After 2 physician's and a dermatologist viewed, poked, scrutinized, questioned, and inspected this mysterious commodity known as "Kevin's rash", the earlier suspicion was confirmed. He now has a new malicious villain to conquer--Herpes Zoster, or more commonly known as Shingles.
If you have ever had chicken pox you carry the virus that causes it in your body for the rest of your life. Under normal circumstances, your body's immune system keeps the virus under control. When we get older our immune system weakens which is why so many seniors get Shingles. But if you are under stress, and/or your immune system is compromised as in chemotherapy, the virus can flare up. When Kevin's cell counts were so low a week ago, he didn't have any resistance to the virus.
Herpes Zoster travels just under the skin along the dermal nerve pathways. Kevin's is on his left elbow and down the underside of his left arm to his palm and fingers and a small area on his back. The rash is raised and red and develops small fluid filled pustules that turn into brown crusts, just like chicken pox. The difference is it doesn't itch, like chicken pox, but because the virus travels along the nerve, there is much nerve pain on the skin surface. The usually pain killers aren't effective because they don't faze nerve pain.
Elavil seems to work the best so Kevin is taking a low dose just at night so he can sleep--this is a nasty drug. Tylenol can be used in the day to take some of the edge off of it. Thank God Kevin has the high pain tolerance that he does! His left hand and fingers are the most painful right now--especially if anything touches them. I have wrapped his whole hand and lower arm to keep the clothes from rubbing on the skin and so it is more comfortable when his hand is in contact with anything. That seems to help with the discomfort.
Now the bad thing is that this will delay his 4th round of chemo for a week--hopefully not more. He can't start that until the pustules are crusted over because his immune system will be further taxed and the Shingles could go to one of his organs. The beasties, however, will not sit idle and wait--they believe in kicking a guy when he is down--no sportsmanship conduct on their end! Also, the more delays we have, the shorter recovery Kevin will have between the transplant and fall semester at SJU.
Usually Shingles is treated with oral anti-viral medications, of which there are several. However, they are only effective if you start them early. Kevin has had the rash since Wednesday, so we needed to get them started right away. After consultation with Dr. Bendel and the physician's at CentraCare, it was decided he needs to get the medication IV so hopefully it will kick in sooner and be more effective. We will be able to do this at home every 8 hours with the trusty CAD pump provided by Option Care. However, the first dose needs to be at the hospital just in case Kevin has a reaction. It takes an hour to run in.
Now by the time all of this was arranged, it was 4pm. If you remember my entry from yesterday, tonight is the concert at Excel Energy center--Hope Kids have a box suite. Kevin needed to leave at 5:30 in order to pick up his buddy and get to the concert at 8 pm. He really was looking forward to this fun event and needed it to take his mind off his struggles for just a little while. Therefore, it was decided to wait with the IV infusion at the hospital until after the concert tonight. So when Kevin gets back to St. Cloud, he'll go to the ER and they will do the first infusion there. Then 8 hrs later, we'll have Option Care bring the IV pump and bags to the house so we can do the rest of them at home. But by now he should be entrenched in his box suite with some good friends, good music, and good food--just a slice of normalcy to give him the boost he needs to continue the battle. He will PREVAIL!!