Living with chronic acne and my Sotret experience

If you read through my blogs you will know how paranoid I am with my chronic acne condition. It’s been there since my preteen days and never quite left me. I could always relate to those commercials that had a pretty girl, with a forever surprising look, who wakes up every morning to new breakouts. That was exactly my story (except the pretty part) but sadly no OTC med could cure me of my breakouts totally. In subsequent days, I was made to believe that my acne will go away once I become older. However, things got worse over the years. Much later, a few years ago, my routine blood workup detected under active thyroid gland and low vitamin D level. I was started on Levothyroxine and on Vitamin D replacement.

My daily care routine to keep off acne 

And my pimple saga continues

Almost two years have passed since and I am doing fine except for the acne part. I can tell you it’s most annoying to live with something that makes your life less extraordinary. It’s not worth to live with a constant pain of not being able to get rid of an apparently benign medical condition. There must be a cure and I must see the end and I decided to see a dermatologist.

The first visit

The doctor heard me out. He sat through my ramblings, examined my face and asked for a few blood workups and started me on medication. These are new blood workup for me.

LH (Luteinizing hormone), FSH (Follicle stimulating hormone), Prolactin, Testesterone, TSH (Thyroid stimulating hormone)

He also started me on:

Mizoz ER (Minocycline) antibiotic x 1 month

D Acne Foaming Facewash

UV Acne Sunscreen

Deriva BPO Gel

Asked me to stop all kind of cosmetic and market products

Asked me stop all natural products (yogurt, honey, facepacks, eggs, besan etc.)

After 3 weeks of first visit:

I was feeling much better inside and out. The itchiness had reduced, the cystic pimples dried up. A few fresh bumps did show up but those were of harmless kind and subsided soon with Deriva BPO gel. The only disappointing thing - the acne had started to leave dark scars on my face.

On the second visit after 4 weeks

My doctor told me that I look better. My general pathology is reasonably good. Meanwhile I also did ultrasound to rule out PCOS and it was normal too. He then asked me if I am pregnant or planning to get pregnant because he wants to start me on a medicine called Sotret which pregnant women cannot take since there is high risk of serious birth defects. 

Sotret is Isotretinoin molecule prescribed for treating severe nodular acne and is supposed to be very effective with my kind of chronic acne. I was bit apprehensive but then I was willing to go to any extent to get rid off my acne. 

So, on the second visit I was started on:

Sotret 20 mg OD x 1 month

Emolene hydrating cream

So, he started me on Sotret 20 mg once daily and asked to drink profuse water along with it. With all the goodness Sotret comes with some noticeable changes and my side effects got prominent pretty soon. Within 3-4 days my face got noticeably tan, skin dried up, lips, throat and eyes were considerably  dehydrated. This is inspite of applying the moisturizing cream 2 times at least. I also started applying eye lubricant.

After 3 weeks of second visit:

I am on the third week of Sotret now and have not been too much cranky as many on Isotretinoin complain of. However the hyperpigmentation, dry skin and withered look continue to pull me down off and on.

My third visit is pending on the third week of July. Will keep you posted. 

My daily care routine to keep off acne

My whole life has revolved around one single medical condition and if you are curious it is that part of my life that I have been fighting since forever. Yes, this seemingly non serious medical condition, a.k.a acne, can have extraordinary effect on your skin and mind. I was in my pre teens, must be eleven or twelve, when my face saw a tiny breakout on my cheek for the very first time. It started in a benign manner and every other day I would count another one and then another and then another. I tried every single, over the counter medicine. I tried natural therapy and I tried grand mother's age old secrets. But my pimple saga continued.

Later in life, when I started working as a healthcare provider I dragged myself through several examinations like ultrasound, blood work up like thyroid profile, hormonal profiles, Vitamin D, B12 and other ilks. Apart from a high thyroxine and a low vitamin D level (which my doctor said needs minor tweaking) I was cleared of all other medical conditions. So, was it idiopathic? I am still trying to figure out!

More than twenty years and many seasons later, I still continue to have breakouts and have sort of accepted the fact that I will have to live with it forever. So, I try and stick to my own daily care regime. Treating acne is an arduous process and there is no real quick fix. So, continue to have patience.

1)   A clear and clean skin can do wonders. So, no matter how exhausted you are do not go to sleep without cleaning your face. I clean my face after work at home with medicated cleansing lotion . Sometimes when my face seems very dull and dry I use cleansing milk as well. I wash thoroughly with Acne Foaming Face Wash (salicylic + acicylic acid) later on. This medicated foaming face wash is anti bacterial and doesn't dry skin.

2)   Face toner is a must. I have started using toners after shower only recently. I refrigerate my rose toner and it feels great the whole day long. Skin toner has an astringent properties that closes the open pores and help fight bacteria and guards our skin.

3)   Do moisturize daily, sometimes two times even, so what you have oily and acne prone skin.. I use aloe vera gel to hydrate my face. (Hydration is an important part of keeping off breakouts. Drink sufficient amount of water and keep your body hydrated.) There are several good brands selling virgin aloe vera. You can grow it yourself as well. I have just stated growing mine. It grows fast and has an addon therapeutic appeal to the eyes. I use Emolene hydra cream occasionally.

4)   Treat the raw breakouts. I use benzoyl peroxide + adapalene gel on the fresh breakouts. I apply a just a dab on the breakouts and it works wonders. Just for the record, I have had a desperate delirium of importing benzoyl peroxide (Oxy 5) from the US and also had bought 6 packs (it was not even buy one get deal) when I visited the NYC. Deriva BPO gel is as good. I also use sandalwood paste mixed with turmeric powder and apply it on the pimple. It has a drying effect and soaks in the grime and oil in no time.

5)   Another very important thing is to apply UV protection on face, neck and exposed areas liberally. I use D acne SPF 40 +, anti acne, anti grease sunscreen cream.

To sum up, you need to upgrade your daily face care kit with some must haves and I want to pitch in mine. A cleansing lotion, foaming face wash, skin toner, aloe vera gel and a SPF cream. Following a daily care routine certainly helps in maintaining the much needed balance. It also helps in feeling good every day. Do try and keep me updated.

Note: I am also planning to see a doctor later this month for my acne. Will keep you posted with more tips.

Photo: Hedy Lamarr

You may also like:

And my pimple saga continues

Happiness in a storm

We have spent an inordinate amount of time figuring out the relationship between positive mindfulness  and its impact on our health, and today medical science has proven that positivism influences our brain cells and escalates our health. That explains why some patients with terminal disease live longer than others, or why with some people life seems easier than others. 

This is unarguably also the reason why my opthalmologist tells me to live stress free since negative emotion flares up health conditions. With each bout of stress my eye condition flares up and this leaves me extremely low and to a more stressful existence. Talking of which, now I know how my parents were being able to pull through extraordinary life circumstances inspite of being faced with some handsome health conditions in different phases of their lives. They have been fostering positive emotions all through, in the middle of all bizarre health crises and have had an extraordinary time fighting those.

The impact of positivist on health got reiterated only the other day ,when my boss, a renowned doctor himself, mailed me an article by Jane E Brody. "A Positive Outlook May Be Good for Your Health". The article wonderfully explains what happens to you when you are positive and sums up 8 skills to practice to stay happy and calm when your health is not going good. Quoting from the article:

An important goal of the training is to help people feel happy, calm and satisfied in the midst of a health crisis. Improvements in their health and longevity are a bonus. Each participant is encouraged to learn at least three of the eight skills and practice one or more each day. The eight skills are:

■ Recognize a positive event each day.

■ Savor that event and log it in a journal or tell someone about it.

■ Start a daily gratitude journal.

■ List a personal strength and note how you used it.

■ Set an attainable goal and note your progress.

■ Report a relatively minor stress and list ways to reappraise the event positively.

■ Recognize and practice small acts of kindness daily.

■ Practice mindfulness, focusing on the here and now rather than the past or future.

Why you need to confide in your doctor?

The power of good relationship between a doctor and patient is immense and the impact of this on treatment of diseases is extraordinary. The relationship can fantastically improve the mental health of a patient. A noncongenial relationship may lead to situations where the important health facts are missed making the diagnosis incomplete and misleading. As a patient you have to confide in your doctor, you have to ask him questions, share your problems and also sometimes take call of changing your doctor. It's simple, doable and a two way process. The compatibility factor is very important.

If your doctor shows you the door or cuts you short or is not keen on listening to you it's time you saw another doctor. No one in the clinic will ever going to tell you that your doctor is incompetent so you have to take the call. Researches have proved that the best doctors are not always the best relation makers. They have a signature tuning issue with the patients which could be attributed mostly to the lack of time.

On the flip side, this is true for the doctors as well. There are many instances where the patients visit a doctor just because the doctor is available, stays near his place or because his doctor in on leave. To top it, the trust factor is virtually zero. This is impeccably demoralizing for the doctor and may be considered as one of the many reasons why a doctor refuses a patient.

We cannot deny the fact that inspite of all the bad names that the profession has acquired over the years, the doctors are no better than a trapeze artist, trying to keep himself on the balance all the time.This probably is the reason why the doctors have to conduct series of diagnostics on patients who are supposed to undergo just a cataract operation! The evidence based on the clinical examination is not enough to keep a doctor off a suing. This is appalling but true.

Given such scenario, the relationship between the doctors/ medicos and the patients is of immense significance. It's not just about the doctor and patient but also about a whole league of medicos that constantly strive to strike a humane chord. An agreeable doctor-patient relationship enhances a lot of aspect that is not only medical but societal, economic, political etc.

Confiding in your doctor helps you immensely in getting the best medical help. Your doctor will tell you everything about the line of treatment that he is planning for you. You will be updated about your health issues very precisely. The transparency will help in eradicating many uncalled for hassles.

Once the trust factor is established your doctor will not go overboard with the tests and diagnostics. He will keep you in the frame always before conducting any test. If and when your doctor is convinced that you are not going to sue him he will be able to treat you more freely. Also, less and only justifiable tests will be performed on you resulting in less expense for your pockets.

Nothing like being able to confide in your doctor because he is the one who is supposed to know all about your personal stuffs. Once you know that your doctor is not going to divulge your profile you will find a friend in him. That should be the objective that every doctor and patient must strive for.

Photo credit ~ irishhospital

 

How to prepare yourself before doctor's visit and make most out of it

I have been meeting patients everyday for several years and have noticed that there has been a striking shift in the delineation of the patients. Patients are more involved, interactive and informed than the pre-internet days. Also, as much as we revere the profession of a medical practitioner, the role of a doctor has been most discussed and often criticized.  What a doctor should do and what he should not, how he should and how he should not etc. have put their lives on perpetual edge. We are quick in passing judgments about their societal and tangible roles as in rendering proper, timely and cost effective medical treatment.

However, how many of us are aware about our roles as patients? Are we doing our bits as patients? What are our duties towards a healthy doctor-patient relationship?

This article is research based and I would hope that reading through this will help you understand your role as a patient. Aside this, you will also find this article helpful in organizing your medical data and coping with your medical condition. So, how to make most out of your doctor's visit?

What  you must do

Take the usual dose of medication before seeing your doctor

If the appointment is in the morning time you should not miss any of the morning doses. This, especially, is relevant for the hypertensive patients who are on regular anti hypertensive medication. If he the morning dose of medicine it gets difficult for the doctor to alter and correct the dose of medicines. 

Carry all the medical documents along

You, as a patient should carry his medical file, even the ones that he feels irrelevant. Let the doctors decide on that. This would make the visit so much smooth. The doctor gets to know the history, the medical conditions, the past hospitalizations in less time. Besides, the risk of missing an important information is averted.

Carry the medicines you are currently on

The doctor would most definitely want to know about the medicines his patient is currently on. This also may help him detect the probable side effects that the patient might be having from a medicine. You, as a patient, should keep records of the previous treatment. inform your doctor about drug allergies, supplements you are on, sensitivity issues, past hospitalizations, other illnesses that you are being treated for etc. 

Nothing wrong in being internet savvy but choose your source smartly

With the advent of internet life has been so much easier. From battery to books to medical conditions to their treatment - most of us are now self educated medicos. This may run us into grave things that we may not be able to reverse. Internet is great but we must not feed ourselves on the unauthenticated sources of information. At the end of the day, only a doctor, you heard it right, only a doctor will be able to treat you right - not the internet.

Bring along mags, books, ipods etc.

You should not equate visit to a doctor with visit to a friend's or with visit to the super market. You should come prepared with the probable waiting times. Let's face it - doctors are supposed to run into emergency anytime. 

Consider involving your friend/ spouse/ parent

Come along with someone with whom you are comfortable and may disclose your personal stuffs. Sometimes, patients are unwilling to share medical history with the doctor that may have played an important role in the diagnosis.

Speak up and ask

Feel free to ask questions to your doctor. You should know about your health conditions and what your doctor is planning for you. Ask about the medicines, plan of treatment, diagnosis etc. Also, make sure you can read your doctor's hand writing. Else you can ask for a typed/ legible prescription. 

What you must not do

Know your conditions and health issues. Respecting the value of time you should come prepared with all the questions you want to ask your doctor.  Also, keep in mind that not all doctors want to be asked. So:

D not interrupt your doctor. Value his expertise.
Do not take calls in between. Do not get distracted by your gadgets. Switch off your phone and gadgets before entering doctor's office
Do not digress too much. Come prepared with the questions that you want to ask your doctor. So, be very precise and crisp and choose your questions wisely.
Do not be repetitive. Some doctors do not indulge in too many questions. Keep it short and specific.
Do not pad your queries. Be open and matter of fact.

Do not record the session with prior permission. Do ask for permission. Else, most doctors going to shoo you off.

PS: I work in healthcare facility for more than ten years now. 

You may also read:

A guide to various heart conditions: Know your heart

What to ask your doctor before coronary angiogram

Photo credit ~ AMD

How well you know your heart: A guide to various heart conditions

Today, everyone is familiar with the term ‘heart disease’, but not everyone is conversant with the spectrum of diseases related to the heart. What commonly referred to as heart disease is actually a bouquet of heart conditions with some connections and many differences. Heart ailment is a terrible thing to dwell with. It’s dreadful. As much as it sounds bizarre, it is heart-warming to know that this petite fist size organ can manipulate all rhythms of our lives. As a heart patient, caregiver, conceivable candidate for heart disease, as a healthy person we must initiate to know more about the most beautiful part of our body that works sequentially 365 days, nonstop.

Heart disease talks may get intimidating more so for a non-medic like me. Having said that, I have tried to demystify it, and so this article happened

Angina, atherosclerosis, heart attack

We come across many people who often say that they are having angina. What is this angina? Angina is simply chest discomfort, fullness, irritability that is caused by reduced blood flow in the body. Arteries are channels that supply blood with oxygen in the body. Arteries get clogged and taper due to calcium and fat deposits from bad food and sickly lifestyle. People with unstable angina show signs of discomfort on chest, neck, arms and even stomach and need to get immediate medical help. Since our whole body is like a fish bone array of arteries, they may get clogged elsewhere also. Likewise they are referred to as cerebral (brain), pulmonary (lung), peripheral (limbs), renal (kidney), carotid (neck) etc. These are all cardio vascular events. Heart attack (MI - myocardial infarction) happens when an artery is clogged completely (100% occlusion). Heart attack is a life threatening condition. After heart attack (if not treated immediately) the area gets dead requiring extra effort to keep other areas of the heart healthy.

Arrhythmias

Some people suffer from arrhythmias. Arrhythmia is abnormal irregular heart rhythms caused by erratic electrical system in the heart. Heart may go slow, race, skip etc. They can cause a variety of symptoms like dizziness, fatigue, shortness of breath, blackouts, fainting and palpitations. Arrhythmias may feel like flutters in the heart and is a very disturbing feeling. If left untreated, arrhythmias can be life threatening. There are different kinds of arrhythmias, like, VT, SVT, AF (AFib), tachycardia, bradycardia etc.of which only your cardiologist can guide you with.

Heart valve disease

Heart valves are shafts that control the flow of blood in one direction only. The valves lie at the exit of each heart chamber and maintain one way blood flow without leakage. It is important that I go into little details here. It took me many years to understand how heart valves function but it is not that complex after all.

The heart has four chambers. Right and left atria and right and left ventricles. Blood flows from right and left atria into your ventricles through the tricuspid and mitral valves. When the ventricles are full, the tricuspid and mitral valves shut. This prevents blood from flowing backward into the atria while the ventricles contract. As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles. Blood from the right ventricle passes through the open pulmonic valve into the pulmonary artery, and blood from the left ventricle passes through the aortic valve into the aorta and the rest of the body. This pattern is repeated over and over with each heartbeat, causing blood to flow continuously to the heart, lungs and the body.

Heart valve disease can develop at or before birth (congenital) or can be acquired sometime during one's lifetime.  Children often acquire inflammation of the valve, holes in the heart (ASD, VSA), etc. which sometimes remain undetected until adulthood. Valve disease is mostly caused by untreated rheumatic fevers caused by bacterial infection in childhood. Valve problems are characterized by weakness, extreme lethargy, shortness of breath swelling of ankle, joints, feet. .

Heart failure

Heart failures are extreme conditions when our heart slows down and fails to pump good blood to the whole body. Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body's needs for blood and oxygen. This can be due to thickening (hypetrophic cardiomyopathy), restricting (restrictive cardiomyopathy), enlarging (dilated cardiomyopathy) of the heart, heart muscles or the heart sac. Heart failure is a serious condition that needs long term treatment and in many cases inspite of optimum medical help patients do not survive.

Heart conditions are triggered by uncontrolled blood pressure, chronic diabetes, kidney disease, high levels of bad cholesterol (low HDL), unhealthy eating habits (binge eating and excess sugar, high carb and less nutrient dense diet), smoking, obesity, sedentary and erratic way of life. Although by modifying these we may achieve a heart safe body, we can never be sure.  

Photo credit ~ irishfoundation

What to ask Your Doctor before Coronary Angiogram?

Coronary angiogram is a complex yet arty procedure where the cardiologist dexterously inserts a narrow tube called catheter through the femoral/ radial artery with plastic introducer sheath. The catheter is guided through the artery into the heart and then dye is injected into the artery. The dye flows through the artery to the heart and stops or goes slow at the clogs in the heart arteries. The percentage of block is asserted by the cardiologists. This whole process is monitored through a highly defined x-ray machine managed by specialized technicians. As much as it sounds easy, coronary angiogram has immense risks attached if not performed by specialized team.

This article will give you insight into the urgency of the procedure or if at all you require it or if you will benefit from it or not

How important or necessary is this test for diagnosis?

Angiography is an important procedure that confirms the ailment. It's just an invasive diagnostic that help the doctors decide on the treatment thereafter. The urgency and the immediate need of the procedure can only be decided by the consultants, who will be knowing the degree and the importance of the procedure.

When is it done?

Doctors recommend angiography when you are symptomatic of pain in your chest, jaw, neck or arm (that can't be explained by other tests), unstable angina, a heart defect you were born with, a heart valve problem that requires surgery.

What to keep in mind before angiogram?

If you:

Are allergic to iodine dye used in the test

Have ever had a serious allergic reaction

Have asthma

Are allergic to any medicines

Have any bleeding problems or are taking blood-thinning medicines

Have a history of kidney problems or chronic diabetes

What will happen during the procedure?

During a coronary angiogram, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The x-ray machine rapidly takes a series of images (angiograms), giving a detailed look at the inside of your blood vessels and the heart.

What are the risks?

Most of the times, major complications are rare. However, potential risks and complications include: heart attack, stroke, injury to the catheterized artery, irregular heart rhythms, allergic reactions to the dye or medications used during the procedure, kidney damage, excessive bleeding, infection, blood clots, radiation exposure from the X-rays

What does it reveal?

An angiogram show doctors what's wrong with your blood vessels. It can:

Show how many of your coronary arteries are blocked or narrowed

Locate the blockages in your blood vessels

Show how much blood flow is blocked through your blood vessels

Check the results of previous coronary bypass surgery or stenting

Check the blood flow through your heart and blood vessels

Check the size and movement of the heart valves

Based on the results, your cardiologist decides on the treatment from which you would be optimally benefited. For instance, that you would benefit from having coronary angioplasty, bypass surgery, valve replacement or just medical management.

Bunions and Heel Spur: Two painful feet conditions

The two terrible feet conditions that people often suffer from are heel spur and bunions. Both are inexpressibly painful and are persistent so much so that it becomes hard to get rid of them. 

Calcaneal spur, commonly known as heel spur, is the in-growth of the calcaneal (heel bone) mostly due to deposit of calcium. Bunion is a foot condition where the big toe bends towards the second toe forming a sharp bony prominence. Pains, from mild to severe, are caused by the inflammation and the bone pressing against the shoe.  Bunions are more common in women and are caused by a number of reasons, including wearing shoes that are too tight, years of abnormal motion, poor foot mechanics, bone deformities, flat feet and arthritis. However, common to both feet conditions are our body weight. Obese people are more prone and it’s generally reported that being overweight is an aggravating factor.

 Symptoms of heel spur:

Excessive continuing pain on putting your heel flat

On slow and less walking it decreases temporarily

On fast walking, jumping, carrying weights the pain increases

Treatment:

Stretching exercises

Losing body weight

Wearing shoes that have cushions, heel cradle and heel cup all over and absorb shocks

R.I.C.E therapy

Symptoms of bunions:

Moderate to severe pain on walking

Bony growth of the big toe

Big toe bent towards the other toes

Both feet usually affected

Treatment:

Choose shoes with roomy toe box, cushioned cradle and padding all over to accommodate the bony prominence.

Losing body weight

R.I.C.E therapy

Surgery is an option when conservative treatment fails and you have chronic pains.

What is  RICE-(M)?

R – Relative Rest

I – Ice

C – Compression

E – Elevation

M – Motion

Chuck the High Heels now

High heels make you look sassy and elegant and make you feel fantastically beautiful. Having to wear, balance and walk comfortably in high heels, is an art in itself. Wearing them is at the discretion of the individuals, and being aware is another thing. The effects of wearing habitual high heels are slow but could be severe at some point and it varies from individual to individual.

1. Back, feet, legs ache: constant wearing could lead to chronic lower back pain and muscle sprains which could lead to severe injuries and bone shortening, ligament and cartilage tearing and knee injury.

2. Spine stress and posture defect: Wearing high heels regularly could deform the spine and affect the posture by dis-balancing body movements.

3. Bunions and severe feet condition: High heels lead to unhealthy feet and legs leading to conditions like bunions, in growing toe nails and other severe conditions that might require surgical intervention.

4. Restricted blood circulation: In some cases they may lead to constricted blood circulation leading to unhealthy nervous system.

6. Mental imbalance: In rare cases, it's been found that the mental health has been impaired to certain extent.