Tag Archives: Acitretin

PSORIASIS BLOG – Treatment Update 11

Treatment Update 11

General Notes March – July 2013

(Gravelly Voice):  “Previously on Toby Hadoke’s Psoriasis Blog”: Skin. Ow. Red patches. Flakes. Poor mental health. Bad puns. Many attempts to make severe dermatological conditions vaguely amusing. One or two attempts to make serious dermatological conditions vaguely amusing that have actually worked.  I have been seeing Dr McBride (dermatology consultant) every four weeks and Dr Mizara (dermo-psychologist) ever fortnight or so: both are based at The Royal Free Hospital Hamsptead. I have been injecting adalimumab, a biologic treatment, since just before Christmas.

“And now, the continuation”.

cauliflower dog
I worry these treatment blogs get too technical and self-indulgent, so I’m trying to lighten the mood with a picture of a cauliflower dog.

Bloods, cholesterol and liver were generally better last month but as with Norman Tebbit’s current application to join the human race here in the 21st Century, there’s still plenty of work to be done before anything can be signed off. Plus, I’ve not been as good or disciplined this month. The patterns of exercise, healthy eating and intelligent application of alcohol are pretty much what you’d expect (i.e everything I like doing is bad for me and everything I hate doing is good for me). My scalp is still the most stubborn area, and Dr McBride says that alcohol can really affect the scalp as it has various yeast-based side effects and that helps to maintain a healthy harvest of scurf across one’s cranial landscape. Essentially Nizoral Shampoo clears the yeast from the face and scalp and then the coal tar shampoo one uses more regularly keeps the psoriasis at bay: but the more yeasty you are, the harder that makes the coal tar’s job. Still, if anyone wants some bread that tastes of the road then gather up the powdery residue all over my head and shoulders; add water; prove;  knead and bake ; et voila!

(I can’t believe I just typed that but it’s staying in).

“We haven’t quite cracked you yet have we?” said Dr McBride with as much ruefulness as someone whose glass is permanently half full could possibly muster. She’s very cheerful for some who has to look at bodies whose outer membranes look like they’ve been through a spaper shredder all day: there’s no doom and gloom at all in her assessment but rather an acknowledgement that there is still work to do. All things considered I am doing OK but not brilliantly: there are patches of bad skin on my arms and hands and a little on my sides. All things considered, she says, I am doing well, even if that “doing well” is relative (and in this case, it’s relative is a remorseless bastard).

In my other sessions Dr Mizara notes that my skin reacts very acutely to emotional stresses. I wasn’t aware that mine was especially sensitive but she suggests that it is. Part of me finds this really annoying (Pathetic skin, pull yourself together you big wuss!) whilst another sort of secretly quite chuffed (Oh, I am special am I? Like a poet or something?).

I filled in my last questionnaire for Nurse Annie about the effect that adalimumab has on my behaviour in certain carnal areas. Some things must remain a secret from even you dear reader, but all in all I am as sturdy/impotent, rampant/frigid and effective/disappointing as usual (delete as appropriate, depending on how you’ve found me to be). Quite what some anonymous boffin is going to do with my regular sex reports is anyone’s guess but I hope my candour is of use to medical science. Or at least provides them with a good laugh.

I put on weight in April/May. Dr McBride said I had to see how I’d respond if I did exercise and didn’t drink for a month – but no pressure, she said. It’s not a test and if I can’t manage it I mustn’t beat myself up. I reassured her that she’d not be disappointed with me and that I’d do my best.

Turns out, my best was shit.

Current Treatments: I am still splashing Dovonex (calciptrotriol) scalp application on my bonce, Silkis (a vitamin D cream, basically) to my arms and affected skin patches, and washing my hair with a mixture of Nizoral and coal tar shampoo (see above). There’s pro-topic for my face too but apart from some dryness underneath if I let my beard grow too long I’m remarkably unblemished on the old fizzog. I also take a massive Vitamin D booster every fortnight.

I’m overweight even though I have been eating as well as possible since June (bearing in mind I live out of a bag and am often reliant on fast food) so I need to do something about that fairly sharpish. I’ve not experienced  the great breakthrough that I had hoped the biologics would be – it seems that there are no easy answers, and I certainly can’t expect to be given any until I’m in slightly better shape than I currently am. Psoriasis is a condition that requires some assistance from its host to give it its marching orders; I can’t really complain that I’m not healthy if I drink as much as I want, have a weakness for chilli peanuts and think that taking the stairs occasionally is a workout.

 

The Skin On My Arms 6th April 2013
The Skin On My Arms 6th April 2013

As I write this Dr McBride has asked to see me in a fortnight. I’ve gone from once a month to every two weeks now which should be an indication that things aren’t as good as they might be. And I’ll be honest, that’s a tough thing to bear … it’s an equal opportunities condition ; for every Stride Forward there has to be an all Two Steps Back shortlist.  That said, she is seeing me because she is being very supportive at a difficult time: I went into my last appointment in the doldrums and emerged ameliorated and hopeful. Likewise, my latest session with Dr Mizara left me feeling emboldened and determined when I’d gone in full of self-doubt, self-recrimination and negativity.

Both doctors have provided reassurance and sympathy as well as medical insight. They’re convinced that the mental issues I had over Christmas were induced by acitretin and when I fretted that most people probably don’t need to be seen as often as I am by Dr Mizara, Dr McBride showed me figures that indicated many had had far more sessions, and that when everyone emerges from the derma-psychology tunnel the light is bright and warming (and probably ultra-violet too because it makes your skin better). Indeed, she even went to the extent of calling Dr Mizara (who was doubtless busy elsewhere) down to back up her figures and provide an extra ear; once again the call of duty was answered long ago and continues to soar so far above and beyond that I’m surprised I can still see it.

It may just be that I need a skin and brain transplant and I might finally get rid of this thing. I hadn’t done a blood test this week as I’ve been all over the place so I did one after seeing Dr McBride. I dread the results: she’s ordered a streptococcal test in case that’s been a contributor (I have had the odd throaty scare) but she’d be better off looking for traces of Sancerre. Since then though, it’s been healthy living, no booze, and plenty of exercise (bear in mind that “plenty” for me probably means a light bout for most, far more robust examples of humanity).

Dr McBride is right, we haven’t cracked it yet, but then I haven’t cracked either (apart from physically on various patches of my skin, but I’m used to that).

PSORIASIS BLOG – FRUIT OF THE LOON

FRUIT OF THE LOON

Christmas 2012 … (cue clanging chimes of doom)

OK, I may as well get this out of the way early on. I had a few mental health issues over the Christmas period. It was horrible, but I suppose at least it will enable us to examine the links between mental health and psoriasis, which I am coming to realise have a very intimate relationship. It’s one not many people know about and those who do don’t really acknowledge it:  like a staff room affair or the Catholic Church and paedophilia. Of course, this was the whole impetus behind the much needed See Psoriasis, Look Deeper campaign, so my breakdown has been rather timely. Come to think of it, too timely. Perhaps they put something in my Horlicks to set me off in order to draw attention to their scheme? Like a piece of psychologically primed product placement.

Anyway, if I may my candour on this will stop there. I have friends and family for whom this period was difficult and whilst I don’t mind breaching my own privacy it’s not acceptable to do so with theirs, so I’ll be scant on the detail if I may. But let’s put it like this, it was quite serious: it wasn’t a sadface-put-on-my-Facebook-profile-because-I’m-feeling-a-bit-needy sort of crisis; it was a wearing-underpants-on-my-head-and-sticking-two-pencils-up-my-nose-I’m-just-off-to-Hartlepool-to-buy-some-exploding-trousers kind of discombobulation. I’m alright now, mending slowly, and received great support from people very dear to me. I have been taken off acitretin which doesn’t help lighten one’s mood apprently. The dermatology department at the Royal Free, who have cared for me so well, dropped everything to facilitate my stabilisation. The psychiatric care I received however (mostly at a different hospital), was a real eye-opener to how mental illness is treated in this country, and will be something I blog about in detail when … when I’m a bit further away from it all. I’m still a trifle raw and also don’t want to give the impression that I am currently incapable of rationality, because that couldn’t be further from the truth. Some distance is necessary before I address this very serious issue though. Suffice to say for now then, that the whole system for dealing with a psychological crisis seems designed to ensure that if you aren’t mental when you go in, you sure are by the time you come out. Fortunately I had a wife at home who could rescue me; many others aren’t so fortunate.

Skin-wise this relates, as obviously a lot of one’s deep seated frustration and self-esteem issues are related to the fact that one has spent much of one’s life looking in the mirror at a scaly red flake monster. When I say one, by the way, I mean me, but I’m trying to be all professional and distant because that’s sexier (referring to myself as “one” is fine and sane – it’s when I start describing myself as “both of us” you’ll know that I’ve flipped). In addition, when one’s feelings venture into this kind of territory the temptation is to hit the bottle. Hit? I did a bit more than that. When I wasn’t working I administered Grievous Bottley Harm, nutted a Chablis and kicked the shit out of some very nice malt scotch whisky. Curious how when I am working I manage not to drink at all – when I am on stage I don’t drink till after a show, when I’m doing a telly job I don’t drink during the whole shoot … but when I’m left to my own devices and thoughts, I unleash a torrential downpour of liquor that would kill a horse (and therefore probably add lustre to the flavour of certain burgers on the market until relatively recently).

What the drink did, of course, was to facilitate the outpouring of all sorts of things that need dealing with sensibly rather than splurging out amidst random thoughts and slurred vowels. What I do know, as I write this, several weeks sober, is that what it didn’t do was help. It made things worse. Which is why it is ridiculous that I always turn to it when I want to make things better. So I have stopped.

Watch this space.

I’ve been tentative about publishing this as it all sounds a bit bloody needy, and frankly, could have potentially damaging professional consequences (nobody wants to hire a self-confessed nutcase who drinks too much). Oh well, what the hell: I’m on the mend, I’m working (and therefore, potential employers, distinctly available and able, fear not), I’m dry and have thrown myself into a ridiculous Doctor Who based project to prevent me from staring at my own navel for too long.

Meanwhile, Dr Mizara is being very clever at tying everything together. There are various things that haunt me from the past but they are done and dusted and I really need to get over them. I need to stop concentrating on the things that frustrate and worry me and instead enjoy the very many things that make my life a blessed and fortunate one. The experts tell me I need to love myself as well, but I was always told that that made you go blind. I clearly have a lot of hard work to do, but they say you have to hit rock bottom in order to get yourself straight so maybe it’s good for me even if it’s not particularly enjoyable to experience. It’s like exercise. Or John Craven’s Newsround. Or a Bran Flake.

Onwards, then, and I’ve only got upwards to go …

PSORIASIS BLOG – Treatment Update Eight

Treatment Update Eight

Early January 2013

Please read the disclaimer if new to this blog.

First up, cliffhanger resolutions – my fingers seem to have got less painful, and no arthropathy was spotted in my X-Rays. In one bound I was free (but whilst on the starting blocks I was clearly a hypochondriac)! It could be that my new treatment regime has helped … whatever, the finger joints are not a current concern, so thank goodness for that.

The time has come to commit to the most pointy and extreme of all the treatments of psoriasis. No more creams. Light treatment – not on your nelly. Pills – your boys took one hell of a beating. It’s time for me and adalimumab to get acquainted. Dr McBride pronounces it as if she’s been saying it all her life: I think she’s been practicing at home. I’ve been practicing at home and I still can’t say it. It is used to treat arthritis, Crohn’s disease, all sorts, and with psoriasis one has to have found all other treatments ineffective before being allowed to use it (and special funding has to be applied for). I am a drain on the economy and for that I apologise. I don’t drop litter though.

A quick explanation: biologic medications are specifically designed to act in certain ways to correct a malfunctioning part of one’s physical make-up which in turn causes a disease. Insulin is probably the A List celebrity of the biologics world. As for my particular example, the impossible-to-pronounce adalimumab, I shall quote from the Psoriasis Association and hope they don’t mind : Adalimumab (Humira) works by blocking TNF-alpha, a ‘chemical messenger’ that signals to other cells in the immune system to create inflammation. People with psoriasis have too much of this chemical in their body, and adalimumab helps to lower this to a more normal level, leading to an improvement in symptoms. Adalimumab is an immunosuppressant, meaning people taking it are more at risk of infection. Because of this, people will be tested for active and latent (hidden) infections, such as tuberculosis (TB), before starting treatment, and are advised to have regular flu jabs.

 

The latest addition to my fridge

So just before Christmas, Senior Nurse Annie, who is the biologics guru and an extremely nice person, brought me into one of the rooms of the day care centre and talked me through the administration of my own injections. This sounds scary, and I’d love to play it up and make it seem so because then you’d all think I was terribly brave. But, it isn’t. You get a big thick plastic pen device, not unlike Doctor Who’s sonic screwdriver, and you unscrew a couple of handily labelled caps. In fact, they’re labelled 1 and 2 but I was so inept and struggling with #1 that Annie said it didn’t matter what order I did it in so I threw caution to the wind and pulled #2 off first. I don’t play by no rules you squares. The injections come with their own antibacterial swabs, and on day one I was to have two doses – the first administered by Annie, the second by me. I could inject into my stomach or the top of my leg. The leg seemed the best option – sturdier and less wobbly. One has to grab a wodge of skin to make it firm, swab the area, push the pen device on and depress the button on the top – like clicking a Parker before writing a letter. Except you don’t stab yourself with a biro – unless you’re a nutter or have a tight deadline for Doctor Who Magazine. There was a bit of pain and one has to wait until one hears a sort of fizzing release sound before removing the thing. I did the second dose myself and it was fine, although it does produce a little spot of blood.

As with any treatment, it is not all roses. If ever I decide to become a pregnant woman I will have to be very careful, and side effects can include upper respiratory tract infections, abdominal pain, headache, rash, injection site reactions and urinary tract infections. These joyous visitations usually occur after the first dose and decrease after that so I think I’ve managed to avoid the worst.

I also agreed to fill in various questionnaires. One of these was a slightly more detailed version of the PAASI test which studies the impact of psoriasis on the sufferer’s everyday life. The second one was a bit more grown up, and Annie thoughtfully vacated the room as I grappled with questions about erections and all sorts. Still, I hope the answers are useful to them and that my candour has helped the cause of medical science (whilst going on record that my erections are perfectly alright thank you very much – indeed, the two I’ve had over the past six months have been quite splendid).

The next dose of adalimumab was due Christmas Day (one week later) and the next a fortnight after that, so I went home with two lots, the transport of which required a cool bag supplied by the hospital. I did my own on Christmas Day but asked my retired medical professional of a mother to supervise. She did, but it didn’t stop her telling everyone afterwards how pathetic I had been. She wouldn’t have lasted long at the Royal Free.

It takes a few weeks to kick in, and I am being weaned off the ciclosporin in the meantime (75g morning and night). The injections will be done at home, fortnightly, and to that end the medicine is delivered to my home (saves the NHS paying VAT apparently), where it has to be kept in the fridge – which is why, I guess, they make it look like a pen rather than a mushroom.

And let’s hope it works, as there isn’t very far to go beyond this. I’m in the Last Chance Saloon, and there’s only one thing left behind the bar that’s doing to hit the spot (or in my case, massive amount of spots) …

PSORIASIS BLOG – Treatment Update Seven

Treatment Update Seven

11th Dec 2012

Oh, and if you’ve popped by to tell me to eat hay or give up cheese, please read the  disclaimer here before posting anything. I will publish any replies but not necessarily engage with them ; if you have your own cures or theories I am happy to air them, but won’t be batting opinion back and forth – this is a blog about my personal experience and the medication I am receiving.

 

You might well cry Mr Bond, but try having psoriasis. Dr No-Can’t-Do-Anything-About-That! Moonflaker! Skinfall (et cetera)…

I cried during Skyfall. I should have known something was amiss then. And I didn’t just cry at the emotional -oh-no-someone’s-dead bits. I got teary when anything with the vague whiff of a fan pleasing nod occurred or if Daniel Craig did something quintessentially Bond-esque. Shaken Martini (weep!), cool old skool car gets revealed (unleash the waterworks!), Miss Moneypenny (lachrymosity alert!).

I alluded to various personal and work issues in my last blog too, and yet even those now seem as if they are related to my somewhat discombobulated state. I usually take such things in my stride and frankly my profession is riddled with frustrations and disappointments, so why have I been feeling different lately? Well, I found out last night …

I had an appointment on Tuesday and saw a very charming locum doctor (Dr McBride was indisposed) who was rigorous in his examination, had a gently probing questioning style and was rather regretful when the time came to inform me of my cholesterol levels. I’d predicted a slight rise from the alarming 6.7 I was at but even I was bowled over when a colossal 8.8 had registered from my latest blood sample. That won’t do. One of the reasons is that I am currently on two medications – ciclosporin and acitretin. I am supposed to be reducing the ciclosporin and increasing the acitretin, but because my skin hasn’t been great, I haven’t reduced the ciclosporin at the speed I should be. Each medicine has a cholesterol raising side effect. Taking both at pretty optimum levels (I’m on 25mg of acitretin – the maximum dose is 35mg – and 200mg of ciclosporin) raises my cholesterol twice! The fact that I’ve been eating American food and staying away from the gym probably doesn’t help but let’s ignore that for now and lay the blame squarely at the feet of my drugs!

I have also had an X-Ray to see if the pain in the three fingers of my left hand is psoriasis related arthropathy or something else. If it is it’ll be a relief to know precisely what it is that’s causing the often intense discomfort, but that relief will be sullied by the fact that I have arthritis. So let’s see. I would rather I didn’t have something else wrong with me to be honest. I’m only 38 and I feel like a laptop that’s just this second passed its warranty period – annoying things seem to have suddenly stopped working for no apparently good reason.

And so, last night, I did a turn at a medical do, where it’s safe to say that my comedic musings went down resoundingly adequately. Both Doctors McBride and Mizara (yes, Mizara, I’ve been spelling her name wrong!) were there and spent much of a precious night off talking to one of their annoying patients. Me. During our chats I learned that acitretin can cause upsets in one’s emotional state and can increase anxiety. Suddenly everything fell into place. I’ve been worried about work, money, life, but more so than usual and occasionally quite alarmingly (I have felt like I’ve been teetering on a precipice). And so it’s a relief to discover that it’s not me being weird (I really did think I was going a bit nuts). It’s the bloody pills. So as of today I am off the acitretin, and hopefully this’ll restore me to my usual calm, cheerful, emotionally repressed, buttoned up, grumpy self! It’s a relief as I’m not massively comfortable dropping industrial amounts of pillage down my neck morning and night, and my stomach has always felt a bit dicky since I have been taking all of this stuff.

 

It probably won’t look like this but I wanted a scary looking injection picture to elicit maximum sympathy

I now have to consider – in consultation with my wife – whether I want to chance biologics; those A List, expensive drugs which are self-administered by injection. Frightening but with a reassuringly lofty, industrious aura about them. They’re injections for goodness’ sake; they are bound to work, surely, because you have to stab yourself to administer them. What would be the point in doing something so intensely medical, so brave, so … dare I say it, manly, if it just made me feel a tiny bit better? That’d be like trying to wipe a sniffle with a baseball bat studded with nails. Just sounding a note of warning, by the way, Dr McBride said that one in one hundred patients has an adverse reaction to biologics. With characteristic self-pity I remarked that that would probably be me then, and she said that that is what all psoriasis sufferers think and say. Bugger. Not only am I self-centred and paranoid, I am predictably so. Never mind – I am enjoying this because it turns out that I can blame the hallmarks of my disease for every twattish thing I do, say, think or feel now. That’s kind of reassuring. There are side effects to the biologics, but she won’t tell me about those in detail until I’ve decided whether to take them or not. I am to come back in a couple of weeks with my decision.

Crikey, that’s a first for this blog. A cliffhanger ending …

Toby Hadoke will return …

PSORIASIS BLOG – Treatment Update Six

Treatment Update Six

November/December 2012

Oh, and a timely reminder to read the disclaimer here – please don’t post a reponse to anything here until you have had a look.

All that is lodged in my memory from Doctor McBride’s session in early November (I’ve been away having fun … I mean working, since) is that my progress has regressed at tad. And I have regressed further since then I am afraid to say. That’s obvious from the physical side: then, I had a few light patches on my arms, and now (at the time of writing I’m seeing her again in just a few hours) there are shadows on my arms and sides. Shadows with a dusty surface and a reddish tinge. Let’s be fair, I’ve not looked after myself as much as I did when I was at the Edinburgh Fringe; wheatgrass shots and fruit/veg smoothies each morning, a strict exercise regime that had me in the gym nearly every day, no alcohol, pretty early nights. Since then I’ve let myself go a little bit, so surprise, surprise my Cholesterol is at a whopping 6.7 (I had it down to 4.5!!) which is not good, whilst my Triglycerides (fat in the blood) are at 3.6. I can’t remember if that is good or bad but it’ll be interesting to see how they compare to the blood I gave yesterday. “Gave”? I make it sound like I am benevolently donating something as opposed to having my plasma sucked from me so that it can be broken down into numbers in order to discover what level of the Unhealthy Scale I have ascended this month. I asked Dr McBride if we could hold off with statins and so keep my daily intake of pills below the hundred mark and in return I would endeavour to get as healthy as before; I am convinced that self-discipline might be a better long term option than pill popping.

Well, I think I have probably failed.

“Can you tell what it is yet?” It’s my arm, with a creeping barrage of mild psoriasis doing its best to ruin an otherwise perfect and robust limb.

I went to a Doctor Who convention (don’t snigger at the back) in Chicago (see, I got to go to Chicago for free, oh ye sniggerers) at Thanksgiving, where I ate American food and drank American drink. The latter is like English drink but weaker, not as nice or three times more expensive, but not especially better or worse for you. The former is like English food but with added dollops of fat, syrup, sugar and insanity. Like sweet potatoes? Not until they’re topped with marshmallow you won’t! So I have put on weight and developed very, very dry(but not red, sore or painful – I’m dusty rather than crusty) patches on my arms and sides. My scalp could single-handedly provide the snow for the world’s entire collection of nativity displays. So bad has it been that I have adopted an entirely beige clothing policy in order to minimise the embarrassment and camouflage the cascade of detritus. My lips have also been drier than a sarcastic Martini but that is because of the acitretin (which, coupled with ubiquitous Stateside air conditioning has left my gob like the lunar surface but with slightly fewer golf balls).

Now, of course, we don’t know if food is a trigger (probably not) but general physical well-being is definitely important. However, my visit to Doctor Mazara yesterday (2nd December) indicates that various personal and professional stresses are responsible for my mild flare up. I don’t need to go into the whys and the wherefores (especially not after my last, rather maudlin, blog), but the fun times in Chicago have been karmically balanced by some less joyous developments. As ever I have tried to greet each unwelcome visitor with a smile and Dr Mazara helps me to do this by offering good advice; only control what you can, life isn’t always easy, and accept the fact that one has to work to keep one’s personal life happy and that the profession I’ve chosen generates frustration and upheaval. Irrespective of what is happening, we are responsible for our own moods; dwelling on the uncontrollable gets us nowhere and taking life by the scruff of the neck and staying positive can work wonders. So that’s the prescription – open the advent calendar doors and make sure there are only happy scenes behind them.

There are certain things I have to do to change the things that aren’t going so well, and I am working on them. Dr Mazara cites coming to her and getting to grips with the emotional side of the disease as positive steps and examples of why one shouldn’t bottle one’s feelings up. Interesting, having gone to her feeling fairly rotten I reacted well to the idea that just being there and talking openly was a marked improvement on how I would have approached this a year ago. In plucking a positive (and you’ll note, one that put me in a good light) from all the surrounding difficulties she managed to spin me out of my self-indulgent miasma (by indulging me!). My visits to her have made me a little raw when I think about the disease, but she assures me that this is a good thing. Great – crying makes one better apparently. That’s no good if you’re on a bus! Oh well then, there’s no alternative fellow sufferers – never mind the pills, just watch Old Yeller or Bambi once a week and you’ll be fine.

So – let’s see what my physical readings are when Dr McBride goes over my bloods later. I also have agony in the joints of three of the fingers of my left hand. I am worried this may be the result of some kind of related arthritis, but let’s not panic … he said, having been panicking all month. But that’s the point, I don’t know if it is or not until I find out, and the only way to find out is to do something about it. Don’t fret about what might be, only deal with what is (oh no, I sound like Yoda except all my words in the right order are). Accentuate the positive. No humbug this Christmas then …

PSORIASIS BLOG – Sunny Misposition

9th October 2012 Part Two

Slightly out of date but I’ve dithered.

DISCLAIMER: If you here for laughs (of which I only aim to provide the mildest), maybe check out some of the earlier entries before this one.

At my last appointment, and in the interests of full disclosure, I had to share with Dr McBride (and therefore do so now with the half dozen of you that read this) that my spirits have not been especially high recently. I do this not for sympathy but because I am trying to fully understand the link between mental health and my condition, and as I am part of an initiative to raise awareness of this (the See Psoriasis: Look Deeper campaign) I will have to be honest about it. There’s a possibility that acitretin can cause depression, but without going into specifics, I think that that is unlikely in my case. We talked about the mental framework of psoriasis patients. Apparently, that subconscious fear that the condition might break out at any moment affects the way we anticipate things. It is not unusual for a psoriasis sufferer to have higher states of anxiety than other, less mottled people. Dr McBride couches this state as an “anticipation of doom”. The way in which we psoriasis sufferers think is different due to the fact that we internalise our fears about a recurrence of the disease (for we are never truly free of it – the dermatological equivalent of the Daleks, it can only ever be kept at bay, not wholly defeated). Much of this is down to learnt emotion: the things we fear are thoughts not actuality. You know the sort of thing – worrying that you’ve left the oven on, fearing you will die on your arse at every gig (maybe that’s specific to me), abject terror that Boris Johnson will end up as Prime Minister (alright, I’m not alone in that one, and it also may have nothing to do with psoriasis and everything to do with having the scantest interest in a positive future for mankind). But anticipatory fear – with which I wrack myself all too consistently – can be traced to my mental attitude to my disease.

 

There you go – clowns are funny. Take a break, smile at the clown, and then dive back in to the angst-ridden text.

I fret about simple things like train journeys and am terrified of phoning people lest I be calling at an inconvenient time or they simply want me to fuck off. Now, these psychological somersaults aren’t the sole province of psoriasis sufferers, but they are examples of behaviour and the cognitive dysfunction of those of us in the cult of the crusty.

One of the reasons I am seeing Dr Mazara is to try to come to terms with the fact that much of what I worry about is abstraction rather than reality. I also need reassurance that the fact that I do fret and worry and suffer from depression isn’t simply self-indulgence (my biggest fear of them all – being thought self-indulgent; a trait I despise). The entire approach being taken to my condition by the experts is to establish that there are sound medical reasons for the way that I feel. It’s a frustrating area: my worry about a recurrence of psoriasis leads to stress, stress exacerbates the psoriasis, the resurgence of the rash exacerbates stress, and so I have two insatiable beasts feeding themselves off each other and having the discourtesy to do so in my brain and body, the inconsiderate sods.

Physically though, I’m in as good shape as I have been since I scored the winning runs for England at Lords’. Sadly, that was in a dream, but I was pretty fit in it, and got comparably so in reality thanks to the physical regimen I stuck to in Edinburgh. Compared to the shambolic, overweight, blotchy man who first shuffled into Dr McBride’s view I am now in a sustained period of remission from those stubborn body-wide plaques and am at a pretty steady 12 stone (could do with losing another half stone to be totally perky, but as a default it’s a hell of a lot better than I am used to). Largely thanks to my wife’s encouragement in such matters I eat better, have a genuinely more positive and proactive attitude to my physical well-being and spent the first half of the year totally alcohol free. To the naked eye I have a healthier colour and more sparkle. “If you were a dog you’d have a nice wet nose,” is how Dr McBride puts it.  I’d also bite children and dry hump a kitchen table leg, but I didn’t tell her that.

But … I am still not well.

The fact that my arms are a little more affected than they were six weeks ago is explicable and not too alarming, and I even came out of my hospital visit feeling much better about the fact that … the fact that I don’t feel much better. And I am not a maudlin whinger – as someone who spends most of his time amongst, and attempting to generate, laughter I think I get a pass on the whole “oh, poor me” brush that depressives can be tarred with. As I type this I’m in two minds about whether to publish it or not, because I am wary of the cult of narcissism that the internet promotes, of self indulgence, and of people who think that things get them down more than they do anybody else. I don’t know how I feel compared to everybody else because I have no idea how everybody else feels. But I know when the blackness descends it is very difficult to motivate myself to do anything. I know I shut down a bit when contemplating awkward situations. I know I stay up to the early hours drinking just so that I get access to those emotions that I generally keep under wraps because I – like most psoriasis sufferers – am used to internalising misery (and physical pain) just so that I can function of a day to day basis. I know that I find myself mired in indolence. I know I feel unable to get enthused about anything and in a state of anxiety about the simplest things like anticipating a train journey. I know I replay conversations, fretting that the way that person X said “hello”/”goodbye”/”when’s the bus due” means that they hate me and think I am an idiot.

This all may well be a very complex and self-absorbed way of saying I’m so lazy my brain has to come up with all sorts of reasons for not doing anything, so that I can then justify them to myself in medical terms rather than admit that I am just a boring, apathetic narcissist. I don’t know, but the two medical professionals I see haven’t laughed me out of the room (I’ve never actually be laughed out of a room – I have been un-laughed out of a room, and that’s bad enough). In fact, the major breakthrough with all of this is that everything I don’t like about my behaviour has been identified and explained by Dr Mazara, and that knowledge brings understanding, understanding brings strength, and strength creates the ability to do something about it. Let’s see eh? I’m game. And if any of this sounds like awful motivational speak then yes, I probably would have thought the same 12 months ago – but it has helped. It really has.

So there we go, that’s how I am today. I am very lucky that my consultant is someone who has made it her mission to create bespoke treatment for psoriasis that takes the patient’s emotions and personality into account as much as their genes and cells. And that I feel able to speak to her about it. So I thought I’d tell you too, just in case it helps. It may just be that you’ll think I’m a dick, but do you know what, my personality is such that I’d assume that’s what you were thinking anyway, so what have I got to lose?

There we go – that blog was awkward, potentially embarrassing and quite painful to endure, but what the hell, I’ve done Christmas gigs at Opus …