Thursday, June 8, 2017

The Cost of: A Course of Dermatologist Treatment

via, my real dermatologist's office is honestly fancier

As I mentioned in April, I've been seeing a dermatologist, which has been a good but imperfect experience. I was inspired to go because my current government insurance is likely the best I'll ever have and my skin had been acting up differently (not product-induced, as I hadn't added anything new in the preceding four months). I'd been extremely happy with my previous CosRx BHA-centric routine (briefly described here, cheapest on Amazon, resulted in an unprecedented four months "cyst"-free* until the problem week that inspired the dermatologist trip), but then I had a really icky bump that, in a new development, seemed like it might leave a textured scar. So off I went, to a well-regarded NYC-area dermatologist primarily known for botox and related aesthetic treatments, but also for aggressive acne treatment.

I can't be the only chronically acne-prone American with this experience, but being able to just call in and schedule my own dermatologist appointment, with someone very willing to administer cortisone shots and prescribe a broad spectrum of new medications if the previous one(s) didn't work promptly, still seems an impossible luxury! As a young teen with persistent acne and restrictive health insurance (had one dermatology referral ever, when I presented with all over the face cystic acne, the worst it's ever been, and it still wasn't enough for Accutane to be in the realm of consideration), I've always longed desperately for the ability to get the level of dermatologist care I'm receiving now. I suppose that's part of what's inspired me to follow through with several months of (still-expensive, even with insurance) treatment, an urge to resolve the question of whether that "impossible luxury" of easy access to a dermatologist would have alleviated my persistently "cyst"-prone acne sooner, and better, than the years of experimentation and over the counter product-centric routine I eventually discovered (old, pre-CosRx routine described here).

Nearly four months in, I find that I prefer my old CosRx-centric routine (a two-step combo of the BHA A-Sol and BHA Blackhead Power Liquid) and that I may regret my dermatologist experiment. It's involved a few new prescriptions, which required stopping BHA and my Vitamin C Serum, not a great trade-off. I have only a few months before I switch insurance again, which will likely stop this process. Presently, I've been referred to another specialist, and am curious about the result, so I'll keep going. Overall, my skin has not done better than I believe it would have on my previous routine. While prescriptions were always an important part of treating my persistent acne and I would certainly recommend a dermatologist, if at all possible, if one's acne ever takes a sudden, extreme turn for the worse, for my more low-level but chronic acne problem, a hybrid prescription and over the counter routine, without any of my new medications, still seems best.

There've been a few valuable lessons though. Cortisone shots are pretty magical, and this experience makes me more willing to schedule an emergency cortisone shot if I ever have a nasty cyst that conflicts with an important life event. It's expensive with insurance, but could be worth it because, well, vanity. Also, despite another non-dermatologist doctor's recommendation, scaling back Retin-A Micro to once every other day was not good for my acne. When I went back to daily use on the derm's advice, I had a similar, though much briefer, adjustment period as when it was first prescribed to me, and I saw some immediate improvement with my acne.

The most obvious downside of my experiment is that, even with good insurance, it's been extremely expensive. Each visit averages out to $150, including the $35/visit specialist copay and post-insurance fees for a cortisone shot at each visit, and sometimes an extraction. I've been doing monthly follow-ups,  this doctor's usual practice until it's very clear that a new regimen is working, so it adds up. Note that one's mileage with costs will vary based on insurance provider and policy.

The co-pays on my prescriptions have been... slightly jaw-dropping, for someone accustomed to the same $10/refill copay for everything, even when on less robust insurance. This derm's aggressive approach occasionally involves specially compounded medications, so they default to sending prescriptions, even ones that can be fulfilled at chain pharmacies, to a specialty place with higher co-pays. Admittedly, I could have opted out for most of my medications, but I chose not to in order to give this experiment a full try. I was given Acanya (a 1.2% clindamycin and 2.5% benzoyl peroxide gel, which I don't like, as the BP wreaked complete havoc on my skin at first), which is always expensive, at $40 with insurance and a manufacturer coupon. I'll be coy about the other copays, as I'm a little embarrassed, many could likely have been adjusted down significantly had I immediately called back and asked for the prescription to be sent to a normal chain pharmacy. 

*Acne nomenclature has always confused me. I've had medical professionals, including this derm, refer to my usual breakouts, which always come to a head eventually (TMI acne treatment-related post warning) as cystic acne and to some of the bumps as cysts. Yet there's also evidence that "true" cysts don't come to a head. I've had that kind also, though thankfully it's extremely rare and hasn't happened in years. Those cysts tend to be smaller as they don't really get inflamed, and they hang around for months before disappearing on their own. 

Monday, June 5, 2017

Long Weekend in D.C.

Xu Bing's Monkeys Grasp for the Moon

For the Memorial Day weekend, I visited my younger sister, W, in the Washington, D.C. area. W graduated with her master's degree last year, and now lives and works in the D.C. suburbs. We had a wonderful time! I'd been to D.C. before, so we didn't feel any pressure to go out and see too many things, just wandered through D.C., Georgetown, and the Old Town area of Alexandria. We also saw LP in concert, and she was fantastic. (I think people are most likely to know her from one of her songs having recently been in Orange is the New Black, but I hadn't watched that season and her music was new to me before I went to the concert.)

We splurged on one fancy meal, at 1789 in Georgetown. I really enjoyed the food, and the restaurant is located in a cool historical house. Pictured above is the foie gras dish (a dainty but satisfying portion - looks bigger in the photo than it actually was!) and the duck, both of which were delicious. The plates were all beautifully composed, and they make good use of seasonal vegetables. (I had a burrata dish, not pictured, where asparagus and peas were the highlight of the dish, and I don't usually especially like either vegetable.)

Follow the link for a few more photos, from some of the Smithsonian museums, and restaurant recommendations!

Tuesday, May 30, 2017

May Shopping Reflections

This month's shopping was exclusively done secondhand, via eBay and TheRealReal. I haven't been discussing minimalism terribly often recently because it has taken a backseat while work and life have been so hectic, but I continue to believe that using the secondhand market for clothing whenever possible is the least complicated way of being an ethical fashion consumer. There are so many challenges when trying to identify truly ethical brands to buy new, given the lack of transparency in the industry. (Working in law, I have an unusually hard time trusting any company's representations to their customers.)

My view on secondhand clothing is that, once an item hits the secondhand market, it's already been produced and sold once at retail, to at least one customer who didn't end up particularly wanting it. At that point, if someone is able to buy it and put it to good use, that's better than it going to the landfill. The only morally weird things that I can think of is if retail customers use "well I can always resell" to encourage overconsumption, but I'm skeptical that this is a big problem for most mall brands that I'm in the market for, as those items don't hold their value well.

That's not to say that everyone can feasibly embrace secondhand shopping for all their clothing needs. This thoughtful post by SA touches on the many challenges with that, and I can certainly vouch for how relying overly much on TheRealReal would cause various problems. Particularly when one doesn't have time for or access to good thrifting, shopping entirely secondhand may be a real challenge. "Mistake" purchases generally can't be easily returned, increasing the amount of money one needs for the whole effort. Shipping and return shipping on TheRealReal cost about $18 combined, and their size measurements are super-wonky, so one has to do considerable research or know a brand well to attempt educated purchases, and even then, mistakes will still happen.

With two out of my three secondhand purchases this year, the outcome has been imperfect in terms of sizing and how well the style works for my body. Don't get me wrong, they're both wearable and I've been wearing each problem dress a fair bit, but they're things I would have had to think seriously about returning, had I bought them retail. Still, while I haven't been the most successful with my secondhand purchases, I never truly regret them. All were items that I noticed and was interested in back when they were originally in stock, months or years ago. After they sold out, I'd occasionally search eBay for them. I'd always done my best to research sizing too, and made the most educated guess I could about what sizes I would buy, if the price was right. So they were well thought-out choices on which I knew I was assuming a risk.

This also wasn't the most frugal month, so I'm still quite "over budget" for the year so far, by $219.71 to be precise (($150 x 5) - $555.98 - $154.21 - $94.79 - $35.93 - $128.80 = -$219.71). I'll have to shop carefully for quite a few more months, it seems. As for next month, I'm very likely to try a few things from J.Crew Factory, as I recently mentioned. Also, while wandering around D.C. with my sister this Memorial Day weekend, we stopped by Anthropologie and I was very taken with this opal and rose quartz Rosaline stacking ring set and may be tempted to snag it. (I've wanted a dainty opal ring on and off for years now, but had been thinking it should be fine jewelry instead, though generally never had room in my budget. I'm not sure costume jewelry is the best way to satisfy the urge, particularly when Anthropologie's offerings might not be the highest quality.) Whatever I settle on, hopefully it'll be a bit under my monthly target, so I'll continue making up the current shortfall. 

Fashion - (TOTAL: $128.80)
  • Tory Burch T-Shirt Dress - $87.95 - (old, similar styles but dramatically different prints) - I saw this years ago and thought it was pretty, but the price was higher than I could spend. Every so often, I'd search eBay with no luck. I finally saw it on TheRealReal in medium and I decided to go for it. Well, I guessed wrong about my size, as it runs big. It's a 100% pima cotton unlined t-shirt dress, which Tory Burch seems to do in new prints most years, and it's stretchy and meant to fitted and even a bit clingy (it's a thick enough fabric that it should skim the body nicely rather than emphasize things awkwardly). I thought I'd need to size up to accommodate my chest, but a small would have fit and the medium is a little baggy everywhere. I still like wearing this because it's so comfortable, it's machine washable, and it's pretty too. The style is fantastic for business-casual days at work in summer. Franish has one, but I can't find the post!
  • Madewell Moontide Dress (old, eBay) - $40.85 - I kept eyeing this in the Madewell sale section back in the day and had ample opportunities to get it then, but never pulled the trigger. This design is relatively common on eBay, but generally not at a price I'm comfortable with, so when it came up in medium at this price, it seemed meant to be. This dress is a cotton-silk blend with a cotton lining, which is a bit of a rarity with Madewell. (They do a lot of silk dresses with a poly lining, ick.) The cotton-silk has no stretch, and this design also runs a tiny bit tighter in the chest than many of their other relaxed fit-looking dresses. It fits right, so I consider this a successful purchase. My one quibble is that the fabric is a touch thicker and heavier than I hoped for a summer dress, but that's probably a good thing to prevent possible wardrobe malfunctions.

Somewhat relatedly, I used to really love Madewell, particularly the dresses and sweaters, but it's now been several seasons since I've seen anything I like there. My last purchases, until now but this month likely doesn't count because it was on eBay, were in October and December of 2015. This silk bell-sleeve dress is the only thing they currently have that I'd even take a second look at. (I don't love bell sleeves, but that one isn't too exaggerated and is balanced out by the simplicity of the rest of the design.) I don't know what happened, or if it's just me being weird and picky! Am I the only former Madewell fan who feels this way?

Linking up with Franish and the Budgeting Bloggers this month, as usual. Please do go check out what everyone else bought this month.

Friday, May 26, 2017

Odds and Ends

I started this month with the best of intentions, blogging-wise. Then one of my cases went to trial and all those good intentions were scuttled. Whether as a clerk or attorney, trial is probably the most intense of undertakings that a litigation-inclined lawyer ever encounters. It's also increasingly rare  in American federal courts (as to both criminal and civil). I've had two trials in my ten months as a clerk, one co-clerk had four, and another co-clerk had zero, but with one coming up.

There's been almost no shopping, though I did snag two items on the secondhand market that I had been thinking about for a long time. Because I detest polyester summer clothing, cold shoulders, most sleeve ruffles or flares, and off the shoulder tops and dresses, most of my usual retail stores currently have nothing of interest. J.Crew Factory's been the only place I've seen anything that I'm remotely interested in trying: there's a striped cotton midi skirt very similar to the one I loved last year, though with an elastic waist instead of a zipper, and the linen-cotton sidewalk skirt in fun colors that I might want to try out next month. I also find the bright and beachy embroidered linen dress pictured above to be oddly compelling though the shape is outside of my comfort zone. 

Here are a few other non-shopping things I've been thinking about in the last few hectic months.

Fitness Trackers

I sort of resent what I spent on my Fitbit Flex (old version I own here). I'd suspected that fitness trackers are one of those things that's rarely a good idea from a frugality perspective. The simpler ones (still retailing at ~$80) are really just expensive pedometers, as they can't track heart rate and therefore have no hope of tracking calories burned accurately. From reading reviews back when researching the purchase, the entire genre seems prone to breaking down in significantly less than a year of normal use. I'd almost think that one should just get the Apple Watch because it would at least be reliable, have a real warranty, and actually have some real functions in addition to fitness tracking.

As for my specific complaints about the Fitbit Flex? It stopped holding a charge well about two months in. The silicone wristband was so badly designed that each one began splitting and soon became unusable within three months. Good replacement bands are hard to find. I have this, but the metal clasps cause heinous contact dermatitis, so I can only use it as a silent alarm clock and keep it on my wrist as little as possible. The irony is that I'm likely getting my money's worth: I needed a reliable silent alarm because I had a year of waking up two and a half hours earlier than K. It seemed clear that the cheaper pillow-shaking or wrist-shaking silent alarms weren't reliable. Cheaper fitness trackers also didn't seem to have a reliable alarm. As a silent alarm clock, in which case the problems aren't as important because I only wear it to sleep, the Fitbit Flex has actually been just fine.

American Medical Care

I finally went to a branch of the New York Public Library and got myself a library card for access to their e-book collection, which has been fantastic. One of the best-written books I've read since is Paul Kalanithi's When Breath Becomes Air, which is excellent and also incredibly sad. 

Only somewhat relatedly, as someone prone to thinking about worst case scenarios, I have considerable anxiety about American medical care and well, paying for it. I have no reason to be anxious right now, as a generally healthy young adult with decent (if expensive, but that's never news) employee-sponsored health insurance, but well, I can't help but think that no matter how financially secure I become in the future, after decades of work, a solid bout of serious illness in the family could easily decimate that work within weeks or months.  

Early on in Kalanithi's book, he spends months with frequent bouts of serious, what sounds like an eight on a scale of ten pain. He, a working doctor, specifically thought of cancer as a possible cause. When he finally saw another doctor, he or she concurred. They didn't end up running a test, and so he wasn't diagnosed then, and the cancer grew. I don't think cost or access was the issue, more his punishing schedule as a neurosurgical resident. Still, cost or access is the issue so often here. I myself have nothing to fear budget-wise or insurance-wise, yet even I still get antsy and drag my feet, worry about receiving a shocking bill in the mail, every time I need to schedule an appointment. 

I can't help but contrast the American experience with that of extended family in Taiwan (home of one of the cheapest and best health care systems in the world). Last year, there were two cancer scares, each starting with some kind of whole-body preventative, just-because scan (must have included something like a MRI, though I might be wrong) that cost something like $500 USD each. The scan caught, for one person, possible colon cancer that thankfully proved benign after a surgical biopsy and a multi-day hospital stay, and in the other, the earliest stages of breast cancer. Diagnosis and treatment in both cases was easy, swift, and not at all the cause of any financial anxiety. For additional, far less serious, context about the Taiwanese system, I'm not on the national healthcare system, but during a 2011 trip, I had a walk-in visit with a popular dermatologist and got a two-month's supply of name-brand acne prescription medication, all for $15 USD out of pocket. All this is unimaginable here.  

Friday, April 28, 2017

April Shopping Reflections

My interview season has finally come to a close and, with that, I'm hoping to get back to writing more regularly. With my commute on top of the normal level of busy for my current job (I've been spending significantly more hours out of the house for work than K at his biglaw firm for months now - many biglaw practice groups have been slow this year) on top of the interviews, I've been worn out. Part of the problem is that I don't think I'm physically capable of fully adjusting to my new sleep schedule. My law firm schedule aligned perfectly with my natural sleep cycle, and moving everything up by two and a half hours has not been fun. I've been on my current schedule for half a year now, and even with the assistance of melatonin, I still have trouble falling asleep every night. 

This was a fairly low-shopping month, which is proper, in light of last month's dramatic spending. I am now $240.91 over budget for the year (($150 x 4) - $555.98 - $154.21 - $94.79 - $35.93 = -$240.91), compared to last month's $354.98, so I'll need a few more low-shopping months to catch up, but I am on the right track. 

In other news, I've been seeing a kind of fancy dermatologist, mostly out of curiosity and because, as a short-term government employee, I briefly am in possession of the best health insurance I'm likely to ever have (biglaw firms are not known for robust health insurance offerings). This will probably be the only time in my life that I can justify regularly seeing a dermatologist for fairly routine care.

Spoiler alert: The dermatologist prescribed some new medications, but I don't think their course of treatment actually works better for me than my most recent over-the-counter CosRx BHA-centric routine (cheapest on Amazon, see my quick review here). Cortisone shots are miraculous, but imperfect, but those are expensive even after insurance. I haven't been reporting on my skincare purchases these past two months, because they've fallen more in the category of medical necessity rather than discretionary purchase while my skin adjusts to new prescriptions. 

Fashion - (TOTAL: $35.93) 
  • Ann Taylor Mosaic Lace Shift Dress (only one size left) - $35.93 - I couldn't help but snag this dress when it briefly popped back in stock in my size. I actually have another one in a near-identical color (navy blue rather than this royal blue) from late summer of 2015. I loved that one so much, I wanted a back up. I couldn't tell from the stock photos, but the lace pattern on the 2015 version was different, a bit more delicate. The fabric is otherwise the same cotton and nylon blend for the lace with a polyester lining. The dress is quite light and good for most seasons, even summer (though if the lining weren't polyester, it'd breathe better). I also wear the older dress in cold weather with tights, a cardigan, and a coat. Ann Taylor is currently stocking a lace shift dress in this same cotton-nylon blend in bright pink and steel gray, but in a leaf-patterned lace. Note that this dress runs quite large, though it's also a bit short of hem. I normally am a 4 or 6 regular in Ann Taylor dresses, but a 2 regular gets a "just right" fit for me in this dress. 

Linking up with Franish and the Budgeting Bloggers as usual this month. Please do go check out what everyone else bought this month!