6 ways to tell when you need a new derm.

[Guest guest]

1. Patient - " Doc, these topicals you prescribed last time are

making me flare like crazy.

I'm no longer a moderate case but a severe case. "

Doc - " You have to stick with it. It gets worse before it

gets better. "

2. Patient - " Doc, can I try oral antibiotics ? My face can't

tolerate *any* topical it seems.

I'd prefer clarithromycin ..it has fewer

side-effects and I'm outside a lot "

Doc - " I've never heard of it. I'll give you some

minocycline though "

3. Patient - " Doc, can I try an oral antihypertensive ? My flushing

is almost 100%

sympathetic nerve related....I'm convinced of

that "

Doc - " I've never prescribed those for rosacea. Here, try a

topical steroid "

4. Patient - " Doc, can I have a script for some Zyrtec ? It's helped

a bit in the past "

Doc - " Umm, I'll give you one for claritin "

5. Patient - " I'm thinking of getting PhotoDerm done. Have any of

your patients had success with this ? "

Doc - " *confused look* Umm...it's very new. I've never

recommended it for cea. "

6. Patient - " Doc, what are your thoughts on very low dose

isotretinoin ? "

Doc - " *very pissy tone* I don't believe in a half-ass

approach, and I have 18 years experience "

hi-ho hi-ho, looking for a new derm I go.

Glenn

[Guest guest]

I almost laughed at this one until I thought back about four years,

when I was dealing with derms. The truth I encountered in my

experience with derms is that the vast majority make their money from

cosmetic procedures, and don't give a rat's *ss about rosacea. Those

who might be inclined to help, are either too lazy or arrogant to

look into emerging techniques which can make all the difference to a

rosacea sufferer. It's just easier for them to look at their book and

follow the instructions, which usually include leaving patients on

2.5% hydrocortisone, the Kiss of Death. To be honest, my own humble

MD, right around the corner from my house, helped me far more than

any derm or specialist I saw. He is a flexible and competent man. He

ran (3) rounds of blood testing and urinalysis to rule out the likes

of carcinoid and lupus. He tried clonidine, which helped somewhat.

He then suggested clonazepam (valium family tranquilizer) which

helped some more. He listened to my ideas, and worked with me. He

knew as much about topicals as any derm I had seen. If I came across

something which I thought might help, I would discuss it with him and

if he saw no contraindications he would let me try it out. He did not

know about photoderm (treatment for rosacea was FDA approved in 1998,

and I started treatment in early 2000 after learning of PD on my

own). My own symptoms were restricted to severe vascular flushing

with no acne. Photoderm and YAG laser have cleared most of my

symptoms. But for the (3) years before my first tx, my MD helped me

substantially, and the four derms I saw were worse than useless.

~Jim

******************************************************************

1. Patient - " Doc, these topicals you prescribed last time are

making me flare like crazy.

I'm no longer a moderate case but a severe

case. "

Doc - " You have to stick with it. It gets worse before it

gets better. "

2. Patient - " Doc, can I try oral antibiotics ? My face can't

tolerate *any* topical it seems.

I'd prefer clarithromycin ..it has fewer

side-effects and I'm outside a lot "

Doc - " I've never heard of it. I'll give you some

minocycline though "

3. Patient - " Doc, can I try an oral antihypertensive ? My

flushing

is almost 100%

sympathetic nerve related....I'm convinced of

that "

Doc - " I've never prescribed those for rosacea. Here, try

a

topical steroid "

4. Patient - " Doc, can I have a script for some Zyrtec ? It's

helped

a bit in the past "

Doc - " Umm, I'll give you one for claritin "

5. Patient - " I'm thinking of getting PhotoDerm done. Have any of

your patients had success with this ? "

Doc - " *confused look* Umm...it's very new. I've never

recommended it for cea. "

6. Patient - " Doc, what are your thoughts on very low dose

isotretinoin ? "

Doc - " *very pissy tone* I don't believe in a half-ass

approach, and I have 18 years experience "

hi-ho hi-ho, looking for a new derm I go.

Glenn

[Guest guest]

Glenn--I also laughed when I read this, in an ironic kind of way.

Your experience mirrors mine with derms. I absolutely agree with Jim

on this one; all the derms want to do is cosmetic surgery. They don't

want to treat. In my opinion, the only reason most of them do is to

expose patients to their cosmetic surgery--patients who wouldn't

ordinarily even think about the cosmetic approach.

Also, like Jim, I found that my GP was much more helpful, concerned,

knowledgeable and willing to try new things. Even his physician's

asst knew more about rosacea than my derm did. If I need to see a dr

for this, I will go back to my GP.

[Guest guest]

-Speaking of Doctors, saw mine yesterday and when I told her that I

had started taking EPO, Flax oil and GSE for my skin she just shook

her head and refused to discuss it further...I also told her that the

MetroCream gave me the same bad reaction as the Noritate...I'm

starting to think maybe she works for the drug companies...

-- In rosacea-support@y..., Glenn wrote:

> 1. Patient - " Doc, these topicals you prescribed last time are

> making me flare like crazy.

> I'm no longer a moderate case but a severe

case. "

> Doc - " You have to stick with it. It gets worse before

it

> gets better. "

>

> 2. Patient - " Doc, can I try oral antibiotics ? My face can't

> tolerate *any* topical it seems.

> I'd prefer clarithromycin ..it has fewer

> side-effects and I'm outside a lot "

> Doc - " I've never heard of it. I'll give you some

> minocycline though "

>

> 3. Patient - " Doc, can I try an oral antihypertensive ? My

flushing

> is almost 100%

> sympathetic nerve related....I'm convinced of

> that "

> Doc - " I've never prescribed those for rosacea. Here,

try a

> topical steroid "

>

> 4. Patient - " Doc, can I have a script for some Zyrtec ? It's

helped

> a bit in the past "

> Doc - " Umm, I'll give you one for claritin "

>

> 5. Patient - " I'm thinking of getting PhotoDerm done. Have any

of

> your patients had success with this ? "

> Doc - " *confused look* Umm...it's very new. I've never

> recommended it for cea. "

>

> 6. Patient - " Doc, what are your thoughts on very low dose

> isotretinoin ? "

> Doc - " *very pissy tone* I don't believe in a half-ass

> approach, and I have 18 years experience "

>

>

> hi-ho hi-ho, looking for a new derm I go.

>

> Glenn