Saddle River Residents submitted real medical questions.

What is Herpes Zoster, and will I get it? (H.T. Saddle River Resident)

Herpes Zoster better known as shingles is a common malady that can affect anyone. It is a member of the Herpes virus family that includes fever blisters and genital ulcers. An infection with Varicella zoster virus results in chickenpox, which is characterized by pustules on the face, trunk and the arms and legs. You usually acquire this infection as a child and it is very contagious. Once you have that infection, it can be reactivated later in life as Herpes zoster or shingles. This virus lives in the sensory nerves until it is reactivated. When shingles activates, severe burning pain often precedes the skin eruption by several days 48-72 hours to be precise. It occurs in a specific area of the body innervated by a group of sensory nerves on one side.  This eruptive area is called a dermatome and most doctors have dermatome maps in their offices. These characteristics help to make the diagnosis.

Shingles is most common in people over the age of 50. The infection can be spread to people who have never been exposed to the virus, have never had chickenpox. In such cases, the person would manifest the new exposure to the virus infection by getting chickenpox.  In an adult that is not fun.

Zoster often causes major problems.  Besides the pain, involvement of the eye can result in blindness, and there can be loss of taste.  Sometimes the pain can last long after the pustules have gone and this is called post-herpetic neuralgia. The pain can last for months.

Some people are called immunocompromised when they are taking medications for cancer or some forms of autoimmune disease like rheumatoid arthritis.  In such cases the zoster can disseminate and go all over the body, not just the dermatomes. People who have disseminated zoster are seriously ill and can have hepatitis, pneumonia and even meningoencephalitis (which is a form of brain infection).

The disease is diagnosed through special tests which are usually unnecessary, unless there is something strange about the patient or the presentation is atypical. Zoster is generally easy to diagnose.  The disease can be treated easy with antiviral drugs which need to be taken for about 5-7 days.  Examples are Acyclovir, Famcyclovir, and Valcyclovir.

Not all is bad, because there is now a vaccine for Varicella Zoster and it’s a good idea for people over the age of 50 to get it. I was just told that the vaccine is available at many pharmacies and even in supermarkets. I believe that it is worth a trip.  In the event of an accidental direct exposure to the virus, one can be injected with something called zoster immune globulin, which can weaken the virus’s expression  It has to be given within 10 days of exposure.

Is the sun dangerous to me and what are some of the medications that can be a problem when I sit out in the sun? (T.P. Saddle River Resident)

This is the time of the year when all of us are at the poolside or down the shore.  You were out in the sun just briefly, but you got a very bad sunburn. Why, you ask?  Well, It could be from a medication for rheumatoid arthritis or related syndromes that is giving you what’s called “sun sensitivity”. It’s actually called photosensitivity, a reaction of the immune system that can make you more susceptible to sunburns and sun rashes.  You should consult with your doctor if you are on any drug, especially one that you have been taking for a long time.  There is no age limit for these reactions.  You are on a medicine and you want to get a tan, but you don’t want to suffer with blisters and a painful rash. It is always good to be on the side of caution and check these drugs out before you don your bathing suit and sit in the sun.

Some of the agents commonly taken that can cause photosensitivity are Aspirin, Ibuprofen (Advil, Motrin) or Naproxen (Aleve). There are many other drugs that cause this reaction.

To avoid bad sunburn, use a sunscreen with an SPF of 30 or higher that covers both the UVA and UVB rays. Try a bunch of different forms of sunscreen: cream, spray, gel, lotions.  If you like to go in an out of water, get a sunscreen that will stay on your skin (water resistant). Understand that just because the day is cloudy, you can still get burned and still have a photosensitive reaction.

Remember to wear sunglasses and avoid burning your eyes. 

As a doctor, I should tell you to get your rays after 3 p.m. when the sun is not as strong. You can get tanned without the burn and the possibility of melanoma is less—but still a serious issue. Do not get burned in mid-day sun and do not go to tanning booths. They are dangerous to your health and you must check your skin at least once per month for suspicious lesions if you like to sit in the sun, especially if you are a fair person. Remember, everyone should have their birthday suit checked from top to bottom by a dermatologist on or near their birthday.

Is there importance to checking the color of my stool every time I go to the bathroom? (M.Z. Saddle River Resident)

Even though it may be unseemly, it is a good idea. Why?  Because paying attention to your stool can save your life. Changes in the color of one’s stool color or texture may be normal, but some changes should be evaluated. The normal color of stool is light to dark brown and stool color changes with diet, drinks, and illnesses. As an example, if your stool is black and foul-smelling you might be bleeding from your bowel, and blood is coming from any part of your 27 feet of intestine. Bright red blood in the stool might be from many things: a bleeding internal or external hemorrhoid, a hemorrhage from an outpouching of the bowel wall called a diverticulum, a blood vessel malformation or possibly a colon tumor.  Black stools mean that the blood has had a time to travel through the intestine and change color over time when mixed with digested food or acid. Such could come from an ulcer of the duodenum or even parts of the stomach, but this is usually associated with vomit of “coffee ground” like material.

Certain dietary ingredients can also change the color of stool. Food like beets or licorice, or medications like Pepto Bismol can turn the stool black. Often the stool can include small amounts of blood not seen by the naked eye and a condition like chronic anemia might prompt your doctor to do a rectal exam and get a small sample of stool on the examining glove. Your doctor can test the normal colored stool for blood, and if positive might suggest a colonoscopy to evaluate you for polyps or actual colonic tumors. Diagnosed early, this common cancer can be totally cured.

A white chalky stool can signal liver disease like hepatitis or biliary (gallbladder) tract disease. A white stool simply indicates that the green bile has not had the chance to color the stool because of an obstruction. Abdominal pain, itching, nausea, dark urine and light stool suggests hepatitis.

Green stool is a common color change. It’s usually due to bile in the stool due to diarrhea where the transit of vegetables and food in the bowel might be accelerated. This rapid movement of food through the bowel might not allow the enzymes of digestion to work and the stool is green.