Flake Confessions - 2

Chapter Two
The Onset

I was warned when I moved to the Colorado high desert (western side of the Rockies) that the dry air and penetrating sun would be bad for my skin. It was my mortgage banker, in fact, who said "find a good dermatologist." He wasn't speaking from any particular awareness of my skin problems — it's just true that high desert climate is hard on skin, especially pale Nordic skin. But this was before I knew I had psoriasis. I knew about my vitiligo and the irksome allergy-related rashes that would come and go.

I built a house in Grand Junction with my first wife. After fifteen years of college she was finally a credentialed professional with two college degrees. We had been married for seventeen years, during which time we lived in Eureka and Alameda, California, Denver, Colorado, and Washington, D.C. In that same decade and a half I grew from lowly sailor, through college student, to hi‑tech professional, then an executive, and now my own business. Stress? You bet. Lots of it. But I loved it.

Our new house in Grand Junction, Colorado, was also my place of business. I'd manufactured a beautiful office for myself with glorious views of the desert that had, in prehistoric times, been an inland sea. I took pride in my manicured lawn. Played volleyball with the neighbor kids. Learned how to in-line skate; bought a hot tub and soaked with glorious indifference under the star-filled desert sky. I had a mountain bike and took afternoons off to go on long rides along paths flanking miles of irrigation ditches.

My skin seemed oblivious for a season or two. Nothing new. The pigment-less blotches got sunburned and the rashes waxed and waned. I was somewhat careful not to get overexposed, and that seemed to be all that was required. But then the dandruff set in.

Dandruff wasn't news to me, either. Switch shampoos. Rinse well. Don't scratch. All the usual remedies. But this was tough dandruff. Couldn't shake it. My barber was the first person to mention psoriasis. I thought, "Okay. So it may be psoria-whatever. I'll get over it." I did sort of get over it, or I should say more serious crises diminished its importance.

The marriage collapsed. I sold the house in Grand Junction and moved away.

My dandruff and I moved to Kentucky to start a new life in the Blue Grass. Goodbye high desert, new house and hot tub. Hello condo on a golf course, a.k.a. Twentieth Century Southern living.

I'll probably never know what triggered the severe psoriasis, whether it was the sudden climate change, from arid to humid, or the trauma of such a drastic life change. I've often thought it was the failed marriage, that God was punishing me for divorcing the woman I had pledged my life to. Or perhaps he was punishing me for marrying another woman, less than a year later.

My second marriage lasted four years, during which psoriasis became an all-too-blatant fact of life. It would be convenient to blame the onset of the severe psoriasis on wife number two — too convenient. I'll talk more about what I "blame" my psoriasis on, later. For now, let's leave it at this: The women in my life may or may not be catalyzing influences on my psoriasis, but even if they are, there's more to it than that.

Much more.

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Ed's Postscript (11/29/2007): Though I pooh-pooh the concept of stress as a trigger for psoriasis later in the book, now — nearly two decades after these events transpired — with a much more sympathetic view of stress as a psoriasis trigger, it makes perfect sense to me that this late-Eighties, early-Nineties period was the start of my flaking life. I'd never been as stressed as I was in these years. Abandoning a career in favor of self-employment, plus uprooting and moving 1200 miles, plus experiencing the fast erosion of a nearly-twenty-year marriage ... my life before all of this had been becalmed in comparison.

And there was a boringly Plebeian reason why it took me so long to seek professional medical counsel about my worsening skin — I had virtually no health insurance. I remember very vaguely grappling with the issue of no health insurance shortly after moving and launching my own consulting business. I did have a couple of retainers I'd negotiated before I left the East Coast and this plus a modest nest egg enabled me to explore a few options. I ultimately settled on a health insurance package that was, at the time, issued for short durations to "hunters." As I said, my memory of all this is vague, but I believe the package was designed largely to cover medical expenses that might be incurred by uninsured hunters who have "accidents" during "the season." There was a lot of hunting seasons in Colorado at that time, so the insurance was available year around, but it had to be purchased repeatedly for these "short durations." If I recall correctly, it covered major medical and that was about it. Effectively this meant running around to consult specialists about things like skin issues was problematic.

Not much has changed. Uncounted tens of thousands of Americans with psoriasis in 2007 have little or no recourse to effective treatment because of lack of insurance. Even if they manage an educated diagnosis from a public health doctor, even if they are given some supply of "trial samples" of psoriasis drugs (usually topicals) the long term commitments required for effective psoriasis therapy are beyond reach. The most effective therapies for severe, recalcitrant psoriasis — systemic biologic therapies administered routinely and perhaps for a lifetime, or clinically supervised light treatments — are completely out of reach for many of the uninsured in the U.S.

I believe if the statistics were known the number of people suffering from psoriasis who have not been diagnosed or received appropriate treatments for psoriasis would be staggering, especially if we include people with mild to moderate levels of the disease. While some of this shortfall in health care can be attributed to an assortment of non-insurance-related factors, the problem of the uninsured plays a significant role — just as it does for many other health problems in the United States today.

This is why I refuse to dismiss the pursuit of alternatives to professional medical treatment for psoriasis. There are far more people than any of us have counted who simply don't have access to conventional health care for psoriasis. If one in twenty of those people find relief in a diet, or dietary supplement, or non-prescription palliative, I cheer for them. In my mind, to advocate only methods of therapy that some people simply cannot obtain is not only narrow-minded, it is immoral. Put another way, as a society we can afford to treat alternative medicine with enmity only if and when all of us can afford conventional state-of-the-art medical care.

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The period of time covered in this chapter was from September, 1988 through August, 1994. The barber who suggested my "dandruff" might be psoriasis did so in late 1989 or early 1990; I moved from Colorado to Kentucky in the Fall of 1990, remarried in the Spring of 1991 and separated from my second wife in September of 1994.

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