Looked at objectively, Rhus radicans is an excellent plant. More widely known by its popular name, poison ivy, it belongs to a distinguished family, the Anacardiaceae, which includes mangoes (Mangifera indica), pistachios (Pistacia verna) and the signature genus of the family, cashew nuts (Anacardium occidentale). Its own genus, Rhus, bears a name assigned by ancient Greek botanists, who knew a close relative as a culinary plant, the acid seed of which is still used in Syrian and Lebanese cooking as one of the ingredients – with olive oil, thyme and oregano – of Zaatar, a special fragrant bread. The genus is widely distributed throughout the temperate and sub-tropical regions of … Continue reading
Skin: A Biography by Sharad Paul (2013)
reviewed by Robert Norman, D.O. Dr. Sharad Paul’s book Skin: A Biography is a wonderful tale of the integument and its contents, fueled by Dr. Paul’s innate curiosity and appetite for life. He shifts his literary focus from Einstein to Sir Edmund Hillary, Darwin to Mendel, and to many others, each time capturing a unique aspect of what we all have in common – skin. His journeys take us with him around the world, including Iceland, where he lectures and investigates evolutionary skin biology while being offered whale and puffin cuisine by the locals. In one of my favorite chapters, Touching God, he focuses on touch, the first human sensation … Continue reading
Window of Opportunity
Abstract: A young dermatologist discovers that treating the patient may entail more than just examining his skin. Sometimes, it is more important to treat the person than address the “chief complaint.” Keywords: doctor-patient relationship, aneurysm, skin exam, IT’s a busy morning at the clinic. My next patient is a 62-year-old man. After some small talk, he quickly turns to the point of his visit: evaluation of suspicious skin lesions on his back. “I’m only here because my wife’s concerned about these two spots. Otherwise, I feel fine.” He seems to be in a hurry, so I quickly examine his back and find only benign keratoses. When I offer to do … Continue reading
Sunscreen Application: A Contact Sport
The Sunday NY Times (June 30, 2013) has a fine photo essay on sunscreen application to kids in New York City. It’s a fun collection that OJCPCD readers may appreciate: Adults wear sunscreen to reduce the threat of sun damage, skin cancer, uneven tan lines and wrinkles. Children wear [sunscreen] because they have to. Inspired by seeing his niece resist his brother’s attempts to apply sunscreen, the photographer Nolan Conway visited parks in New York City in late April and early May, looking for parents and children who were engaged in similar battles. Genevieve Chamorro, who was at Brooklyn Bridge Park with her sons, Oliver and Sebastian, says her sons … Continue reading
The Great Melanoma Epidemic and Diagnostic Drift
Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal. Ivan Illich, Medical Nemesis Abstract: The incidence of malignant melanoma (MM) has risen sharply over the past few decades, while the melanoma death rate has barely budged. This suggests that lesions not formerly called MM are now labeled as such. The trend to reclassify benign lesions as malignant is called “diagnostic drift.” The lowering threshold of dermatopathologists for diagnosing MM and aggressive screening of the populace are key factors in this spurious epidemic. About author: Mary Iaculli is a third-year medical student at the University of … Continue reading
Osler on Medical Practice
Louis Chargin, M.D. (1879? – 1969)
Recollections of an Office Visit by, the then pre-teen, Barry Mayer, M.D., FACR My uncle had a dairy farm in Orange County, New York where I spent all summer and most of my vacations working and playing from the ages of about 7 to 11 years old. Our family primary care physician was a loyal referrer to Dr. Louis Chargin, a renown Bronx dermatologist. As a youngster I had seen him at least once for problems I can’t remember now. One summer, when I was around ten, I developed an annular eruption about 2-3 inches in diameter on the extensor surface of my right forearm. It was a mystery to … Continue reading
Doctors First, Specialists Second
One morning, I pulled an empty chart from the rack on the examination room door: new patient, Ms. Judith Cornish, age forty-seven. I knocked twice and entered. “Good morning, I’m Dr. Shaw,” I flipped open the chart. “You are Ms. Cornish?” (I always used last names. It was formal, I know, but I preferred erring on the side of respect, not familiarity). I extended my hand. She sat, leaning forward in a chair, one very lean leg crossed over the other. “Good morning. Yes, I’m Judy,” she said in a husky voice. She shook my hand half-heartedly. In five seconds, I had processed a huge amount of diagnostic information: One, … Continue reading
A Pain in the Bottom
Bottom: “Ready. Name what part I am for, and proceed.” A Mid-Summer Night’s Dream, I, ii. Abstract: Over a one-month period a 17-year-old male presented with severe recurrent rectal discomfort clinically diagnosed as proctitis with anal fissure. Both episodes responded to a course of antibiotics and topical steroid ointments. On clinical examination the degree of rectal mucositis corresponded to that of his anterior oral mucosa, apparent side effects of oral isotretinoin therapy. A history of constipation may have contributed to the finding of anal fissure. Several similar cases have been documented in the medical literature. Clinicians would do well to consider the possibility of isotretinoin-induced proctitis in patients on oral … Continue reading
Listen to the Patient…
Notes from the Xanadu Clinic, Norfolk Island, South Pacific The patient is a 65 yo man with a one week history of intense lancinating pain in the right upper quadrant. He was examined by his internist who suspected gall bladder disease and ordered an abdominal ultrasound. It was negative, so an abdominal CT scan was scheduled. Between the ultrasound and the CT scan the patient developed a rash on the abdomen and back. He attributed it to one of the new drugs he was prescribed for his abdominal symptoms. I saw him today for elective surgery of a skin cancer. I greeted him with “How are you today?” He answered, … Continue reading
