where did it go?

[Guest guest]

I just had a There's Something About -moment with a funny laugh with my

patient and his wife!Pt with recurrent rash over a few years. Last

year I felt it was polymorphous light reaction (no blood tests suggested lupus...

fyi). But this time it occurred with no sun exposure. But the rash

usually occurs when pt's been sweating and doing some home repair and wood sawing.

So now we wonder about a reaction to whatever is in treated wood.So I

bring pt in. Rash again is mostly in uncovered areas... could be sun-exposed areas,

or areas exposed to sawdust. Well that's neither here nor there, and not

funny.Pt agreed to biopsy. Consent signed. Anesth injected. Note 95%

done while waiting for anesth effect. I dictated in front of pt himself, but

he's Deaf so it was only interesting for him to see voice recognition working for

me. Still nothing funny.Skin cleansed, sterile field, 3 mm punch

biopsy... yadda, yadda. I used a fine needle to hold the skin tissue gently as

I used a blade to cut the deep tissue free. Suddenly, just as the blade cut thru the

tissue, the biopsy DISAPPEARED. It was kind of like Frodo slipping on the

ring, it just disappeared! I wish I had a video of my face because I can only

imagine the expression. For a few moments I carefully examined the needle, the

blade, the sterile field drape... no skin tissue ... then I had to tell the

patient. Somehow I don't think I blushed much. But we picked up his arm,

looked under the drape, looked across the exam table, on the floor,on my

tie/shirt/pants/shoes, on the wall, on patient's clothes. We looked

everywhere! And that little bugger of a 3mm forearm punch biopsy is no where to be

found!!!Second attempt to biopsy the rash went better... but I was

nervous it would happen again! And I'm still worried about when the tissue

will be found. Pt and wife were good about it. We laughed. I

explained that I've done dozens before and never had the biopsy disappeared like

that. We joked that where ever it flew to, when I find it, I'll mail it back.Somehow I had to email the group because, as a solo-solo, I don't have any

staff to enjoy a chuckle with.By the way, for any There's Something

About fans out there, I did check my earlobe. There was nothing

there! ;-)Next time I'm going to use scissors rather than a

blade.Tim---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

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