The Dermatologist

What is the deal with doctors who make you make an appointment like, 6 weeks in advance and no earlier? It's REALLY annoying. My regular doctor does that - it is in fact extremely hard to get an appointment with him as he is also chief of the NY Presbyterian-Cornell Medical Center (the one up on like, York and 70th). It's not like I KNOW in advance when I'm going to be sick...

Anyway, okay, so I get it when an important doc like my regular doctor does this, but my dermatologist? Every time I call, they say the next available appointment is in 6 weeks. The problem is, back when I was living in NYC, I pretty much only called up the dermatologist when I had an emergency zit breakout and needed him to zap it immediately.

So back towards the end of October, I called my dermatologist's office to be greeted by the gruff receptionist, who told me the next available appointment was on December 18th. Which is today. I used to not like my dermatologist very much, although it wasn't really a personal thing, I just resented the 6 week wait for an emergency zit zapping.

However, today I have newfound respect for him. This is what happened:

I'm sitting in the exam room, shivering, as I am wearing a gown since I have not only a crazy acne breakout, but a crazy eczema breakout all over my body too. The dermatologist comes in.

Dr: Wow, you've got a major breakout on your face.
Me: Yes, I realize that. Which is why I'm hear. (Dr comes closer, peering at my face with those weird dermatologst goggle things on his face). You see, I figured out the reason for the breakouts. It's 'cause I'm gluten intolerant. (Dr. peers at me like, "yeah, ok"). No, really. See, remember before when I used to come and I had the major face breakouts? (Dr nods). So, I did this elimination diet, and I eliminated all wheat and gluten, and my skin cleared up. Which is why I haven't been to see you since 2005. So, I recently got accidentally glutened, but when I do, I get these crazy stomach cramps and then my face starts getting all these crazy zits. (Dr. looks at me very skeptically). No, really! But the zits don't go away for a long time, and look, I get this weird eczema all over my body.
Dr: Okaaaay, well, let's see your eczema.
Me: Look it, it's all over my legs. See? And I just started breaking out on my chest too. And always, I get it first on my elbows. (Show him my left elbow). It's very weird because I always get it on one elbow first, then I get it on the other elbow, then I get it on my leg near my knee, and then I get it on the other knee. But the ones on my elbows itch the most. And this one on the left was going away but it came back again recently. But the one on the right totally went away.
Dr: (grabbing my elbow). How interesting! Let me see that elbow! (peers at it from all angles through those dermo-goggles. Hmmm. Did you know, there is an eczema called dermatitis herpitformus which is related to celiac disease and gluten intolerance? In fact, it is a sure sign of gluten-related problems. I would like to do a biopsy.
Me: But maybe I will get a false negative, 'cause I don't eat gluten on a regular basis. Just on an accidental one.
Dr: Yes, it might be a false negative. Also because this dermatitis is not very severe, so that might also be the reason for a false negative. But I'd like to do 2 biopsies on it, and I will send them to a special dermatitis herpetiformus lab. And if it is a positive, then you can get a medication that will alleviate the skin problems from the gluten intolerance.
Me: Erm. Okay. But then will you zap my zits?
Dr: Yes. (calls nurse over, and says he will be doing a biopsy, then injects my patch of eczema with anesthesia). Lie on your side. (Starts cutting off my skin, then puts stitches where my skin was). Okay, so you'll need to come back in a week so I can take the stitches out. I'll be right back.
Me: Okay. (Dr comes back in) So, I have these two really painful pimples that haven't surfaced yet, so will you do your zapping thing with the needle and make them go away, please?
Dr: Okay (Injects pimples with needle). You really should have come to see me earlier - you're a real mess as far as your skin is concerned.
Me: (huffy) Well, I called as soon as I knew what my dates would be for New York and this was the earliest appointment I could get. I called back at the end of October.
(hoping for apology from Dr, but he remains silent).
Dr: Okay, so make an appointment for next week so I can take out your stitches. Clean the stitches every night with hydrogen peroxide and bacitraycin. And I'm going to prescribe you some topical medication for your face, and if there's no improvement within a few weeks, I want you to take this antibiotic, and I'm going to give you a one month dose, to really knock everything out.
Me: Okay. But ick to the antibiotics. They're not good for me.
Dr: Well, it might be the only solution in this case. (leaves the room after handing me huge pile of prescriptions. Then I go out to the receptionist desk to pay).
Receptionist: Okay. So you don't have insurance...that'll be $400.
Me: !@#$!?

Though all in all, I have new respect for my dermatologist for spotting the celiac-related dermatitis. Very cool. Don't think it would have been the same in France, as on the Official French Association for Sufferers of Celiac Disease and Gluten Intolerance it says that "The only way to test for celiac disease is via a colonoscopy. Skin biopsies and blood tests do not count". Also the dermatologist was very cool in that he was very sympathetic to my plight, saying it must be hard for me as in Europe it is a very wheat based diet whereas in the US it is very corn based.

I suppose sometimes the 6 week wait for an appointment can be worth it.