So how are you doing, Gregg? What brings you in, man?
OK, well, I've got a big alien baby mass on my left foot.
So you have an alien toe?
Yeah.
On top of his regular toe. GREGG: On top of my regular--
Oh my gosh.
Yeah.
It's gross.
Is it cancerous?
Is it something weird where it's going
to affect his toe forever?
DR. BRAD: Right. Right.
I mean--
Terri's really concerned.
The challenge about somebody that's
coming into the office with something
like this on their foot is that they're scared.
They're nervous.
So you have to deal with the fear of the patient.
Your mind does go to all kinds of stuff.
Even there's stuff on my body that I-- you know,
I think I'm just like, I need to biopsy that
and see exactly what it is.
So I understand, you know?
Totally.
So those fears are OK, and we'll get to the bottom of all that.
So how long have you been dealing with this?
I first noticed it in probably like '88, '89.
DR. BRAD: OK.
So 30 something years ago.
Do you think there's been like a little fear
in getting it taken care of?
Why wouldn't you want to just get this off and get
a definitive diagnosis on it?
Because of self-denial.
So no news is good news for those types of situation.
You and the rest of the world.
That's what everybody does. TERRI: Denial.
It's serious denial.
Seriously.
So is it OK if I take off your socks and shoes?
GREGG: Yes. - OK, cool.
Let's check it out, man.
You can already see it through the sock.
GREGG: Yeah.
I can see right there.
DR. BRAD: Yep.
DR. BRAD: Yeah.
I mean, it-- it really does pop out at you, you know?
For sure.
Does that hurt?
GREGG: Not really.
DR. BRAD: It's definitely freely movable.
And when I'm feeling around in there, you do-- you do
feel that gel-like material--
Yeah
--in there.
As I'm looking at Gregg's mystery growth,
I'm really looking to make sure it's not overly hard.
It has a good base and border around it,
and you can kind of move it.
If it's firm and hard, those are telltale signs that it
could be something serious.
To me, I don't know if it's gel or--
TERRI: It's weird. DR. BRAD: --or what.
It is. Yeah.
It's weird.
Honestly, I don't know exactly what it is, you know, from you
know, this vantage point.
But that's normal.
I mean, when we have skin and we have something that's
growing up, the vessels do kind of overlap and intertwine
in it.
OK.
One test I'd like to do, if there is gel in there
if I turn the lights off and put a flashlight on it,
sometimes you can really see the gel.
OK.
DR. BRAD: And we could probably really see the vein
and see exactly where it's going.
So actually, let's do that now--
TERRI: OK.
--and we'll see exactly what we're looking through there.
GREGG: OK.
One second.
Turn the lights off.
Cool.
All right.
And we're going to put it right up to the side here.
TERRI: Oh, wow.
DR. BRAD: Yeah.
And you can see that vein going through it on the top.
Oh.
DR. BRAD: And I'll try on this side.
TERRI: That's weird
DR. BRAD: A ton of vessels going through there.
TERRI: So is that gel or what?
I mean--
You can really see the gelatinous fluid in there.
Good.
OK, one second there.
Cool.
All right, so doing that test right there,
you really go through a few different things in your head,
all right?
There's different kinds of cysts, right?
One is a ganglion cyst.
Ganglion cysts have like gelatinous fluid in there,
and it does kind of feel like that, you know, initially.
There's other cysts called synovial cysts.
And synovial cysts can come from joint fluid
and it is over a joint, so that's possible too.
There's soft tissue masses.
There's soft tissue tumors, OK?
I know that one of your concerns earlier was, you know,
could this be something life threatening?
You know, could it be cancer, you know, things like that.
Those are very serious things to discuss with a patient.
And look, it could be.
There's definitely a possibility that something like this
could be cancerous.
Any time you have a mass or a tumor, that's always a thought
that you need to play through your mind.
OK?
We're not going to fully know that until we biopsy it and get
a final determination on it.
So Gregg, the plan right now is to take
you to surgery so you don't have to deal with this again.
So you won't have the pain.
You won't have the mass.
How's that sound?
That sounds great.
DR. BRAD: Terri, you're game?
Absolutely.
GREGG: Let's go-- let's do it.
So I'll see you the day of surgery.
- Thank you, sir. - Thank you, doctor.
Appreciate it. DR. BRAD: Nice meeting you both.
GREGG: Nice meeting you. - OK?
Take care.
It's really stressful and scary.
I-- I don't want to lose him.
He's--
Ain't nothing going gonna happen.
It's all-- everything's OK.
I know you keep saying that.
But for me it's a real fear and losing you is not--
I can't handle that.
[BEEPING]
I can't believe he actually got wheeled into surgery.
You know, I kept wondering if he was going
to back out at the last minute.
He-- he's in such denial.
He deserves to have this gone so that he's not walking
around in pain every day.
So the step for the surgery today
is planning out the incision around the mass.
You know, the mass is big and the toe is small.
So when you have a mass like that at the tip of a toe,
there's not a lot of room to close skin over.
So that's going to be tricky, but we can do it.
Let's do it.
[CHUCKLES]
So we're going to make the incision over this mass,
try to get out everything possible to get a great biopsy.
So one of the things we noticed in the office
when we did that light test, we saw all the vessels
that were going through it.
We're going to try to preserve every vessel
that we possibly can.
So we're going to start our incision.
[BEEPING]
SARAH: I untied on that so you can connect to your incision
back here.
Ultimately, it would be nice to not pop it.
SARAH: Absolutely.
Whenever you're removing a cyst,
sometimes it's filled with gel and they pop a lot.
I don't want that to explode all over the place,
and I just want to send it off to the lab in full.
This looks like a little cotton ball.
It does. - Or like--
It's very fluffy.
--like popcorn.
Hopefully we don't pop it.
Hopefully not.
It's getting free.
I think you have to come down proximally.
DR. BRAD: All right.
Let's see.
I think we got one more cut to go, Sarah.
SARAH: All right.
DR. BRAD: So release this stalk.
SARAH: Snip, snip.
DR. BRAD: Wow.
SARAH: That's impressive.
That's crazy.
SARAH: All in one piece.
That's the best.
I'm so happy right now.
I finally got Gregg's mystery growth removed in one piece,
and it's just sitting in the palm of my hand.
It looks like a little eyeball.
SARAH: It does.
DR. BRAD: Yeah.
I can't say I've necessarily felt an eyeball before,
but this feels like what an eyeball would feel like.
I'm really excited that the mass didn't
pop when we were taking it out.
That'll give the pathologist a good read
on exactly what it is.
The next step is just closing the skin
and giving him a good cosmetic result.
SARAH: Nice.
Very, very nice.
So we're done the case.
It feels really good.
We got this huge mass out of Gregg's toe.
We kept it completely intact.
Beautiful.
Awesome.
Let's go.
Let's go get some popcorn.
Oh.
Right now?
DR. BRAD: So I'm seeing Gregg today for his follow up.
He had this bubble on his toe.
I removed it, and I just want to see him, see how he's doing.
And he's coming in with his wife today,
and I know she was pretty concerned that it was cancer.
So I just want to go over the biopsy results with them.
I'm glad it's gone.
I just want those results.
[KNOCKING]
- Yo, Gregg. - Hey.
Hey, Dr. Brad. DR. BRAD: What's up?
How are we doing, guys?
I'm well.
How are you feeling after the surgery?
Oh, psh, great.
DR. BRAD: Yeah?
I didn't realize how much pain I really was in until I
don't have any more pain. - Sure, man.
Yeah.
Well, I just want to check out--
OK. DR. BRAD: --the foot.
Sure.
DR. BRAD: OK?
Was this the right foot?
TERRI: Yes.
DR. BRAD: This was--
I operated on this foot?
TERRI: Yes.
It's just a little pink.
You can't even tell there was a surgery.
DR. BRAD: It has to be on this foot.
TERRI: I'm serious.
No, it's right.
You can't even hardly-- it's just pink.
Come on, man.
This looks freaking good.
TERRI: It looks amazing.
This looks really good.
I didn't even know if I took off the right sock and shoe.
I was looking at that foot.
I was like, dude.
Is this the actual foot that I did?
It looked that good.
But this looks fantastic.
Let's-- let's get to the main reason you're here, OK?
And you know, go over your biopsy results.
TERRI: Oh, yes. Please.
OK.
Well, I have them here.
OK.
Let's see here, Gregg.
So left foot, soft tissue mass, and the results are a benign--
TERRI: Yeah.
GREGG: Yes.
DR. BRAD: --which means no cancer.
No cancer.
It is a neurofibroma.
TERRI: OK.
OK?
A neurofibroma can sometimes appear like this,
and it envelopes around a toe-like area
so it creates that bubble-like mass.
But the good news is here benign.
That's the best word I've heard today.
So, look, all of--
Thank goodness.
All of your worries and especially yours
can finally be put to bed.
Gregg, honestly, man, no cancer.
It's a huge win for us.
I mean, seriously, you guys are going
to live the rest of your life without having
to worry about this stupid little alien toe.
It's back to space, right?
That's it. DR. BRAD: Peace out.
Now it's gone.
My hope for Gregg is that if there's ever anything
on his body anymore that he's scared to get checked out,
hopefully this gives him a fresh outlook
that he can go to doctors, be safe,
and look forward to his result.
[MUSIC PLAYING]