Talk:Shingles/Archive 1

Initial text

Added public domain text from http://www.ninds.nih.gov/health_and_medical/disorders/shingles_doc.htm — Preceding unsigned comment added by 213.253.39.89 (talk) 05:03, 5 August 2002 (UTC)

Prevention

Does anyone have statistics about people developing shingles from having full-blown out break of Chickenpox vs. being vaccinated? It would be interesting to see if the inert Varicella-zoster virus vaccination reduced the occurrence of Shingles. If so then this method of shingle prevention is copyrighted by me --Supercoop 16:01, 2004 Oct 13 (UTC) and released to the community under GFDL. :)

Prognosis

I noticed that under the prognosis section that it said rash and pain usually subside within three to five days. I believe this is a mistake and that it should actually say three to five weeks. Not only was a friend of mine recently stricken with the illness for a good 4 and a half weeks, but I have found many links on the web which agree with the prognosis of 3-5 weeks, such as [[1]] and [[2]]. I made the correction to the article. --Nicholas_FJ 10:57, 4 January 2007 (UTC)

I agree, but someone reverted your edit. One of my friends had shingles too, and the pain lasted for around 4 weeks. I've taken a look at various medical sites and your links. It seems to be correct...67.127.59.119 23:55, 26 May 2007 (UTC)

Never mind, your edit is still there. But there is another section with pictures that remains unchanged.67.127.59.119 23:57, 26 May 2007 (UTC)

With information from this site, I've changed the cycle sections from days/pain disappearing to weeks/cycle continues.

Acyclovir vs. aciclovir

User:Techelf reverted a change I made to the article, about how to spell acyclovir, valacyclovir and famcyclovir, vaguely citing "WP policy". I checked the style guide to see if any changes had happened recently that I was not aware of, and drug naming in articles is still not covered there. I checked WikiProject Medicine to see if there was any guideline on drug name usage, and found none.

The only thing I could find to support Techelf's idea of "WP policy" was a naming convention at Wikipedia:WikiProject Drugs, which does establish a convention to use INN names for article titles, with redirects at the other accectped spellings. A WikiProject established naming convention regulates where an article resides in the database, it does not establish what spelling is used in other articles, especially ones not covered by the WikiProject.

If there is some other policy I'm not aware of, please let me know. Otherwise, I intend to follow the policy at the manual of style and return the spelling used in this article by "following the spelling style preferred by the first major contributor (that is, not a stub) to the article." Gentgeen 02:20, 2 June 2006 (UTC)

The Manual of Style says that use of the "style preferred by the first major contributor" only applies where "all else fails". I don't really think that applies here.

1. Firstly, you're correct in that I was referring to the Wikipedia:Naming_conventions_(chemistry)#Drug-related_articles. Because of that policy, article titles for the drugs in question are the International Nonproprietary Names (INN): aciclovir, valaciclovir and famciclovir. Looking through the "What links here" on each of those articles, it seems the general consensus is to link the INN – it simply doesn't make sense to use the United States Adopted Name (USAN) when article titles are INNs. (And incidentally, even the USAN is "famciclovir").
2. Even if you use the "all else fails" option, the first major contribution to this article was edit 8404076 by User:Jfdwolff. This contribution was in British English. He used "acyclovir", "valaciclovir" and "famciclovir" because these were the British Approved Names (BAN) at the time (when the UK was in the process of full transition to INNs). BANs are now the same as INNs, thus the INN spellings aciclovir, valaciclovir and famciclovir seem justified.

I probably should've explained myself a little more clearly initially, but these are my reasons (and probably those of some other editors of this page) for using INNs. -Techelf 11:22, 2 June 2006 (UTC)

Parts of this article appear to be written by a child so I am removing one for now. 24.154.173.50 00:05, 5 June 2006 (UTC)

Citation needed

However, prior to the vaccine, it has long been known that adults received natural immune boosting from contact with children infected with varicella. This helped to suppress the reactivation of herpes zoster. Sounds like anti-vaccine drivel to me, but I'll give it a week or so. -- KelleyCook 20:34, 15 June 2006 (UTC)

Here's a study out of Boston, Mass. [3] Gentgeen 20:37, 15 June 2006 (UTC)

yeah I had just found it referenced in the Yih study and was about to strikeout my comment KelleyCook 20:39, 15 June 2006 (UTC)

St Anthony's Fire

Whoever wrote that this ailment is known as St Anthony's fire in Italy and Malta... are you sure of that? in France, the term is known to have been used to designate ergotism, which was particularly virulent in the high and late middle ages ... and I doubt that usage would have varied that much.--Svartalf 20:21, 18 June 2006 (UTC)

It's right: in Italy shingles is generally known as 'fuoco di Sant'Antonio'. I don't know how was 'ergotism' called in the same region and if it was ever common there since rye isn't a normally grown in the mediterranean region. Plch 15:56, 30 October 2006 (UTC)

The italian version of Wikipedia (see Ergot) states that the term fuoco di Sant'Antonio, as well as fuoco sacro (sacred fire) and fuoco degli ardenti (fire of the burning men), was applied indistinctly to both shingles and ergotism during the Middle Ages (some early symptoms are similar, so the confusion is understandable). Ergotism being much less common nowadays, the term continues to be applied to shingles almost exclusively. About ergotism being uncommon in Italy, there are documented outbreaks in Milan in 1128 and 1132 (the last one in 1795), as well as Turin (1798) and other cities in continental Italy (which by the way can hardly be defined "mediterranean"). Rye was (and still is) a very common crop, at least in northern Italy. -- EmirCalabuch 14:52, 6 January 2007 (UTC)

Shingles Too

My doctor told me it is very common. Everything I read is that it's common in adults over the age of 50 or 60. I am 38 and was just diagnosed with shingles. -- Shinglestoo 30 July 2006

i got shinlges on my back and stomach at 17 casue i had the flu, nose bleeds and was going to court at the same time that was just too much stress for me

shingles

Is it possible to get shingles (if you're a bigger person) underneath your belly? perry

It's possible to get shingles on any part of the body however some locations are much more common.--Gbleem 12:27, 28 September 2006 (UTC)

--Weeghman 00:58, 2 November 2007 (UTC)Correct. It follows a dermatone pathway and will generally re-emerge along the same pathway, however subsequent outbreaks are less painful. I have just (three weeks ago) been diagnosed with shingles and, as many of you know, it is quite painful. There is also a 25% chance of postherpetic neuralgia, which I have also contracted. This means the pain associated with the shingles can continue on for as long as a year. (I apologize for any spelling errors. I must admit I am hindered by overuse of spellcheck over the years).

stages

The main text says things tend to clear up in 3-5 weeks, but the Stages section says 4-5 days. I wonder if that refers to the person in the photograph specifically -- if so it should be clarified. Cbogartdenver 13:46, 19 September 2006 (UTC)

std

is herpes zoster an STD? crabs and scabies and HPV can be transmitted skin to skin, which makes me think that this may also be an STD, if so i think it should be added to Template STD/STI Qrc2006 09:29, 22 September 2006 (UTC)

It's not an STD. There are lots of diseases that can be transmitted by skin to skin contact or during sex that are not considered STD's. --Gbleem 12:26, 28 September 2006 (UTC)

Additionally, if you contract the viracella zoster virus from someone with shingles, you develop chicken pox, not shingles. Gentgeen 04:57, 29 September 2006 (UTC)

vaccination effect

"Prior to implementation of the universal varicella vaccination program in the U.S., incidence of shingles increased with advancing age." This is confusing to me because later the article says that shingles will increase because of lack of exposure to unvaccinated children. If I assume incidence is measured including all people then maybe there is a clearer way to say this? --Gbleem 03:00, 25 November 2006 (UTC)

Herpes Zoster vs Herpes Simplex

Does Herpes Zoster have anything to do with Herpes Simplex? Are they caused by 2 completely different viruses? Why are the names similar?Pvkc 20:33, 22 January 2007 (UTC)

I have added a link to the introduction that should make that easier to find. —The preceding unsigned comment was added by Meggar (talk • contribs) 07:19, 23 January 2007 (UTC).

In case you did not get the answer you wanted, there are approximately 8 herpes viruses that infect human beings. Herpes zoster, when in chicken pox form, is called varicella zoster, is related to Herpes simplex. However, zoster is not an STD, it's only contagious when the skin is erupted, and has a different etiology. You should read the Herpesviridae for more information. Orangemarlin 23:27, 8 April 2007 (UTC)

Chickenpox

I am thinking chickenpox should be mentioned in the first paragraph due to the interconnection between the two. MDSNYDER 17:35, 31 March 2007 (UTC)

Done Orangemarlin 23:24, 8 April 2007 (UTC)

Herbal treatment

I added the paragraph on the herbal treatment in the treatment section. I have had patients get considerable relief from pain and the diminuition of lesions, which eventually retreated using Melissa officinalis (lemon balm) alone in strong infusion form. Ethanolic tinctures also helped, but not as much. I am not sure that the antiviral action is the only way that the herb helps, as I am familiar with the clinical use of the essential oil topically and the nonpolar compounds are not known to be antiviral. And a patient with recurrent shingles found significant relief, but as her immune system was compromised by cancer, it did recur, signifying that the herb was not systemically antiviral (or completely so). St. John's wort is also known to be of use in the treatment. Karen S Vaughan 20:03, 14 May 2007 (UTC)

This is a medical article. If you have verified and peer-reviewed references, please give them. See WP:VERIFY. In addition, personal observation is considered a violation of own research guidelines of Wikipedia. Orangemarlin 20:11, 14 May 2007 (UTC)

I reverted all of these edits. The articles described very limited success, have not been repeated by reputable researchers, and actually did not refer to zoster. It is amazing that the Dimitrova article in Acta Microbiolgica Bulgaria has been repeated ad nauseum by the naturalist industry, but no current peer-reviewed article has been written about Melissa officinalis effects on any of the Herpes-type viruses. Let's stick with science and medicine in this article and leave the New Age herbal stuff to the Homeopathy article. Orangemarlin 00:40, 15 May 2007 (UTC)

If you can't tell the difference between botanical medicine, which accounts for 85% of medicine worldwide and homeopathy which deals with immaterial doses, you aren't competent to revert the edits. The Germans have been using Melissa officinalis topically for years. When medicines are used for years effectively it matters not a whit that no one has paid for double-blind placebo controlled studies. They don't exist for bypass operations either, or for that matter for the use of parachutes. Just because American doctors are undereducated in botanical medicine doesn't make it invalid. KSVaughan2 03:02, 3 June 2007 (UTC)

Please refrain from personal attacks and being uncivil. Homeopathy is considered a pseudoscience. There are no verifiable references that I could find for herbal treatments of Herpes zoster. Orangemarlin 03:37, 3 June 2007 (UTC)

I had no references whatsoever to homeopathy. All references to botanical medicine were dealing with material dosages. A 70:1 extract is hardly homeopathic. And the only reference to my own clinical experience was in the talk section, not the article itself. You certainly haven't looked very far for herbal treatments if you cannot find them.KSVaughan2 05:40, 3 June 2007 (UTC)

Please refer to WP:CITET when creating references within this article. This format allows for easier access to the articles by id links, standard formatting of citations, and allows for easier editing of references. In addition, I reverted sentences with sources that did not meet the standards of both WP:VERIFY or reliable sources. In addition, fringe theories are not allowed according to Wikipedia standards for verified sources. I retained all statements that utilized reliable sources from acceptable medical and scientific research journals which were primary sources. However, there were two instances where you cut and pasted directly from the reference, in violation of copyright rules. The sentences should have been reverted, but I thought they added to the article. What remains is not Homeopathy and does qualify as acceptable and clearly referenced medical science. Orangemarlin 06:17, 3 June 2007 (UTC)

Orangemarlin, there never was a reference to Homeopathy and I consider your repeated labels to be either poorly informed or a personal attack. An herb is not a homeopathic remedy (any more than a vitamin is):

Homeopathic formulas are based on the theory that even when a remedy is diluted with water to the point where no starting material remains, the water will retain a "memory" of what it was once in contact with. Homeopaths assert that the therapeutic potency of a remedy can be increased by serial dilution combined with succussion, or vigorous shaking. This dilution is often repeated such that there is no active molecule present in the solution. (Wikipedia article on Homeopathy)

All discussion of Melissa officinalis, and other herbs are dealing with substantial medicinal dosages as are used by the majority of doctors outside of the United States. They are not fringe theories because they deal with substantial botanical medicine treatments, which have been in clinical use for centuries and continue to be used clinically with success. It is true that the expensive double blind tests are not always available on substances that cannot be patented- who would expend money on such without a possibility of return? However this is also true of perhaps a majority of medical procedures and all but the most current medicines of the 20th and 21st centuries. Melissa has been used medicinally since the time of Galen. And a 70:1 superconcentration of the extract marketed by a reputable German pharmaceutical company is the anthesis of homeopathy where perhaps a 1:90 ("90x") dilution (with succussion) might be used. And while I know of substantial clinical use of the herbs cited for shingles, I know of no effective homeopathics. My degree is in (high dose) botanical medicine.

(FYI, the homeopaths of the 19th century frequently made use of mother tinctures which were material medicine, and often in large doses that seem to go against their theories. And their provings involved taking overdoses of substances on the theory that the symptoms of the overdose would show what the diluted substance would cure. A questionable theory, but one that did yield some useful case reports on high dose effects.)

It is a pity that doctors in the United States do not have the opportunity to study botanical medicine, which is required for doctors in Germany and other European countries because it leaves them with a level of ignorance about the primary forms of medicine used worldwide. It also prevents them from using some very useful medicines that were in wide use when my father was doing hospital rounds before Penicillin and which will be increasingly important as we enter a post-antibiotic age. (Did you know that a number of herbs contain Multiple Drug Resistance Pump Inhibitors?) In removing references to botanical treatments, you have removed significant information that

1. appeared in peer-reviewed journals of botanical medicine
2. can be helpful in pointing towards new areas of research
3. refers to clinical use common in the world medical community and disregards its observation
4. can be used by people with backgrounds in clinical botanical medicine to alleviate the suffering of herpes zoster

That is contrary to the spirit of Wikipedia. KSVaughan2 02:04, 5 June 2007 (UTC)

1. Peer-reviewed? Not that I could tell. They were in secondary sources, or you actually misinterpreted the findings.
2. I'm not certain that the purpose of Wikipedia should be to direct research in any way. I'll let the great science and medical researchers figure that out.
3. Common where?
4. Not proven, and original research isn't acceptable.
5. Contrary to whose spirit of Wikipedia?

Homeopathy is considered pseudoscience, plain and simple. Every single article I read, except for some of the junk science ones that were provided by you, made no claim that shingles could be cured by herbs or vitamins. In every case, there was some, and that was rare, evidence that it might give a positive effect to anti-viral medication. But in no case was there any significant finding, either statistically or by observation, that anything but antivirals worked. In fact, not immediately treating zoster with an approved anti-viral could lead to serious neuralgia, blindness, or other debilitation. The standard of medical care is antivirals. To state anything otherwise, unless it is to clearly state that in some very rare cases, antiviral treatments could be improved. And please quit making negative characterizations about US physicians, of which I am one. I don't know of single doctor that wouldn't try anything to save a life of a patient. But when there is a perfectly acceptable treatment for zoster, I'm not going to prescribe lemon grass. Also, I'm frankly tired of your pro-German medical commentary. Let me speak to some of my uncles and aunts about German health care--oh that's right, the SS medical officers killed them accidentally while testing some herbs on them. Orangemarlin 06:01, 5 June 2007 (UTC)

Define homeopathy. Don't tell me it is pseudoscience, just define it because I see no evidence that you can tell it from botanical medicine or vitamins, which anyone with a modicum of medical education ought to be able to do. (And don't be racist about German medicine unless you have peer reviewed evidence that the SS tested herbs on anyone.) The standard of treatment in the first 72 hours may be antivirals but there is plenty that can be done for people who miss that window. KSVaughan2 06:44, 5 June 2007 (UTC)

A note to Orangemarlin: KSVaughn is correct in that you do not know what homeopathy is. If you did, you would not characterize herbal treament as homeopathy. I think, even though you may be quoting Wikipedia guidelines as you understand them, KSVaughn at least wants the courtesy of correctly identifying the branch of medicine she is using: herbology, not homeopathy.

Anyway, as it is, I think it's nice this info about melissa officinalis is on the talk page. I'm going through a painful bout of shingles and I appreciate the information. Softlavender (talk) 10:59, 11 December 2007 (UTC)

Other Treatments

There is a comment in 'hyperhealth pro 6.0' used by medical practitioners to the effect that,Vitamin B12 may help to alleviate the pain associated with shingles and in particular Postherpetic Neuralgia, and is linked to references. I do not have access to this site only a print out, does anyone know the references involved so this can be added to the text? Also understand that N3 fatty acids such as fishoil capsules and/or flaxseed oil also reduce the pain. Plenty of references on pain reduction in other conditions, anyone got one for shingles?Jagra 06:03, 26 May 2007 (UTC)

Medical practitioners where? Who? References? Orangemarlin 06:46, 26 May 2007 (UTC)

Hyperhealth is a database that practitioners may subscribe to, my only reference is a printout from a licensed general practitioner (doctor) and so i dont have access to the imbedded references in the document, hence my querry before adding to the text of this site.Jagra02:22, 27 May 2007 (UTC)

It makes some sense as the elderly are susceptable to shingles and cyancobalamin B12 insufficency or deficiency occurs more in the elderly, which can lead to subacute combined degeneration of spinal cord and associated PNS symptoms likely to involve ganglions? also see (www.emedicine.com/neuro/topic439.htm) , up to 21% of geriatrics may be deficient, Apart from this specific condition "how lack of vitamin b12 damages nerves is not clear. It is thought that lack of this vitamin causes an abnormal formation of fatty acids, which are used to build cell membranes and nerve myelin sheathes" This article also suggests that in addition to structual changes of B12 deficiency functional effects on neurotransmitter synthesis and neuronal conduction may occur. which could involve postherpetic neuralgia, hence my interest in the aforementioned ref. b12 supplementation can reverse such symptoms of deficiency. Omega-3 fatty acids play a role in the fortification of myelin sheathes and reduce pain caused by inflammation, see the wP sites for ref's.Jagra Jagra 03:24, 27 May 2007 (UTC)

You cannot relate one disease state, that is due to a vitamin deficiency, to another disease state that is caused by a virus. Elderly patients may have weakened immune systems, but I doubt B12 is causal. This isn't science, it's the realm of homeopathy and GNC products. Orangemarlin 05:03, 27 May 2007 (UTC)

I'm afraid you are the one that has not researched the scientific literature, for there is much evidence for the use of Vitamin therapy in Shingles, Remember we are not discussing which therapy is best but whether Vitamin B12 has any place in Shingles treatment.

There are many places even in western countries where diagnosis and treatment within 72 hrs is problematic, including remote areas of Australia and Canada, probably not in the US? Remember that Wikipeadia is not just for city livers but is meant to be universal. What about those that do not get diagnosis within 72hrs, even city dwellers if they do not know the urgency can miss out, what then? Some countries will not allow scipts for antivirals after 72 hrs, because there is no reliable evidence for effectiveness after 72 hrs for antivirals, what about them?

I suggest that previous treatments used before antivirals are then the best option, and B12 treatment is right up there. AS such i think it deserves a place in this article. If you are unable to do the research, (i suggest you start with pubmed), I will post at least 16 references from the medical science literature from a dozen countries over 50 years up to 1998, supporting Vit B12 as a treatment. It has the advantage in such circumstances as likely addressing the damage and even possibly addressing the precipitating cause for viral outbreak (as discussed above) which antivirals do not. What references and evidence do you have to support 'weakened immune system' as the major cause of shingles in the elderly, or is that just supersition? There is even argunent for combination therapy but so far the research has not been done, no extra return for drug companies ?

Hardly the relm of homeopathy as you claim, so i suggest we stick to the science and not make snide remarks befitting a one eyed drug salesman! Jagra 07:07, 30 May 2007 (UTC)

Put the references here, and we'll see, I'm open to any new ideas. Antivirals work, but need to be used with 2-3 days. Your suggestion would have someone trying some magic potion which, if it worked, we would know about it by now. And by delaying the use of antivirals, there is potential of serious scarring, pain, and blindness. And in the case where diagnosis and treatment is not available, you don't think that attempting the antivirals makes sense? Vitamin B-12 is going to work instead? I think I'll risk making the pharmaceutical company slightly more wealthy to save a patient.. Homeopathy does not save patients. Your uncivil remarks ("befitting a one-eyed drug salesman") does not indicate your willingness to accept science, instead of unverified claims. By the way, if you're posting references, please make certain they are from bonafide peer-reviewed journals. Orangemarlin 08:55, 30 May 2007 (UTC)

I suggest you read my comments more carefully and not try to put words into my mouth or jump to innappropriate conclusions! I went to some length to spell out circumstances where B12 treatment might be appropriate, viz after 72 hrs when commencing antivirals is ineffective,or in conjuction with antivirals. Particually in countries where the health authorities will not approve practitioners prescribing them after 72 hrs and where prior authorization is needed for any antiviral script(perhaps you would risk jail also?) do you really think antivirals will be readily available in remote locations when practitioner diagnosis is not? At no time have I suggested Vitamins instead of antivirals within 72 hrs when antivirals are available. I repeat there is a place for other treatments in this condition. your assumption that I do not accept science is also out of line, again read my comments,

This is also the age of complimentary medicine and many practicing GP's offer this knowing their patients expect it, at least in Europe, UK, and Australia and hyperhealth is one database used by such practitioners that uses published science references. I AM PLEASED TO POST REFERENCES BUT HOW ABOUT YOU DO LIKEWISE? I am still waiting for your refs that 'weakened immune systems' are the primary cause of shingles in the aged, and please remember, evidence not opinion regardless of journal bonifides. Jagra 10:39, 30 May 2007 (UTC)

References are already in the article. I am not asking to place a change in the article, so my inclination to post references is nil. Once again, you accuse me of some pretty nasty stuff. I've already asked you to read rules of civility and now I'm going to ask you to read sections on assuming good faith and refraining from personal attacks. And if antivirals are not useful or are not indicated, there is little that can be done. At that point I would use unverified and unproven remedies, but only to let the patient try something, knowing if anything happened positive, it was random rather as a result of the homeopathic remedy. Once again, since I don't have time to be reading up on how pyramids or crystals help people, please place some references from refereed and peer-reviewed journals. I do not own this article, so if you want to create a section on unproven, homeopathic remedies that have some obscure references and some potential, then be my guest. If the references are secondary, non peer-reviewed, or from a naturalistic, holistic or homeopathic magazine, I will remove it. Here is what bothers me about what you are proposing--I think medical patients in Europe are odd (they smoke like crazy and go to their physician asking for some vitamin therapy for heart disease), I think physicians in Europe are odd (they actually go along with this hooey), and I think Wikipedia, being the first place people run to these days, does a disservice to patients when they come here, read that Vitamin B12 plus a good crystal, will alleviate their shingles. Today with advanced medicines available, a patient should head to their doctor seconds after symptoms appear and get antivirals. Outside of trekking in the Amazon, or some other strange place, there should be no one in the civilized world who's more than 1 hour from medical care.Orangemarlin 15:03, 30 May 2007 (UTC)

You continue to try and associate my comments with homeophathy, crystals, pyramids and majic potions, which i consider a personal attack, despite my request that you stick to the science, so i will ignore your idiosynchrasies.

You claim that the evidence for your assertation that 'weakened immune resposes' is the major cause of shingles in the aged, is to be found in the references for the Article, however I have reread these together with many of the links and can find no such evidence, there is plenty of opinion but no evidence. As such the statement is at best an Hypothesis. The section on Causes should say as much, and allow for other hypothesis, and I will correct this. Even the latest International Guidelines to be released in June 2007 say "THe cellular and immunological events that lead to reactivation are poorly understood" Ref (12) of the Article says in population studies that "Immunosuppressive conditions had little impact on overall incidence"

So that without any further references to evidence posted by you, means that other hypotheses are equally valid even if not popular, such is science, Having spent my available time checking out your rerferences I will post mine in the near future. Never been to the Amazon but have often been more than 72 hrs from medical help in the first world and I suspect others in the 2nd and third world with access to Wikipeadia would be also, and deserve a more general approach.Jagra 09:43, 31 May 2007 (UTC)

If you have references, then please, throw in a sentence. But I don't want to give it undue weight, because I've seen it too many times. People see some bogus article, and think that it indicates they can cure cancer by eating pomegranites or something. Orangemarlin 19:55, 31 May 2007 (UTC)

I'm sorry, but I read the references again, and they clearly state that persons over 50-55 begin to show suppression of the immune system. I don't see where you're going with that particular thought. Orangemarlin 00:25, 1 June 2007 (UTC)

People may have weakened immune response and also get shingles it does not necessarily mean A causes B and as I said above there is yet no evidence for the statement, it could be mere coincidence. Just as likely the aged have Vitamin B 12 deficiency (21% do, see emedicine site above) which damages nerves and the spinal cord, and get shingles another coincidence?. You seem to want to pick between coincidences based on current opinions not evidence. Until the evidence is in(double blind controlled studies and all) you cannot dismiss other hypotheses. It may well turn out to be a combination of both the above?

If you go to Pubmed, and enter Herpes Zoster and Vitamin B you will find 80 or so Peer Reveiwed articles, over 50 years, in many countries ,implicating Vitamin B 12 in the condition, such a bevee of work is not easily dismissed accept with evidence, opinions no matter how credible or recent do not count, over other opinions until the evidence is clear. There is no evidence yet for how Zoster is reactivated, thats where I am going. If need be I will list all 80 ref's in the article but that should not be necessary. Instead I will add a small section shortly.

Jagra 05:47, 4 June 2007 (UTC)

<reduced indent>I don't think arguing with you about these issues helps in making this a better article. I did do a pubmed search, and here's what I found: it is clear that vitamins and other micronutrients are necessary for a strong immune system. I bet I learned that in Physiology 101 when I was getting my bachelor's degree. And a strong immune system may do prevent any number of diseases. For example, I rarely get a cold because I believe in eating a wide range of fruit and vegetables with appropriate supplements. But I don't know that for sure (and certainly I'm not going to begin eating chocolate ice cream and french fries every day). It's also well known that elderly patients have poorer diets than the general populations (other than teenagers), so of course supplementing the diet is going to help their resistance to zoster and lots of other diseases. I could not find any evidence that B12 itself would have any beneficial effect on a patient suffering from zoster, although I will admit to not reading every article. In fact one article here seem to indicate the contrary, although I had a difficult time following the logic. Does B12 enhance the effect of certain anti-virals? Yes, it appears so. Does it work alone? No. In fact, going back to your original argument that someone may be 3 days away from getting the drug, I don't think B12 will do much at all, unless their immune system is compromised by poor nutrition. Moreover, I don't think that vitamin/micronutrients are notable for zoster alone, but probably belongs in an article that discusses nutritional effects on general viral load. As for zoster reactivation, no they don't know why, and because of that fact, it's really hard to design an experiment that would show prevention. Orangemarlin 01:28, 5 June 2007 (UTC)

This is all getting very personal, folks, especially now we're on to the SS etc. Could it not be resolved by allowing reference(s) to natural/herbal/homeopathic/pseudoscience which clearly indicates that the reference is indeed to such & contains appropriate cross-references to the discussion regarding those areas, as has indeed been done in this discussion via fringe theories etc? I've used Wikipedia a lot but never before felt the justification to contribute, so apologies if this contribution is poor. I'll read up on the guidelines.

Done and done, some tidying up of the Treatment section may now be in order with other paragraphs moved to the new subsection? Jagra 23:42, 6 June 2007 (UTC)

You need to review the undue weight statements for a neutral point of view. I am convinced that B12 has a somewhat synergistic effect, much of your other edits gave undue weight to animal studies, to secondary and tertiary reviews, and to speculative statements. A quick scan of published articles on "treatment" of zoster shows that 95% of articles discuss standard and typical antiviral treatments. Less than 5% including anything beyond that, and even there it is complementary. This article cannot spend paragraphs giving weight to non-standard treatments. However, I do agree that it needed mention. In addition, this is an English Wikipedia and as such references must be in English, unless there is an authoritative translation into English. Good job on your edits. Orangemarlin 03:01, 7 June 2007 (UTC)

Whilst your reverting my edit was provocative of you to say the least, I am prepared to look at your ‘logic’.

1.Yes the language of this version of wiki is English Language,The core policy of wiki in regard to citing references verifiability says, that quoting of English language sources is preferred but not absolutely mandated as you imply. Only if there is an alternative English source of equal quality is that so. In my edit I referenced foreign sources to indicate extent of usage (including India in English ) and more recent publication on the subject in Europe, only where there was no English source of that date or later, your correct response to this should have been to cite a better reference if you have one not to revert.! Other cases where I have cited foreign sources are where there are no equivalent English sources or to support such quoted English sources. If we are trying to be economic I can remove some double references in this vein, more appropriate to journal papers I write.

2. English Language is spoken by about 1 billion people world wide either as a primary or second language, and this is the potential audience of this version. It includes countries such as India, Pakistan, Sth Africa, Nigeria, and Jamaica. In fact more people speak English in India than any other country, the second highest is China. In my country a course of antivirals for shingles costs about us$200.00 how many people in the English speaking world have access to or can afford such treatment? A minority at best. At the moment the Article in my point of view gives undue weight to treatments that are not accessible to the majority of potential readers. A more neutral point of view is needed where other views are given adequate expression, and you display bias particularly relating to class (favouring one particular social class and ignoring others) by seeking to reduce another point of view, more relevant to another majority group of English speakers.

3. Animal studies? can find only one that includes an animal model of herpes, so I will replace that with another reference, if you insist.

4. I too have done a search of Pubmed and find there are 5,566 peer reviewed papers on Herpes Zoster and Treatment, but only 1,309 of these involve antivirals, that’s about 23 %. of the published literature, not the 95% you claim from a ‘quick scan’? Leaving plenty of space in the Article for Other Treatments without Undue weight being invoked, or even a consideration. So far there is about 12 lines on antivirals in the Article some in Prominent Position, which could be disputed. Leaving that aside for now, that means about 40 lines for Other Treatments, of which we have 14 lines after your reverting. A clear imbalance that I will address. There are also 4 lines on pain management drugs, meaning another 12 lines for alternatives, for a total of 38 lines, for me to address as of now. My original edit that you reverted had about 29 lines, so not undue weight at all.

5. Your point of view is now that you think Vitamin B12 has a synergistic treatment effect, I think that it has separate effect. ‘For the virus to reactivate it has to move from the cytoplasm of the (nerve) cell to the nucleus’ in the words of the international herpes management forum (http://www.ihmf.org/guidelines/latest.asp) also it is known that many of the physiological effects of cobalamin occur in the cytoplasm, see (http://www.emedicine.com/neuro/topic439.htm) this is the area where future research may determine the matter. Until then my point of veiw is as valid as yours, and both need to be given room in the article.

6. My approach to my edit however was one of Complementary medicine rather than Alternative medicine trying to give a neutral point of veiw citing comparision studies of different treatments, giving due weight to the results, so individuals can see the difference, these are not synergist trials. However I also included combination trials where synergism may occur I deliberatly did not make a wholely alternative edit, (I know there is confusion on the meaning of these terms, particuly in the US) my distiction, confirmed on the wiki site, is that complementary medicine may be prescribed by medical practitioners, often in combination with drugs, but alternative medicine would not be so prescribed. Perhaps you have confused the terms! or is your preference and intention for me to make the case for an alternative medicine edit? The refernces that I cited showed vitamin b12 being used in a complementary way. I also titled the subsection Complementary not Alternative deliberately. Complementary medicine is now much practised in the English speaking world, and deserves a separate mention, the section can be prefaced if need be.Jagra 05:31, 8 June 2007 (UTC)

I have moved some para's to the Prevention subsection and added a Complementary subsection for reasons given above. Also could not find in the ref's you cite support for your words "although it has little effect by itself", so have removed them and will add ref's to contradict your opinion so expressed. Also breakfast cereals are not fortified with B12 in otherparts of the world, so have removed these words also.Jagra 07:19, 8 June 2007 (UTC)

<reduced indent> What are you talking about? Do you even read these articles. The Dehara article states that ONE patient was given continuous cervical epidural block, intravenous infusion of acyclovir for five days, and oral paramethasone and Vitamin B12. That's a pretty powerful cocktail of medications and pain killers, and the Vitamin B12 had no relevance. The second article was a review article, which would be considered a secondary source, which I will revert. I'm tired of this. You are pushing your POV for some odd and unproven medical strategy. Please read WP:NPOV. There is absolutely no evidence that I can find that proves your point. I'm leaving some of it, because there is some indication that it can be helpful with antivirals, but that's all. It cures nothing. And as for cereal, does it matter? In many countries breakfast cereals are fortified with all essential vitamins and minerals. Orangemarlin 07:38, 8 June 2007 (UTC)

Moved your edits to a section for natural treatment. Do not add to it so that undue weight is not given to non standard medical practice.Orangemarlin 07:31, 8 June 2007 (UTC)

Notice you have removed my edits without discussion and so i will do likewise in future and reinstate adinfinitum unless you discuss and not dismiss arrogantly. Your comments about pseudoscience are laughable given most of the references are peer reveiwed , just not your peers!! ie scientists. Your bias shows again.Jagra 05:00, 17 June 2007 (UTC)

I am sure that the editors of the journal 'Herpes' the official magazine of the International Herpes Management Forum, whose latest guidelines I have quoted, together with articles from the Journal of the American Osteopathic Association and Arch Intern Med and British Jounal of Nursing and Holistic Nursing Practice among others could hardly be accussed of publishing pseudo science. But you dismiss them all with a zest for official recognition. Just what is a GA and why are you trying to suppress other contributions, that offer different perspectives? It seems there is not much evidence for the "Other Drugs' mainly opinions, see above discussion. Also at present undue weight is given to this catergory, see my discussion above re undue weight and need for more balance in this article, it is far from finished. Jagra 05:40, 17 June 2007 (UTC)

<reduce indent> GA He means the article has been upgraded to, well, a Good article, and is ready more or less, for consideration as a featured article. I really fail to see what your problem is, the vitamin treatment is listed under prevention, where it belongs. When you can produce a peer reviewed, scientific study, showing that any of these complimentary treatments are more effective, as effective, nearly as effective ( or hell, effective at all) as a course of antivirals, then maybe there would be something to talk about, but since you haven't, there isn't. I'm gonna quote OM here "delaying the use of antivirals, there is potential of serious scarring, pain, and blindness" just in case you missed it the first time. This isn't an ideological dispute, between "eastern" and "western" medicine, or "natural" and "unnatural" medicines, it's a matter of informing people about the proper treatment for this condition. ornis 06:24, 17 June 2007 (UTC)

I think I need to assist Jagra in understanding science and the scientific method. The scientific method utilizes research to test a hypothesis. You continue to take one small comment out of context in the whole of the material and try to prove your point. I left in one sentence of what you wrote (after cleaning it up and making it readable to an English reader), because the weight of several paragraphs is greater than the worth of what you are insisting is science. You are representing fringe theories and those of us who believe that individuals reading this article deserve accurate and well-researched science will continue to revert your highly POV and frankly, dangerous, edits. I would suggest that there are articles where your edits will be welcomed, including Homeopathy, Herbalism and other pseudoscience articles. If you can provide one study that tests your herbs and vitamins in a repeated, large-scale, randomized, double-blind study, please go for it, and I'll be more than happy to work with you. But everything I've read that you keep posting indicates that you are quote-mining for something that supports your POV. It won't fly.Orangemarlin 06:26, 17 June 2007 (UTC)

Here you go again, throwing mud instead of discussing the facts. Perhaps you should study Jungian psychology to understand your problem, not mine! You don't need to teach me about scientific method i,m at least qualified in it! Qouting an authorative scource who,s papers reference the literature, such as the International Herpes management forum is acceeptable in science articles (not papers) and this is not a paper! Perhaps you have never published elsewhere! What I am demonstrating is that many of your 'other drugs' are also not studied in the condition to the level that you ask of complimentary treatments. Double standards if I have ever seen it. It won't fly, and that's not but my opinion see my editsJagra 08:06, 17 June 2007 (UTC)

Jung? I think perhaps you should study Skinner. As for the rest of your post I really can't make heads nor tails of it. ornis 08:17, 17 June 2007 (UTC)

No I really did mean Jungian Psychology and Gestalt for good measure, where what you accuse others of is often your own failing, as demonstrated here above!!Jagra 03:47, 18 June 2007 (UTC)

I believe that I was once again attacked personally by Jagra. Of course, I cannot make sense of what he is writing, so I'll ignore it. Orangemarlin 14:48, 17 June 2007 (UTC)

Well I'm sure you will understand this!I have reviewed your referencing for the ‘Other Drugs’ section in accordance with the standards you ask of complementary contributions. I have found your referencing abysmal!

For instance I found;

foreign language reference,

case report only reference,

Studies where the number of patients could not be statistically significant

Open trial studies

Opinion articles with no citing of primary references

Review articles

Studies not repeated or large scale

The primary refs for other drugs cites review articles not primary sources, and these are well out of date, interestingly it mentions other sources as the International herpes management forum for updates, That is precisely what my edit did and so I have reinstated it, it is the full paragraph and is one of five of their major statements and recommendations, with a cat 3 clasification. The only thing this is out of context with is your out of date opinions POV.

On the basis of your own criteria the ‘Other Drugs‘ section should be reverted, however instead I accept the same criteria as you have used, a case of “do as I do, not what I say” and will reinstate the relevant edits.Jagra 03:47, 18 June 2007 (UTC)

Break

<r-indet> Alright bear with me, while I go through these inclusions. “Antiviral drugs are useful (for herpes zoster) but have a limited effect on post-herpetic neuralgia prevention.”

For one this is not a quote from either of the source you cite, which in any case bear out the statements of the "Antiviral" section, while concluding that PHN is still poorly understood, and further research is needed, particularly on patients over 50.

“There is only limited clinical evidence to support the use of aspirin, acetaminophen/paracetamol, non-steroidal anti-inflammatory drugs, NSAIDs), opioid analgesics (including tramadol), tricyclic antidepressants (especially nortriptyline), gabapentin and pregabalin in the pharmacologic management of acute pain in herpes zoster “ “

Again, not a quote from either of the sources. And in any case, the second, while notionally supporting the "..limited clinical evidence.." statement, puts this down to a lack of suitably large scale trials. ornis 05:43, 18 June 2007 (UTC)

Are you suggesting that Jagra is cherry-picking, misrepresenting sources, engaging in OR and synthesis? How horrible!  ;) &#0149;Jim62sch&#0149; 16:45, 18 June 2007 (UTC)

Yes well, just wanted to make sure, you know. ornis 00:29, 19 June 2007 (UTC)

Fair cop, try now. If the trials are not done then there is only 'limited evidence'!Jagra 04:18, 20 June 2007 (UTC)

I note that you have again, for the second time referred to my edits, as Homeopathy, and Pseudo-science, at least you dropped the crystals and pyramids accusation of last time (see above). As I told you then my work contains no such subjects or citing, and I consider your constant accusations as personal attack. You have made similar accusations against others also unjustifiably. (see Herbal Treatment item above). I agree with KS Vaughan (Herbal Treatment) in that you seem to have great difficulty in differentiating between Biological medicine/science and Pseudo science. Also you seem not to understand the difference between an Article and a scientific Paper. So I will attempt to teach you, an article in a say a medical science publication would be an Editorial, Letter to the Editor, or Invited Article. A scientific paper is what journals publish as Content. This Wiki Page is called an Article for good reason, it is not a science paper per se. but an open invited Article. Different rules apply to the drafting of papers and articles, if you have any doubts, ask your favourite journal for their rules. You are trying to apply a standard on others that is both inappropriate for an Article and which you yourself do not adhere to in your own edits. double standards see above previous comments.

I have also noted that having reached a stand-off consensus with KS Vaughan 5/6/07 that you have over time reverted half of her edits, without even any further discussion. I am sure that Wiki would not approve of such tactics, of slow war! All of my citing is and will be to Peer reviewed papers or quotations from acknowledged authorities or experts, up to date on the subject. It seems that you want to choose between publications that others cite, as to those which merit your approval NPOV. You should also be aware that the primary sources in the references you cite in other drugs section are largely out of date by about a decade. That is why I have included authorative quotations from the latest 2007 IHMF recommendations. They may disagree with your own citing but that is not reason to revert them, cross referencing might be, thanks fellows, but you doing so again will give the impression of both Bias and NPOV. Rather readers are entitled to be aware of different opinions. These quotations are form recommendations with the following quality. “Consistent evidence from controlled clinical trials. For example, for an antiviral this would include results from at least one well-designed, randomized, clinical trial, and, in the case of laboratory studies, consistent evidence from comparative studies” and “Evidence from opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees”. For all of the reasons above I have re-instated them again.

You have also reverted citing of calls by other members of the medical profession, including the official magazine of British Nursing, Holistic nursing and foreign (to US) doctors, for Complimentary treatment in PHN. Reverted without explanation or reason, which once again gives rise to bias and NPOV on your part. It is clear from the discussions above that you personally do not accept complementary therapy and can’t distinguish it from alternative medicine. Once again it is not your place to pass judgement on other members of the medical profession, or to deny readers a more broader perspective, unless Wiki have a core policy against such treatment? Used sensibly it is not dangerous as you claim, you advocate and include details of multiple drugs that will be used in combination. Drug/CAM interactions are no different in risk than multiple drug/drug interactions, if applied by doctors in a Complimentary manner. But it could be dangerous on your part to revert and not include important drug effects in vulnerable populations, particularly one, B 12, in which you have already agreed has a synergistic effect in treatment. (see above discussion) I have reinstated the subsection for the above reasons. At this time I have yet to add specific CAM therapies and are prepared to discuss same but will be using citing standards that you use or accept elsewhere in this article.Jagra 04:29, 20 June 2007 (UTC)For clarification this was addressed to orangemartinJagra 01:14, 22 June 2007 (UTC)

I think you have me confused with someone else. And I'm not from the US, AND... you should read FAQ#Pseudoscience. As for your new source, well the first quote you pulled from it, was Category 3, "Evidence from opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees." viz, largely anecdotal. and the second one from the"Research Needed" category. So erm, what's you point? PHN is not well understood, and more research is needed. I call quote mining to prove a point. ornis 04:46, 20 June 2007 (UTC)

I believe that Jagra has reached the point of being disruptive. His tendentious editing to force his POV is no longer acceptable. Several editors have reverted what are plainly unverified and original research edits from Jagra. In attempt to reduce the weight given to these unproven and essentially useless therapies, an edit was made reducing it to one sentence, which had a verifiable reference. That's all it deserves.Orangemarlin 06:52, 20 June 2007 (UTC)

And let's be honest. This article is rated as a good article which means it was reviewed (along with edit history) and found to meet the criteria of a Good Article. It was also listed in the Medicine Portal, and is listed as a Good Article for WikiProject Microbiology, Wikiproject Medicine and WikiProject Viruses. It was found to be neutral and verifiable in each case. And I'm getting really tired of the anti-US bias of Jagra. Do I need to state the medical care level of the US? I can if you would like. We don't practice junk medicine in the US, and we certainly don't use Homeopathy or other fringe medicine. Orangemarlin 07:02, 20 June 2007 (UTC)

I will respect the Break you have now asked for whilst sensible dialogue occurs, not possible before butI suggest you look again Ornis the first qoute i made in 'other drugs' is catergory one and the second category three, as I described above, Cat 3 descriptive studies and reports of expert commitees are hardly heresay. My point is that no balance is given in the use of 'other drugs', (other than for analgesics) giving an expectation that they will be useful. Furthermore that the use of corticosteroids is missing and it has Cat 1 evidence. On top of this many of these drugs can have considerable 'side effects' in the population most likely affected, but no comment is made in the Article. The quotes I have made are the balanced, conservative statements and recommendations of an authorative organization, not my POV, as claimed by orangemartin, i am not trying to prove any point other than to get some balance in this article, neutral point of view at present much is insular.

In the antiviral section, the statement made is " Use of acylovir is most effective in moderating the progress of the symptoms, and in preventing post-herpetic neuralgia" an over the top unsupported statement POV!, when other expert opinion is that it is moderately effective in shingles, ( different to moderating symptoms) and has limited value in PHN, more research needed. and also that antiviral treatment only has a 'degree of efficacy' It is also only effective 'where available' and as outlined above in a minority of the English speaking world.I will post these edits here so you can have a close look!

Antivirals

“Current antiviral therapy for herpes zoster is moderately effective. Aciclovir, valaciclovir and famciclovir initiated within 72 h of rash onset reduce viral shedding, new lesion formation, time to lesion healing and time to pain resolution” “Current antiviral therapies provide a degree of efficacy against varicella infection and herpes zoster,”

Where available “Antiviral drugs are useful (for herpes zoster) but have a limited effect on post-herpetic neuralgia prevention.”

Other Drugs

“Antiviral therapy, oral corticosteroids and neural blockade are appropriate in the pharmacologic management of acute pain in herpes zoster”, “There is only limited clinical evidence to support the use of aspirin, acetaminophen/paracetamol, non-steroidal anti-inflammatory drugs, NSAIDs), opioid analgesics (including tramadol), tricyclic antidepressants (especially nortriptyline), gabapentin and pregabalin in the pharmacologic management of acute pain in herpes zoster “ It should be noted that drugs such as corticosteroids, anticonvulsants, and H2 blockers such as cimetadine that may be used in PHN may interfere with the bioavailability of vitamin B 12. in at risk populations such as the aged, who should be monitored accordingly.>“Medications are available to ameliorate the pain of PHN, but data suggest that these agents provide incomplete pain relief and their use is often accompanied by troubling side effects, especially in the population with whom they are most often used” (the aged and immuno-compromised). —Preceding unsigned comment added by Jagra (talk • contribs) 16:49, June 20, 2007

You have also reverted the COmplimentary Therapy edit of mine but make no discussion regarding this. So I first have to ask you are you also against complementary therapy in medicine? or do you not like the last edit on this section for other reasons?. Need a response if I am expected to Break.Jagra 01:21, 21 June 2007 (UTC)

I am not against anything. I am for sourced and accurate references that prove safety and efficacy. Your edits quote mine without actually reading them, because if you did, in almost every case, the articles do not support what you state. And finally, Therapies do not "compliment" anything. The word is complementary. Orangemarlin 01:25, 21 June 2007 (UTC)

Seems a number of people are having trouble reading and understanding the 'evidence' so to make it easier, as i am still waiting ornis response to above, here is more about your edits, see if I read these properly! Jagra 01:12, 22 June 2007 (UTC)

<reduce indent> The current text supporting reference (ref 7 the BMJ article), merely says of antivirals ‘should reduce likelihood of PHN’ “should’ equates with ‘may’ not ‘will’. This is not support for the current statement " Use of acylovir is most effective in moderating the progress of the symptoms, and in preventing post-herpetic neuralgia", which can be read as, “--- acyclovir is most effective --------- in preventing post-herpetic neuralgia”! Pure POV Furthermore the current reference says in a text box “Recent guidelines with supporting evidence and further information” and gives the IHMF website and guidelines that I have already quoted from as Statements and Recommendations ( You should consider these as the conclusions of a well developed paper extensively referenced, and under the imprimatur of the IHMFs Current Guidelines.as Editors of the prestigious journal Herpes)These further contradicts the current statement as does the meta-analysis paper from prestigious journal Pain the official journal of the World Institute of Pain that I cite, the concluding paragraph of which says, “There is limited evidence that current interventions prevent or shorten PHN.” and for good measure so does the most recent paper on the subject also cited concludes. “Although antiviral agents are appropriate for acute HZ, and the use of neural blockade and sympathetic blockade may be helpful in reducing pain in selected patients with HZ, there is little evidence that these interventions will reduce the likelihood of developing PHN.” Quote mining hardly, just presenting the evidence so it will be read, hopefully.

The current article statement needs to be altered and I propose the following; “Where they can be accessed and in time, antiviral drugs such as acyclovir are the treatment of choice, with most evidence for ameliorating the progress of symptoms in shingles (herpes zoster), and may have a limited effect on the development of post herpetic neuralgia (PHN).”

OTHER DRUGS Cimetidine, the support references are a bit wonky, one is a foreign language paper, another a single case study, and the other is a small study with cohort size too small for statistical significance, and the authors admit it is a very small sample and the results only suggestive. The next reference has only 12 healthy participants. Hardly evidence, borders on original research but it sets the standard for this Article that I am happy to work with it, but put it at the bottom. All of this takes 8 lines, a useful precedent.

This section lacks clarity on the general ineffectiveness of drugs in treating PHN and the high probability of serious ‘side effects’ from such drugs in the aged. Also explanation as to why some Cat 1 treatments have been left out? Would you like me to draft something more appropriate?Jagra 01:12, 22 June 2007 (UTC)

Your tendentious editing and accusatory tone here is not worth much more trouble. Please stop your POV warring, because frankly it is wearing thin. I don't care about Cimetidine, so I'll delete if that makes you happy. Might I suggest you spend time with the Homeopathy or Naturopathy articles, where your editing will be appreciated.Orangemarlin 01:50, 22 June 2007 (UTC)

Orangemartin I did read your ref,s, see my comments of 18 june, By posting these and the Quotes I had hoped you would read them and clean up your edits, however it seems I need to explain in detail to be understood! and I do request that you cease the personal attackand read my references.Jagra 01:02, 23 June 2007 (UTC)

<reduce Indent> Lets now look closer then at your referencing in the “Other Drugs” section.

Another break to deal with tendentious comments

Of your ‘Other Drugs’ references, the first, is an opinion article in a consumer magazine, that gives no primary scource references, Your next ref 7, the BMJ article again, uses as its main ref, on this subject, ref 10, a 2003 paper PMID 12652389 however the current IHMF paper and recommendatios I have Quoted uses, their ref 25, a more recent consensus paper, Jan 2007 by the same authors and 20 others, including both of the authors of the BMJ article you cite, see PMID 17143845. that is much more conservative, and hence the IHMF recommendations, that I have Quoted are the most recent, based on current data, and consensus. Your last ref 5, grades the treatments in a Table with the following comments. Antidepressants and Gabapentin, ‘consistent good quality evidence’ Amitriptyline, lidocaine patch, capsicum and opioid, as ‘inconsistent and limited quality evidence’ What are we to make of such contradiction? Moreever its ref’s for these statements date from 1989, though to 2002, most in the mid 90’s. Once again it is not the current data.

Your references are out of date and superceeded by the IHMF recommendations as the the most current and authorative and reliable source. and moreover conservative, which is what Wiki readers deserve! Leaving your ref’s will only confuse readers, and one should be conservative in suggesting drugs. After all we are writing to possible patients, not just their doctors! The BMJ article also says ‘All these medications should be used with close monitoring as there are considerable risks in elderly patients” A warning we also should give. So with this in mind I have prepared an edit of the ‘Other Drugs’ section as follows;

OTHER DRUGS

“The long term complication of herpes zoster is, Post Herpetic Neuralgia which may cause persistent pain that lasts for years. Pain management is difficult and conventional treatment may be ineffective. Alternative agents to analgesics may be tried, by your doctor, including tricyclic antidepressants in small doses (particularly amitriptyline), anticonvulsants (e.g. gabapentin), oral corticosteroids, lidocaine patch, opiods and/or topical capsaicin. Intrathecal methylprednisolone may be used in selected patients with persistent pain. Over-the-counter topical anesthetics may reduce pain associated with the disease. However it should be realised there is only limited clinical evidence to support such use of aspirin, acetaminophen/paracetamol, non-steroidal anti-inflammatory drugs, ( NSAIDs), opioid analgesics (including tramadol), tricyclic antidepressants (especially nortriptyline), and anticonvulsants (gabapentin and pregabalin)” Medications are available to ameliorate the pain of PHN, but data suggests these agents provide incomplete pain relief and their use is often accompanied by troubling side effects, especially in the populations of the aged and immuno-compromised, who should be monitored closely.

Cimetidine etc, if you must!

It should also be noted that drugs such as corticosteroids, anticonvulsants, and H2 blockers such as cimetidine that may be used in PHN may interfere with the bioavailability of vitamin B 12, particularly at risk are the aged. in at risk populations such as the aged, who should be monitored accordingly.Jagra 01:02, 23 June 2007 (UTC)

Who cares about Vitamin B12 and this article. Would you stop! Your articles about Vitamin B12 have NOTHING to do with Herpes zoster. Once again, please take the edits to the B-12 article. They might have some interest there. But let's just make a comment about your obsession with B12. One takes the anti-viral for 7 days. Seven days!!! The cimetidine is used to reduce renal clearance of the antivirals. No one is going to die, the immune system is not going to suffer, nor is the world going to fall on anyone's head because Vitamin B-12 is not available to the body for 7 days. You have now spammed this page for over a week. Several editors have read your comments and dismissed them out of hand. I'm being nice and writing you back. But I'm honestly done. Orangemarlin 05:28, 23 June 2007 (UTC)

You also fail to point out that (amongst other things) the body stores years worth of B12, that H2 blockers only effect protein bound B12, nor of course any of the potential side effects of excess b12. As OM has pointed out all of this is better off in the B12 article, I fail to see what you hope to achieve by this slow edit war of yours. Honestly, it's getting tired. ornis 06:20, 23 June 2007 (UTC)

Thank you for the comments Ornis but really my Edits above in this Break have little to do with B12, rather to do with NPOV See 'A Vital Component; Good Research' and 'best and most reputable source'. Good science is about attention to detail and I object to the label Tendentious, which is synonomous with Bias and the use of the word here is another form of personal attack I'm happy to leave the B12 clause out if you must until i find more evidence relating deficiency to shingles. Although I dont agree it is not relevant in the elderly and really all I have recommended is monitoring! and as most B12 in the diet is protein bound, unless they are already on supplements, and likely being monitored or know they are not deficient . Lets get down to the other Edits made above and below, after a week, with lack of detail comment on everything else I assume is consensus, so on with it.Jagra

On reflection I consider the Cimetidine item should remain in the Article, after all I have been asking for inclusion of treatments that can be used when a person either can’t access antiviral drugs or miss the small time window. There does seem to be an historical reporting of its use in the literature, and others calls such as PMID 7907508. It matters little to me whether they are considered drugs or to my mind as complementary treatments.

Also worthy of this type of consideration is the use of digestive enzymes. There has been a large scale double blind, multi-center controlled study that showed promising results, reported in a foreign paper with English abstract PMID 7713467. With further clarification as to the type of trial reported in an English review article with details, PMID 16813460. The medical science explanation seems to be reduction of TGF-B overproduction in diseases chariterized by this, including shingles, and a controlled clinical study including H Z patients has demonstrated this effect of digestive enzymes, PMID 11561866.Jagra 01:58, 25 June 2007 (UTC)

COMPLEMENTARY THERAPIES

Digestive Enzymes, are available on script and in some over the counter preparations. Before the availability of antivirals, oral pancreatic enzyme therapy in shingles was used in some countries and later subjected to clinical and scientific research. A large scale multi-centre clinical study, using an oral preperation of such enzymes, has shown promising results. The results of another clinical study support the concept that oral enzyme therapy is beneficial in diseases characterized in part by TGF-beta overproduction that included shingles patients. TGF-B has also been found higher in instances of VZV Jagra 01:58, 25 June 2007 (UTC)

Vitamin C in large doses of 2,000 Mg every hour for several days will turn the herpes zoster attack around and force it's retreat. Stress can cause a temporary case of scurvy, aiding in the growth of the herpes virus.65.11.249.253 05:06, 31 July 2007 (UTC)Sleddi98@bellsouth.net

(The material in the rest of this section was added by 65.11.249.253 in the same edit [4] as above. PrimeHunter (talk) 23:28, 23 December 2007 (UTC))

Orthomolecular Medicine News Service, June 15, 2005 SHINGLES [Herpes Zoster] TREATMENT THAT WORKS

OMNS - Shingles can be cleared up by using a safe, convenient, inexpensive, nonprescription treatment of vitamin C. Vitamin C is anti-viral and anti-toxin and inactivates the virus that causes shingles. If you have shingles and want relief, you can try this:

Go to a discount store and buy a large bottle of 1000 mg vitamin C tablets. The cost should be less than $15.

Begin when you wake in the morning by taking 3000 mg of vitamin C every 30 minutes and continue until you have a single episode of loose stool (not quite diarrhea). If you haven't had loose stool after 15 hours on this dosage, increase the vitamin C to 4000 mg every 30 minutes.

After you have a loose bowel movement, reduce the dosage to 2000 mg of vitamin C taken every hour. You will quickly find the dosage that is right for you. Adjust the dosage of vitamin C downward to stay below the dosage that will cause loose stool and adjust it upward to relieve shingles symptoms. Continue the oral vitamin C therapy until the shingles disappear.

It sounds too simple to be true, doesn't it? But it works in the majority of cases, as recently reconfirmed by Thomas E. Levy, M.D., J.D. (1)

Sometimes it's necessary to take vitamin C intravenously (IV) for massive shingles outbreaks. (2) Much higher concentrations of vitamin C in the blood can be achieved intravenously than when taken orally. As early as 1950, the medical literature reported that one physician had confirmed intravenous vitamin C curing shingles in 327 patients within 72 hours. (3) Ask your doctor if he or she offers vitamin C IV and, if not, ask friends or search the Internet to find a doctor or facility that does offer this treatment.

Vitamin C blood serum levels of individuals fall during periods of high stress and they develop sub-clinical scurvy (depleted vitamin C levels). This situation can set the stage for a shingles attack.

Remember, a vitamin can act as a drug, but a drug can never act as a vitamin.

With vitamin therapy, at any given quantity, frequently divided doses are more effective than one large single dose.

The reason one nutrient can cure so many different illnesses is because a deficiency of one nutrient can cause many different illnesses.

What is Orthomolecular Medicine?

Linus Pauling defined orthomolecular medicine as "the treatment of disease by the provision of the optimum molecular environment, especially the optimum concentrations of substances normally present in the human body." Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org http://www.orthomolecular.org/resources/omns/v01n05.shtml

(End of material added by 65.11.249.253)

Cease your edit warring

It's time for you to read red flags. But in case you fail to read it, I'll list them here:

• Surprising or apparently important claims that are not widely known--none of the claims that are made are known by any medical practitioner, have not been well studied under the scientific method, or are published widely.
• Claims not supported or claims that are contradicted by the prevailing view in the relevant academic community. Be particularly careful when proponents say there is a conspiracy to silence them--many of the claims that have been written are contradicted by the sources utilized, but in many cases are contradicted by the prevailing standard of care in medicine.

Exceptional claims should be supported by multiple reliable sources, especially regarding scientific or medical topics. There are no reliable sources that have been utilized in the edits, except for ones that specifically state the opposite or have no statement about the claims. WP:Fringe theories are not acceptable in this article, not just by me, but a number of editors who have reviewed it, including one administrator who's attention was brought to this article. I do not make threats, nor do I ever take anything to any type of community action, but your edit warring is pushing all of us. It's time to stop, and gain consensus, if you can. But read your articles first, because you have not proven any claim that you make. Orangemarlin 01:49, 2 July 2007 (UTC)

Good Article Review

Here are my suggestions:

• References are needed:
  • "Shingles incidence is high in the elderly (over 60)"
  • "It affects some 1 million people per year in the United States"
    • I could not find this statement. Orangemarlin 16:30, 1 June 2007 (UTC)
• Please follow the order of sections as defined in Manual of Style (medicine-related articles)
• According to the manual of sytle above (Do not include detailed dosage and titration information.), dosages should be excluded.
• The Tai Chi section should be excluded or a short sentence about it would be enough somewhere in the therapy section.
• eMedicine should be excluded from the external links section as it's already in the infobox.

Thanks in advance! NCurse _work 16:50, 30 May 2007 (UTC)

Thank you, Orangemarlin for your work! I can't make it a GA as long as:

• it contains a rewrite template
• a sentence without reference ("The incidence rate in children aged less than 10 years was approximately 70 cases/100,000 person-years, increasing to 550 cases/100,000 person-years among adults aged 50 to 59 years.")
• and the order of sections should follow WP:MEDMOS

NCurse _work 15:58, 10 June 2007 (UTC)

Contagiousness

I'm kind of puzzled by this sentence: "Shingles cannot be passed from one person to another." It then goes on to say how you can catch shingles from another person. Am I missing something? Truncat 19:35, 31 May 2007 (UTC)

let me read it more carefully, but Shingles itself cannot be passed from one person to another. However, if you have never had Chicken Pox, you will get chicken pox from a person who has shingles. Does that make sense? Orangemarlin 19:49, 31 May 2007 (UTC)

I reread the section, and it's clear. Shingles cannot be passed from one person to another. So if you have had chicken pox, you can be next to someone with shingles and never catch it. If you have resistance (either through having chicken pox or getting the varicella vaccine), you will not get the disease. If you have no resistance, then you will get chicken pox, not shingles. Really, I hope that makes sense. Orangemarlin 19:53, 31 May 2007 (UTC)

Would it be better to discuss infection/contagion/transmission in terms of the infecting organims rather than the manifest condition? At presentt hat bit is awkwardly phrased. Midgley 17:29, 20 July 2007 (UTC)

Gibberish

This needs a complete rewrite: "The use of complementary therapies in post herpetic neuralgia (PHN) has been called for by some medical professionals, in the management of aged patients.[citation needed] Although unproven in randomized clinical trials, it may assist in improving patient outcomes and reducing healthcare costs.[18] Cyanocobalamin Vitamin B 12, is naturally found in meats and dairy foods and is also obtained from vitamin supplements or fortified foods. Vitamin B12 deficiency may reduce white blood cell count, so it may be used as a complement to standard antiviral therapy.[19]" &#0149;Jim62sch&#0149; 21:12, 8 June 2007 (UTC)

BMJ

Recent review in the British Medical Journal doi:10.1136/bmj.39206.571042.AE JFW | T@lk 09:34, 10 June 2007 (UTC)

Good article. I need to get the PubMed code for it. Orangemarlin 03:51, 11 June 2007 (UTC)

on the hands and feet

I found the similarities between pictures of herpes zoster on the hands and Dyshidrotic eczema on the hands unnervingly alike. I spent many days sweating it out that I had shingles. Could someone peraps find a place to add in addition to the fact that Herpes Zoster is quite unusual on the hands it looks alot like Dyshidrotic eczema (it really does!)Perhaps this seems superfluous, I think it is alike enough to warrent note (?) —Preceding unsigned comment added by 207.3.151.34 (talk) 23:29, 25 September 2007 (UTC)