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    Shingles and Chemotherapy

    Asked Oct 2, 2007, 01:28 PM 15 Answers
    Hi all,

    My mother was diagnosed with NH Lymphoma last fall. She went through 6 months of chemotherapy on one drug that was found to be ineffective.

    She is now on a clinical trial for another medication that after 5 weeks gave her the shingles. She has been out of the chemo scheudule now for over a month while they try to get the shingles cleared up.

    Her doctor won't tell us much. She is in pain and is frightened because she doesn't know what is next. We all know that NHL isn't curable - only treatable. If they can't give her treatment because it gives her shingles, are there other alternatives?

    Does anyone have experience in this area?

    Last edited by Emland; Oct 2, 2007 at 01:28 PM. Reason: typo
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    statictable's Avatar
    statictable Posts: 436, Reputation: 34
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    #2

    Oct 2, 2007, 04:15 PM
    Her Doctor won't tell you much? Has your mother been present during your discussions with her Doctor? Be sure the medical staff understands that your mother has no problem with you communicating one on one with any staff member. Her Doctor must make time for any questions you have and must clearly define all options. Sorry I didn't answer your question but your mom's MD is the best source to answer most of your questions. Your mother may wish to have a "Health Care Surrogate" which gives legal status to one or more individuals she has chosen and as a health care surrogate the person/s can review medical records, charts, study results, pharmacy records, staff notes and so on. If you are located on the West Coast this may not be needed but if you are located in the S.E. a surrogate would be my choice. I hope some good answers await posting and wish best for your mother's health.
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    gbwillner's Avatar
    gbwillner Posts: 27, Reputation: 1
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    #3

    Oct 3, 2007, 03:44 PM
    Quote Originally Posted by Emland
    Hi all,

    My mother was diagnosed with NH Lymphoma last fall. She went through 6 months of chemotherapy on one drug that was found to be ineffective.

    She is now on a clinical trial for another medication that after 5 weeks gave her the shingles. She has been out of the chemo scheudule now for over a month while they try to get the shingles cleared up.

    Her doctor won't tell us much. She is in pain and is frightened because she doesn't know what is next. We all know that NHL isn't curable - only treatable. If they can't give her treatment because it gives her shingles, are there other alternatives?

    Does anyone have experience in this area?
    First off, you need to understand that the treatment did not itself cause shingles. Shingles is a recurrence of the Varisella Zoster virus, which commonly causes chicken pox. When your mom was given chemotherapy, her immune system was suppressed, and the virus came back. Stopping chemotherapy temporarily will allow the immune system to recover and the body to fight the infection. When she is over the infection, chemotherapy can resume, with some chance that the virus will recur again (I can't say what the odds are).
    Treatments for NHL can be very successful or not, depending on the type of NHL (there are many subtypes). The five-year survival for most NHL is pretty high with appropriate therapy, so I would keep my hopes high if I were you.
    I hope this answers your question.
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    J_9's Avatar
    J_9 Posts: 39,800, Reputation: 5594
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    #4

    Oct 3, 2007, 04:02 PM


    Quote Originally Posted by gbwillner
    First off, you need to understand that the treatment did not itself cause shingles. Shingles is a recurrence of the Varisella Zoster virus, which commonly causes chicken pox. When your mom was given chemotherapy, her immune system was suppressed, and the virus came back. Stopping chemotherapy temporarily will allow the immune system to recover and the body to fight the infection. When she is over the infection, chemotherapy can resume, with some chance that the virus will recur again (I can't say what the odds are).
    Treatments for NHL can be very successful or not, depending on the type of NHL (there are many subtypes). The five-year survival for most NHL is pretty high with appropriate therapy, so I would keep my hopes high if I were you.
    I hope this answers your question.
    I can't add any more to this post it is virtually perfect. Except for a spelling mistake, LOL

    Varicella Zoster virus is what causes chickenpox AND shingles.

    What happens is that once you have had chickenpox, the varicella zoster virus lies dormant in your nerves. Years later, usually after exposure, even stress, it is known to reappear.

    Now, it is more common in the older population whose immune system is compromised, such as your mother. Now, unless her chemo had a variation of herpes zoster or varicella zoster (which is virtually impossible), it is highly unlikely that the treatment itself caused the infection.

    Here is a little tidbit to back up what we have been saying:

    people with weakened immune systems from HIV/AIDS, those who are receiving medical treatments, such as steroids, radiation and chemotherapy, or those who have a history of bone or lymphatic cancer are more likely to develop shingles. Most people develop shingles only once, but recurrences in other areas are possible.

    A person with shingles can pass the varicella-zoster virus to anyone who hasn't had chickenpox before. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles. The infection can be serious for certain groups of people with immune system deficiencies. The varicella-zoster virus cannot be spread to another person with a normal immune system who has already had chickenpox.

    Until the shingles blisters scab over, avoid physical contact with:

    * Anyone who's never had chickenpox
    * Anyone who has a weak immune system
    * Newborns
    * Pregnant women (A chickenpox infection can be dangerous for the developing baby.)
    So, again, it was not the chemo that caused your Mom to have shingles.

    Oops, guess I did have a little more to add. :o
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    Emland's Avatar
    Emland Posts: 2,468, Reputation: 496
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    #5

    Oct 3, 2007, 05:16 PM
    Thanks, gb and J.

    I didn't realize she is contagious. I have never had chicken pox. My children have, though. What is the incubation for CP?
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    J_9's Avatar
    J_9 Posts: 39,800, Reputation: 5594
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    #6

    Oct 3, 2007, 05:21 PM


    If you have never had it, and you were exposed to mom, you may get CP. About 10 - 17 days.
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    Emland's Avatar
    Emland Posts: 2,468, Reputation: 496
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    #7

    Oct 3, 2007, 05:24 PM
    Another question. Can the NHL progress dramatically while she is off the chemo? She is complaining of pain more severe than she has experienced so far. How much does pain relate to how far the NHL has progressed? My mom has a high tolerance for pain - she suffered from polio as a child and broke a disc in her back in her late 30s.
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    Emland's Avatar
    Emland Posts: 2,468, Reputation: 496
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    #8

    Oct 3, 2007, 05:27 PM
    Quote Originally Posted by J_9
    If you have never had it, and you were exposed to mom, you may get CP. About 10 - 17 days.
    Great - I have a dance competition in about 2 weeks. Figure the odds...
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    J_9's Avatar
    J_9 Posts: 39,800, Reputation: 5594
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    #9

    Oct 3, 2007, 05:28 PM


    The progression of NHL is really as individual as we all are.

    Now as far as the pain. Shingles is VERY painful, even for the folks with a high tolerance to pain.

    This is really a question she needs to talk to her oncologist about. It may or may not have to do with her NHL, it may or may not have to do with her shingles.
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    Emland's Avatar
    Emland Posts: 2,468, Reputation: 496
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    #10

    Oct 3, 2007, 05:34 PM
    The shingles are bothering her, but the pain is in her abdomen where the NHL has been indentified. She can't wear a bra or anything banded around her middle. Unless she is going to church or the doctor, she keeps her muu-muu.
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    J_9's Avatar
    J_9 Posts: 39,800, Reputation: 5594
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    #11

    Oct 3, 2007, 05:37 PM
    Yes, shingles attacks the center portion of the body, around the waistline approximately. A little above and/or a little below.
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    Emland's Avatar
    Emland Posts: 2,468, Reputation: 496
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    #12

    Oct 3, 2007, 05:42 PM
    The pain she has is internal. She describes it as being skewered.
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    J_9's Avatar
    J_9 Posts: 39,800, Reputation: 5594
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    #13

    Oct 3, 2007, 05:44 PM
    Sounds like shingles to me. My sister had it and that is pretty much how she described it.
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    Emland's Avatar
    Emland Posts: 2,468, Reputation: 496
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    #14

    Oct 3, 2007, 05:47 PM
    I will let her know then. She is afraid the NHL is advancing while she isn't on the chemo.
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    inthebox's Avatar
    inthebox Posts: 787, Reputation: 179
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    #15

    Oct 3, 2007, 08:06 PM
    Emland:

    Lymphoma Information Network - Adult Non-Hodgkin's Lymphoma

    What You Need To Know About Non-Hodgkin's Lymphoma - National Cancer Institute

    I'd get second opinion[s] or ask your oncologist more specific questions.



    Varicella-zoster vaccine - I'm not sure if she would be a candidate for this.

    Since 1995, live attenuated varicella virus vaccine (Varivax) has been available in the US and has been up to 99% effective in protecting susceptible individuals from varicella infection. The higher-potency vaccine introduced in 2005 appears effective PREVENTING zoster.
    It has been proposed that zoster occurs when varicella antibody titers and varicella-specific cellular immunity drop to a level at which they no longer are completely effective in preventing viral invasion. Evidence for this hypothesis includes observation that pediatricians, who presumably are reexposed to varicella virus routinely and thus maintain high levels of immunity, seldom develop zoster. Indeed, administration of varicella vaccine to OLDER individuals whose antibody titers and cellular immunity have fallen over time appears to decrease their risk of developing zoster. The high-potency, live attenuated VZV vaccine recently introduced by Merck has demonstrated a reduction in the incidence rate of herpes zoster of 51.3% during 3 years of follow-up in one study.


    Varicella-zoster IMMUNE GLOBULIN : The Centers for Disease Control and Prevention (CDC) currently recommend administration of varicella-zoster immune globulin (VZIG) to
    PREVENT OR MODIFY clinical illness in persons with exposure to varicella or zoster who are SUSCEPTIBLE OR IMMUNOCOMPROMISED. VZIG provides maximum benefit when administered as soon as possible after the presumed exposure, but VZIG may be effective if administered as late as 96 hours after exposure. Protection after VZIG administration lasts for an average of approximately 3 weeks, according to the CDC.




    Grace and Peace
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    inthebox's Avatar
    inthebox Posts: 787, Reputation: 179
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    #16

    Oct 3, 2007, 08:21 PM
    I want to correct something about varivax - the shingles vaccination:

    Slide 19. Zoster Vaccine: Contraindicated in Immunocompromised Patients
    A thornier question is: since we can't give it to immunocompromised patients, who are the immunocompromised patients? Some are obvious such as HIV seropositive patients, patients with leukemia or lymphoma, and organ transplant recipients. There are a lot of other grey areas, though, that are difficult to sort out. The Advisory Committee on Immunization Practices (ACIP) offers some guidance. They define corticosteroid use as more than 2 mg/kg of body weight or more than 20 mg/day for more than 2 weeks. So use of corticosteroids or prednisone would be considered immunocompromising. For patients receiving chemotherapy or radiation therapy for malignancies, it is recommended that live-virus vaccines should not be administered for at least 3 months after that immunosuppressive therapy has been terminated.



    Grace and Peace
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