An Almost Disastrous First Dermatology Visit


The empty lobby at the dermatology clinic at lunch time left me feeling quite anxious after I missed my 11:30 a.m. appointment, which I thought was at 1:30 p.m.

Wednesday morning started out quietly enough. I took the morning to rest as I had to work on my Monday day off. I looked forward to my first dermatology appointment at 1:30 p.m. I drove into town around 12:30 to give myself plenty of time. Then it dawned on me.

My dermatology appointment was at 11:30 a.m., not 1:30 p.m.

After double checking my calendar I decided to drive straight to the clinic. Even though the door was unlocked, I only found an “out to lunch” sign on the counter. A call to the scheduling center confirmed I missed my appointment. I’d waited over two months for this visit. Now I found myself one hour late to it.

The scheduler on the phone told me I could take the next available appointment with the dermatologist on May 8th, or with her colleague on May 2nd. She also gave me the option to stay in the clinic office until the staff returned from lunch. I opted for the latter.

As I waited all I could think about is what a disaster the first visit is turning out to be. Being late meant possibly not seeing the new dermatologist for weeks. One little mistake could mushroom into huge consequences for all my treatments.

As I waited all I could think about is what a disaster the first visit is turning out to be. Being late meant possibly not seeing the new dermatologist for weeks.

Awkward Beginnings

Finally, someone returned to the office. I sheepishly asked if she had started working yet, and shared how I felt embarrassed about missing my 11:30 appointment. The receptionist said it was okay, and took my information down. She then asked me to wait until the medical staff returned.

Dr. C’s medical assistant returned and started looking into my situation. He said they could work me into her schedule, but I needed to wait there for up to two hours. Ironically, I ended up getting a 1:45 p.m. appointment, only 15 minutes later than what I first thought. Around 2:00 p.m. the medical assistant called me into the exam room.

I felt anxious changing to a new medical group and system. Right off I felt awkward when I tried to sit on the exam table and asked for a gown.

“On the first visit the doctor likes you to keep your clothes on and sit in the chair,” the assistant informed me. I thought it sounded like rules for a first date, but went with it.

I felt anxious changing to a new medical group and system. Right off I felt awkward when I tried to sit on the exam table and asked for a gown.

Next, he told me the doctor is using an exam recording device that transmits to the Dominican Republic. It apparently helps with documentation so the doctor doesn’t need to worry about writing notes later. I didn’t want to make a fuss on my first visit and told him it would be fine.

Dr. C. walked in a few minutes later. She told me right away that she didn’t have that much time for the visit since I was being squeezed into her schedule.

Having no time to waste, I quickly dove into all my dermatology concerns assuming she could keep up. Continue reading →

My Last Dermatology Visit: As Good as It Gets?

I couldn’t believe what I read in a letter dated November 21 from Western Health Advantage (WHA), my health insurance provided. They approved my continuation of care request for one more visit in December.

I’d already said goodbye to Dr. M and his team at the November appointment. With excitement, I called the Dermatology department to book my last dermatology visit at UC Davis Health. “I’m sorry Mr. Chang,” she flatly said, “Dr. Maverakis does not have any open appointments for the rest of the year.”

Getting that Elusive Last Appointment

What? After waiting weeks to hear back from WHA I now faced denial at the dermatology office? “You can call back as many times as you want to check for cancelled appointments,” the receptionist told me. They don’t keep a waiting list, but would be fine if I called ad infinitum.

So, I called back a few days later. No appointments still. Another call revealed that the university holidays on the last two weeks of the month hurt my chances of landing that coveted appointment. Then I called WHA about extending the continuation of care. Let’s just say that 45-minute phone call made me want to call back UC Davis to get an appointment in December.

Finally, the receptionist took pity on me. He said he would write my name and number down and give me any cancellations that arose. Sure enough, within a few hours, I booked a 9:15 a.m. on Friday morning, December 15th. Why couldn’t he do that from the start? Anyhow, I felt grateful to have the appointment no matter how I got it.

With this health care system, I’m guessing this is as good as it gets.

Assessing my Skin Concerns

Dr. M understandably wants me to taper completely off of cyclosporine. Tremfya (guselkumabis the key treatment we looked to replace it. This visit happened to coincide with my 17th week on the new biologic.

Check out the new Treatments Tried section with a list of Tremfya blogs.

How would he assess my psoriasis and eczema after using it for four months?

Continue reading →

Exercising Again & My Heart Loves It

My running shoes started getting more use recently with interval workouts in the neighborhood.

Since around Thanksgiving I started exercising regularly again. That’s when I bought my first Apple Watch with great workout tracking features, including GPS. I never liked running with my phone. A sad excuse for not exercising.

I hate to admit that I let my body go with bad health habits. I didn’t just stop exercising regularly, I slept too late and too little, and ate too much fast and junk food. Over time I noticed the effects–rising blood pressure, weight gain, moodiness, lack of energy, and disliking myself.

I’m still not sure if psoriasis improves with exercise, as I used to be fit while still with flaring psoriasis. But when I went to the AAD medical meeting, I received a healthy dose of motivation to revive healthy habits. I’m at the age where my heart and overall health starts to go, and psoriasis doesn’t help with the attendant inflammation. More and more studies show the impact of severe psoriasis on lifespan too–up to five years. That’s sobering.


Apple Watch Activity Levels March 2017

After the AAD meeting I started running intervals about every other day. Not soon after, my daughter Lydia started running intervals with me. On off days I go for a walk, use the rowing machine at a slow pace for about 20 minutes, or take a rest day.

The screen shot shows my Apple Watch Activity levels for March 2017–closed circles show progress and daily goals reached. The outer circle measures calories burned (current goal 500 calories), the middle exercise minutes (set by Apple for 30 minutes), and the inner circle highlights hours standing with a daily goal of 12 hours. Overall it’s the best month I’ve had, with 15 workouts recorded.

Here’s the interval workout routine:

  1. Stretch and use inhaler (for asthma)
  2. Slow jog one minute, then fast walk for a minute and a half
  3. Start around 9-10 intervals of running for one minute (~6:30-7:30 min/mile pace), then resting for 1:30-2:00
  4. Cool down with final slow jog, 5-10 minute walk, and stretching

Overall the workout takes about 35 minutes–up to an hour with stretching and walking.

I now sleep with my Apple Watch and can look at my sleeping habits and quality. My resting heart rate is the best sign that my workouts are improving my heart health. Over the past month it dropped ten beats per minute. My blood pressure also dropped down into normal range.

My body and heart love the exercise–and just maybe I’ll need less medication to control my psoriasis too if there’s less inflammation in my body overall. That’s the hope.

For more on exercise and psoriasis, check out my recent Everyday Health column Get Off the Couch! Exercise Can Help Your Psoriasis.