Re: Re: Tripwires in terminology

[Guest guest]

Marjorie,

Actually I think I agree. It would be really cool if rosacea triggers were

more defined and constant. That's part of what sucks about this " condition. "

It is so poorly understood and hard to manage. I think it's an area very

worthy of deeper scrutiny. I want to be cured asap! If you figure out what

causes it, I will be deeply grateful to you. In fact, even if you try

unsuccessfully to figure out what causes it I will be grateful for your

efforts. ; )

JF

Re: Diet and triggers

> > > >

> > > > Brady, I believe you are misquoting/misunderstanding NRS, but in

> > > your

> > > > defense I don't believe they are clear in their presentation --

> and

> > > > the confusion strikes at the heart of what is meant by a

> trigger,

> > > and

> > > > what is meant by an exacerbation of rosacea, something it sounds

> > > like

> > > > (to your credit) you're struggling with as well.

> > > >

> > > > On the NRS's page What Is cea (www.rosacea.org/p2.html)

> under

> > > the

> > > > section Can Anything Make cea Worse they clearly include

> > > flushing

> > > > alone as within their definition of a trigger, but note that

> > > flushing

> > > > can also exacerbate rosacea:

> > > >

> > > > " Facial lushing can make symptoms worse. It can even cause

> flare-ups

> > > > in patients whose rosacea was under control with medications.

> > > > Flushing can be triggered by many things ... hard exercise --

> even

> > > > menopause or some medicines. The most common triggers are: hot

> > > > drinks, alcohol, spicy foods, stress, sunlight, extreme heat or

> > > cold.

> > > > Experts say you should avoid anything that causes flushing. But

> what

> > > > bothers one person may not cause a problem in another. You will

> need

> > > > to find out what things affect you and decide if you want to

> change

> > > > your habits to avoid them. Just remember -- flushing may affect

> your

> > > > success in controlling rosacea. Talk to your doctor about how

> you

> > > can

> > > > learn to identify -- and deal with -- your own flushing

> triggers. "

> > > >

> > > > In the above quote, the word 'triggers' links to a new

> > > page, " Factors

> > > > That May Trigger cea Flare-Ups " . This is a confusing link,

> made

> > > > worse by the page's title until we recognise that 'trigger'

> here is

> > > > used as a verb, not a noun; replace 'trigger' with 'cause' and

> > > you'll

> > > > see what I mean.

> > > >

> > > > I suspect this list of factors (tripwires) wasn't intended to be

> > > > viewed exclusively as triggers (as was the noun used on the

> What is

> > > > cea page). These are also -- in some cases primarily --

> > > > situations, exposures, and conditions that exacerbate underlying

> > > > rosacea, in whatever combination of subclassifications a

> particular

> > > > person manifests.

> > > >

> > > > It's a subtle, and I believe an important and verrrry confusing

> > > > distinction that the NRS is making even more confusing. The

> overlap

> > > > is understandable since some vascular or inflammatory triggers

> that

> > > > impact rosaceans and non-rosaceans (things like the 'niacin

> flush'

> > > > affects both rosaceans and non-rosaceans) can also exacerbate

> > > > underlying rosacea in some rosaceans, under the right

> conditions. A

> > > > few minutes in the hot sun OR a half-glass of wine can cause a

> > > > transient flush in anyone, but several hours in the sun AND a

> jug of

> > > > Wild Irish Rose in a rosacean might also induce a full rosacean

> > > > exacerbation, whatever that manifestation may be, in a

> particular

> > > > person. In others, the trigger and related condition are

> > > inseparable:

> > > > a 'hot flash' can trigger a flush in rosaceans and non-

> rosaceans but

> > > > menopause -- with its hormonal changes causing vascular

> instability,

> > > > emotional stress, and drier skin -- can exacerbate underlying

> > > > rosacea.

> > > >

> > > > The distinction is important because the mechanisms behind

> triggers

> > > > are usually well-understood and apply to both rosaceans and non-

> > > > rosaceans, as compared to the poorly-understood mechanisms

> behind

> > > > these factors that exacerbate underlying rosacea.

> > > >

> > > > Also, we rosaceans are constantly told to avoid flushing

> triggers

> > > > because they may worsen or hasten the underlying progression of

> our

> > > > rosacea, separate from whether they also cause an immediate

> > > > exacerbation of rosacean signs and symptoms (though as I

> commented

> > > in

> > > > the other post, I'm not aware of the proof of this assertion,

> > > > although there is clear proof we need to avoid

> > > > irritative/inflammatory triggers.)

> > > >

> > > > In comparing this NRS list of factors to the vascular and

> > > > inflammatory triggers from my last post: First, it includes all

> the

> > > > environmental, physical and emotional stress, alcohol and spicy

> > > foods

> > > > that are common flush inducers. Second, it includes nearly all

> the

> > > > foods I talked about that contain or induce small peptide

> release,

> > > > specifically histamine. (so much so that the last entry, " foods

> high

> > > > in histamine " is superfluous.) The NRS list includes topicals,

> as I

> > > > did, though I segregated them into an inflammatory subgroup; the

> > > > redness that comes from topicals is not vascular in origin, but

> it

> > > > comes from direct irritation/inflammation of skin cells.

> > > >

> > > > Interesting for this discussion, Brady, is what the NRS list

> does

> > > NOT

> > > > include: it does not include any common food allergens and

> > > > intolerances -- no mention of nuts, wheat (indeed, it

> specifically

> > > > says that bread is OK), glutan, dairy products, or soy

> products. To

> > > > be consistent with the rest of the listing, chocolate is

> probably

> > > > included because it contains vasoactive amines, not because

> it's an

> > > > allergen. So I don't see anything on this page that supports an

> > > > allergy or intolerance link to rosacea, or other factors that

> > > support

> > > > a highly restrictive diet, even a temporary elimination diet. It

> > > > seems to me that the foods listed are included specifically, if

> not

> > > > exclusively, because they might trigger a flush (in rosaceans

> and

> > > non-

> > > > rosaceans).

> > > >

> > > > Like I said, this is all pretty confusing. I have a vague sense

> of

> > > > how a trigger is different from a factor that exacerbates

> rosacea,

> > > > but it falls apart when I try to bring it all together with

> what I

> > > > already know and don't know about rosacea. It's a real, " the

> devil

> > > is

> > > > in the details " situation, when we take the time to really look

> at

> > > > the NRS list rather than just toss it off or use specific

> elements

> > > to

> > > > defend a stance, or what we sort of understand superficially

> about

> > > > rosacea without questioning ourselves too deeply. We're told

> this

> > > > list was produced by the NRS but " Complied from patient

> histories by

> > > > Dr. Wilkin. " I've come across his name before. I'm

> going to

> > > > contact the NRS and see if I can ask Dr. Wilkins to comment on

> this

> > > > list further.

> > > >

> > > > Anyway, Brady, your comments about allergy, and the relationship

> > > > between allergies and flushing, in the last two paragraphs of

> your

> > > > post are not factually correct. I genuinely appreciate some of

> your

> > > > nuggets of truth and insight and I always enjoy your words, but

> > > > still, so much of what you say in your posts and book has no

> reality

> > > > for me. Like religious beliefs, I respect them as your beliefs,

> and

> > > > part of showing you respect is not to challenge your belief

> system.

> > > > They're your beliefs, and I'm glad they work for you and others.

> > > >

> > > > Take care.

> > > >

> > > > Marjorie

> > > >

> > > > Marjorie Lazoff, MD

> > > >

> > > >

> > > >

> > > >

[Guest guest]

We seem to be using the words " trigger " and " tripwire " interchangeably.

To me a trigger is a known event which will cause, for example, a cea

flare (such as eating food which has previously caused a flare).

A tripwire is a hidden or unknown event which causes a reaction. I guess a

tripwire becomes a trigger once identified.

Excuse me if I'm being a bit pedantic about this, but I think there are

differences. Does anyone else agree?

Barry

[Guest guest]

> To me a trigger is a known event which will cause, for example, a cea

> flare (such as eating food which has previously caused a flare).

>

> A tripwire is a hidden or unknown event which causes a reaction. I guess a

> tripwire becomes a trigger once identified.

Barry,

As someone who speaks English as a second language, and as someone who is

translator/interpretor by original profession, I agree.

Alena