So, here’s a medical…

So, here's a medical post -- I have a couple of non-serious things going on that I could use some help with.

One, is that ever since I got pregnant with Anand, I've been beset by pimples. My doctor says that this is not an uncommon reaction to the testosterone. Pfui. I'm not good at dealing with them, but now that life is finally returning to normal and I have a little time for self-care (as opposed to student-care and child-care), I'm trying a combination of the tablet my doctor prescribed and some medicated face wash.

Here's the thing. My doctor is a family practice doctor, not a dermatologist. And when we talked, she said that since we've been battling this acne for a while (we tried a course of the tablets in March, which worked, but then they recurred starting in September and have gotten worse again), I might want to consider a chemical peel; she thought it would help with that active acne, and possibly with the acne scars too. And we talked some about the pluses and minuses of that process, and she'll have her office check whether my insurance covers it, and then I can decide if I want to do it.

But when I was talking to a pediatrician friend about this, her reaction was that I should definitely not let a family doctor do a chemical peel or microdermabrasion on my face -- that there are keloid scarring risks, and that a family doctor isn't qualified to handle this kind of thing, and if I want to do it, I should go to a dermatologist. And okay, that sounds reasonable, but it feels a little weird/insulting too -- I like my family doctor, and if she says her office does these procedures and she's comfortable with them, is there really any reason not to believe she knows what she's doing? That's question one.

Question two is more of a ethical one. Her office sells medicated washes / blemish sticks / moisturizers. And, okay, they're not that expensive -- no more so than salon products. And I do find it reassuring having a doctor tell me that these are actually useful products that will work, as opposed to my somewhat randomly choosing something off a shelf in a salon or drugstore. But it feels a little -- iffy. To have a doctor shilling patent nostrums, you know? But on the other hand, if these products are out there, and they work well, and they're priced reasonably, why shouldn't the patient have access to them with the guidance of their doctor? Ugh. I dunno. I ended up buying the wash and blemish stick, but not the notably-more-pricey moisturizer, and I'm not sure if that was reasonable, or if I somehow got taken. My pediatrician friend does not seem to think too highly of my doctor after all this, and I don't know if I should take that seriously. I like my doctor otherwise, but I don't know her that well -- I just started seeing her this year, and this is the second time we've met.

And now here's question three. I've been having fairly serious neck and back pain for a long time now, and have just been living with it, but at this point, now that I'm done breastfeeding, I'm considering breast reduction surgery. (My breasts are somewhere between DD and F, depending on who measures them, and I'm 5'0". It's a lot of weight for a small frame.) I've researched it a fair bit online, and the surgery seems like a reasonable approach, with a very high success/satisfaction rate. But I am, of course, hesitant to take on any kind of surgery, because, y'know, it's people cutting into me. And what about loss of sensation? I like sensation. It looks like my insurance may cover this, but I don't want to rush into it. On the other hand, I've been thinking about this for a long time -- several years, actually. I only waited this long because of the aforementioned breastfeeding. Still, I guess I feel like I could use some personal anecdotes / advice at this stage.

Whew. That's it. Any advice?

19 thoughts on “So, here’s a medical…”

  1. Can’t speak to the second problem, but on the first — I’m inclined to agree you should see a dermatologist. Particularly if she’s not experienced with dark skin; I’ve heard it forms keloids more easily than fair skin does.

  2. Now, I’ve never been post-pregnancy, but I find a lot of over-the-counter/medicated washes/etc to be irritating to my skin and have the opposite effect to what I want to do. My skin breaks out hormonally depending on the TOM, not hugely, but its there. I’ve had good experience going as mild as possible with products that are natural/organic without Sodium Lauryl/Laureth Sulfate, without the parabens and pthalates (or at least as much as possible) and without the mineral oil. The Body Shop has a nice line of organics….

    I have a GYN who sells ‘natural supplements’…so I think it is something more and more doctors are doing. I do understand your hesitation, but if you think your dr is comfortable, and you trust her, then do it. Its better to go with someone you trust.

    In terms of the boob-reduction, I’ve got a similar size ratio. I’ve actually found I have less pain when I don’t wear a bra, the bra seems to twist me out of a comfortable posture…. (I wear one to work, and to church, but that is it) I would never have one, I can’t imagine being smaller, and I like the proportions my body has….

    The other thing you have to consider is scarring. Have you ever had any surgery in the past? Do you scar badly? because that could be an issue……

  3. Thanks — this is all helpful. I wish I could go without a bra — I do sometimes, on the weekend at home, but after a few hours, I have to go put one on because my back is hurting too much.

    I can easily imagine having smaller breasts — I would be able to run! I have to say, that’s one of the most exciting ideas for me. Even if I strap myself into the tightest sports bras, I can’t really run now without pain from breasts bouncing around.

    I don’t think I scar badly — but I have to admit, I don’t really care if there are some scars. It’s not as if anyone sees my breasts unless they’re having sex with me, and if they’re doing that, well, hopefully they’re having enough fun that a scar or two won’t bother them. I already have a ton of stretch marks, and while I don’t love them, I’m used to them. I have c-section scars, and I don’t mind them. I kind of like those, actually. Is that weird?

  4. Mary Anne–I definitely think you should not only consult a dermatologist but shop around for a new family doc. I am scandalized that she is selling aesthetics products out of her office and I think this is a clear conflict of interest for your health. I’ve written about pharma/doctor gifts and conflicts of interest in the past and this is way over the line. Research has found that even a small gift such as free pizza can compromise a doctor’s objectivity about a product. How much more so a cash flow coming from selling that product out of her office?!

    Our family doctor is dual-certified as an internal medicine doctor and pediatrician and absolutely does not sell anything from her office. Nor, in eleven years, has she ever handed me a free sample. Not everyone is able to find a great doctor like this one, but you are in the Chicago suburbs, so I think your chances of finding a good, ethical doctor who practices solid, evidence-based medicine are pretty good.

    About the acne–one thing I’ve heard of that works for some people is going on an elimination diet to see if something you are eating is causing your acne. It is not a very mainstream concept, but it is harmless to try (except for the deprivation of a week or so without foods you like). One caveat I have for you is that among people of Asian origin, rice is a common allergen. A lot of times rice is a “safe” food on a Western elimination diet. That may not be the case for you. I recall years ago a Korean acquaintance of mine was breastfeeding her baby, and something in her milk was giving the baby colic. She eliminated one thing after another from her diet until she was eating only rice. Well, it turned out it was rice. So don’t assume you aren’t allergic to rice (sad as that would be). I had been having some intermittant acne on my body, and it turned out to be something that was coming in contact with my skin. (On that note, you might want to also stop using products on your face and then add them back one by one to see if you break out.)

    I can’t advise on the breast reduction, but I’ve heard nothing but good things about it, and I think that preservation of sensation is a valid conversation to have with your surgeon.

  5. I would see a dermatologist and find out if there are other alternatives before a chemical peel.
    As far as the products in your doctor’s office, it’s part of the commercialization of medicine, which I’m not thrilled with, but it’s a common trend. They are no better or worse than a salon carrying name brand products.
    I’ve known several women who have had breast reduction surgery, and all have been much happier for it. If it’s what you really want, go for it.

  6. I cannot agree more with the commenters who recommend getting the opinion of a dermatologist. If you don’t like what the dermatologist says, you can always go back to your regular doctor but I would never let a regular doctor do any special procedure on me. really.

    I have never had a doctor sell me anything except maybe contact lenses. I think that is really pretty nutty, actually. I have been lucky enough to be part of hmos at major medical schools/universities and there’s probably a reason they don’t allow it. I would take down the brand name and research things before buying them.

  7. I’ve considered a breast lift (not unhappy w/the size of my breasts, but I’ve gained and lost weight and they are uncomfortable shape-wise) and like you am concerned about the loss of sensation. So any time I learn someone’s had breast reduction surgery, I’ve asked about that. In all cases, the woman have said there was no loss of sensation…and in one case, the woman said it was better afterwards.

  8. I would definitely consult a dermatologist before tying anything as invasive and, well, scary, as a chemical peel.

    I recently (the past two years) discovered that *not* washing my face was the solution to my skin problems: I’ve switched to a good rub with a terrycloth and very warm water, and an application of organic oils like arganium twice a day (morning and evening) instead of expensive creams. occasionally I exfoliate in the shower, and every few weeks I change which oil I’m using, or replace it with a simple but really moisturizing cream like a pure cold cream or sorts. I have a lot less problems than I had before, and I used to think my skin was oily! Obviously I’m not saying this would work for you, but, you know. anecdotes, etc.

    On doctors selling products, I… would seriously consider changing doctors too, I admit, or at least I’d stay well away from those products. I can’t help but see it as a conflict of interest, which strikes me as unhealthy.

    On breast reduction… I probably need to gather my thoughts and come back to comment later if I have the strength. (here’s the gist in case I don’t! I had one in 2006. It went very well! I just gained a lot of weight afterwards and now my boobs are back to what they were before. Oh, and I did lose some sensation, yeah. It is a little sad.)

  9. If the doctors remove the nipples completely and reattach them (usually done when nipples are hanging very low for aesthetic reasons), you will lose sensation as they cut through all the nerves. You can also end up losing the nipple if it doesn’t reattach well (not that common, but did happen to a coworker’s friend).

    I have three friends who have gone through it. One would not do it again; she said it did not help her back as much as she thought it would, recovery was very tough with small kids, and she did lose some sensation. She says scarring is noticeable, but she doesn’t mind. One feels great about it, although she had a bad infection (solved pretty quickly), did lose sensation, and has some scarring. The other has more mixed feelings about the whole thing (ended up more lopsided, which makes her feel more self-conscious, but has much less back pain), but has made peace with it.

  10. I definitely don’t want them moving the nipples! But my impression is that they used to do that a lot more in the past, and don’t do it much now. I wouldn’t do it for aesthetic reasons.

    I’m still thinking about what y’all have said, but my instinct right now is to skip the chemical peel and dermatologist for now (the scarring isn’t that bad), and see whether the medicated wash / moisturizer regimen solves the problem. Hope so.

    For most of my life, I basically washed my face with a bit of soap in the shower, and had great skin, so didn’t worry about it. This acne attack at 37 was a rude awakening. So I feel like I’m suddenly having to learn things other people have been doing for a long time. Sigh.

    I do think shopping for a new family doctor might make sense. Sigh. It’s a pain, because we have the UIC HMO, which kind of sucks, and really limits our options — most local doctors don’t take this insurance. I think we may switch to the PPO in the spring, when they next allow changes. Although that has its own problems — because the state of Illinois (my employer) is a year behind on its payments, it means paying for everything up front and then hoping to get reimbursed. Sigh.

  11. Oh, one more question. The doctor’s office manager (who was shilling the stuff) was very insistent that I not use a moisturizer that has alcohol. Is this a big deal? It turns out that all the moisturizers in the house do have alcohol. Should I go try to find a non-alcohol option?

    Recommendations for face cream would be welcome. I think my mom used Nivea, but that always seemed kind of annoyingly thick. But I don’t like really watery lotions either. Something in the middle?

  12. I use Cetaphil lotion and cleanser –both recommended by my dermatologist when I was like 12. Neither has fragrance which has alcohol which is very drying. That dermatologist always said that dry skin cultivated a fine field for acne. Also, neither is expensive. Both are available at Costco in double-packs. Never shop again! (That’s my motto.)

  13. I can’t help with either of your actual questions, but I can tell you that you won’t necessarily have to pay your doctors up front if you decide to go with the UIC PPO. I keep expecting my doctors to drop out of the PPO or at least to start asking for up-front payment, but none of them have done it so far.

  14. 1. Dermatologist. I would not let a family doctor anywhere near my face. And, I would spend some time researching either a brown doctor or someone with lots of experience treating brown skin. There are some specific things that make a difference.

    2. Unethical to sell products. I would only purchase products recommended by a dermatologist or that you did lots of research on.

    3. Are you wearing really good, supportive bras in the correct size? I’ve seen scaring and a close friend had some problems after her surgery and had to have it redone.

  15. I am also prone to pimples and my doctor recommended a plain old erythromycin gel (prescription, super-cheap) and benzoyl peroxide (OTC–some people find this harsh on their skins but I had no problem). Miracle cure. Completely non-invasive. For anything more complex I would have gone to a dermatologist, that’s what they’re for.

    My doctor also does not sell or give out products and in fact they don’t take visits from drug reps. I like them a lot. I know my dentist sells a couple of products but they’re not aesthetic, they’re prescription-level toothpaste for sensitivity (and inexpensive).

    Have you ever tried sports bras from Title Nine? They have a HUGE variety and they sell the only running bra that works for me. I have a short torso so nothing pull-over fits, and this is a counter-intuitive tank of a bra with a padded cup and a band so strong I have to fasten it and front and turn it around. But it works and is comfortable. (Your abs will also change your running; when I tighten my core it changes how my shoulders and back feel.)

  16. FWIW, I used to have terrible acne through my 20s, and after trying various dermatological medicated creams, etc. (and avoiding the tablets because they tend to cause yeast infections or other unpleasant physical side effects), what I ended up switching to was the Clinique range of cleansers and moisturizers specifically aimed at women with acne. I found them really helpful – they didn’t make my skin perfect, but they caused a real improvement without any bad side effects.

    (Nowadays I still have acne, but it’s so mild in comparison to the old days that I just make sure to use an oil-free moisturizer, but otherwise ignore it.)

  17. I had to learn about skin care in my late 30s too! I picked up this book randomly and found it helpful: http://www.skintypesolutions.com/home

    You can decide how deeply you want to get into her methodology and product recommendations, but what I found helpful was the basic science of how the skin works and what damages it and different skin types. Even us brown people should be using daily sunscreen on our faces — who would have thunk it? She breaks it down beyond the usual oily-dry skin types to a bunch of other factors. Plus quizzes are always fun to take.

    That said, if the cause is hormonal, you might also want to look at some information on food & hormones, maybe a nutritionist? Some foods like soy lead the body to produce/simulate (? fuzzy on the science here) estrogen, others testosterone, that could be affecting your skin.

    My question about your doctor is, what is she recommending to diagnose/treat the causes rather than just the external symptoms? Peels and moisturizers may or may not help after the fact, but if the root cause isn’t treated, I don’t think she’s doing her job.

    And don’t worry about offending her. Doctors should be used to 1) patients going to specialists — that’s why specialists exist, and 2) patients getting second opinions. That’s standard practice for any invasive procedure. If she’s offended by you seeking to be proactive about your health, she’s probably not the right person for you.

    Not sure what else you’ve tried for the back pain, but if it’s just about pain and not aesthetics, I found the book Healing Back Pain by Dr John Sarno really helpful (totally eliminated my chronic pain). Again, ymmv …

    but I guess I’ll opt for reading a book vs (or before) having a medical procedure any day.

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