Mikala Monroe

Journal 10

3/11/24; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 5:00 P.M.

Today I was with Annalee, she doesn’t have as many patients as Brooke or Christine since she’s

still new but she had around 30 today. While being with Annale, I noticed she likes to build a

relationship with her patients. She was asking them about how their work is going and how their

kids are. And by her doing that it seemed like they felt more comfortable and more open with

her. She was telling me about one patient that she was examining his face and he started snorting

at her like a hog trying to scare her and I couldn't help but laugh because I would've thought he

was trying to bite me. We had one patient come in with seb derm in her scalp so she prescribed

her some ketoconazol shampoo to help with the irritation and itch. Then she had one patient

come in for a C&D, he had a biopsy taken a few weeks beforehand that came back as a

squamous cell. So she did the C&D to make sure there was none left.

3/12/24; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 4:45 P.M.

Today I was with Brooke and I saw something new. There was a patient that was 8 months

pregnant, and she had a mole on her hip that looked concerning. I didn’t know this but it takes

longer for pregnant women to heal and they're more at risk of getting keloid from scars. So what

Brooke did instead was she took like a sticker and pressed it on the mole really hard, and then

she did it 3 more times and she put it on a specimen sheet that they came with and if there are

any melanocytes present then they would have to remove it but if not then it can stay. So that

was interesting to learn there's other options for people who are at risk when getting biopsies. A

drug rep also brought us breakfast and lunch so that was good. I think it’s kind of interesting
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watching the interactions between the drug reps and the doctors because you can tell which reps

people like and don’t like.

3/13/24; 7:45 A.M. - 12:00 P.M.; 12:30 P.M. - 5:15 P.M.

Today I was with Christine and it was a pretty busy morning. I learned a few new terms, one was

lichen keratosis, which I’m beginning to learn there are many types of keratosis. Essentially it’s

the same thing as a seborrheic keratosis but it has more of a red color and wart like feel. The

other term I learned was idiopathic guttate hypomelanosis which is the flat white spots that we

get all over our body from sun exposure. One of the patients we saw today was an older woman

who came in for a rash that she keeps getting all the way around her eyes but this time it was

spreading to her chin so Chrstine spoke to Dr. Cohen, and told her to take a biopsy, and also told

her to ask the patient if she had any muscle soreness or lupus because based on what she's telling

us, it seems like it could be from an autoimmune disease. But the patient had no type of muscle

soreness or any autoimmune disease, so hopefully the biopsy gives us a little more information.

Another patient we had came in a few weeks ago for rosacea and was given a topical to put on

his face but today he came back saying it worked for 2 weeks and now it doesn’t work at all. So

by examining the rest of his body, Christine determined that he had keratosis pilaris which is a

skin type that causes rough red patches on parts of the skin. So based on that we had to tell him

there isn’t really a cure for it since it’s a skin type, but it was kind of sad that there isn’t really

anything we can do to help him, he just has to manage it.

3/14/24; 9:15 A.M. - 12:30 P.M.

Today I was in gray for part of the day because I had to take my kitten to get fixed, but I came

and still got some of my hours instead of just taking the day off. It was slow but a good bit of our

patients this morning were revisiting to see if the medication they were prescribed still works and
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almost every patient had good results. Some of them maybe needed something else prescribed to

“create their perfect concoction” is what Christine says. Because some medication can be

working but just not enough, so sometimes they need something added to make it work better.

There was a patient that came in with something in between her toes and so Christine scraped

some of it off to see what's underneath. When she took some of it off, she could see some blood

vessels which means it is most likely a wart so she froze it with liquid nitrogen. I also got my

grandmother to make an appointment since the last few times I went with her to her dermatology

appointments, I didn’t really like how he was assessing her. He would just look at her arms and

hands and pay no attention to her face, or ask to look at any other parts of her body. There had

been a few spots on her face and body that have worried me for quite a while and when I told her

to go to the dermatologist a few weeks ago, she told me she just went last month and that he

didn’t even pay attention to her face. So Christine was able to look her over and I told her what I

was worried about and she was confused too that her last dermatologist didn’t do anything about

those spots on her face and body. So Christine took a couple biopsies of the spots but she said it

looks like psoriasis because of the way they look and how they’re sprinkled around on her body

and they hurt. But I had to leave shortly after to go pick up my cat from the vet so it was a short

day, but at least I got a few hours in.

3/15/24; 8:00 A.M. - 12:00 P.M.; 12:30 P.M. - 3:30 P.M.

Today I was back in the Macon office and the morning was pretty slow, so this helped me catch

up on all my school work and work on my projects a little more. With only 5 weeks left, I am

definitely feeling the pressure. We had a patient come in for a rash that she has been having all

over her legs for a while. In her last appointment she saw Brooke and she said it could be

psoriasis but she took a biopsy and it came back as possible lichen planus which is an
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autoimmune disease where the body creates lesions on the skin that itch, but the biopsy also

showed several other possibilities it could be. So today Christine took another biopsy for a more

clear answer and offered to give her a loading dose of Dupixent to help with the itching. I’ve

realized while being here that I am more up to date on products and remedies that can be used to

treat conditions, and I think a lot of that I learn from TikTok. So it makes me feel better when a

patient is trying to explain something they’re using to Christine that she doesn’t know much

about, I can speak up and try to explain it better since I like to find out how it works on the skin.

Day Time In Lunch Time Out Hours

Monday, March 7:45 A.M. 12:00 P.M. - 5:00 P.M. 8.45

11th 12:30 P.M.

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

March 12th 12:30 P.M.

Wednesday, 7:45 A.M. 12:00 P.M. - 5:15 P.M. 9

March 13th 12:30 P.M.

Thursday, 9:15 A.M. - 12:30 P.M. 3.15

March 14th

Friday, March 8:00 A.M. 12:00 P.M. - 3:30 P.M. 7

15th 12:30 P.M.

Total Weekly 36.30

Hours

Total Hours to 305.15

Date