Tip 1: Dealing with a Break In
We had a break in at our office recently. We are very security conscious and have video monitors on the exterior, the waiting room, and the front office. My office manager also added glass breakage detection to our alarm system. The system went off at 4 am. The thief broke a side window in a treatment room, rushed into the hallway, grabbed an old computer, and left. Unfortunately, the computer was the one we use to store patient photos. The photos were on a separate hard drive attached to the computer. The drive had not been backed up, although it had crossed my mind. As the thief was departing, the wire connecting the external hard drive to the computer disconnected, and the hard drive was found on the treatment room floor. The hard drive still works. If we had lost all our patient photos, it would have been a disaster. My manager was in at 4 am, with the police, and got the window boarded up. She saw no reason to disturb me.
We learned a few lessons from this incident:
- Have a smart office manager who treats the business as she would her own is a great asset.
- Always back up and have the backups of critical material off-site. Needless to say, we started doing this immediately after the incident.
- Do not scrimp on security. The computer was among the least valuable items near at hand. The rapidity of the alarm almost certainly reduced the number of items stolen to one.
Gerald Bock, MD
Tip 2: Treating Hyperhidrosis in Children
Some children experience hyperhidrosis. To treat them, I use injections in a grid pattern: about 3 units per injection, about 1.5 cm apart. I use 50 units total for each axilla, which is about right for many children. The range might be 35 to 75 units/axilla depending on the size of the area of excess sweating. The neuromodulator, onabotulinumtoxinA (Botox), is safe, the worst side effect is the cost if you do not have a drug plan to pay for it.
For the procedure, I like to use BD-II 0.3 mL insulin syringes with 31 gauge needles, because they hurt the least. I use onabotulinumtoxinA reconstituted with 1 mL of normal saline, with benzoyl alcohol preservative. I inject into the dermis, raising a little wheal, like a tuberculosis test. I pause for a moment at the end of each injection, to allow interstitial pressure to decline, so that there will be less waste of onabotulinumtoxinA leaking out of the skin and the needle tip each time the needle is withdrawn from the skin.
It is important to make sure there are no bubbles in the syringe, because if there are bubbles they will compress during injection, then expand after the needle is withdrawn from the skin, expelling onabotulinumtoxinA from the needle tip and wasting it.
It is also helpful to have bright lights and nice music in the treatment rooms.
Kevin C. Smith, MD, FRCPC
Niagara Falls, ON, Canada
Tip 3: Treating Chalazions
I have had nice success treating chalazions with intralesional triamcinolone acetonide (Kenalog). Most patients come in after weeks or months of using warm compresses or topical antibiotic eye drops as per their family or eye doctor, and are frustrated by the “perma-pimple” on their eye. I start my injection at 10 mg/mL, usually 0.1 cc through an insulin syringe, right in the middle of the chalazion (similar to a keloid or cyst or large pimple). If in 1 month it has not sufficiently reduced or responded, then I will go up to 20 mg/mL and if needed 40 mg/mL a month later. Usually the responses are quick, on the order of 2 to 4 days, and the patient is grateful.
Benjamin Barankin, MD, FRCPC
Toronto, ON, Canada
Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.