Before each dermatologist appointment I feel a surge of adrenalin and anticipation. The psoriasis treatment decisions made in a single appointment can impact my life in many ways. I may need to start a new psoriasis treatment that takes a lot of time, energy, and brings unending discomfort. That happened two appointments ago when the doctor prescribed the inconvenient, but effective, wet wrap therapy. Or I might have a problem that I’ve been waiting to address such as the questions I had last month about how to manage the psoriasis on my scalp or the eczema on my eyelids. That last appointment I also learned I would soon change medications, but not quite yet.
I am at a psoriasis treatment crossroads for a couple of reasons. I’ve tried a plethora of medications and therapies over the years. Finding an option that hasn’t given me a bad side effect, or just plain didn’t help before, has become increasingly more difficult. Another alternative is to wait for new treatments to gain regulatory approval for severe plaque psoriasis. (If you’re interested in what medications are in the pipeline you can find a list here). Currently the list shows one oral medication that is already approved by the FDA and out to patients. That one, Apremilast (Otezla), happens to be the one that my dermatologist and I decided I would try next. I didn’t think much of it at the appointment as sometimes these drugs can take more time than expected to make it to market. But sure enough this one became available recently. The medication I take now, cyclosporine, is by far the most effective medication I’ve used over the years. It happens to have a long list of side effects and is approved for use for only one year in the U.S. So for these reasons it’s time to make a change.
I’ve chronicled changing medications in the blog not that long ago, including one that failed due to side effects in the first week of usage. Each change brings excitement and dread. This time I feel a bit more dread since I’ll need to stop the cyclosporine. I explained to my friends that stopping cyclosporine for me is like breaking loose a dam of water, hoping the untested dam downstream — the new medication — will stop the rushing river of psoriasis inflammation. I need the new medication, or some combination of therapies, to hold the dam. On the other hand I get excited that maybe it’ll be one that works better than all the others. We’ll find out soon — at my next appointment in early November.In the meantime I need to manage the emotions that come with changing psoriasis treatments.
Here are four ways that have helped me in the past, and that I will no doubt employ as I make the medication switch in the next couple of months.
Research the medication. I know I’m in a research hospital when the physicians give me printouts of recent studies detailing every medication we discuss. I appreciate the material they provide in addition to what I can find on the Internet. I feel comfortable emailing or messaging my doctors if I have any concerns or questions. The more I know, the less I leave to chance. Doing research on medications gives the power of knowledge.
Seek support. Unfortunately, learning about a medication, especially the potential side effects, often makes me feel more anxious than before. It helps to talk about my fears or worries with my wife, a friend, or a group at church who will listen to my concerns. I don’t always feel like sharing, but usually I feel better others know what I’m going through.
Stay positive. I am a pessimist at heart. I have a slew of doubts when starting a new treatment. I think about all the different pills, injections, creams, ointments, etc. I’ve used over the years and wonder how this next one’s going to be any different. That pessimistic attitude leads to greater negativity and anxiety. If there’s anything I need when changing medications it’s hope mixed with a bit of courage to face whatever is going to happen. That’s why it’s important to stay positive when facing medication transitions.
Keep a journal. I am a big proponent of writing journals and jotting down notes. With the proliferation of electronic gadgets carried around everywhere it’s easier than ever to jot down or make a voice memos chronicling daily life with psoriasis. Those notes come in handy when I’m making decisions or needing information. For example, when my doctor asks about my reaction to medications, or how long I took which one, I have it with me on my phone. A journal is a great way of detailing what’s happening with your condition.