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Efudex poster child

July 22nd, 2010

Doctors have ailments too!

Dr. Bennett finally did his Efudex for the precancers he’s had. He believes “real men don’t wear sunscreen”  Well finally it has caught up to him. I don’t know what finally motivated him to go through with this as I have been bugging him for at least a year to do it. It must have been revealing my secret crush on Benjamin Netanyahu (“Benji” as I call him, who has great skin) or having enough dermatologists bugging him at meetings about it!

It looked much worse last week (more red and crusty). He finished the 3 wk treatment and his crusts are gone now. Considering he spent at least an hour cooking himself outside talking to someone, he didn’t have too many complications. Just a lot of stares. Some of our colleagues asked him why he didn’t do PDT (Photodynamic therapy) but in his experience the patients said it is too painful. It is quicker though, but no one is  sure if it is as effective. A colleague of ours who is a noted laser expert doesn’t think too much of PDT and doesn’t do it that much, even though he said he should. Personally, I wanted to give him Verdure’s Gentle Glycolic Cleanser but I think he thought that would be wussing out. He was surprised at how much damage was revealed. I wasn’t.

The Efudex must have also penetrated his brain as he let me watch Bridget Jones’ Diary on TV for the 20th time.  I’ll miss that!

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SD pictures/videos

July 18th, 2010

ameliecryingvideolydiawalksvideo

Hanging out in SD

It's not Kauai, but we can pretend for now

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Paradise to a Point

July 18th, 2010

That is my new name for the resort we stayed at (Paradise Point in SD). A lovely place for families, as long as you don’t get locked out of your room due to a faulty lock without milk, bottles, medications, etc. Ants joined us for the stay also. Aside from this and numerous temper tantrums amd hours of crying, we had a great time. We saw beautiful bonfires on the beach and great fireworks from SeaWorld every night. Good food and lots of family time with Grandma, Grandpa and my cousins. We had an early family birthday party for the girls at Firenze Trattoria in Encinitas.  

Another derm-related vacation.  I taught some dermatologists from the Netherlands some suturing techniques and flaps at the UCSD Superficial Anatomy and Cutaneous Surgery course. They were in a good mood despite their recent World Cup loss. If you want to complain about how long it takes for a path result in our office-they said it takes 3 weeks in their country and there are only 2 places to get Mohs. We can complain about the cost of healthcare here, but we’ve got it pretty good in a lot of ways.

It was so nice to spend so much time with the girls. It was really sweet-they both individually gave me a kiss for the first time. So coincidental that they both did so without the other one knowing.  It was an incredibly stressful trip but that made it all worth it

Mission Bay, July 2010Hanging out in SDIt's not Kauai, but we can pretend for now

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Bye, Becca:(

July 12th, 2010

For all who don’t know, Becca’s last day is tomorrow.  We are in the midst of finding a replacement, but luckily have the wonderful and experienced Thu and Frances (from Pasadena) for the summer.

Becca, you’ve been a great assistant and I appreciate all the hard work you put in and your reliability. You’ve handled grace under pressure (OK, maybe not on the first day when you passed out. Then again, I didn’t see that. I’m sure it was a graceful fall…If it wasn’t you’ll have another chance on the first day of anatomy lab). I’ve looked forward to going to work every day to see your smiling face and knowing that things were well taken care of. I think I did an overshare/TMI on breastfeeding, but now you know pumping in the car is always an option (and who couldn’t use this information?). Just pick a song on the radio that has the right beat!

I’m looking forward to calling you Dr. Gra-vez. Don’t forget you are so, so young, so don’t feel like you have to rush into anything careerwise or personally.  As my 7th grade home ec teacher Miss Wilsnack said, “The 20’s are the best!”  I thought I knew what I wanted at your age. What you want keeps evolving and becomes more clear. So party hard and study hard. (In whatever order you choose)

I’ll miss you and your sense of humor. Good luck!

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Earthquake!

July 12th, 2010

Ok. That was scary. I was just thinking about earthquake preparedness as I strolled the aisles at Smart and Final. “Gee…I should really update the earthquake kits…”  Just one day later, I’m standing with a half naked patient putting in my last stitches when we hear a squeaking noise and see the blinds going back and forth, for a LONG time. I’ve been through earthquakes in Chicago (yes, there was one!) Seattle, San Francisco, San Diego, and LA. I think this was the scariest because it was just too long. I’m getting pretty good at discerning a 3.0 from a 5.0. 3.0 is like, “Oh gee that was fun!’ 5.0 is like, “Oh s*@% what do I do again?”

A friendly reminder that texting is the most reliable way of communication during a disaster. Also, it doesn’t how much money you have in the bank or how many credit cards you have, during a disaster you need cold hard cash. A colleague of mine who survived Katrina said you need hundreds of dollars in tens and twenties. I don’t know how you’re supposed to have that on hand (I actually did this for a while but kept dipping into it). I also don’t know how you’re supposed to keep kits at every office, your home (and where in your home?) and the car. Puh-leeze.

So I guess I better stock up on massive cans of beans again. Otherwise I may be stuck eating cat and dog food.

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Thank you, Veterans!

July 4th, 2010

For all that have served or are currently serving in the military (including our wonderful former employee and fellow Pi Phi Kelly McMullan who will soon join the Air Force for medical school) I give thanks for your dedication to our country and ensuring our safety.

I especially thank the Veterans of the Korean War, some of you who are my patients. It is mind boggling that 54,000 Americans lost their lives in this war.

Because of your selflessness and courage, my parents were able to come to this country and make their lives better. My mom came from an extremely poor rural area of South Korea and was given the opportunity to emigrate here, educate herself and meet my dad! My dad came from a wealthy family from North Korea, but lost everything in order to remain free. He had to endure a lot of hardship during the war (such as sneaking across the border more than once and being thrown into the middle of the action-see his recently published war story from the New York Times Op-Ed section-see Blogroll) but was able to come to the US and start anew.

On days when I am whining about having a less than average meal, I try to remember his story of feeling pains of hunger during law school. Freedom and opportunity are things that a lot of us take for granted. Maybe this July 4th we can think of it as more than a BBQ holiday!

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Restylane-L has arrived…

July 4th, 2010

Restylane-L (Restylane with lidocaine, a numbing agent) is here. So far, so good.  Restylane-L’s numbing effects are a bit delayed and I’m not clear still if  the lidocaine really makes a significant difference. Most patients tell me they are pretty numb after an 30 min to an hour of topical lidocaine, but still feel some of the injections particularly around the corners of the mouth and near the upper smile lines. I’m not sure if the effects of Restylane-L will last as long (which in my experience is 9 to 12 mos and beyond), but for now we’re going with it. We’ve even seen a case of microscopic retained Restylane 2 years later during Mohs surgery.

Correct placement is much more important than quantity. I once had a patient younger than I am get 3 syringes put in her face at another office. In the end, she ended up spending more money and had a complication requiring laser treatments. Juvederm XC is the equivalent of Restylane-L. In the end, both Juvederm and Restylane are great products with no discernable difference in my opinion. Both look very natural in the end.

A lot of people also ask about Sculptra and fat transfer. I do perform fat transfer, but not Sculptra. I still think hyaluronic acid is the best way to go. I don’t perform Sculptra for several reasons, that being said, it is not because it isn’t a good product. It is much more expensive than hyaluronic acid fillers. With the amount of money it would cost, one could get many syringes of hyaluronic fillers. It also has a higher risk of nodules and is not used in the lips. Fat transfer is more invasive and because a large quantity of fat must be injected in order to get reasonable results, you can look younger but fatter/chipmunky due to unpredictable resorption. It is somewhat unpredictable in its final result in comparison to hyaluronic acid.

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Polidocanol is now FDA-approved for veins

May 14th, 2010

Yay! Finally, the FDA has approved polidocanol. I’ve always used polidocanol for spider veins, though use was off-label. It’s safe, effective, painless, and has been used in Europe and Canada for years. I’ll be sure to get a supply of Asclera soon. There is a limit to how much can be used in one session, but it is rare that a patient needs that much.

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