Australian Doctor Australian Doctor 15th September 2017 | Page 32

Therapy Update from previous page The mended object then becomes more valuable than it was when it was whole. The object takes on a more detailed and interesting personal biography, and is a metaphor for resiliency and longevity.

My work with these two women was to help them repair the cracks they perceived in themselves, acknowledging their resilience and not burying or denying what had happened. Slow repair, through years of CBT and mindfulness, created

NEW ACZONE ® dapsone 7.5 % w / w topical gel

· Once-daily dosing 1

· Proven efficacy and tolerability at week 12 1, 2

· Studied in large pivotal trials used for the approval of a topical acne drug 1, 2

stronger women, and one told me at the end of our sessions together that she felt whole.

Big mind The Zen philosophy and its core paradoxes are often hard to reconcile with the

PBS Information: ACZONE ® is not listed on the PBS. way we are taught medicine within a scientific, evidencebased paradigm. Even in the mental health area we try to compartmentalise( DSM-5) and stay within evidencebased treatment modalities. Despite this, there are areas of commonality with Zen.

BEFORE PRESCRIBING, PLEASE REVIEW APPROVED PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ALLERGAN BY PHONING 1800 252 224 OR FROM www. allergan. com. au / products

Australian Minimum Product Information. ACZONE ® topical gel is a prescription medicine containing 75 mg / g( 7.5 % w / w) of dapsone. Indications: For the topical treatment of acne vulgaris in patients 12 years of age and older. Contraindications: Hypersensitivity to ingredients; individuals with congenital or idiopathic methaemoglobinaemia. Precautions: Only apply to affected areas and unbroken skin. For external use only. Avoid contact with eyes, eyelids and mouth. If contact with eyes occurs, rinse thoroughly with water. Use with caution in patients- with G6PD deficiency; on oral dapsone or antimalarial medications; on trimethoprim / sulfamethoxazole( TMP / SMX); lactating; below 12 years and over 65 years; on medications which may induce methaemoglobinaemia or on topical antibiotics or topical retinoids. Use in pregnancy is not recommended. Interactions: Trimethoprim / sulfamethoxazole( TMP / SMX) co-administration may cause increases levels of dapsone and its metabolites. Topical application of ACZONE ® 7.5 % w / w gel followed by benzoyl peroxide in patients with acne vulgaris may result in a temporary local yellow or orange discolouration of the skin and facial hair. Concomitant use of ACZONE ® 7.5 % w / w gel with drugs that induce methaemoglobinaemia may increase the risk for developing this condition. Adverse Reactions( AE): ≥1.0 %: dry skin, pruritus, pain. Dosage / Method of Use: For dermatological( topical) use only. After the skin is gently washed and patted dry, approximately a pea-sized amount of ACZONE ® 7.5 % w / w gel, should be applied in a thin layer to the entire face once daily. In addition, a thin layer may be applied to other affected areas once daily. ACZONE ® 7.5 % w / w gel should be rubbed in gently and completely. Patients should be instructed to wash their hands after application. Date of first inclusion in the ARTG: 10 January 2017

References: 1. ACZONE ® Gel 7.5 % Approved Product Information. 2. Thiboutot DM et al. Efficacy, Safety, and Dermal Tolerability of Dapsone Gel, 7.5 % in Patients with Moderate Acne Vulgaris: A Pooled Analysis of Two Phase 3 Trials. J Clin Aesthet Dermatol 2016; 9( 10): 18 – 27.

™ ® Trademark( s) and registered trademark( s) of Allergan, Inc. Allergan Australia Pty Ltd 810 Pacific Highway, Gordon NSW 2072. ABN 85 000 612 831. © 2017 Allergan. All rights reserved. AU / 0391 / 2016 Date of preparation: February 2017.

AN APP FOR MINDFULNESS

BUDDHIST beliefs have been appropriated by Western practitioners and morphed into non – religious mindfulness practices. I’ m a fan of mindfulness but, like any psychological strategy, you need training to deliver this effectively to patients. In the meantime, a good mindfulness and guided meditation app to recommend is Smiling Mind.

Zen theory expounds the idea of‘ big mind’, where mind is not confined to individual brains, but refers to the universal, infinite interconnectedness of all things.

US neuropsychologist Robert Rosenbaum summarises it neatly:“ We begin to sense that even in our difficulties, life and death, health and sickness are cousins, members of some larger family of which we are also part.” 1

Applying‘ big mind’ in general practice works on a number of levels for me. It builds on my exploration of a patient’ s wider( including deceased) family, and I find the concept liberates me from feeling I need to solve everything on my own.

The patient, their community and wider forces, such as time, will help me. So many doctors are ground down by needing to have all the answers, denying uncertainty and embracing a firm diagnosis.

‘ Big mind’ helps us with the reality of our own humanity, our own imperfections and the oftenuncertain area we work in.

Helping patients be more Zen Clearly, Zen helps me in my life and, by extension, my practice, but I don’ t feel a need to convert anyone. Instead it helps me help others. An example would be the young woman with postnatal depression on that busy morning shift.

The week before, she had been really low, unmotivated, house-bound and complaining non-stop about her baby’ s poor sleep patterns. We negotiated for her to walk every day and return to yoga classes on a Sunday morning when the baby’ s father was home. This all helped and a week later she was attending playgroup again.

What made the most difference, though, was my Zen and‘ big mind’ approach to the sleeplessness.

I pointed out that she did have sleep periods, so that when she was woken, she needed to remember that sleep would happen again soon. I also suggested that when the baby woke, and woke her, she could tell him some of the happy childhood memories she had shared with her mother.

Telling her baby these stories changed her focus, altered her tone of voice, lifted her mood and had the desired effect— the baby responded by starting to sleep more. ●

Dr Young is a GP in Blacktown, NSW

Reference

1. Rosenbaum, R. Zen and the Heart of Psychotherapy Routledge 2000.

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