Mikala Monroe

Journal 8

2/27/24; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 4:45 P.M.

Today I was with Brooke and it was pretty slow to be honest. There was a man who came in with

his wife and it was really upsetting to watch how she treated him. He was 76 but he had a history

of melanoma and he had other health conditions that kept him from being able to walk very well.

While we were in the room, the wife kind of acted as if it was a burden to have to take him to all

of his appointments. When it was time to go his wife told him to get up and walk and he told her

he couldn’t and they were going back and forth about it, so he tried to walk and almost fell. We

had to get him a wheelchair for him to get down to his car. And then while we were trying to get

him in the car, his wife almost backed over him so it was a tough situation. It kind of showed me

that we should treat our patients the best we can because we don’t know how they’re care is at

home. There was also a little girl with autism that came in for psoriasis all over her body. I had

seen Brooke examine her last time and she almost kicked Brooke in the stomach. This time her

psoriasis looked worse than last time because she keeps scratching and picking at it. We had to

give her an injection of Skyrizi in her thigh and it was difficult to hold her down because her

caretaker wasn’t even helping us, and she even tried to bite one of the medical assistants. It is

definitely good that I am seeing cases like this so I will be prepared for patients who aren’t

compliant in the future.

2/28/24; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 4:45 P.M.

Today I was with Christine. We had a patient this morning who was struggling with itchiness

and hives all over, and he would get hot flashes. He brought up that he grew up on well water

and all of this didn’t start until he started using city water so he went to an allergist but they said

they don’t test for allergies to water so they referred him to the dermatologist. Since he had no
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visible spots that Christine could biopsy, we couldn’t do anything other than send him a new

prescription for hydroxyzine to help him with the itching in case this is an allergic reaction to

something like his water. We had another patient come in that we saw last month. She had a case

of perioral dermatitis because she wore masks all the time and she was washing her masks with

Pine Sol. So her last appointment, Christine prescribed her a prescription hydrocortisone cream

and it helped her a lot. In the afternoon we had a patient come in with an infected cyst on his

neck and it looked like it was very painful. If it’s a normal cyst, we give them a couple of

options. If it doesn’t bother them we tell them it’s fine to leave alone but warn them that there is

the possibility that it can get bigger. If they don’t like it or if it bothers them, then we can use a

punch biopsy to drain it. The only downside to this is that it has a sack so without removing the

sack it will most likely fill back up. The other option is to set it up for it to be removed by one of

the surgeons. In the case that it is infected we recommend to drain it and put the patient on

antibiotics to kill the infection. This was the case with this patient, so we drained it and a good

bit of the sack came out so there might be a chance it won’t refill at all.

2/29/24; 8:00 A.M. - 11:45 P.M.; 1:00 P.M. - 4:00 P.M.

Today I was in Gray with Christine. It was pretty slow, we only had a few patients in the

morning. One of the patients was a young boy taking accutane. Usually for accutane, the most

common side effect we see is dryness but for this boy, he was experiencing a few of the others.

He was having GI issues, headaches and nosebleeds, which really isn’t that common. We had

another patient come in with a follow up on seb derm around his nose, eyebrows, and scalp as

well as folliculitis on his back. His last appointment he was prescribed ketoconazole shampoo for

the seb derm in his scalp and on his face, and then the clindamycin solution for the folliculitis but

he got it mixed up and has been putting the clindamycin on his nose and eyebrows which has
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made the seb derm worse. We ended up writing it down for him so he is able to treat it correctly

and get some relief. In the afternoon there was a patient who came in complaining of a rash on

her side and back and before Christine looked at it, she asked the patient if she ever had chicken

pox and the patient said yes so when we looked she said “Ahha” because she knew it was

shingles. So the MA asked how she knew and she said that shingles is unilateral so it never

crosses the midline of the spine and the rash stopped right along the line of the patient's spine.

We had another patient who was an older man and he was having blister-like sores all over his

body and he was picking at them so we weren’t able to do a biopsy because it would just come

back as irritated skin. So Christine prescribed him mupirocin to put on the inside of his nose

which I hadn’t heard of before and when i asked why she explained that staph harbors in the

nose, so if we treat the source it will treat everywhere it spreads to.

3/1/24; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 3:00 P.M.

Today I was back in Macon and I had a bit of an experience this morning because the first

patient we saw had a blackhead in her private area which I didn’t know you could get blackheads

down there so that was interesting. But Christine did a good job of removing that and the same

patient also had some milia on her foreheads so she removed those as well, which is always

satisfying to watch. We also had a patient who had a case of periorbital dermatitis on her eyelids

so Christine prescribed her a non-steroidal cream to put on her eyes. I’ve noticed a few times

during my time going in with patients that if you ask them if they have been using any new

products they will say no, but then halfway through the appointment they talk about something

new they’ve been using. And this was the case with this patient, Christine asked if she had been

using any new products or makeup and she said no but then when Christine asked her how old

her mascara was she said it was a brand new tube and a new product, so Christine told her to stop
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using it and go back to her old one. One of our last patients had some keloids on her neck, so

Chrisitne injected them with some steroids to help them go down and stop itching.

Day Time In Lunch Time Out Hours

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

February 27th 12:30 P.M.

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

February 28th 1:00 P.M.

Thursday, 8:00 A.M. 11:45 A.M. - 4.00 P.M. 6.45

February 29th 1:00 P.M.

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

1st 12:30 P.M.

Total Weekly 30
Hours

Total Hours to 229.5

Date