Tag Archives: Psoriasis Treatment

PSORIASIS BLOG – Defending The NHS

Warning: whilst this blog is never especially funny, this entry is especially not especially funny. It does have a slight dig at someone from the telly though, in an attempt to prove how hip and relevant I am.

The NHS is getting a lot of gyp at the moment, from the usual suspects. I am sure it is not perfect and I have had bad experiences at its hands, but the critics are hardly agenda free and so I feel compelled to redress the balance in my own humble corner of the internet.

 

Wayne Deakin - excellent Aussie comic and fellow dermatological disaster area
Wayne Deakin – excellent Aussie comic and fellow dermatological disaster area

Having met psoriasis sufferers from  other countries I’ve benefitted from several reminders of just how damned lucky I am to live in this fair isle. Helen – The Flaky Fashionista – is from Ireland as has hand to fork out for every cream and every UV session. The latter were over 40 quid a time – I had to have it three days a week for about three months. I have to tell a lot of jokes to earn that kind of money. Talking of jokes, my fellow comedian Wayne Deakin and I bonded over our shared assignations with this red mistress of the skin – I worked with him this weekend in Liverpool and we compared patches. In Australia he spends about $240 (about £120) a time on tubes of cream to treat an outbreak. You’ve seen the coverage on my body. In his position I’d need to get a bigger boat on which to tell and awful lot of jokes to a group of lottery winners with money to burn.

The most moving encounter I had in this regard was at a Doctor Who convention in Chicago last year when a gentleman left my show – My Stepson Stole My Sonic Screwdriver – because he hadn’t know about its psoriatic content and it messed with his head a bit. He came to apologise (which wasn’t necessary) and told me his story. His partner clearly loved him but there was a lot of pain there for both of them. Whilst she and my wife shared their experiences I listened as he explained how the condition had led to him losing work and so his medical insurance no longer covered him and so he couldn’t treat his severe condition. The doctors under whose care we was under stopped looking after him when he no longer had the requisite resources. And I thought Leah from The Apprentice was as cold a doctor as you could find. As a result this poor fellow was now scarred physically and emotionally and was not in a position to secure much work. A ridiculous, callous self perpetuating situation which left him feeling helpless and in a huge amount of pain.

 

 

The NHS, like the BBC, is generally envied trhoughout the world: those that seek to dismantle either have an alarming agenda.
The NHS, like the BBC, is generally envied trhoughout the world: those that seek to dismantle either have an alarming agenda.

And me, here in the UK? I pay prescription charges – a fraction of the money paid by anyone above for the huge variety of treatments that I have outlined in this blog. I am a self-emplyed itinerant player, the kind of figure I would need to match what my fellow flakies have to fork out is beyond my reach. The extensive and dogged campaign my condition has waged on my skin for the past 25 years would have required a serious finanacial investment, just so I could not endure excruciating pain and emotional shame every day. I’m surely a better citizen when I’m not like that? Had I had to practically bankrupt myself to maintain my treatment I probably would have given up – not because the condition is bearable, but because psoriasis sufferers allow themselves to go through much more than they actually should because what we have isn’t life threatening. For many years I endured an unecessary level of physical and mental discomfort because I thought that was my lot in life – it was only when the specialists at the Royal Free told me that I absolutely didn’t have to live like that that I was made aware that there was much that could be done and treatments which could have an effect I had hitherto only dreamed of (and that I didn’t have to pay for them).

Had that not happened, and had I neglected my treatment for financial comfort, I almost certainly wouldn’t have been able to work, so would have been a drain in the state rather than a taxpaying contributor to it. And to be perfectly honest, the level of agony that would have resulted from a cessation of my treatment, and the anguish that would have accompanied that … I’d have probably topped myself. And I don’t mean that metaphorically.

And that wouldn’t have made anyone laugh.  I know I don’t contribute much to society, but I like to think that my continued presence on this Earth is worth something to some people.

And if that is the case, I have the NHS to thank.

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 – Treatment Update 10

Treatment Update 10

22/1/2013 – 5/2/2013 (2 visits)

camembert
“It’s all my fault,” said the evil but deliciously oozing cheese and cholesterol level alarmist.

OK numbers fans – my cholesterol is down to 6.8. Still higher than it should be, but nowhere near the alarming levels it was at just after Christmas. Good news for my blood, bad news for whisky and Camembert fans (both of which I consumed in abundance over Christmas).  My liver is totally back to normal (even I can’t deny that not having a drink since January 5th might have contributed to this in some small way).

According to Dr McBride lots of psoriasis patients drink a lot, and even those that don’t can get a fatty liver common amongst boozers, which is something that we have been monitoring. That said, I don’t have to have any bloods taken next time – the reason for my regular donation of plasma recently is to see if the ciclosporin is up to no good in my system. It raises cholesterol amongst other things: another reason to wean me off it. Further impetus comes from the fact that when dosage drops between a certain point (a different place, dependent upon the reactions of each individual patient) it stops working altogether and is fairly pointless. Down to 50g morning and night then, with a view to getting rid of it completely. As a result my arms are a bit sore and red, particularly the underside just around the elbow.

As all these psoriasis drugs seem to have some kind of side effect I ask Dr McBride what I might expect if I react badly to adalimumab. She rather coyly says that she’s not telling me, which is quite alarming: what could she be alluding to? Might I become Dr Hadoke and Mr Hyde: by day a bumbling, slightly grumpy man who can never find his Oyster card, and by night a rather bumbling, grumpy man who can never find his Oyster card and so kills people? Watch this space. What she does tell me is that it can leave on open to infection, hence the rapid reduction of the immuno suppressing ciclosporin. The combination of the two could leave me as open to infection as (insert name of crap football team here)’s  goal is to, um, letting in a goal.

Science-wise, I had some stuff written down about adalimumab and TNFs.  I wasn’t sure I had quite grasped what the latter was, even though I knew they were something that I had unusually high levels of, so I have asked Doctor McBride to tell me in her own words. “It’s TNF Alpha, which is Tumecrosis Factor Alpha which is raised in psoriasis. It’s an inflammatory mediator which is raised in psoriasis but also raised in depression. Sometimes when we treat people who are depressed with anti TNFs  then their mood lifts but it’s not across the board and occasionally when people take anti TNFs they can get depression. “ So there you go.

salad
“What’s that?”
“The rest of your life mate.”
“Looks a bit dull – can’t I add anything nice to it?”
“Nope”
“Oh.”

 

So, to the layman, in treating the skin adalimumab also has an impact on reducing levels of anxiety. This helps with suppressing the desire to use alcohol as an escape – not just alcohol actually. We use anything:  psoriasis suffers tend to eat a lot, smoke, drink and not talk about our emotions. We’re a dermatological jigsaw with many fractured pieces that need putting back together rather carefully.

February appointment – addendum. Good and bad news by my latest visit – cholesterol back up (7.9 – I have not been looking after myself; not Camembert but Fish and Chips and Curry) but I am now off the ciclosporin. My arms are still not looking too clever and my face and scalp need constant attention, but the rest of me is pretty good (relatively speaking). Upon my return to the hospital I will be subjected to my 16 week assessment with both Dr McBride and adalimumab wrangler Nurse Annie to see how well I am responding. Hopefully it’ll be good (though I won’t be allowed Fish and Chips to celebrate – maybe a pint of salad or a shot of cous cous .. Oh, I love being old and ill).

PSORIASIS BLOG – Treatment Update 9

Treatment Update Nine

Mid-January 2013 (various dates)

This is a summary of various visits which might be a bit jumbled as I didn’t keep especially good notes and have been in nearly every week.…

 

assets_Images_projects_Royal Free Hospital_RoyalFreeHospital-2.jpg.40f6e983dbf7b1917df0804023e1653c
The Royal Free Hospital ; not so named because Prince Charles and the Queen aren’t allowed in.

Before going in to see Dr McBride there are various things I have to do. I don’t know what they test my urine for but they didn’t rush me into hospital so it must have been quite splendid wee. They also check my weight (a tad over what I’d like to be) and blood pressure (no idea why, but I don’t like having it taken; it feels like my veins are about to burst).

I am a few weeks into my biologics treatment, and being monitored as a result of my breakdown, so Dr McBride is seeing me every week (during one check-up we have a very surreal conversation about one’s “inner chimp” … you had to be there*). Dr Mizara was away for a bit but I had a session with her when she came back which was extremely useful. I am being weaned off ciclosporin too (75g morning and night). Early in the month my cholesterol has gone up to an all-time high of 8.9 which really needs addressing. I can’t go on statins until I’m off ciclosporin as they seem to have an Israel/Palestine thing going on. I have to start the ball rolling with my GP though (place your bets now as to whether I have got around to it before the next blog). Also, my liver’s up a bit. Wonder why that could be? (Christmas Time, Mistletoe and Wine … and then some more wine … and perhaps a little more)

The reason that Doctor McBride is seeing me weekly at the moment is, I think, to ensure that I don’t start dribbling or talking to a hat (see previous blog). As ever she takes time to talk and give me insight and understanding. She and her team were fabulous over Christmas when I was in real need of help, and the aftercare is very effective. Anyway, I’ll concentrate on the purely medicinal side for now, as I think regular readers will be pretty clued up as to the gold standard TLC I get from all of the team at the Royal Free Dermatology unit. Their absence from the New Year’s Honours list was notable.

On a later visit my PAASI score is good, which is something. Another positive is that I seem to be responding well to the adalimumab. I only had my blood done before my appointment so we didn’t have the full results but the general analysis is OK. I will have to wait for the specifics. Skin-wise I’m pretty clear and people have commented on the brightness of my face (without prompting). I have had a slight outbreak on my arms around my elbows so that needs monitoring, but as far as my pink body armour goes, this is something of a giant leap. My scalp, as ever, remains incorrectly proportioned as far as the hair:scurf ratio goes. There’s a little patch of dry skin on my back but otherwise my trunk is free not only from plaques but also that reddish discolouration that is usually here reminding me that even when I’m in remission a potential outbreak is never far away.

images
I’m the human equivalent of this apparently. Twice.

Dr McBride says that I look healthy – if I was a dog I’d have a nice wet nose. Ah. Yes, regular readers, you’re right. She has said that once before. Suddenly I am reminded that though the team here remember our names and are conversant with our history and individual problems, they do not hang on every word spoken during our sessions (we on the other hand, do). I am one patient of many on just one day. They see patients on other days. I generally go once a month, so in addition to my Tuesday there are another three per month where a constant stream of disparate patients occupies my seat. So of course Dr McBride doesn’t know that she’s used that metaphor on me before. I know though, and ruefully note how effective the caring side of this process is because it’s just one tiny, isolated moment where I realise that I am not as special as I like to think. I suspect most patients with most illnesses feel that all the time as they negotiate the medical treadmill. Brilliantly, of course, as I mull this over later Dr McBride e-mails me out of the blue. The full analysis of my bloods is through, and she thought I’d probably like to know now, rather than wait until next time, that they have shown significant improvement since my first visit this year. She didn’t need to do that, but obviously knew I was a bit concerned so took a moment of her own time to reassure me across cyberspace.

I feel all special again, which puts a bit of a spring in my step. My nose feels a little wet too.

*I will blog about this at another time – Dr McBride has been reading a book called The Chimp Paradox which is useful for psoriasis sufferers. It helps us gain some understanding about the mental processes we go through that prevent us from having a stress free life.

 

Psoriasis Blog – Guest Post

Guest Post

A nice lady from across the pond called Katie Brind’Amour has been in touch and asked if I would print an article in this blog about her psoriasis-related work. I am not one to deny my – ooh, tens of readers any avenue to psoriasis treatment and and so who am I to say “no”? I do not know Katie and cannot personally endorse her work, but I share the information because … well, because she asked nicely. Here it is (with apologies for the American spellings :)):

Making a Move on Your Psoriasis—at Home

Many individuals with psoriasis are no strangers to home remedies or alternative therapies. Others are so desperate for symptom relief that they would bathe in a tub of mashed potatoes and tapioca pudding if someone told them it could clear psoriatic patches of skin. But which at-home treatments really have some evidence behind them?

Slather on Some Homey Goodness

Perhaps one of the most familiar methods for self-treatment of psoriasis is a topical cream or ointment. Instead of searching for the best dye-free, scent-free lotion since sliced bread, opt for a new topical option: oils. To be sure that none of your new home-based therapies for psoriasis interfere with other medications or ointments you may be using, check with your healthcare provider before making changes.

Fish oil (from over-the-counter supplement capsules or bottles) applied directly to the skin may help reduce inflammation and itching for some people. Olive oil or vegetable oil may also be massaged gently into the skin—including the scalp—to try to reduce scaling and improve moisture retention in the skin. Skin and hair products with tea tree oil may also help alleviate scalp psoriasis.

If oil doesn’t provide relief, consider a regular oat, Epsom salt, or Dead Sea salt bath to relieve redness and itchiness. Creams with aloe, capsaicin, or mahonia may also help stop pain and inflammation, although more research is still needed.

In addition to non-irritating lotions and oils, opt for cleansers, body washes, shampoos, and other hygiene products with as few added colors, scents, and chemicals as possible. Some individuals with psoriasis are sensitive to additives in topical products, especially during outbreaks. The natural minerals found in hard water may be helpful for skin integrity, as well, so avoid using a water softener if you have one.

Eat, Drink, and Feel Merry

Oral supplements and a psoriasis-friendly diet also provide some people considerable relief from the woes of psoriasis.  In addition to some of the topical treatments mentioned above, oral option for psoriasis treatment do exist outside of the pharmacy.

Consider a few simple supplement options. Popular helpers include omega-3 fatty acids, turmeric, milk thistle, and vitamin D. Some of these may relieve inflammation, calm redness, and reduce the frequency of outbreaks, but the effects vary from person to person. Always check with a physician before adding an oral supplement to your care plan.

If you’ve got the gumption to go beyond a daily pill, think about a more holistic change. Revising your diet to be a customized home-based treatment for psoriasis may be your literal “meal ticket” to a healthier you. Be patient, however—it can take up to three months for dietary changes to really work through your system and create a significant change in your psoriasis symptoms.

Firstly, have your doctor check you for food allergies and sensitivities. According to the National Psoriasis Foundation, as many as 1 in 4 people with psoriasis may also have a gluten sensitivity or allergy. If you have an undiagnosed problem with a specific food or food group (like dairy), some of your psoriasis symptoms may be a direct result of repeated exposure to the food. Immediately eliminate any allergens; observe changes in your symptoms over the next three months. If nothing seems to improve, try reintroducing them one by one to your diet to see whether they make your symptoms worse.

If you would rather focus on what you can eat instead of what you can’t, opt for a balanced diet rich in vegetables, fruits, lean protein, and whole grains. Depending on your other health needs, consider targeting a heart healthy, anti-inflammatory, or low-fat diet. No matter your choice, consider finding a regular place in your diet for cranberries, fish, nuts, chocolate, soy, leafy greens, mangoes, squash, and other foods that are naturally rich in antioxidants and valuable nutrients.

Building Your Own Treatment Regimen

After you have identified the most effective topical treatments and diet for your individual symptoms, consider upping the ante (without spending money). Exercise therapy can be highly effective for some people with psoriasis. In addition to increasing your sun exposure and offering a wealth of benefits to your entire body, exercise can promote range of motion and relieve swelling and pain for those with psoriatic arthritis.

Regular exercise (aim for five times each week) can come in a variety of forms. Find the most enjoyable option and make it fit into your schedule—no excuses. Great options for beginners include walking, swimming, stationary cycling, yoga, tai chi, and badminton. Stretch before and after each workout as well as throughout the day, particularly if you have arthritis. If your psoriasis limits the activities that are comfortable for you, ask a health professional or trainer for advice on finding a safe activity for you.

Collectively, a home treatment plan that you maintain and alter as necessary may be your ticket to clearer skin and fewer attacks. Home-based therapies can be at least as important to your health and recovery as pharmaceuticals, and may even enable you to use fewer pharmaceuticals in the long run. Pay attention to your symptoms, track your progress, and make your at-home therapies the answer you’ve been searching for!

 

Katie Brind’Amour, MS, is a Certified Health Education Specialist and freelance health and wellness writer. She enjoys writing about the importance of diet and lifestyle in management of chronic health conditions and is slowly chipping away at her PhD in Health Services Management. Katie also blogs for Women’s Healthcare Topics and loves finding excuses for sneaking dark chocolate into her daily diet.

 

 

 

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 …