The Binding of Isaac: Rebirth

Sometimes it takes upwards to an hour to finally find Pyromaniac, and usually, once I get a run rolling on, I'm never able to find the Sharp Plug in the shop, no matter how many times I visit them/reroll their items. And the TWO times I did manage to get both Pyromaniac and Sharp Plug, I wasn't able to get a way to regenerate health (no explosive shots/no bombs/no rooms with enemies that deal explosive damage), so I simply couldn't do anything. Sooooo infuriating.

When I do these sort of runs I'll usually only stick to god rooms, since they can give you things like Scapular and Habit, both of which are great for rerolling items, plus you don't have to give up your health like you would in devil deals. Most of the time I'll end up finding Habit before Sharp Plug, then I'll use that to force a Sharp Plug.
Fanny Pack + Gimpy are two fairly common items that can be a decent source of healing as well, and they pair well with D20 spamming if you decide to do that. Spamming the D20 to get some full health pills/cards could be a good idea too (you can drop trinkets/cards/pills by holding left Ctrl, so you can move them to any room you want).

It took me around 100 Monster Manual uses to get a full Meat Boy + Bandage Girl, to give you an idea of how much of a health pool you'll need.