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On Stress and Immune Systems
from Mike B.

Hi Ed.  Thanks to your note at PsorChat, I've just been to see your site's Mar-Apr update. 

Here are my own comments on stress and P., since there seems to be a lot of controversy over whether there's a connection.  My own feeling is that whether or not stress can be a trigger, in my case at least it can definitely be a very significant aggravating factor.  The last time I was hospitalized, for four solid weeks, they made no progress at all in breaking the erythrodermic flare-up.  My manager at work was computer-illiterate, to put it mildly, and insisted I phone in twice a day to assist him. It was only after they cut him off from contact with me that we succeeded (and fairly quickly at that) in making progress and getting the P cleared up.

I question whether an unusually stubborn and resistant case of P might be associated with an unusually strong immune system. I tend to shrug off most bugs going around. There’s probably not too many guys my age (mid-60's now) who still have not only their appendix but also their tonsils, and both of those now seem to be accepted as part of the immune system even if maybe it's still not clear what they do.  I did have problems with my tonsils as a kid, but invariably during the fall when it was a no-no (at least in New York) to take them out then because of "polio season.” So I never did lose them.

Update on my current treatment(s) ... my doc wants to get me onto Humira, but the cost is covered only on a "Section 8" [Canada] (nothing else works) basis, in this case specifically lights, cyclosporine and methotrexate (MTX), so we're going that route first.  We'd ruled out lights two or three years back since I burned relatively easily even at low exposures, and he started me on the other two (together) back in December.  He took me off the cyclosporine in February because my creatinine level was creeping up to the point of concern, same as back when I was on its Phase 3 testing, but I'm still on the MTX (and folic acid on the "off" days) with no apparent problems other than I'm starting to get starter-spots on my arms again.  I'm down to quarterly blood testing now (next one in a couple of weeks), and I see him again in June, so we'll see what he decides then.

Oh, and I've been using very little of the Betaderm ointment lately ... it was primarily for itch-discomfort relief, and one thing I've gained (probably from the other meds) is that there's virtually no itch any more, even on those miserable "psoreczema" patches on my lower legs. Sores on the sides of my feet are back (but not open), so it's probably time to check again whether my long-standing mild hypoglycemia has finally flipped over into diabetes.

Best, -Mike

*****

Backstory: Read FlakeHQ Interviews: Mike Bailin

Ed’s Response: Oh yes, stress. Perhaps the most infamous thing I said in the first edition of Flake: Confessions of a Psoriatic was that I didn’t believe stress was a trigger for psoriasis. In the second edition postscript to Chapter 4 online here I muted that claim somewhat in the postscript, but was still smug about it. Today, I’m willing to say stress probably IS a trigger for some people and it most certainly is a common aggravating factor for most people with active skin psoriasis. The reason I’m reversing my earlier denial is twofold:

1. Too many people associate stress in their lives with the emergence of P or significant P flares. The archives here are full of testimonials to this. Not to pay attention to this evidence, even though it’s anecdotal, is probably foolhardy.

2. I have not understood how my own stress manifests. For reasons it would take another lifetime to unravel, I grew up with many strong socio-psychological defense mechanisms. I was the one who was relatively cool in a crisis, hard to make angry, existing within a very narrow emotive range. As I’ve grown older and lived through lots of personal crises, these youthful defense mechanisms have started to unravel. Now, with a few decades distance from the onset of my P, I can look back and see evidence of stress contributing to my psoriasis. In fact, I can see it clearly. Now I wonder how I could have had no idea at the time. Actually, I know the answer to that, too, but that answer is another story for another time.

Oh yes, P and our immune systems. I have been living the life of a flaker with complete confidence in the hypothesis that P is the consequence of a misfiring immune system. ALL of our systemic medications for P emerge from this hypothesis: methotrexate, cyclosporine, soriatane and all the biologics. Each of them thwarts some part of the immune system’s inflammatory response. All of them have potentially nasty side effects.

I have nightmares in which all the systemic medicines are taken off the market for use in the treatment of psoriasis because they merely inhibit a symptom without fixing its cause, and in so doing they stack up adverse events many times worse than the symptoms they are designed to stop.

Please remember! As I write these lines I am entering my 5th year of dependence on Humira (a biologic) and have spent the past decade hop-scotching through the entire candyland of systemic meds for P! So, yes, I’m exhibiting a bit of dichotomy here and sooner or later I’m going to have to resolve the conflict. I’ll keep you apprised.

My immediate problem, however, is an emerging third leg in this conflict of mine. The first leg is what I practice – using systemic medicines to treat P for over a decade, now. The second leg is my growing uncertainty about the propriety of systemics directed at changing my immune system’s inflammatory response. The third leg – the new leg – is my growing knowledge about and suspicion that the real cause of my P might be in my gut – more correctly put, might be coming from my gut. If my immune system is responding to something untoward going on in my gut with an appropriate inflammatory response that just happens to result in psoriasis-like symptoms, might a real “cure” be obtained by focusing on the problem in my gut? Perhaps. For me, right now, it’s a nagging three-legged dilemma.

Your strong immune system might just add weight to those forces pulling me toward a new non-systemic-meds approach to treating psoriasis. But it might not. Problem is I don’t know enough about the immune system. Are your healthy tonsils and appendix indicative of any immune system function that relates to P? I don’t know.

You’re marching into the “systemics phase” where I’ve been for more than 10 years and may be leaving shortly. Three weeks ago I was hospitalized for a fourth bout with a critical infection in my face. I’ve had two rounds of MRSA in my scalp, one round of MRSA in my sinuses, and this time it was a more severe sinus infection but was diagnosed as a non-MRSA form of staph. In the hospital I was IV-dosed with two strong antibiotics for three days; I’m just now winding up the follow-up course of oral antibiotics. The last thing my hospital infection specialist said to me was, “You may want to reconsider your use of Humira. It makes you more susceptible to these kinds of infections.”

And now I’m wondering if the stress from all these impending decisions is going to make me flare?  -Ed

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