Sanity or Self-Esteem?

When I went in to see my dermatologist last week, I didn't think I'd be reduced to tears by the end of appointment. Yes, I do have a slight phobia of doctors (my finger nails are usually bitten down to the numbs and I pop a prescribed Xanax or two), but this was going to be a breeze. I scheduled to see the doctor to get some medicine for my acne that has reared it's ugly head once again (no pun intended).

After trying the topical prescription I already had, along with various face washes, nothing was helping it this time. I have dealt with acne in varying degrees for my entire life. It was bad this time, but my arsenal of cover up and concealer kept my confidence up. But it was still unsettling to see red cysts forming on my face, down my chin, as if it was leading to a trail magical trail down my face. Since I had the day off from work from the holiday and my insurance covered it, I made the appointment to get some magic pills or cream to ease my mind.

For the appointment, I made sure not to pack on the usual concealing makeup that I usually do before I set out of the house. Waking up late, I didn't have a chance to really stare at myself. It was a a toss on the cleanliest sweatpants I have on the ground, throw my hair up in a bun and run out the door sort of morning. So when I finally was called into the examining room, I didn't realize that I was exposing my personal problem in such a raw way until I saw the nurses' faces. After going through my issue with the flare-ups, which were becoming less flare and more there, she sat there nodding.

"I can see there are red and purple spots. Clearly, signs of cystic acne. And those faint marks? They are scars. This is serious," she said as I shuffled uncomfortably in the chair. Cystic? Purple? Scars? This was not what I signed up for -- a play-by-play of what was on my face.

"It isn't as bad as it was when I was a teenager, before I did the Accutane treatment" I said, waiting for her to reassure me that it wasn't, but she wasn't agreeing me. She was looking down at the chart, going through the time machine of my files.

Back then, my entire face was covered in nasty spots that were filled with white heads that slayed my self-esteem. Imagine being 16 and waking up with a six-millimeter pimple in the middle of your nose on a regular basis. I was called cheese grater face and dirty by catty teenage girls, words that would send me into crying fits, despite having great friends who reassured me I was pretty despite the acne.

It was in this very office that I made the decision with my mother to go on Accutane, the miracle drug for acne sufferers everywhere. It was supposed to be the end to all of the acne that crippled my personality and held me back from being the girl I always wanted to be -- outgoing and friendly. After reading all of the warnings, agreeing to go on the mandatory birth control, to get the monthly blood tests and appointments, I began my six-month Accutane journey in May of 2006, right before my 17 birthday.

Yes, I was warned my lips would become so dried out that no matter how much Vaseline I slathered on, the layers came off like snake skin. Yes, I was warned that my back and joints would be incredible tender, making it almost impossible to lay on my back at night. And I was told that the sun would give me an excruciating sunburn, and that I would have to keep covered even if I was going for a walk in the summertime. But hearing it from a doctor and reading it on paper does not mean anything until you are laying in your bed sobbing because your face is still broken out, your lips look like a dried-out sponge and your back hurts too much to sleep.

Out of all of the side effects, the most difficult to endure were the mood swings and anxiety. It isn't a secret -- the warning labels are all over the packaging. Some individuals on Accutane experience mood swings, increased anxiety and sometimes suicidal thoughts. At the time, I was charged with hormones, depressed about my face and anxious about my friends leaving for college. It probably did not help that mental illness runs on both sides of my family, including both parents.

That summer, while most people girls are experiencing their first boyfriend and first shore trip with their friends, I had a bunch of new firsts. My first panic attack, my first entire day laying in a dark room because of depression, the first time I had to take a muscle relaxer because of my back pain, the first time I felt hopeless. My parents were on me like hawks, making sure that I was not in any way harming myself, or that I was too close to the edge of a mental breakdown. Night after night, they reassured me this would be the end of my acne nightmare and it would be worth it.

Finally, right near the end of my treatment, the changes were becoming apparent. My face was being to become clear in ways that I hadn't seen it since age 10. No longer were there red dots on my face, but soft white skin. Going back for my senior year, people were amazed at how great my face looked. The panic attacks, cracked lips, back pain and torture were forgotten for the moment. I became more active on the school paper, in the school choir and drama club. No longer was I afraid to go for I wanted because my face. The summer of hell was worth it, and I would never have to deal with acne again, right?

Throughout my college years, the acne began to creep back slowly. During stressful times, during my time of the month, breakouts would flare up. It was never as bad as life before Accutane, though, and nothing concealer couldn't fix. But after college, I noticed my flare-ups were continuing to get worse. Maybe it was stress of a full-time job, bills or trying to figure out what the hell I was doing with my life. After tubes of topical creams and cleanses, I realized the big guns would be brought in-but never, ever did I think that Accutane, the bazooka of the arsenal, would be brought back on the table.

So when my doctor came into the room and told me that our options were limited with treatment, I was stunned. Most both control pills were off the table with me because of my family history of heart disease and stroke. I never really responded to antibiotics well in the past, and it affected another preexisting condition that I am in the process trying to get under control. It was up to me to pick the lesser of two evils: play Russian Roulette that I may make another health condition worse, or go back on Accutane for another round of hell. My doctor reminded me I was not 17 anymore, and that I may not experience all of the old side effects.

That was true, but now I was a 23-year-old young woman on an antidepressant, expected to be a functioning member of society in the public relations industry. I could not afford to have my face look like a dried up sponge, or have my emotions send me into a debilitating downward spiral. Again, my doctor assured me that I would be monitored, and he would only agree to do the treatment on me if my psychologist agreed to monitor my mental health. He also pointed out that it may not happen, and my side effects may be kept to a minimum.

Although I was still undecided, I agreed go through the paperwork necessary for the treatment in case I decided to make the commitment. As the nurse began reading the side effects, the mandated quizzes and the strict 28-day blood test required every month, the tears sprung from my eyes. The thought that my body, my chemicals, were turning against me physically on my face after going through such lengths to banish it forever was too much. Acne was suppose to be something teenagers dealt with, something I had already done.

It was in that room, that same room, where I was told that the same medicine would do the trick. Was having clear skin worth the effects this pill could have on my body, my mental health and overall quality of life? As the nurse pulled me into a hug, I profusely apologized for crying, explaining it was just a horrible flashback of something that I had not thought about for a while. After composing myself, I assured her I would read all the paper work, start my lab work then decide if I would be going through the treatment.

That was four days ago, and I am still undecided what the right decision is for me. I know that I am an adult and that the choice is ultimately my own, but that does not make it any easier. This week, I plan to talk it over with my primary doctor and my psychologist to get their opinion medically on how this would effect my overall health. Whatever I choose, I know that there will be a down side but the trick is choosing the down side that won't bring me down permanently.