Skyline Happenings

A few years ago I had a small basal cell carcinoma scraped off my lower leg, band-aid applied and that was that. This year I had a different dermatologist and a similar lesion. This time it was scraped off and I was sent to a Moh’s surgeon (basically a Dermatologist with special Moh’s training.  It began as a technique called chemosurgery, developed by Frederic E. Mohs, MD, in the late 1930s, but was not widely known. In the mid 1960s, Perry Robins, MD, became the first dermatologist to study the technique with Dr. Mohs, and he helped advance the procedure into what is now called Mohs micrographic surgery). 

I was one of multiple patients that day – it felt a bit like an assembly line in my little surgery booth. A wide excisional biopsy was done, a prescription for opiods written (not filled), and a follow up scheduled. It took about 3 hours to complete this visit – 6 weeks to heal.

Later I talked to a general surgeon asking, “Is all this Moh’s surgery really needed. I’m not concerned about a cosmetic result.” He felt that either nothing needed to be done or a simple excision by a general surgeon would be his choices. Basal cell carcinomas have a very low potential for becoming a problem.

The lucrative side of Dermatology is now enticing venture capitalists to set up stand alone dermatology clinics staffed by physician assistants. The potential abuses and over-treatments are well documented in this article in the New York Times. Moral of the story: seek a second opinion is the treatment appears too aggressive and/or if you are not seen by a board certified Dermatologist. Thanks to Joan Horner for recommending this article.

Do you get 8 hours of sleep? Matthew Walker says we should and tells us why. He was recently  interviewed on NPR – click here for the link. Or perhaps you have insomnia or a medical problem which keeps you up. There are specialists in sleep disorders at local hospitals – a few of whom specialize in cognitive behavioral therapy for insomnia. The most common disorder is sleep apnea – something you should be tested for if you have hypertension, diabetes, daytime sleepiness or a history of strokes. Heavy snoring is the clue to a sleep breathing disorder which can make all of these conditions worse.

My sister ruptured her bowel and almost died while taking antibiotics for Lime Disease. C Difficile was the culprit. It appears that our “intestinal flora” is a lot more complicated than we know. Manipulating it may harmful, but also may be surprisingly beneficial according to on-going research in alternating the flora with favorable “bugs.”

The Economist has a very interesting article about a whole new field of study in medicine: “When, at the turn of the century, the first human genomes were sequenced, many biologists felt they had had delivered into their hands the keys to unlocking numerous puzzles about disease. Since then there has indeed been a fruitful effort to understand how the thousands of human genes which control hormones, enzymes and other molecules of the body serve to regulate health. But, in an unexpected turn of events, it is also now apparent that the human genome is not the only one to which attention should be paid. Human guts contain microbes, lots of them. Added together, the genes in these bugs’ genomes amount to perhaps 150 times the number in the human genome alone. If the bacteria in question were doing little more than swimming around digesting lettuce, this would be of small consequence. But they are doing much more than that.” Click here for the full article!

Data: Journal of the National Cancer Institute; Chart: Chris Canipe / Axios

Ed note: One thing that might falsely improve survival is the early diagnosis bias. In other words, the earlier a disease is diagnosed the longer the survival. Men still die from prostate cancer, but so many early diagnoses are made with the PSA that the survival looks longer – even though the majority would have live out normal lives with the localized cancer. Despite that bias, great strides are being made with melanoma, lymphoma and breast cancer – but lung cancer, pancreatic, liver cancer and others remain very difficult to treat.