ignored.

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