- 7 hours ago
dr pimple popper breaking out Episode 11 Engsub
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00:00The following program contains medical procedures and treatments involving dermatology. Viewer discretion is advised.
00:05I'm Dr. Sandra Lee, a.k.a. Dr. Pimple Popper.
00:08Pretty sure that was the coolest thing I've ever seen.
00:11Come break out with me and all my new patients.
00:14Plus, I'll share my expertise with some amazing young dermatologists.
00:18Pimple popping is not taught in residence.
00:21We'll see how they break out, seeing things they have never seen, and of course, see how they pop.
00:29I can't believe it's not butter on Dr. Pimple Popper Breaking Out.
00:37Red flaky patches, head to toe.
00:41It's just really painful.
00:44I really thought it would just go away, but it's growing bigger.
00:48The bumps are on my hands, my arms, my face, my chest, my toes, everywhere.
00:54To think that I'd have to use something for the rest of my life, it's quite scary.
01:00Yes, and I can't dispute that.
01:03I'm not scared of fighting wildland fires, but I'm scared of needles.
01:07The concern was there's a lot of important vessels.
01:10Oh my God.
01:12You just had a macadamia nut.
01:35My name is Dave.
01:36I'm 58 years old.
01:37I'm from Bakersfield, California.
01:39My name is Robin, and I'm Dave's girlfriend.
01:41There we go.
01:43I'm a wildland firefighter, and I have a bump on my head.
01:49My bump is the size of between a larger size marble and a golf ball.
01:55It moves around on the top of my head.
01:57It's kind of squishy.
01:59It's sore and painful.
02:02I noticed this 15 years ago.
02:06I thought it would just go away, but then over the past few years, it's growing bigger.
02:14About three years ago, I went to a doctor, and they just kind of brushed it off, thinking
02:21it would go away, but then it's, you know, it's not going away.
02:25I haven't been to another doctor since.
02:28I haven't been able to find the right type of doctor that has the passion to give me the
02:33right answers for what I have going on on top of my head.
02:38All right.
02:39The trail's right over here.
02:42You know?
02:43Yeah.
02:43Looks 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.
02:59That's my, like, yoga.
03:00It's my getaway.
03:02It's very calming.
03:05Such a beautiful place.
03:08I think it's really nice.
03:12Okay, slow down a little bit.
03:14Okay, we're going to have to stop here.
03:20Yeah, it's starting to bother me a little bit.
03:22It's killing me here.
03:24Yeah.
03:25Just with the helmet on, it's just bothering it really bad.
03:29Yeah.
03:29Yeah, you don't need to be in pain.
03:31All right, let's go.
03:33All right.
03:36The bump on my head is growing, and now I can't even wear a bike helmet anymore without pain.
03:42I 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.
03:59It's just a passion.
04:01I 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 has affected my firefighting because the straps on my helmet are pressing down on
04:21my bump, and 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,
04:59it's not a big deal.
05:00It's really difficult to find those doctors who take you seriously.
05:03And I know we all do that.
05:05We procrastinate.
05:06But what's going to happen if something bad happens and it's cancer?
05:10You know, I mean, that's why it's so important to get this taken care of now.
05:17I feel that a doctor should take some passion in trying to treat a person instead of just
05:23trying to blow 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
05:34or something of that sort.
05:45I'm nervous because of just the uncertainty of what this is.
05:49What if I am already too late at this point?
05:55Oh, hi.
05:56Hey.
05:57Hello, guys.
05:58How are you?
05:58I'm Dr. Lee.
05:59Dave.
05:59Nice to meet you.
06:00Nice to meet you.
06:00Nice to meet you.
06:01I'm Robin.
06:02Hi.
06:02Nice to meet you guys.
06:03My girlfriend.
06:04Welcome.
06:04Are you guys from California?
06:05Yes.
06:06Yeah.
06:06Ah, okay.
06:07From Bakersfield.
06:08Oh, okay.
06:09How 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.
06:25And I never thought anything of it.
06:27I just always thought, ah, it's just a bump, you know, maybe it'll go away.
06:30Right.
06:30But, you know, I'm also a wildland firefighter.
06:32So having the helmet on my head is starting to get a little sore, a little painful from having...
06:39Right, 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.
06:46Thank you.
06:47For sure.
06:47So thank you.
06:48In 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.
07:00I'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.
07:05Right, right.
07:05And I'm like, my father had bladder cancer, my sister had breast cancer, and it's not like,
07:10I just, you know, getting a little bit more concerned about it.
07:13Okay.
07:14Okay.
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.
07:25Your cowlick is just right behind it.
07:26Oh my gosh.
07:28So, I do think this is a pylor cyst because it moves around pretty well.
07:34Yeah.
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.
07:42Yeah.
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
07:47of problems.
07:48That's good to find out.
07:49Okay.
07:49It's a cyst instead of something.
07:51I think so.
07:52That's what I think it is.
07:53But I can't tell you for sure until I actually do the surgery and I see it.
07:57Okay.
07:58That's one step and I go, okay, this very much looks like a pylor cyst.
08:01Okay.
08:01So when you.
08:02Yeah.
08:02But the next step too is I send it to dermatopathologist who 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.
08:15And that's really interesting from my perspective because he is under extreme circumstances
08:21on 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
08:44vessels.
08:46All right.
08:46Let me go get ready.
08:47Okay.
08:48So we can get that knot off your head.
08:49Well, thank you so much.
08:50Of course.
08:50I'll be back.
08:51Okay.
08:53This is going to be the hard part, dealing with the needles.
08:58My biggest fear is I'm not scared of fighting wildland fires, but I'm scared of needles.
09:04You ready?
09:08Oh boy.
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?
09:22Needles.
09:22I'm here with Dave and his lovely girlfriend, Robin, and he's got a pilar cyst on the top
09:27of his head.
09:28I'm going to make sure that I numb this up really well, and I'm discovering that he's
09:32pretty scared of needles.
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.
09:52Timid.
09:54Sorry.
09:54I'm sorry.
09:55I'm sorry.
09:56It was a little joke.
09:57One of my best tactics for distracting patients is jokes, and I can already see David calming
10:02down a little bit.
10:03My main concern now is addressing the pilar cyst 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
10:13difficult.
10:14All right.
10:15So 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 pilar cyst.
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.
10:41It's just...
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 pilar cyst, it really came
10:57out very nice.
10:58Now I'm going to stitch him up and he should be ready for action.
11:00Want to see the cyst?
11:02Yes.
11:03You guys, are you guys okay with that?
11:04Yeah.
11:04Oh my gosh.
11:06Are you kidding me?
11:08That's it?
11:09You'll test that to see if there's any...
11:11Oh, 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.
11:28You know, I can put that all behind me.
11:31Thanks for being here.
11:32I'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.
11:52All right.
11:52Sounds 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.
12:02All right.
12:02And 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, right.
12:35And just go right along this side here.
12:37My main job is helping out at a farm.
12:39But with the cold climate here, my skin can just flare up at any moment.
12:44And so moving my joints is so painful.
12:47Lifting hay, feeding animals, it's something that I really, really, really struggle with
12:52on 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.
13:04My parents brought me to see a doctor and I was diagnosed with psoriasis.
13:10They 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
13:28a lot of shame, but 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
13:43to show people that 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!
14:22How are you?
14:24It's so nice to see you.
14:25It's so good to see you come inside.
14:27Oh yes, it's freezing.
14:27How was your flight?
14:29It feels good.
14:30It was really long.
14:31I've been wanting Brianna to visit me here in Canada, so Brianna hasn't really wanted to
14:35come to Canada because it's so cold and she's been worried about how that could affect her
14:38skin.
14:39Like it's affecting mine now.
14:40Also, tell me about your trip.
14:42How was it?
14:43Yeah.
14:44Yeah.
14:44I was like, I know how you do it, dude.
14:46Like it's freezing.
14:48Bri and I are psoriasis sisters and I know the cold can be really hard on you so with
14:53Bri out here I'm super worried about her with her joints and pain and I can't imagine
14:57that would be easy on anybody, especially somebody with a condition like that.
15:02Since 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.
15:09Yeah.
15:10So I always try and be super body positive online and it's been a challenge because at
15:16some point I'm going to have to share that things aren't really that positive for me
15:19at the moment.
15:20I mean, 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
15:31out again.
15:32Yeah.
15:32I understand where she's coming from having frustration seeing doctors in the past that
15:36just don't really listen to you, but I really think she should see somebody and get
15:41a new perspective.
15:43Yeah.
15:44It's been some time since you've been.
15:45There's new stuff out there.
15:47New doctors always have something different to offer too.
15:49So, yeah, I think it's a good idea, especially if you're going to be out here until who knows.
15:55Yeah, you're right.
15:57Maybe it's time to make the effort.
15:59I think it'll be worth it.
16:01You should go.
16:02Would you come with me?
16:03I'd love to.
16:04Oh, 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 they
16:28keep 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
16:37kind of develop a family.
16:39And that is what is so wonderful about social media.
16:44I'm finally here.
16:45I 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.
16:57How are you?
16:57I'm good.
16:58How are you?
16:58It's very nice to meet you.
17:00Nice to meet you.
17:00What's your name?
17:01My 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.
17:08So that's why you're maybe being here.
17:10Yes.
17:11Well, nice to meet you guys.
17:13Welcome.
17:13I think I see what you're here for, huh?
17:17Yes.
17:17I've got psoriasis.
17:18Okay.
17:19And I've had it for...
17:20Okay.
17:21Probably since I was like 12.
17:22But then it started getting 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.
17:31I've done light therapy.
17:33I've tried everything.
17:34None of it worked.
17:42I've tried everything.
17:43None of it worked.
17:44I'm here with Bri, who has psoriasis.
17:46And she really hasn't found any treatments that work.
17:48So hopefully we can find one for her.
17:51I was offered the biologic treatments.
17:53And 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.
18:03Oh, okay.
18:03Raising awareness for my skin and showing positivity.
18:06Telling yourself you're beautiful.
18:07You know, having a good mindset about life.
18:09Right.
18:10And showing people that you can still travel.
18:12You can still make beautiful friends.
18:13Yeah, so I found her Instagram because of the psoriasis stuff.
18:17Oh, okay.
18:17So I followed her and I was like,
18:18Hey, we got the same name.
18:19Like, psoriasisters, if you will.
18:22So 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,
18:33but then changing her mind now, deciding that she's now ready for treatment,
18:37something must have changed here.
18:39Now 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 when they get more negative waves because of that?
18:47Is that what you're saying?
18:48Yeah, yeah, for sure.
18:49Weather can affect psoriasis.
18:51Sunlight can make psoriasis better.
18:53Living in colder weather causes you to cover up your skin,
18:57but you're also hiding your psoriasis from the sun.
18:59I'm not ashamed of it, but there is that underlying worry for me,
19:03that when I get older, how bad it could get.
19:05I have joint problems, like sometimes if my skin's really flaring up and angry,
19:09bending up and down, moving my elbows.
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.
19:19I'm young now, and to think that I'd have to use something for the rest of my life,
19:24it's quite scary.
19:26Yes, yes, it is.
19:27Bree has debilitating joint pain, and it really affects her to the level
19:31that she's rethinking her beliefs on treatment options.
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,
19:51which means it's really kind of raised off the skin as opposed to 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,
20:24you 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.
20:59There are some biologics out now that don't have that risk.
21:04Biologics help to control inflammatory processes.
21:07This is a very competitive and lucrative business for pharmaceutical companies.
21:12And I think that it's going to benefit patients
21:15because they're going to get better at formulating these medications
21:19with less 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
21:45and just have more space in my mind to do more for the community.
21:49Yeah.
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.
21:57I 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
22:14after they hear that I've chosen this route.
22:18I 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.
22:25So I'm not too nervous about it anymore.
22:27Thank you.
22:28Nice to meet you.
22:30Nice to meet you.
22:30Nice to meet you too.
22:31I'll be seeing you.
22:32I'll be seeing you guys online too.
22:33Yeah.
22:34Yeah.
22:44You ready?
22:45Yeah.
22:46Let's do this.
22:47My name is Beth.
22:48I'm 43.
22:49I'm from Dalton, Georgia.
22:50I have my sister here with me and 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 and 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 my
23:34ear canal to collapse so 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.
23:46I'm Beth.
23:47When I was five years old I had my first surgery.
23:51From the age of five until like my late teens, if they tried to remove any of them they would
23:55just grow back and it's just over the years the bumps keep popping up and the one on my
24:02cheek just getting bigger and bigger.
24:03I'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 and an
24:13ENT.
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.
24:39She's just got so much love and I just want the world to know that and see that.
24:47The bump that bothers me the most is the one right under my lip because it's probably one
24:51of 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 and 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.
25:25My 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.
25:51Hi, come on in.
25:52We're going to be going straight back to room 6.
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?
26:05Thank you.
26:05Thank 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.
26:29Hi.
26:29I wanted to ask if you have that scan.
26:32Let me check.
26:32Okay.
26:33Perfect.
26:34Here it is.
26:35Thank you.
26:36Alright, looking pretty good.
26:38Hey.
26:38Hey Dr. Lee.
26:39Hey, how are you?
26:40Nice to see you.
26:41Good to see you as well.
26:42How are you?
26:43Very good.
26:44How are you?
26:44I'm good.
26:45Thank you for coming in again.
26:46Dr. Tomasin is really looking to get more variety and more experience under his belt.
26:51I 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.
27:02So 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.
27:08Let's go.
27:08I'm excited.
27:12Hi.
27:12Nice to see you.
27:13I'm Dr. Lee.
27:14How are you doing?
27:15I'm doing good.
27:15Beth, this is Dr. Tomasian.
27:16Hi.
27:17Good to meet you.
27:17The dermatologist who works in our area and I'm Sandra.
27:20I'm Annie, Beth's sister.
27:21Oh, very nice to meet you.
27:22Nice to meet you.
27:23Thanks for coming along too.
27:25Yeah, that's really lovely.
27:26Thank you.
27:26So I thought if you don't mind.
27:28No, not at all.
27:28You could join me and we kind of, it's kind of showing in my way so I can retire and
27:32live
27:32on my own.
27:33Just kidding.
27:34But 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 swollen.
27:51Oh, okay.
27:51This cheek.
27:52Yes, my left one.
27:54That's definitely a first and it's not what I expected.
27:57That's a massive neurofibroma.
27:59It's in a risky area and 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
28:19on your skin that are composed of nerve tissue.
28:21I have Dr. Tomasian here and I think that this is a good opportunity to kind of show him what
28:26dermatologists can and can't do to help a patient with a condition like this.
28:30I think this neurofibroma, you can debulk.
28:35But the concern right here is there's a lot of important vessels and nerves.
28:41I mean, obviously this is where it all connects to your head, your brain, right?
28:45This is too complicated for us to do in an office setting like this.
28:49This is probably like more ENT.
28:51Yeah.
28:53The doctor monitored it.
28:54About five, he decided to do surgery.
28:57At five years old?
28:58Yeah, to do like a debulking surgery.
29:00Got it.
29:00Why did they stop surgeries to help people get at age time?
29:03She aged out of her parents' insurance.
29:06So for years, she didn't go to any doctors.
29:09I want to see whether other things might bother you and what might be something that we think
29:13that we can help you with as well.
29:15There's the big one on my toe that certain shoes push on it.
29:18Oh, okay.
29:19And it hurts, yeah.
29:20And the ones on my hands, I love to do crafts and stuff.
29:24Especially sewing.
29:25Me too, yes.
29:26And threading my machine.
29:27I'm always, especially this one, banging it against the side of the machine and that really 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
29:43large 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 it's, I think it'll leave a
29:56little indentation 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 looks normal that way.
30:07And this one, you know, it most of us make it.
30:10Yeah, it's right there on my face.
30:12The way 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?
30:23Yeah.
30:23All over my feet.
30:24Right there.
30:25Oh, it's like covering over your toenail.
30:27Yeah.
30:27It hurts.
30:28It still pushes on it for too long.
30:30Or, you know, I'm walking and it just rubs back and forth.
30:33Yeah, I 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.
30:45Like try to take it out from inside and like kind of flop it back over 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.
30:54Okay.
30:54I want it to improve your functioning, but also make it look more aesthetically pleasing.
30:59He'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.
31:12Thank you.
31:15Right now I'm more anxious than anything because, you know, it's something I've been waiting
31:19for, but my greatest fear at this point is something, you know, might not go as planned
31:24and then it might look worse than it did before.
31:30Are you okay with him putting a little numbing on that side?
31:34Yeah.
31:34Why don't you try that?
31:35Dr. Tomasi knows.
31:36We're going to remove four NFs, one on the face that I'm going to shave off,
31:41another one on the hand that I'm going to shave off, but the other one, which I think
31:44kind 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,
31:55certainly.
31:56And here's the first tip for Dr. Tomasi.
31:58One of my pet peeves when I see people remove things like this is they use their tweezers
32:04and they pick it up.
32:06And I don't like that because you automatically leave a divot.
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.
32:37Okay.
32:37And then you can glove up here.
32:38Like let's do that.
32:40The cheek was pretty straightforward.
32:41And since Dr. Tomasi has seen the way that I like to cut and cauterize and NF, I'm going
32:46to let him do the other one on her hand.
32:51I bet you never thought you'd be double teamed like this.
32:56Working side by side with Dr. Lee 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.
33:03And it's a really cool experience to have both those aspects of surgery.
33:08Dr. Lee?
33:09Yeah.
33:10Her neurofibroma is like pretty in there.
33:13I would just take the top because if you buzz it, you'll shrink some of it too.
33:17Do you know what I mean?
33:18Because 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
33:25ones or these thermal ones.
33:27I love that Dr. Tomasian is asking questions because it shows that he is cognizant of doing
33:32just enough.
33:34Neurofibromas on the skin can sometimes dive down pretty deep and he's really encountering
33:37one.
33:38It doesn't seem like there's an ending to it, but there's an important point where you know
33:41where to stop.
33:43He's okay?
33:44Yes.
33:44Okay.
33:48This is not going 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
34:00it and 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.
34:10If 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
34:17the toe.
34:18This growth on her toe is right over the nail matrix and so that's where actually all the
34:23cells are that produces the nail.
34:24So I have to make sure I'm not going deep enough to really traumatize that nail matrix
34:29because 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.
34:47Uh oh, look at those bundle of nerve cells there.
35:12A little bit of vessels there.
35:16I don't like to blindly just cut in places, you know?
35:19I'm here with the dermatologist Dr. Tomasian.
35:22We're here with Beth and I've removed three of her neurofibromas and I'm working on the
35:28one on her toe and 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, we 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.
35:52From 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.
36:27There'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 her.
36:44I think overall we did a pretty nice job.
36:47It 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.
36:54Do you want to see your hand a little bit?
36:55Did you see it already?
36:56Oh, really?
36:57There's her hand there.
37:00There's your...
37:01Okay.
37:01Oh, wow.
37:02Yes.
37:02That's nice, huh?
37:03That would be really nice.
37:04I think because I know how much that bothered you and was on your face that I realized,
37:08let's just put like a couple of little stitches in there.
37:10That'll make it nicer.
37:12And then you saw the other hand.
37:14Let me see.
37:14I think that's the one that we took a little shave off.
37:18And then your toe, do you want to lift up your foot to see?
37:21Oh, wow.
37:22Yes.
37:23That's way better.
37:24I feel amazing.
37:27Dr. Lee removed the bump on my toe and that to me is just a big deal because I won't
37:33have
37:34any more pain.
37:35Now 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.
37:48Thank you.
37:49The 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.
38:02Thank you.
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.
38:59Good 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 and 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.
40:17Now I know that it's an option there and I can stop and start whenever I feel.
40:21You 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 Biologix 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 Biologix, 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.
41:04My 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!
41:17So visiting me!
41:19Gracias.
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