Dermatology - Week 3 - Day 15-19

Day 15
June 15, 2008

First day of the Dermatology rotation. I am very excited about this because I have an extensive history in Derm as a patient. As a wrestler I experienced many skin problems, and have also been treated for psoriasis for 10 years.

In the morning all three of us sat in on Dr. Kuan’s clinic. He is an older physician, and has a resident type on the computer for him while he still uses the ‘old school’ paper. I was very eager to learn and asked a lot of questions.

The resident would take some time to explain some concepts to us.

At one point, Dr. Kuan said ‘In Taiwan you must have studied dermatology before being allowed in the clinic. I think I was being too aggressive with my questioning. So I held back with him after that. I decided it would be a good idea to purchase a dermatology hand book. This way I can also look at the computer screen, which is generally written in English.

In the afternoon, all three of us shadowed Dr. Hu. This woman had incredible energy. She came from Hong Kong. I wonder if it is her Hong Kong traits or her unique personality that exudes this feeling. She reminded me of a late teen in her youthful happy energy. She was very excited about showing us her Cosmetic center. She gave us her contact information and wanted to read our blog and take pictures with us. She said the best thing about being a dermatologist is using the treatment on herself! She was fun. She also was open to us asking questions. There was a stark contrast between this session and our morning session. Many of her patients came with cosmetic cases. I find myself enjoying the beauty of cosmetic medicine. I think my Mom is disappointed for me to say this. I think she feels that it would be shallow for me to go into cosmetic medicine. I believe that people can heal from the outside-in just as people can heal from the inside-out.

Day 16
June 16, 2008

Today I have been organizing plans for the present and future. Sometimes it is difficult to balance time with friends, family, and solitude. I am trying my best.

The Taiwan medical system is so efficient. The doctor stays in one room at the clinic while the patients come in one after another. In 3 hours the doctor saw more than 60 patients. There is less time for building of rapport as the patient just starts talking about the problem as soon as they walk in. The previous patient is still in the room with the next patient looming over their shoulder. I love it how each patient has a national insurance card where all their medical history is accessible as soon as it is inserted in the magical computer slot.

Due to this high volume of cases my dermatological learning has been thru repetition. Now that I have a handbook of dermatological disease I can read about the disease as the doctor is talking to the patient. This way I won’t have to bug the Doc with too many questions. I tend to ask a lot. Eczema, dermatitis, psoriasis, hair loss, scar reduction, hyperpigmintation, vitiligo. These are very common. The doctor I shadowed today specializes in hair transplantation and a procedure in which he forms a double eyelid. Many Asians want this feature. I asked if I could watch his operation tomorrow and he agreed .

Laundry time then dinner.

I am making some time every day for Board studying. I guess I am hard core. That is what Tammy said. I think it’s just that I love medicine.

Day 17
June 17, 2009

I was able to catch up on sleep today after having to be up at 5 am to go to Taipei for a morning pathological meeting the day before.

We went on rounds in the ward at 10 am. We were then sent to the treatment room. I saw a case of actinic keratosis and I also saw a biopsy taken with a differential of T cell lymphoma lesions or eczema.

I was granted permission to visit Dr. Huang and watch him perform the blepharoplasty (double eyelid surgery) in the afternoon. I feel that Dr. Huang is a gifted doctor and really cares for his patients. I am waiting for the surgery to begin while I wait in Taipei. While waiting I have been walking around Taipei, drinking tea and visiting Banks and business offices eavesdropping on conversations. There are a few English speaking Caucasians around. I am now less of a novelty.

Apparently plastic surgeons, dermatologists and opthamologists can do this cosmetic surgery in Taiwan. Interesting overlap.

I was able to see a second blepharoplasty of the lower eyelid to improve puffiness under the eye. The patient seems to experience pain. During these procedures only local anesthesia is administered. I believe this is probably a stark contrast from the United States.

I also witnessed a hair transplant. Dr. Huang specializes in this procedure. Hair from the posterior side of the scalp were removed follicle by follicle and inserted into the excisions made at the anterior scalp. A time consuming process, but the doctor explained that re-growth is about 90 percent.

The highlight of the day for me was to watch the upper eyelid blepharoplasty. This doctor does about 200 procedures a year, and he uses a technique he learned in Japan. Many Asians do not have a ligament attached to the orbicularis muscle of the eye. This will not allow a crease on the eyelid. Many Asians find the double eyelid more beautiful as it opens the eye. I find it fascinating how different cultures vary in their standards of beauty. Myself, aesthetically I prefer the look of an asian eye without the double eyelid. Many people want what they can’t have I guess. The procedure took 40 minutes and had a very noticeable effect. Only complications are swelling for a few days.

After the surgery I went by myself to the religious relic/herbal medicine area of Taipei. I was on a mission to find some herbs to try. I walked in and they asked me what was wrong. We stumbled through English with random Chinese words thrown in that I used to try to be a little less of an outsider. It would make them giggle. I told them nothing was wrong, but I wanted something to make me feel good. They ground up a mixture. I know there was Ginseng as part of the mixture. The woman that sold me the herbs flexed her muscle and pointed to her head indicating that the tincture would make me feel strong and smart. Later I asked a resident in acupuncture and he said the concoction would enhance my Qi and blood flow. Cool! It seems as if they don’t regulate who sells these herbs. No prescription needed. Interesting.

Day 18
June 18, 2009

This morning Tammy, Bill, and I were lucky enough to shadow a doctor who really spent a lot of time with us, explaining differential diagnoses and having us interact with patients.

I felt comfortable asking questions, and he would pull out books to show us images and concepts. He will be attending UC-Davis in the fall to study Law. I offered to show him around a bit. It will be a great opportunity to show him about Touro and Osteopathy! He seemed incredibly excited.

He walked around fast and had a big toothy grin. His excitement for teaching us showed me that he really loved to learn. I admire him for that. He is certified in Pediatrics and Dermatology! And now he will study law. When you love what you are learning you will be great to your patients I believe. From my brief interaction I feel he is one of the best doctors I have been around. He took us out to lunch and let his enthusiasm seep into us.

In the afternoon we shadowed Dr. Kuan, the same doctor from the first day. We were able to see many lasers as he treated patients for warts, pitting scars, nevi, dark circles under eyes, and hyperpigmentation. I did not realize how many various forms of laser are used.

When warts are removed we were told it is important to wear a tight mask to prevent wart growth in our trachea. That gave me a horrible scare!

Many people ask us to dinner here. Our dermatologist preceptor did. Regrettfully I had to say no because I wanted to take care of some personal chores and exercise. I am realizing I can’t say yes to everything in life.

Day 19
June 19, 2009

We shadowed a female dermatologist. She was cycling through patients very quickly, and it was difficult to ask her questions. Still, we were learning through repetition. I flip through my Dermatology handbook while she works with the patient and the computer screen written in English.

This doctor asked us questions at the beginning about our impression of the patient’s pathology. Generally, this was beyond my knowledge base, but I could reason. I think she assumed we had already completed our dermatology coursework.