Kate Tate-11/14/07-Two Website Reviews on Shingles
I have chosen my first website for review because it is large and very reputable. The home page and website is as follows:
http://www.ninds.nih.gov/disorders/shingles. It is the National Institute of Neurological Disorders and Stroke (NINDS) created by the US Congress in 1950. It is one of more than two dozen research institutes and centers which comprise the NIH (National Institutes of Health), as well as an agency of the US Public Health Department and has a reputation in world neuroscience fifty years. The scientists at NINDS are both in public and private institutions, such as medical schools and universities, hospitals, as well as employees of the Institute’s own laboratories. Their mission is to obtain new neuroscience research information and disseminate it to the world. NINDS provides grants-in-aid to public and private institutions and persons in related fields of neuroscience and information. They share the information with the world, on the world-wide website, through and with the NIH, and in publicly-available Congressional testimonies, in order to ease the burden of neurological disease in the world. Although it is made up of PhDs and MDs,like Dr. John T. Povlishock,PhD., Chair of Anatomy and Neurobiology at Virginia Commonwealth University, research fellows, assistants and staff, NINDS does not diagnose or advise individuals. Their research deals with over 600 neurological disorders which strike over an estimated 50 billion Americans alone. This extensive website covers every neurological disease and disorder known, as well as neurological consequences of diseases such as AIDS, Alzheimer’s, epilepsy, motor neuron disorder, multiple sclerosis, Parkinsons, to name a few. It provided me with extensive detailed information on my subject shingles and other links just as formidable.The strong points of the NINDS website include this well-documented knowledge, reputation and clear, easy to follow presentation. I do not find any downside to this website or its ease of use. As another of its strong points, this website offers two other excellent links to www.vzvfoundation.org and www.paincare.org, as well as its own MEDLINEplus and excellent glossary.
This website covered the subject shingles by topic: what is it? Is there treatment? Prognosis? What research is being done? To summarize here, shingles is a virus related to chickenpox (varicella zoster) and actually its name ‘variola’ from Latin which means ‘smallpox’. During the Middle Ages shingles actually disfigured and killed millions of people. At risk persons have had chickenpox, and in fact persons who have not had chickenpox will not contract shingles. Shingles begins as a rash of fluid-filled blisters, which most commonly itch and appear a skin path on the trunk, therefore, shingles derives from ‘cingulum’ or girdle; but the virus outbreak can appear on the back, neck, and more seriously the eye and face. Shingles is associated with pain, both at onset, during and following the outbreak of a rash and the pain can last for several months, as in the case of an amputee. In this context the pain is called postherpetic neuralgia abbreviated PHN. Shingles primarily appears in any immune-compromised individuals and especially chronically-ill older persons. A survey I did in my nutrition class revealed that tired students as young as 20 through 30 years of age had already had an outbreak of trunk shingles! One older fellow in our class had the facial shingles, which at its onset, doctors thought was skin cancer. It is also possible to have this virus reactivate more than once. Shingles is both contagious and not,ie., a person afflicted with shingles can actually cause a chickenpox breakout in another only if that person has never had chickenpox. Scientists are still researching specific mechanisms as to cause of the dormancy and reactivation.
In our A&PI course we learned that in the body’s infinite wisdom from the cellular level to tissues, organs and organ systems, that bodily functions are totally interdependent on the interaction or communication of the cells and systems and neural stimultion. ‘Central intelligence’, even before the formation of the brain in the developing fetus still communicates cell specialization and tissue segmentation. We learned that the skin is a most complex organ and that it has critical blood and nerve supply in order to perform its varied functions. We also learned that there are areas of skin which correspond to the segmentation based on their sensory and motor distribution. These are called dermatomes. The strip of skin which demonstrates the path of the shingles virus is exactly the distribution path of the affected sensory spinal nerve. On the excellent link website to VZVfoundation, the varicella zoster virus is described as one lying dormant and reappearing in one out of seven over the age of 85, and further, the description of facial shingles is described almost exactly in the Book of Job in the Bible, so some scientists believe it has actually evolved and mutated and survived over 70 million years! Scientists believe shingles, in the original affliction with chickenpox, leaves virus particles that leave the blisters and move into the nervous system, and when the varicella zoster virus reactivates it moves down the nerve fibers which extend from the sensory cell bodies of the dorsal root ganglia and present on the corresponding dermatome. In A&PI course and text we studied this in our neurology section which is why I found this so interesting and shingles relates to our course material this semester. In 2006 the FDA approved a VZV vaccine(Zostavax) for use in people over 60 who have had chickenpox, but only in the actual wisdom of ‘central intelligence’ will the explanation lie, as to how the body ‘remembers’ and reactivates the virus and further may remember it as in the herpes zoster ‘family’ resulting in only cold sores. In fact shingles is grouped with the herpesviruses simplex, which can also ‘hide’ in the nervous system and remain latent for years, and is related to the human papilloma viruses. When shingles presents in or near the eye, ‘ophthalmic’ shingles, can cause delayed or immediate blindness and is extremely painful; and when it is in or near the ear it is called Ramsay-Hunt Syndrome. Shingles can lead to congenital malformations in newborns if the pregnant mom is undiagnosed or untreated. Treatment ranges from zoster immune globulin in the aforementioned case to antivirals,eg.,acyclovir; pain treatment, steroids, nerve blocks. In summary, once again, we are reminded of the awesome complexity of the workings of the human body and its evolutionary journey through the ages and history of mankind and all living things. In its wisdom and beauty, the body’s own visual dermatome evidence gives a heads-up to the diagnostician!
The second website I chose to review is smaller and meets the requirement for websites of one of each size by comparison. It is www.aftershingles.com , founded by the VNAA, Visiting Nurse Association of America (www.vnaa.org). Over 25 years of existence, this organization is extremely dedicated to the goal of achieving home health care for Americans. This shingles website was dedicated solely for the intention of providing caregivers and patients the basic information and websites with the information to assist them in dealing with shingles as an affliction. It was developed with an unrestricted grant made possible by Endo Pharmaceuticals Inc., who are the makers of Lidoderm, a topical anesthetic commonly used on the skin for itch and pain in shingles. The VNAA website and organization is highly political in its workings, (which is not really a worst feature, but sponsors are on all the web pages), because they seek continual endorsement to survive. Created in 1983 as a non-profit, their mission is to “support, promote and advance Visiting Nurse Associations in their mission to serve their communities.” They utilize business development, national public imaging, member services, and government advocacy and have offices in Boston, MA and Washington, DC., which they provide on their website, along with all the other information resource websites they recommend for further study, several of which were also listed on my first NINDS website, so definitely a strongpoint to this website for me. Another strongpoint is the presentation of the material about shingles I found very easy to follow as behooves a sick or other layperson and provides answers and specifics to all questions which would be of concern to the nurse! The actual members then are the associate members, such as the home health organizations and all support products and services which participate to keep this vital American group going and they are listed, as well as their Board members list with Director Andrew Carter, CEO, topping the list with long credits to his name. Their credibility goes up as you can access all of the information presented at their Congressional hearings and meetings.
In researching all of the material on this site, I found it in agreement with most everything I had previously researched both academically and clinically with the exception to the answer to “Is shingles contagious?” and here they kept it too simple and didn’t explain that you can ‘catch it’ if you never had chickenpox before, but you would get chickenpox the first time. They just said, “No. You cannot get shingles from someone who has it” – based on the fact it is ‘hidden within,’ as we discussed above. This could be misleading and potentially dangerous. They did make the statement just above this that “only people who have had chickenpox can get shingles,” and further on they do discuss this accurately. So no criticism here as to information accuracy. I truly enjoyed reading this site over and gained much practical information clinically from it to apply to my nursing and caregiving work. For example in explaining the pain and itch symptoms, it allowed me to relate better to what potentially patients might be suffering and they explained postherpetic pain very simply for the layperson. Treatment options were varied and represented the common choices well with no prejudicial treatment of one company or product over another. They did point out that Lidoderm is presently the only specific FDA-approved medication for treatment of PHN, but I believe it does work the best by patch and topically in the cases I have witnessed. The downside by reviewing this website was that it correlates exactly and with less specifics to the first, more detailed website number one and so, in this case, I am hardpressed to add anything new which correlates to the anatomy and physiology of class, except to state that it relates in the ways described above. I would like to add though that I do believe that it shingles reactivation is most definitely under immune and nervous system control, but the fact that it potentially lays dormant in the anterior gray horns of the spinal cord (reference to our textbook) is fascinating to me. New research is looking into the analysis of cerebrospinal fluid and links to precancerous red flags in biochemistry.
