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and Too Speedy Doc
Dear Ed (and
all): Whew! Treat this
with humor? What a concept! I have a sense of humor...
but never thought of this as too funny. Now I do! I have been
giggling just at the little guy on the creativity page, lying on his
back, covered in red splotches, scratching.
I haven't smiled about this since I got it just over a year ago!
I am now in
love with all of you! Ria? I am ROLFing.
“Sharing a bit of ourselves everywhere we go”! Tooo
Now, I have a
question. The word
"occlusion." I am assuming this is about wrapping your
scales after medicating. Is
this a normal or usual
type of treatment?
I have been
given some creams that have a warning that scared me to death.
It basically said not to use very much of the product, because the side
effects could be severe, up to and including death.
That will give you pause! I wonder if it is safe to use
occlusion in that instance?
I don't have
very good doctors. I say that, because my dermo has literally thrown
up his hands and said, “I don't have hospital privileges. I've done all
I can do for you. Go see this
So, after a 6
month wait for an appointment, I saw the specialist. He was in the
room less than 5 minutes, couldn't wait to get to the next patient.
It's like a game he's playing — trying to beat his "personal
best" for the number of patients seen in a day! He tossed an Rx
for this cream and ran. I asked, “Will you please explain this a
bit more?” “It will be on
the med,” he said as he disappeared. I actually had tears in
my eyes when I turned my paper into the billing clerk. I was trying so
hard not to cry. I waited 6 months for this “guru!”
I've never had
a remission, and I've never talked to anyone that had psoriasis. I
am immensely grateful to find you here. I’ll appreciate any
feedback. Even housekeeping tips from an experienced flaker! I
look forward to hearing from you! Please put "PS" at the
beginning of the subject line, so I'll know it's from here. Thanks
all! -Nikki B.
address is firstname.lastname@example.org.
Response: Welcome, Nikki.
I want to handle that med label warning first, the one that said
the side effects could be severe, up to and including death.
That’s stated so that, in case you die, you won’t sue the
manufacturer for nondisclosure. Frankly,
I’m surprised we don’t see the same warning on bottled water.
make light of it. Topical
corticosteroids can and do have adverse effects, which is part of the
reason why derms, in the U.S., at least, insist on meeting with topical
therapy flakers every so often. They
may or may not actually look at us, but they are supposed to eyeball the
situation to determine if the sun might be shining through those spots
we’ve been smearing all this time. (Thinning
skin is one of those nasty side effects of topical corticosteroid
Let me put it
another way, over-using topical corticosteroids would not be an effective
suicide technique. It allows
way too much time for a change of heart.
about occlusion. It involves
applying the topical medicine then covering the area with an air barrier,
usually something plastic or rubber. Flakers
often use plastic wrap of the kitchen variety (e.g., Saran Wrap) to
occlude lesions on their limbs. Scalp
P is usually occluded under a shower cap.
So-called “food handlers gloves” are recommended for occluding
the hands. And I use 8 gallon
trash bags, taped tight at the ankle, to occlude my feet.
You can buy full-body occlusion suits.
In the illustrations they look like rubber sweats.
tend to make whatever medicine you’re using work as though it were
stronger. For one thing,
preventing air flow keeps the base compound (grease or oil) from
evaporating. It can soak into
the skin more thoroughly and along with it goes the medicine.
P plaque lesions are thickened, coarse skin usually bearing many
layers of dead skin cells. Sometimes,
without occlusion, it’s very difficult for topical medications to be
absorbed into the lesion effectively.
Occlusion improves the odds that enough medicine will make it
through the scale, down to the living dermis, to actually do its work.
You share a
common complaint amongst flakers — their docs tend to be harried and
insensitive, they come off as uncaring or unknowing and unsympathetic.
In January, March, May, July, September and November I side solidly
with the flakers. DERMS ARE JERKS. (I’ve
priced having the bumper stickers printed....)
But then in February, April, June, August, October and December
I’m required to speak up for the derms.
Our hands are tied, our
knowledge is insufficient, alternatives are limited and outcomes are
painfully predictable. Do you
want us to lie, to say we can cure you, to promise everything will be
better in the morning? In the
next room is a hapless 19 year
old who is checkered with skin cancer from way too many hours in the
tanning bed. Her,
I can help. Now, what else can
I do for you? It is terrible to
be in a no-win situation, but that’s mostly where the derms have found
themselves with regard to psoriasis. They
can lead us on with hyped-up optimism about the next thing we haven’t
tried, but it would be less than honest of them to let you think the next
thing might be The Cure.
For the most part I think derms dread we flakers as patients.
Oh not another one!
And I have unlimited awe for those derms who have made treating P
their specialty. They are
Mother Teresa’s of-a-sort. Mother
Teresa must have known she would not stamp out poverty in Calcutta.
Now, just about
the time I talk me self into sort of understanding why derms are jerks,
along comes one who is a real Sphincter,
if you know what I mean. Overall,
they do tend to make us cry.
Stay in touch Nikki. Here we laugh at least as much as we cry! -Ed