Tag Archives: Dovonex

Psoriasis Blog – Treatment Update 12

Treatment Update 12

General Notes Dec 2013 – Feb 2014

You never write, you never call.

You’re correct, I haven’t been, even though things have being happening for the undoubted Dermatological Disaster About Town that I am. I’ll update about a couple of events I have been to shortly, but if you’re in Manchester towards the end of April there’s going to be quite a lot going on. At the moment it just says “Psoriasis Thing” in my diary – hopefully more enlightening info will make its way out soon.

Anyway – treatment continues. I’m still coming away with a full bag from the chemists (so may I heavily recommend the yearly £104 prescription pre-pay thingy? It’s saved me a fortune). I still have Pro-Topic for that stubborn bit on my face which lurks under the surface and occasionally sprouts up requiring a quick splurge which sends it packing really quickly. Having had awful, livid, stubborn, painful and embarrassing scales on either side of my nose for most of my 20s when I should have been all young and handsome, I really should remind myself now and again of how miraculous a change this simple application has been (and it was only prescribed once I was seen by Dr McBride at the Royal Free – provking a faith in her which I retain to this day).

2014-01-14 21.40.44 HDR
Bandages and hat to stop Sebco messing up the sheets. Who wouldn’t want to go to bed with that? He smells of coal tar too, you say? Sign up the whole of womankind for that heady combination…

My knees are a little red in places but my arms are the worst. They’re nothing like they were though and a consistent regimen of applying Doublebase moisturiser to my face and arms morning and night keeps me flake free even if I am a little pink when you look closely (but if you are, I’ll be certain to ask you why you’re doing it!). I have a tube of SebCo (I’ve done the “it’s the most Olympian of all the psoriasis ointments” joke already, surely?) which requires a bit of discipline – application to my arms and scalp overnight for a week. I had a go at this last month and it really did help – especially with my persistently dusty scalp. But the tube burst and so when I squeezed it came out of both ends – it’s bad enough having tar smelling goo on my body (I have to wear special bandages and headgear to protect the sheets) but I don’t want it all over the carpet. So I have a new tube which I will squeeze more carefully, but that means I need a week at home really. I don’t want it exploding in my bag.

My bloods in december were the best they have ever been – so good in fact, that Dr McBride had to look them up as they hadn’t (as is normally the case) been sent to her due to all the abhorrences and anomalies they usually contain. Liver function (the one affected by booze) was the healthiest since records (i.e. my Royal Free medical notes) began. You’ll be surprised to learn that I celebrated that good news by having a very convivial Christmas and have continued with indulgence and bad habits ever since. So my next ones will probably be awful (I was too close to my appointment with the last lot so won’t get the results till next time). We’ve been here before haven’t we?

If physically I have been found wanting, mentally things are looking a lot better. Dr Mizara has been great a providing perspective and coping mechanisms so we have started to review the progress I have made under her and to stagger our meetings a bit so I am seeing her with less frequency. I will blog separately about psoriasis and mental health as it deserves a bit of proper explanation.

In the meantime, I am still injecting myself with adalimumab, which I make far too big a deal of apparently. I think I am being all big and brave (I’m stabbing myself and I have a big, scary looking industrial bin thing to put my used needle-pens into) but my better half just guffaws. Still I feel big and brave and imagine its the sort of thing Rambo would wince about if he had to do it. I’ve got the double whammy of Nizoral and Coal Tar shampoo which, like everything else, is a good combo if I am disciplined but an itinerant lifestyle and slapdash nature mean that I occasionally get caught out and regret not wearing beige. So I am not, therefore, convinced that the Dovonex Scalp Application is doing me much cop but I am slapping that on, and sometimes the Exorex Coal Tar lotion as well because it’s better to be belt and braces innit (though in my case it’s Belt, Braces, Safety Pins, Piece Of String Tied Round The Waist and Unpleasant Smelling Industrial Trouser Keeper-Uppers That Have To Be Applied Twice Daily And Still Might Not Keep Your Trousers Up Entirely).

I have taken a course of Erithromycin as I was sunning quite throaty and would have been a bit susceptible to streptococcal throat infection from a long flight and a weekend in an LA hotel, and am now back on the preventative Cefalexyn. I am a bit worried about the fact that I have to keep knocking back antibiotics and must as Dr McBride about it next time. It doesn’t seem natural, but of course a strep throat infection is a trigger for a massive outbreak so I want to be avoiding one of those at all costs.

In summary then – General Synopsis: no pain, occasional dry patches, lots of medicine. Forecast: I need to lose a bit of weight, do some exercise, and be more disciplined with my medication.

Cue David Byrne – “Same as it ever was, same as it ever was”.

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).