Sul kak is uneasy, uneasy because he has been having acute pain on the right side of his chest since the last four days now.
He has already received 2-3 injections from ‘Ashraf Saeb’ –the local pharmacist who doubles as the local ‘doctor saeb’ for the locality.
There has been no relief in the pain and what is more, Sul kak has developed redness and fluid filled skin lesions on the right side of his chest and back, exactly on the area where the pain was.
On the way back from his zuhr prayers Sul kak had talked to his close friend and neighbour about it. And on hearing the description of his signs and symptoms he had immediately replied, ‘This is Mal-der, Sulkak. Don’t go to any doctor for this. Their medicines don’t help it. You should immediately go for ‘maetrawun’. If you want I will accompany you to Gul Saeb, the famous Maetrawan wol of the town.’
Now, Sul kak is in a fix. Should he go to a doctor or to amaetrawan wol?
He is really suffering from the pain and he wants quick relief. No pain killers are helping him and he has not been able to sleep since the last 4 days now.
Ultimately he decides against the advice of his close friend and visits the dermatologist of his town. Here is what transpires between Sulkak and the dermatologist.
‘Asalam u alaikum, doctor’
‘Walaikum Asalam. How can I help you? What is the problem’ the doctor looks with empathy at the anxious face of Sulkak.
‘Doctor, I have severe pain on the right side of my chest since last 4 days. And I have not slept even for an hour over these days. Please have a look at my chest. My friends said that this is ‘Mal-der’.
The doctor, after examining Sul Kak properly says to him, ‘Yes, it is certainly ‘Mal-der’ or Herpes zoster as we call it in our language. So, you had pain for 4 days—but when did the rash start?’
‘Doctor, it started yesterday only but I had severe pain prior to that as well and the same is still continuing’
‘Ok, it is good that you have come to us within a short time only after the onset of rash. We can treat it better at this stage. If you had come much later, may be after 2-3 days, then some of the drugs won’t have helped.’
‘But then doctor, some people told me not to go to a doctor for this. They advised me to go to a ‘maetrawan wol’. So should I go to him or not?’
‘The doctor smiles and says, ‘Let me answer this question in detail. I know that you are an educated person and you can understand it well.
See, Herpes zoster (mal-der in our local language)or ‘Shingles’ in English language is basically caused by a virus known as ‘Varicella zoster’ virus. This virus usually infects humans in childhood only and causes what is known as ‘Chickenpox’ or ‘waawpet’ in our local language. The virus, after gaining entry into our body, remains inside the body life-long in a dormant state. And it favours a typical site for this—it remains or rests in our nerve roots.
Once our immunity, our defence system against infections in the body, goes down because of any reason, the virus gets a chance to become active again. It then replicates and travels along the nerve sheath from its original resting place and infects the skin that is supplied by the same nerve trunk. That is why we have the skin lesions along a segment on one side of the body in this disease.’
‘OK, so that is why my right side only is involved and it is restricted to a particular area only on the chest. But why is it so painful? And why is the pain not going away by analgesics?’ Sul kak asks.
‘I will tell you the reason. See, once the virus gets activated, it travels along the nerve trunk as I told you earlier. While travelling along the nerve it causes an inflammation of this nerve which is known as ‘Neuritis’ in medical parlance. This neuritis is the cause of severe pain in Herpes zoster.
And as it is the nerve that is inflamed, it does not respond well to traditional analgesics but only to specific drugs that have an effect on the nerves specifically.’
‘But what about ‘maetrawun’—does it have a role to play?’
‘Again, I would like to answer this particular question in detail because I want to pass on an important message to our people in this regard. We Kashmiris are really health conscious people but there are a few myths and wrong practices that we are still continuing even in today’s age.
About ‘maetrawun’ first—let me tell you that medical science does not dismiss the role of this particular treatment altogether in human disease.’
‘Is that so, doctor!?’ Sul-kak exclaims.
‘Yes, that is true. We, in allopathy call this mode of treatment as ‘Hypnotherapy’. And hypnotherapy is a treatment option that has been used in a number of human diseases in well designed clinical studies.
You may be surprised to know that hypnotherapy has been used in diseases like Irritable Bowel Syndrome (IBS), atopic eczema, warts and many other human diseases including Herpes zoster.
However, what is the most important thing is to use medical treatment first and keep hypnotherapy as a reserve if the condition does not respond to medical therapies alone. And the role of hypnotherapy comes late in the disease if the person has intractable neuralgic pain that does not respond to drugs alone.
Hypnotherapy does not have a role in the acute stage of the disease.
I will tell you about a patient of ours whom we saw in our centre recently. This person, a male of about 40-years had lost his eye-sight just because he had not treated his herpes zoster on time and had resorted to maetrawun or hypnotherapy alone as treatment.’
‘Oh my God, is it true? Can this disease lead to such complications as well?’
‘Yes, that is true and that is why I want to put this message across. At some sites like the forehead/eyes, ears and perianal or genital areas the treatment of Herpes zoster has to be immediate and robust. Otherwise the person is going to land into serious complications. If Herpes zoster involved the forehead or area around the eyes, it can lead to a permanent blindness in the affected eye. That is an unfortunate event and that should not have happened in today’s age when we have access to many effective drugs against this virus.
This particular person that I am talking about, had gone to a famous hypnotherapist (maetrawan wol) of our city and he had been categorically told by that therapist not to go to a doctor. He had been told like ‘If you go to a doctor, don’t come to me then. If you want me to treat you, you should not use any medicines given by any doctor’.
Now that is something criminal and in the light of law that therapist has to be tried in a court of law and punished for causing irreparable damage to that poor guy.’
‘Now, that is terrible. This should not have happened!’
‘Yes, certainly terrible and sad. In fact, this article is just in response to that sad event that I witnessed myself and I made up my mind to write on it that day only.
Treat Herpes zoster scientifically and we as doctors are not averse to hypnotherapy as a treatment option.
But hypnotherapy should be a supplementary treatment and not the whole treatment per se.
We have effective drugs for Herpes zoster and if we treat the condition in the first 2-3 days after the onset of rash we can cut short the course of the disease.
Remember that the most distressing thing about Herpes zoster or Shingles is the prolonged neuralgic pain that persists for a long time even after the skin lesions have healed completely. This distressing symptom can be prevented to a great extent if the disease is treated early and effectively.
Remember, you need to treat Mal-der or Herpes zoster early and effectively to prevent both short-term and long-term complications.
Dr Imran Majid is Associate Professor Dermatology, Consultant CUTIS Institute of Dermatology Hyderpora Srinagar
