Grateful – A Young Woman’s Journey for Health

Published on by jackiedosalLeave a comment

I’m feeling quite grateful today in many ways. I just had lunch with an old friend from my medical training. She’s always been a lovely person, but today, I was reminded how truly beautiful she is inside and out.

Nancy, at 32, is a two-time breast cancer survivor in addition to having lost her mother at a young age due to breast cancer. She recently underwent a total mastectomy with reconstruction, and the aftermath left it difficult for her to exercise due to removal of muscles in her back used for her reconstruction. In turn, she gained about 25 pounds after her surgery. The pain of losing her mother to cancer, then getting diagnosed herself, along with a recurrence and painful surgery are enough for anyone to give up. But not Nancy, she always keeps a smile on her face and tries to look at the bright side — her attitude is inspirational.

Today at lunch, we talked for a while. She was disappointed at her weight but motivated to lose the pounds. She splurged on a personal trainer and reported it has been “life-changing” for her since it’s helped her get out some energy and internal frustration.

While her physical recovery has been taxing, there were two other aspects of her journey that I couldn’t help but appreciate: (1) her struggle to accept her surgical scars, and (2) her lifelong battle with acne. Both may be easily overlooked or tossed aside as unimportant, but with the skin being my passion, I knew that it was more important to her than she let on.

Nancy told me that she has finally started actively dating, but hadn’t found the right person yet. Part of her hesitation to be more pro-active about her dating life originates from self-consciousness about her surgical scars. While easy to feel comforted about your appearance when in a relationship with a loving partner, it is harder to flaunt surgical scars when developing a new relationship.

I never truly appreciated how difficult the breast cancer journey can be for a single woman until talking with her.

Nancy admitted that things were looking pretty good after the reconstruction, but the scars were still notable. I happily informed her that the world of scar therapy has immensely advanced, and laser treatment of scars has really been miraculous. Below I show one of the scars I treated that resulted from a skin cancer surgery. Nancy was so happy and hopeful once I let her know her options.

Creating hope for people is one of the best things I can do as a physician and friend.

Mohs scar B&A composite
Laser scar revision following Mohs surgery. Photo: Dr. Jacquelyn Dosal

The second topic seems trivial compared to Nancy’s breast cancer journey, but it was definitely noticeable! Nancy had clear skin! Still battling with her acne in her 30s, she finally decided to proceed with Accutane (isotretinoin) — with unbelievable results. Instead of being distracted by deep cystic pimples, my eye instead focused on her beautiful smile, which is just so radiant and representative of her personality. As I examined her face, I was proud of my specialty of Dermatology, and I was proud of the often-vilified medication’s (Accutane) ability to remove self-consciousness from people who may be hiding their skin and face. No more cover up needed. It is truly one of the most powerful tools I have in giving people back their self-confidence. There is no reason to suffer from scarring acne when a miraculous cure exists for those who truly suffer. (That’s right, I didn’t say “dangerous,” I said “miraculous.” More on that later.)

Accutane B&A composite
Selfies taken by my patient during  her Accutane (isotretinoin) journey.

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I share Nancy’s story because she has truly inspired me. She keeps my troubles and worries in perspective — she reminds me to be grateful.grateful

I’m grateful for my health, family, and healthy skin. I’m grateful for my job as a dermatologist, a job that I love. I’m grateful for the chance to give others clear skin. I’m one of the few doctors that people actually like to see… I don’t make people take diabetes or blood pressure medication. People are usually motivated to use my prescribed treatments to improve their skin. It is the only organ system we can see with our eyes, and thus the benefits are often both somatic (of the body) and psychological. I love what I do, and I’m so happy to share it with others.

I was so refreshed and happy to see Nancy. Life’s a journey, not a destination, and Nancy is still on her journey for health, love, and fitness. On her way, she found clear skin, hope for her scars, and the best attitude one could ask for!

 

Dr. Jackie Dosal is a board-certified dermatologist in Miami, FL.  About Dr. Dosal: http://goo.gl/hbgqZW

#Getnaked. Check your skin!

Published on by jackiedosalLeave a comment

I diagnosed two melanomas last week. My partner diagnosed another one the same week. Three melanoms in one week!!! Much to your surprise, here was the order of the most dangerous:
#1 most deadly case last week — melanoma on the bottom of the foot.
#2 most deadly case last week — melanoma on the lower leg.
#3 most deadly case last week — melanoma on the face.
Now, most of this has to do with how advanced the melanoma was when it presented, but there is an important lesson here. Alot of people will poo-poo a dark or unusual lesion on the lower body, since they don’t feel like the lower body gets alot of sun exposure.
Melanoma can happen ANYWHERE! The most common location for women to develop melanoma is the legs (as illustrated above — patients #1 and #2 were women).
I’ve said it before:

Screen Shot 2015-10-12 at 5.45.48 AM

If your dermatologist doesn’t make you #getnaked, find another one.

When you come to me for a full body skin examination, I check everywhere (unless you absolutely decline, I will respect your privacy!). But seriously, your dermatologist should be checking in between your toes, looking through your scalp, and checking where the sun doesn’t shine! I used to have a teacher in dermatology residency that would drill into us that if we weren’t checking the buttocks, we had not finished our full body exam. It was a little embarassing when she asked in front of the patient, but the point was well taken.
Bob Marley died of melanoma on his foot.
In truth, some melanomas are not sun induced (how would sun get to the bottom of your foot?), and these melanomas are more similar to other cancers that happen spontaneously. Therefore, everyone should come in for an annual skin exam, even people with dark skin.
I also strongly urge all of you to take a look at your skin regularly. Take a hand mirror and look ALL around before you get in the shower. Look at your spouse’s and your children’s skin. Become a “skin checker.”

What should I be looking for?

Dermatologists will often talk about the ABCDE method of detecting of melanoma. This is a great tool to help identify potentially suspicious lesions. Each letter corresponds to a characteristic of a mole that may signal an issue:

A stands for asymmetry — if a mole is asymmetrical. One half is not like the other half.
B stands for border — if the edges are ragged, not smooth.
C stands for color — if there are more than 1 or 2 colors present.
D stands for diameter — if it is more than >6 mm or the size of a pencil eraser.
E stands for evolution — if any mole is changing.

https://www.aad.org/spot-skin-cancer/learn-about-skin-cancer/detect-skin-cancer/what-to-look-for
https://www.aad.org/spot-skin-cancer/learn-about-skin-cancer/detect-skin-cancer/what-to-look-for

If you feel that any of your moles have met these criteria, don’t panic, but please do see your dermatologist for a professional evaluation.
As an aside, you should never feel funny going to the dermatologist to check any spot on your skin. The spot in question may be benign, but just being in the office may help identify other problem areas. More often than not, the worrisome spot is fine, but I may subsequently locate an inconspicious lesion that is a problem (potentially a skin cancer). This was the case in patient #3.
90% of melanomas are curable if caught early. Take care of yourself and your family — #getnaked and check your skin!