Anon talks to DrB about Weeks 2 and 3 with The Eczema Solution and Twitter
The Combined Approach self-help programme with Twitter: Weeks 2 and 3 - Treatment
Anon spoke here first to DrB two weeks ago, about how he came to start using The Combined Approach to treat his chronic atopic eczema. He is using the self-help format, The Eczema Solution book, but adding social support by sharing his progress with others on Twitter. Let's see how the first two weeks treatment have gone for him....
DrB: You have been using all three levels of treatment for two weeks. How are you now, compared to when you started? How much difference do you and others notice already?
Anon: Great results so far. It has made a huge difference, with literally hundreds less scratchings per day. My skin is healing really fast. I now get hours at a time where my skin is "silent" - bliss! Also, I can now do things like swimming with no worries in advance or adverse effects during or after. And my eczema pretty much never disturbs my sleep now! Both my wife and my parents have commented how much better my skin is looking. And others have commented how well I am looking - I suspect they notice a difference but can't put their finger on what has changed!
DrB: Lets look at your progress over these two weeks with the six questions I use in clinic. Number one: from using the hand tally counter, what is your frequency of scratching now? And number two, how much of this scratching s due to itch, how much is not?
Anon: This last week my scratching frequency has been as low as 74 on one day, but it is averaging at 180 a day - before, it was over 450 a day. And now I think about 75% of my scratching is because of itch: before, on one day, it was only 15%. The habit-scratching is certainly fading away since I started habit reversal.
DrB: Right. Next, question three: when does most scratching seem to happen now?
Anon: My danger times now are first thing in the morning, then early evening when I first get home, and finally at bedtime! Otherwise, more generally: I scratch with stress, or if I get upset, and when I am concentrating on remaining calm…
DrB: Next, question four: on a scale 0 to 10, with 10 is as bad as it can get, and 0 is no eczema at all, what do you score your eczema overall, today?
Anon: I would say my eczema score now is .... 2 out of 10!
DrB: Great! And where is it?
Anon: Well, I have been 100% clear on my tummy, my back and shoulders for a week now: Otherwise, scattered patches remain where it was all over before: on my face, neck, chest, arms, legs and ankle.
DrB: We must always remember the scalp? How are you up there?
Anon: Ah! Still some remaining there! I find the scalp hard to monitor - and hard to moisturise: instead of preventing it drying, I am treating dryness, and I know I need to turn that round. I use a special scalp moisturiser - and I must use it more often!
DrB: Can you estimate the percentage of your eczema that is acute now, rather than chronic, and longstanding?
Anon: I would say 80% is the old, chronic stuff that I had at the start of week 1, and it is slowly on the way out since the start of week 2, and now is way less bothersome. The 20% acute now is left over from the recent flare-up at the end of week 2.
DrB: So, those six questions give an overview of your progress with the three levels of treatment continued for two weeks. Lets now go through each of the levels. Emollients are level one - how often, and how are you using your moisturisers now?
Anon: Right now, it's twice a day, but more often with the flare-up, and on my hands. I am planning to add an application at 5pm to help me through the early evening danger time. Waiting until later is too late. And my new way of using moisturiser, gently and thinly, is quite different to before - when I was sometimes slapping it on, and causing irritation! And I need to use much less as time passes - at the start of the two weeks I needed to put moisturiser on every couple of hours.
DrB: And level two is topical steroids. How are you using them now?
Anon: Once a day on the chronic areas. Evenings I repeat on areas that are flare-up. And I am continuing to treat where I passed the Look Good Point, to get the hidden healing.
DrB: Exactly, and after 10 days to two weeks of hidden healing on previously chronic eczema areas, you can stop the steroids, but continue moisturiserising as needed.
Level three is habit reversal - do you use the fists & pinch tactic?
Anon: Habit reversal fists work well for me, but not the pinching - somehow pinching intensifies my itch! Instead of pinching I may tap my fingers of one hand on the knuckles of a fist of the other - that seems to work. Or I tap a finger against a thumb, or my fingers on the desk, for thirty seconds - when making a fist seems an odd thing to do, say in a meeting at work!
DrB: Do you have other skin-safe behaviours?
Anon: Instead of rubbing my eyes, I can do gentle blinking thirty times. And instead of rubbing my dry lips with my teeth, I tap my tongue against the roof of my mouth, again for thirty seconds. And my focused skin-safe tactics for danger-times now are:
First thing in morning - get into shower as quickly as possible, rather than scratching whilst I wake up slowly. Early evening - a full application of emollients around 5, and I now I don't change my clothes when get home. Bedtime - I need to do all my preparations in good time - like emollient on early, so it’s quick as possible from sofa to bed!
DrB: That’s really excellent. Now on, focus your habit reversal: plan day by day, danger time by danger time, without looking too far ahead. And try writing down your plan, & talk about it with others. Both these things can help it all happen! How are your stress levels now? Are you able to cope with pressures better than before?
Anon: Certainly can. When my eczema is bad it adds a fairly high base level of stress to each day - all the itch, scratching and pain; and the need for creams; and worrying about how I look. Any extra stress on top of all that, and coping becomes a real problem. But now, with how things have got so much better, things are really so much more manageable.
DrB: Has the programme been difficult to follow?
Anon: Not at all! It is admirably simple. The staged approach makes it easy to follow, and The Eczema Solution book does a great job - explaining, helping and giving guidance. But before, doing it on my own, will power and effort was difficult to maintain - this time, the support through Twitter has made all the difference. It has increased my commitment, knowing others - including you - are following my progress. Before, I floundered when I took a day off - I have learnt I must work at it every day: then it really works for me, as you can see from my results so far….
DrB: That’s it, exactly! So we will continue follow your reports on Twitter, and let's have another Q&A at the end of week five. You are doing really well....
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