I’m currently in Bangkok for a training camp and took the opportunity to get in touch with Dr Jay from the CAP Clinic.

In this post I’ll detail what I learned from Dr Jay, my CAP experience so far and my thoughts on CAP treatment overall.

First of all – let me preface this article with the following:

There has been chatter in the community, particularly from Dr Rappaport and others that CAP is a “scam” and Jay is just “doing it for money” or something along those lines. After meeting Jay in person, I’m confident his intentions are genuine, the treatment is getting genuine results and it’s very unlikely he’s in it “just for the money”. After spending several hours talking to Jay over a period of weeks (both in person and on Whatsapp) it’s obvious he has vast experience treating TSW patients with success and his knowledge is invaluable.

The fact he doesn’t even have a website or social media page and the clinic is FULL just from word-of-mouth testimonials reinforces this.

So let’s rewind, how did I even end up seeing Jay in the first place?

I’m in Bangkok for badminton training and I sent Jay an email asking if I could meet him for a consult (I had to hunt his email address down from a fellow warrior – like I said, he’s not on the web publicly!)

The goal was not to start CAP treatment but just to meet him and learn as much as possible and also get his opinion on my skin.

Jay responded after about a three days and said he could do a consult by email, no need to come to the clinic. He asked for some photos and a summary of my history.

I told him my skin was stable and I have had good results with NMT but still get flares, and showed him some photos.

He responded with a copy-paste of his basic knowledge of TSW, and then addressed my photos and told me I’m dealing with possible fungal infection and “hardened skin”. It was important to live in an irritant and allergen free environment which might include replanning my entire lifestyle, and also living in a sea/sun climate could also help. Also the importance of staying mentally positive.

He actually did not mention CAP at all in this first email so, I replied and asked why it’s not recommended for me. He said he didn’t realise I was willing to do CAP and said it could help me quite a lot and I would see some good results within 3-4 months and my skin could return to very stable/normal within 12 months.

I knew I didn’t have 12 months or even 3-4 months (probably one or two months at most) but I told him I’d come in to see him anyway while I’m here.

My arrival at the clinic was quite an interesting moment for me. After dealing with TSW for 5+ years, I have actually never met another TSW patient in real life. I walked in the door and there were around four other people there sitting around, each in different stages of TSW. I said hello quickly before Jay ushered me into the consult room right away.

My initial talk with Jay lasted over three hours where he explained his entire understanding of TSW. Obviously it’s far too much to recite here but here are the main useful points I took away:

• TSW is not a random process. The initial “withdrawal” lasts 3-6 months of intense redness/oozing/swelling. Then the healing process begins.
• Flares are always caused by something – either illness, alcohol, stress, or more commonly exposure to irritants and allergens in your environment.
• The most common irritants for TSW skin are toilet detergents, pesticide/insecticide, antiseptic products, paint for house painting, cement dust from construction sites, but can also be other things depending on the individual.
• How fast you heal depends on your skin thickness and your healing rate. Steroids destroy your healing rate to a low percentage (like 5%) and CAP brings this healing rate up to 100% about 5x faster than it would rise naturally.
• If your healing rate is high, you will recover from flares much quicker.
• Many TSW patients are also dealing with “hardened skin”. This is different from TSW skin. It’s common you can have TSW skin on your face and hardened skin on your body and vice versa, so what you think is a singular problem is actually two separate problems caused by two separate things (and require separate treatment methods).
• Hardened skin is caused by three things:
  • Physical damage to the skin (i.e. heavy scratching)
  • Chemical damage
  • Using moisturizer on TSW/damaged skin. This is the most common cause. It happens because moisturizer is designed to be used on healthy skin. Moisturizers help your skin by absorbing more water from the atmosphere. If used on compromised skin, the moisturizer gets into the lower skin layers where it shouldn’t be, pull water from your skin, and your body produces a “hardened” layer as a protective measure. The more moisturizer you use, the harder this skin becomes.
• How long your skin takes to heal depends on the amount of steroids you used – both potency and volume. Jay estimates this is in grams/kilograms. If you’ve used in the kilograms, your recovery will probably take 5+ years.
• TSW skin is susceptible to a fungal infection known as tinea incognito, which cannot be treated with antifungal medication. Both oral and topical antifungals upset the cell regeneration process, so these treatments almost always cause a flare-up. Instead, fungal infections can be treated by long soaks in the ocean (30+ minutes). The CAP machine also kills fungus and bacteria.

Already within this body of knowledge a lot of things started to make more sense to me.

I am fortunate to have 5+ years experience of dealing with TSW, self-experimentation, travelling and living in many different climates/environments, and a vast archive of photo history, and also the data points of see-sawing between flawless skin and terrible skin, sometimes within the span of just a few months (have written about this before).

During my consult I even flicked through many of my photos and he would tell me “that’s a fungal flare, that’s a bacterial flare, that’s irritants” etc etc.

In this five years I’ve managed to get my skin to about 90% and I’ve concluded (it seems correctly) that the most important factor is your environment. If I live by the beach, in a warm climate, swim often, and don’t use any moisturizer or products on my skin at all (except for water), my skin generally stabilizes to the point I don’t even need to think about it.

Here are some “aha!” moments I had during the consult.

Environment

I had known something was irritating my skin in certain environments, which is why I always flared in specific locations. For example, I know in New Zealand and Australia my skin always flares within a week or two no matter what I eat or where I stay. I have also heard the same from countless people (as in, I’ve literally lost count of how many I’ve met at this point). These are people who say they had eczema or allergies their entire life, then they left New Zealand and within a week or two, ta da! All their problems magically went away. And then they returned to New Zealand and ta da! They’re magically sick again.

Being island countries and also being geographical neighbours, this could be specific flora/fauna in the country causing this. It could also be chemical – for example – New Zealand and Australia are two of the few countries in the world where glyphosate (a highly toxic pesticide) is legal and we spray it on practically everything (it’s illegal in most of the world). This means it’s likely also in our water supply and just in the air we breathe. Even when you go to the supermarket, if you touch an apple and then touch your face, now you probably have glyphosate on your face. We’re also one of the few countries who add fluoride and chlorine to our water (and those are just the things they tell us about).

Jay believes pesticides/insecticides and chemicals are one of the most common irritants. So while I can’t say glyphosate or fluoride/chlorine are definitively the problem, it gives you an idea of how an irritant could become systemic in a country.

Specific locations

Part of NMT is you need to exercise daily. I play badminton and I also run/triathlon. One interesting thing I noticed was after going for a long run, my skin always felt good, but after playing badminton my skin always felt hot/uncomfortable.

The thing about badminton halls is they’re not well ventilated (because any airflow affects the shuttlecock). We also sweat like dogs because this makes the halls steaming hot, so the courts are wiped down with antiseptic multiple times per day.

It now makes more sense why I might flare while training for a badminton tournament (being in the badminton hall every day) but my skin improves while training for a marathon (running outside every day).

However, in Kenya, I used to train at a badminton hall at an NGO and things were different. My skin was fine and I used to stay at that hall for 5+ hours a day. Why didn’t my skin flare? Well, the courts were never wiped down with antiseptic. How do I know? Because we were responsible for cleaning the courts ourselves, and we never did! (haha). We mopped them with water before playing so they weren’t slippery, but we never used disinfectant the whole six months I was there. And – no flare! Just a coincidence? Maybe, but probably not.

Sun/sea

I had known swimming in the ocean had always been beneficial, and I had known it kept bacterial infections at bay, but I didn’t know it also addressed fungal infections.

Very often during my flares I would have scaly patches on my skin and my first instinct was always “fungus!” so I would use antifungal cream on it for a few weeks, but it never worked. Now I know it probably did work somewhat, but it also makes the flare worse.

We know that sunlight is good for managing bacterial infections, but combined with the ocean for fungal infections, this really is the perfect 1-2 punch for managing TSW skin.

I know my skin has been the best I’ve had in my entire life! when I was living in the Cook Islands, running in the sun shirtless every day and swimming kilometres every week in the clearest ocean I’ve ever seen.

Also other times I’ve moved near the beach in other countries I’ve experienced the same thing (except New Zealand and Australia, sadly).

Africa

Africa has always been a mystery to me. My flares resolve quickly any time I go there (less than a week), and the two six month stretches I’ve lived in Kenya and Tanzania I’ve had perfect skin – and I wasn’t living by the ocean.

One possibility I’m now considering is it’s related to the accommodation. They do not use fancy chemicals to clean your accommodation in Africa. A lady simply comes in with a bucket and a mop and cleans your floors, wipes down your surfaces and that’s it. They just use a basic soap that isn’t fragrant or antibacterial etc.

Since Jay says your accommodation is the single most important factor of your healing, I think this could be a large part of it. I know there are also fewer pesticides etc in the air, you can tell by how quickly your fruit rots after you buy it, and there are sometimes bugs in it. All natural!

One thing Jay said about New Zealand is he suspects the country is “too clean” – meaning they disinfect everything, spray all the food and antiseptic is everywhere, similar to Singapore where he used to live. This is not a good place for TSW patients, as a place being “unclean” isn’t actually that harmful for them, but a place full of chemicals is.

CAP treatment?

After my consult, I talked to Jay about starting CAP and what he recommended.

He pointed to the room and said “you can do a session right now if you want” and I decided to go ahead and try it out.

We only did a few parts of my body, mostly the folds of my elbows and knees and my face and neck.

Obviously you can’t notice anything after one session but it was interesting to see how the process works and experience it.

I will try a few more sessions and report back with my thoughts on it.

Sending love!