Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Unmasking Skin Cancer: A Dermatologist's Perspective
What's the difference between standard skin cancer removal and Mohs surgery? Ashley McGuinness, MD, FAAD breaks down this specialized technique that achieves remarkable 98-99% cure rates while preserving healthy tissue. While standard excisions examine only 1-2% of margins, Mohs surgery meticulously evaluates 100% through a precise mapping approach.
During this eye-opening conversation with host Dr. Jason Edwards, Dr. McGuinness addresses the alarming 1.8% annual rise in skin cancer rates since 2000. She attributes this to better detection methods, our aging population, and the consequences of tanning bed popularity in past decades. When discussing internet myths claiming sunscreen causes cancer, she provides clear evidence of UV radiation's harmful effects while offering practical alternatives like physical blockers or UPF clothing for those with chemical concerns.
The discussion takes a fascinating turn toward technology as Dr. McGuinness reveals how AI is transforming dermatology. From full-body mole mapping to algorithms that detect subtle changes invisible to the human eye, these advances complement clinical expertise without replacing it. For self-examination, she emphasizes the critical "ABCDE" approach to identify potential melanomas: check for Asymmetry, Border irregularity, Color variations, Diameter larger than a pencil eraser, and most importantly, Evolution over time.
Beyond cancer detection, the conversation explores factors in skin aging, from UV exposure and dehydration to facial movements and lifestyle choices. Dr. McGuinness shares simple strategies anyone can implement: staying well-hydrated, using daily sunscreen, and avoiding tobacco and excessive alcohol. Whether you're concerned about skin cancer prevention or preserving your skin's youthful appearance, this episode delivers practical wisdom from a leading specialist in the field.
Hello, this is Jason Edwards and this is Doc Discussions. I'm here with one of my co-workers, ashley McGinnis. Ashley, how are you doing today?
Speaker 2:I'm good. Thanks so much for having me.
Speaker 1:Ashley, you're a dermatologist who specializes in Mohs surgery. Is that correct?
Speaker 2:That's correct.
Speaker 1:Yeah, and where are you from?
Speaker 2:I'm originally from St Charles, so I'm a St Louis local.
Speaker 1:Very good. And then, where did you do your schooling at?
Speaker 2:So I did my undergraduate studies at Rockhurst University in Kansas City, Missouri.
Speaker 1:How about that? It's a Jesuit college, right.
Speaker 2:Jesuit college. So I went through the Catholic school system here and stuck around with it for college and then transitioned to SLU here in town for medical school.
Speaker 1:Okay.
Speaker 2:And then after that I did my intern year and my three years of dermatology training at the University of Iowa City or University of Iowa and Iowa City.
Speaker 1:Sure.
Speaker 2:And then after dermatology I did the Mohs Surgery Fellowship up at Mayo Clinic in.
Speaker 1:Rochester Just up the road a little bit right.
Speaker 2:Yeah, just up the road, Kept graduating further and further north before I moved home.
Speaker 1:Yeah, I remember my interview at Iowa. To me it seemed like a great town, iowa City and Corvallis, I think, which is right next to it. I'm probably mispronouncing that.
Speaker 2:No, that's okay. Iowa City is a great city and it's not too far from St Louis, great college town feel. Lots of fun things to do. You get the Division I sports kind of experience. Coralville is the neighboring suburb and it's exploded. I mean, even since we started residency there it grew a lot. They now have a minor league hockey team there.
Speaker 1:That's pretty fun to attend to and you know Iowa's kind of famous for their children's hospital, overlooks the football stadium and of course football's huge in any Big Ten university, but especially Iowa, and the football players always wave at the kids in the Pediatric Cancer Center, which is a beautiful thing.
Speaker 2:It's amazing and it's really fun. I mean being on both ends One, if you're on a pediatrics rotation, being up there with the kiddos and seeing it. I mean it makes everybody's day. And then if you're in the crowds getting to wave up there, I mean it's very cool to see both the home team and the opposing team all getting into it too.
Speaker 1:Yeah, what a special thing. And so and you're married to a physician, is that right?
Speaker 2:I am yeah.
Speaker 1:So what's your husband do?
Speaker 2:So he is a board certified anesthesiologist but he actually did a fellowship in interventional pain.
Speaker 1:How about?
Speaker 2:that, so he practices interventional pain over in Alton.
Speaker 1:Very good, very good, and so you've got a practice here in St Louis and we've shared a few mutual patients. Yes, can you explain to people you know, like the lay person, what Mohs surgery is?
Speaker 2:Yeah, that's a great question. So Mohs surgery is a specialized form of skin cancer removal, a surgical form of skin cancer removal, and the way we do Mohs surgery is it's all under local anesthesia, meaning the patient's not asleep for the procedure. We just numb it with injections and we remove the skin cancer with a small rim of healthy skin. And while the patient waits we check all of the edges, both on the outside and the deep edge, to see if everything's off the patient, if there's a little bit more. I have a map that I've created on both the patient and on the tissue that I've removed. That tells me where we need to remove a little additional skin and we repeat that process until everything's gone and then we reconstruct the patient based on what the final defect is.
Speaker 1:And so when you make the map, I remember in textbooks they kind of quartered it where they make it into quarters. Is it more complicated than that, or is each section quartered?
Speaker 2:It's a good question. So it depends on the size and the shape of the lesion itself. So sometimes you'll process it just in one single piece. I personally make more of our standard size pieces. I mark a 12 o'clock kind of some hashes at 12 o'clock, 3 o'clock, 6 o'clock and 9 o'clock, so it almost looks like a little clock face and we put inks in there. So it tells us you know, the blue ink may be at your 12 o'clock and your green ink is at your 6 o'clock, and if you see something between 12 and 3, you just take tissue between 12 and three and you can spare the rest of the healthy skin.
Speaker 1:Yeah, so so, um, you know you, you excise kind of the same amount of tumor as you would with um. You know which is all of it with the normal excision. But the beauty of Moses, it leaves more natural tissue, more normal tissue, and so your surgical defect is less right. You got it and so you have a better cosmetic outcome.
Speaker 2:You got it Better. Cosmetic outcome it's tissue sparing and then the way we actually process the tissue. You're actually evaluating 100% of the margin as opposed to a standard excision. You look at 1% to 2% actually of the standard margin.
Speaker 1:Yeah.
Speaker 2:So it does give you a superior cure rate. You're talking more for your average run-of-the-mill skin cancer 98, 99%, as opposed to about a 95 to 97% cure rate. But huge benefit for cosmetically sensitive areas like the face, where you don't have much real estate to spare and you want all the healthy tissue you can keep.
Speaker 1:For sure. And when we're talking about skin cancers specifically here we're talking about basal cell carcinomas and squamous cell carcinomas, correct?
Speaker 2:Those are our most common kind of bread and butter cases that we do. A lot of People are starting to use Mohs for melanoma in situ and thin melanomas, your early stage melanomas, especially on the head and neck. Yeah, we do Mohs for more uncommon skin cancers as well, but they're just few and far between, as opposed to the basal cells and squamous cells.
Speaker 1:And the rationale for not doing it for kind of a standard melanoma or more advanced is you really want a very large rind of normal tissue between the blade and the tumor, because you don't want the margin to be as close with the melanoma, because the recurrence rate's higher.
Speaker 2:That's correct and the other thing is is that it just has been standard of care to have wide local excision for so long. So I know a lot of people are starting to do studies and kind of compare MOSE for melanoma to your standard of care, which is wide local excision.
Speaker 1:Yeah.
Speaker 2:The other thing that makes it difficult is if you need to do a sentinel lymph node biopsy for an aggressive melanoma. You can't necessarily time that very well with Mohs. It's hard to do when there's two surgical subspecialties that are both in the mix.
Speaker 1:And another thing I remember from my textbooks there was kind of a region of the face and I think the rationale was that it was kind of like this embryological H or center point where cancers were thought to be more aggressive. Am I anywhere close on this?
Speaker 2:That's correct. So there is. We call them the high risk, medium risk and low risk locations but it is more central face, so kind of eyelids, temples, ears, nose, lips that are traditionally thought of as your high risk areas.
Speaker 1:Yeah.
Speaker 2:Skin is thinner there. From a cosmetic standpoint, a functional standpoint, you don't have much real estate and because of the nature of the tissue there skin cancers can behave more aggressively in those areas. So typically if you have a basal cell or a squamous cell in those areas it automatically qualifies for most.
Speaker 1:And then I also remember, like with the lips specifically, that cancers are more prevalent on the lower lip compared to the upper lip. Do you know why that is?
Speaker 2:It may be, I don't know if it's because you get some shading from nose and that sort of thing.
Speaker 1:Good mustache.
Speaker 2:A good mustache on a man, or a woman, I guess. But you know, I think some of it is just anatomic location, with it being a little more exposed to the sun.
Speaker 1:Yeah.
Speaker 2:I don't know with tobacco exposure. You know, a lot of times with like chewing tobacco and things like that, a lot of times people have it stored in their lower lip and we know tobacco use also increases your risk of squamous cells on the lip as well.
Speaker 1:Yeah, now I'm going to get into the old online misinformation here. I love it so recently I've seen some posts where people talk about it's actually the sunscreen that's causing the cancers and not the sun itself. What are your thoughts on that?
Speaker 2:So I think it's been well proven that UV exposure both chronic, you know cumulative sun exposure, as well as intermittent intense sun exposure. So a sunburn here or there does increase your risk of developing skin cancer. Yeah, I know there's been a lot of concerns over especially chemical sunscreens in recent years. You know what types of effects are these having? I don't necessarily think they're causing skin cancers. I don't think we necessarily know. You know, could they be harmful in high, high doses.
Speaker 2:If they were in your bloodstream, Maybe I don't think you're absorbing enough of it to probably reach those levels of harm in general, which is why they've been approved for use. But I always tell people if you're very concerned about it, some good alternatives would be like a zinc oxide, titanium dioxide, more of those physical sunscreens, because the way they work is they actually sit on top of the skin, they're not actually absorbed into the skin and they still provide a protective barrier from UV, or just using sun protective clothing. They make a lot of UPF clothing that actually has that sun protection built in now. So if you're concerned about it, you know there are alternatives to still protect you from the sun and protect you from that UV induced damage.
Speaker 1:Yeah, I mean, and you know, when it comes to just like misinformation and stuff like this in general, I mean it's okay to be skeptical I think you don't want to be naive and so it's okay to have some skepticism. But you know, from all the evidence out there, it looks like sunscreen in general is very safe. And then there's some kind of, like you said, higher end ones that you know maybe technically safer, right, but yeah, and then the sun shirts, I mean those work you can get in the water and they don't. It's not like the old cotton hang shirt.
Speaker 1:I mean they're breathable and the technology with the clothing is good.
Speaker 2:Yeah, and so that's always a strong move. Yeah, and I think it's nice too, for people who say they don't like the feel of sunscreen or just forget to reapply. Yeah, you know, if it's on, if you've got a sun shirt on, you've got that UPF, that SPF of 50, essentially built in for as long as you've got it on, which is very nice. Yeah, if you're going to plan on spending the whole day outside.
Speaker 1:I totally agree, and you know you're in the water that comes off, or I don't know how well it's done. Even if it's the waterproof, you don't know if it's going to stay or not.
Speaker 2:Right, exactly.
Speaker 1:Um, there there does appear to be a trend, um, with increasing not only rates of squamous cell carcinoma and basal cell carcinoma, but also melanoma since 2000, at least through 2020. And what I'm looking at here it says about 1.8% annually, which seems like a lot. Have you guys noticed that, and what do you think's behind it?
Speaker 2:That's a good question, and I think there's a lot of factors that probably play into us seeing more and more of it. One is, I think, patient education. You know people are more and more aware and are taking a look at their own skin, which is awesome because you know you're your own best advocate. So if you're the one that sees your body every day, so if you're noticing it and bringing it to somebody's attention, I think that is something that has driven numbers up.
Speaker 2:So just better detection Better detection and better detection by patients, better detection by dermatologists. As we know, more and more and more patients are seeing dermatologists. I think our aging population in general increases those numbers just because it's cumulative sun exposure risk increases those numbers, just because you know it's cumulative sun exposure risk. I think tanning bed use, especially in you know, we think about rates of tanning bed use 80s, 90s, early 2000s. I think we're seeing a lot of repercussions of tanning bed use as well.
Speaker 1:I grew up in a small town. In small towns, you know, everything's tanning. It's like there's a pizza shop and tanning it's like a combo. There's the gas station and tanning. It just goes hand in hand.
Speaker 2:Yeah, and it's shocking that you're like you still see them.
Speaker 1:We know how bad they are and there's still a few lingering, which is concerning yeah, so when you talk about ultraviolet light, which is what we consider, the kind that damages the skin, that causes DNA changes which precipitates cancer, there's UVA and UVB light. Is one of them worse than the other?
Speaker 2:It's typically thought that you know. Uvb typically causes burning rays. It doesn't penetrate as deep into your skin as the UVA. Uva penetrates a little bit deeper, so traditionally people think UVA is what causes aging and more of the skin cancer that those cellular changes but, it's really a combination of both.
Speaker 2:So that's why they always say when you look for a sunscreen, look for something that says broad spectrum, because you want to cover yourself for both, and they both penetrate even car windows. So I always tell people you should at least be putting something on in the morning. At least do your face. You know a daily moisturizer with a sunscreen. Even if you're not going to be out and about, you are still getting some of that exposure.
Speaker 1:Yeah, I started using this brand called proven, and you probably I mean there's all these products, right Um, but it was, of course, developed by dermatologists. That should be your next venture, right?
Speaker 2:I mean you can do it, but um but it, you know developed by dermatologists and everything's.
Speaker 1:You know, um, supposed to be like heavily scientifically studied, and they take, you know it's personalized, right. I mean, people don't know you can get personalized vitamins. You can. You know you can send off a stool sample and get personalized vitamins, all kinds of personalized stuff. But it's, it's. You know this is not, as you know, intricate. They just get your demographics where you live and then send you, you know, face cream or what, but, but it has, I can tell there's sunscreen in it. I don't get out that much, but um, but you know we all want to stay looking young and um, and, and part of it's certainly sun damage. What are the things that you know cause the wrinkles? Um, or you know, or age the skin?
Speaker 2:Yeah, so I think UV exposure is a big thing. A lot of times people also notice that just dryness of the skin. You know, when you're dry you tend to notice some of those fine lines and wrinkles more than you would if your skin is moisturized.
Speaker 1:Yeah.
Speaker 2:So keeping nice, moisturized skin also makes you look a little more youthful. And then also just dynamic movement. You know we move all of our muscles. Every time we move our muscles of our face they make wrinkles. The more you move those muscles you get wrinkles, which is why people do Botox to paralyze some of those muscles.
Speaker 1:Okay, yeah. And then, of course, you know, there's, you know, one thing I notice with patients if I see somebody who looks, you know, significantly younger than their age, you know, with regard to their skin, I think usually I, you know, I'll ask them do you drink a lot of water? Because people will just drink a lot of water, you know, or you know that that's a part of their, you know their regimen is to, you know, drink plenty of water, and I think that alone, you know, helps reduce the wrinkles.
Speaker 2:Oh yeah, hydration status is huge, definitely. And then things like you know, smoking and alcohol use, we know contribute to accelerated aging as well, so kind of just having that healthy lifestyle overall, you know, water consumption, healthy diet, avoiding heavy amounts of alcohol or tobacco use in general.
Speaker 1:Yeah.
Speaker 2:All go a long way, both on the inside and on the outside.
Speaker 1:For sure. Yeah, you know, I think of Lydie Kravitz, the singer, who's a raw vegan, and I mean that guy looks great he does look great and I mean sometimes it could be just genetics too, right, but I mean certainly eating kind of a low nitrate diet, you know, like you said, helps inside and outside, and if you have great blood flow, um, you know, to your heart and your kidneys, you probably have great blood flow to your skin exactly.
Speaker 1:Exactly the. You know. Ai, artificial intelligence, is kind of all the new rave. Have they integrated any of that technology into Mohs or dermatology?
Speaker 2:They are starting to and starting to do some studies. Actually, when I was at Mayo Clinic for fellowship, they were starting to utilize a full body camera for high risk patients and kind of studying that for mole mapping, essentially to look for changes, and they were going to use AI technology.
Speaker 2:Then at each visit they have the patient photographed and then have an AI algorithm look for subtle changes in moles. That then would be followed up with a dermatologist. You know dermatoscopic, you know better evaluation. So that's one thing I've seen. I've seen a lot of apps now kind of advertise that are take a photo of your spot and upload it and kind of get a diagnosis. So I think they're trying to refine some of those and some of that may be very helpful, especially when triaging patients. You know, and you're doing almost a telederm. Especially when triaging patients. You know, and you're doing almost a telederm, does this need to be seen next week or can we maybe see this next month? So I think that's nice and people are starting to actually implement it in Mohs in terms of seeing how AI compares to a physician in terms of can it identify a basal cell or not, and what's that agreement like with the Mohs surgeon.
Speaker 1:Okay, so they do like a Kappa analysis between the two. Yeah, the, I think the, the taking the pictures I mean even with people with their phones, is one of the things that you just never had before, because you know when you see a patient and make a note in a you know, write about something or or it, you know it's hard to really tell how it changes over time. Usually as a doctor you just see them in one point in time and kind of make a judgment over that, and so that's really cool to have you know something that kind of tracks it, and so you kind of have this dynamic picture of what's going on with the lesion over time.
Speaker 2:Yeah, it's very, very interesting and they were even talking about adding dermoscopy, so like magnifying the lesion and looking at pigment patterns and even from that even magnified view, looking at these very subtle changes in moles, which is very cool because it's something like you said. I mean, we're seeing them as snapshot in time. So if you have these photographs and then have something that can pick up very subtle changes in color that maybe our eyes can't even pick up, yeah.
Speaker 2:I mean just adding another tool to your armamentarium. Obviously, you always need the clinical aspect behind some of that AI stuff, but I think it's just going to be another tool for us to use.
Speaker 1:Yeah, yeah, I think that's. It's kind of like a copilot, right.
Speaker 2:Yeah.
Speaker 1:Just something to help you be better. And then, ok, so you've got squamous cell carcinoma, we've got basal cell carcinoma, and these are the common cancers and most of the time, you know, they don't spread to the lymph nodes and they don't metastasize. When they do, it's wild. I mean, you know it's very rare. But when they do spread to other parts of the body, I mean they can be really aggressive. Yes, but melanoma is like the really scary cancer, because that doesn't have to be very big before it gets into the bloodstream and can spread anywhere and everywhere. And it does, and the metastasis can bleed and you know that's a big deal. What are the you know, when somebody's looking at a lesion, what are the main criteria that would be suggestive of a melanoma?
Speaker 2:That's a good question. So for the most common subtype of melanoma it's called a superficial spreading melanoma and because it's the most common, people have come up with all sorts of things to help people identify, you know, worrisome signs on themselves. So I think the most common and most helpful one is the ABCDEs of melanoma. So when you look at a mole, something that's asymmetric, something that's borders are irregular, if a lesion's got multiple colors. So if you're looking at a spot and it's uniformly brown, that's a reassuring sign. But if you see brown with black and blue, that might raise your suspicion. For D they usually say bigger than the diameter of a pencil eraser. And then the big thing for me is the E is the evolution. So if you had a mole that you know it looked one way for 10 years and three months ago it looks a little, started to look a little bit different, that should really raise your suspicion.
Speaker 1:Yeah.
Speaker 2:And all of those are, but it's helpful for somebody who's seeing their skin at home or having a loved one take a peek at their skin to say what of these might be worth calling a doc about.
Speaker 1:You know I have a rule with things that may be melanoma and it goes with your E. You know, you're saying the E is really important for you. If a patient's concerned, you know, then then usually I'm concerned, you know, or I'm saying don't sleep on that, trust your instinct, because I mean we all have spots all over us. There's a reason you're concerned and it's probably that it's evolving and it's changing a little bit quicker. And so I always tell patients you know, if you're concerned, just go ahead and get in and see somebody.
Speaker 2:It's better safe than sorry you bet Now Merkel cell carcinoma.
Speaker 1:they always say it's similar to melanoma. I mean it's caused by polyomavirus and stuff like that.
Speaker 2:It's a little bit different. But is that mostly on the skin too? It is, and I think Merkel cell in general tends to overall behave more aggressively when you catch it. Typically people are needing a sentinel lymph node, biopsy sampling their lymph nodes, no matter what in addition to local control of the tumor, whereas melanoma, if you catch it early enough, it's surgical removal and you're kind of done with it.
Speaker 1:Yeah.
Speaker 2:But it tends to be on the skin as well.
Speaker 1:And the very first episode we ever did. I talked about Jimmy Buffett, who I'm a big fan of we ever did.
Speaker 1:I talked about Jimmy Buffett, who I'm a big fan of, and he had Merkel cell carcinoma and ultimately died from it. And of course Jimmy's near and dear to my heart, but the one. There's several cancers that are highly immunogenic cancers, meaning the immune system plays a big role in modulating the cancer and kind of keeping it in check or not. And so if you're immune compromised, you know you'd have worse results and if you had a good immune system it may keep it from spreading. But specifically melanoma and Merkel cell carcinoma are highly immunogenic cancers and so they've got these new immune therapies that they use sometimes in lieu of chemotherapies. But it's a systemic therapy and I've seen some just dramatic responses, especially with Merkel cell carcinomas. You know, previously you thought, like you know, we can give them something, but it's, you know, some chemotherapy but they're not going to do well, and then I've seen patients where it just melts away. I mean it's very remarkable.
Speaker 2:Yeah, the immunotherapy has been a total game changer. I mean for really. I mean for metastatic squamous cell, for melanoma, for Merkel cell, because traditional chemotherapy one from a side effect profile, you know has historically been really tough on patients and two outcomes for a lot of these skin cancers were not as good as for other types of cancer with traditional chemotherapy. And with time they've just expanded the armamentarium, which is awesome because it gives us more backup options and just more options for patients if they don't tolerate things.
Speaker 1:Yeah, now, so you're a Mohs surgeon, do you do? Are you doing strictly Mohs surgery or do you do some like regular derm with Mohs?
Speaker 2:Right now I'm only doing Mohs surgery.
Speaker 1:Good, that's a good sign.
Speaker 2:I miss general dermatology a little bit, but yeah, unfortunately slash. Fortunately the skin cancer treatment does keep me busy.
Speaker 1:Good.
Speaker 2:But like you said before, I mean so many of ours are curable with very, very high cure rates, so it's a very rewarding type of procedure.
Speaker 1:Yeah, for sure, and you know, kind of going back to your training, I mean dermatology is a tough, tough specialty to get into. I mean it be able to do that at the University of Iowa and then Mayo Clinic is really remarkable and, to be honest, we're really lucky to have somebody like you in our community and I'm glad that you're doing mostly Mohs surgeries because that's your specialty and I'm glad you're popular enough that you're getting enough patients to stay busy with just that. If you're a patient out there looking for a doctor, a busy doctor is typically a good doctor because other doctors are referring to them. I've been told to never to do this, but I noticed you might be a little bit pregnant. What's going on there?
Speaker 2:My husband and I are expecting identical twin girls come here June of this year, so not too far from now.
Speaker 1:Well, God bless you. What are your thoughts on that? I mean, that seems like it's going to be a lot.
Speaker 2:Yeah, so we're going from zero to two, which is awesome, amazing. We're very excited, but also terrifying at the same time. But you know, we're going to take it one day at a time and they're already very loved by everybody in their lives, so we're very excited.
Speaker 1:Yeah, I mean, you and your husband seem like you're very functional human beings, and it certainly helps to have some family nearby, and so you're going to have a little bit of support from mom and dad.
Speaker 2:Absolutely, and we knew we always wanted to move home, we wanted to care for people in our community. But it's just an extra bonus now, with two on the way that our parents are at most 10 to 15 minutes away from us.
Speaker 1:Oh, so your husband's parents are here as well. Yeah, oh, thank goodness it's going to be so awesome.
Speaker 2:So he grew up in O'Fallon, I grew up in St Charles and we've got family all around.
Speaker 1:Yeah, you know it's. It's, in many ways, the most difficult thing you'll ever do, but also the most rewarding and challenging, but I think, I think it'll be a true blessing and you're probably bringing two smart kids into this world.
Speaker 2:I hope so. We've had challenges in a lot of other areas of life, but this will be a totally new challenge and, yeah, I think we're up for it.
Speaker 1:Yeah, and I mean, challenges are good for us, it's you know Sisyphus pushing the boulder up the mountain, you know it's he need. You need that boulder. You know you don't want to just skip through life and not continue to grow as a person and I think one of the things that makes people universally happy is to see progress in their own life. And then the beauty of having a child is you know, you can, you know, once you've kind of ran your course, you know you get to see the progress through your own child's life and so in a sense it's kind of redoing the hero's journey. If you're a Joseph Campbell fan, Absolutely.
Speaker 2:Yeah. I think it'll be very rewarding and very exciting to see them grow and kind of do their own thing and develop their own personalities, and so it'll be very, very fun.
Speaker 1:Yeah, I'm happy for you.
Speaker 2:Thank you so.
Speaker 1:I mentioned Joseph Campbell. Are there any good books that you like?
Speaker 2:So I am a historical fiction lover that's like what I tend to gravitate towards. So I actually just finished the Women it's about the nurses in the Vietnam War.
Speaker 2:And it's a historical fiction book but it's kind of about the unsung people who weren't acknowledged but did a lot of care and hard work during the Vietnam War. But I love historical fiction books, especially ones that have strong heroine stories. So the Alice Network is another great one about like an underground female driven spy network during the Great War and I just love those books because you learn a little bit but they're still enjoyable from a fictional standpoint.
Speaker 1:I agree. I mean stories. Just hearing facts don't really stick Right. You need to be able to tell a story.
Speaker 2:Yes.
Speaker 1:So in that book the Women does it take place stateside or in Vietnam, or in both?
Speaker 2:Mostly in Vietnam. Okay, yeah, so it starts the first chapter or two they're back state side, but then she is deployed and working in army hospitals in Vietnam and it makes you appreciate people who put their lives on the line and take care of people who put their lives on the line for us on a daily basis.
Speaker 1:Yeah, yeah. Actually it makes me think of my father. He was a corpsman, which is kind of like a nurse at Balboa Hospital during Vietnam. So he wasn't in Vietnam, but when patients came back, or were flown over, you know, saw a lot of patients and in the military medical system it's a little bit different than the general medical system. I mean you have nurses do a lot more, you know, in the field of battle for sure, the theater war.
Speaker 1:Then you know, they do stateside. Not that they don't do a lot stateside, but I mean they're allowed to do a lot more.
Speaker 2:It's all hands on deck, especially, you know, in the book they talked about the mass casualties and it really is. You know you need everybody just to pick up whatever you can do. So I think it was a great story about like teamwork and, you know, emotional strength, physical strength and just being there for each other and that's what's important.
Speaker 1:Yeah, for sure, I'll end on this. Actually, I did a short stint at Mayo Clinic and they had a mass casualty event when I was there. Oh my gosh, which is Rochester's a small city? It is very small, I mean beautiful hospital, huge hospitals, a hundred and something OR beds. Yeah, it's huge but um, it was this huge car wreck that happened. I don't think it was like foggy or something like that.
Speaker 1:And they like we're asking, like other doctors, to come to the ER because, I mean, it's just the last place. You'd expect a mash casualty event. Um, but um, uh. That would have been like maybe 2010 or something like that.
Speaker 2:I can gosh, I can't imagine.
Speaker 1:Yeah, it was pretty crazy. I obviously didn't go, but anyway.
Speaker 2:What a wild experience.
Speaker 1:Yeah, you always got to be ready, oh my gosh, yes, and sometimes things like that happen and you just got to jump in and help.
Speaker 2:You do. It's like when you're on an airplane.
Speaker 1:Yeah, I'm always with my wife, who's an OB-GYN, so I'm always safe on that one. Same with myself and my husband. I'm like if they call over.
Speaker 2:I'm like, you're the anesthesiologist. If you need me, then call for me yeah.
Speaker 1:I'll be your backup. I'll be right there. Yeah, I'm the backup, your primary.
Speaker 2:Ashley, how do people? As a patient, you will need a referral from your general dermatologist. If you have a biopsy proven skin cancer that needs treatment, you can either call our office or make an appointment on that. S-c-h-w-e-i-g-e-r-d-e-r-mcom and I am currently at the office in Chesterfield. So Schweiger Dermatology in Chesterfield.
Speaker 1:And so they can reach you at 314-878-3839.
Speaker 2:That's correct.
Speaker 1:Well, I want to thank you for the good care that you've given our mutual patients and I want to thank you for coming on today, and I really appreciate you.
Speaker 2:Thank you so much for having me and, of course, for sharing patients and taking good care of our mutual patients. It's always a pleasure to share patients and discuss cases with you.
Speaker 1:You bet Thanks so much.
Speaker 2:Ashley, thank you.