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!