Prescription Medication in Foreign Lands

Right around the time I arrived in Curacao, yet another pimple proved to be the straw that finally broke this camel's back. I have suffered with acne for as long as I can remember, going back at least 10 years. I'm 31, the teenage stuff should have stopped ages ago. I'm like one of those Proactive commercials - I've tried *everything*, from various drugstore cleansers and remedies, to more expensive "systems" like Proactive and Murad. I've gone on and off birth control pills and I've worked on changes to my diet. I've been to a number of dermatologists who have put me on various antibiotics and prescription creams. Every once in a while something makes it less horrifying, but nothing has completely alleviated the issue. In Africa, my malaria medication doubled as anti-acne, but again, not perfect, and once I got off those meds, the problems resumed with a vengeance. Out on my sailing adventure, I thought that I could shirk it off and not worry about it, and/or that the sun and the salt would take care of things naturally. But after a few weeks of new big, painful zits daily, that often bled and sometimes scar, I realized I simply couldn't take it anymore.

(I should insert a word here to answer all of you who would try to offer comforting comments of "it's hardly noticeable" and "beauty comes from within" and all that jazz. Acne is extremely painful psychologically, and unless you've suffered it or some other deformity, it's really hard for you to understand just how horrifying it can be. I never ever leave the house without makeup (when I'm not in profusely humid environments where I can't). With each new blemish I feel like there are neon lights around it, and my old scars will never fade enough to make me forget they were there. When I see myself in photos I cringe, and I often sit and wonder what my face would be like if it were clear. I know I'm pretty as-is, but gosh what would I look like if...Every single person I meet with flawless or near flawless skin is the subject of my inner jealousy (wrong wrong I KNOW, but can't help it!) And I share a silent sad bond with anyone I meet who also suffers.)

The end-of-the line for acne is a medication called Accutane or Roaccutane overseas. You've probably heard of it, along with its miraculous powers and/or horror stories. Accutane works by reducing the size of your sebaceous glands (oil producing glands), decreasing cell buildup that leads to pimples, killing acne bacteria and reducing inflammation. Once you finish treatment, it's possible that you never have acne again. (Though many patients require a second course some time later).

Sounds fantastic, right? It is until you hear about the side effects: extremely dry skin, very painful cracked lips and extreme sensitivity to the sun. These effects are guaranteed. There's a whole laundry list of others that are possible, including severe liver damage, and in the case of pregnancy, horrifying birth defects. In the US, Accutane is highly controlled. In order to go on it you must submit to monthly pregnancy and liver function tests. And for each monthly refill, you and your doctor and pharmacist have to jump through a litany of hoops and paperwork.

But I'm not IN the states now am I? Back in Curacao I decided to try my luck and getting it, figuring I'd probably at least need to see a doctor. On a little errand run, I kept my eyes open for a clinic, but what I came to first was a pharmacy. Eh, why not, I'll give it a shot. So I walked in and asked the pharmacist if they had it. It took writing out the word before she understood me, but yes, they did in fact have it available. "Have you taken before?" she asked. "Oh yes, I have." "OK. You sometimes have to see a doctor, but for you it's OK." She went to the back and produced a couple of boxes, amounting to 60 10mg pills. The bill was $153 bucks - OUCH. But the prospect of starting treatment right there and then far outweighed the cost.

I took the first pill that night and practically trembled putting it to my mouth. WHAT THE HECK was I thinking taking some medication that severely dehydrates you and increases sun sensitivity when I'm setting out to SAIL in the TROPICS!? But I was going to start out on the lowest possible dosage (per my Doctor's unofficial advise in the states), and treat it with great respect. I'd commit to drinking as much water as I possibly could, use loads of sunblock, but also work on getting a good base down before the medicine really kicked in. And, of course, keep alcohol to a minimum.

After 20 days of 10mg/day, I can safely say I think I'm improving. I knew to expect to get worse before I got better, and really I think I stayed about the same. But the pimples clear up much quicker than before, and my skin tone seems to be evening out. I have not experienced ANY side effects yet, but I literally drink 4-5 liters of water a day. 5 liters is 1.3 gallons. This doesn't count any coffee, juice or soft drinks I may have. I put on 30spf on my face every morning, and duck out of the sun when I think I've had enough (usually not more than 15 minutes if I can help it).

I will do 10mg/day for another 10 days. Then, per doctor recommendation, it'll go to 10mg 2x/day. This will last for another 3-5 months.

Obtaining more in Panama was slightly more involved, but not by much. I went to a pharmacy and found that I did in fact need a prescription. Just having the pills wasn't sufficient as it's a regulated medication. I was directed to a doctor on the next block. For $5 he wrote me a scrip for a month. I told him I should probably get 2 months worth since I'm heading out on a boat. OK, another $5 then. I walked back to the pharmacy and the ladies got upset - I didn't have the prescription in triplicate. One called the doctor and found that he didn't have carbon paper. So, get this, she sort of tucks the special in-triplicate pad of forms into the crook of her wrist, and discreetly beckons me to follow her. (All communication only in Spanish btw, with the doctor as well). We walk over to the doctor's office and he signs where he needs to. Back at the pharmacy, I'm all sorted with 1 month of pills at my new dosage - so 60 10mg pills for $106 (cheaper than curacao, but still expensive). The whole scenario took about 45 minutes.

I suspect that the increased dosage will result in more noticeable dryness, as if I go with less water for a day (when I was on/off planes, buses, taxis), my skin gets scaly. But presumably my face will get even better. And with time, it'll even be pretty, in my eyes.