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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
00:09thing 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 residence. We'll see
00:22how they break out, seeing things they have never seen, and of course, see how they pop.
00:28I can't believe it's not butter on Dr. Pimple Popper Breaking Out.
00:37Red flaky patches, head to toe. It's just really painful. I really thought it would just go
00:46away, but it's growing bigger. The bumps are on my hands, my arms, my face, my chest, my
00:51toes, everywhere. To think that I'd have to use something for the rest of my life, it's
00:58quite scary. Yes, and I can't dispute that. I'm not scared of fighting wildland fires, but
01:05I'm scared of needles. The concern was there's a lot of important vessels. Oh my God. You
01:12just had a macadamia knife.
01:35My name is Dave. I'm 58 years old. I'm from Bakersfield, California. My name is Robin, and I'm Dave's girlfriend.
01:41There we go. I'm a wildland
01:44firefighter, and I have a bump on my head. My bump is the size between a larger size marble and
01:54a golf ball. It moves around on the top of my head. It's kind of squishy. It's sore and painful.
02:02I noticed this 15 years ago. I thought it would just go away, but then over the past few years,
02:10it's growing bigger.
02:14About three years ago, I went to a doctor, and they just kind of brushed it off, thinking it would
02:21go away, but then it's, you know, it's not going away.
02:24I haven't been to another doctor since. I haven't been able to find the right type of doctor that has
02:31the passion to give me the right answers for what I have going on on top of my head.
02:38All right, the trail's right over here.
02:43Yeah, looks like it's going to be a nice ride.
02:45Yeah.
02:47I've been cycling since I was 15 years old.
02:53I cycle to escape what we have in everyday life. That's my, like, yoga. It's my getaway. It's very calming.
03:05Such a beautiful place.
03:08I think it's really nice.
03:12Okay, slow down a little bit. Okay, we're going to have to stop here.
03:20Yeah, it's starting to bother me a little bit. It's killing me here. Yeah.
03:25With the helmet on, it's just bothering it really bad. Yeah. Yeah, you don't need to be in pain.
03:31All right, let's go. All right.
03:36The bump on my head is growing and now I can't even wear a bike helmet anymore without pain.
03:43I have to wear helmets at work all the time and, you know, I mean, it's got the straps too.
03:50And then just, you know, wearing it and it's pushing down on the bump.
03:57I work as a wildland firefighter. It's just a passion. I can't sit at a desk.
04:03You're not only saving the forest, but you're saving people's property and their lives.
04:07There has been countless times my helmet has saved my life in the forest.
04:11You have branches falling out of trees, which they call widow makers.
04:15But my bump is affecting my firefighting because the straps on my helmet are pressing down on my bump.
04:22And it's very, very painful.
04:24So if my bump grows and I can't wear my helmet, I wouldn't be able to do this job.
04:30If I can't work or ride my bike, I don't know what I'm going to do at that point.
04:39I haven't had a doctor that I can trust that, you know, is going to look at this and figure
04:49it out or care about...
04:51Take it seriously.
04:52Or just taking it seriously for me.
04:54It's so hard to just find the right doctor who isn't just going to brush you off and say it's
04:59not a big deal.
05:00It's really difficult to find those doctors who take you seriously.
05:03And I know we all do that. We procrastinate.
05:06But what's going to happen if something bad happens and it's cancer, you know?
05:10I mean, that's why it's so important to get this taken care of now.
05:16Yeah.
05:16I feel that a doctor should take some passion in trying to treat a person instead of just trying to
05:24blow it off as if it's nothing.
05:25I feel seeing Dr. Lee now is very important because I am very worried that this is cancer or something
05:35of that sort.
05:45I'm nervous because just the uncertainty of what this is.
05:49What if I am already too late at this point?
05:55Oh, hi!
05:56Hello, guys.
05:57How are you?
05:58I'm Dr. Lee.
05:59Dave.
05:59Nice to meet you.
06:01I'm Robin.
06:02Hi.
06:02Nice to meet you guys.
06:03Welcome.
06:04Are you guys from California?
06:05Yes.
06:06Yeah.
06:06Ah, okay.
06:07From Bakersfield.
06:08Oh, okay.
06:08Not that far then.
06:09Yeah.
06:09That's good.
06:10You look pretty good.
06:11What's going on?
06:12Well, I've had this bump on my head for about the last 10 or 15 years.
06:20Okay.
06:20It just kind of happened like overnight.
06:24And I never thought anything of it.
06:26I just always thought, ah, it's just a bump, you know?
06:29Maybe it'll go away.
06:30Right.
06:30But, you know, I'm also a wildland firefighter, so having the helmet on my head is starting
06:36to get a little sore and a little painful from having-
06:39Because it's right, right, right.
06:40And it might irritate it, too.
06:41Right.
06:41By the way, thank you for everything that you do for us.
06:43We need people like you, more people like you in our state.
06:47For sure, so thank you.
06:47In California, I'm especially grateful for firefighters.
06:51We need firefighters.
06:53And so we need Dave.
06:55And if anything gets in the way of him being able to properly fight fire, I'm there.
06:59I'm here to help him.
07:01I mean, I've gone to other doctors and it's just like, you know, don't worry about it kind
07:05of thing.
07:05And I'm like, my father had bladder cancer.
07:08My sister had breast cancer and it's sun-like.
07:10I'm just getting a little bit more concerned about it.
07:14Okay.
07:14All right.
07:15Let's take a look and see what we have here.
07:19It's right at the vertex of your scalp.
07:22It's actually right where your cowlick is, really.
07:24Oh, really?
07:24Oh, wow.
07:24Your cowlick is just right behind it.
07:26Oh, my gosh.
07:28So, I do think this is a pilar cyst because it moves around pretty well.
07:33Yeah.
07:34You know, it's not stuck or adherent to your skull.
07:37Mm-hmm.
07:37It does get sore though.
07:39I can imagine, but I bet it's from pressure mainly.
07:41Yeah.
07:42Like things rubbing on it.
07:43Yeah.
07:43I wouldn't want you to wear something and make it inflamed because that can cause a lot of
07:47problems.
07:48That's good to find out.
07:49It's a cyst instead of something.
07:51I think so.
07:52That's what I think it is.
07:53Yeah.
07:53But I can't tell you for sure until I actually do the surgery and I see it.
07:57Okay.
07:57Yeah.
07:58That's one step and I go, okay, this very much looks like a pilar cyst.
08:01Okay.
08:01So, when you...
08:01Yeah.
08:02But the next step too is I send it to dermatopathologist.
08:05Oh, okay.
08:05Who looks at it.
08:06Oh, good.
08:06Just to confirm.
08:07Okay.
08:08Okay.
08:08Okay.
08:09Yeah.
08:09Yeah.
08:10Exactly.
08:12I can tell that Dave is pretty concerned about this bump on his head and that's really interesting
08:16from my perspective because he is under extreme circumstances on a daily basis when he works.
08:23So, for him to stress out about a bump like this, I guess from my perspective as a dermatologist,
08:28it seems like a little bit out of proportion.
08:31So, what we're going to do is make sure you're nice and comfortable.
08:33Yeah.
08:34The scalp likes to bleed and generally compared to other parts of the body.
08:38So, we put some numbing and let it sit there.
08:39The numbing fluid has a little bit of epinephrine in it and that will locally constrict the blood vessels.
08:46All right.
08:46Let me go get ready.
08:48So, we can get that knot off your head.
08:49Well, thank you so much.
08:50Okay.
08:50Of course.
08:50I'll be back.
08:51Okay.
08:52Everything going to be okay?
08:54The needles.
08:55This is going to be the hard part, dealing with the needles.
08:57My biggest fear is I'm not scared of fighting wildland fires, but I'm scared of needles.
09:04You ready?
09:08Boy.
09:09I'm a little scared.
09:10What is the reason?
09:11What do you have?
09:12Needles.
09:18I'm a little scared.
09:20What is the reason?
09:21What do you have?
09:21Needles.
09:22I'm here with Dave and his lovely girlfriend, Robin, and he's got a pylosis on the top of his head.
09:28I'm going to make sure that I numb this up really well, and I'm discovering that he's pretty scared of
09:33needles.
09:33I've seen this a lot.
09:35I mean, macho, tough guys who are really scared, but I get it.
09:39It definitely is something that is a lot of people's kryptonite.
09:44How are you feeling?
09:46Just feeling little pricks.
09:47We don't say that in here.
09:49Oh, gosh.
09:52Timidome.
09:53Sorry.
09:54I'm sorry.
09:55I'm sorry.
09:55It was a little joke.
09:57One of my best tactics for distracting patients is jokes.
10:00And I can already see David calming down a little bit.
10:03My main concern now is addressing the pylosis and making sure that I can remove this.
10:08I mean, those years of heavy helmets pushing this and smooshing it down can make this very difficult.
10:14All right, so you shouldn't feel anything other than us touching you.
10:18Okay.
10:20Let's see what we have here.
10:28This is definitely a pylosis.
10:30Oh, my gosh.
10:31I'm just going to very carefully squeeze.
10:37I'm just trying to ease it out.
10:38Am I hurting you at all?
10:40Well, no.
10:41Just feel pressure?
10:42Feel pressure.
10:43It's almost out.
10:47You just had a macadamia nut.
10:50Wow.
10:52Despite all my worries that this is going to be a troublesome pylor cyst, it really came out very nice.
10:57Now I'm going to stitch him up and he should be ready for action.
11:00Want to see the cyst?
11:02Yes.
11:03Are you guys okay with it?
11:04Do it.
11:04Do it.
11:05Oh, my gosh.
11:06Are you kidding me?
11:07That's it?
11:09You'll test that?
11:10Yes.
11:10Oh, I see.
11:12I look forward to seeing you in your helmet taking care of our state.
11:17You still got to do the biopsy, but I'm very relieved that this isn't cancer.
11:23Just to have all that stress and anxiety off of me is just fantastic.
11:28Now I can put that all behind me.
11:31Thanks for being here.
11:33I'm so glad it's done.
11:34Me too.
11:48We're going to spread some straw for the sheep to lay on so they stay warm at night.
11:52Alright, sounds good.
11:54My name is Bree.
11:55I'm 22 years old, originally from Australia, but now I'm living in Canada.
11:59I'll get you to take yours over to that side.
12:01I'll take mine over here.
12:02Alright.
12:03And I've got psoriasis.
12:07My condition looks like red flaky patches, head to toe, down my arms, legs.
12:14It can be really itchy, visibly inflamed.
12:19My condition gives me joint inflammation, especially in my fingers, my knees and elbows.
12:26It's just really painful.
12:29Just sprinkle it along here and just put very little so they all get in there.
12:34Yeah, go ahead.
12:35And just go right along this side here.
12:37My main job is helping out at a farm, but with the cold climate here, my skin can just flare
12:42up at any moment.
12:44And so moving my joints is so painful.
12:47Lifting hay, feeding animals is something that I really, really, really struggle with on a daily basis.
12:55I've had this now for about seven years.
12:57When I was 15, I first noticed my condition on one elbow.
13:02At first it was about the size of a 10 cent piece.
13:05My parents brought me to see a doctor and I was diagnosed with psoriasis.
13:09They treated me with steroid creams.
13:12They didn't work and they then moved on to UV therapy and also oral treatment as well.
13:18None of it worked.
13:20People living with psoriasis definitely get a lot of judgement from others.
13:23People would tell you that you look ugly or look different and that can often lead to a lot of
13:28shame.
13:28But I don't have a lot of trust in the doctors.
13:34So when I gave up on the doctors, I turned to social media.
13:38I started my social media because I wasn't ashamed of how my skin looked and I wanted to show people
13:44that they could feel the same about their skin.
13:46And I was able to spread awareness and really build a big community online.
13:51I found positivity through my own journey.
13:53I've learned to accept my skin for how it is.
13:57Recently, my skin started getting worse.
13:59It's been even more painful and itchy than it's ever been before.
14:07Through my community on social media, I've met a really good friend.
14:10I call her like my psoriasis sister, Brianna.
14:12Same name, same height, same age.
14:15And we just hit it off from the get-go.
14:17And she's just, yeah, my bestie.
14:21Hi!
14:22Hi! How are you?
14:25Very good to see you come inside.
14:27Oh, yes, it's freezing.
14:27How was your flight?
14:29It was good. It was really long.
14:31I've been wanting Brianna to visit me here in Canada.
14:33So Brianna hasn't really wanted to come to Canada because it's so cold and she's been worried about how that
14:38could affect her skin like it's affecting mine now.
14:40Also, tell me about your trip. How was it?
14:43Yeah, I was like, I don't know how you do it, dude. Like, it's freezing.
14:47Bri and I are psoriasis sisters and I know the cold can be really hard on you so with Bri
14:53out here I'm super worried about her with her joints and pain and I can't imagine that would be easy
14:58on anybody, especially somebody with a condition like that.
15:01Since it is like super cold out here, how have you been doing?
15:05Like my skin has completely like just spread and flared up.
15:09Yeah. Yeah.
15:10So I always try and be super body positive online and it's been a challenge because at some point I'm
15:16going to have to share that things aren't really that positive for me at the moment.
15:19I mean, have you, are you seeing anybody out here for it?
15:22I haven't been to a dermatologist or like a doctor in like four years.
15:27It's sort of got to the point now that I'm just very scared of, you know, not working out again.
15:31Yeah, I understand where she's coming from having frustration seeing doctors in the past that just don't really listen to
15:37you.
15:38But I really think she should see somebody and get a new perspective.
15:43It's been some time since you've been, there's new stuff out there, new doctors always have something different to offer
15:49too.
15:49So, I think it's a good idea, especially if you're going to be out here until who knows.
15:55Yeah, you're right. Maybe it's time to make the effort.
15:59I think, I think it'll be worth it. You should go.
16:01Would you come with me?
16:03I'd love to.
16:03Oh, I'm going to give you a hug.
16:18Social media has really changed the landscape of everything, I would say.
16:22Also, dermatology, for many reasons, it really helps people deal with skin conditions.
16:28They keep private to themselves and they realize that they're not alone.
16:32Building communities like that, you can really get to know people, share knowledge, and really kind of develop a family.
16:39And that is what is so wonderful about social media.
16:44I'll finally hear. I wonder how it's going to go.
16:49You guys can have a seat and Dr. Lee will be in shortly, okay?
16:54Well, hello you guys.
16:56Hi. How are you?
16:57I'm good with you.
16:58I'm Dr. Lee. It's very nice to meet you.
16:59Nice to meet you.
17:00What's your name?
17:00My name's Bri.
17:01Nice to meet you, Bri.
17:02And who do you have here?
17:03This is my best friend, Brianna.
17:05Oh, that's wonderful for you to come.
17:07Brianna, okay, so that's why you're maybe being Bri.
17:09Yeah.
17:10Well, nice to meet you guys.
17:12Welcome.
17:13I think I see what you're here for, huh?
17:17Yeah, so I've got psoriasis and I've had it for probably since I was like 12, but then it started
17:23getting bad when I was 15.
17:24Did you see anybody for it?
17:26I got treatment.
17:27They gave me different steroid creams.
17:29I've done tar ointment.
17:30I've done light therapy.
17:33I've tried everything.
17:34None of it worked.
17:42I'm here with Bri who has psoriasis and she really hasn't found any treatments that work, so hopefully we can
17:49find one for her.
17:51I was offered the biologic treatments and for me that long term I had a lot of worries about that.
17:56I just remember leaving very scared of the treatments.
17:58That's where I stopped treatment.
18:00But I do a lot of work online through my social media, raising awareness for my skin and showing positivity,
18:06telling yourself you're beautiful, you know, having a good mindset about life.
18:09Right.
18:10And showing people that you can still travel, you can still make beautiful friends.
18:13Yeah, so I found her Instagram because of the psoriasis stuff.
18:16Oh, okay.
18:17So I followed her and I was like, hey, we got the same name, like, psoriasisters, if you will.
18:21So you have psoriasis as well, is that correct?
18:24Yes, I do.
18:25But I'm doing pretty good right now.
18:28Okay.
18:29You know, for her to put up with psoriasis and not treating it for so long, but then changing her
18:33mind now, deciding that she's now ready for treatment, something must have changed here.
18:38Now I'm living in the snow in Canada, and that's been a lot harder for me.
18:42Do you think that your psoriasis affects you in more negative ways because of that?
18:46Is that what you're saying?
18:48Yeah, for sure.
18:49Weather can affect psoriasis.
18:50Sunlight can make psoriasis better.
18:53Living in colder weather causes you to cover up your skin, but you're also hiding your psoriasis from the sun.
18:59I'm not ashamed of it, but there is that underlying worry for me that when I get older, how bad
19:05it could get.
19:05I have joint problems, like sometimes if my skin's really flaring up and angry, bending up and down, moving my
19:11elbows.
19:12But side effects is a big question of mine.
19:14It's one of the reasons that I haven't made the jump to use biologics.
19:18Right.
19:18I'm young now and to think that I'd have to use something for the rest of my life.
19:24Yes.
19:24It's quite scary.
19:26Yes.
19:27Yes, it is.
19:27Bree has debilitating joint pain and it really affects her to the level that she's rethinking her beliefs on treatment
19:34options.
19:35We want to be the most aggressive with what we can do here.
19:38So not just a topical cream, but hopefully we can figure something out today.
19:42So let me take a look and see what you have here.
19:46Yeah, sure.
19:46You said it started on your elbows.
19:48You have more like a plaque type psoriasis, which means it's really kind of raised off the skin as opposed
19:54to a patch.
19:55The patch is pretty flat.
19:57And then your knees sort of have plaques, but these guttate plaques as well as just widespread plaques.
20:04So the way that we kind of quantify the severity or the extent of your psoriasis is using percentages.
20:11We say to make it easy that 1% is essentially like a handprint.
20:15So I would say it's probably like close to 50%, 40% of your body, a good amount of you,
20:23you know?
20:26So psoriasis, we still don't know exactly why people get it.
20:30We strongly suspect it's a disorder of inflammation.
20:34And the reason that they think this is because biologics are working.
20:37There's really some biologics now that can clear people up really quickly.
20:41And I know you have some concerns about long-term side effects.
20:44And I can't dispute that because we don't know what happens in 100 years from now.
20:50There are some risks for developing an infection easier and certain cancers.
20:58There are some biologics out now that don't have that risk.
21:04Biologics help to control inflammatory processes.
21:08This is a very competitive and lucrative business for pharmaceutical companies.
21:12And I think that it's going to benefit patients because they're going to get better at formulating these medications with
21:19less risk but more potential reward.
21:22So do you think you might want to try a biologic?
21:27This has always been a huge chunk of who I am.
21:32If this part of me is, you know, not there anymore, what can I replace that with?
21:37But now it's become more of a community of people.
21:39And I think it will give me a bigger space to help other people.
21:43To give them more information about what they can do and just have more space in my mind to do
21:47more for the community.
21:48Yeah.
21:49Yeah.
21:50I think when you see that, oh, I'm the same person.
21:53This is not, I'm not different.
21:55I just don't have my psoriasis.
21:56I don't have my joint pain.
21:58I think it's important for me just to see what my life is like without all of this.
22:02And actually I want to find a solution because I don't want people to feel pain.
22:06I mean, so many people are going to be following you and your progress too.
22:10Dr. Lee wants me to try biologics.
22:11I don't believe that my followers are going to feel any type of betrayal after they hear that I've chosen
22:16this route.
22:17I think a lot of people are going to be super happy for me.
22:20I'm ready to take it now because her explaining the process made me more comfortable to try today.
22:26So I'm not too nervous about it anymore.
22:28Nice to meet you.
22:29Nice to meet you.
22:30Nice to meet you.
22:31I'll be seeing you.
22:32I'll be seeing you guys online.
22:33Yeah.
22:43You ready?
22:44Yeah.
22:45Let's do this.
22:46My name is Beth.
22:48I'm 43.
22:49I'm from Dalton, Georgia.
22:50I have my sister here with me.
22:52And I have hundreds of bumps all over me.
23:02My name is Beth.
23:03I'm 43.
23:04I'm from Dalton, Georgia.
23:05I have my sister here with me.
23:07And I have hundreds of bumps all over me.
23:14I've had neurofibromatosis since birth.
23:17You can call it NF for short.
23:20The bumps are on my hands, my arms, my face, my chest, my toes.
23:27Everywhere.
23:28The one on my cheek is rather heavy, so it's pulled my ear down out of place and caused
23:33my ear canal to collapse.
23:35So I have a bit of hearing difficulties on that side.
23:38Having NF is, like, always feeling like the elephant in the room, really.
23:42Hi.
23:43Welcome.
23:43Hi.
23:44Here to see Dr. Lee today?
23:45Yes.
23:45I'm Beth.
23:47When I was five years old, I had my first surgery.
23:50It's from the age of five until, like, my late teens.
23:53If they tried to remove any of them, they would just grow back.
23:57And it's just, over the years, the bumps keep popping up and the one on my cheek just
24:02getting bigger and bigger.
24:04I've never went to a dermatologist before, mostly because I just never thought about it.
24:08Yeah, really, when you were younger, she only really saw a primary care physician
24:13and an ENT.
24:14I think I kind of slipped through the cracks of not knowing who was the right doctor to
24:18help with my condition.
24:21So close.
24:23So when Beth was younger, it didn't really seem to affect her as much.
24:28She was more outgoing.
24:31Now her confidence level has been affected by it.
24:35Beth is an amazing aunt.
24:37My son refers to her as his Beth.
24:40She's just got so much love, and I just want the world to know that and see that.
24:46The bump that bothers me the most is the one right under my lip, because it's probably
24:51one of the first things people will see, because, you know, I'm talking and so it draws attention
24:55to it.
24:57One of the worst incidents I've had of people look at me was I was called a monster by a
25:02little kid.
25:04It hurts to hear her talk about these things, because all of the things that she's dealt
25:09with for years.
25:11And she doesn't really, she doesn't talk about herself very much.
25:15She doesn't talk about her feelings.
25:18Let me see your hands.
25:20I never really paid attention to how much that one was right in there.
25:24My condition can be really uncomfortable because of the nerve pain.
25:29Because of the bump on my toe, I can't wear certain shoes.
25:33When I'm walking, it does get sore.
25:36One of the things I love is sewing.
25:39When I use my hands a lot sewing and stuff, my hands bump against the side of the machine,
25:43and that does hurt.
25:45And so I'm worried that the bumps are going to get in the way of the things I love.
25:50Hi, come on in.
25:52Hi.
25:52We're going to be going straight back to room six.
25:54Hi.
25:55I don't want to live in constant pain anymore.
25:57I feel like the conditions ruined my life because it's just holding me back from so much.
26:03Dr. Lee will be in shortly, okay?
26:06Thank you so much.
26:06No problem.
26:07I hope Dr. Lee can just do any amount of anything to help me because any little relief
26:14from this would be just a weight lifted for me.
26:17Life changing.
26:18Yeah.
26:28Hello, guys.
26:29I wanted to ask if you have that scan.
26:31Let me check.
26:32Okay.
26:33Perfect.
26:34Here it is.
26:36All right.
26:37Looking pretty good.
26:37Hey.
26:38Hey, Dr. Lee.
26:39Hey, how are you?
26:40Nice to see you.
26:41Good to see you as well.
26:43Very good.
26:43How are you?
26:44I'm good.
26:45Thank you for coming in again.
26:46Dr. Tomasina is really looking to get more variety and more experience under his belt.
26:50I learn from doctors that come to visit me and in turn, hopefully I can pass something
26:55on to him.
26:55How are things going?
26:56How is your office doing?
26:57No complaints.
26:58You're working pretty hard and you're building it and things are going well?
27:01I'm trying, yeah.
27:01So I have a patient for you today who I think is going to be very interesting.
27:06You're going to see in just a second.
27:07Let's go.
27:08I'm excited.
27:11Hi.
27:12Nice to see you.
27:13I'm Dr. Lee.
27:14How are you doing?
27:15Beth, this is Dr. Tomasian.
27:16Good to meet you.
27:17Dermatologist who works in our area.
27:19And I'm Sandra.
27:20I'm Annie, Beth's sister.
27:21Nice to meet you guys.
27:23Thanks for coming along too.
27:24Yeah, that's really lovely.
27:26So I thought if you don't mind.
27:28No, not at all.
27:28Join me and we kind of, it's kind of showing in my way so I can retire and live on.
27:33Just kidding.
27:35But what's going on?
27:36I have neurofibromatosis type one.
27:39Okay.
27:39I was diagnosed at five years old.
27:42They did like a surgery to kind of figure out what I did.
27:46Well, what did you have that made them?
27:48Like a little puffy cheek.
27:50It always stayed like swollen.
27:51Oh, okay.
27:51This cheek.
27:52Yes, my left one.
27:54That's definitely a first.
27:55And it's not what I expected.
27:57That's a massive neurofibroma.
27:59It's in a risky area.
28:01And I don't think we could do that in the office.
28:08I have neurofibromatosis type one.
28:11Okay.
28:11I have Beth here who has NF1, which is a condition where you present with a lot of benign tumors
28:18on your skin that are composed of nerve tissue.
28:21I have Dr. Tomasian here.
28:22And I think that this is a good opportunity to kind of show him what dermatologists can
28:27and can't do to help a patient with a condition like this.
28:30I think this neurofibroma, you can depop, but the concern right here is there's a lot of important vessels and
28:40nerves.
28:40I mean, obviously this is where it all connects to your head, your brain, right?
28:45Yeah.
28:45This is too complicated for us to do in an office setting like this.
28:49Oh, yeah.
28:49This is probably like more ENT.
28:52Yeah.
28:52The doctor monitored it.
28:54About five, he decided to do surgery.
28:57At five years old?
28:58Yeah, to do like a debulking surgery.
28:59Got it.
29:00Why did they stop surgery to help debulk it at age 10?
29:03She aged out of her parents' insurance.
29:05So for years, she didn't go to any doctors.
29:08I want to see whether other things might bother you and what might be something that we think that we
29:14can help you with as well.
29:15There's the big one on my toe that certain shoes push on it.
29:18Oh, okay.
29:18And it hurts.
29:19Yeah.
29:20And the ones on my hands, I love to do crafts and stuff.
29:24Especially sewing.
29:25Me too.
29:25Yes.
29:25And threading my machine, I'm always like, especially this one banging it against the side of the machine and that
29:31really hurts.
29:32This plexiform neurofibroma that she has, it's not really something that you can do in the office setting.
29:38But I think that it's very important to show Dr. Tomasian that even though we can't help her with the
29:42large one she has on her cheek,
29:44we can help her with some of these other things that equally cause her distress and pain.
29:51So this one right here, I would probably prefer to excise that one because I think it'll leave a little
29:56indentation there.
29:57This one right here, we could shave it off because it's actually a part of the body like that has
30:02a dip in it.
30:03If it has a little dip in it there, that's no problem.
30:05Yeah.
30:06It's normal that way.
30:06Yeah.
30:07And this one, you know, most of us make it.
30:10Yeah.
30:10It's right there on my face where everybody looks when I'm talking and stuff.
30:15Yeah.
30:16Yeah.
30:16I think that one you can certainly just shave that one off.
30:19And then there's one on your toe.
30:21Did you want to show it to me?
30:22Yeah.
30:23All over my feet right there.
30:25Oh, it's like covering over your toe now.
30:27Yeah.
30:27It hurts.
30:28It still pushes on it for too long or, you know, I'm walking and it just rubs back and forth.
30:32Yeah.
30:34I mean, this one I feel like because I see it's like right across your proximal nail fold here.
30:39I would try to enucleate it and leave that and sort of take a little of this off and just
30:44sew it to the end, like try to take it out from inside and like kind of flop it back
30:48over again.
30:48We might not get the whole thing, but, you know, if we can get it smaller, that'd be nice.
30:52Any bit you can do, I'd be grateful for.
30:53Yeah.
30:53Okay.
30:54I want it to improve your functioning, but also make it look more aesthetically pleasing.
30:58He's going to help us to speed us up.
31:00It's either that or it's going to slow us down.
31:02I'm pretty fast.
31:03Okay.
31:04I'm still kidding.
31:05I do that only to people I love.
31:06Yeah.
31:07All right.
31:07So we got our work cut out for us.
31:08We got to get everything ready.
31:10So we'll be back in just a bit.
31:11Okay?
31:11All right.
31:12Let's do it.
31:13No problem.
31:15Right now I'm more anxious than anything because, you know, it's something I've been waiting for.
31:19But my greatest fear at this point is something, you know, might not go as planned and then it might
31:25look worse than it did before.
31:30Are you okay with him putting a little numbing on that side?
31:33Yeah.
31:34Why don't you try that?
31:35Dr. Tomas.
31:36Yes.
31:36We're going to remove four NFs.
31:39One on the face that I'm going to shave off.
31:41Another one on the hand that I'm going to shave off.
31:43But the other one, which I think kind of dives down deeper on her hand, we're going to excise.
31:48And then we're going to address the one on her big toe.
31:50For all of them, I really want to get as much of the NF tissue I can, but not leave
31:54an indentation, certainly.
31:56And here's the first tip for Dr. Tomasian.
31:58One of my pet peeves when I see people remove things like this is they use their tweezers and they
32:04pick it up.
32:05Mm-hmm.
32:06And I don't like that because you automatically leave a divot.
32:11Mm-hmm.
32:12So I will stretch it and sort of trim it that way.
32:17Now these neurofibromas might like sort of pop out a little bit.
32:20So that's the issue there too.
32:27I don't lift it and you can see how it herniates it.
32:30So on the edges, if they're rolled up a little, I'll kind of sculpt them a little.
32:35I'm going to have you remove that one too.
32:37And then you can glove up here.
32:38Perfect.
32:38Like, let's do that.
32:39The cheek was pretty straightforward and since Dr. Tomasian has seen the way that I like to cut and cauterize
32:45and NF,
32:46I'm going to let him do the other one on her hand.
32:51Bet you never thought you'd be double teamed like this when you were coming.
32:56Working side by side with Dr. Li is amazing.
32:58Not only am I learning what she's doing, but she has the trust in me to work on the patient
33:02as well.
33:02And it's a really cool experience to have both those aspects of surgery.
33:08Dr. Li.
33:08Yeah.
33:10Her neurofibroma is like pretty in there.
33:13I would just check the top because if you buzz it, you'll shrink some of it too.
33:17Do you know what I mean?
33:17Because I'm trying to make it look aesthetically pleasing.
33:20I'm not trying to necessarily remove the whole neurofibroma unless they're like these sub-Q ones or these normal ones.
33:27I love that Dr. Tomasian is asking questions because it shows that he is cognizant of doing just enough.
33:34Neurofibromas on the skin can sometimes dive down pretty deep and he's really encountering one.
33:38It doesn't seem like there's an ending to it, but there's an important point where you know where to stop.
33:43Is it okay?
33:43Yes.
33:44Okay.
33:48This is not going to want to come out without a fight.
33:51I'm kind of making a smaller hole to take this out of, but I got to keep the pieces too.
33:56I'm able to pull this neurofibroma up and pull it away from the skin so I can get underneath it
34:00and try to take the whole thing out.
34:02That looks great.
34:03I think that's going to heal fantastically.
34:05And I think this one looks pretty good too.
34:09If you could stitch up the hand please, I'm going to start on the toe.
34:13As Dr. Tomasian is finishing up the sutures on her right hand, I'm going to start tackling the toe.
34:18This growth on her toe is right over the nail matrix.
34:21And so that's where actually all the cells are that produces the nail.
34:24So I have to make sure I'm not going deep enough to really traumatize that nail matrix.
34:28Because if that happens, that can be permanent and she's not going to like that.
34:35Okay, so what kind of neurofibroma do we have going on here?
34:42I'm just going to slowly debulk it and see.
34:48Look at those bundle of nerve cells there.
34:58What kind of neurofibroma do we have going on here?
35:01I'm just going to slowly debulk it and see.
35:08Look at those bundle of nerve cells there.
35:12A little bit of vessels there.
35:16I don't like to blindly just cut places, you know?
35:19I'm here with the dermatologist Dr. Tomasian.
35:22We're here with Beth and I've removed three of our neurofibromas.
35:26And I'm working on the one on her toe.
35:29And it's proving to be difficult.
35:31I just want to get this annoying little vessel that wants to ooze on us.
35:36You're going to debulk more there?
35:40Actually, no.
35:41We took out an amount there, not a huge amount.
35:44I just want to make this flatter and pulled off of your nail a little bit.
35:49You don't want to go that deep there.
35:51Yeah.
35:52For my years of experience, I feel like it's best to try to debulk it just enough in this case.
35:58Because I know there's a nail matrix under there and you don't want to damage your toenail.
36:02So I'm going to put a deep stitch in and I'm going to pull it up a little bit here.
36:06I think that's going to be pretty good.
36:09I'll try to sew that a little bit.
36:11I think that's like important though is knowing when to stop too.
36:14Yes, yes.
36:15Because again, you remind yourself, you don't want to create more problems.
36:19When I looked at it, I thought there was potential to debulk a little bit more.
36:23And Dr. Lee said, probably not a good idea.
36:26There's important structures.
36:27She knows when to stop.
36:29So you get a great result and not cause any complications to your patient.
36:35I think we did okay here.
36:37I think it was really pretty kind of stuck to you that we could debulk it.
36:41I just don't want to affect any of the important stuff that goes on right under it.
36:44I think overall we did a pretty nice job.
36:46It was great to have Dr. Tomasian work with me and we removed the ones that really bother her.
36:52And that's going to make her life better.
36:53Do you want to see your hand a little bit?
36:55Did you see it already?
36:56I don't really.
36:57There's her hand there.
37:00There's your...
37:01Okay.
37:02Oh wow, yeah.
37:02That's nice, huh?
37:03That would be really nice.
37:04I think because I know how much that bothered you.
37:06It was on your face that I realized, let's just put like a couple of little stitches in there.
37:10Yeah.
37:10That'll make it nicer.
37:11And then you saw the other hand.
37:14Let me see.
37:14I think that's the one that we took a little shave off, so.
37:18And then your toe, do you want to lift up your foot to see?
37:21Oh wow, yeah.
37:22That's way better.
37:24I feel amazing.
37:27Dr. Lee removed the bump on my toe.
37:30And that to me is just a big deal because I won't have any more pain.
37:34Now I can wear all kinds of other shoes that I hadn't been able to.
37:39The bumps on my hands, they're gone.
37:42And so now I'm going to be able to maybe just craft all night if I want to.
37:48The one that was on my chin is going to have the biggest impact.
37:53I feel like sometimes when I'm talking to people, they were looking at it and not me.
37:58You know, they can look at me.
38:01Thank you guys.
38:02Bye.
38:03Bye-bye.
38:04My only regret is that I wish I would have done this sooner or knew I could.
38:09Dr. Lee was really today like a superhero to me.
38:13He just came in and saved my day.
38:22It's been three months since I saw Beth and she is so happy.
38:31Since Dr. Lee removed the bump on the back of my hand, it's so much easier to sew.
38:36Her hand is so much more comfortable and she has been sewing up a storm.
38:45She can wear sneakers a lot easier now that the NF on her big toe has been shaved down.
38:52Are those cute?
38:53Yeah.
38:54Are they comfortable?
38:55Yeah.
38:56Beth, you are so beautiful and it's such a pleasure to know you.
39:00Good luck with everything.
39:03It's been three months since I saw Dave and his cute pilar cyst and his head is looking perfectly round.
39:13Hi, it's Dave.
39:14And I'm about here on the trail, Dr. Lee.
39:17Wearing my helmet is so much more comfortable now.
39:20I don't have any more pain.
39:22It fits comfortably on my head.
39:25I'm so grateful to find out that the cyst was not cancerous and he's doing great.
39:30He's out riding his bike all the time.
39:33His firefighter helmets and his bike helmets fit perfectly on his head and he can wear them comfortably for hours.
39:39It fits a lot snugger and it's not putting so much stress on my head.
39:44Thank you for fighting all those fires for us, Dave, and happy cycling.
39:58It's been two and a half months now since I've seen Dr. Lee and my psoriasis is practically gone.
40:08I'm so stoked about the results.
40:11So far I've had two biologic shots and I haven't had any side effects at all.
40:16Now I know that it's an option there and I can stop and start whenever I feel.
40:20You go, chickens!
40:22My joint pain's gone down at least 80% and it means that now when I'm on the farm I
40:28can do a lot more lifting.
40:29It's given me so much freedom.
40:31It's changed my life.
40:35Hi everyone, so I've got some really big news to share with you.
40:38I actually started Biologics and I'm so happy that I did.
40:41I've been sharing my journey with my online community as well.
40:44Anyone who is considering using Biologics definitely see a dermatologist and talk about their options.
40:48Despite my beliefs of people being able to accept their skin, I still don't want people to be in pain.
40:55I think it's important for them to seek comfort and I can't wait for more people to see my message.
41:01How's it going?
41:02I have to show you my skin.
41:03My psoriasis sister Brianna, it's pretty awesome to be able to see how happy she is for me.
41:08Wow.
41:08Right?
41:09That works so fast too.
41:11Because of Dr. Lee, I'm in total control of my own skin for once in my life.
41:14Psoriasis truth!
41:16For life!
41:16Don't only mind im shall be magic.
41:17My psoriasis truth!
41:19Sure!
41:19Because of Dr. Lee was in low剛剛 the pandemic, everything that looks alsoackenclclangsup saw
41:19For life toам a serving Heavenly doctor and student in my husband, our baby,
41:19Theless mejores is familiar and aquele and how our society needs to be seen in the world.
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