Skin spots to look out for

Dr. Scott's Skin Spot Screening Spiel

Many people look at their skin and wonder "what the heck is that"?

Skin spots are normal for most people, some part of normal aging and some as a reaction to sun exposure.

The most common and harmless ones to see pop up are benign moles a.k.a. Nevi, little red dots called cherry angiomas and seborrheic keratoses which are lovingly called "senile barnacles" by some. These don't need anything done to them if they don't bother you.

The next step up are actinic keratoses which are pre-cancerous skin spots. They feel like rough, mostly flat areas usually on the head and arms/hands. These are easily gotten rid of with liquid nitrogen cryotherapy in clinic if there are just a few or a topical chemotherapy cream if there are a bunch.

Past that, the big things to look for are called the ABCDE's.

Asymmetry (good moles are generally nice and symmetric)
Borders (good moles you can usually tell right where they start and stop)
Color (multicolored usually isn't good)
Dimensions (try to keep them smaller than a pencil eraser)
Evolving (changing in size, shape, color, bleeding or itching)

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen). Those are the over-the-counter ones. Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on. All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation. However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock. every other organ system that you have. The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before. For women who have had children, they generally know what a 10 is, but for men it's a little harder. When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?" The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth. The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...

Pain

Sorry to be a pain I would say about 90% of the comments I hear from people about their pain threshold is that they think they have a high pain tolerance. Which is statistically impossible unless I just attract people who have a high pain tolerance. We traditionally ask people to rate their pain on a 1-10/10 scale and while we hear a lot of 9's and 10's, I would say that, having been present for a number of them, a 10/10 would be giving birth to a first child. For those who haven't experienced that, my old psychiatry resident described it as "so if I lit you on fire and ran you over with my truck, you would not be in any more pain than you are now" (he was also a former Marine sniper which might explain that). But this is pretty pervasive throughout the medical system and got me wondering as to how people's understanding of what their pain threshold was matched up to what it really was. Fortunately, there were researchers who had a yen to poke peopl...

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