There are few things that could drive me to write about my personal health online, but yesterday’s trip to the doctor definitely qualifies. In mid-August I got what I originally thought was a spider bite and eventually realized was Staphylococcus aureus. I have had this before. Staph infections are a serious concern because they are resistant to commonly prescribed antibiotics, and can be life-threatening if not treated appropriately. So I got my clindamycin, which helped somewhat, but did not alleviate the symptoms entirely which led me back to my doctor who referred me to dermatology. The thing I find most frustrating about western medicine is the focus on treating the symptoms instead of treating the root of the problem. Against my better judgement I called derm to schedule an appointment and was told the next one available with the doctor I was referred to was Feb. 3. Not so helpful. Eventually I was able to schedule an appointment with the one doctor who was available and perhaps out of sheer relief of getting in to see anyone, I became optimistic that this person — the only dermatologist in UW Health who had an opening yet in 2007 — could help me.
I arrived and (after waiting 45 minutes) was introduced to the doc, who within 30 seconds left the room, slammed the door and yelled at the nurse for failing to have me remove all my makeup. She apologized profusely to me for her error and his behavior, claiming he must be having a bad day and normally wasn’t like this. Good start.
When he returned and asked why I was there (ah… the infection on my face maybe?) I explained the situation and then mentioned my ongoing battle with Melasma as a secondary problem that I had basically learned to live with and accept, at least for the time being. I was totally unprepared for the next half-hour which consisted of a lecture about a) how bad my Melasma is b) how the sunscreen I’m using is ineffective and c) how there is basically no hope for treating it.
To elaborate on each point, I asked him how he normally treated patients with Melasma and he responded with “Triluma”. Triluma is a triple-action cream composed of fluocinolone acetonide, hydroquinone and tretinoin which, to over-simplify somewhat, are bleaches and chemicals that decrease and prevent pigmentation. Hydroquinone is notorious for producing exogenous ochronosis, which is similar to Melasma, only the spots are blue-grey and more difficult to get rid of. It has also repeatedly caused cancer when tested on animals and will likely be banned by the FDA. Everyone I’ve known (myself included) who has tried Triluma has had initial success followed by rebound pigmentation that was worse then the original problem. I asked him about this and he dismissed all of it immediately, except for the fact that I had used Triluma and it hadn’t worked. To that he replied “obviously”. Have a magical day buddy.
As for sunscreen, I feel like this is something I know a little bit about, and presumably something he should know a lot about. He dismissed the new zinc nano-technology and told me the three sunscreens I use (the top three as rated by EWG) didn’t provide much protection at all. The only real option for me, he said, was opaque makeup used by skin cancer patients and severe burn victims that is essentially a mask. Feeling defeated, I asked where I could find these. He said he didn’t know of any brand names, and didn’t know of any products sold commercially.
By this point I was contemplating jumping out of the third story window, which apparently was illuminating my horrific melasma so clearly. Instead, I asked if there were any other options. He recommended the Q-switched laser (I think Yag uses this technology). He said it would definitely work and there would be no rebound effect because it destroys the melanocytes (which produce pigmentation) in your skin. But, 100% skin protection (i.e. the cancer mask/makeup) after the procedure is mandatory, indefinitely. No outdoor activities, no trips to warm places and certainly no sailing for the foreseeable future. He then added “it’s extremely expensive and you would probably have to have it done every year.” Which makes no sense. If there’s no redarkening, why would you need annual treatments? At this point I was too distraught to really care, and he seemed to be wrapping up the appointment anyway. I think he noticed I was upset at this point and that’s when he came up with the ever-popular “It’s not a big deal you know, it’s not like you have cancer.”
I get that this is not an immediate threat to my health (although there are increasing numbers of studies which show a correlation between Melasma and breast cancer, but that’s a whole different topic) and that I could have something much, much worse. I am grateful for my health. But something that significantly changes what you eat, how you live, what you wear, what you do and how you do it IS a big deal. How a doctor gets away with making that kind of flippant remark is beyond me. No wonder his schedule was open.
He asked if that was all, and I mentioned again why I was there in the first place. He interrupted me, wrote me a prescription for an antibiotic that I don’t need and isn’t even effective against staph, gave me a brochure for a plastic surgery center (where Yag is done) and walked out of the room. The nurse (who had been in the room for the last 10 minutes of the appointment) apologized for his behavior again, and suggested I reschedule with a different doctor.
We all have bad days, and on the off-chance this doctor had just found out his dog died or whatever, I’ll refrain from identifying his last name. If you happen to be in the market for a dermatologist at UW Health East in Madison, I would be wary of anyone named David. And happy to elaborate (even further) on his compassion and charming bedside manner, or lack thereof.
