Mikala Monroe

Journal 7

2/19/2024; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 4:45 P.M.

Today I was with one of the new PAs, her name is Annalee. She is fresh out of PA school so

they were a little hesitant to put me with her but I told them I felt like it would benefit me a lot

since she is just now coming out of PA school and I will be going into PA school soon. Since she

is newer she doesn't have near as many patients as Brooke or Christine. This gave me a lot of

time to ask questions and I felt like she understood I’m wanting to learn rather than just follow

her around and observe. There wasn’t anything I haven’t seen today, just skin checks and

freezing pre-cancers which will probably be normal for me when I first start seeing patients in

the future as well.

2/20/2024; 7:45 A.M. - 12:00 P.M.; 1:00 P.M. - 4:45 P.M.

Today I was with Brooke and it felt like the day was going by so slow so we were all kind of just

dragging. It was steady, not a crazy amount of patients. There was something that surprised me

today, there was a patient who came in with a history of stage 4 melanoma on his lung. That’s

not common at all, if anything the most common cancer to see that deep would be squamous cell

cancer but that wasn’t the case for him. There was also a patient who came in with a ganglion

cyst, which is commonly found on the hands and wrists. I knew about these already because

there are videos of people slamming a book on them to make them pop under the skin, which

isn’t recommended but it gets rid of it for a while. And then there was a patient with a

hypertrophic scar on his arm, which is kind of like a step down from a keloid. It was very itchy

for him so Brooke injected some steroids into it which should cause it to flatten a little and stop

itching.
Mikala Monroe

2/21/2024; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. -

I am with Brooke again today since she wasn’t in Warner Robins. We are slow again today, not

as steady as yesterday. We’ve mostly had skin checks and 1 or 2 biopsies which isn’t bad at all

because we don’t want to find spots on patients. One of the patients who had to get a biopsy had

a strange rash only on her arm, and the steroid cream she was given for it didn’t work so Brooke

took a punch biopsy of it so we could figure out what it is. She has prescribed chemo cream to a

couple of patients who had multiple pre-cancers on their face. And a drug rep brought us Chick

Fil A for lunch so that was really good. I’ve realized over the past couple of weeks that I am able

to associate medications to conditions and think of what Brooke or Christine will prescribe to the

patients.

2/22/2024; 8:00 A.M. - 12:00 P.M.; 1:00 P.M. - 4:00 P.M.

Today I was in Gray with Christine, and it has been slow as usual. We had a patient come in with

androgenic alopecia, and I did learn that there are a lot more types of alopecia than I thought

there were because Christine was just going through all of them trying to figure out what kind of

alopecia she has. Then there was another patient which was a 13 year old boy who is starting

accutane since he had a severe case of acne on his back, chest and face. Since Accutane is a more

harsh medication, which was originally invented to treat skin cancer, it’s common for people to

have concerns about their children starting it. The mother of this 13 year old told us that her

husband took accutane and while on accutane, he had to get a rib removed with a tumor that was

growing behind it and the doctors associated it to accutane. This is mostly why accutane has such

a bad reputation and people are scared to go on it, because if something coincidentally occurs

while on it, it is automatically associated with it. There was also a patient who came in that was

an older man in a wheelchair and he lived in the assisted living homes across the street. He had a
Mikala Monroe

possible squamous cell cancer growing on his shoulder for up to 2 years and it was probably the

biggest one I've seen the whole time I've been interning here. I feel like when I am a PA, it

would be nice to offer free skin checks to senior centers and assisted living homes in the area,

because not everyone at that age will have someone to help them to go to the doctor.

2/23/2024; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 3:00 P.M.

Today I was back in the Macon office with Christine. Since it’s a Friday it wasn’t too busy. This

morning we had two young patients who were here discussing acne, one of them has been using

adapalene gel which is a less strong retinoid and she has also been using clindamycin benzoyl

peroxide which is a topical cream. She was also on a low dose of birth control and her skin

looked so much better, she just had some post acne hyperpigmentation. It was kind of confusing

though because she was worried about gaining weight with the birth control she is on yet she

also wanted to start accutane which requires you to be on 2 forms of birth control but Christine

told her she wasn't a candidate for it since she barely had any active breakouts. I noticed that

Christine is also recommending our Skin Sense department to a lot of the patients, especially the

ones with acne since they have a lot of scarring. For these patients she is particularly

recommending microdermabrasion which is where the esthetician takes a wand with little tiny

needles and exfoliates the face. This creates tiny little wounds in the top layer of the skin which

triggers the skin to produce more collagen so it can fill in and brighten the scars. We also had an

older patient who had trouble getting up on the examination table since they are so tall so I think

it would benefit the office a lot to invest in electronic tables that could move up and down so

patients don’t have trouble climbing.

Mikala Monroe

Day Time In Lunch Time Out Hours Worked

Monday, 7:45 A.M. 12:00 P.M. - 4:45 P.M. 8.30

February 19th 12:30 P.M.

Tuesday, 7:45 A.M. 12:00 P.M. - 4:45 P.M. 8

February 20th 1:00 P.M.

Wednesday, 7:45 A.M. 12:00 P.M. - 4:00 P.M. 7.45

February 21st 12:30 P.M.

Thursday, 8:00 A.M. 11:45 P.M. - 4:45 P.M. 7.30

February 22nd 1:00 P.M.

Friday, 7:45 A.M. 12:00 P.M. - 3:00 P.M. 6.45

February 23rd 12:30 P.M.

Total Weekly 38.30

Hours

Total Hours to 200

Date

Dr. Kaninjing,

I realize I am behind in my hours, for a few weeks I have been unable to come 5 days a week but

that will not be an issue from now on so I should be able to get up to 40 hours the next few

weeks which will help me get caught back up.