Tag / psoriasis

by Howard H Chang

Skyrizi Week 3: Three Questions Waiting to Be Answered

I can’t believe I finished my third week of taking Skyrizi (Risankizumab). In the coming week I take my second dose. This dose is a loading dose administered at week four. The dosing moves into every twelve weeks thereafter.

The biggest questions I have when I take a new medication are if it will work, when it will start working, and will I have side effects. See below for my updated impressions on these three questions.

Will Skyrizi Work to Clear My Psoriasis?

This is a crystal ball question to be determined in the coming weeks. But if you make me give an answer of what I predict I’ll tend to take the pessimistic view. When a drug claims that X out of 10 people who took it during clinical trials reached PASI 75 or 90, or even cleared, I’m skeptical I would be one of them. 

I’m usually the X out of ten that did not reach any notable level of psoriasis clearance. I know, I know. Past results do not predict future outcomes. Too many variables must play out before making any conclusions. My body changes over time. New medications have different mechanisms of action in my body than others. But I’ve faced disappointment after weeks and months of waiting on a new drug enough times to not get my hopes up.

Follow My Skyrizi Journey!

Starting Skyrizi for Psoriasis Week 0

Skyrizi’s website makes the following claims:

  1. In clinical trials, 3 out of 4 people achieved 90% clearer skin at four months, after just two doses
  2. Of those, nearly 9 out of 10 sustained 90% clearer skin through one year
  3. Also, 8 out of 10 people achieved clear or almost clear skin at four months, after just two doses.

Number 1 and 3 sound like the same results told in two different ways. Number 2 says that those who did respond sustained it after a year. Okay, awesome numbers to be sure. I just hope I’m not the 1 out of 4 or 10 who doesn’t get a great response.

When will Skyrizi Start Working?

Continue reading →
by Howard H Chang

Treat Psoriasis Seriously–World Psoriasis Day 2018

 

Today, October 29th, is World Psoriasis Day. Each year I look forward to this day as I think about the 125 million people around the world who understand on some level what it means to live with psoriasis. Nobody needs to feel alone with this disease.

This special day each year is sponsored by the International Federation of Psoriasis Associations (IFPA). I volunteer as a Psocial Ambassador (blogger) for a member association, the National Psoriasis Foundation (NPF). The theme this year is PsoSerious: Treat Psoriasis Seriously. The NPF encourages those living with psoriasis to pledge https://www.psoriasis.org/world-psoriasis-day/pledge to take one action toward treating your psoriasis more seriously.

My World Psoriasis Day Action: Get a Flu Shot

A couple days ago I got a flu shot in honor of World Psoriasis Day. Three years ago, during Easter weekend, I truly had influenza. I experience high fever, extreme fatigue, and achy muscles among other symptoms. The doctors ruled out sepsis/infection with a blood test and at the same time tested for viruses. Sure enough, I had H3N2 Influenza A late in the flu season.

I sadly missed out on speaking at Good Friday Service and Easter Sunday Worship at church. I hated putting that extra work on my colleagues, but I could not even get out of bed. In twenty years of ministering in churches that Easter is the only one I have missed. On a different Easter weekend I even spoke on two hours of sleep as I kept watch over my sick daughter. Not much keeps me away from church on Sunday.

The worst part of getting Influenza A, though, was not work related. My psoriasis and eczema flares with fever, especially from bacterial and viral infections. It’s a huge trigger for me and I try to avoid getting sick at all costs because of it. That means getting a flu shot is important and necessary to manage my skin during the winter and spring seasons.

A worthy action for me in honor of World Psoriasis Day.

My psoriasis and eczema flares with fever, especially from bacterial and viral infections. It’s a huge trigger for me and I try to avoid getting sick at all costs because of it.

Take Psoriasis Seriously

This year’s World Psoriasis Day resonates with me for another reason as well: psoriasis is serious business. I shared a frustrating part of my psoriasis story at the Experience Innovation Network’s CXO Roundtable in San Francisco last Tuesday. I sat at Table 7 as the patient partner in a design workshop meant for healthcare executives. The workshop led the participants through the steps of designing healthcare around the patient from the beginning of the process. The challenge I presented before my table involved my multiple insurance denials for combination therapy.

As I voiced the story of using multiple treatments to treat recalcitrant psoriasis since childhood I could see the deep concern and compassion on the participants’ faces. They felt frustrated along with me as I told about an inflexible insurance provider that would not cover two expensive medications that I needed to properly treat my psoriasis.

I know I am a few weeks away from becoming covered from head to toe with psoriatic lesions if treatment fails me completely. I can’t stomach the thought of returning to the misery and pain of red, painful, hot, and itchy lesions all over my body. When my skin is flaring that much I can’t hide it all under clothes as I would want to. Unwelcome stares and questions invariably follow me wherever I go.

I’ve also learned how psoriasis causes inflammation throughout my body, not just on my skin. I hate hearing about those studies that show that those with psoriasis are at a higher risk for cardiovascular disease, metabolic syndrome, diabetes, and other autoimmune conditions as comorbidities. With severe psoriasis and lots of inflammation over the years I just might die younger than I otherwise would have.

I’ve also learned how psoriasis causes inflammation throughout my body, not just on my skin.

Indeed, it goes without saying that I must take seriously adopting changes and treatments that minimize those impacts psoriasis might have on my quality and longevity of life.

But Not Too Seriously

At the same time, I’m learning to not take psoriasis too seriously. It’s easy for me to lock my mind and emotions with my condition. I am obviously more than my psoriasis, and life is more than clearing my skin inflammation. I don’t need to take myself or my psoriasis too seriously.

My wife Lori recently reminded me the important role laughter has in healing. I fell in love with her infectious laughter, and her ability to laugh together at some otherwise painful circumstances and challenging situations. We had a silly moment in Wal Mart where we wore plush masks out late on a shopping date (should’ve purchased these for Halloween!)

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Life gets too serious sometimes, so I need to continue to find ways to bring some levity and perspective even in the midst of insurance denials, flaring skin, and frustrating treatments.

Check out the Treaments Tried page for my personal experience taking Otezla and Tremfya!

Personal Family Update: Taking Care of Mom

Finally, I want to give a family update that has impacted my life, including my blogging and social media advocacy. My mom learned she has advanced stage lymphoma a couple months ago. I’ve been flying to Southern California every three weeks to accompany her to oncology appointments and chemotherapy infusions. As I write this I am on my way to Orange County to take mom to the infusion center in Irvine, CA the next two days.

I love my parents dearly and am glad I can be an hour away to help them when needed. Unfortunately, I’ve needed to take a break from writing as work at church, family, and personal health took precedence. Praying mom responds well to treatment and can experience remission after these courses of treatment.

 

 

 

by Howard H Chang

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.

2 Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, 3 because you know that the testing of your faith produces perseverance.4 Let perseverance finish its work so that you may be mature and complete, not lacking anything.

by Howard H Chang

Traveling with Psoriasis

[The view from The Getty Center in Los Angeles, June 2017]

I originally wrote this article for The Itch to Beat Psoriasis on Everyday Health. The editor needed to cut it down by almost half. My enthusiasm for travel apparently could not be contained in under 1000 words. So, I have the full, original article here.

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Last summer my family and I took a weeklong vacation to South Dakota to see the Badlands and Mount Rushmore. Besides waking the family up for the early morning flight, everything went according to plan. We went to lunch in downtown Rapid City, SD to pass the time before checking into the hotel. Then it dawned on me—I forgot my injectable biologic to treat my psoriasis in my backpack in the trunk of the rental car.

I immediately panicked, knowing that it would keep in room temperatures for a couple weeks, but not in a heated car in summer. We ran back to the car, and pulled out my backpack in a desperate attempt to save my medication. Sadly, it was too late—it felt as hot as the air in the car. After a quick call to the medication’s manufacturer I learned I couldn’t use it any longer.

badlands sign fam

Last summer’s trip to South Dakota at the Badlands National Park. Unfortunately, I fried my biologic on the first day of this trip, but my skin mostly stayed under control.

In the end that incident didn’t ruin my trip or affect my skin adversely. I took it as a learning experience to not give up on travel, but to continue to refine how I travel. Even after making mistakes like at last summer’s vacation, I still look forward to traveling. Psoriasis need not take those opportunities away from me to see the world.

I do recognize, however, that traveling with a chronic condition like psoriasis takes special preparation and planning. The key principle I apply when traveling is to think about what I do at home for my psoriasis. Then, I take as much of what I do in my daily routine with me on the trip. What works at home often works on the road with some modification.

Scouring online I found some great articles on the topic of traveling with psoriasis in general, including 7 Tips for Traveling with Psoriasis here on Everyday Health. I keep those in mind as I share the process of what I do when traveling.

Preparing for an Upcoming Trip

A successful trip begins with preparation and packing. My before-the-trip routine begin with arranged travel plans so I know where I will be and when, including how I will get there. Once I know the destination and arrangements, I go through a checklist in my mind to make sure I have everything I need for the duration of the trip.

Prioritize Prescription Medications

I put top priority on packing enough of my prescription medication. I often can purchase over the counter items, or even clothes when I’m out of town, but it’s harder to replace my prescriptions. I do carry the number to call if I need medical care outside of my home area. But even if I can replace them, I don’t want to take the time out to do so if I don’t have to.

The last time I traveled to Chicago for a conference I prepared as usual. But the morning of the trip I forgot one of my prescription topical medications on the bathroom counter. Providentially, I keep travel size tubes of the same medication in my backpack. That tube contained just enough medication for the trip.

Redundancy in packing medications is one way I prioritize them when I travel with psoriasis. That in turn means I need to have enough on hand to pack for the trip. Going over my travel plans with my doctor before the trip, ordering prescription refills, and calling my insurance provider to find out what to do if I lose my prescription medication ensures I have what I need as I leave my home base.

Review Daily Routines

When I’m packing, I go over my daily routines from morning to night. In the morning, I use a topical medication, take a pill, and apply moisturizers. Those items go on a packing list. I do the same for the afternoon, evening, showering, and bedtime routines. By going over the daily routine I make sure have what I’ll need for each day.

Store Travel Ready Items

Over many trips, I’ve collected travel size containers, samples, and items that I set aside in a medication tub. Only the items on my list make it in the tub. Before each trip, I replenish medications and toiletries I need for the length of the trip. That tub minimizes the potential for forgetting an essential item, and easily packs in my suitcase.

Pack Everything Needed

I used to worry about over packing. Once I traveled with a friend to Europe to speak at a conference. I packed a large duffle bag with all my medications, moisturizers, and sets of clothes. My friend didn’t need to pack as much. He criticized how much I packed, primarily concerned that those driving us mainly have small cars. I explained to him that I need it to take care of my skin.

I don’t bring huge suitcases for an overnight trip, but at the same time I don’t worry about what others think, or make myself travel with a small bag. If it’s a longer trip, I pack larger moisturizer containers and whatever else I need to feel comfortable. I pack what I need, even if it costs more in luggage fees.

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On the Magnificent Mile in Chicago I found a very tall Abraham Lincoln to take a picture with.

During a Trip

When the trip starts, I need to keep focused on my health maintenance. It’s easy to get caught up in the conference I’m attending, or the national park I’m visiting. But taking the time to manage my health is just as important during travel.

Minimize Vacation/Travel Stress

My family growing up stuck to early starts and long days on vacations. We packed in all we could do each day, wanting to maximize the time and opportunities on the trip. I found vacations more stressful than staying home.

I know stress is a part of travel, but I try to minimize the stress as much as possible as it’s also a trigger for my psoriasis. When I plan a vacation, I schedule rest and late starts whenever possible. Packing early and getting to the airport in plenty of time also minimizes anxiety. I practice mindfulness, prayer, and deep breathing whenever I need to calm down.

Keeping those home routines helps me with stress management as well. On my last trip, I committed to exercise in the hotel gym. Two of the four nights I ran on the treadmill. Instead of staying out longer with new friends, I kept to my regular bedtime. Breaks during the day helped me stay focused and healthy.

Communicate Special Accommodations

A key to a successful trip for me is letting people know my needs and accommodations. If I’m staying at a hotel, I call ahead to ask if they use any cleaning products or fragrances that might irritate me. I also ask about hypoallergenic options for bedding.

From time to time I stay with friends or hosts. I struggled in the past to tell them I need hypoallergenic laundry detergent on bed sheets, or explain that I need a separate bathroom with around 45 minutes to get ready. I’ve found most people understand once I explain my situation.

Moisturize Skin on the Go

I used to wonder why my skin seemed to feel worse on flights. I soon realized that the dry air in the cabin dried out and irritated my skin. I now take a small container of moisturizer with me to use periodically on travel days. I also hydrate as much as possible on planes.

Moisturizing becomes especially important in hot, dry climates. When I visit my parents in Southern California, sometimes the dry Santa Ana winds create low relative humidity. Checking weather reports provides important information for how much skin moisturizing might be needed.

Look Out for Psoriasis Triggers

The National Psoriasis Foundation (NPF), in the article “Causes and Triggers,” states that “Psoriasis triggers are not universal. What may cause one person’s psoriasis to become active, may not affect another.” It’s important, then, to know your psoriasis triggers and try to avoid them—especially while traveling.

Some universal triggers the NPF mentions include stress, injury to skin, and infection. To prevent these and other triggers I apply sunscreen in sunny environments, wash my hands to prevent infections, and protect my skin from damage such as bug bites, or getting scratched.

Mentally Prepare for Onlookers

Summertime is a peak travel time. While I love going to the beach, or taking the kids to an amusement park, I don’t like exposing psoriatic skin in those situations. One spring my daughter and I took a cruise to the Panama Canal with my parents as a relief from the stress of ineffective psoriasis treatments. I needed the break away and the warm climate during the winter, but I was over ninety percent covered in lesions. It took some courage, but I went out on the deck anyhow to relax and catch some sunlight.

Over the years, I’ve learned to ignore people who stare, or ready what I’ll say if they ask about my skin. Explaining it’s not contagious, and it’s an autoimmune condition, helps me feel empowered, and educates others in the process.

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My daughters and I drove into San Francisco to take in the National Psoriasis Foundation Walk and do some shopping. One of my favorite cities in the world, and near where I grew up.

After the Trip Ends

When a trip ends, I tend to experience mixed feelings. I’m glad to be home where I can sleep in my own bed and resume my normal routines. At the same time, I miss the adventure of traveling. I might also need follow-up care for my skin.

The last time I went to a five-day conference my skin did not do well at all. Despite my best intentions and planning, something triggered a flare. The time and effort to calm the flare was an unfortunate consequence of travel, but one I know might occur. Checking in with my doctor, taking inventory of skin care supplies, and allowing for a low-key reentry into daily life also become part of my routine after a trip.

The trip to South Dakota fulfilled part of a bucket list item to visit the all national parks in the United States. I’ve traveled to Africa, Asia, Europe, Central America, and various parts of the country. So much of the world lies unseen and unvisited for me. Traveling gives me opportunities to meet new people, see old friends, appreciate natural beauty, and experience different cultures.

The memories I make on those trips make the extra effort to care for my psoriasis on them all worth it.

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On the Los Angeles trip we also visited the California Science Center where the Space Shuttle Endeavour resides. The family voted this part of the trip as one of the best moments of the week.

 

For some great specific tips on international travel, see International Travel with Psoriasis.

by Howard H Chang

Another Inconvenient Psoriasis Treatment

Tomorrow I have my next dermatology clinic visit in the morning. I’ve been putting off something Dr. Maverakis asked me to do last time: patch testing for any reaction to using coal tar formulations.

When you look at the tar you might understand why I put it off. You can’t smell it, but trust me that it smells like the road after repaving, or the roof after renovations. The La Brea Tar Pits aren’t too far behind. The darker formulation is crude coal tar in Aquaphor, and the lighter one is LCD coal tar in a Cetaphil cream.

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Crude coal tar formulation on my inner arm covered it with gauze. Will my skin react to it?

I’m almost hoping that my skin will react negatively to the tar formulations. The idea of slathering crude coal tar on my body for four or more hours, covered with plastic wrap, doesn’t sound pleasant–at all. I’ll need to go into Sacramento, about a 30 minute drive, three times a week for phototherapy first.

We also need to figure out where I can stay in the clinic as no facilities exist right now for patients doing Goeckerman Therapy. The current bathroom set aside for this treatment to wash off the tar is used as storage. A new bathroom is under construction. I’ll get to check that out tomorrow. I might even get my own office behind the clinic to hang out in my pajamas!

I’m open to trying this treatment as I need a break from cyclosporine. Cyclosporine works great for both psoriasis and atopic dermatitis. But it also has a long list of nasty side effects, including hypertension and kidney concerns.

See my blog on 6 Inconvenient Treatments I’ve Tried for Psoriasis–I’ll no doubt be adding a seventh soon.

 

 

 

 

by Howard H Chang

Not Going to DC After All, But . . .

I will still join the National Psoriasis Foundation‘s Capitol Hill visits remotely! It will be an early call, but I’m glad I can still participate even though I won’t be there in person. A couple years ago I visited the local office of my congressman. I definitely look forward to chatting with John Garamendi’s staff in Washington D.C. too.

The winter storm #Stella unfortunately canceled my flight from Phoenix to Washington DC’s Reagan airport. I found out when I woke up for my first flight out of Sacramento. Sadly, although I knew cancellation was a possibility, it became a reality as I saw the alert in the wee hours of the morning. I’m still in some kind of denial, as I still haven’t unpacked my bags.

I do welcome the rest, though. Last week’s trip to Orlando for the American Academy of Dermatology annual meeting, and a week full of work at church tired me out. Yesterday I spoke in two consecutive church services on short sleep after Daylight Savings Time. My wife rejoiced when she found out I would stay home, worried that I might fly into a blizzard, and knowing how busy I’ve been recently.

This afternoon I finally got around to working on a couple chores I’d put off for weeks: washing the cars, and mowing the lawns. Now I’m spending time catching up on emails and blogging. I spent some much needed time with the kids, too, with my son helping me with the work.

Even though I’m not going to DC, I hope to go next time. And I get to enjoy the 80 degree weather here in Sacramento. It’s disappointing, but not all bad.

by Howard H Chang

The Future of Psoriasis Care

If you could look forward to coming medical innovations in psoriasis treatment and care, what would you want to see?

In my Everyday Health column The Itch to Beat Psoriasis,  I address questions medical innovation, cure and prevention, and what a life free of psoriasis might look like. As always, I’m grateful to Janssen for the invitation, supporting my travel expenses, and putting together a great team for the patient panel.

In the column I did not share how going to San Diego that weekend became quite a journey. The storms in California raged during my travel both ways. Matt Iseman showed up a bit late to our prep meeting, which amped up my anxiety as I hoped we’d have more time to talk about how the panel would be conducted.

The overwhelming consensus from the panel is the need for immediate relief so those living with autoimmune conditions. The impact of chronic conditions cannot be overstated. It’s written on the lives of those who battle everyday.

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I joined Matt Iseman, Brooke Abbott, and Mariah Leach for an immunology patient panel in January

Turns out everything went better than I could have expected. The researches gave us a warm round of applause at the end. Afterwards, I met a couple people who wanted to follow up with what we talked about. The huge storm that hit home even passed just before I landed at Sacramento airport!

All in all a great trip to share the patient story to those who everyday work hard to improve our lives.

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You can read the column The Future of Psoriasis Care here.