Professional Documents
Culture Documents
Journal 7
Journal 7
Journal 7
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
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
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.
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.
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
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