Sunday, January 20, 2013

AIDS and aides

I had a students ask me the other day if you see much AIDS in nursing homes in Utah. Honestly, I've only seen one AIDS patient at clinical in the past couple of years. That resident was young (in his 30's) and was in the facility for a cancer secondary to HIV. He also had severe weakness. He died a couple of weeks past admission. That is not the norm. More people are living with AIDS as a chronic illness.
Seeing how students reacted to the resident was interesting. I remember in the 90's nurses and aides didn't want to take care of HIV patients and were freaked out by the disease. This resident, everyone wanted to take care of. I think the students wore him out by taking such excellent care of him. It was a nice change.
If you do have a resident with HIV remember standard precautions are the same for everyone. Wash your hands and wear protective equipment (gloves, gowns, mask) if you are going to come into contact with bodily secretions! If you are not coming into contact with any secretions then you are not at risk for catching anything!

Information about AIDS
A.D.A.M. Medical Encyclopedia.


Acquired immune deficiency syndrome
Last reviewed: April 30, 2012.
AIDS (acquired immune deficiency syndrome) is the final stage of HIV disease, which causes severe damage to the immune system.

Causes, incidence, and risk factors

AIDS is the sixth leading cause of death among people ages 25 - 44 in the United States, down from number one in 1995. Millions of people around the world are living with HIV/AIDS, including many children under age 15.
Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers.
Common bacteria, yeast, parasites, and viruses that usually do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS.
HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out before ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk have been shown to transmit infection to others.
The virus can be spread (transmitted):
  • Through sexual contact -- including oral, vaginal, and anal sex
  • Through blood -- via blood transfusions (now extremely rare in the U.S.) or needle sharing
  • From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk
Other methods of spreading the virus are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.
HIV infection is NOT spread by:
  • Casual contact such as hugging
  • Mosquitoes
  • Participation in sports
  • Touching items that were touched by a person infected with the virus
AIDS and blood or organ donation:
  • AIDS is NOT transmitted to a person who DONATES blood or organs. People who donate organs are never in direct contact with people who receive them. Likewise, a person who donates blood is never in contact with the person receiving it. In all these procedures, sterile needles and instruments are used.
  • However, HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly.
People at highest risk for getting HIV include:
  • Injection drug users who share needles
  • Infants born to mothers with HIV who didn't receive HIV therapy during pregnancy
  • People engaging in unprotected sex, especially with people who have other high-risk behaviors, are HIV-positive, or have AIDS
  • People who received blood transfusions or clotting products between 1977 and 1985 (before screening for the virus became standard practice)
  • Sexual partners of those who participate in high-risk activities (such as injection drug use or anal sex)


AIDS begins with HIV infection. People who are infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops.
Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm3 ).
Almost all people infected with HIV, if they are not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from significantly damaging their immune system.
The symptoms of AIDS are mainly the result of infections that do not normally develop in people with a healthy immune system. These are called opportunistic infections.
People with AIDS have had their immune system damaged by HIV and are very susceptible to these opportunistic infections. Common symptoms are:
  • Chills
  • Fever
  • Rash
  • Sweats (particularly at night)
  • Swollen lymph glands
  • Weakness
  • Weight loss
Note: At first, infection with HIV may produce no symptoms. Some people, however, do experience flu-like symptoms with fever, rash, sore throat, and swollen lymph nodes, usually 2 - 4 weeks after contracting the virus. This is called the acute retroviral syndrome. Some people with HIV infection stay symptom-free for years between the time when they are exposed to the virus and when they develop AIDS.

Signs and tests

CD4 cells are a type of T cell. T cells are cells of the immune system. They are also called "helper cells."
The following is a list of AIDS-related infections and cancers that people with AIDS may get as their CD4 count decreases. In the past, having AIDS was defined as having HIV infection and getting one of these other diseases. Today, according to the Centers for Disease Control and Prevention, a person may also be diagnosed with AIDS if they are HIV-positive and have a CD4 cell count below 200 cells/mm3, even if they don't have an opportunistic infection.
AIDS may also be diagnosed if a person develops one of the opportunistic infections and cancers that occur more commonly in people with HIV infection. These infections are unusual in people with a healthy immune system.
Many other illnesses and their symptoms may develop, in addition to those listed here.
The following illnesses are common with a CD4 count below 350 cells/mm3:
  • Herpes simplex virus -- causes ulcers/small blisters in the mouth or genitals, happens more often and usually much more severely in an HIV-infected person than in someone without HIV infection
  • Herpes zoster (shingles) -- ulcers/small blisters over a patch of skin, caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox
  • Kaposi's sarcoma -- cancer of the skin, lungs, and bowel due to a herpes virus (HHV-8). It can happen at any CD4 count, but is more likely to happen at lower CD4 counts, and is much more common in men than in women.
  • Non-Hodgkin's lymphoma -- cancer of the lymph nodes
  • Oral or vaginal thrush -- yeast (typically Candida albicans) infection of the mouth or vagina
  • Tuberculosis -- infection by tuberculosis bacteria mostly affects the lungs, but can also affect other organs such as the bowel, lining of the heart or lungs, brain, or lining of the central nervous system (brain and spinal cord)
Common with CD4 count below 200 cells/mm3:
  • Bacillary angiomatosis -- skin sores caused by a bacteria called Bartonella, which may be caused by cat scratches
  • Candida esophagitis -- painful yeast infection of the tube through which food travels, called the esophagus
  • Pneumocystis jiroveci pneumonia, "PCP pneumonia," previously called Pneumocystis carinii pneumonia, caused by a fungus
Common with CD4 count below 100 cells/mm3:
  • AIDS dementia -- worsening and slowing of mental function, caused by HIV
  • Cryptococcal meningitis -- fungal infection of the lining of the brain
  • Cryptosporidium diarrhea -- extreme diarrhea caused by a parasite that affects the gastrointestinal tract
  • Progressive multifocal leukoencephalopathy -- a disease of the brain caused by a virus (called the JC virus) that results in a severe decline in mental and physical functions
  • Toxoplasma encephalitis -- infection of the brain by a parasite, called Toxoplasma gondii, which is often found in cat feces; causes lesions (sores) in the brain
  • Wasting syndrome -- extreme weight loss and loss of appetite, caused by HIV itself
Common with CD4 count below 50/mm3:
  • Cytomegalovirus infection -- a viral infection that can affect almost any organ system, especially the large bowel and the eyes
  • Mycobacterium avium -- a blood infection by a bacterium related to tuberculosis
In addition to the CD4 count, a test called HIV RNA level (or viral load) may be used to monitor patients. Basic screening lab tests and regular cervical Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in women with a compromised immune system. Anal Pap smears to detect potential cancers may also be important in both HIV-infected men and women.


There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality and length of life for those who have already developed symptoms.
Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. This is measured by the viral load (how much free virus is found in the blood). Preventing the virus from replicating can improve T-cell counts and help the immune system recover from the HIV infection.
HAART is not a cure for HIV, but it has been very effective for the past 12 years. People on HAART with suppressed levels of HIV can still transmit the virus to others through sex or by sharing needles. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mm3), life can be significantly prolonged and improved.
However, HIV may become resistant to one combination of HAART, especially in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether an HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each person, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and before starting therapy.
When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for treating drug-resistant HIV.
Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are:
  • Collection of fat on the back ("buffalo hump") and abdomen
  • Diarrhea
  • General sick feeling (malaise)
  • Headache
  • Nausea
  • Weakness
When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of cholesterol and glucose (sugar) in the blood.
Any doctor prescribing HAART should carefully watch the patient for possible side effects. In addition, blood tests measuring CD4 counts and HIV viral load should be taken every 3 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the amount of HIV virus in the blood to a level where it cannot be detected.
Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen, Procrit, and Recomon) and filgrastim (G-CSF or Neupogen) are sometimes used to treat AIDS-associated anemia and low white blood cell counts.
Medications are also used to prevent opportunistic infections (such as Pneumocystis jiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

Support Groups

Joining support groups where members share common experiences and problems can often help the emotional stress of devastating illnesses. See AIDS - support group.

Expectations (prognosis)

Right now, there is no cure for AIDS. It is always fatal without treatment. In the U.S., most patients survive many years after diagnosis because of the availability of HAART. HAART has dramatically increased the amount of time people with HIV remain alive.
Research on drug treatments and vaccine development continues. However, HIV medications are not always available in the developing world, where most of the epidemic is raging.


When a person is infected with HIV, the virus slowly begins to destroy that person's immune system. How fast this occurs differs in each individual. Treatment with HAART can help slow or halt the destruction of the immune system.
Once the immune system is severely damaged, that person has AIDS, and is now susceptible to infections and cancers that most healthy adults would not get. However, antiretroviral treatment can still be very effective, even at that stage of illness.

Calling your health care provider

Call for an appointment with your health care provider if you have any of the risk factors for HIV infection, or if you develop symptoms of AIDS. By law, the results of HIV testing must be kept confidential. Your health care provider will review results of your testing with you.


See: Safe sex to learn how to reduce the chance of catching or spreading HIV and other sexually transmitted illnesses (STIs)
Tips for preventing HIV/AIDS:
  • Do not use illicit drugs and do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones. These programs can also provide referrals for addiction treatment.
  • Avoid contact with another person's blood. You may need to wear protective clothing, masks, and goggles when caring for people who are injured.
  • Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. Infected people should tell any sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use preventive measures (such as condoms) to reduce the rate of transmission.
  • HIV-positive women who wish to become pregnant should seek counseling about the risk to their unborn child, and methods to help prevent their baby from becoming infected. The use of certain medications dramatically reduces the chances that the baby will become infected during pregnancy.
  • The Public Health Service recommends that HIV-infected women in the United States avoid breastfeeding to prevent transmitting HIV to their infants through breast milk.
Safer sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there is a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.
The riskiest sexual behavior is receiving unprotected anal intercourse. The least risky sexual behavior is receiving oral sex. There is some risk of HIV transmission when performing oral sex on a man, but this is less risky than unprotected vaginal intercourse. Female-to-male transmission of the virus is much less likely than male-to-female transmission. Performing oral sex on a woman who does not have her period has a low risk of transmission.
HIV-positive patients who are taking antiretroviral medications are less likely to transmit the virus. For example, pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to their baby less than 1% of the time, compared with 13% to 40% of the time if medications are not used.
The U.S. blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood.
If you believe you have been exposed to HIV, seek medical attention IMMEDIATELY. There is some evidence that an immediate course of antiviral drugs can reduce the chances that you will be infected. This is called post-exposure prophylaxis (PEP), and it has been used to prevent transmission in health care workers injured by needlesticks.
There is less information available about how effective PEP is for people exposed to HIV through sexual activity or injection drug use, but it appears to be effective. If you believe you have been exposed, discuss the possibility with a knowledgeable specialist (check local AIDS organizations for the latest information) as soon as possible. Anyone who has been sexually assaulted should consider the potential risks and benefits of PEP.


  1. Quinn TC. Epidemiology of human immunodeficiency virus infection and acquired immunodeficiency syndrome. In: Goldman L, Schafer AI,eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap392.
  2.  Sterling TR, Chaisson RE. General clinical manifestations of human immunodeficiency virus infection (including the acute retroviral syndrome and oral, cutaneous, renal, ocular, metabolic, and cardiac diseases). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 121.
Review Date: 4/30/2012.
Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
Logo of A.D.A.M.


Practicing blood pressures at CNA class

"I hope you know what you are doing." Practicing blood pressures at Utah CNA class

"Can you hear that?"
Blood pressures at CNA school

"Do you hear what I hear?"
Utah CNA school
Utah CNA class
Utah CNA training

Saturday, January 19, 2013

Sharon Lindsay Lovington Illinois Obituary

Sharon Lee Foster was born on September 23, 1937 to Evelyn Lucille Ireland Foster and William Dale “Pete” Foster (or Dale William, his brothers and sisters could not agree on which it was).  Sharon’s mother grew up in Decatur and her father in Lovington.  
Sharon as a baby

Sharon and her brother Peter Foster grew up in Lovington. Sharon spoke fondly of her memories of Lovington as a busy city and missed the stores and shops of her youth.
In high school Sharon had many friends and was a cheerleader.
Sharon and Pete

Sharon with her mom, Evelyn and brother Pete.

Sharon and Pete

Sharon loved Lovington. She lived in Fisher and was active in the community. She was instrumental in creating the Fisher park and even painted the clown on top of the baby swings. As part of the women's club she helped plan the park, raise money for it and even helped build it. Ultimately she returned to Lovington. She thought Lovington should somehow use the name to its advantage and wanted the post office to postmark valentine cards with the town’s name.

Sharon and Dave
Sharon met David Lindsay in Lovington and they were married in August 1957, they divorced after many years of marriage. They had three children, Don (Carol), Dava (Ghan), and Darci (Gary). Sharon in keeping with the Foster name was a foster parent for many years.
Sharon with her children, parents, brother Pete and his family.

Sharon, Dava, Darci, Don

Evelyn, Sharon, Darci Dava, Don, Alexis, Addie, Kirk, October

Grandchildren and great grandchilren at Evelyn's 100th birthday party.

Pete, Sharon and Evelyn

Sharon and Evelyn

On a cruise with Don and his family

At Myrtle Beach with Kirk (Darci's son) and Don's family

Sharon worked for 30 years with elderly in the community and several nursing homes. She also worked for the American Red Cross and managed the Champaign county meals on wheels program.

She was a supporter of “Another mother for Peace.” Sharon had very strong political views and loved to write letters to politicians and share those views. She advocated for less war, more peace and free birth control.

Sharon was an environmentalist and took pride in leaving a small carbon foot print on the planet. She enjoyed gardening and took great pride in growing as much of her own food as she could. She liked to eat kale, greens, garlic, tomatoes and even flowers from her garden.
Gardening with Alika

After retiring Sharon stayed busy writing. She had several trivia books for seniors published and was a regular writer for “A New Day” magazine. In addition to writing for A New Day she served on their advisory committee. Sharon’s last columns were published in the January/February 2013 edition. Sharon believed it was important for the brain to stay active. Sharon’s mental abilities never left her. A few weeks before her death she was still beating her daughter Dava at Scrabble.
At Rockhome Garden's in September 2012

September 2012

September 2010. Sharon in Lovington with Don, Sean, Alika and her dog Polly.

Sharon’s education included Occupational Therapy and Therapeutic Recreation at the University of Illinois and Resident Activity Coordination Training at Youngstown State University.

She loved to bowl and said that when her health deteriorated to where she couldn’t enjoy bowling it was time to die. Not only did she love to bowl she was an excellent bowler!

She started many a conversation with “welllllll.” Sharon didn’t complain and had an incredibly positive attitude. Sharon failed to mention to her children that she had cancer. It was only over a game of scrabble when Dava asked her what had happened to her breast that she said, “welllll, I might have a little cancer.” Even when her health failed her and she had to depend on others (which she could not stand!) she did it with grace and a smile on her face. Sharon was always doing for others and did not like having others do for her.

Sharon and Addie
Sharon loved her children and being a mother and grandmother were the most important things in her life. She was devastated when her youngest daughter Darci died. Sharon always said she would never go through chemo but in the end she tried chemo not because she feared death but because she wanted to live to be there for Darci’s daughter Addie. Leaving Addie was the hardest thing for her. Sharon could talk about her own death without a tear but she could not talk about leaving Addie.

At Pete's in Tulsa with Dava, Darci, Nancy, Addie and Alexis

In Lovington with Alika, Sean and Don.

Dinner with David

Somewhere in California
Sharon loved all her grandchildren. When Alika was born Don’s wife was in the army and was sent to Germany during Desert Storm. Sharon went to Utah and stayed with Don taking care of Alika for nine months.

Many of Sharon’s friends were surprised by her death, most were not aware that she was sick. Even the month before she died she did not admit to her friends that she was not well. More than one person expressed surprise saying “but she said she felt fine.” Wellll, she fibbed! Sharon didn’t like to complain so rather than admit she felt bad she told everyone she was fine.

Sharon wanted very much to die in Lovington in her home. Her grandson Shane made that possible. He spent the last two months of her life living with her at her home in Lovington. Sharon said that Shane was both an excellent cook and company.
Sharon with a little Shane.
Sharon is survived by Don and his children, Alika, David and Sean.
Dava and her children, Shane DeYoung, Kyle DeYoung and Alexis Bunyarattaphantu
Darci’s children, Kirk and Addie Patton.
She is also survived by her great grandchildren, Sydney Meeks, October, Ashtin, Dade, Gage and Kale DeYoung, a great great grandson, Jackson,  her brother Pete, his wife Nancy and her nephews Stason and Brock Foster.

Along with her “welllll” Sharon always said “nothing last for ever” and “keep having fun.”

Watching Polly eat corn on the cob
Sharon was loved by all her family, many friends, neighbors and her dogs Polly and Okie.

Sharon died at her home on January 17, 2013. A memorial service will be held in Lovington on Saturday March 23. McMullin-Young Funeral Home in Lovington is in charge of the arrangements.
 Please don’t send flowers, honor Sharon’s memory by planting a tree in the spring.

Friday, January 18, 2013

People who don't stink still wear deodorant

For most people, putting on deodorant is a necessary ritual on par with brushing teeth or washing hands. But for those who produce no armpit stench, it is totally unnecessary.
Despite that, more than three-quarters of those people still use deodorant at least once a week, a new study finds.
The findings, published in the latest issue of the Journal of Investigative Dermatology, show just how much a person's daily life is dictated by what's considered normal.
"They're spending their money, exposing their skin to what may in a few instances not be good for their skin. It sort of suggests to me that there are a lot of conformists around," said study co-author Ian Day, a genetic epidemiologist at the University of Bristol.
Several years ago ago, scientists discovered that a gene called ABCC11 determined whether people produced wet or dry earwax. Interestingly, people who produce the "dry" version of earwax also lack a chemical in their armpits that bacteria feed on to cause underarm odor.
"This key gene is basically the single determinant of whether you do produce underarm odor or not," Day said.
While only 2 percent of Europeans lack the genes for smelly armpits, most East Asians and almost all Koreans lack this gene, Day told LiveScience.
No one knows exactly why gene prevalence varies so much between populations, but its absence in East Asia suggests that being stinky was evolutionarily selected against there over the last several thousand years, he said.
The new findings came as a surprising twist on a larger study investigating chemical exposures in 6,495 women and their babies in Britain. Researchers took blood samples (which contain genetic material) from the women and asked them what types of hygiene products they used daily. As a result, the researchers could investigate how genes related to product usage.
About 98 percent of the women had the gene for smell-producing armpits. Of those, 95 percent used deodorant on a regular basis.
But of the the 117 non-odor producing women, over three-quarters still used deodorant daily. That suggests the majority of women are using a product every day, when they have no need to, Day said. The researchers estimated that about $32 per person each year -- or a total of $14.3 million -- is spent on deodorants by people who don't produce odor.
Though the team didn't look at men, they think the results should generalize. (Other studies have found that men in general are slightly less fastidious in their deodorant use, Day said.)
Because the study didn't intend to look at deodorant use, the researchers can't tease out why smell-free women continue to slather on the odor-reducing product. But one possibility is that social pressure or conformity plays a large part in some of our most common hygiene routines, Day said.

Great CNA class

A BIG BIG thanks to Carol, Claudia, and the rest of the team at CCCNA for starting me off on this journey of working in healthcare. I just passed my NCLEX-RN exam and am so excited to take the next step in my career. You guys made this field seem so alive and full of purpose. You are the best!

And you thought your job as a CNA was tough

This mannequin has the worst posture. Or maybe she's just so tired of standing she can't take it anymore, or maybe the mannequin is so anorexic she is about to fall down from lack of nutrition. What designer thought this was a good look?

And you thought your job as a CNA was tough try being a mannequin. I guess the plus is they get to wear cool hats. Well some of them do, others look like they've gone through a couple of rounds of chemo.

Wednesday, January 16, 2013


My son got a nasty case of shingles. I guess there is no un-nasty case of shingles. I thought I would post a couple of pictures of my son's lovely body and some information about shingles from the PubMed site.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.
A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.
A.D.A.M. Medical Encyclopedia.


Herpes zoster
 Shingles (herpes zoster) is a painful, blistering skin rash due to the varicella-zoster virus, the virus that causes chickenpox.
 Causes, incidence, and risk factors
After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves years later.
The reason the virus suddenly becomes active again is not clear. Often only one attack occurs.
Shingles may develop in any age group, but you are more likely to develop the condition if:
  • You are older than 60
  • You had chickenpox before age 1
  • Your immune system is weakened by medications or disease
If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or a chickenpox vaccine, they can develop chickenpox, not shingles.


The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe and is usually present before any rash appears.
Red patches on the skin, followed by small blisters, form in most people.
  • The blisters break, forming small sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare.
  • The rash usually involves a narrow area from the spine around to the front of the belly area or chest.
  • The rash may involve the face, eyes, mouth, and ears.
Other symptoms may include:
  • Abdominal pain
  • Fever and chills
  • General ill feeling
  • Genital sores
  • Headache
  • Joint pain
  • Swollen glands (lymph nodes)
You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. The symptoms may include:
  • Difficulty moving some of the muscles in the face
  • Drooping eyelid (ptosis)
  • Hearing loss
  • Loss of eye motion
  • Taste problems
  • Vision problems

Signs and tests

Your health care provider can make the diagnosis by looking at your skin and asking questions about your medical history.
Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles.
Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus, but they cannot confirm that the rash is due to shingles.


Your health care provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease. Acyclovir, famciclovir, and valacyclovir may be used.
The medications should be started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The drugs are usually given in pill form, and in high doses. Some people may need to receive the medicine through a vein (by IV).
Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These drugs do not work in all patients.
Other medicines may include:
  • Antihistamines to reduce itching (taken by mouth or applied to the skin)
  • Pain medicines
  • Zostrix, a cream containing capsaicin (an extract of pepper) that may reduce the risk of postherpetic neuralgia
Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion, may help to relieve itching and discomfort.
Resting in bed until the fever goes down is recommended.
  • Keep the skin clean.
  • Do not reuse contaminated items.
  • Wash nondisposable items in boiling water or disinfect them before using them again
You may need to stay away from people while the sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women.

Expectations (prognosis)

Herpes zoster usually clears up in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.
Sometimes, the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia.
Postherpetic neuralgia is more likely to occur in people over age 60. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe.


Complications may include:
  • Another attack of shingles
  • Bacterial skin infections
  • Blindness (if shingles occurs in the eye)
  • Deafness
  • Infection, including encephalitis or sepsis (blood infection) in persons with a weakened immune system
  • Ramsay Hunt syndrome if shingles affects the nerves in the face

Calling your health care provider

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.


Avoid touching the rash and blisters on persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.
A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles.
The United States Advisory Committee on Immunization Practices (ACIP) has recommended that adults older than 60 receive the herpes zoster vaccine as part of routine medical care.


  1. Cohen J. Varicella-Zoster virus (chickenpox, shingles). In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 383.
  2. Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 12.
Review Date: 5/30/2012.
Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.