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Don’t Bring Up Diabetes, Doctor
July 30, 2009
Well, you wanted to know about my trip to the dermatologist today and how things turned out. So let me tell you…
First, I was the youngest person in the waiting room by a good 30 years.
Second, it’s amazing, but there was nothing said about my diabetes. No mention of it. No questions that incorporated my self-management or my diagnosis or blood glucose levels or anything whatsoever to maybe trace my care of myself alongside what was going on with my skin. Maybe it doesn’t matter, but then again (and this is based solely on generalized hearsay about dermatologists), maybe the doctor didn’t consult my chart. She only asked generalized questions about the issues I brought up. So maybe they don’t feel it’s necessary to look into my medical history?
Could diabetes not really be on a dermatologist’s radar? That’d be strange, because I find that everyone in the medical community to this point, from primary-care physician to endocrinologist (obviously) to podiatrist, even dentist to psychiatrist to phlebotomist, has asked about the diabetes. Not a visit to date (except for today) has been diabetes-discussion free.
Anything that’s anything to do with my body has in some way involved the diabetes.
But the derm? Diabetes wasn’t breached.
Third, I learned, during the examination, that the little things on my forehead that Kathryn was worried might be basal-cell carcinoma, these two or three little (2-millimeter) blips were instead what I thought they were: sebaceous hyperplasia.
I can’t blame Kathryn for worrying, because she’s had skin cancer and is very tuned into anything amiss with her significant other’s skin. But when we — Kathryn and I — first discussed my forehead abnormalities and I agreed to see the doctor, I did some online research and self-diagnosed sebaceous hyperplasia.
So, yesterday, when the medical resident came into my room first, alone (to pave the way for the doctor), I told her straight up that I suspected the lesions were sebaceous hyperplasia. I told her this because (a) I want to establish that I’m an informed patient, but also (b) because it’s just a fun condition to say out loud. Suh-bay-shuss hy-per-play-sha.
The resident seemed uninterested in my diagnosis — in fact she didn’t really acknowledge what I said, although I know she heard me. That’s fine. The only thing that irritated me was that when the attending and the resident returned to the room ten minutes later, and the attending looked at my forehead under the lighted magnifying glass, she said, “Well, I agree with Dr. Marks’ diagnosis. This is sebaceous hyperplasia.”
“Hey!” I wanted to say, “Didn’t Dr. Marks tell you that that’s what I thought it was, too? Come on! At least give a nod that I was correct.” But no. The resident had to be all “I’ve got all this medical schooling and I’m earning the points with my attending.”
Sebaceous hyperplasia is, according to most definitions I found online, a common, benign condition of sebaceous glands in adults of middle age or older. Yes, sadly, I guess at 35 I have to start thinking that maybe I’m nearing — or at — middle age. Time is happening to me.
The lesions, of which I have three — which are pretty minor and hardly noticable unless you’re right in front of my forehead, and then only one’s visible, and that only if you look very closely — well, they’re typically basically soft, small papules on the face, particularly the nose, cheeks, and forehead. This condition is something that won’t go away on its own, but I don’t think there’s much to worry about. The “effective treatment,” I was informed, was to have them removed via laser. However, in the same breath the doctor said that to do so would be considered cosmetic surgery and therefore wouldn’t be covered by my insurance.
Really, two or three hundred bucks for something minor like this? I’m not that vain. I’m not worried about this unless it becomes pervasive sebacious hyperplasia and marks a more noticable constellation on my forehead.
For now, its just a wee glitch (very wee) on my forehead. I’m going to leave it. Or maybe I can find a way to see if my endocrinologist thinks that this condition, these lesions, are affecting my diabetes and therefore need to be removed, which would therefore make the procedure covered by insurance?
Oh, and fourth (I almost forgot [OK, no, I didn't almost forget]): I’ve been diagnosed with rosacea and got a prescription for something called Metrogel (metronidazole gel) (and yes, the name: sounds a bit kinky!). So you can add rosacea to the long line of diseases I keep finding out I have. That bit of splotchy ruddiness on my cheeks and nose that has flared up on and off for the past few months wasn’t simply due to a few wayward days with too much oily food. The good news is that it’s early enough that I can manage this condition with the Metrogel, and in fact and it’s too early, or not pronounced enough, to even allow me to participate in the university’s rosacea clinical study, in which I’d get to fill out a huge questionnaire and then have a few of the rosacea pimples (of which I have none at the moment) biopsied.
I’d totally do that, though. More time off from work to wander around in the university hospital. Which you know I love.
Anyway, that’s news from Michigan.
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