Cutaneous Horn - aka Devil Horn

Can a human grow horns??

Yes, kind of.....One of my favorite skin lesions is a relatively common lesion called a keratoacanthoma.  These neoplasms (growths, benign or malignant) often arise very quickly and are filled with a central keratin (fibrous proteinaceous material that makes up hairs/nails) material.  They are usually very round with pink edges the central area is filled with the hard keratin, which can continue to grow leading to a 'horn'.
  

The lesions usually arise from a hair follicle and tend to look like ingrown hairs or pimples at the beginning until they take on their characteristic appearance.  These lesions tend to resolve on their own over time because they outgrow their blood supply but scar if left to resolve on their own.  That being said most patients elect to have them removed surgically in the office because they are tender and we can not reliably predict the histology of the lesion (cancerous or not cancerous).

These lesions are interesting to see in the clinic because they are usually rather alarming to the patients when they're discovered given they are tender, usually somewhat irritated and rather ominous appearing.  That being said it's satisfying from my perspective because the treatment is straight-forward and technically enjoyable.  You can either shave the lesion off at the based flush with the surrounding skin and then use electrodissection (electrocautery) to destroy remaining cells on the base or do an elliptical surgical excision.

These lesions have been hypothesized to be the entity referred to in more art and literature when characters, such as the devil, have horns.

But Doctor, I don't eat anything!

One of the most prevalent issues I help patients deal with on a daily basis is weight loss.  The foundation of what is now popularized as "Wellness" is healthy eating, exercise, and achieving a healthy weight. 


The title of this post is an oft heard phrase in my clinic.  Although, I do believe that many patients feel that they are not currently eating very much, people would be surprised to learn how few calories it takes to maintain their weight...let alone lose it.

Frequently by the time I see a patient dealing with obesity they've already gained the weight that is making them obese and are now just maintaining.
Under the laws of physics patients don't just magically become obese without, at some point, bringing in more calories than they are burning.  It is true that there are certain medical conditions that slow or speed up your metabolism but the principle is the same, if you are gaining weight, you are taking in more calories than your body "needs."


You can calculate your basal metabolic rate or BMR by visiting http://www.myfitnesspal.com/tools/bmr-calculator.  This is a simple tool that helps to guide you on how many calories you need each day just to maintain your weight.  The nutritionists out there will likely point out the many pitfalls in using such a calculator because each individual's BMR is personal but this serves as a useful starting point. 


I strongly suggest patients who are motivated to lose weight to use an application for their smartphone called MyFitnesPal.  This app communicates with another application called RunKeeper.  Both of these apps are free and easy to use.  They help track your caloric intake, measure your calories expended by exercise, and keep you on track with your caloric goals for the day/week/month. 


A recent study came out reviewing the effectiveness of smartphone applications in helping patients to lose weight.  http://www.ncbi.nlm.nih.gov/pubmed/25402403.  This study found that overall these apps are not any more effective than placebo in helping patients to lose weight.  But there were some interesting findings.  Patients who benefited the most were those who were motivated to lose weight, and these tools did help.  For those who weren't motivated, the app did not help-- because they didn't use it!  They also found that use of the apps decreased significantly after the first month.  Like any other long-term lifestyle interventions, if you only intervene for a month, at the end of a six month study there won't be any positive results.  So, I'm not sure this study is going to change my recommendations.  If a patient is motivated to lose weight AND they are willing to stick with a program of lifestyle change, the tools such as MyFitnessPal can be very useful. 


I've had many patients who have successfully lost weight and maintained their weight loss with these tools.  I have used MyFitnessPal myself to lose 20 lbs. 


Weight loss and maintaining a healthy weight are challenging, long-term issues but the cause is not hopeless. 

As you can see, I didn't remember I had this blog!  But I think it can be used as a helpful forum for communication with patients and the public about medical issues.

First and Foremost!  When you Google me you'll see my old address listed everywhere.  I'm working diligently to get these addresses changed to the new practice.

Town Center Family Care
21 Hospital Drive
Suite 290
Palm Coast, Florida 32164
Phone 386-437-7977

For those of you thinking to yourself, "Oh geez it's all the way in Palm Coast!"  Don't fret, it's on state route 100 right next to I-95 and Flagler Hospital in the Town Center Medical Building.  It is five miles South of Palm Coast Parkway, so I really consider it the Flagler Beach area (that's only somewhat of a stretch).

I hoping to move this blog in a useful direction other that relentless self-promotion soon, so please stay tuned!

Stay Classy Northeast Florida - Dr. K

I'm happy to announce to my existing patients and future patients in Flagler County Florida that I will be joining forces with Dr. Donnette Williams in Palm Coast, Florida at Town Center Family Care starting August 5th, 2015.  This change will provide flexibility for myself and my patients in a more intimate, patient-friendly environment.  The last two years as an employee of Florida Health Care Plans has been educational and rewarding.  I have learned the skills necessary to navigate the Florida Health Care Plans system and look forward to continuing to serve the members as a contracted physician.  Our new professional website will be www.towncenterfamilycare.com.  Existing patients of mine can call member services at Florida Health Care Plans to August 5th to ensure they retain me at their PCP or if they have traditional insurance such as Florida Blue or MedSave just call to schedule at appointment.  My phone number will be (386) 437-7977.  Our address is Town Center Family Care, 21 Hospital Drive, Suite #290, Palm Coast, FL 32164.  We are on St Rt 100, right next to Florida Hospital Flagler.

Welcome

Hello All - Thanks for Visiting. This is my new blog dedicated to giving a little insight into the life and times of family medicine resident.