I need help... PP is killing me!

[Hoss350]

I need some advice, folks, I am in the unenviable position (which I am sure you have all been in) of having to decide between which of the scary-sounding, horrible treatments that they have for P that I should go with.

First, a quick history. I am 27 years old, and have, up to this spring, been dealing with what most would call a mild case of plaque psoriasis for most of my life. I remember having it in my scalp as a kid, and around the more stressful times in my life (high school graduation, SATS, college graduation, etc) I found myself having flare-ups. Mostly in my armpits and scalp. Mostly they went away after a few months.

However, my real nightmare started this spring, and I have been a wreck ever since. I am covered in plaque P. I have spots on my feet, shins, calves, thighs, backs of my legs, buttocks, unmentionables, back, stomach, necks, face, scalp… okay, I could have said everywhere, but I wouldn’t want you to think I was exaggerating. My back and legs are literally covered. My stomach and chest are spotty, mainly due to the fact that it is easier to get the ointments on there, much harder to get it on my back and legs with my bad back.

I am using clobetasol ointment on the non-sensistve areas on m body. I am using Protopic ointment on my face, armpits, groin/unmentionables, etc, and a clobetasol soloution on my scalp.

It is NOT working. Spots go away, but come back quickly with a vengeance as soon as I lose track of where they were and stop applying the ointment. I am literally bathing in this crap every day, and that scares me because I read about cancer and all sorts of nasty stuff as side effects of this, and to boot, the doc told me specifically not to apply it all over (as if I had a choice, the P is all over!!!).

So I am looking at other options. The PA that was helping me told me that ointment was my only option, which ticked me off because there were other options that I knew about specifically. So I told her to get the Doc in there and lets talk!

He told me the following:

There is the MTX, which sounds dangerous, and has the side effect of killing your liver.

There is Enbrel, which is so expensive that most insurance companies won’t pick it up until you’ve exhausted other options. Also, the PA told me some story about how you had to have so much % body surface coverage of P to qualify. I was shocked that I did not have enough!!! I am covered in the stuff!!! But the Doc debunked that one pretty quickly as soon as he came in. I think my PA is kind of lazy.

There is Some synthetic vitamin A derivative that causes high cholesterol, which with my family history, I am terrified of

And finally, there is narrow band UVB, which my friends that have P also tell me is totally worthless.

I am scared right now that I may be stuck like this forever, or that the only other option is to take huge risks on drugs that may or may not even work!!! I cannot sleep from the itching, which is effecting my entire life. I am a zombie. When I fall asleep, my wife has to wake me up because I’ll sleep-scratch until I bleed all over. It looks like a scene from CSI on the bed in the morning sometimes!!! I am sorry this is so long, but I really need some help here guys. Which treatments have you folks found to be the safest, or most effective, or at least worth the risk? Is there any truth to the insurance company/enbrel thing? Is there any hope at all, or am I just as screwed as I think I am???

[sergecosta]

I have mild psoriasis and I hate topicals. How a dermatologist could send you home to use topicals with the coverage that you have is ridiculous!

This condition can make anyone go crazy. It is truly a wonder how some of us get up every morning and proceed with our lives with the best faces possible.

Have you considered signing up for a clinical trial at some reputable university or institution? There are some exciting items coming down the pipeline such as the interleukin inhibitors that have given many people a new life.

Everytime you put on medication topically, there is always a chance the medicine will never reach where it needs to go. That alone is an absolutely sad concept. I had a well-respected dermatologist in the Boston area tell me, with no hesitation, that topicals are "absolutely useless." The miracle is not so much in the medicine clearing your lesions -- but actually getting where it needs to go to regions below the epidermis. That's why many of us apply medicine after showers when the skin is still moist, and apply oils to increase the absorption of medicine, etc.

I think interleukin inhibitors should be injected subcutaneously for any psoriasis patient -- including the scalp. And none of this nonsense that one can ignore scalp psoriasis (or learn to live with scalp psoriasis) because it is covered up by hair. One dermatologist suggested that I should not worry about scalp psoriasis. I reminded her that to me it is not a cosmetic issue. My scalp has been continuously inflamed, in form or another, since 1991!!!

I am, of course, delighted that some of these biologics have been bringing so much relief to many individuals. But I feel that mild psoriasis patients need some new approaches as well.

[Jillian1507]

Hi Hoss!

I'm sorry to hear that you are going thru such a rough patch, but everyone here definitely understands your pain and frustration. As many of us here are terrified of the side effects of ointments, pills, etc. many people have looked into the alternative route. I'm 25 and had PERFECT (well almost! LOL) skin - no zits, NOTHING, just a little dry scalp that I chalked up to being dandruff - NOTHING MAJOR. All of a sudden it started as a "rash" on the back of my neck in Dec. 2004 and has blossomed into craziness. I was fed up with the fact that my skin was like this and figured something had to have caused it, since I never had issues before. Check out the alternative section, as many of us have modified our diets, tried teas, supplements, BJ's formula, etc. Many of these things are inexpensive and relatively safe. Please be aware that these things do not work overnight and that you have to be patient - could take 4 weeks, could take 6 months - it just depends. I have cut out wheat and dairy products (not too bad once you stock your house accordingly) and have been taking supplements and I have seen a major improvement. My hair stylist has said that my scalp looks 100% better than before, which was raw, red & disgusting - I seriously wanted to shave my head - NO JOKE.

Not everyone "believes" in the alternative route, but I personally think you have nothing to lose, but your skin problems, right? If it doesn't work, then you are in the same situation as now and if it does, AWESOME!!!! It has not completely gone away (right now I am 6 1/2 months pregnant), but has improved greatly. Some people have seen 100% success, while others may see a 50% or 75% - who knows until you try.

Everyone here is so super nice and ask questions if you have any - that's what the Boards are all about!

Hope this helps

[MikeK]

Hi Hoss,

Welcome to the board. :cool: Nice to meet you.

I'm sorry to hear that you're going through such a rough time. :(

First, it sounds like you need a new dermatologist. His PA's bedside manner leaves a lot to be desired, IMHO.

Second, you might want to seriously consider going for UVB light treatments. Light treatments can be a pain (literally -- some people have been burned by them) because you would have to go for treatments three times a week for several months. They don't work for everyone, and you may run into insurance issues (the NPF has an insurance advocacy service that goes to bat for people who are having insurance issues) and you would have to go for treatments three times a week for several months for treatment but they can be a safe and effective weapon in the war against psoriasis. Home light units are available and are often (at least partially) by insurance. As I mentioned, not everyone responds to light treatments so most doctors and insurance companies generally insist that patients undergo their initial treatment at a doctor's office or clinic. Several people who post here have been able to waive that requirement. Here's a link to the NPF's discussion of light treatments: http://www.psoriasis.org/treatment/psoriasis/phototherapy/.

Here's some thoughts on some of the other treatment options that were either offered by the PA or that you may want to consider: Methotrexate or MTX -- MTX is actually a form of chemotherapy that in lower doses is prescribed for psoriasis and/or psoriatic arthritis. It can cause birth defects -- even in cases where a man who fathers a child while he's taking MTX. As you mentioned, MTX's potential side effects include liver failure and death. You CANNOT drink alcohol if go on MTX. People who are on MTX have to undergo frequent bloodwork and some doctors require that their patients undergo a liver biopsy after they've been on MTX for a certain number of years. A lot of people who post here are on MTX. MTX is used as a treatment for Juvenile Rheumatoid Arthritis and there are several parents who post here whose children are on MTX. (In some cases since they were toddlers.) As I mentioned, MTX's potential side effects include liver failure. The good news is that nausea and fatigue are the two most common complaints by people who post here who are on MTX. Sadly, had two posters (both adults) developed serious health problems that may be related to MTX. Liz was diagnosed with kidney disease. (Here's a link to her story: http://www.psoriasis.org/forum/showthread.php?t=9785&highlight=kidney+disease.) Sadly, Midnight needed a liver transplant. (Here's a link to her story: http://www.psoriasis.org/forum/showthread.php?p=39721#post3972.) Liz still posts here from time to time. She has her good and bad days. We haven't heard from Midnight since she shared her very sad experience with us. (I hope and pray that they're both o.k.) I'm not telling you their stories to scare you or to discourage you from using using a treatment that might help you. I'm letting you know about them so that you can make a fully informed decision concerning her treatment options. Some insurance companies require people to start with MTX before moving onto to other, more expensive treatments. Here's a link to some additional information about MTX: http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/met1257.shtml; Soriatane (www.soriatane.com) (Soriatane is the synthetic vitamin A derivative that you mentioned.) Soriatane is very expensive so it may not be an insurance company's first choice for treatment. Soriatane can cause birth defects. A woman cannot become pregnant for a minimum of three years after she finishes taking Soriatane. I'm not sure if a similar warning applies to fathers. I do know that both men and woman who have taken Soriatane cannot donate for a minimum of three years after they finish taking it because there is a concern that the donated blood can cause birth defects if it is given to a woman who subsequently becomes pregnant. You CANNOT drink alcohol if you take Soriatane. You would also have to undergo frequent bloodwork. As you mentioned,Soriatane can cause cholesterol problems. Some people can tolerate Soriatane's side effects and some people cannot. Cyclosporine has a very fascinating history. Cyclosporine was first developed and approved to prevent rejection of transplanted organs in transplant recipients. Someone noticed that the psoriasis in transplant recipients who also had psoriasis started to get better. That led to additional research and testing and actually let to a change in the way that doctors and scientists thought about psoriasis. Before cylcosporine the thinking was that psoriasis was an incurable skin disease. Thanks to cyclosporine, doctors and scientists now know that it's an autoimmune disease. Cycloporine can be a very effective treatment for psoriasis. It often works very quickly and is sometimes used to get severe flares under control so that other treatments can be used. Cyclosporine is such a powerful medication that a psoriasis patient can only use it for a maximum of one year. Your aut would have to undergo frequent bloodwork if you go on cyclosporine. A friend of mine who was on cyclosporine told me that he also had to undergo urine tests because it can cause kidney problems. Here's a link to some additional information about cyclosporine: http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/san1393.shtml. Biologics The biologic drugs include Enbrel (www.enbrel.com or http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/enb1159.shtml), Remicade (www.remicade.com or http://www.rxlist.com/cgi/generic3/infliximab.htm) and Humira (www.humira.com or http://www.rxlist.com/cgi/generic3/humira.htm.) (A more complete list of the biologic medications can be found here: http://www.psoriasis.org/treatment/psoriasis/biologics/.) The biologic medications are all part of an exciting new class of medications that have only recently become available. (They've only become available in the last 10 years or so.) All of them have some pretty serious potential side effects. Because biologics are so new, so most of their potential side effects are not yet known. Enbrel is the biologic that's probably discussed most often here on the board. The good news is that most people report being pleased with the results that they've seen. The bad news is that some people have deveopled serious health problems while on Enbrel. Fortunately, the number of people who've developed serious health problems while on Enbrel are so few and far between that their stories are easy to remember and find. Sadly, Bill (bluewater) developed Lymphoma shortly after he started Enbrel. He very understandably blamed Enbrel. (Sadly, his screen name has been deleted; Since he no longer posts here, so there's also no way of knowing how well he is doing. I hope and pray that he's o.k.) I'll give you a link to the thread where he shared the sad news of his diagnosis later on in this post. Sadly, Karen (Kiki223) developed liver cancer and several other serious health problems after being on Enbrel for all of five weeks. She posted that her doctors concluded that her health issues were cause by Enbrel. She doesn't post very often and we haven't heard from her in a while. I hope and pray that she's o.k.) I'll also give you a link to the thread where she discussed her experience with us. That being said, here's the links to those sometimes very sad discussions about people who've developed health problems while on Enbrel, Humira and Remicade:

http://www.psoriasis.org/forum/showthread.php?t=24175&highlight=remicade+hospital;

http://www.psoriasis.org/forum/showthread.php?t=18975&highlight=reaction+remicade;

http://www.psoriasis.org/forum/showthread.php?t=17891&highlight=reaction+remicade;

http://www.psoriasis.org/forum/showthread.php?t=23527&highlight=allergic.

http://www.psoriasis.org/forum/showthread.php?t=24030

http://www.psoriasis.org/forum/showthread.php?p=293896&highlight=L%27hermitte%27s+sign#post293896

http://www.psoriasis.org/forum/showthread.php?p=313346&highlight=L%27hermitte%27s+sign#post313346

http://www.psoriasis.org/forum/showthread.php?t=23028&highlight=brain+lesions

http://www.psoriasis.org/forum/showthread.php?p=226418#post226418;

http://www.psoriasis.org/forum/showthread.php?t=3414;

http://www.psoriasis.org/forum/showthread.php?t=4919; (Tiffany posted an update. The problems that she experienced turned out to be UNRELATED to Enbrel. Here's a link: http://www.psoriasis.org/forum/showthread.php?p=62631#post62631.)

http://www.psoriasis.org/forum/showthread.php?t=16949.

I'm not sharing these heartbreaking stories with you to scare you or to discourage you from using any treatment that you and your doctor decide is right for you. I'm letting you know about them, because I believe that a fully informed patient makes the best patient. As I mentioned, most people report being pleased with the results that they've seen from these very powerful medication.

That being said, a lot of people who post here are on biologic medications. They don't work for everyone, but most people report being pleased with the results that they have seen. Some people have had to try more then one biologic in order to find the one that was right for them. Most people report experiencing little or no side effects. Most of the biologic medications are given by self injection (kind of sort of like an insulin shot) at home. Remicade is given by infusion (similar to a blood transfusion) at a doctors office. Some doctors require patients to take MTX along with Remicade. There's at least one biologic medication (Amevive -- http://www.amevive.com/ or http://www.rxlist.com/cgi/generic3/amevive.htm) that's given via injection that has to be given by a nurse at a doctors office. All of the biologic medications are very expensive, so some insurance companies require patients to start with a less expensive drug (i.e., MTX) before they'll approve a biologic.I'm sorry that this turned into such a novel. You're probaby suffering from information overload. :rolleyes: I hope that it helps in some small way. Feel better! Good luck. Keep us posted. Let us know if you have any other questions and please don't be a stranger.

Mike

[partial]

Look at all treatment options.

Your friends saying that NBUVB (or any other treatment option) is worthless holds no merit. What works for one, might not for another.

I spent time talking to the derm about all treatments options. My decision was to go from least intrusive/least potential side effects, and work up from there.

I started with topicals. My derm was very matter of fact in her opinion of the "black box" side affects. She was very up to date and familiar with potential problems and offered her professional opinion on them, as they related to my situation.

I tried topicals. They worked for a while, but when taking the recommended break to avoid skin thinning or whatever, the p came back worse than before.

I had a hard time even thinking about biologics, as I don't react well to internal medications, and had a really hard time justifying to myself that the potential benefits outweighed the potential side effects.

NBUVB was not available where I was. The derm OK'd giving tanning a shot, as long as it was done in moderation and carefully.

Worked wonders for me, went from 50+ percent plaque coverage, to maybe 1 percent (about 1-2% now that I have tapered off, I can say that I was 100% clear for a while). I am still doing tanning almost a year later to keep things under control while I fight with the insurance company to be able to get NBUVB, but go less than co-workers who are doing it to maintain a tan.

The one thing that I found, was that it was tough to stick to any treatment, since results were not immediate (I got lucky with tanning, as it cleared the p on my eyebrows after only a couple of visits and motivated me to stay with it).

Others here have had great success with biologics, natural treatments, etc. You just have to find what works for you and give whatever you try enough time to make a difference that is big enough so that you stick with it.

Good luck.

[RichJ]

hi hoss350'
sorry i can't help much but welcome to the p family. you have met some of the wonderful people on here and will find alot of great info. welcome and nice to meet you.

try and have a good day all

richard

[DottieD]

Greetings hoss -
I see you've already received a lot of good information, but I'll add my two cents' worth.

One: scratching usually makes pp much worse. Can you take benedryl or use some anti-scratch lotion? When I allow myself to scratch an area vigorously, it invariably gets a localized flare-up.

Two: My derm said not to use clobetasol continuously and recommended using it for 2 weeks, then going off of it for a week. I got better results using it for 1 week, then going off for a week. Evidently our bodies acclimate to the steroid and it becomes less effective if we don't take breaks.

Three: Psoriasis is an inflammatory disease, and I have received significant relief from changing my diet to remove or decrease foods that promote inflammation. The biggest offenders are liver, eggs, farm-raised salmon (but not the wild type), and fatty meat, particularly fatty pork (sausage, ribs, hot dogs, etc). Dark meat of chicken and turkey is also fairly high.

You may see an improvement in your skin if you cut these foods out of your diet (as much as realistically possible) and reduce your meat intake to one serving of lean meat a day (I try to eat more fish). It certainly helped me and it's easy to do.

Best of luck to you. You're not alone! DottieD

[Ihurt]

Im one of those people and (nurses) that thinks after you become a certain percentage covered (50%) you need to think about a biologic because it means that the "systemic" part of the disease took over.

Personally Im on MXT and Humira. My skin is clear. Enbrel completely cleared my skin but did little for my arthritis. I was also on Remicade and that's a long story, but for P alone, really...Enbrel would be your choice next. One shot weekly, and it works pretty quickly.

Yes we are all making a deal with the devil when it comes to biologics, but so far of any of the three I have had, I had no side effects and my quality of life was better just not having P! My PA is quite a different story though. MXT also clears P, but some people get the side effects of fatigue from it. I would talk to the Derm about Enbrel.

Good luck, and I hope you feel better really really soon.

[carolyn1965]

Welcome Hoss,

I know exactly what you are going though and I think we have all been though it. It is very depressing and agrivating to say the least. But #1 Keep your chin up and talk - don't let the depression get to you (I know easier said than done) we are all here to talk if you need us. And now on to my 2 cents:

Most Derms willdo whatever they can do for you if you choose the Enbrel. (I also had to be pre-approved) and I was denied the first time, but Dr was persistant and got me approved - best thing I ever did. If your Derm won't help believe me there are Derms that will - I don't think they all believe us about the itch - I sometimes question my own and am currently looking for a new one because of this. Believe me I know its real - your lucky your wife still sleeps in the same room - My husband has moved out of the bedroom because of the scales all over the bed, because I can't sleep and because i constantly itch. Creams and lotions got to be useless as they all do and so (probably will) the Enbrel after a time (mine took 2 years) but skin was almost 100% clear and itch gone. After that came Humira (also helped for about 1-1/2 years) then came the allergic reactions and now Remicade (after 2 infusions I am not sure that this is working) especially on the itch. I absolutely sympathise with you on the itch I am with you on that. I have a UVB light which I followed Derms instructions and endedn up with 2nd Degree burns ALL over my body even the privates and in the Hosp burn unit so please be carefull with this (start at a tanning salon and see if it helps).
I don't know much about the food thing - i haven't really been able to fiond one food that really triggers it, so not really up on that and would also love more info on this.


Good luck and let me know - let me know if I can help further

Carolyn

[Hoss350]

Wow, thanks for all of the info, guys. You all spent a lot of time on these posts, appreciate it very much.

I have tried diet modification, but have found that my trigger is stress. Ruthless cycle, that. Get a little stressed, get a flare up, flare up stresses you out, get even more flare up, get even more stressed... Well, I'm sure you all get the point.

I am considering a relatively large lifestyle change that might help reduce my stress load. I am currently commuting 93 miles one way to work. About 200 miles daily. Getting up at 4 am to drive down and be there by 7. Leaving at 4:30 or 5 to get home about 7. It is sucking the life out of me.

I have re-evaluated my team, hired an assistant to take care of on-site admin stuff, and figure I'll be able to relocate back to our home office (about 10 miles from home) in a few weeks as soon as I get him on board and running smoothly.

In addition, I start NBUVB this afternoon, and figure i'll talk to the doc about doing this in conjunction with Soriatane, as this one seems to be the least harmful of the drugs, and then work my way up from there if this doesn't work.

I guess it helps to just make a decision and stick with it, right, wrong, or indifferent. YOu guys helped me do that. I appreciate that very much.

[DAguilar]

It has not completely gone away (right now I am 6 1/2 months pregnant), but has improved greatly. Some people have seen 100% success, while others may see a 50% or 75% - who knows until you try.

Everyone here is so super nice and ask questions if you have any - that's what the Boards are all about!

Hope this helps

Jillian,
You say you are 6 months pregnant and these supplements work for you. I thought that when a woman who suffers from P is pregnant that their skin clears up. When I was pregnant with my daughter my P cleared up completely. But when I was two weeks up to my due date my P flared up really bad, and ended up covering over 90% of my body. I was completely miserable. They ended up having to induce labor because of any possible risk to the baby and I was not able to have a c-section (not that I wanted one anyways). I was just curious as to whether or not you started using these supplements before your pregnancy or during and whether or not they really work. I've used supplements in the past and they were of no help to me. Congratualtions on your pregnancy!

[Kyle James]

I'm 22 years old and have P on my scalp, probably 75%, a small spot in my ear, on my chest and one small spot on my leg and I'm terrified it will spread. It has been in this mode for about 5 years. I don't take any drugs but simply try to live with it as it sounds like you did for years. Do you have any idea what triggered the spread and how are you doing now? Hope you're coping well. Kyle

[grannyfranny]

Jillian,
You say you are 6 months pregnant and these supplements work for you. I thought that when a woman who suffers from P is pregnant that their skin clears up. When I was pregnant with my daughter my P cleared up completely. But when I was two weeks up to my due date my P flared up really bad, and ended up covering over 90% of my body. I was completely miserable. They ended up having to induce labor because of any possible risk to the baby and I was not able to have a c-section (not that I wanted one anyways). I was just curious as to whether or not you started using these supplements before your pregnancy or during and whether or not they really work. I've used supplements in the past and they were of no help to me. Congratualtions on your pregnancy!


Sorry,,,not all clear when pregnant. I did and felt lucky. Some get better and some get worse.
I was sure it had something to do with hormones but,,,,,,,NOT,,,,,,tried birth controll pills and later had a hysterectomy. Only pregnancy helped me.

[Jillian1507]

Jillian,
You say you are 6 months pregnant and these supplements work for you. I thought that when a woman who suffers from P is pregnant that their skin clears up. When I was pregnant with my daughter my P cleared up completely. But when I was two weeks up to my due date my P flared up really bad, and ended up covering over 90% of my body. I was completely miserable. They ended up having to induce labor because of any possible risk to the baby and I was not able to have a c-section (not that I wanted one anyways). I was just curious as to whether or not you started using these supplements before your pregnancy or during and whether or not they really work. I've used supplements in the past and they were of no help to me. Congratualtions on your pregnancy!

Hi DAguilar!

I've been on supplements and diet mods since last August and became prego in April. My skin had improved greatly prior to getting pregnant. My skin now is doing well - not 100% healed though. I think that mine is definitely stressed related as well as related to food sensitivities/allergies. After the baby is born (due date is late Jan), I plan on going to an allergist to see if we can figure something out.

The one thing that I don't understand is that many women do clear or get much better during pregnancy, so to me it sounds like hormones have something to do with it. Why we haven't figured out the connection at this point is beyond me ?!?!?!

[Hoss350]

I'm 22 years old and have P on my scalp, probably 75%, a small spot in my ear, on my chest and one small spot on my leg and I'm terrified it will spread. It has been in this mode for about 5 years.
That was me, too. Mostly small patches, scalp, armpits, etc for the first 26 years of my life, off an on. 3 months on, 10 months off, or so. Not enough to really bother me. I just used moisturizer and possibly some OTC hydrocortisone on the pits.

I don't take any drugs but simply try to live with it as it sounds like you did for years. Do you have any idea what triggered the spread and how are you doing now? Hope you're coping well. Kyle

Thanks for your support. The trigger on my spread was a combination of things. First off, I injured myself last year pretty severely, which has resulted in chronic back pain and two herniated and ruptured discs at L4-L5 AND L5-S1. This resulted in a sort of "quarter life crisis" in which I finally recognized my own mortality and vincibility in a way that people younger than 25 have a rough time doing. The constant, debilitating pain caused me a lot of physical stress, and the recognition that I would never again be the strapping, 6'3" 265 pound athlete that I was before the injury caused me a lot of psycological stress.

In addition, starting around January 1st, 2007, I was put in charge of a construction project that is 4 times larger than any project I had ever done to date, and was to be done on a constricted time schedule that seemed impossible at the time. It is 93 miles from my home, and given the challenges, I decided to not attempt to run it remotely, instead opting to relocate my office to the site. This means I commute 200 miles per day. Awaken at 4 am, drive to site by 7 am, leave site at 5-6 pm, get home somewhere around 8 pm depending on timing of the departure. This, coupled with the demands of delivering an almost impossible feat of construction in the given time, has added to my stress level, to the point to where I flared up.

To avoid flaring up in a manner similar to me, simply don't allow yourself to be so stupid as to get injured and get saddled with a herculean task all in the same year. To be sure, WORRYING about it is going to do nothing but make your chances of flaring WORSE, so my advice is to just not worry about it, and whatever will be will be.

I wish you the best with your malady, and pray to everything good and righteous in this world that you don't end up like me.

[Kyle James]

It seems the more and more I read about this the more I realize that stress is a huge factor. That factored with diet & lack of sleep etc really aggravates this whole disease. I too commute and have very long days but try to not let anything get the better of me. But I'm still scared and can't believe that there isn't more help out there, patrticularly positive information. Everything I read is terrible and I feel everyone's pain. Is yours getting any better? Are you finding any relief or anything that is helping at all. I wish you too only the best in your journey. Keep in touch...Kyle

[montecido]

Dear Hoss350 I am a medical professional,I also take mtx and am very satisfied with it. It is inexpensive and safe for most people. Mtx gained its scary reputation due to high doses used in treating cancer.Doses used for P are smaller.Do the required blood work and follow directions carefully.If you do have liver problems d/t mtx. they are reversible. Talk to your Dr. its a good Treatment for most .