A cyst punch and biopsy on a wonderful popaholic patient!


DR. LEE: This is Priscilla, and she came here, and none of her friends were able to come with her. We can see this little… she’s got a, like a blackhead, probably a little cyst here but a little punctum(?) right there, see the little opening there? So I’m gonna put a little numbing around it and another baby black head over there. PRISCILLA: I’m gonna say hi to my friends, ’cause they’re jealous of me. DR: What are their names? PRISCILLA: There’s Victor.
DR: (rising terminal) Victor. PRISCILLA: And there’s Cassie.
DR: Cassie. PRISCILLA: And Heather.
DR: And Heather. Okay. Which one’s like the biggest popaholic? Patient: Oh, Heather. She pumps(?) out. DR: Really? (laughs) That is so funny. baby pinch here — you can see — baby pinch — I’m avoiding that little punctum(?) because that’s where it could get me. In fact, I’m gonna start mumbling. I don’t wanna keep my mouth open because it could squirt me DR: are you okay?
PRISCILLA: Oh, totally.
DR: Good. ‘kay, just a little… And this is a numbing that has a little bit of a buffer in it so it doesn’t sting, really, as much as it could possibly. And we’ll put a little numbing under there too, if we need to. And then you’ll be able to watch us there, see? I know. So, one thing which is nice, ’cause you’re a popaholic, You’ll appreciate how I do these sorts of things. I’m using a little punch here, okay, little 4mm punch. PRISCILLA: Such as…(?) One of the tricks that we do actually, that I haven’t explained before, is that when we remove an area, if I know which way I’m going to stitch it, DR: Like i’m going to stitch it closed this way
PATIENT: Yeah I remember this DR: I actually want to stretch it that way. Because by doing that, if you put a punch, it will make it slightly oval instead of circle ’cause this is stretching the skin, and it’ll bounce back, and I’ll be able to pull it closed.
PRISCILLA: (inaudible) I don’t know if I ever said that, did I?
PRISCILLA: Yes, you did. DR: Wow, you’re on it then!
PATIENT: Oh,, totally on it. DR: Make sure I’m not hurting you PRISCILLA: My favorite video was the Independence Day one DR: The in… Oh yes, I know. That one was fun, that I did that.
PRISCILLA: (inaudible) DR: You know that I was was at the… I’m just going to push against you Here, actually. Do you want to see a little bit of it? It’s on my thumb. PRISCILLA: Holy c**p! There’s no way!
DR. LEE:DR: What? ‘Cause you can’t believe that that’s you? Patient: *That* was inside of me? Yeah, I know. I’m gonna squeeze your back here for a little. Patient: Wow….bigger than I thought. DR: Yeah, wait ’til you see this part too! PRISCILLA: Oh my gosh… DR: Okay, I’m gonna keep you squeezing it… (inaudible) Forceps with teeth. I’m gonna squeeze you here and see if I can get that whole thing out, then (inaudible). See how friable it is, the edge? I can’t get it out like um… Make sure I’m not hurting you. PRISCILLA: I felt something.
DR: You do? Okay. Let me just put some numbing… PRISCILLA: No no no, I mean it didn’t hurt at all.
DR: underneath…No no! DR: Girl! I could numb it, all right?
PRISCILLA: Do it. DR: Don’t worry about it, all right?
PRISCILLA: (inaudible) the doctor (inaudible) (laughing) DR: If you feel like, get it, I always put more numb in it, because underneath, I didn’t numb up underneath. Cause if I do I can get into the…you okay? I’m gonna put numbing there. If I don’t…if I numb underneath, It puts pressure into the sac, it puts liquid, and then it squirts me. DR: So I usually just numb on top.
PRISCILLA: Got it. DR: So sometimes when I get under it, when I open it, then I can put numbing underneath it. PRISCILLA: Yeah that one where it fell on your shoe, that was crazy. DR: Yeah no, but that was an infected one.
PRISCILLA: Yeah. DR: So yours isn’t gonna do that. PRISCILLA: Yeah yeah, that was insane. DR: See here. Yep, it’s under there! You’ll be surprised how big it is. PRISCILLA: (voice trembling with excitement) Oh wow. DR: Let me not drop that. (excited sigh) I’ve never had anyone — Whoah, no, we’ve had people this excited before, I suppose, but it’s pretty cool to have someone so excited. PRISCILLA: Super exciting! DR: See, we did that all. I think we got it all ! (whispering) That’s good now. (normal voice) Not hurting you? PRISCILLA: I don’t think you realize how much people really are into this. DR: I, I realize it. (laughs) I do realize it.
PRISCILLA: Really? Yeah? Yeah. At work…at work… (sounds like “ow, ow”) DR. It is pretty cool. I’m hurting?
PRISCILLA: No. DR: I thought you said ‘ow’. Okay. PATIENT: At work I show everyone
DR: Yeah, that’s a cool thing too. People tend to wanna share their love. When they’re [excited by] something, they wanna share it. So that’s kind of nice. PRISCILLA: (inaudible) DR. (inaudible) be surpocked (surprised + shocked) You’ll be shocked actually. PRISCILLA: Well what I learned from watching your videos is that there’s a lot more on the bottom. DR: So….It’s… DR. Because it’s under you. You can’t really know. DR: Am I hurting you?
PRISCILLA: No.
DR: Okay. You can’t really know how it will exactly feel. And you see, it’s not infected, but do you smell a little smell? PRISCILLA: No.
DR: No you don’t? Okay. I’ll have to tell you, like d’you…, because people ask me that all the time. PRISCILLA: What’s the smell?
DR: It just smells like — I don’t know — skin, or something. Right? Would you say that? I’m sorry I pulled your hair there. PRISCILLA: No, don’t worry.I put a lot of hurricane(?) today. DR: Oh, this is not…Girl! You don’t be sensitive about it! PATIENT: (inaudible due to crosstalk)
DR: I just thought that I would ask you that because then…. because that’s what people want to know. PRISCILLA: I put some Coco Chanel for you today. PRISCILLA:So you see — I’m gonna show everybody here now — Do you see how it’s like oval this way? Cause I think I was… That’s how Iwant to close it up. And I pull this way to try to maximize the chance that it won’t be more in that shape. Now Ijust want to make sure Ithat I got it all. I think I did (inaudible) (inaudible) some of our little ones and wrap them individually, okay? little sterile thingies Yeah, looks like I got it all. And this stitch comes out in like, mmmm….. Like 10 days.
PRISCILLA:DR: Do you want…You can actually have “Victor” or somebody do it for you. (inaudible) PRISCILLA: Yeah… (inaudible) (laughs) PRISCILLA: (inaudible) DR: Okay. PRISCILLA: (inaudible) take a shower (inaudible) days DR: Yeah. That’s right. Did you hear the one where I joked with them, and I told them, like, did they want piña colada, or did they want… I remember that one! DR: Oh! (chuckles) PRISCILLA: The fireman and the mom one DR: Oh, did I, did I tell him? DR: I didn’t tell him that, though.
PRISCILLA: No, you didn’t tell him that. He was (inaudible) DR: Yeah, we do that. There’s….that’s what’s so interesting about this, why I ka(?), sometimes I do, like, It’s very much like a “Humans of New York”, if you follow that [blog] PRISCILLA: Yeah
DR: If you follow that guy. Do you follow that [blog], Christie? It’s actually really interesting. This guy takes photos. He started doing it in New York City. Taking photos of random people. And then he would ask them, “What’s the hardest time in your life?.” “Like, tell me about the biggest hardship or something that you had in your life.” So he’d get stories out of people. But he’d be anonymous. CHRISTIE: because you do ask a lot of questions. It’s really nice to hear DR: Really? It’s annoying to some people. Well, you know, one of my questions I used to ask all the time was Did I do this at the ER? I proably did, Christie. I stopped doing this for a while I would ask like my older patients, “In your lifetime, what would have been your most interesting time in your life?” I do that every now and then. Some of the things people say are so cute. I’m gonna put a little pressure ’cause I’m gonna push out this little blackhead here on you Without even numbing. There. Good. Good. So this one’s…let’s have you put a Band-Aid on that… See that’s the..this is the top of your skin PRISCILLA: What the h*ck is that? The top of the skin.And this is the contents of it. DR: See, this is the sac.
PRISCILLA: That’s insane! DR: It is.
PRISCILLA: How is that stuff come into my body? Wait ’till you see it. Let’s show her the video. PRISCILLA: Wowwwwwwwww…. Patient: Oh my g*d.DR: So that’s when you just pinched a little. So I put a little more numbing. And then, even more came out! Iphone: You’ll be surprised how big it isYeah! Soldier! See, we got all of it out. Did end up getting all of it out. PRISCILLA: That’s me! Look at that You’re just red because I squeezed too hard. And there is the little blackhead, right? There’s the blackhead right there. Patient: That is insane! IPHHONE: I’m gonna put a little pressure on you… Patient: Wow that’s a baby. So she says that this was a maybe a blackhead or whitehead and tried to squeeze it. Nothing ever squeezed out. Patient: Yeah, I got a scar because of it. I don’t think it is, ’cause of…maybe that’s what it is now. Just a light scar. Sorry, a little numbing there. I just put one little pinch in your skin I try to just stick to one pinch, ’cause then Push the volume in there slowly And it won’t be as tender Little pinch. Did you feel that one?
Patient: Nope DR: Okay. Just (inaudible) patient PATIENT: Best comfortably(?) yet. DR: A super sharp, one of our more expensive, we do this more on the face (inaudible) This can be a little (inaudible) fine little shaving here tiniest little morsel of skin there we want to make that piece flat I gotta send that in. The tiny little thing there. Just to see what comes out. (inaudible) I think it might be So, like I told her, a fibrous papule like this, it can grow back I see some scar tissue though So we’ll see. That might stay just the same. I don’t think it’ll be worse. be able to check it

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