Visit Notes, Instructions, in Disarray
Last updated: December 2022
In looking for my printed notes for a story I’m working on, I found, on a chair: one sock, one old dog leash, the program for the US Open tournament on the day I attended (9/3/21), a membership card to the Amherst Cinema (our local independent theater), a yellow legal pad with scrawled notes that I can no longer read, a New Yorker magazine dated 11/22/21 (I save them thinking I’ll catch up but I never do), a cloth for wiping down my laptop, and, drumroll…a dermatologist’s note from an undated visit to Brigham Dermatology Associates in Boston.
What does the doctor's note say?
- backs of hands
- forearms (front and back)
- forehead/left cheek
- neck including backs of ears and chest.
A second doctor's note
In a pile crammed into the drawer of a cabinet, I found, in another dermatologist’s handwriting:
- Triamcinolone 2 times/day x 2 weeks
- Vaseline or Aquaphor after
- Hands: Twice a day x 10 days
I have no idea of the date from the first one. The second one is also undated, but at least I “filed it” (on the chair) with the after visit summary from the date of the visit, 10/8/21.
The summary makes more sense
The printed instructions are clearer:
For the top of the hands and the left lower leg:
- At night before bed, apply triamcinolone 0.1 % ointment and cover with Tegaderm or plastic wrap. Leave on overnight. Can take off in the morning.
- Repeat each night for 2 weeks
- Throughout the day, you can apply Vaseline to the hands.
Then, a note: Lichen simplex chronicus.
I've forgotten what this was
I might have known what that was at the time, but I didn’t write it down. When I looked it up, I remembered. It is hardening of the skin from picking at it. Here is the formal definition: It’s “a common form of chronic neurodermatitis that presents as dry, patchy areas of skin that are scaly and thick. The hypertrophic epidermis generally seen is typically the result of habitual scratching or rubbing of a specific area of the skin.”1
OK, true confessions, here is the story about that one. My left hand is worse than my right. “You’re right-handed, right?” my dermatologist asked. I said I was and that I knew that the left hand is often worse in countries where the driver sits on that side, due to sun exposure from driving. She said that is true, but it is also because I have been using my right hand to pick at my left.
She didn’t say it in a judgmental way, but the info was enough to embarrass me. I vowed to do better and to STOP PICKING!
Triamcinolone is a corticosteroid, and the point of applying it was to soften the skin.
I need a better system for keeping track of my doctors' notes
I’m sure I did what they said. But I wish I had a better system, or any system at all, for keeping track of what I treated and when. When I start an ointment or the chemo cream combination I use, I try to remember to mark it on my wall calendar so that I can know when to stop. But sometimes I forget to do it. I think I’ll keep track of it in my head, and then I forget.
It wouldn’t be hard to make a folder (as in actual paper folder) with the current instructions, including start and finish. It wouldn’t be hard to make a folder with “done” on it, and the old instructions, with dates, inside. It would keep me from wasting energy, getting confused, and trying to reconstruct what the notes meant.
As I write this, it’s the start of the New Year. It’s as good a time as any to vow to get more organized with my skin cancer notes and instructions.
Do you have any kind of system with your visit notes and instructions?
How often do you worry about skin cancer coming back?
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