Family, Internal Medicine, General Medical Questions/Shingles

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Question
I have gotten Shingles 3 times in 6 months. All in different spots. I am 50 years old and active and not overweight. I have a very low immune system as I have had 8 surgeries in 7 years. 6 of the surgeries have been on my hip. I had been on crutches for 5 years. My problem is I do not sleep more than 4 hours a night. What can I do to get my immunity up?  What other problems would there be in getting Shingles that many times. The Dr says my body is stressed. I would really really like to not have Shingles again. Thank you for your time.

Answer
Hi Theresa

Sorry for the delay. I have been away. Thanks for the question.

Shingles is not uncommon in otherwise normal people who are under stress. But 3 times in half a year is a bit too frequent.

In normal people, in response to stress, your immunity temporarily heightens. But after the acute stress is over, your immunity actually comes down to below normal for say a few weeks while it recharges and then returns to normal.

Examples of stress can be anything from surgeries, unbalanced diet, physical or psychological stresses, medical illnesses, and sleep deprivation can also reduce your immunity. You mentioned you sleep not more than 4 hours a night. One needs to compare with one's normal self. Is say 3 - 4 hours sleep per night normal sleep requirement for you? I personally need 9 hours to be satisfied, but my colleague only needs 4 and functions better than me. So each person is different. If you normally do need say 6 - 7 hours sleep, and recent 6 months for whatever reason you have only been getting under 4 hours, then yes that can be a stressor enough to trigger recurrent shingles.

In addition your doctor might also ask quick screening questions to see if there is any specific underlying medical condition that's making you chronically immunocompromised. Examples include: diabetes, leukaemia, lymphoma, AIDS, any cancer, autoimmune diseases, long term steroid use etc.

Shingles in most people is more of a nuisance than life threatening condition. It is painful, itchy and changes the appearance of your skin. Uncommonly, it can cause pneumonia and encephalitis (spread to your lungs, face, ear and brain) and if have spreaded, clinically you would be a lot sicker than just painful itchy rash say on the body. To be on the safe side, with each recurrence, again get yourself checked out by a family doctor in person.

In terms what to do to avoid recurrent shingles, there are two things: (1) optimise your immunity, and that comes from what we all know already: adequate sleep, balanced diet, moderate exercise as comfortable, and avoid stress. Easily said but hard to do well. Optimising immunity also means checking to see if there is any underlying medical disease that's making you chronically immunocompromised. This involves your doctor taking history, examining you, and doing some blood tests. Often we don't find a specific underlying medical condition behind your recurrent shingles. (2) In general, antiviral medication for shingles work best if started within 48 - 72 hours of onset of rash. You can have an extra script ready for next time, but also make sure to re-book to be re-checked if recurs, just in case it's not shingles or if it is more severe.  

Hope this helps. Please feel free to ask around for second or even third opinions. If the doctors you ask all say similar things then chances are it's probably accurate for the time being.
Here's are a few quick links on shingles:
http://www.patient.co.uk/health/shingles-herpes-zoster-leaflet
http://www.gpnotebook.co.uk/simplepage.cfm?ID=1141243908
http://emedicine.medscape.com/article/1132465-overview

All the best!

Regards,
George

Family, Internal Medicine, General Medical Questions

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George Wang

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I can answer most of your general medical questions to some extent. My role as a general practitioner is to screen for & advise on preventable diseases; diagnose common conditions across all fields of medicine and advise on early treatment options; identify serious illnesses and refer onto relevant specialists for further input if required. If you think your question is something your usual family doctor can answer, then quite likely I can too. You can write to me in English or Chinese whichever you prefer.

Experience

I am a fellow of Royal Australian College of General Practitioners. I practiced as a general practitioner in Australia, as well as work in Emergency and Radiologist departments.

Organizations
RACGP (Royal Australian College of General Practitioners) RANZCR (Royal Australian & New Zealand College of Radiologists) ASUM (Australasian Society of Ultrasonography in Medicine)

Education/Credentials
MBBS, BSc(Med) from University of New South Wales. FRACGP. Postgraduate diploma in surgical anatomy from University of Melbourne. Currently studying master of medicine at Sydney University, and diploma of medical ultrasonography.

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