Geoffrey and group,

I am astounded at the amount of information that I have come across as
I have started going back in my file cabinet looking at the benefits
of topical drug therapy over oral systemic therapy in treating many
types of diseases, especially dermal and musculoskeletal. This
modality has the advantage of deliverying high concentrations of the
drug directly to the cells affected and also bypasses the first pass
effect of hepatic metabolism, thus allowing an effective concentration
to be delivered to the problem site. I cannot believe I have used
this topical therapy for so many years effectivly in my own canine and
feline patients (dermal, vascular, and neural pain diseases), and yet
have never considered having my compounding pharmacists make me some
of the very drugs that I was aware carried so many dermal benefits.
The same drugs I was opposed to using systemically in myself, because
I did not want to have to deal with the systemic side affects. Even
my own neurologist who takes care of me, and is one of the best in
Alabama, has never recommended topical therapy when I have complained
of the severe neural pain.

You know it is amazing that I have seen over 20 different doctors all
in different fields over 5 years for this disease and its variety of
symtoms, and not one of them ever suggested topical pain therapy
despite my continued complaints of the debilitating symptoms at
certain times. The only specialist that I have not seen is a pain
doctor.

I am coming to see more and more as the years go by that the reason
that we as a rosacean community do not recieve new experimental
treatments is due in part to our own lack of knowledge, our lack of
drive, and also because the doctors that we see are either to busy to
keep up, or that they do not really care enough about these
individuals sitting in front of them to get out a book, review current
literature, get on the phone and call another speciality (even a
pharmacist) to find out if there is any new information or treatments,
or even experimental things to try (with the patient understanding
that it might or might not work) out there.

I guess it is my fault though for not thinking about using this
treatment modality, when I review many articles week after week
dealing with successful topical treatment in both in vet and human
medicine, from pain specialist and pharmacist and yet have never
thought about talking to my own compounding pharmacists.

We are going to have to realize that compounding pharmists can be some
our strongest advicates in getting experimental treatment to us. They
will even go so far as call your doctor and speak for you. Then all
the doctor has to do is say ok.

This is an unbelievable source that is totally untapped in opening up
new treatments for ourselves. Compounding pharmacists will even get
online and search the new articles and literature for us.

I have things compounded all the time for my patients that come from
other doctors that never even mention it to these clients for there
animals.

Geoffrey and I have been discussing this for several weeks now and
this morning I have gathered some of these articles and sent them to
him to review and get his input. The evidence is there that
Gabapentin, Amitryptilline, Clonidine, Ketamine and many more drugs
are very effective at dealing with vascular and neural pathological
processes in the localized dermis and even underlying musculature.
The likelyhood of any toxicity from these drugs used in this manner is
almost 0 due to there systemic use at even higher dosages.

Desensitizing the facial nerves and vessels with these drugs over 4-6
weeks may even decrease our flushing threshold and possibly decrease
permanent facial redness.

Hopefully we will not all get our hopes up over this for nothing, but
I truly think if we are persistant in pursuing this, things will
happen for us.

Sincerely,

Dr. Young