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Thread: Just had the condensed protocol with Dr Darm -- Help

  1. #11
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    Hi Steve;

    You may be experiencing this post laser trauma because of the use of a shallow filter. When I underwent a treatment with Dr. Darm, I reacted very badly with a 560/550 filter. This filter is extremely shallow and a lot of the time the blood vessels get overheated-causing some to rupture.

    But don't worry too much, your skin should return to normal soon. It took me about 2 months following that particular treatment. I also was very impressed with the results once things had “calmed down”. Prior to this, I had a treatment a month before with Dr. Darm where he used a combination 590/640 filter in addition to the yag. I responded very well.


    Kris Jacobs

  2. #12
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    Day 15 and the flaring has seemed to have gotten worse. If I'm not in a CONSTANT flare, then I'm pretty damn close to one. Clonidine seems to help a little. And it is the constant nature of the problem which is worrisome. If I could just see some improvement, I'm sure my spirits would rise.

    I'm having trouble sleeping. Every night for the last week I will get a flare several hours after I finally fall asleep where I'm sweaty and flaring. Then I'm up for a couple of hours, and if I get back to sleep the process repeats itself. Very strange. Any suggestions here would be much appreciated, as I'm sure the sleep deficit is not helpful.

    Darm has me on oral steroids; topical steroids (2.5%); clonidine; long acting Inderal; ibuprofen; and, of course, I'm using cold compresses. I might just start sucking on some ice chips throughout the day.

    Darm still feels it's a normal post treatment flare, which may take 4-6 weeks to go away, but it sure is discouraging, and frankly, scary, because it is so debilitating.

    Well, anyway thnks for listening and the suggestions, it feels better to talk about it.

  3. #13
    Senior Member keisha06's Avatar
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    Hi Steve,
    If you're looking for something to help you sleep amitriptyline (spelling ) might help. When my rosacea first came out I would flush horribly all over my face, really hot and burning - as a result I would up in a vicious circle of not getting much sleep - I would sleep for a couple of hours (after a couple of hours trying to get to sleep) and then wake up and not go back to sleep.

    My doctor ended up prescribing the amitriptyline (spelling?) which assists in sleeping (it is actually and old style anti-depressant) - it is non-addicting and you can take a very wide range of dosage - took me about 60 mg a night to get good sleep and I was dopy the next morning but pretty quickly (about 1.5 weeks) I got it down to only 10 mg as my sleep patterns settled and then went off it. Made a real difference to get that sleep and my doctor actually has been willing to give me a prescription to take as I need. I seldom do but when I'm having a flare, they are very helpful (10 mg puts me to sleep and keeps me asleep for a good period of time) and at least I don't have to worry about lack of sleep on top of everything else.

    Wishing you all the best and that the flare calms soon for you!
    Diane
    Vancouver Island, BC

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    Hi Steve and Diana,

    Sorry to interfere and I don’t want to make things more difficult for you Steve, but I have had (and still have to some degree) the same symptoms as you after a treatment in the UK last year and amitriptyline was given to me for neural pain and to get more sleep, but it only made my flushing worse. I checked with my pharmacist and one of the actions of this drug is (or can be) the dilation of the superficial blood vessels, also in the face. I found some relief just recently with a drug called Remeron (mirtazapine). It is also an older anti-depressant but also works on the flushings and it is an antihistamine altogether. I really feel less flushed and red after a horrific period of 11 months. I also added 20 mg. Propranolol to my moxonidine (0,2 mg, 3 times a day) and altogether this is the one and only thing that seems to work. I do need to add that I have used the Remeron only one month now and added the propranolol a week ago, but I saw immediate improvement.

    Just wanted to share my experience, and every person is and reacts different of course,

    Natalja

  5. #15
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    Default Re: Just had the condensed protocol with Dr Darm -- Help

    Quote Originally Posted by SteveYork
    I just had 5 genesis/IPL treatments with Dr. Darm's office under their condensed protocol, finishing 9 days ago, and I'm going through a very bad post treatment period. My skin is so sensitve to everything and it is flaring left, right, up and down. I'm flaring to old triggers which haven't bothered me in years and new ones which never bothered me in the past. And I'm also having these weird flares where I'll flare to a trigger and my whole body will start sweating, which may have something to do with having the flu last week. In 10 years of rosacea, I never have been close to being this bad. At this point, I'm very discouraged, disappointed and depressed. Darm says these post treatment flares will eventually go away, but after reading some of the messages on this board, which I just found, I'm starting to panic.

    Can someone who has gone through the condensed treatment give me some idea as what I'm going to face in the days and weeks to come. I'm very near the end of my rope, because I went from a very minor case of rosacea to this. Thanks in advance. Steve.


    Hi Steve,

    Diane offered some very good advice as did several others.

    The condensed treatment protocol was developed to treat deeper into the skin by (1) Not allowing blood vessels to regrow and contribute to optical deflectane and as a heat source sink (both of which decrease effectiveness of deep blood vessel treatment), and (2) to treat mast cells and nerve cells of the dermal skin (both of these are important in regrowth of blood vessels).

    I am sorry to hear about your bad experience. Things should calm down within 2 to 4 weeks after your last treatment. This really does happen in most cases. In the meantime, I would definitely dsicuss aggressive oral treatments to help break the inflammatory cycle. These all must be discussed with your physician:

    1. First, please stop using the 2.5% topical hydrocortisone. Nothing greater than 1% should ever be applied topically and even then, for very short time periods.

    2. It is wise to continue the methylpredisolone dose packs.

    3. Please discuss high dose clarithromycin, azithromycin or Roxithromycin. The Roxithromycin or clarithromycin are great for these cases.

    4. Topical noritate and Elidel are a couple of the recommended topicals for this type of case.

    5. Diane's recommendation of Elavil is an excellent one for most cases -- nighttime dosing preferable.

    6. Clonidine is excellent. Discuss increasing the dose to the maximal dose and dropping beta blockers -- they are of no use under these conditions.

    7. I believe Dr. Darm still has access to the soothing topical gel masks -- the latest anti-inflammatory version is very soothing and feels wonderful. He should give you three or four and keep them in your fridge, rotate them and put them on nice and cool. That should last an hour. Be diligent and change them every hour for right now. This truly helps.

    8. The flu or cold is definitely not helping. Zinc gluconate 50 mgs helps with the cold and with rosacea symptoms. Just double check to make sure all these orals are compatable.

    9. Discontinue cleansing face for short period and swith over to long soaks with spring water. If you are not allergic to ragweed, topical soaks with spring water with chamomile and caffeine can diminish the inflammation considerably.

    This is a lot of advice -- every piece should be discussed with your physician. This should dissipate in a couple weeks by itself. Hang in there. It can fluctuate considerably right now.

    I hope you find some helpful tips here. Hang in there and please report back every 5 to 7 days.

  6. #16
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    Day 21 -- Symptomatically, from a flushing standpoint, I don't feel that I'm very much better for my last report, although I've been able to put together 6 nights of relatively good sleep (at least compared to last week), through the judicious use of Klonopin, and in that regard i feel better.

    I'm still suffering from these night flushes, which I never had prior to the treatments. They occur about 2-4 hours after I go to sleep, waking me with the feeling that my whole body is overheated, and oftentimes ina full body sweat. Once I get up, the flush seems to disapate rapidly. They seem very analogous to the accounts I've read of a women's "hot flashes." I then take a klonopin and clonidine to get back to sleep, and the process typically repeats itself in another 3-4 hours. This is very strange, and I wish I understood the mechanism of these night flushes, because in understanding they may not be so worrisome. These night flushes are my main concern.

    These last couple of days, my face has looked much worse then from when i first stepped into Dr. Darm's office. That's not much of a standard, however, as I only had very mild rosacea. The last couple of days it has been red, starting to breakout, and has that orange peel texture. Because I'm not feeling a very active flush during the day, I attribute this physical condition to weening off the topical steroids, which I've been doing these last days. I'm going back on the Biaxin for a week or two, and I'm going to start Elidel, so i suspect this area to improve rapidly.

    Clonidine, so far, appears to suppress the day time flush, at least when I'm on a maximum dosage of 4-5 0.1 tablets. At least this is my impression; it's a bit hard to tell when your on all these supressing meds (e.g., steroids).

    Speaking of steroids, I've weened myself off the topicals (not fun), but will continue on a lower dose of oral steroids (20mg/day).

    I may have seen some improvement in my trigger sensativity in the last week or so. Its so hard to tell when you are in a aflare, becauuse your trying to avoid all your triggers. Any improvement has been marginal and gradual.

    I'm still very much worse in terms of flushing and trigger sensitivity then I was prior to the treatments. Going from mild rosacea to this is unerving at best. Darm still believes that it is part of the natural healing process which will take some time to resolve, so I have no choice but to give it that time.

    This has not been a fun experience, but I appreciate the support and suggestions. Hopefully next week, I'll have some better news to report.

    Steve.

  7. #17
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    I should add that Darm has been very helpful throughout this whole ordeal taking my calls during the week and weekends; answering questions; alleviating concerns; and phoning in and experimenting with different medications. I just hope that this post treatment flare resolves itself soon.

  8. #18
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    Hi Steve,

    I'm sorry to hear your having such a rough time. I can tell you that it takes me a solid month to recover fully from treatments. I see Dr. Darm as well and for the first few weeks I am flushy and trigger much more easily. Things for me eventually calm down and I am much better off having done the lasers than not. I hope it will turn out the same way for you.

    Be careful with the Klonopin. If I'm not mistaken this should only be taken a couple of times a week, otherwise a nasty re-bound effect can occur.

    Hang in there and try to stay calm if you can.

    Tricia

  9. #19
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    Day 25 -- This last weekend was very bad.

    Pursuant to Docs instruction, I started on Elidel instead of topical steroids on Friday; kept taking klonopin; and on Saturday started with a clonidine patch (very neat idea). On the first application of Elidel, I only put it on the apples of my cheeks.

    And I flared progressively worse from Friday to Sunday.

    I knew it was an external trigger, because the flare was so sudden and intense. So, it is probably one of these meds. I initially thought it could be the klonopin, so I dropped that on Sunday. It couldn't be the Elidel, because that is like a steroid almost. So, I continued with the Elidel on Sunday, and you all know what is coming -- I continued to flare. The flare was so bad it made me sweat.

    I live in florida, so people thought I was in the sun too long. Actually, it was so bad my face starrted to get lumpy.

    Anyway, Elidel was the culprit. My skin must be too sensative for these types of topicals at this time. But it is something that folks should probably keep in mind post IPL/Laser -- your skin sensativity may not allow topicals for awhile.

    And if I had not been in such a bad post treatment flare already, then I would probably have tried to test the Elidel on a portion of my face for a week or ten days to see how it reacted. I guess hindsight is 20/20.

    Well anyway, Sunday night was real bad -- burning, stinging sensation, red. I guess most of you have already been there. So I load up on the meds that I believe work, and now i'm feeling relatively much better.

    I hope I have better news next time. Keep the kind advise coming.

    Steve

  10. #20
    Senior Member IowaDavid's Avatar
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    Quote Originally Posted by SteveYork
    Day 25 -- This last weekend was very bad.

    Pursuant to Docs instruction, I started on Elidel instead of topical steroids on Friday; kept taking klonopin; and on Saturday started with a clonidine patch (very neat idea). On the first application of Elidel, I only put it on the apples of my cheeks.

    And I flared progressively worse from Friday to Sunday.

    I knew it was an external trigger, because the flare was so sudden and intense. So, it is probably one of these meds. I initially thought it could be the klonopin, so I dropped that on Sunday. It couldn't be the Elidel, because that is like a steroid almost. So, I continued with the Elidel on Sunday, and you all know what is coming -- I continued to flare. The flare was so bad it made me sweat.

    I live in florida, so people thought I was in the sun too long. Actually, it was so bad my face starrted to get lumpy.

    Anyway, Elidel was the culprit. My skin must be too sensative for these types of topicals at this time. But it is something that folks should probably keep in mind post IPL/Laser -- your skin sensativity may not allow topicals for awhile.

    And if I had not been in such a bad post treatment flare already, then I would probably have tried to test the Elidel on a portion of my face for a week or ten days to see how it reacted. I guess hindsight is 20/20.

    Well anyway, Sunday night was real bad -- burning, stinging sensation, red. I guess most of you have already been there. So I load up on the meds that I believe work, and now i'm feeling relatively much better.

    I hope I have better news next time. Keep the kind advise coming.

    Steve
    I don't know if I mentioned this to you, but Toleraine Soothing Light Facial Fluid was the problem topical for me after getting laser treatments. And fan irritation. That moisturizer is about as gentle as I have found, yet it still caused me extreme problems over time with cumulative irritation.

    Hope the Elidel break works for you. If you take the irritant away, your skin should begin to recover.
    35 year-old male
    Erythmatotelangiectatic rosacea & Ocular
    20 + laser treatments.
    Toleraine Soothing Light Facial Fluid for moisturizer. I don't use a special cleanser. Clonidine daily; klonopin sometimes.
    BEST and CURRENT TREATMENT I use: Low-Level Red Light Therapy LED array.
    Please feel free to PM me with your low-level red light therapy (LLRLT) questions. I'm happy to help if I can.

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