fun with unpronounce-able diagnoses

another week, another profoundly good time spent here in bend...i could seriously get used to being here non-stop, although sometimes i worry that since we're packing it all in now, what would be left to do if we actually moved here?? explore the many hundreds more hiking and biking trails, lakes, and secret spots i guess. or maybe have the cash to actually go and experiment the culinary wonders of central oregon, etc etc.
employment still seems a world away, so now is the time to savor whatever relative freedom i have. so far, it's delicious. as it turns out, living life the way it should be lived doesn't take all that much effort at all. (minus the lack of cash, that part sucks)

spent this past weekend exploring the newberry volcano national monument, paulina peak and waterfall, and the east lake areas. lava flows just continue to amaze me. obsidion chunks the size of minivans are not meant to be taken lightly. so i don't. went to summerfest downtown on sunday...a bit of a people watching excursion, really. still trying to piece together who lives here and how and why, and who's just stealing clean air for the summer. there is the same aversion to people of the so-cal persuasion here as we had to new yorkers in new england, which cracks me up. except that new yorkers at least have the decency to take themselves seriously. southern californians....who knows. here is my summerfest food analogy of what i observed this weekend:

if new yorkers- actually forget new yorkers- there really aren't any here, no fair to poke fun if there's no reaction, plus people here on the left coast don't get it anyway. start over...

if oregonians are the pulled pork sliders and sensational pint of locally brewed hoppy beverage then the southern californians are the cotton candy (in a bag no less) and diet coke.

* nothing against diet coke, it's a great weakness of mine. but it's just chemicals and coloring with some fizz marketed to make you think you're somehow being healthy by drinking it...no one knows why it's supposed to be good, and we (i) know i should move on, but for some reason we (i) just can't get enough of it. and the cotton candy...well...yeah, i mean, like duh.

anyways

back to the real reason i'm here...dermatology, lest i forget...and sometimes i do....
last week was actually quite a turn around in terms of clinical fun. one morning we saw 4 patients with really obscure crazy diagnoses, which made me momentarily reconsider the seriousness of this specialty...

the 2 most interesting i'll discuss just cause i'll probably never see anything like that again, and, well....they were super cool, maybe a tad gross. anything weird is bound to be cool, and these were off the weird-dar scale.

osteoma cutis. bone chunks that grow in your skin. (collective eeew) little fibronous or cystic irritations that become calcified and grow, not unlike a pearl...in subcutaneous tissue. how's that for a biopsy finding...glad i didn't have to do the 'splaining to that patient. don't worry ma'am, you're not an alien/part dinosaur/freak of nature, although we can't entirely rule it out....
the best part was watching the entire staff scramble to figure out how to order a facial x-ray. they gave up and had to call a radiologist. now, i know i'm just a student and all, but how hard is it really?

cicatricial pemphigoid. not only is it super fun to say (if you dare), but it's super fun to see. unless you're the patient, in which case it's terrifying. you get bullous blisters that erupt and scar over, causing crazy adhesions. this pt had ocular and nasal involvement. she could barely breath out of her left nostril anymore. her left eye had big old skin bridges that only allowed her to move her eyeball in very limited directions. left untreated, it can certainly cause blindness and all kinds of strictures in places that are never good, like all your airways. treatment is mostly a half ass prevention thing, but ultimately surgery is where you're headed, which leads to more scarring....what a downward spiral that becomes. plus i'm still not ok with eyeball surgery. i might never be. it is the one thing that still makes me squirm.

my icing on the cake for last week was getting in on a bunch of decent surgeries...which i loooove.
my favorite was a shy little old gentleman in his 90's who wanted me to hold his hand while he was getting numbed up. "you could hold my hand if you wanted to, miss".... how do you say no to that? he took a nap while i was suturing him up. so cute.

and on tap for this week is getting to work with a PA who graduated from my program, so it's fun to compare notes. plus she's giving me free reign, which i feel entitled to at this point.
and, and...
wednesday is laser day... a whole day devoted to zapping people! wed afternoon is solely dedicated to tatoo removals. i can't wait. cause for one, there's the point and shoot aspect, which is thrilling if you've never done it, probably boring if you have...but then there's also the whole anticipation of seeing just how awful these tatoos are that people are willing to go along with being zapped for minutes on end to get them removed....will have to make a top 3 list for sure, so stay tuned!