Derma-holiday

It is the last day of my first week of Derm. Now some people may think I'm doing this rotation just for its reputation of being an "easy" one, much as the "lifestyle" of practicing dermatologists (along with anesthesiologists, ophthalmologists, and radiologists) is viewed to be. This is not true. As a family medicine doctor, I will be seeing a ton of skin complaints, so I really do want to get more exposure to dermatitis, rashes, lesions, etc. I want to be able to take care of "lumps and bumps" in my office, so I wanted to do some more biopsies, sewing, freezing, etc. It makes sense to do this rotation. But it is totally cake.

I usually come in around 8 a.m. and have been done around 4-4:30 (sometimes with 2-hour lunch breaks!) most days. It's very chill. Although I am totally comfortable going in first, taking patients' histories and doing an exam, and then talking to a resident/consultant, this often just backs things up. Most of these things are very fast, straightforward, and so visual that it is generally more efficient to just go in together. And, despite being a fourth year and supposedly "beyond" shadowing, I don't really mind the passivity of the learning that is going on. I really don't care anymore (about much of anything!). I'm seeing, I'm learning, I'm doing some little procedures. It's fairly mindless. But it's all good. I'm not sure I can take any more than 2 weeks total of full-time checking out and scraping weird rashes (I prefer to have it "sprinkled in" among other stuff), but it's a very relaxing way to spend a couple of weeks towards the end of the fourth year.

I've seen a lot of dermatitis, exacerbated especially by the fact that the air in MN is soooooo dry in the winter (on a personal note, I'm allergic to this Avaguard water-free scrub that's all around, so I end up washing my hands about a bazillion times a day, and I myself have to use Vanicream [this is a cream that is only sold in Rochester!] around the clock). I've seen a good amount of acne in teenagers-- it boggles my mind how many different washes, creams, pills, etc. people try for this. I've seen my share of questionable fungal rashes although I have yet to see a positive KOH prep. There are a lot of skin checks and skin cancer follow-ups. There have been two young children with fairly large periorbital hemangiomas which, although bothersome to parents, generally involute spontaneously and should just be watched. And a couple of weird things, such as nephrogenic sclerosing dermopathy (NSD), sprinkled in. Yesterday, I had the most spritely 75-year old woman I had ever met bounce around the room while she told me about all these "growths" (seborrheic keratoses) that were just "soooo irritating!!!" and that she just wanted "OFF!!!", which was quite amusing. I've also had a couple of patients with virtually nonexistent tiny telangiectasias on their cheeks that they just had to have lasered off because they were so disturbing. This I don't have too much patience for, but there is patient demand.

Another cool thing (related to dermatology) is that the speaker at the Internal Medicine Grand Rounds on Wednesday was Dr. Michael Oxman, the primary author of the New England Journal of Medicine article that spearheaded my research project! He spoke on the findings of the Shingles Prevention Study, one which showed that a new Merck vaccine (Zostavax) was extremely effective in reducing the incidence and burden of illness of herpes zoster (shingles) in adults over 60 years of age. The FDA has now widely approved this vaccine for all immunocompetent adults in this age range. My research project involved determining the epidemiology of (and risk factors for) zoster in renal transplant patients in case such a vaccine might be of use in this population.

So I will be working a bit on the layout of my research poster this weekend. And, because I don't have to go back to the clinic until Monday morning, I will surely be enjoying my weekend off! Yay for derma-holiday.