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00:00The following program contains medical procedures and treatments involving dermatology. Viewer
00:04discretion is advised. I'm Dr. Sandra Lee, aka Dr. Pimple Popper. Pretty sure that was the coolest
00:10thing I've ever seen. Come break out with me and all my new patients. Plus, I'll share my expertise
00:15with some amazing young dermatologists. Pimple popping is not taught in residency. We'll see
00:21how they break out, seeing things they have never seen, and of course, seeing how they pop.
00:29I can't believe it's not butter. On Dr. Pimple Popper, Breaking Out.
00:36Tonight, on Dr. Pimple Popper, Breaking Out. The puff that comes out of the boil smells like
00:41halitosis. I've had this slump on my back about five years. The bottom of the bump here is a scab.
00:47I have thousands of tumors. I have a face that you can never forget. I'm a fourth year medical
00:54student, and I'm here to learn from Dr. Sandra Lee.
00:59I'm sorry. It hurts a little bit. Cancer is scary. I've been married to him for so long that I
01:06don't
01:06know that I could go on without him. This is like full thickness in this area. You can try to
01:12kind
01:12of smooth that area down. I just want to see where that lipoma is. It's just being stubborn, huh?
01:20Yeah, you got an ornery one. See how it kind of herniate or bulge out. If I can't get this
01:26area smooth and flat, this could really lead to dire health consequences. Okay, it's your turn.
01:31I am nervous about suturing. I've only done it once. Be careful.
01:47My name is Katrina. I'm 39. How? I am a freelance producer in the Atlanta area.
02:00And I live with HS. HS is a skin condition that causes boils that essentially open and ooze
02:14blood and pus. My HS is under my arms, under my breasts, my thighs, my groin.
02:25My butt. Oh, my God. This is what happens. I just took my shirt off. All of this is on
02:36my clothes now. And as you can see, it comes from everywhere. The pus that comes out of
02:42the boils, it's like a cloudy, like a milky consistency. That's what happens. And the smell smells like
02:53halitosis. Oh, sorry. It hurts so bad. I'm in pain like 95% of the time. So, yeah. I'm in
03:04pain right now.
03:05In my research with HS, I've learned that it's chronic. But I've read that the surgery is the most
03:11long-lasting option. But when I first got to a doctor, she's the one that suggested trying injections
03:17in my stomach. And it kind of seemed like it's working for me. And I ended up reading about it,
03:22and there were so many case studies of people developing cancer. I'm not going to give myself
03:29a shot that's going to give me cancer. Like, the one thing that's kind of seemed like it's working
03:33for me is possibly going to kill me anyway. Mom, are you down here? Yes, ma'am.
03:40Okay. So, I grabbed all this stuff. But, you know, I really don't, you know,
03:44not into all of this stuff like y'all. So, I am a single mother of three teenage girls.
03:51My oldest daughter, Ariel, she's in college. And she's actually home today. Before my HS,
03:59me and my daughters did something every weekend called a Saturday. It's been a year since I've
04:05taken my babies on a date. So, I just planned a little at-home spa. I was trying to be
04:13special.
04:14Yeah. So, this is nice. I appreciate it. But I do want to know why we haven't been out.
04:20Like we used to. I can't be tired. You can be tired, but where's all this tiredness coming from?
04:28My HS is a secret. Nobody's ever seen it. My daughters don't know.
04:34I literally call it my secret shade.
04:39I'm diagnosed with a debilitating health condition. I get boils and knots and sores
04:47in places that causes me to not be able to move. And that's why we haven't been out in a
04:53whole year.
04:55That's scary, Mom. Would you be comfortable showing me what it looks like?
05:02I've hidden it because I'm ashamed. And I just, I just had this thing. I don't want nobody to look
05:08at
05:08me like I'm some disease. But I need to show my daughters what my skin looks like.
05:15Okay.
05:22Wow. Oh my gosh.
05:28Does it hurt right now? All the time.
05:33You're still my mom. I still love you. And I just want you to be okay. I hate that she's
05:39going through that.
05:41I'm scared that it's going to become too much. And I just want her to feel beautiful again and be
05:47herself.
05:48It's time. It's getting worse. Hopefully I will be going to get a surgery. Okay.
05:55That is going to correct it. I am begging, praying, hoping and wishing that Dr. Lee
06:02can give me the surgery. I just need it done.
06:20I am on my way to work with my giant coffee because I need it to get me through the
06:24day.
06:24I was actually thinking when I got into the car today about this patient that I saw yesterday.
06:29One of the craziest things that she has to deal with on her skin.
06:33She's dealing with it as best as she can. She always tries to look on the bright side.
06:38So realize that there's people that are going through things that you don't even know.
06:41That stay hidden from the world and you have no idea. I feel like that's a good message for today.
06:48Love you guys. Have a good day.
07:06You look great. What are you here for?
07:09Because I'm a reptile. I'm just like, that's what I call my HS skin.
07:14Oh, you have HS. Okay. Hydradinitis superativa.
07:17Yes.
07:18When did you get this diagnosis?
07:20And my original diagnosis was probably like five or six years ago,
07:24but I had been dealing with it by that time for like 10 years.
07:27The doctor gave me like shots in my stomach. The shots kind of kept it at bay.
07:31So a biologic?
07:33Yeah.
07:33All right. How long did you take that for?
07:36Uh, probably like six months.
07:37How did you, did you notice an improvement there or?
07:40It, it kind of was an improvement, but it's like it did other things.
07:43It was like a big thing about it possibly causing cancer.
07:47And that was my other concern.
07:49So you decided to stop it?
07:51Biologic medications are a new class of treatment options
07:55that actually target inflammatory conditions, but they do carry some risks.
08:00There is an increased risk potentially of Crohn's or ulcerative colitis,
08:04but they also carry cancer warnings, which can be very scary for some patients.
08:08All right. Do you mind if I take a look and see what's going on here?
08:11We usually start to see this condition in adolescents.
08:13I think you can see this more often in females and males.
08:18Hydradinitis superativa is really a condition that is terrible that you really suffer alone.
08:24So do you understand a little bit about what happens here?
08:27It's like a disorder of the hair follicle really.
08:30And it happens in these particular areas.
08:33You get a series of abscesses and, or they're called boils really.
08:37And they create these fistulas or these sinus tracts where they kind of connect
08:41from one place to the other. So you've probably seen this where you push on one area
08:45and it pops out the other side. You know that they're sort of connected or there's a whole
08:50range under there of tunnels. And you have a good amount of scarring here and good amount of tunnels.
08:55And it's pretty much the expanse of your, of your armpit.
08:58Mm-hmm. All right.
08:59And then I have them like right here.
09:01On the inguinal area here.
09:02Okay.
09:03I have like a big one right here.
09:04Do you want me to take a look?
09:05Mm-hmm.
09:05Okay.
09:06Katrina's hydradinitis is pretty severe and very active. She has boils and tunnels there with a
09:12lot of pain and discomfort and oozing. This is really important to know as I decide how to treat this.
09:18Right.
09:19Yeah, I see.
09:21There are some treatment options that people are really seeing some differences. And so there's two
09:26approaches that we do with HS. There's the medical approach and the surgical approach. So medical
09:34approach is oral corticosteroids, um, antibiotics, um, also a biologic, which is what you tried before,
09:43right? And then there's surgical approaches. Surgical approaches are newer and that is like
09:48what we call de-roofing. I don't think that is something that we would do today.
09:52Yeah. That's what I've been wanting is the surgery.
09:55Yeah, but you should really be on a biologic first.
10:00Did I come all the way from Jonesboro, Georgia to California to be told by another dermatologist
10:07what they cannot do? I've done the shots, the steroid, the antibiotic, like,
10:13can I just get my armpits cut off?
10:34I'm here with Katrina who has hydratonitis superativa, HS. Katrina really came in wanting surgery,
10:42but it's not quite so easy as that, because there's a lot of inflammation in it. I'm here
10:45here. There's a lot of oozing and I think it's really important to control that by medical means
10:50before we proceed with surgery. You should really be on a biologic first, because I think that's
10:55going to really help you. It's going to shrink down the area. It's going to dry it up. Surgery is
11:00more invasive. But I understand your concern with the biologic because there's a lot of little side
11:05effects that you're concerned about. But I do really like the fact that you saw an improvement with
11:13it. I did. That's a very good sign. I want to present you another option of a newer biologic
11:20that works in a different way that doesn't have as many of the side effects there. And then if you
11:25have some of those areas that persist, then you go and you you do a surgical like de-roofing of
11:31them
11:31to eliminate them. So what do you think? I just want it fixed. Whatever you think. There's some things we
11:40could do temporarily to make it go away. We could today inject a little steroid in it. It's not a
11:46permanent thing. It's sort of a temporary. If you feel like something's coming up, you're trying to
11:50like calm it down before before it gets bad. I think that's something that we can do today. Certainly
11:56that's going to make you feel better going home. So let me grab some stuff for you. Okay. Thank you.
12:02I don't want to trade HS for cancer. So hearing there's an option with less of a cancer risk,
12:07I feel very, very relieved.
12:13Okay, just a little baby pinch here, okay?
12:18Steroid injections are really a temporary band-aid for HS. They're just really going to
12:23broadly decrease the activity, the irritation, the inflammation in the area. So by injecting an area
12:30of her skin that's really painful and uncomfortable, it's going to help to calm that area down and give
12:35some relief temporarily. Good, done.
12:42So I'm going to connect you with another HS, a dermatologist and a surgeon in Atlanta. We're
12:48going to also work on getting you a new biologic that has a better safety profile, like fewer things
12:53you have to worry about, less risk of cancer and things like that, okay? Okay. HS is a really
12:58complicated disease. So maybe with this new modern biologic, it's going to really help to dry up these
13:05HS lesions so that a potential future surgery will be much easier for her. So we'll keep watching her.
13:11I think you're going to do great. I'm excited. Yeah, then watch out.
13:16When I walked in Dr. Lee's office today, I was not at the end of my rope. I was actually
13:20hanging
13:21from my rope. And now I feel like there's an actual resolution. It sounds like it's going to be a
13:29slow
13:29process, but like they say, slow and steady wins the race. Thank you so much.
13:37Watch out. See you travel back. Okay.
13:40I know what this could potentially mean for me, that I can go back to being normal. And I'm just,
13:47I'm very happy, very hopeful.
14:01Grab your water.
14:04Isn't this gorgeous? Look at these mountains. I love the palm trees. You don't see that in Virginia.
14:11Yeah. See where the trail starts?
14:14Would it be a hoot while we're walking somebody famous like pops up? Who's the hunkiest Hollywood
14:21star that you'd like to see? I don't want hunk. I want older. Available. I'm Kim. I'm 69 years old.
14:29I
14:29have thousands of tumors all over my body. Starting from the top of my scalp, moving down to my face,
14:38my neck,
14:40both my stomach and my back, on my spine. I have a face that you can never forget. Some people
14:48have
14:48freckles. I have bumps. Wildflowers everywhere. I am so happy that Sharon could come with me. She's my
14:56first cousin. I've known her all of our lives. That's built so when it rains. Shortly after birth,
15:03I was diagnosed with neurofibromatosis. Neurofibromatosis is a genetic neurological disorder
15:10which causes tumors wherever you have nerves. And of course, that's your entire body. The tumors grew
15:17as I grew. When I was in my 20s, I had no tumors on my face. So it didn't really
15:23affect me as much
15:24until my mid-30s. Then it was like Explosion City after that. The doctors didn't have a lot of
15:33knowledge what NF was. The doctors took off the tumors. But some of them have a base and some do
15:41not have a base. Meaning, when you take them off, there's nothing underneath it. And it just kind of
15:46is like a cavernous cave. And it can make the condition worse. With NF tumors, people stop and stare.
15:54And say unkind things. But with my attitude of life, I try to stay positive. I hate to say it,
16:02but I needed water. Okay. I love going outside for hikes. But sometimes I get tired. So how are you
16:12doing? I have central sleep apnea. I was falling asleep at a stoplight. That's when I knew I had to
16:19go in and get it checked because that was not good. The central sleep apnea,
16:25your brain shuts down. Shuts down? Shuts down, tells you not to breathe. Oh, wow. And I found out that
16:32I was stopping breathing over 50 times an hour. With my BiPAP machine, it goes, you know, like from
16:40nose and mouth. The nose, mouth, and then it goes to the back. Even the little ones, some of them
16:47are
16:47in the way. I think it's extremely unfortunate that she was born this way. We have 35 first cousins.
16:57None of them have this condition. You have to get a good seal on your mask in order to breathe.
17:03If you don't get a really good night's sleep consistently, most people's lives are shortened
17:09considerably. I don't want to be tired. I'm too young to be tired all the time. So now's the time.
17:16Now's the time. And I know that Dr. Lee can take some off so that I can get that good
17:21seal,
17:22so that I can sleep, so I can have the quality of life that I want.
17:29I think this will make a huge difference if she can, she can help you.
17:42You got your BiPAP. Yeah. Yes. Are you ready? I'm ready as I'm going to be.
17:52I am anxious. I want to live a long life. And you want to be healthy. I want to be
17:57healthy.
18:00Kimberly? I'm very concerned that if, you know, Dr. Lee can't help her, that she will have a shortened
18:06life. Hello, guys. How are you? I'm Kim. Nice to meet you, Kim. Welcome. I'm Sharon. Nice to meet you,
18:21too. Nice to meet you. Welcome. I'm glad you brought somebody out with you. Very nice to meet you. I'm
18:25glad she can. Great. Yes. I see you have neurofibromatosis. Yes. Right? So people get a lot of
18:33these neurofibromas, which are benign, but people get a range of them. Some people get not very many,
18:39and some people get neurofibromas on top of neurofibromas, you know? So, yes. Kim has a pretty severe
18:46form of neurofibromatosis, which is a pretty complex genetic neurological condition. These bumps are not
18:55life-threatening, but they can affect your daily living. They can affect your ability to breathe.
19:00They're composed of a bundle of nerves, and maybe they can cause you pain. So, um, what brings you
19:07here to see me today? So I have a BiPAP machine. Okay. And I would like to be able to
19:12get a better seal
19:13on my face. Okay. Okay. So sleep apnea, so you have to wear that, that really has to have a
19:18pretty
19:18tight seal around your mouth area. I could spend six hours on three square inches of Kim's face to
19:25try to make it smooth. So I'm really glad she's come in with a specific request here that I can
19:31potentially help with. Sleep apnea is not related to neurofibromatosis. They're independent diagnoses.
19:37She just happens to have sleep apnea and neurofibromatosis. So if I can do something to help to seal
19:43that mask on her face so she sleeps better, this is a very big deal. The ones down here in
19:50that line
19:50and this one. Okay. I would like, if we could, to concentrate like on the front of the face. Okay.
19:58So mainly here, along here, like this kind here, that's a little more work. You can try to kind of
20:05smooth that area down because this is like full thickness in this area. I would suggest numbing it
20:13and taking what we call a loop electrocautery and trying to sculpt them, but parts of them are
20:19still going to be there. Yeah, I understand. The challenge with Kim is to remove some of these
20:24neurofibromas so that we get the tightest seal. So for the cheek, I'm going to cut a wedge essentially
20:30of skin out there and pull that together and sew that together. In terms of her chin, my goal here
20:36is
20:36to really shave them off and make that area of a more contour, normal chin. If I can create a
20:42better
20:43seal there so she can get the proper oxygen she needs when she's sleeping, her life is going to be
20:48so much better. Um, okay. I'm hoping that will be successful. Thanks. Of course. I'll see you guys.
20:54I'll see you guys in a little bit, okay? Sleep is very, very important to your health.
21:00And so I'm just hoping and praying that she'll get the job done.
21:10Little baby pinch here, okay? I'm removing tumors from two different parts of Kim's face,
21:15her cheek and her chin. On her cheek area, I'm going to excise this area. I have to strategize
21:21and just make sure when I pull together skin after I remove some neurofibromas,
21:26I'm not just pulling in other neurofibromas. This could be a challenge.
21:31I'm going to cover you, okay? It's going to cover your mouth a little bit. Make sure I'm not hurting
21:35you.
21:40Sorry about my sniffing noises here.
21:42All right, I know you're doing my chapter here.
21:48We're excising this one instead, as I said.
21:54Okay, got it.
21:57The cheek was a success and now I need to attack that chin of hers. The chin growths that I
22:03want to
22:04remove, it's too wide of an area to properly close them like I did on the cheek. So I'm going
22:10to shave
22:10them down using an electrocautery device. It's going to be a little loud here. It's a device that
22:15really can just pull off those neurofibromas. And the fun begins. Okay. The main thing I'm concerned
22:23about is if I just take the top off of these, are they like icebergs under the skin? Would they
22:28sort
22:28of herniate and just push back up onto the surface of the skin? Let me just do one little spot
22:34right
22:34here, okay? I'm trying to get rid of the bumps on her skin, but I also don't want to create
22:38indents in her skin. And if they do that, they could leave a hole under the skin. If I can't
22:43get
22:43this ear as smooth and flat, she's not going to get a tight seal with her sleep apnea mask.
22:50See how it kind of will not be like herniate or bulge out more. Like they want to come out,
22:57but they don't really want to come out. I'm like that. This is what I was afraid of.
23:09I see them trying to bulge out again.
23:15I'm here with Kim, who has pretty extensive neurofibromatosis. I need to get these flat so
23:20she can have a good seal with her sleep apnea mask. Because if we don't, she's really going to
23:25develop uncontrolled sleep apnea, and this could really lead to dire health consequences.
23:30It's like whack-a-mole. It is kind of like that because they're under there,
23:34and if you get part of them, sometimes just like it like gives it more space to like see them
23:39trying
23:39to bulge out again. See that's like tucked in, and then I might get a little squeeze and there it
23:47comes
23:48again. These chin growths that she has in neurofibromas have a potential to herniate out,
23:54because there's a weakening in the opening. So if this bump was tucked in there and kept in place
24:00with your skin, but now I shave off that skin, what's going to stop that whole thing from popping out?
24:06I think when the swelling goes down, it's going to look better. A little swollen, nothing crazy right now.
24:13Ah, you think you got them smoothed out? Do you see the difference for you too?
24:17Yeah. I mean overall it's swollen, but like it's less bumpy. Visually it may not look that impressive,
24:24the amount of neurofibromas I removed on Kim, but I successfully removed the ones that have been
24:30getting in the way of her sleep apnea mask, and this means the first good night of sleep for Kim.
24:34You did great. Oh yeah, look how flatter that is there. Yeah. I did try to shave this down a
24:42little
24:42bit. Hopefully that'll help you to fit your mask better. With neurofibromatosis, I knew that Dr. Lee
24:49couldn't take everything away, but she was really good at looking at the ones that would have the
24:55highest impact. Well, how do you feel? I really think the mask is going to fit so much better with
25:00this gone, so it's really going to, I think, make a big difference. People forget how important sleep is.
25:06It affects your longevity of your life. I'm looking forward to being around longer.
25:11Thank you. Bye.
25:13Dr. Lee really changed my life. I'm glad I could come. Thanks. I'm really glad I could come.
25:24It's quite a place. Yeah. My name is Emil. I'm 77 years old. I have a lump on my back,
25:31probably the size of an avocado. I've had this lump on my back about five years. It's my beach buddy.
25:40I love the beach. I go to the beach a lot. I love the sun. At the beach, my wife
25:46was noticing other
25:47people noticing my back. I didn't feel good the way they were looking at him, so I knew he needed
25:53to
25:53take care. And now it looks like there's like a lesion on the bottom portion of the of the pub.
26:01The
26:02lesion is like a crater that keeps getting deeper. It breaks open, then it starts to bleed.
26:08Not a lot of blood, but enough to just make you wonder. Yeah. I have my reservations about going to
26:17the
26:17doctor because, you know, they usually give you negative news, and I don't like to hear negative
26:22stuff very much. But when I started seeing how concerned she was about the bump, I gave it second
26:29thoughts. I'm glad you decided to come and see her. So thank you. I appreciate that. You're welcome.
26:36We've been together for 49 years, and I cannot imagine my life without him in it. We have a bond
26:43that's very rare. Hoping for the best. I don't want to find something that's not good. I know, I know.
26:55We'll see. Emil? So cancer is scary. Don't do that. Okay. My life, I don't know that I could go
27:08walk without him. So if we can find out what it is, then we can fix it. Dr. Lee will
27:14be right in,
27:15okay? Okay. Thank you. Thank you. Hey, you're welcome. I've been married to him for so long that
27:19I want him to be around for another 50 years if possible. So to me it's scary, but it's more
27:27scary
27:27you're not knowing. My name is Geely Amid. I'm a fourth year medical student.
27:45And I'm here today to learn from Dr. Sandra Lee.
28:04Hi, good morning. I'm Geely. I'm here to see Dr. Lee. I met Dr. Lee at a dermatology conference
28:12that I decided to go to on my own time. We just started speaking about dermatology and
28:18the intricacy of it. And we kind of just bonded over that. And we talked about me coming and working
28:24with her. Dr. Lee. Hey. Hi. How are you? Oh my gosh. It's so nice to finally see you over
28:33here.
28:33It's been so long. I know. This is so lovely. I'm doing something that I've never done before. I've
28:38invited a wonderful medical student who's interested in going into dermatology to come along with me on my
28:44pimple popping journey. Her name is Geely and she's absolutely lovely and she really loves dermatology.
28:50I think she'd be a great dermatologist. And I'm really excited and hope that I can help her along the
28:56way.
28:56I've had a lot of medical students ask me and I've been very reluctant to do it because it's work.
29:02You know, it's extra work for me to manage my patient and somebody else. But I also want people
29:06who are really serious about dermatology. And you are. And I'm hoping that this will help, you know,
29:13help kind of bolster your application to dermatology. You know, anything that I can do to
29:17stand out or get experience or learn from like a doctor is an opportunity that doesn't really come
29:23along often. Striving for a career in dermatology, it's very competitive. And having somebody who's
29:31willing to help you with such experience and where Dr. Lee is in her career, the ability to learn from
29:38her is a huge privilege. Let me grab his chart. We're going to go take a look at him, okay?
29:43Okay,
29:43let's go. I think it's very interesting to have Gilly here because it's nice to get her early on.
29:49You just want to form them into the dermatologist they're going to be. I really think she has good
29:54bones for it. I think she really wants to help people. Hello, guys. Hi, how are you? I'm Dr. Lee.
30:01Nice meeting you. Very nice to meet you. Hi, Dr. Lee. I'm Sylvia. Nice to meet you. This is Gilly.
30:06Gilly. Nice to meet you. Yes, she's going into dermatology. Oh,
30:11so I hope you don't mind. She's going to kind of follow me along today. Sure. Okay,
30:15so what's going on today? What are you doing here? I have a bump on my back below my right
30:19shoulder.
30:20Okay. There is also at the bottom of the bump, there is a sore. It's a collision. Right, a sore.
30:28Okay, so you have two things kind of going on in the same general area, right? Correct. Okay. Can I
30:33take a
30:34look and see? Sure. Thank you. Emil really is a perfect first patient for Gilly to see because
30:40he's got two different skin conditions going on and it will kind of test her knowledge on
30:45dermatology really from the get-go. Okay, do you have any idea what that might be or just thoughts
30:52about it? No pressure. It looks like it could be a lipoma. Yes. Just because it's a little bit mobile
30:59and soft. Right, I think it's a lipoma. But then yeah, I do see this other area here. I mean
31:06it looks
31:07ulcerated and like it's been bleeding a little bit. Yes. I don't know if he's been in the sun a
31:13lot and
31:13something that's causing damage to the cells. Yes. Something like actinic keratosis. Yes, so actinic
31:20keratosis is like a pre-cancer. They can develop into basal cell carcinoma which are very common
31:30types of skin cancers but that are not life-threatening, okay? That's good. They just locally grow.
31:38After the doctor told us that it was non-threatening, I was relieved. I was really,
31:43really relieved and so was my wife. Oh yeah.
31:48What I'm going to do is I'm going to numb up that lipoma. Okay. And then I'm going to also
31:53design
31:53a removal of that basal cell to try to get it out entirely. Okay? All right. Okay. All right,
31:59I'll see you in a little bit, okay? Okay. You sit tight for a minute. We'll get you started. All
32:02right.
32:08So my main concern is the basal cell here. So I'm going to take approximately like a few millimeters
32:16beyond this, you know, just to make sure. But just from what I see here, the shape of it is
32:23not very
32:24conducive to a closure. So normally I would design a closure to be this way. I've never removed a
32:33basal cell that's over a lipoma. So we're going to try to extend the line this way more so that
32:38I get
32:39to this lipoma here. But we're going to take that out because we're taking out that skin cancer. So
32:44let's lie you on your side, okay? The lipoma and his BCC are not related. They're just two different skin
32:51conditions and they happen to be really atop each other. So my plan here is to really address the BCC
32:57first because that is the skin cancer, you know, and that's something that I want to remove completely.
33:03After that or while I'm removing that, I'm trying to think of the easiest way I can remove this lipoma,
33:09leaving the smallest scar. In fact, maybe combining these scars. All right, I'm going to put a little
33:15baby picture, okay? All right. My first thought is to kind of explain this in a way to Gilly that
33:23she understands my thought process. When you approach an excision, you don't want to go through it timidly.
33:28Go decisively. You know what you're doing. You have the confidence. You've done this before
33:34and you just want to get things done. And you shouldn't feel anything other than us touching you.
33:40So I'm going to first remove that basal cell. So I just do a straight edge. Let's see the skin
33:47here
33:47is very thick. It's got thick skin. Well, that's good, right? Yeah.
33:53See, there's that lipoma because the doors are open. What you do with a standard excision of a BCC,
34:01which is a type of skin cancer, you want to remove maybe up to five millimeters of skin around the
34:07basal
34:07cell. And then you also want to make sure you get under it. So in this case, if you want
34:12to close
34:12something properly, you want to go to the subcutaneous space, which is that fat space.
34:17So if I get under there and I don't see any basal cell, there's a good chance I'm removing it
34:23completely. I'm feeling pretty good that this is not going to be deeper than the subcutaneous space,
34:28that this is not invading muscle or anything deeper.
34:33It's off. We're going to send it to the lab for a biopsy. I've successfully removed the basal cell
34:38carcinoma from his skin. So that's good. That's the first step. But I also have to deal with this
34:43lipoma that's kind of sidled up on the side here. I got to make sure that I can extend an
34:49excision to
34:50get access to it, to be able to squeeze it out. And ideally, I would like to take it out
34:55whole.
34:55I just want to see where that lipoma is. It's just not as easy to separate from your fibrous tissue.
35:03But that's okay. We fight with them. I'm going to try to give it a squeeze just to see if
35:06it pops.
35:12Maybe a little bit. Yeah, you got an ornery one.
35:26I'm here with Emil, who has this really ornery lipoma. It's fibrous. It's stubborn. It tears easily.
35:33And it is completely embarrassing me. But I will say that this is a really good teachable moment.
35:39Nothing is ever exactly as you would predict. And you have to be ready for that.
35:44Sometimes it eases out if we wiggle it. Wow. I've seen a lipoma removal once in the textbook.
35:52But this is the first time I've seen it in practice. His is more of a fibrous lipoma here.
35:58So it's a little harder for us to remove. It doesn't want to come out. It does.
36:07Wow. Oh my God. Almost out. I'm about to present this to Gilly here.
36:13It's so cool. Hey, it's crispy. Like chicken fat or steak fat.
36:19Yeah, that's exactly what it looks like. Yeah.
36:23So we got it all out. And I do think we're going to try to pull this together. Let's see
36:28how that closes.
36:29Now that the tough part is over, I have a great opportunity for Gilly to get her hands dirty.
36:34Do you guys mind? Can I have her put in like one little top stitch?
36:37I don't mind. Do you mind?
36:39No. I don't mind. I have my body.
36:43Let's go ahead.
36:45I am kind of nervous about suturing. I've only ever done it in my suture kit.
36:51So I'm pretty nervous right now.
36:54Yeah. That's good. I mean, she's got balls, man.
36:59See how this is more shallow there? So pull out of this side here.
37:03Okay. Yeah. But come back now at the same level. Yeah. Yeah. That's good.
37:08There you go. And then now stay there. Let go of that.
37:11Keep in the middle. Yeah, exactly. Exactly. Perfect. Look at that. What a pro.
37:21Getting experience with Dr. Lee is something that I didn't even dream possible before. And it just
37:28confirms that this is what I want to do with my career. Here's a lipoma. This was a stubborn one.
37:35Yeah. Yeah. The knitting. Yeah. So you can say you're a gristly guy. See what I mean?
37:41I'm glad that she got it out of there because she did lift a heavy load off of me and
37:46my wife.
37:47I'm just thinking how worse it could have been. And I'm feeling thankful. I'm grateful.
37:52I thank you, Dr. Lee. You're welcome. Let's do it again.
37:57I'm really, really happy. Now I'm ready to celebrate our 50th wedding anniversary.
38:03There's no clouds in our heads. We know we're going to make it. We're going to celebrate.
38:07I love you. I love you too.
38:12Gilead and I had the pleasure of removing Emil's basal cell carcinoma and lipoma four months ago.
38:21He and his mustache are looking great. I am so glad it's summertime. And I'm ready for the beach.
38:26Plus, Sylvia can feel good about his health and celebrate 50 years together.
38:31And I'll be able to spend another 50 years with him. Hopefully. Oh, yeah. Thank you. Good luck, Emil.
38:37No. It's been three months since I saw Kim and removed those neurofibromas that got in the way of
38:44her sleep apnea device. Dr. Lee, let me show you my fit now. She's getting a lot more rest,
38:50keeping her breathing and her heart healthy. Now it's so tired she can't understand the word I say.
38:57Kim and Sharon are now loving hanging out with each other and hiking every day. I mean,
39:02I want to go hiking with them. Thank you, Dr. Lee, for all you've done. Good luck, Kim.
39:10Hey, Mom. Hi, baby. What you doing, girl, putting up this stuff? When I saw Dr. Lee,
39:17she gave me the biologic medicine that I had to give myself some stomach injections. And she referred
39:24me to NHS specialist named Dr. Jamie Wiseman. And once Dr. Wiseman saw that the biologic was actually
39:34working, we were able to schedule and begin the procedure of these surgeries. So when I push with
39:40this gumball blade, it's going to pop into the tunnel. We've gotten her on a very effective medication to
39:46prevent the acute phase and the progression of the disease. Now and probe the tunnel here. And it's going to
39:52tell you exactly which direction to go and how you can cut. But we're going to have to clean up
39:56the tunnels and the scarring that have happened so far. So now it has been about three weeks since
40:02the unroofing. And I feel amazing. Oh my goodness.
40:14Does it hurt? Nope. Not no more, girl. I can do all this. I am no longer worried about cancer.
40:21There's no more oozing. There's no more burning. I feel like a brand new person.
40:28I can see the difference. I can hear the difference. I love you, babe. I love you too.
40:37Before, I didn't go anywhere. I was in the house. Didn't do anything with my daughters really anymore.
40:43We used to do these things called Saturdays. Those were ruined because of this. But now, like,
40:47we can be inside. We can be outside. Like, we could be everywhere. Like,
40:51I really do feel so much better. Oh! Girl, who is that girl? I'm grateful to Dr. Lee
41:00for this experience and for her leading me to Dr. Wiseman.
41:03Dr. Wiseman. They gave me my life back. This is everything.
41:10I guess so anything that day.
41:10But then, there's no média And it's a dream.
41:11been a rather dangerous to do If you happen with your一直 in to I'm
41:11one of thegasps in your home Thenisijn family.
41:11And legacy, and the 마무�ically, are, so God who has ever decreased,
41:12How the first thing is is the fundamental to you about the quality of mind.
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