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hillaj1

A medical students accutance experience

I started a blog on the web site, but I didnt know which was better to reach out to people--the blog section or the message boards. Any opinion on this is much appreciated. thanks!

Hi all,

So here's a synopsis of my story. I am 24 years old and have dealt/suffered with acne since I was 13. Like many of you (if there is anyone reading this), I have tried so many OTC products, prescription products, facials, etc, etc, etc (sorry for the redundancy, but seriously, it's seems like its been that many etc's worth of failed treatments). My last treatment regimen consisted of cetaphil cleanser, minocycline, acanya topical (BP/clinda), and cerave moisturizer. Like many of you, I have spent countless hours perusing this site looking for the next 'miracle' wash, lotion, topical that was going to get me out of my acne funk. I know WAY more about every ingredient in every product than humanly possible. Many tries, many failures, more irritation, more acne, less fun, more hiding.

At Christmas, I was finally sick of everything as my treatment wasn't working and I was avoiding friends and family. Something needed to be done. I am getting ahead of my self, let me recap the holidays real quick. I was taking a trip for new years to visit some fraternity brothers from college, and was very worried about all the 'face' time I was going to be putting in with people in bars/parties, plus the idea of not being able to wash my face and apply BP every 12 hours to prevent my weekly breakout from occurring before I could get out of dodge. This is exactly the type of situation that acne can ruin. Something that everyone is looking forward to (a reunion), that you can't enjoy because of acne. Literally, on this trip, I was thinking about what my face looked like 95% of the time I was there. The other 5% of the time I was wasted.

I am currently in medical school in my third year, and have developed lots (and lots) of anxiety concerning my acne (not looking patient's in the face is not exactly acceptable). I have kicked ass academically in school, and not feeling as confident dealing with people ALL day due to my acne--I decided something to be done. During Christmas break, I first decided to try and deal with my anxiety with medication. After my second day or so a SSRI for generalized anxiety disorder, I decided the hell with that, I needed to do something to address the underlying cause of my anxiety, and not the anxiety itself. So I went to my dermatologist, and got hooked up with Accutane.

I was prescribed 80 mg, alternated with 40 mg, each day. Thursday night I was on call at the hospital and couldn't pick up prescription. I had to stay up awake for 30 straight hours w/o washing my face (talk about an anxiety inducing experience). I was in and out of surgeries with surgical masks strapped across my face, sweating, and fretting. Yesterday was my first day (80) and today I took 40mg. Last night, I went out and had 5 beers (a big no, no--risks of acute live failure/hepatitis/transaminitis as well as hypertryglyceridemia induced pancreatitis---we have lots of words in medicine to keep the masses confused). But seriously, I needed to have a few drinks, because the next six months of sobriety are going to be real bitch for me. All my friends were wondering why I was being such a "insert expletive of your choice." I chalked it up to being post-call (the day after being awake all night when you feel like zombie). Normally, I can drink 12 beers and still spout off all of Ranson's Criteria for assessing acute pancreatitis (not trying to brag, just trying to objectively qualify my level of alcohol tolerance). Needless to say, I drank five beers over about 4 hours , felt nothing, and drove home.

Today (Day 2) I took 40 mg and washed with cetaphil and a light application of cerave. I already enjoy not having to apply the BP everyday. Such a pain in the ass, as I am sure many of you can relate. No side effects thus far, though I am not feeling dizzy like I did in the mornings on minocycline. Thus, so far so good. I immediately checked my sclera (white part of the eyes) and in the veins under my tongue this morning to check for signs of "jaundice" (hyperbilirubinemia--high levels of bilirubin the blood-- causes yellowing of the body's mucus membranes and eventually skin). Bilirubin is the breakdown product hemoglobin, the oxygen carrying heavy metal/protein complex of red blood cells (RBCs). RBC lifespan is 120 days. After this time, the spleen chews them up and delivers the goods to the liver to process. The liver conjugates (makes more soluble) and excretes the bilirubin into the bile, which is stored in the gallbladder, and excreted into the GI tract with cholesterol. If your liver sucks (like from taking lots of Vit A (accutane) and drink EtOH (alochol) causing hepatic failure) levels of bilirubin in the blood will rise and jaundice ensues There's your medical lesson for the day. More to come if I can think of some good ones. I will likely have more time on my hands now that I won't be boozing when I am not studying/in the House (hospital).

Holy hell, that's the most I have written down since I was in high school. Definitely feels good to vent. Reading other's blogs and posts have helped my cope with acne over the past few years, so I hope I can provide a unique perspective for those on accutane. Take care all, and I will try to stay up to date with my posts. Alright team, ready.....break.

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Hey, how's it giong on accutane so far? I'm surprised that you decided to take it, being a medical student and all and knowing the full extent of how dangerious a medication it is, but being an acne sufferer like yourself i can see how the benefit would outweigh the risk. I am debating starting it myself, but coming from a medical background, it's so hard for me to make that final decision of taking the capsules because i am aware of how miserable a medication can make you if you happen to be the unlucky few that end up with permanent side effects and i've been doing a lot of research and reading a lot of clinical studies, which is probably not a good idea bc i'm just psyching myself up even more. I'm giving myself a month, if my acne gets worse or i realize that i can't live with it anymore, i'll jump on the tane bandwagon. I just don't want to do irreversable damage to my health for a "superficial" reason, as most people will see it.

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copied from my blog in blog section:

Yo gang,

Day 3, no noticeable difference in my skin today, except there is less redness and irritation from not using BP anymore. My skin actually feels kind of like of own instead of mask with paste on it. Not a bad feeling. I bought some aquaphor today to prepare for the ensuing dry lips that seems commonplace amongst accutane users. I also hit the gym pretty hard. One of the common side effects of accutane is myalgias (muscle aches) and low energy. I haven't experienced either so far. We will see tomorrow if I am anymore sore than usual after a good workout.

User silver and gold, thanks for the shout out on my comment section. Peer support is always good for the psyche. As many of you can probably relate, talking about your acne problems with your friends and family isn't fun/realistic--its just damn awkward. The internet is a great thing. I had some other comments on the message board. I have copied my blog there; not sure which people look at more, the blogs or the message board. One user was surprised I was taking accutane knowing all of the possible side effects. Well here's the deal. Yes there are side effects. But guess what, the mental suffering and anxiety that I have put up with for what seems like my entire adult life has brought me to this precipice. Acne is not superficial when it begins to impact your ability to begin relationships and careers. Believe it or not, even in the medical community, when I apply for residency programs this fall, my complexion will make a difference. I have had acne free periods in my life, and they are awesome. I have no social anxiety, I get more women (sorry girls, I am not a misogynist, but it's true--attractive girls do not go for guys with acne. I know this for a fact), I can workout any time of day without having to schedule washing my face and applying BP, I can swim anytime of day, lay out in the sun, get muddy, etc. Looking forward to getting back to this.

So there it is. I will be on call tomorrow night which means I will be awake for another 30 straight hours starting at 5 am tomorrow. It will be my first call without having to lug a towel, BP, lotion, and cleanser. Just a couple of pills. That in itself already feels good. I won't have to make up some bullshit excuse to run off for five minutes from my team to wash my damn face. Its the little things in life that people without acne don't understand. Good night fellow acne sufferers, and god speed.

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Copied from my blog:

Day 4 and 5

So I just got back from a night of call at the hospital. I was actually able to grab 2 hours of sleep in a reclining arm chair in a empty patient room without getting paged. That is a successful night my friends. Plus I got let go early; often, I may have to stay until noon. All in all, today has started off on the right foot.

Yesterday was a 40mg day and today I took 80 mg with a vitamin water and some trail mix. You are instructed not to lay down for 30 minutes after taking accutane. Essentially, this is to avoid esophagitis (inflammation of the esophagus--the tube that connects your oropharynx (throat) to your stomach). An increasing number of people in industrialized countries suffer from reflux/heartburn. This is due to an incompetent LES (lower esophageal sphincter--a band of muscle that keeps acidic gastric contents in the stomach and out of the esophagus as the stomach contracts). Throw some caustic medication in there (such as accutane), and boom--esophageal irritation. The esophagus is not built to withstand chronic assault like the stomach. It is lined by a different type of epithelium (cell lining) that isn't as "tough", if you will. I think I fell asleep 2 minutes after taking my pills and woke up supine (laying down). So much for doctor's orders.

My skin is starting to dry and redden a bit along my cheeks--a traditionally oily territory for me, not unaccustomed to 3 to 4 blotches per day with tissue paper to remove excess oil. Oily looking skin for me has been just as big of a problem as breakouts. Sometimes, the two don't even seem to go hand in hand. Some of my clearest days have been marked by what seems to be excessive oil. I am talking sweaty looking oil. The kind that makes you want to go to the gym so you can fit in. Yea, that kind of oil. This was one of the the biggest contributing factors into my choosing to start accutane.

I think I may have experienced my first accutane side effect--dermatitis. I have a few itchy, dry splotchy areas along my wrists, especially near my watch band. These areas are similar to the skin irritation I experienced during an adverse drug reaction (allergy) to a sulfa antibiotic (bactrim) in college, which ended up with me in the emergency room and a room of doctors, residents, and medical students staring at my junk to make sure the rash hadn't involved my family jewels (it hadn't, but they wouldn't take my word for it). I will expand on dermatitis in my next log. For now friends, I'm exhausted, and going to sleep for a 5 or 6 hours. Adios.

Edited by hillaj1

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Day 6

Today was a 40 mg day. The skin irritation along my wrists was incredibly itchy during my workout this afternoon. The dermatologist told me to take it easy at the gym, but exercise is a great way to blow off steam. So I ran 4 miles and then did a light upper body workout. The body fuels the mind, right? I thought maybe I would talk about dermatitis, but I hate dermatology and I find it very boring. This probably stems from years of repressed feelings toward the field because of acne. My lips are pretty dry right now and I am getting some flakes on my face. No initial breakout so far, but there is a 1-2 cm red blotch on the left side of my face that is unlike any pimple I have ever had. We shall see what it turns into overnight. Sort of like a really shitty Christmas. The left side of my nares (flared out portion of your nose) is stark red, as my pores have pushed out some large plugs of crap. This is not something that is typical for me, so I will chalk it up to the accutane. No new side effects to speak of. I am very tired, but it's probably from waking up at 5 am after 3 beers at my local watering hole last night. Steering clear of alcohol continues to be my Achilles heel.

In other news, I delivered my first baby today. Well, it wasn't "my" baby (thank God) but it was a baby. Pretty cool experience, I have to admit. OB/GYN still not in my future as a career though. Think I will stick to Radiology (the roots of my interest in Radiology probably stems from enjoying hiding in the dark with acne).

On a separate note, I lost a friend Monday night while I was on call. He was 25 and one hell of a guy. This brings up a rather important topic related to acne and accutane--mental illness. It is very important to be conscious of our mood while taking accutane. While there has not been a proven link between depression/suicidal ideation with this medicine, there have been case reports. In medicine, we use the mneumonic SIGECAPS to screen patient for depression. S--changes in sleep, either excessive or insomnia. I--lack of Interest in things you typically enjoy. G--feelings of Guilt. E---decreased energy. C--inability to concentrate. A--appetite changes. P--psychomotor (an example would be tremors). S--suicidal ideation. These are important symptoms to be aware of. Acne in it's own right can cause you to get pretty down on yourself and lead to isolation. If you have a roommate or family members you see often, tell them you are on accutane. Close friends and family can be an excellent resource to help monitor your mood. Also, these forums are a great outlet for self expression and peer support. That being said, I miss my friend very much. Though I know none of you, I do know there are plenty of people out there that care for you. I don't know who first said this, but I read it a while ago and it stuck with me:

"Be kinder than necessary, for everyone you meet is fighting some kind of battle."

Good night good people,

Drew

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Hey Drew! Sounds like you're well on your way to handsome acne free skin! I'm so sorry to hear about your friend. I'll be sure to check back on you so keep us posted on how everything is going and good luck!

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Day 7

Today was an 80 mg day, and things looked pretty good this AM when I went to the hospital. The red 'thing' on my cheek has faded some, though my nose is still pretty red (rudolph red). Doesn't help when I have to keep putting masks on all day; a touch irritating. Then this afternoon, I went to the bathroom and bam, OIL. Lots of it. The last few days had been very dry. I think my pores are beginning to purge, but there aren't any new large pimples as of yet. There is a lot of flaking. So, at this point, sort of a combination flaking with oil. I went for a long run outside today as the sun was setting (got to avoid sun exposure, right?). Pretty damn cold when it got dark, but well worth it. I washed with cetaphil, shaved with Neutrogena, and applied a generous layer of CeraVe to combat these flakes. Aquaphor is handling the chapped lips pretty well at this point. My nose is very dry, but no bleeds so far. Handling it with some intranasal sodium chloride (saline) spray. I stopped taking my daily multivitamin last week due to the Vitamin A it contains. Don't want to overdue it. I have begun varying my diet with more fruits and vegetables to obtain vitamins. Probably what I should have been doing all along, but damn it's expensive. I have always enjoyed things that can be bought at GNC and can be eaten while walking, but I am starting to cut back on those too--trying to be more 'natural'. Pretty granola of me. We will see how long it lasts. If I start noodle dancing in my room, I will know the Accutane is causing my personality to change. I have informed my roommate (also a med student) to be on the look out. I have call tomorrow night, hopefully no patients will slip on the oil from my purging pores and break their hip. Could be found liable in court. Peace out.

Drew

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Hello :)

Congratulations on your first baby delivery! That, I would imagine, would be wonderful. I'm sure you'll remember that experience for life.

On another note, I am sorry to hear (or read) about your friend. Mental illness really is no joke. It's good that you used here as an outlet to get it off your chest. From one accutaner to another, *hug*.

"Be kinder than necessary, for everyone you meet is fighting some kind of battle."...

True words.

You take care.

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Day 8, 9, and 10

Hey gang

So it's been a busy weekend so far. Friday was a 40 mg day and I pulled a 30 hour shift at the House in the OR and the Labor and Delivery wards. My face got to lookin' pretty rough around midnight so I washed with some cetaphil I brought with me. I have 3 new actives which look about like my regular weekly breakout, possible a bit worse. This may be signs of an IB, or perhaps an exacerbation of my usual breakout. I had lot of surgical masks on throughout the day and night. Having your breath trapped against your face for hours at a time adds exponentially to the "oily" nature of my skin. Something I dread each time I put on. Pretty sure when I take it off people look at me and think, "is it hot in here or something?" I actually had someone ask me one time in the fall if I was "OK", and if I needed a "breather". The three actives literally popped up within 2 hours. I looked in the mirror (compulsive habit) at one point and they weren't there. 2 hours later, hello boys.

So, the night from hell finally ended around Saturday morning at 11 am, and I was let off. I raced home, popped my 80 mg dose, ate some breakfast, took a long shower, and then went to sleep until 5 pm. Last night I grilled out with some friends and drank 3/4 of a bottle of red wine. My attempt at sobriety is a work in progress. This is something I will remember when I encounter patient's that have problems complying with doctor's orders. Today I have a long day of studying ahead of me, and am about to head out to Starbucks for my fix. My face has felt "itchy" for the past 48 hours, and I have 7 or 8 dry, itchy areas of skin on my arms and back. My nostrils have become even drier, but still no bleeds. I would say my face is slightly worse than when I started, but isn't freaking me out (knock on wood). Kind of a short post for three days, but I have never been the most loquacious individual.

Drew

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Day 11 and 12

Coming up on 2 weeks, hell yea. Yesterday was an 80mg day and today a 40mg day. My optimism stems from the fact that my face looks perhaps the exact same as when I started, which means that it is not worse. There's a silver lining for you. I went for a 4 mile run yesterday as the sun was setting. Last week when I did that my nose turned bright red the next day, probably secondary to sun exposure. So, yesterday I applied Cetaphil 50 spf (I had a free tube that came with cleanser) and......voila, no drewdolph today. I am hesitant about applying too much of the 50 spf though, because historically sunscreens have trigerred bad breakouts. I have an old tube of Proactiv 15 spf from my proactiv days (still do not miss the smell of that shit). The sunscreen was the one product that didn't suck in the whole batch. Maybe I will give it a try again on the next run tomorrow. Lips aren't chapped at all right now, the nighttime Aquaphor is really doing the trick. My wrists have been dry and VERY itchy, which is multiplied 10 fold when I sweat. I bought some Curel anti itch lotion (they were out of the eucerin I wanted) and applied some last night. It made me itch worse initially, though today my wrists feel pretty normal. One new possible side effect: Trouble sleeping the past two nights--tossing and turning almost all night. Maybe the accutane, maybe stress from the hospital/studying, who knows. I should be pretty exhausted tonight after waking up at 4:30, a full day of work, a workout, and then studying and perhaps a beer or glass of wine. I bought 6 bottles of wine yesterday. Not to get wasted (because I can't), but to start to enjoy drinking small amounts slowly. I also bought some wine books. I need a new hobby to replace my weekend benders. Perhaps this will be the start to a new cultural cultivation. At the hospital right now with an hour off before I have to go to clinic. No surgical masks this week, and only one call Saturday night. As long as my face doesn't freak out (knock on wood), shouldn't be a bad week. Damn, I'm thirsty.

Drew

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I find your blog very interesting, I enjoy your style of writing. I hope accutane gives you the results you want, and when you get them you should go on a massive bender to celebrate :)

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Day 13 and 14

Man o Man,

2 weeks down, many more to go. Allybatty, thanks for the post. My face right now is now worse than when I started, but really not terrible. I have developed no cysts in the past two weeks, and I usually would get at least one each week. The skin under my nostrils and at my nasolabial (between your nose and cheeks) folds is getting very dry. It would appear the drying effect is starting kick in. I think I have definitely been having an IB, because my weekly breakout in the past would start on Monday with 3-4 little bastards and 1 big bastard. Now, I have broken out each day in new places with very multiple small, superficial whiteheads in weird places. They pop very easily (if i shave or apply slight pressure). I know we are not supposed to pop our pimples, but let's get real, that's f*cking impossible. I don't know if they monitor language on this site (anyone?). They shouldn't, it's the 21st century, we all have terrible mouths. Our parents' generation started it, our grandparents are too old to realize it, and our kids will be dropping F-bombs before they can say their ABCs. I digress.

On the plus side, today was the first day I looked in the mirror at 3 pm and didn't have to blotch off the 'ol cheek grease. I hope this continues, but I am ready for anything.

The dermatitis/eczema on my wrists is all but gone, even after a sweaty workout today. Last night was my first restful sleep in three nights. I think the 4:30 wake ups finally caught up with me. Soreness, however, is my newest complaint. I lifted weights on Sunday and Tuesday and today. My sternum (breastbone) feels like I have been punched in the chest after doing some weighted sets of Dips on Tuesday. I have never felt this kind of soreness after working out. I am definitely going to have to cut back some, because it hurts when I take a deep breath, which really sucked when I went running last night. My symptoms are most similar to something called costochondritis. Costochondritis is an inflammation of the cartilage that connects a rib to the sternum. Typically responds to NSAIDs (non steroidal anti inflammatories, such as advil/ibuprofen, aleve/naproxen). Thus, I will take 400 mg tonight and hopefully feel better.

"Comparisons are Odious"

Famous quote, google it.

Drew

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I definitely experienced the sore chest while running, too. I run pretty regularly, and the soreness went away around my 1 month mark. Hope the same happens for you, because I know that it's a really annoying feeling, Ha. Anyway, hang in there through the IB - it only gets better from here! :)

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2 weeks down already :D You'll be clear in no time

and i have NO idea how you can work 30 hour shifts, i begin to lose consciousness after 7 :lol:

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Day 15, 16, and 17

Peoples,

My last call night for 3 weeks ended this morning at 7AM. Praise (insert monotheistic reference of choice). I start a new service tomorrow, and I don't have to be there until 7:30 everyday. I havent been at the hospital that late since last July. A freakin' godsend. My face made it through the sleepless night with a cetaphil wash around 8 pm with some CeraVe to follow up. I currently have 6 actives, and blackheads that are purging from my nose. But in all honesty, I don't look that bad, and I am my toughest critic. My oil is definitely reduced, which is awesome. I am just hoping this IB is on it's way out and not ready for round 2 this week. Time will tell I suppose.

My rash on my wrists is back after washing my hands 50 times in the past 24 hours, combined with latex gloves and alcohol foam. It itches like a son of a bitch but the lotion I bought helps. I am going for a run in about half an hour, so we will see how much the sweat aggravates it if I apply some lotion right before I go out. My chest still feels like I have been punched. Hopefully it won't affect my run, because it's 71 degrees F outside, which had got me pretty fired up.

Sorry for the short post, but I'm losing daylight.

Drew

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