Posey Diagnosed With Shingles, Giants Need Caution

A few hours before first pitch in the San Francisco Giants game against the Colorado Rockies on Wednesday evening, news broke that Giants catcher Buster Posey was pulled from the lineup. The problem? Posey’s come down with shingles.

Shingles is caused by the same virus (varicella-roster) that causes chicken pox in children. The virus remains in the body’s nerves in a dormant state until activated years later. According to the National Institutes of Health, those adults most likely to develop shingles are over the age of 60, had chicken pox before the age of one, or have an immune system weakened by medication or disease. Stress, and stress-related fatigue, can also trigger a shingles outbreak.

Posey turned 25 in March. Giants beat writer Andrew Baggarly reported that Posey remembers having chicken pox when he was five or six years old. That suggests that medications, stress or weakened immune system were the likely triggering factors for Posey’s case of shingles.

Initial symptoms include fatigue and flu-like aches and pains. A few days later, pain and tingling begin, followed by a rash of blisters. Typically, the rash appears near the spine (where the virus lays dormant over the years), the chest, the stomach, or around the face and eyes. A shingles rash around the eyes can be very dangerous and lead to serious vision problems. Unlike chicken pox, the rash caused by shingles is more painful than itchy.

According to Baggarly, Posey first started feeling “run down” toward the end of spring training. The blistery rash appeared late on Sunday, at the end of the Giants game against the Arizona Diamondbacks. Posey’s rash is under his left arm and around his left shoulder and back. He does not have a rash on his face.

Posey was scheduled to be off on Monday, and the Giants were idle on Tuesday. Doctors started Posey on anti-viral medication and advised him that the condition “generally clears in four to five days, but can take as long as three weeks.”  The National Institutes of Health’s website states that the condition usually clears in “two to three weeks.”

About one of every five patients with shingles develops postherptic neuralgia (PHN), although the incidence is as high as fifty percent in patients over 60 years. Patients with PHN suffer from deep and unbearable pain that can significantly curtail their physical activities. PHN can last anywhere from 30 days to several years.

After Posey was pulled from the Giants lineup, but before first pitch in Wednesday night’s game, manager Bruce Bochy said that Posey was available to pinch hit and “will play” in Thursday’s game. Bochy’s comments struck me as a bluff, trying to leave the Rockies unsure as to whether Posey truly was unavailable. After all, Posey is just starting his comeback from the horrific left leg he suffered last season after a vicious home plate collision. The Giants had planned on giving Posey extra days off this season, to keep his leg strong and his body fresh. And yet, in a game that was already out of hand, with the Rockies leading 16-8 in the eighth inning, Bochy sent Posey up to pinch hit. Mercifully, he flied out to right field and returned to the dugout.

There is a lot we don’t know about Posey’s case of shingles: how severe the rash is, how severe the pain is, how fatigued he feels, etc. Nevertheless, given his season-ending leg injury last year, and the fact that this season is just a week old, the Giants would be wise to take a cautious approach. Nevertheless, Posey is in the starting lineup for Thursday’s game against the Rockies.

In 2009, relief pitcher LaTroy Hawkins, then with the Houston Astros, was diagnosed with shingles and developed tremendous back pain. He pitched with the pain for several weeks, with bad results. Eventually, the Astros put him on the disabled list. He returned to game action after fifteen days.

No doubt the Giants are anxious to keep Posey in the lineup as much as possible. San Francisco’s offense took a big hit last year when Posey went down in late May. In the first three games of the season, Posey had four hits in fourteen plate appearances, including one home run. More importantly, though, the Giants started the season with only one back-up catcher, twenty-two year old Hector Sanchez. The Giants optioned Eli Whiteside to Triple-A and traded Chris Stewart to the New York Yankees. Whiteside was Posey’s main backup in 2010. He and Stewart split catching duties after Posey was injured last season.

Sanchez jumped from Single-A to Triple-A in 2011, mostly due to his hitting, and looked over-matched behind the plate during his September call-up. His catching skills have improved but he has a lot to learn, particularly when it comes to working with the Giants’ starters. Other than Barry Zito, the rotation has performed uncharacteristically poorly so far this season, putting even more pressure on Sanchez should he have to carry a bigger load.

The Giants have a tough call to make. Posey says he’s well enough to play and is likely eager to get back to game action after missing two-thirds of last season. Hector Sanchez wasn’t expected to catch multiple games per week. Eli Whiteside is only a phone call away, but the Giants would have to either put Posey on the disabled list or send another player to Triple-A to make room for Whiteside.

Shingles can be tricky, and if not properly treated, could lead to a longer and more painful recovery period. The prudent thing might be to give Posey a few more days rest and then re-evaluate the situation. As the Giants learned last season, they can’t afford to lose Posey for a significant period of time.