Sunday, 20 September 2015

1 Year Update - [After Second Operation]

Howdy People, it's been a while I know but...  I figured the next update would be better aligned to my next update to Dr. Umar which is September, soooo... here it is...

During July, I had an appointment to have the biopsy and my first of three rounds of steroids.  Upon arrival for my appointment the Dermatologist very kindly decline to perform the biopsy.  She told me she was happy to provide the steroids which she did, but then questioned why a biopsy was required.  I told her that it was required by Dr. Umar and needed in order to understand if there were any complications.  After asking her if she had contacted Dr. Umar on this point (as per my phone calls and confirmed emails) she said it's nothing to do with Dr. Umar as I was now her patient and she was best qualified to advise me from this point forwards and said she felt the steroids were sufficient, but the biopsy was unnecessary.  I respectfully maintained that Dr. Umar was still my Dermatologist and he needed the biopsy, this resulted in the Dr. stating I was free to seek another Dr. if I didn't want her opinion.  I politely asked upon which grounds she concluded that a biopsy was not necessary and she said she would seek the opinion of one of the other partners.  I agreed to have the the steroids the same say and told her I would be back in touch regarding the decision for the biopsy.  A few days later, I then went on a much needed holiday. 

After two fabulous weeks in the sun and well rested, I took up the challenge and asked again about the biopsy and got a very polite, thanks for asking again, but still NO!  I then started contacting other consultants from the reference list I received from my local Dr. and had an appointment booked with a much more helpful Dr. (having explained the pantomime that had taken place).  All was set and I was due to go the difficult Dr. again, but only for round two of my steroids and as if by magic, she had a complete change of heart, was very friendly, all smiles and said "OK, so today we first take the biopsy from the left side side, then give you steroids in the right side".  Huh (I thought)?  Did that just happen?  Did I dream the last month's conversation with this same Dr who was adamant not to give me a biopsy?  All very strange.  She was extremely helpful, calm and couldn't do enough to help, perhaps I just caught her on a bad day last time? 

Anyways, I got the results this week!  They confirmed that there was no re-occurrence of Akne Keloidalis Nuchae which was my biggest relief.  They did, however confirm that there was hypertrophy.  This explains the thickening of the skin on some parts of my scar.  This confirms exactly what Dr. Umar believed was the case and is what he believes is hampering the expected hair growth. 

I am to wait for the progress of the final of the three phases of steroids before being clear on the next course of action.  My wish is that the steroids will flatten the hypertophy sufficiently such that the hair that is still yet to come through the surface will grow and I can close this chapter.  I am so close, but still not quite there, so I remain patient.


See below for my current pictures:

Notice the two blue stitches below from the biopsy (one taken with a hair follicle, one taken without):


Although not 100% flat, it is much flatter than it was even after only the first shot of steroids.  I have since had a second and there is one more to go, so I anticipate the scar will become much flatter still.




As I received the biopsy one the left side, no steroids were given an the left as there would be risk of infection.  I did however receive the steroids to the right hand side of the scar.  These pictures were taken a week after the steroids, notice the flatness on the right compared to the left side.






More to follow after the final round of steroids is complete and I have given Dr. Umar my next progress report (December).


Until then, stay tuned.


Patient-AKN-UK.



Friday, 10 July 2015

9 Month Update - [After Second Operation]

Let's get straight into it this month and go straight to the update.  The progress since 3 months ago seems to be minimal in terms of hair growth.  What had previously started to grow has continued and got longer, but nothing more in terms of overall coverage.  There are a few new sproutlings, but barely visible to the eye (and not visible to the camera), however I can feel them breaking the skin surface like sharp little spears, they are definitely there.

I recently had a very meaningful conversation with Dr. Umar re: my progress.  Whilst it was agreed that AKN had been successfully removed, the aesthetic improvements were not yet as we had hoped.  Dr. Umar explained that I may have developed 'hypertrophy' which means some of the scar is harder and thicker than the rest and slightly raised.  This results in limited or slowed hair growth as the hair struggles to push through the tougher skin.  As a result, I have been advised to have:

1) a 2-3mm punch biopsy - For further investigation
2) 3x phases of intralesional steroid injections of Kenolog (triamcinolone) 4lmg/cc - 3 weeks apart


The plan is that this will flatten the scar and thus allow more hair to grow through the skin surface, however we will re-asses after the steroids and biopsy before deciding a way forward.  Take a look at the current status below:














I have my appointment with my local Dr. (under the direction of Dr. Umar) in 4 days time to take the biopsy and give the first dose of steroids, then I will go on holiday to the Caribbean.  I will provide more regular updates during the 3x steroid phases and also when I know more about the results of the biopsy.


Until then, take care and I will share more in approximately 3 weeks time...


Patient-AKN-UK.


Sunday, 29 March 2015

6 Month Update - [After Second Operation]

Well, I wanted to write this blog first thing this morning but the clocks went forward here in Europe and I was busily glued to the television watching the Malaysian Grand Prix.  FORMULA 1 IS BACK!!!  It's a shame my boy from Britain (Lewis Hamilton) didn't win today, but let’s remember he did win last week and he got a very respectable second place today so a great start to my Sunday.


Progress:

Sooo, what's been happening with my recover?  At lasteth, mine hair hath start’d to groweth!!! (Old English meaning "at last my hair has started to grow").  Whilst the growth is modest, it is growth none-the-less, progress is progress.  It is in-keeping with my expected recovery at this stage and is the most significant and amazing update since my sutures (stitches) and bandages were removed in late December 2013.  What began as initial sproutings around 12 weeks ago, are now long, wiry, wispy hairs that I refuse to cut.  Interestingly, the first hair growth was at the exact same location where my AKN began with an acne bump that never healed (circa 1989) - I consider this a symbolic and positive indication of the healing process, as if it is somehow stamping out the ghost of the AKN at the very location where it all began.  My AKN began at the back of my head in the lower central region, approximately one third of the way up from the hair line on my lower neck (approximately where most pony-tails would grow).  There is further hair growth along the lower hair line.  The hair is now very obvious when you see it closely (within a few feet proximity).  It is mostly a clump of soft wispy hair and a lower line which gives the overall impression that my scar is ever so slightly smaller, seemingly narrower.  Perhaps I should let it grow into a pony-tail...  Why (I hear you ask)?  Simply because now, after 28 years, I can :-D

One other point of note is the general pigmentation of my scar is darker than it was and is now closer to the natural colour of my skin, all of which has come together to improve the general appearance at the back of my head.  The darker pigmentation is from the lower hair line and seems to be rising.  This is by far the most significant aesthetic improvement to date and to me is a clear indication that my recovery is heading in the right direction. 



See for yourself.  Take a look at the pictures below (click each to see larger picture):











After Care: 

Daily Routine:
It's simple, twice a day I use Rogaine Foam (known as Regaine Foam in Europe) after each shower.  I gently rub in a small amount of foam into the scar and I am ready for the day.  It makes it feel moisturised and somehow rejuvenated. 

Washing:
I have been so happy with the Burt’s Bees BaoBab More Moisture natural shampoo as recommended by Dr. Umar that I have continued to use it.  It contains a lot of natural good stuff and does not contain a lot of the usual bad stuff (feel free to read up on this topic from above link for actual details).  My hair and scalp feels cleaner and somehow more in balance than with any other product I have ever used.



Concluding Statement:

To be honest, I remain measured in my celebrations at this stage as my healing still remains a work in progress.  I celebrate being AKN free for well over a year, I celebrate no further itching, flaking or bleeding and I celebrate initial hair re-growth and pigmentation improvements.  Although measured, I am optimistic for the future healing as when observed closely, I can also see many more hairs about to break through the skin.  I anticipate that the next two blog updates (June and especially September 2015) will show the likely extent of my finished healing and it will be clear whether I will be discharged from Dr. Umar or if further treatments are required.  Until then, take care...


Patient-AKN-UK