As some of you may recall, I've been on methotrexate since 2008. However it was helping only partially and I was suffering from side effects. Reducing it didn't go so easy, as my body reacted to the lack of drug - the atopic all came back, full-blown with edema around the eyes, scratching all the time, the works.
Prof. B, when he saw me, said I should go back to the methotrexate. But he also knew I was in USA and he pulled out a name of a famous doctor from Oregon. Dr. HN was a pioneer in the field of atopic dermatitis and has seen it all. We decided to go.
Dr. HN's treatment was nothing I'd ever heard of. He took all my bath oils out ("You might've developed contact dermatitis") and made me bathe in plain water. Immediately after the bath, while the skin wet, I applied a steroid cream (betamethasone) on the entire body - including face(!). I did this twice a day for two days.
At this point I was willing to try anything so I gave it a shot. Believe it or not, it worked. The skin was nearly entirely clear at the end of those two days. Once that happened, I started tapering the creams (with Dr. HN's instruction) down to once a day, every other day, and so on until I now put it on twice a week. The face, neck and breasts get protopic (a non-steroidal, immunosuppressant cream), also twice a week.
I also added UV therapy, on which I won't write today.
Bottom line - my skin is clear, without systemic pills that kill my liver and who knows what else. While I'm not thrilled at the thought of putting steroids on, at least I'm treating where it hurts - the skin. And it's working! It's been four months now and my skin is clear as can be (except for my scalp - that's a matter for another post).
Saturday, June 5, 2010
Wednesday, September 23, 2009
The real deal: products I actually use
After years and years of testing, I'm bound to have some insights of my own, right?
Another moisturizer I recently discovered is Neutrogena's "Norwegian Formula: Moisture Wrap Body Lotion". This one helped me out of a tight spot, or rather, a red spot. I had a redness that wouldn't go away, and this one helped it disappear. This came at a cost, though - the skin was flaky when I finished, so take note.
Type-Specific Creams
Well I do. And here they are in front of you.
Please note I am not paid by any of these products/companies to endorse them.
Please note I am not paid by any of these products/companies to endorse them.
Moisture Creams
My baseline, the best of all and most used by far, the one off of which all else is tested is the one and only Vanicream. This is your all-purpose moisturizer. I use jars of it. I use it twice a day for my entire body and carry it with me at all times (in a much smaller container, though). It basically has practically nothing to irritate your skin - the label says: "Free of dyes, Fragrance, ..." and so on. I use it because it's the best. In years of testing I've never found anything better than Vanicream for pure moisturizer. The only one that I've ever substituted for this is Eucerin, specifically Rambam's hospital-brewed version with extra olive oil.
Now, for some variety I use A-Derma's Exomega emollient cream ("for face and body"). It's good for flaky skin, as it seems to expedite new skin growth. I don't use it at all times but keep it in my closet for those flaky skin patches that tend to show up every once in a while.
Another moisturizer I recently discovered is Neutrogena's "Norwegian Formula: Moisture Wrap Body Lotion". This one helped me out of a tight spot, or rather, a red spot. I had a redness that wouldn't go away, and this one helped it disappear. This came at a cost, though - the skin was flaky when I finished, so take note.
Type-Specific Creams
I always keep a couple of prescription steroidal creams handy. These are good for rashes, scratches, and any nasties of that type.
Another type of cream I like to have is something containing Calendula, and I use it for rapid-healing of scratches or open wounds. It's amazing how fast these work. Right now I use Weleda Calendula Baby Cream, but pretty much any Caledula product will do the trick.
Finally, I keep an antibiotic cream handy for the folliculitis, or other infections that tend to cling to the skin.
Bath Products
I use a combination of two products for my bath: Balneum Hermal and Emol. Emol has a small bit of soap in it which helps keep infections away. I use a mix of 1:2 - 1 measuring cup of Balneum for every 2 cups of Emol. However, while Balneum is available from Canada, Emol is not to be found. I'll let you know what I find throughout my new tests...
Another type of cream I like to have is something containing Calendula, and I use it for rapid-healing of scratches or open wounds. It's amazing how fast these work. Right now I use Weleda Calendula Baby Cream, but pretty much any Caledula product will do the trick.
Finally, I keep an antibiotic cream handy for the folliculitis, or other infections that tend to cling to the skin.
Bath Products
I use a combination of two products for my bath: Balneum Hermal and Emol. Emol has a small bit of soap in it which helps keep infections away. I use a mix of 1:2 - 1 measuring cup of Balneum for every 2 cups of Emol. However, while Balneum is available from Canada, Emol is not to be found. I'll let you know what I find throughout my new tests...
Why America needs a health insurance plan or how to choose a health insurance
This one is a guest post by G. Enjoy.
You might be lucky. Then, your employer will pay for your health insurance. It might even be a good health insurance. Of course, there is a down side to it. Once you are fired, or downsized, not only your credit is severed, but your health insurance as well. If you are fired, you are not allowed to be sick. So don't quit your day job, since you'll loose your health insurance.
But I am not lucky. I need to have health insurance on my own. For that, I need to learn which insurance is the best for me. True, my Ph.D. is in communications, but I can do some research. There are just a few things one needs to know. Deductible, co-payments, eligibility and few others. So I am off for the races. My wife's health insurance is not good enough. It only has 30K annual return, and I must have 50K. No go. Furthermore, my wife's insurance costs about 300$ a month for me. It has some good sides. It gives 100% coverage and all pre-conditions I have.
I am lucky. I do not have any pre-conditions. I am as healthy as an ox. If it is healthy. So I need to look for insurance. My university recommended a company. Let's look at it. No deductibles. That's great. I think. I am not really sure. Then again there is a 93$ payment every month. That's expensive, right? Not when you compare it to my wife's insurance. But what about the coverage? Well 90% on most procedures. That's nice. That's good. A hospital room of a semi-private rate. And 70% of non PPO procedures.
What's PPO? Well, each insurance company works with a chain of hospitals and doctors. This chain is called the PPO. If one goes to a member of the PPO, then it is 90% coverage, if one goes to non PPO member coverage is only 70%. In order to find out which hospital and doctor is part of the PPO you need to start yet another small research. I did not have the energy to look at this company's PPO. Still a 93$ a month for 90% coverage, is that good? Is that bad?
I continued searching. The university also tells about four other companies with which one can have insurance. So, I checked them out. One of them was giving a 80% coverage in a price much higher than the one recommended. Well, that's not a choice.
The second company is way, but way, cheaper. I am talking about 57$ and 69$ a month. Now, since I am healthy, why not opt for it? The coverage. Well, that's hard to tell. This company does not work with percentage of the bill the hospital gives you. Instead, it pays back a certain amount for every little thing. Say, a day in a hospital room, 1200$. Miscellaneous during hospitalization another 500$ a day, x-rays 350$ and so on and so forth. But, I don’t know how much a day at the hospital costs. It might be 3000$ and it might be 1000$. If it is the later amount, then I need to take this offer. If it is the first amount, then this offer is not very good. But how can one tell? Should I contact the hospital near by me and ask them how much a day costs? Come to think of it, that's might not be a bad idea after all.
Then there is another company. They use this strange term which caused me to strike them out immediately. They cover the usual, customary and reasonable costs. And they only cover 30% of it after negotiations. Negotiations with whom? I was wondering and about what? Do they negotiate with the hospital about the price or will they negotiate with me about what is reasonable, customary and usual? In any case, I was not about to negotiate with this company, reasonable or unreasonable as it may sound.
And then the last company. They have both deductible and co-payments. They let me choose how big of a deductible I want annually, and then the monthly rate is changed accordingly. If I want 1000$ deductible, I only pay 800$ annually. If I want 250$, I pay 1300$ annually. They also have three types of coverage, silver, which is the simplest, gold and platinum. Their premium varies accordingly. Then again they also use the URC as an acronym, it is that common. But, they do not negotiate and they do not give 90%. They give full coverage of a day at the hospital. No, I am wrong. They give in the silver plan 650$ per day at the hospital. In the gold they give full coverage. No, not full coverage but the Usual, Reasonable and Customary coverage for a semi-private room. In the platinum they give the URC for a private room. But again, I have no clue how much URC room costs. And this company is a bit more expensive than the one my school recommended. But the one my school recommended only covers 90% at the PPO. So I decided to go with the last company.
I re-read their benefits and saw that, wait a minute, they also have a PPO. They give the URC only at the PPO and 80% at non PPO. But where can I found if they have hospitals in my region as part of their PPO? And who is their PPO? And what is this company's real name? Because every company has several other companies which are the local brunches or insurances in every state. And in every state the one big company has a different name. and its PPO also have an unknown name, at least I could not find its name in the insurance company and only a google search led me to find the name of the of the PPO.
So I looked for hospitals of that PPO in my region. By now it was 8 p.m. and I was tired after starting my research at about 11 a.m. A long day of research. By now I've realized there is no way I would do my insurance today, since I got so confused from all the facts, different coverages, PPO, coinsurance, deductible, underwritten. But, then again, I had to find out if my favorite insurance plan has a PPO hospital in my region. Since I was tired I did the little mistake of giving the wrong zip code and therefore for about 10 minutes I was sure the PPO has no hospitals in my region. If this is the case, then of course I cannot have them as my health insurance company, can I?
Luckily, by the fifth time I ran that search I found my mistake and corrected it to realize that most insurance company works with most hospitals in most regions.
So what should I choose, paying 103$ a month to have a 500$ deductible + a full URC coverage or pay 93$ a night to have no deductible and 90% coinsurance of PPO treatment? In the next day I made my decision and fought the different forms I needed to fill out to have the insurance, which I am not sure I have it, just yet.
If you want to compare, in Israel you pay 3.1%-5% of your income as a health tax. If you do not have a job you pay flat fee of 92 NIS (equal to 25$) a month. Everyone is entitled to a not that bad basic coverage. One can add a second lair of insurance for an additional amount of 10-30$ a month, which includes the payment for a second opinion, choosing your own doctors in some places etc. one pays 5$ per quartile for visiting a professional doctor, unless one has a chronic disease then you do not pay at all, and the waiting time for visiting certain professions are long while others are short.
In any case, last year I spent around 424$ for my health insurance, and this year I will spend 1200$ on it. I can only hope I will not have the occasion to find out if this insurance gives me better or worse coverage than the one in Israel, though it sure costs much more. And one last small thing, in Israel I did not spent two work days to find out which health insurance I should buy, only to realize there is no educated way to make such a decision, as I found out happens in the USA.
You might be lucky. Then, your employer will pay for your health insurance. It might even be a good health insurance. Of course, there is a down side to it. Once you are fired, or downsized, not only your credit is severed, but your health insurance as well. If you are fired, you are not allowed to be sick. So don't quit your day job, since you'll loose your health insurance.
But I am not lucky. I need to have health insurance on my own. For that, I need to learn which insurance is the best for me. True, my Ph.D. is in communications, but I can do some research. There are just a few things one needs to know. Deductible, co-payments, eligibility and few others. So I am off for the races. My wife's health insurance is not good enough. It only has 30K annual return, and I must have 50K. No go. Furthermore, my wife's insurance costs about 300$ a month for me. It has some good sides. It gives 100% coverage and all pre-conditions I have.
I am lucky. I do not have any pre-conditions. I am as healthy as an ox. If it is healthy. So I need to look for insurance. My university recommended a company. Let's look at it. No deductibles. That's great. I think. I am not really sure. Then again there is a 93$ payment every month. That's expensive, right? Not when you compare it to my wife's insurance. But what about the coverage? Well 90% on most procedures. That's nice. That's good. A hospital room of a semi-private rate. And 70% of non PPO procedures.
What's PPO? Well, each insurance company works with a chain of hospitals and doctors. This chain is called the PPO. If one goes to a member of the PPO, then it is 90% coverage, if one goes to non PPO member coverage is only 70%. In order to find out which hospital and doctor is part of the PPO you need to start yet another small research. I did not have the energy to look at this company's PPO. Still a 93$ a month for 90% coverage, is that good? Is that bad?
I continued searching. The university also tells about four other companies with which one can have insurance. So, I checked them out. One of them was giving a 80% coverage in a price much higher than the one recommended. Well, that's not a choice.
The second company is way, but way, cheaper. I am talking about 57$ and 69$ a month. Now, since I am healthy, why not opt for it? The coverage. Well, that's hard to tell. This company does not work with percentage of the bill the hospital gives you. Instead, it pays back a certain amount for every little thing. Say, a day in a hospital room, 1200$. Miscellaneous during hospitalization another 500$ a day, x-rays 350$ and so on and so forth. But, I don’t know how much a day at the hospital costs. It might be 3000$ and it might be 1000$. If it is the later amount, then I need to take this offer. If it is the first amount, then this offer is not very good. But how can one tell? Should I contact the hospital near by me and ask them how much a day costs? Come to think of it, that's might not be a bad idea after all.
Then there is another company. They use this strange term which caused me to strike them out immediately. They cover the usual, customary and reasonable costs. And they only cover 30% of it after negotiations. Negotiations with whom? I was wondering and about what? Do they negotiate with the hospital about the price or will they negotiate with me about what is reasonable, customary and usual? In any case, I was not about to negotiate with this company, reasonable or unreasonable as it may sound.
And then the last company. They have both deductible and co-payments. They let me choose how big of a deductible I want annually, and then the monthly rate is changed accordingly. If I want 1000$ deductible, I only pay 800$ annually. If I want 250$, I pay 1300$ annually. They also have three types of coverage, silver, which is the simplest, gold and platinum. Their premium varies accordingly. Then again they also use the URC as an acronym, it is that common. But, they do not negotiate and they do not give 90%. They give full coverage of a day at the hospital. No, I am wrong. They give in the silver plan 650$ per day at the hospital. In the gold they give full coverage. No, not full coverage but the Usual, Reasonable and Customary coverage for a semi-private room. In the platinum they give the URC for a private room. But again, I have no clue how much URC room costs. And this company is a bit more expensive than the one my school recommended. But the one my school recommended only covers 90% at the PPO. So I decided to go with the last company.
I re-read their benefits and saw that, wait a minute, they also have a PPO. They give the URC only at the PPO and 80% at non PPO. But where can I found if they have hospitals in my region as part of their PPO? And who is their PPO? And what is this company's real name? Because every company has several other companies which are the local brunches or insurances in every state. And in every state the one big company has a different name. and its PPO also have an unknown name, at least I could not find its name in the insurance company and only a google search led me to find the name of the of the PPO.
So I looked for hospitals of that PPO in my region. By now it was 8 p.m. and I was tired after starting my research at about 11 a.m. A long day of research. By now I've realized there is no way I would do my insurance today, since I got so confused from all the facts, different coverages, PPO, coinsurance, deductible, underwritten. But, then again, I had to find out if my favorite insurance plan has a PPO hospital in my region. Since I was tired I did the little mistake of giving the wrong zip code and therefore for about 10 minutes I was sure the PPO has no hospitals in my region. If this is the case, then of course I cannot have them as my health insurance company, can I?
Luckily, by the fifth time I ran that search I found my mistake and corrected it to realize that most insurance company works with most hospitals in most regions.
So what should I choose, paying 103$ a month to have a 500$ deductible + a full URC coverage or pay 93$ a night to have no deductible and 90% coinsurance of PPO treatment? In the next day I made my decision and fought the different forms I needed to fill out to have the insurance, which I am not sure I have it, just yet.
If you want to compare, in Israel you pay 3.1%-5% of your income as a health tax. If you do not have a job you pay flat fee of 92 NIS (equal to 25$) a month. Everyone is entitled to a not that bad basic coverage. One can add a second lair of insurance for an additional amount of 10-30$ a month, which includes the payment for a second opinion, choosing your own doctors in some places etc. one pays 5$ per quartile for visiting a professional doctor, unless one has a chronic disease then you do not pay at all, and the waiting time for visiting certain professions are long while others are short.
In any case, last year I spent around 424$ for my health insurance, and this year I will spend 1200$ on it. I can only hope I will not have the occasion to find out if this insurance gives me better or worse coverage than the one in Israel, though it sure costs much more. And one last small thing, in Israel I did not spent two work days to find out which health insurance I should buy, only to realize there is no educated way to make such a decision, as I found out happens in the USA.
Monday, September 7, 2009
Testing, testing: How to Test New Products
There comes a time in every (atopic patient's) life when a new skincare product comes along. Maybe it looks good, or is cheap, sounds interesting or comes with a recommendation from a doctor or friend. How do you know if it's good for you?
Step 1. Think outside the box. Check the description, does it say "for dry skin"? Sensitive skin? Hypoallergenic? Those are a good start. Check the list of ingredients for any obvious no-nos. Fragrances are not recommended. Lanolin or Urea acid might be turn-offs as well.
Also pay attention to the descriptors. This may sound obvious, but "lotion", "cream" and "ointment" are different things, all belonging to the same family - things you spread on your skin. Whereas things that say "cleansing", "body wash" or the like are actually soap-like products to cleanse the skin, either in or out of the shower/tub. Separate once again from the bath oils family (and one that seems entirely absent from USA pharmacies). You probably need at least one product from each family, maybe more. (Why more? One cream might be too expensive to use on the entire body, but great quality, so you use it for your face, while using a second cream for the body. Or you may use a different product for different symptoms - one for rashes, one for scratches, one for infections AKA folliculitis, etc.)
Step 2. Try it once. Try it on a small area. Make sure the world didn't fall apart and neither did your skin. I admit I sometimes skip this step once I get the feeling the product is truly for sensitive skin. Do so at your own risk: you may have an adverse reaction to certain products.
Step 3. Try it methodically. Designate an area of the skin to try out the new product: e.g. one arm. Use the new product instead of your regular alternatives on this area only, and compare the two areas (say arms) after one day, and again after one week of usage. Notice any differences in skin texture, scabbing, rashes and so on. One cream may be better for rashes while another is better for healing scratches. One may leave your skin feeling smoother. Pay close attention.
Notice this step won't work for bath oils, you can't apply on one part of the bath. You just have to try and hope for the best.
Step 4. Make up your mind. Which is better for you? Often there will be no major difference, but sometimes you'll notice an improvement and that's great! Now you have a new member to your product arsenal. Use it as needed and as your budget allows. And you did it without exposing your skin to something harmful.
Coming up next:
The real deal: products I actually use.
Step 1. Think outside the box. Check the description, does it say "for dry skin"? Sensitive skin? Hypoallergenic? Those are a good start. Check the list of ingredients for any obvious no-nos. Fragrances are not recommended. Lanolin or Urea acid might be turn-offs as well.
Also pay attention to the descriptors. This may sound obvious, but "lotion", "cream" and "ointment" are different things, all belonging to the same family - things you spread on your skin. Whereas things that say "cleansing", "body wash" or the like are actually soap-like products to cleanse the skin, either in or out of the shower/tub. Separate once again from the bath oils family (and one that seems entirely absent from USA pharmacies). You probably need at least one product from each family, maybe more. (Why more? One cream might be too expensive to use on the entire body, but great quality, so you use it for your face, while using a second cream for the body. Or you may use a different product for different symptoms - one for rashes, one for scratches, one for infections AKA folliculitis, etc.)
Step 2. Try it once. Try it on a small area. Make sure the world didn't fall apart and neither did your skin. I admit I sometimes skip this step once I get the feeling the product is truly for sensitive skin. Do so at your own risk: you may have an adverse reaction to certain products.
Step 3. Try it methodically. Designate an area of the skin to try out the new product: e.g. one arm. Use the new product instead of your regular alternatives on this area only, and compare the two areas (say arms) after one day, and again after one week of usage. Notice any differences in skin texture, scabbing, rashes and so on. One cream may be better for rashes while another is better for healing scratches. One may leave your skin feeling smoother. Pay close attention.
Notice this step won't work for bath oils, you can't apply on one part of the bath. You just have to try and hope for the best.
Step 4. Make up your mind. Which is better for you? Often there will be no major difference, but sometimes you'll notice an improvement and that's great! Now you have a new member to your product arsenal. Use it as needed and as your budget allows. And you did it without exposing your skin to something harmful.
Coming up next:
The real deal: products I actually use.
Friday, May 8, 2009
Stop scratching!
If you have atopic dermatitis, the above sentence is one you're probably used to hearing. Love it or hate it, I doubt that you can stay indifferent to it.
Let's start at the beginning. As I've mentioned before on this blog, it truly is unhealthy to scratch, as it aggravates the skin and worsens your condition. Those are the bare facts.
However, the flip side of the coin is that it's extremely hard to avoid scratching altogether. First of all you might be doing so unconciously, and even if you're aware of it - well, it friggin' itches, doesn't it?
So how the heck are you supposed not to scratch?
It's an open question. There's no real solution, with stupid ones including parents tying their kids' hands (was that an urban legend or the real deal? hmm) through things I've mentioned before like meditation and self-hypnosis, and hand-occupying hobbies to take your mind off scratching.
But let me tell you one very personal thing. I, for one, absolutely cannot stand it when people tell me to stop scratching. So "here's a plea, from my heart to you" - don't tell me to stop. I'll stop when I'm good and ready to.
Let's start at the beginning. As I've mentioned before on this blog, it truly is unhealthy to scratch, as it aggravates the skin and worsens your condition. Those are the bare facts.
However, the flip side of the coin is that it's extremely hard to avoid scratching altogether. First of all you might be doing so unconciously, and even if you're aware of it - well, it friggin' itches, doesn't it?
So how the heck are you supposed not to scratch?
It's an open question. There's no real solution, with stupid ones including parents tying their kids' hands (was that an urban legend or the real deal? hmm) through things I've mentioned before like meditation and self-hypnosis, and hand-occupying hobbies to take your mind off scratching.
But let me tell you one very personal thing. I, for one, absolutely cannot stand it when people tell me to stop scratching. So "here's a plea, from my heart to you" - don't tell me to stop. I'll stop when I'm good and ready to.
There and back again
It's been nearly a year since I posted last, my apologies.
I had focused most of my atopic-facing energies on opening a group for atopic dermatitis in Israel. We had some measured success with two face-to-face meetings of adult patients of atopic. But then we ran into a brick wall... nothing specific just got stuck. The organization we were working with got shut down and that took the wind out of our sails.
Anyway, I'm back to the blog and we'll see where it takes me. Thanks for listening.
I had focused most of my atopic-facing energies on opening a group for atopic dermatitis in Israel. We had some measured success with two face-to-face meetings of adult patients of atopic. But then we ran into a brick wall... nothing specific just got stuck. The organization we were working with got shut down and that took the wind out of our sails.
Anyway, I'm back to the blog and we'll see where it takes me. Thanks for listening.
Sunday, April 6, 2008
Shout-out - Atopic Dermatitis Group forming in Israel
Hey you, yes, you.
If you feel it's time to stop reading about atopic and start doing something about it...
If you're sick (in more than one sense) of feeling alone with your disease and you want to meet others with the same problem...
If you're a parent of a child that suffers from atopic dermatitis and you think there should be more being done...
... now's your big chance.
We are now in the preliminary stages of forming a group for atopic dermatitis. With the help of "Etza" (=literally "Advice"), the Israeli organization for Self and Mutual Help, two other atopic patients and I are forming the initial core of this group. We will be meeting, hopefully before Passover, to set our initial goals and priorities for this group.
You are very welcome to join us, whether you are an atopic patient yourself, or the parent of one. If you want to join us and influence the direction of this group, now's the time. (You can always join later, but now is better! :-)
Send me a mail: shiri.dori AT gmail.com
We would love to have you with us.
If you feel it's time to stop reading about atopic and start doing something about it...
If you're sick (in more than one sense) of feeling alone with your disease and you want to meet others with the same problem...
If you're a parent of a child that suffers from atopic dermatitis and you think there should be more being done...
... now's your big chance.
We are now in the preliminary stages of forming a group for atopic dermatitis. With the help of "Etza" (=literally "Advice"), the Israeli organization for Self and Mutual Help, two other atopic patients and I are forming the initial core of this group. We will be meeting, hopefully before Passover, to set our initial goals and priorities for this group.
You are very welcome to join us, whether you are an atopic patient yourself, or the parent of one. If you want to join us and influence the direction of this group, now's the time. (You can always join later, but now is better! :-)
Send me a mail: shiri.dori AT gmail.com
We would love to have you with us.
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