Denied! Insurance rejects appeals for Home Phototherapy

I am getting tired and frustrated with my health insurance provider. Really.

On December 15, 2017 my dermatologist, Dr. Maverakis, prescribed a home narrowband Uphototherapy unit. This unit, costing about five-thousand dollars, would treat both my psoriasis and atopic dermatitis (eczema).

With changing medical providers on January 1, I waited until I could see my new dermatologist. After almost missing the appointment, she agreed to submit the application that Dr. Maverakis started a couple months prior.

Surprise! not too long after I received the response from Western Health Advantage, my church’s health insurance provider.

First Insurance Denial

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Here’s an excerpt from the letter:

“The requested service, Home UV Photo therapy booth is being denied by Western Health Advantage (WHA) because it is currently considered Experimental/Investigational for a diagnosis of Psoriasis/Atopic Neurodermatitis. . . . and not a covered benefit under your health insurance plan.”

I couldn’t believe that WHA called home phototherapy “Experimental/Investigational” when I had used it effectively for many years earlier in life. I felt pessimistic about winning an appeal given how their reasoning, and how onerous the appeal process feels.

I Appeal!

Nonetheless, Dr. Carroll and I both sent appeals to WHA. Below is a copy of my letter, which I certainly thought would change the minds of those making those hard decisions at the insurance company:

Dear WHA,

I am writing with regard to a denial letter I received dated February 23, 2018 for a Home UV Photo Therapy unit. I would like to appeal the denial of my dermatologist’s request for this unit to treat my psoriasis and atopic dermatitis.

With the careful supervision of my dermatologists, I have successfully and effectively used phototherapy at home for my skin conditions for many years. Starting in 1981 my father and I built a box with a design and prescription from UCSF Dermatology. I used that UVB unit design off and on for over 25 years until I moved back to California in 2006.  Thereafter I began using cyclosporine, which helped greatly. Now I need to stop using cyclosporine.

I have also utilized phototherapy at the clinic at various times over the past forty years, but do not feel at this time I can go to Sacramento from the Davis/Woodland area three times a week due to my work schedule demands and family needs. I thought a home unit would be perfect to augment my current psoriasis treatment.

Also, I feel it would help my atopic dermatitis. Since tapering down on cyclosporine treatment due to high blood pressure concerns, my atopic dermatitis has become more unpredictable and severe. I mainly use topical steroids for atopic dermatitis, which is not a good long-term solution given the widespread area it affects my skin. My dermatologist and I also considered using Dupixent, the new biologic for atopic dermatitis, but wanted to try the home phototherapy unit first.

While I understand the medical literature is conflicting as to the safety and efficacy of home phototherapy, each patient is an individual and unique case. In my case I need a combination of therapies to keep my immune mediated skin conditions under control.

I do hope that WHA reconsiders approving the phototherapy unit for me given my medical history of using a myriad of treatments over40 years, including home phototherapy.

Sincerely,

Howard H Chang

Second Insurance Denial

The appeals did not work. On March 21st my wife and I heard a package delivered to the front door. Insurance sure does spend a lot of money using FedEx to send denial letters overnight!

The argument now, in addition, is that a phototherapy unit is a convenience item, not unlike a television or radio. What? That’s really what they wrote.

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Excerpt from the letter:

“The following services and supplies are excluded or limited: ‘Personal comfort or convenience items and home or automobile modifications or improvements. This includes, but is not limited to, televisions, radios, chair lifts and purifiers.’ . . . Specifically, a Home UV Photo Therapy Booth is considered a convenience item and is not a coverered benefit.”

I understand that WHA does not want to pay for this unit. But calling it not medically necessary, and a convenience item flies in the face of current dermatologic medical practice. Or am I going crazy? I am going crazy.

I Give Up?

At this time I need to lick my wounds and discuss with my dermatolgist what to do next. At the National Psoriasis Foundation corporate roundtable in Chicago last summer someone mentioned to me that my dermatologist can request to talk to another dermatologist at the insurance. That might be the way to go as the physician who wrote the second letter is not a specialist.

I am also considering buying a scaled down unit directly from the manufacturer. Another option is to just get out in that beautiful California sunshine that should be arriving any day with the coming of spring. WHA can’t stop me from going to my backyard to get some naturaly UVB.

Whatever happens next I won’t give up, though I honestly don’t know how effective more appeals will be. The more I appeal, the more reasons they give to NOT cover the phototherapy booth. Still, at the end of the day, I am grateful for WHA covering my biologics and my family’s hospital stays. But the UVB unit would be nice too.

An Almost Disastrous First Dermatology Visit

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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 →

10 Weeks with Tremfya: One Step Back

Two steps forward, and one step back. This saying aptly describes how I feel about my experience with Tremfya (guselkumab) after ten weeks. Overall I see progress. But during these seventy days I can point to a few setbacks.

When I updated two weeks ago I felt great—positive that Tremfya could take on my psoriasis single-handedly. I continued tapering cyclosporine to three 100mg pills a week (instead of my typical three pills per day). Even the atopic dermatitis stayed mostly under control.

But over the past week the psoriasis took a clear step backwards. When I looked at my skin in a full length mirror I could see an archipelago of bumps that recently emerged. When I put lotion on I could feel the hot spots breaking out on my back, legs, and arms.

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Over the past week the psoriasis took a clear step backwards. When I looked at my skin in a full length mirror I could see an archipelago of bumps that recently emerged.

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I felt similar setbacks in the first few weeks, but now it’s later in the treatment cycle. Ten weeks is not the endpoint to improvement with Tremfya, though I didn’t expect to take one step back at this point.

One Part of the Solution

As those lesions grew in both size and number, I became more and more depressed. Setbacks never feel good. I hate hearing how the downward trend is only a pause in a glorious future. As a person who has experienced severe flares, I dwell on the down trajectory becoming an unstoppable spiral downward.

What broke me out of this negative thought cycle? Accepting that Tremfya might only be part of the solution, not a single solution. Monotherapy is a dream I stubbornly hold onto—taking one medication that suppresses psoriasis by itself. No more phototherapy. No more pills, ointments, or steroids. One injection every eight weeks, and that’s it. The recent outbreak also broke me out this line of thinking.

Tremfya can hit clean-up or be the starting pitcher, to use a baseball analogy. But one medication, however strong or targeted, probably will not adequately do all the work. Teamwork means combination therapy—using multiple approaches, and even lifestyle changes, to face down the enemy.

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Follow my Tremfya journey

Tremfya (Guselkumab) Week One

3 Weeks with Tremfya: The Waiting Game

5 Weeks with Tremfya: Biggest Fear?

6 Weeks with Tremfya: Redefining Expectations

8 Weeks with Tremfya: It’s Working!

12 Weeks with Tremfya: The Third Injection

14 Weeks with Tremfya: What’s Next?

16 Weeks with Tremfya: The Verdict?

20 Weeks with Tremfya: Read the Instructions! (4th Injection)

24 Weeks with Tremfya: A Pattern Emerges

28 Weeks with Tremfya: Still Working? (Injection #5)

38 Weeks with Tremfya: The Question/Answer Edition

42 Weeks with Tremfya: Coping with a Skin Flare

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Final Dermatology Appointment

This coming Friday is my last with Dr. Maverakis at U.C. Davis Health, Dermatology. My insurance provider approved a single visit referral for the remainder of 2017. Since my next appointment falls on the first week on November, that one will be my last.

I will miss the collaboration and rapport built up with Dr. Maverakis. With more time I would want to continue experimenting with the right combination to treat psoriasis and atopic dermatitis. The ideas we generate at appointments come to fruition weeks or months later. This time, however, marks the end. No more tomorrows to return to see if we should continue a therapy, start a new one, or add one to the arsenal.

It took several months accept this change. The blow will soften if the new dermatologist works with me well. Otherwise I would consider more radical changes such as switching health insurance companies through a change in job status, or entering the Marketplace. No good options there, I’m afraid, but health comes first.

Verse of the Week

Finding Joy in Suffering (James 1:2-4)

One of the most impactful passages on how I view living with severe psoriasis comes from James. This passage came to me during a six-week stint at a psoriasis treatment center in Palo Alto, CA the summer after I graduated from high school.

Almost thirty years later I see the wisdom in allowing life’s circumstances, even the unpleasant ones, to positively influence my heart and character. Nothing’s wasted, I like to say.

Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.Let perseverance finish its work so that you may be mature and complete, not lacking anything.

6 Weeks with Tremfya: Redefining Expectations

The sunsets here in Northern California’s Central Valley can light up the sky with a myriad of colors. I took this shot while exercising, reminding me how precious moments like these are to not waste–especially as the wait for Tremfya’s ultimate result continues.

When I started taking Tremfya (guselkumab), I carried an unstated goal and expectation: clear skin. I looked at the graphs and incredible data on the effectiveness of Tremfya and just figured I could enjoy life with less and less psoriasis over the course of sixteen weeks.

At six weeks, some forty-two days later, I’m readjusting my expectations.

I know I need to wait another couple of months to see the full effect of Tremfya on my over-active immune system. But so many other factors become involved in how my skin looks than if I take an injection every eight weeks or not. I just hoped that the new injection would strong arm all those other triggers to where they would give up their fight.

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Follow my Tremfya journey:

Tremfya (Guselkumab) Week One

3 Weeks with Tremfya: The Waiting Game

5 Weeks with Tremfya: Biggest Fear?

8 Weeks with Tremfya: It’s Working!

10 Weeks with Tremfya: One Step Back

12 Weeks with Tremfya: The Third Injection

14 Weeks with Tremfya: What’s Next?

16 Weeks with Tremfya: The Verdict?

20 Weeks with Tremfya: Read the Instructions! (4th Injection)

24 Weeks with Tremfya: A Pattern Emerges

28 Weeks with Tremfya: Still Working? (Injection #5)

38 Weeks with Tremfya: The Question/Answer Edition

42 Weeks with Tremfya: Coping with a Skin Flare

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They are not giving up so far. The biggest factor appears to be tapering cyclosporine. I knew that psoriasis and eczema would inevitably rebound as in the past. While I enjoyed some relief from psoriasis after a few weeks on Tremfya, over the last couple weeks all kinds of rashes broke out on my scalp, trunk, legs—almost everywhere. The spots that went away a few weeks ago came back as itchy, red, and irritated sores.

Tremfya might still win out in the end, but the process is not the straight line to spotless skin I imagined or hoped.bNow that I’ve come back down to earth, what are my expectations for Tremfya? How do I define success if it’s not clear skin with no complications?

Lowering Expectations

As a graduate student, I carried high expectations for everything. I thought I only needed to say something once then (most) everyone would agree and understand. I figured that if I learned a lesson that I learned it for life with no relapse. I expected my work at church to be as easy as learning in school.

My mentor pulled me aside to gently tell me to lower my expectations for just about everything.  What?! That sounded so wrong to my idealistic brain. But my mentor passed on wisdom that applied to so many aspects of my life since, including psoriasis.

So, I’m lowering my expectations for Tremfya. I do hope this awesome new medication can beat the lowered expectations.  But if it can’t quite climb to the top of that mountain, I’ll take something less. I’ll take less than clear skin. I’ll accept if it needs something other than cyclosporine, such as phototherapy, or stronger topical treatments, to work more effectively at suppressing psoriasis.

Of course, I still hope it clears my skin in a couple months. But if it doesn’t by week seven or eight, I won’t fret about it not doing its job . . . at least not quite yet.

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Of course, I still hope Tremfya clears my skin in a couple months. But if it doesn’t by week seven or eight, I won’t fret about it not doing its job . . . yet.

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Raising Awareness

In the meantime, week 6 of Tremfya coincided with the second annual TeamNPF Walk in Sacramento. Last year we registered about 50 people and raised just over five thousand dollars. This year we hit 75 people and seven thousand five hundred raised!

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I’m amazed at how little people know about psoriasis, and the resources available to them. My motivation and encouragement comes from every time someone says that they never met others with psoriasis, or how difficult living with psoriasis can be.

My family came out early in the morning on a Saturday to join the walk and volunteer to lead the walk group. Their support and love means the world to me as I pour so much of my life into inspiring, empowering, and advocating for those impacted by psoriasis.

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Verse of the Week: Isaiah 53:4-5

This verse from Isaiah once haunted me. The suffering servant brought healing to wounds. So why aren’t my wounds of psoriasis gone, I wondered. I came to accept that they are healed, but perhaps not in this lifetime or in the way I might expect.  Now the verse is comfort to me as I put my hope in a future redemption of this body–no matter what happens with Tremfya or any other medication.

Surely he took up our pain
    and bore our suffering,
yet we considered him punished by God,
    stricken by him, and afflicted.
But he was pierced for our transgressions,
    he was crushed for our iniquities;
the punishment that brought us peace was on him,
    and by his wounds we are healed.

3 Weeks with Tremfya: The Waiting Game

The beach at Point Montara Lighthouse (south of San Francisco) proved a wonderful and peaceful spot to spend Labor Day Sunday and Monday with a church group.

Are we there yet? It’s a question every parent has heard asked by a child in a long line or road trip. After three weeks on Tremfya (Guselkumab) I know I shouldn’t be asking the question, but I’m anxious to know when I might find clearer skin. It’s a waiting game that I feel like I’m losing.

I don’t have exact data on when people’s psoriasis started responding to Tremfya. During Phase II trials one paper mentioned patients saw response by the four week check-up. But my dermatologist agrees with the charts I’ve seen where many people respond after the second injection at week 4.

When Will Tremfya Start Working?

In my quest to understand more about how long I might need to wait, I began reading about medication half-life, loading doses, and steady-state concentrations. I seriously want to talk to a pharmacist or a doctor who can explain pharmacokinetics to me. Or I need the pharmacokinetics for dummies book if one’s available.

What I gathered is that it takes 5-7 half-lives for a medication to build up to the desired concentration (steady-state) in the body. I always thought of half-life in terms of degradation, i.e., the time it takes for something to degrade by half (then another half from there). You know, as in carbon or radioactive dating, But apparently there is also a half-life for the concentration of a medication to build up in the body.

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What I gathered is that it takes 5-7 half-lives for a medication to build up to the desired concentration (steady-state) in the body.

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Tremfya’s mean half-life is 15-18 days. With taking the average of the mean (okay I’m just going to use 16.5 days for the sake of argument) 5-7 half-lives would be about 83 (12 weeks) to 116 days (16.5 weeks). The extra dose at week 4 adds another factor I’m not sure how to calculate, but speeds up the process. Another factor, I’m reminded by my pharmacist today, is the time it takes the medication to calm the inflammation on my skin even after reaching steady-state levels in my body.

So, when the charts show the majority of people’s psoriasis responding between 4 and 12 weeks, that matches with my super rudimentary, untrained calculations and what clinical trials show.

I wish today were week 4 (upcoming Monday) so I could take that second injection. Unfortunately, I’m just a couple days past week 3. Are we there yet?

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Follow my Tremfya journey

Tremfya (Guselkumab) Week One

5 Weeks with Tremfya: Biggest Fear?

6 Weeks with Tremfya: Redefining Expectations

8 Weeks with Tremfya: It’s Working!

10 Weeks with Tremfya: One Step Back

12 Weeks with Tremfya: The Third Injection

14 Weeks with Tremfya: What’s Next?

16 Weeks with Tremfya: The Verdict?

20 Weeks with Tremfya: Read the Instructions! (4th Injection)

24 Weeks with Tremfya: A Pattern Emerges

28 Weeks with Tremfya: Still Working? (Injection #5)

38 Weeks with Tremfya: The Question/Answer Edition

42 Weeks with Tremfya: Coping with a Skin Flare

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Two Weeks with Tremfya on Labor Day

I marked two weeks on Tremfya on Labor Day last Monday. The second week on the new medication felt uneventful psoriasis wise. I thought I started seeing some response to the medication on my stomach and back about ten days into the treatment, but those spots returned a few days later. At the same time, my forearms and lower legs do look more clear of psoriasis.

A few more psoriasis spots popped during the third week as well. But I stopped Enbrel (etanercept) over three weeks ago. It’s possible I’m experiencing a psoriasis rebound from discontinuing Enbrel and lowering my cyclosporine dose.

While I can’t say for certain that Tremfya caused me to feel tired or ill, the second week I continued to feel tired and ill. I slept more than normal. I took asthma rescue puffs into my lungs more than usual. Periodic headaches came and went like the tide. But by the Labor Day weekend I started feeling better. I wonder if those symptoms will return after taking the week 4 dose?

During the third week I started running and walking regularly again despite the California Central Valley heat and periodic smoky air due to wild fires. I love running, and knowing I’m doing something positively good for my health motivates me to keep going in under less than ideal environments.

The Stress Factor

Another reason I might still be waiting for my psoriasis to respond to Tremfya is added stress. That second week I went to meetings or gatherings five out of seven nights. I also scrambled to meet a couple blog deadlines, one of which I ended up missing. I don’t miss deadlines, so when I do I feel behind and STRESSED.

That second week marked the end or psoriasis awareness/action month. To commemorate the month I took the opportunity to speak at a biotechnology company in the Bay Area called Dermira. They asked me to share my psoriasis journey with them during their lunch time staff meeting. A lot more people packed the room than I imagined would attend. That day we drove five hours and spent two hours at the company. Awesome day, but stressful and tiring.

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Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.

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My skin gave me the angry looks of red, irritated lesions that emerge during stressful times.

The Guessing Continues

The waiting game is also a guessing game. This blog confirms that I think about what’s happening with psoriasis ALL THE TIME. I try to read the skin “tea leaves,” but only God truly knows what’s going on with my complex immune system. Only he knows what’s going to happen at week 4 and beyond.

I’m reminded of what Jesus said as he taught his followers: Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own. (Matthew 6:34). I have lots to manage today, so I better get to it. Staying in the moment helps me pass the time anyhow while waitng for those half-lives.

9 Weeks Done with Otezla. Keep Going?

Note: below includes a picture of the current condition of my psoriasis on my back and arms. 

I’m entering the time when I expect to see more results from Otezla at two months. I started this new-to-me medication on May 15th for my psoriasis, and hopefully eczema. Unfortunately, instead of improving, I feel more and more inflammation on my skin than I have in a long time.

I had a great exchange with my dermatologist about Otezla. His response when I mentioned Otezla in the conversation?

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I’ve known all along it’s not his favorite medication. Still, I’m hoping that it kicks in soon so I don’t have to switch medications again.

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My lower back and upper arms are particularly broken out as I taper off from cyclosporine and enter my 3rd month on Otezla.

Tapering Cyclosporine

I’m not sure how much to temper my expectations since I also started tapering from Neoral (cyclosporine).

Neoral is a strong immunosuppressor. So, I’m not surprised it works so well for both conditions. I wouldn’t say I’m addicted to it, although I do like how much it keeps both psoriasis and eczema under control with relatively few noticable side effects. It’s hard to stop taking it for that reason.

This drug scares a lot of people, rightly so, as it comes with a long list of advserse effects, including kidney damage and hypertension. My body, though. tolerates it well. I’ve taken cyclosporine off and on for some years. The dermatologists allow me to go back on it after breaks partly because my labs come back mostly normal each time and it works for me. I’m sad to see it go.

Red Light, Green Light?

Stopping Otezla is also a difficult decision, but for another reason. What if it’s just days or a couple weeks away from reducing all this inflammation? I suffered the side effects for weeks and only recently do I feel they are not so severe. What if I persevered through all that insomnia, diarrhea, headache, and lost productivity for nothing?

If I don’t start something else soon, though, I could be covered in redness in a matter of weeks. If I do start another new medication, such as guselkumab that was FDA approved days ago, will that one work? How long might it take?

I’m not sure if I should give Otezla the red light or green light–even if only for a few more weeks.

It’s time to message my dermatologist again to see what he thinks I should do next if my condition doesn’t improve soon–although I already know what he thinks of Otezla. 🙄

 

Why I Hate Taking a New Medication

A little over a week ago I received the news that I would receive a somewhat new psoriasis medication, apremilast (Otezla), direct from the manufacturer. At first I felt a sense of relief that the battles with insurance over covering it came to an end. Then I faced the prospect of taking the medication. A feeling of dread overcame me.

I say I’ve tried every psoriasis medication there is to try. Of course, that’s not completely true, especially with some obscure ones left untried, and more coming out all the time. Over the past few years I’d given up on trying the new ones since my current treatment worked fine.

But it’s time to take a break from cyclosporine, which has a long list of side effects and an FDA limit of one year of usage at a time. That means a new medication.

New Medicine, Same Old Story

I have the memory of an elephant when it comes to how well I felt and did on various medications. Methotrexate makes me want to vomit (still). Adalimumab (Humira) gave me horrible eczema rashes (though cleared psoriasis). Soriatane made my palms and soles of my feet peel so painfully I bound them to survive. Narrowband UVB (phototherapy) burned my skin to where I couldn’t put on clothes without feeling pain.

Apremilast is on the list of haven’t tried, might want to because it’s for psoriasis after all, but I’ve heard and read the stories of the side effects. The pharmacist who counseled me over the phone also described patients she knows with GI issues (diarrhea, vomiting, nausea), headache, insomnia, weight loss (yes!), and depression (no!). The list is not comprehensive, but certainly some of the side effects a patient on this new medication might experience.

Every new medication I’ve tried has the list of warnings, side effects, and potential drug interactions and concerns. Do I want to take that medicine? Not on your life. But I pop that pill hoping that I might be the exception—works super well for me without side effects.

I can dream, anyhow. I can be the one to prove my doctor wrong, who reluctantly prescribed it to me, adding, “It’s a horrible medication.”

Every new medicine I’ve taken I’ve had that same thought, but so far it’s the same old story. I’m human, other humans who took this drug felt X and Y, and I’m feeling X and Y times two.

Stopping this Medication. . . Just Kidding

Today I had enough. Enough of feeling horrible with headaches, bloating, wheezing, and inability to focus. Enough is enough. I’m going to stop taking it, at least the morning dose so I can be a productive person again.

Then my dermatologist messaged me to try it for two months. I hadn’t told him I would take a break this morning—how did he know? He went on to say that the noted side effects improve over time for many people.

As ten o’clock rolled around, I stared at the pills thinking, maybe, just maybe, the side effects will get better if I keep going. Don’t give up so early, I told myself. I can fight through the pain, I coached myself. With a sense of reckless abandon, I grabbed my morning coffee and gulped it down.

Why Did I Just Do That?

As I rushed off to work to counsel a university student, all I could think was, “Why did I just do that?” I could feel the headache and nausea coming on within the first thirty minutes. I needed a time machine to turn back the clock an hour, and fast. Unfortunately, I couldn’t find it.

When the student arrived, I asked if he could wait for a few minutes. I needed to go to the bathroom. Ugh. At least this bathroom need didn’t happen when I gave a talk last Friday. But what about tonight when I lead a group meeting, or on Sunday when I speak again?

This is no way to live.

 

I do hate taking a new medication for all kinds of reasons, principally side effects. If this medication doesn’t do much to stop my psoriasis, the temptation toward indulging bitterness and rage might emerge stronger than ever. Another reason to hate the new medication—it might be a lot of cost and pain for little effectiveness and gain.

But still I take the new medication, because maybe, just maybe, this is the one to clear my skin with less overall side effects.

I can dream, anyhow.