Author: hannah_george

The last day at Cary Dermatology was an extremely fun one! There were lots of raised, scaly, pink spots removed from patients throughout the day and surprisingly, one of these spots Dr. Mangelsdorf had never seen in her entire career as a dermatologist: a possible merkel cell carcinoma. Merkel cell carcinoma is an aggressive cancer that grows extremely quickly and is found in fewer than 20,000 people in the US each year- it’s pretty rare! The prognosis for a patient with merkel cell carcinoma is not good (about 50% pass away) so we are hoping the biopsy comes back clear as this type of cancer is hard to treat when it reaches the lymph nodes. Very interesting, but very unfortunate.

Aside from the rare carcinoma spotting, the best part of today was when Oyinlola and I were able to sit in on a cyst removal. Both of us dressed in our full surgical gear and watched Dr. Mangesldorf remove a cyst that had grown back from a previous removal. Although I had seen a cyst removal previously in the past two weeks, I loved ending my WEP with a surgery as each one is so different. After the procedure, Hailey (one of Dr. Mangelsdorf’s medical assistants) showed Oyinlola and I the “proper” way for us to dispose of our PPE (personal protection equipment). The video attached shows Oyinlola and I trying (and failing) to remove our PPE without “contaminating” ourselves. I found it so hard to remove the gloves with the PPE gown still over my hands- there was just so much material! Unfortunately, I would have gotten the bacteria on my hands should I have been working with a patient that had a contagious disease. It was still super fun to try though!

I learned so much at Cary dermatology these past two weeks and am going to really miss working with Dr. Mangelsdorf, her patients, and her medical assistants. The insight the medical assistants had on the medical world and the transition between undergrad and grad school really got my excited for the years to come. I feel more prepared now and a little goes a long way in that regard! I felt like a part of Dr. Mangelsdorf’s team during my work experience and am super grateful to have had the opportunity to shadow her.

PPE removal fail

Like last week, today’s day started at 1pm! I was able to sleep in and go on a run before coming to Cary Dermatology, making today a very productive one. This productivity was seen in the office today as well. There were a lot of patients seen in the 1pm to 5pm window and it was all hands on deck to get everything done as efficiently and smoothly as possible!

With all of the standard skin checks done today, I saw a procedure done that I had yet to see at Cary Dermatology in the previous week. Dr. Mangelsdorf saw a spot that was of slight concern to both her and a patient, and because this spot was on the larger side, Dr. Mangelsdorf wanted it to get checked out by the lab. Instead of doing a shaving biopsy like she typically would, Dr. Mangelsdorf used a Non-Invasive Adhesive Skin Biopsy Kit. In this kit were four different clear, adhesive stickers and a sharpie. One of the stickers was placed on the area of concern, the sharpie was used to outline this spot onto the sticker, and then the sticker was ripped off, effectively taking cells from the spot with it. This was repeated four times (with each of the stickers) to get as many cells as possible! Dr. Mangesldorf explained that if these cells tested positive for one of two genes that indicated Melanoma, the spot would have to be removed. However, if it was negative, then they could leave the spot alone. This allowed Dr. Mangelsdorf to check this large freckle without having to remove it and create a large scar on the patient. Super interesting!

I can’t wait to see what the last day at Cary Dermatology holds. I’ll miss coming and working with Dr. Mangelsdorf and her medical assistants every day!

Day 6 at Cary Dermatology was a great one! Although I didn’t see many new skin abnormalities or conditions, I felt as though I learned a lot from each patient and met a ton of super sweet people. It’s always good to spend a day focusing on the relationships between the patients and Dr. Mangelsdorf- the people themselves can teach you so much!

One thing that I found super interesting today was when Dr. Mangelsdorf explained Accutane to me. I have a lot of friends that have either been on or are currently on this vigorous acne product, so it was really cool to learn about! For starters, I learned that the correct name for Accutane is actually Isotretinoin, but more people know the brand name Accutane, so that is the name it goes by (much like how some people call a tissue a “Kleenex” although Kleenex is a brand). Accutane, or Isotretinoin I should say, is such an intense acne medication that it is regulated by the federal government! If you are a girl, blood work has to be drawn after every time you go to the dermatologist as you CANNOT be pregnant while on Isotretinoin- the baby would have some serious birth defects. While on this medication, it is super important to constantly moisturize and be cautious of the sun as the dermis (the first layer of skin) is so thin. The patient has to use moisturizer on their face several times a day, use chapstick all the time, and make sure to put sunscreen on when in the sun. Once the skin is clear of any additional breakouts, the medication has to be continued for another 2 months to ensure that the acne does not come back. I now have a new appreciation for those who are on Isotretinoin as it is a very strenuous and intense process!

Today, I enjoyed a “virtual learning day” as Dr. Mangelsdorf wasn’t going to be in the office. Instead of physically seeing different patients, I learned about warts through fake patients presented on my online module. I love the way the modules present the information as you learn background information on the patient first. This makes the case much more realistic/interesting than just presenting information on the specific wart the patient has. In addition, the background given helps you diagnose the patient and prescribe them medication that fits their individual needs. I think that’s super cool! In this particular case Megan Driskell, an eight year old girl, presented with bumps on her fingers and hands that had been there for 3 months, but were asymptomatic. No other family members were effected. When given a picture of the skin exam, I was able to see small, raised lesions that looked quite harmless. I was then asked by the module (it’s pretty interactive!) to describe these lesions. From previous knowledge of working with Dr. Mangelsdorf and the other modules I had completed, I knew that papules were raised bumps with no pus. Through common sense, I was also able to identify the bumps on Megan’s hands as exophytic as they were growing out from her skin. These are the kinds of bumps that Megan had! Then, the module gave me an overview of the symptoms and characteristics of Verruca Vulgaris (the specific type of Megan’s warts). It was super helpful to try to identify all the characteristics myself and then learn more about the condition later as it was easier to understand and remember. I was super excited to see all the information I’d learned last week play a roll in allowing me to understand and identify more skin conditions!

To end a crazy week on a more informational note, Oyinlola and I spent a lot of time doing different modules today. We learned about bacterial skin infections, benign skin lesions, blisters, and infestations and bites, all of which Dr. Mangelsdorf allowed us to choose from a long list of different modules! Oyinlola and I had a great time connecting the dots between the information learned in each of the modules and had fun looking at all the different symptoms of each case (the modules are not shy with detailed pictures!). Did you know that body louse are nicknamed “cooties” and that’s how the saying “he/she has cooties!” started? That statement referred to the person having body lice! I found that so intriguing because in today’s society, the saying has been warped to have an entirely different meaning.

Today was not purely module based, however, as I got to observe Dr. Mangelsdorf put a skin sample into a microscope to look for fungi spores. When we did indeed find some, she allowed me to peer through the microscope and see them for myself! One fungus looked like a circle- as if someone took a pen and just drew a circle on a white sheet of paper. The other fungus, however, was more complex in that it had lots of different winding spindles within it. Both were fascinating to look at under the microscope!

Last, but certainly not least, was my favorite part of the day: removing a basal cell carcinoma! When left too long on the skin, the basal cell can infiltrate several layers deep into the skin. This forces Dr. Mangelsdorf to have to make a very deep, large cut to ensure that all the cancerous basal cell has been removed from the patient. Although the extraction is super cool, the most jaw dropping part is the stitching up of the wound. Dr. Mangelsdorf worked quickly yet skillfully to close one of the largest extraction sites I had ever seen and the end product was a smooth, clean, and tight line of stitches. My eyes were glued onto the procedure the entire time- my body couldn’t tell if i wanted to throw up or get even closer to Dr. Mangelsdorf throughout the procedure. It was an amazing way to end the first week of work experience!

Today was back to the busy 7:45am-5pm schedule, but I didn’t mind as I saw lots of cool procedures, pre-cancerous and cancerous spots (not “cool” per say, but interesting to see what characteristics differ from something benign to something cancerous), and biopsies. To start the day off, several biopsies were done to remove spots on the skin that Dr. Mangelsdorf deemed concerning- one of which she told me may be Melanoma. In order to understand the difference between Basal cancer cells and Melanoma, I completed the Melanoma module online. Here, I learned all the symptoms and signs that characterize Melanoma as well as the best ways to treat it! Bringing both the visual I had of the spot from the patient and the knowledge I obtained from the module together incited deep understanding and excitement in me!

At lunch, a potluck was held in honor of a member of the practice’s last day in the office. Christina, who’s work experience was close by Cary Dermatology today, came by and ate with me in our hour long lunch break. There was a variety of different foods that employees of Cary Dermatology brought or made and Christina and I were not shy when it came to stacking our plates with food! This was a great midday break to a crazy morning at work and really helped refuel me for the packed afternoon to come.

My favorite part of work experience today was getting to shadow a surgery after lunch. Here, I was able to watch Dr. Mangelsdorf preform a procedure that I had watched earlier in the day on one of my modules. It was amazing to get a front row view of what was being done as well as knowing what and why Dr. Mangelsdorf did what she did during the surgery! After the surgery was finished, Dr. Mangelsdorf explained the steps she took to ensure that the sutures were placed correctly and that the scar would heal in a flat and clean manor. It is really an artful practice!

Lastly, before I went home for the day, I watched Dr. Mangelsdorf use a tool I had seen thousands of times on Dr. Pimple Popper- a circular scalpel used to punch a hole into the skin! This was super exciting for me because I knew exactly what it would be used for and how it would be used before I saw Dr. Mangelsdorf use it! Overall, today was the best day so far and I can’t wait to see what another 7:45am-5pm day tomorrow holds.

Doctors sleep in? Being a doctor comes with a lot of stress and long hours, but once a week Dr. Mangelsdorf starts her day later than usual. Today was that sleep in kind of day as work didn’t begin until 1pm! After a long day yesterday, it was nice for me to recharge and come back to Cary Dermatology ready to go– and today, I wasn’t the only person shadowing Dr. Mangelsdorf! Oyinlola joined me for our work experience today and together, we started working on online Dermatology modules meant for Medical students. This was a great way to pass the time when a patient preferred not to have one of us shadow their exam. Learning about the different kinds of acne/forms of skin cancer on these modules and then actually seeing them on Dr. Mangelsdorf’s patients was so interesting. I felt much more knowledgeable and was able to find a new appreciation for the routine skin checks, as I actually understood the terms that Dr. Mangelsdorf used! There are modules on so many different topics and I’m excited to get through as many as I can in the upcoming 2 weeks.

An exciting procedure done by Dr. Mangelsdorf today was when she removed skin abnormalities for biopsy. When Dr. Mangelsdorf found something on the skin that looked cancerous, she needed to send it to the lab to see what exactly the abnormality was. To do this, a needle was inserted into the abnormal spot and the area was numbed. To my surprise, the patient was numbed immediately after the syringe was inserted and no waiting was necessary before the patch of skin or mole was cut off! The actual removal was done with a flexible razor that was bent, placed on the skin, and then gently moved side to side to cut off the concerning patch. However, this is not where the procedure stopped. To ensure that the bleeding from the open wound would not continue throughout the day, Dr. Mangelsdorf used a machine that sent an electrical wave onto the wound–effectively cauterizing the wound and turning the surface a grey color. This was my favorite part of the procedure as it made a very cool electric sound when the current hit the skin and was not something I was expecting Dr. Mangelsdorf to do!

My work experience journey started bright and early today at 7:45 in the morning. When I arrived, Dr. Mangelsdorf showed me around the Cary Dermatology office (which is huge) and introduced me to all the people that keep the practice running smoothly- it truly takes an army! After a brief introduction to the practice, it was time to jump into seeing patients. Out of respect for the patients- and some pretty strict HIPPA laws- I cannot go into detail about the patients I saw today while shadowing. However, I can relay my admiration for Dr. Mangelsdorf and her two assistants, Megan and Hailey. Patients were seen back to back all the way from 8am-5pm (which is a very long time!) and the kind of care that was given to each and every individual that came through the door was absolutely amazing. Dr. Mangelsdorf barely even got a lunch break because she prioritized her patients over her own down time! I really admire that.

Although most of the time all that was needed by the patients was a routine skin check, being able to watch the patients interact with Dr. Mangelsdorf was incredibly interesting. Everybody had their own personality, their own story, and own way of interacting with Dr. Mangelsdorf that proved each appointment to be extremely different although the same checkup was being done in each. Another thing I learned today was that liquid nitrogen is used quite often to treat skin abnormalities that are bothering the patient. By observing the patient’s faces while this was being done, I gathered that this is a rather painful procedure as the liquid nitrogen is freezing cold and feels like the skin is burning. The liquid nitrogen, as a result, will cause a scab to form in the next few days and eventually come off, along with the skin abnormality!

My favorite part of the day was when Hailey, Dr. Mangelsdorf’s assistant, set up a laser in one of the exam rooms and we used the laser to get rid of one of the red spots on Dr. Mangelsdorf’s arm! It was so interesting to see this procedure done up close and be able to see the effects that the laser had on the red spot (the red spot was actually grey afterwards!).

Overall, I had an amazing first day at Cary Dermatology with Dr. Mangelsdorf and am super excited to learn and see so much more in these next two weeks!