Dear Dr. Roach: Several months ago, I was just relaxing, watching a movie at home, when suddenly I got a tremendous pain in my inner left thigh. I tried to walk, thinking it was a bad cramp, but the pain was so intense that I almost passed out. This lasted for only a few minutes (but it felt like an hour). The next day, the area was very sore and tender to the touch. By afternoon, discoloration had begun. I saw my physician two days later, and by that time it had a bruise larger than my hand. I was immediately directed to a radiology center, where they determined that there were no blood clots. My doctor advised that, apparently, a blood vessel had burst. I am wondering how common this is, and if I should expect a recurrence?
Dear Anon.: I see this occasionally. It’s possible that the initial pain was the blood vessel, but I suspect that the muscle cramp came first, and the muscle fibers pulled so hard that they literally tore the tissue, allowing for bleeding into the muscle. Bleeding into a muscle can be very painful, but the blood will eventually find its way out of the muscle, at which point it will show up as a bruise. I suspect that the damage was somewhat higher on the leg than where the bruise was initially, as gravity pulls the blood downward. The bruise will gradually change colors (from dark red to green to yellow to brown) as the blood is digested and absorbed by the tissue macrophages (cells that eat what doesn’t belong).
I seldom see recurrences of this. Stretching and regular exercise are the best ways to prevent severe muscle cramps.
Dear Dr. Roach: I have been on Valtrex to prevent outbreaks of genital herpes. I went to get the shingles vaccine, but they told me that the Valtrex would kill the vaccine immediately. They wanted me to stay off the Valtrex for at least three months and then get the vaccine; I couldn’t take that chance, for fear of a herpes outbreak. My own doctor told me I need only three weeks, but I still didn’t get the vaccine. I know the vaccine will not prevent shingles, but it would make it less severe. What do you recommend?
Dear C.B.V.: The shingles vaccine contains a weakened form of the varicella-zoster virus, which causes both chickenpox and its recurrence, shingles. Acyclovir and the related drugs valacyclovir (Valtrex) and famciclovir (Famvir) prevent the virus from replicating, and are likely to render the vaccine ineffective. According to the Centers for Disease Control and Prevention, these drugs should not be taken for 24 hours before the vaccine or for two weeks afterward. I would recommend getting the shingles vaccine, as an outbreak of genital herpes is unlikely in that short period of time for most people. Plus, the reduction in risk of getting shingles in the first place (it does have some benefit) and the reduction in severity, but also — and most importantly — the reduction in the risk of painful neuropathy after shingles is worth this risk of an outbreak, in my opinion.
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