My thoughts, and into the next phase   
−How should I go to be a dermatologist(AD doctor) again?−



I was astonished at a fresh feeling wind blew out by me.
Although once I had daily ridden bycicle, ...I had completely forgotten the feeling .


I reminded these stormy years...
Marrage, moving and never anticipated tremendous aggravation of my AD.

All of my skin had been painful.
Only a minute, only a second had been unendurable for me.
As patients who quited steroids often said, just a breeze had caused serious pain to my skin.

As I had never been free from gushing itch and stinging pain, even moving my arm or leg a little had been like a torment.
My arms had been hardly lifted, my knees had been enable to straighten, and my body move had been always as if I had been dragging my body.

Since sitting or lying still had been most bearable, I had hardly tryed to be active.

Now I could feel a wind comfortable, provided when crustes covered my injured skin.
I felt I would like to toast this recovery.


And I considered...

"Once when I was a dermatologic physician, I never realized that AD might cause such a misery.
I treated AD patients as if their sufferings were just for theirs, not mine.
I was busy with my own living worry then.

I am ashamed of the days though I yearned for them as well.
At least I was simply comfortable and happy then.
But now I know the truth. I can not go back to the old days.

My heart won't permit me to live as such an easy doctor.
If so, how should I live as a physician from now on?
What dermatologist can I be...?

As my thought as an AD patient is reaching to an way out, another thought as an dermatologist (someday I would be again) is becoming bigger.


Both my knowledge and my body are different from those of past days.

Now I know lots of things around us in our life including chemicals and naturals might cause allergy to us.
I'ts as if our days are always in danger to get a new allergy.

As a doctor, I must fully know about them.
Then I judge what is happening in my patients rightly, suggest what they should avoid to reduce their symptoms and help them to release from their anxiety.
It is important and meaningfull role of a physician.

But recently, another worry is coming up to me.
Dr. Andrew Weil suggests in his book that avoiding to hear and watch news informations is useful to be healthy .
He says knowing produces an excess stress in our mind.
Sad, miserable or dreadful news vainly make us anxious or depressive.

I think it may be very difficult for me to stay healthy both mentally and physically in spite of having profound knowlege of unpleasant things.
Could I be such a superb doctor?


My body has also changed a lot throughout this aggravation.

Various unexpected complications like postural hypotension, irritative bowel syndrome, pollakiuria, unable to get up in the morning were sufficient to change my mind to recognize AD is not a disorder limited within skin problems, but may effect to whole body.

To my sorrow, as a patient, I have not conquered much of the symptoms yet.
Of course I never lose hope, however, it's a true the day I look forward has not come."


Moreover, I found a strange fact AD and chemical sensitivity(CS) seemed to be living together now now in my body.

As you know AD is a skin disease, while CS is supporsed to be mainly as a neurological disorder.
My symptoms were insufficient to be diagnosed as CS.
But I felt there might be a certain relation between these two diseases.

For example, my aggravation of AD started as I was exposed to housing chemicals.
And soon after the aggravation, I became to feel unpleasant when I smelled petrolem, certain kind of solvents and smoke of incense.

I became quite sensitive of various smells.
I often felt a tiny smell easily, as if they were amplified, while others around me felt nothing.

It was interesting my AD friend was in similar condition.
She could feel a smell of stew from a distant house.
I reminded a book about CS said that CS patients sometimes sense little smell to avoid danger for them.

I also noticed my daughter had caught some kind of hypersensitivity to plasticizers.
She is mild AD.
Again AD and CS were in one body.


Between certain periods after AD patients quited long-used steroids, they say they represent some hypersentitive states in which they respond to multiple antigens to aggravate symptoms.
These hypersensitivities are said to lessen as their skin condition is improved.

Were my CS like symptoms similar to those temporal ones?
If so, how could I explain my daughter's case then?


I couldn't help feeling there might be deep relation between AD and CS among the mechanisms each of them originated.
"Are they both allergy, or...?"
I still didn't have an answer.


Since I experienced several complications through AD, now I thought we doctors should see severe AD patient as they also might be deeply sick in other parts of their body.
AD is not a disease limited to skin.

And I concerned it would be difficult for a delmatologist to see AD patients in such a way.
I was a dermatologist from the beginning and not familiar to administrate patients' general conditions.
Would I be able to stand the situation?
Would I be able to be a doctor who can find a way to make those chronic stubborn symptoms improve?


First and foremost, I was still too weak to comeback to a doctor.
Would my health truely recover enough to manage heavy doctor's work and keep up to do it in the future?
I had not solved the original problem.

My old colleagues sometimes called me to ask my comeback, saying, "Now you may be in better health, how about restarting a work from once a week or so?"
I answered, "But I can't wake up in the morning still.", and they couldn't say a word.

Nevertheless I was certificated as a doctor, I hadn't been able to fulfill the duty.
I was always in a mind to feel so sorry and mortified about it.
However, it was an undeniavle fact. I couldn't do anything about that.

Any work contains certain responsibilities in it.
The responsibility as a doctor which directly influence to human bodies is of course especially heavy.
It requires deep concentration and devotion.
To my sorrow again, I didn't have such power yet even while the time of a day I'm in better condition.

I woundn't be back as a doctor for some more time, maybe years or so.
Though possibly I was be able to do better if I had been more ventured.
But I believed in someday I had to reach there and throw myself into a new fighting days.


Well, though I couldn't work yet, now I had a few hours of a day to do something.
I wondered what should I use it for.

Many AD patients in longstanding recovery process without strong drugs may face to a similar problem.

When you are in worst condition, you just focus on surviving everyday.

But when you leave the bottom and get a little better, you may feel hasty.
Now as you might have a little latitude to look around yourself, you will find yourself rather behind your old colleagues.
People surround you may also press you to hurry back to a normal social life.

It's true now you can act better than when your AD was worst.
And it seems reasonable you should undergo rehabilitation to comeback earlier.
But your body power is not enough yet.
Besides, you still are not sure whether your AD may worsen and prevent you again to complete it or not after you start something new.

Probably, in most cases, patients will try to do some part-time job at first, or, in case of students, take credits as possible to finish the academic course.

A housewife can be less anxious because her status is stable as far as the circumstances lead to a divorce.
Now things she should try are to do more houseworks for her families, especially to please her husband.

Anyhow, instead of receiving anyone's nursing or financial assistance, or instead of just spending your savings in a bank, now you must start efforts to stand on your own feets again.

If you challenge a job and accomplish it, you could be self-confident.
If you can earn some money again after the long time, your mind will be brightened.

It may be more desirable if the job is what leads to your future career.
Imagine how and in what job do you want to live at last.
Then you may find a step on what you should get now to reach there.


As myself, my choice was studying medicine.
I needed more knowledge to cure patients as a dermatologic physician in the future.
Besides doing housework and caring for my child, I started to spend other hours to study medicine again.

First, I wanted to review human anatomy.
I thought I should know deeper about our body.
And second...,
I wanted some other measures to fight better against AD.
Present fight is too unfavorable without steroids and tacrolimus!

I never think I'm a genius who can invent a brand-new agent for AD.
I also think a miracle drug should not be a solution.
What I was searching was not those ones, but some more concrete methodology.
I expected there may be, there should be such a therapy.

I was very interested in conventional and alternative medicines.
There are a lot of traditional ones; for example, oriental(chinese) medicine, homeopathy, chiropractic, osteopathy, ayurveda, shamanism...and so on.

They all have taken over for a long time, surely because they are effective at least to some extent experientially, though they has not valued scientifically.

I thought if there presents a believable method which can breakthrough this deadlock in AD, it would be in alternative medicines.
So I wanted to study some of those.

I found and applied for a correspondence course of chiropractic.
Ask, and it shall be given you.

Correspondence course is very good means for sick people like me as well as internet is.

Everyday was still very hard for me.
But in correspondence course, I can study staying in my home, choosing times when I am more vigorous.
And, unlike working, I don't need to worry giving trouble to anyone even if I cannot go well.

We always start from the first step to be a professional.
For getting needed basic knowledges, correspondence course is a useful measure, provided we can cover the school expenses.
Actual training would be the next step.


Now I go back to describe my clinical course.

In spring, it was not too hard for me to move my body.
My skin reduced stiffness, so I could extend my knee completely.

Red color of skin was decreased to light brown (spontaneously increase was daily yet), awful red-purplish change when taking a bath also diminished.

Even normal skin-tone partially appeared.
"I didn't know chronic erythroderma is curable!!"
I was astonished, delighted and filled with a deep emotion that I could reach the point before my life ended.

The texture of my skin had been improved.
Very very slowly, lichenifications, which means bigger changes of skin folds with epidermal thickening; indicating chronic eczema, were becoming smaller and thinner.
Harder itch was resigned at ticker portions.

I had thought vaguely, "When cure occur, healthy parts will expand sick ones."
But it seemed not to be true.
All parts of my skin were simultaneously recovering.
I loved the workings.

My skin was still rough with so many scaling.
But the scales were reducing in size.
I felt less dry, and now I didn't feel like I needed moisturiser.
I quited applying it at the end of the spring and no aggravation occurred.


Some of readers might think now I was cured. But I hadn't.
I was better than former me, and worse than normal people.
I you glanced at me, you would notice my abnormality at once.

When certainly recovered, it seemed I felt more concerned with differences between me the sick and healthy ones.
A goal named "healthy" might be coming closer to me, but might be too far for me to realize forever as well.


Actually, despite of the improvement of appearances, skin ithy was still quite tough.
Since big waves of itch repeatedly visited me even during the daytime, I had to spend about 30 minutes to just endure it several or more times a day.

From afternoon to evening when itch was less, I thought I should try to do some more things because I could have concentration to certain degree then.
But at night, about the time when I went to bed, strong itch broke up any will.

As soon as I was in bed, I couldn't help scratching everywhere of my skin (except face and head where I had no eruption), until it calmed down indeed after 1-2 hours.
I fell asleep, but itch awoke me repeatedly every 1.5-3 hours all night and I needed 0.5-2 hours to scratch until I got into sleep again.


To my interest, when itch occurred, I mostly found 2-10 mm sized skin-tone to pinkish elevated eruptions there.
They all disappeared until the next morning came.

Dermatologically they would be termed as wheals and the diagnosis should be urticaria.
But I couldn't help doubting about calling it as "Urticaria accompanied AD in my case."
Because the wheals looked to originate directly among the mechanism of AD itself.

Although atopic eczema is thought to occur mainly in the epidermis, it might have deep influences to the dermis as well.
Classification of diseases is always temporal and for convenience, which might be changed as time pass by.


By the way, I knew the itch diminished as I scratched from my own experience.
I didn't know why.
But anyhow, I never noticed a phenomenon "Itch increases as you scratch.", as dermatologists often explained.

When my AD had been harder, incrediblly mad itch had used to impose me to take certain oral antihistamines to endure it.
Now scrathing was most reasonable means for me to solve temporal itch, provided moderating the power of scratching so as to minimize the injury of my skin.

Of course, I hurted my skin in some degree by scratching yet.
But the itch of AD is such hard one.
Just rubbing rather increased the itch and irritated me.
Even pinching was not enough because the effect vanished as soon as I took my fingers off.

Tiny papules or slightly exsudated papules lost their itch when I scratch them off.
(Just be careful to keep your hands clean not to cause a bacterial infection.)
Itch from crusted exanthemas also might be released when I removed them if they had mostly cured.


I suppose most readers might be thinking that it's bad for patients to scratch.

Dermatologists often tell AD patients, "Don't scratch!, or you'll not recover."
Don't you think such leadings are coldhearted or harassing? My opinion, based on my experience, is "It's not necessary nor important for patients' cure to keep them off scratching".

Some Japanese dermatologists even refer that AD patients sometimes scratch in order to attract interests of others, as if AD is the same kind as trichotillomania or Munchausen syndrome.
I deeply oppose the opinion.
(Of course trichotillomania can not cured by just ordering not to pick out his/her hairs.)

Or, certain Japanese dermatologic authorities (originally Dr. Makoto Kawashima, the professor of Tokyo Women's Medical University and Dr. Misaki Kobayashi) say AD patients sometimes scratch not because of true itch, but in habit of, calling it "a habitual scratching action".
I disagree it neither.

If it looked AD patients scratch because of mental stresses, we should estimate the phenomenon as stress is a cause of itch.
Even if they looked uncouscious of the occurrence of itch, I think we should be most careful to judge that they are scratching nevertheless they are not itchy.

They will not be cured untill the mechanisms how mental stresses cause itch within their body are cured.

We can see diseases as messages from our body which notify us some abnormalities are put into action.

When some patient decided not to scratch and actually achieved cures, I think they succeeded in not injuring their skin, but somehow ending the stress(or another cause)-itch-scratch cycle.

I think it's cruel AD patients are forbidden even to scratch while they are facing incredible itch.
As itch decrease, they scratch less as a rule.

If you are a AD patient, you may try to reduce scratching when you'd like to.
Maybe it'll be when your itch has decreased and the mechanism in your body is about to become normalized.

You need to be hurt neither by words of doctors who care only superficial looks of your skin, nor by words of your surrounding people (may be your family member) who cannot admit the difficulty you face.
Just forgive and ignore them.


By the way,
though wheals had been disappeared when I woke up, every morning my skin was worn out after a long fight throughout the night.
Painful and itchy was my whole body skin.
As soon as I prepared breakfast within a few munites, I had to rush to take a bath.

Then I went back to bed and endured another itch called by hot bathing.
After a while when it calmed down, I ate breakfast lying.
Repeatedly I tried to get out from bed then, but I never succeeded because my body was too painful/itcy to move.
After all I couldn't help fall asleep again for escaping from the pain.

About noon when I awoke, itch and pain came back at once.
And when I finally left bed, I felt another pain because my skin injuries had not sufficiently covered by dried crusts.

In the end, my life was remained as such that I was functionally valuable only from noon to night.


Before I close this chapter, I refer to my daughter.

A new topic about her was about vegetable juice.

A book of Rika Zarai recommended fresh vegetable juice, saying, boiled vegetable had lost much of valuable vitamins and minerals.
I thought they would be important nutritions for recovery of AD as well.

I bought a jucer in early summer and started to make fresh vegetable juice.
My recipe was 1/2 banch of spinach, 1/6 head of cabbage, a half or more of a carrot, 1/2 apple, 1/2 lemon and a little honey (sometimes some celery for me) for 2 glasses.

My daughter and I drunk it twice a week.
I don't know how much did it affect to my daughter's AD condition, but within 3 months, her neck exanthema almost dimished.
Now she could take a bath without pain. She was happy.

The exanthema somewhat returned when the next winter came, but never became so bad as before.

Maybe vegetable intake is important for AD skin, to supplement sufficient vitamins, minerals, and fibers.
Vegetable juice is a good means for that, since we are becoming to take less vegetables in recent menus.

In fact, however, I quited the juice making next year.
The reason why were, 1)fresh juice was cold in winter, 2)my dauter disliked the taste, 3)it made lots of useless vegetable wastes and 4)washing the juicer made my hands rough.

Instead that, we got used of having ready-made vegetable juice often.
We like one which contain no tomato.
This has been our practice.

・・Nine years have passed since the aggravation.








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