and tell people here we are we have Gil and myself giving you a live procedure
here on YouTube so tell your friends because we're gonna be here for a little
bit we have to get the procedure done so if people come in a little bit late
they'll be able to catch it people are watching this after the fact once it's
put up to the YouTube channel it won't be live of course at that time but when
it's being put out live here on a Wednesday afternoon at 3 o'clock Pacific
time you'll actually be able to comment and will respond to it after the
procedure not during and who knows maybe even Gil will answer some questions for
you guys so we actually are we have 16 people watching us right now so I'll
hand this over to Leanne who will be taking care of our are switching here
and to see comments yeah to see the comments you have to let me set this up
sorry guys I'm setting this up so Leanne can help us with comments when the time
comes for the live comments so they show up over here all these people have
already commented so team epiphany Alex hey Hanna
yes time Morgan hello Hannah and the Beatles 50 hi doc hello all of you thank
you for greeting us and guilt so we actually do have people watching us
let's go ahead and walk on over here to the table and we have it sticking out a
little bit because of how we'll do the procedure and
sorry about that so we'll tell people what's what's going on you can add some
skin lesions before that we thought should be checked have any of them ever
turned out to be any kind of a skin cancer no no no skin cancer let me just
turn on more light for us and then we're talking today about this one right here
and we'll have Ian get a real close-up shot of that you can get you know about
a foot and a half away and then zoom in on it this how long has this been here
do you know Gil and recently the trouble was the flaking and scabby you know come
off and does it have a feel to it when you touch it it seems to be kind of
unique okay well we'll certainly get that off we're
concerned about the possibility of different types of skin cancer probably
the skin cancer I'd be most concerned about me would would be malignant
melanoma chances are it's not but we just want to make sure because that
would be a very bad thing to miss malignant melanoma in screening for it
we think of things called the ABC DS or ABCDE a is there a symmetry like if you
drew a line down the midline of it does one half look like the mirror image or
is it a mirror image of the other half B border irregularity is it nice and
smooth and round C color variation are there different colors to it or more
than one color d diameter greater than four millimeter e evolving color shape
or size if it's changed and you say it's actually kind of changed in the feel of
it so we will get started by having you lie on your well you can lie on your
back if you want with your head on the pillow but we'll have your head kind of
turn so that we can get to it and I think what we'll do is trade here
for a moment and have Ian do the the prep and in fact I'm going to go do the
the anesthetic because you don't want me to do this without anaesthetic okay so
I'm gonna do something we've not done before since I have the the mic on
myself I'm going to carry it over to where I actually draw up the medicine
and the people at home will be able to to hear me talking but we'll come back
and you guys will have that all ready to go so I'm gonna just carry this camera
with me this would be kind of interesting so I'm gonna take you guys
with me and we'll do it Casey nice that style how's that there we go so we're
walking through the entire office and you guys should be able to hear and see
me like I can tell from the tally light that you guys can hear and see me we're
gonna walk to the part of the office where we keep the anesthetic and the
syringes and I'll just draw that up for us
so that we can get this patient taken care of and make sure that he's numb so
that he doesn't feel his his procedure being done let me put you over here I'll
kind of lean down so you can see I get some a syringe and some alcohol and we
don't have any controlled substances here this is just just lidocaine is all
it is
all right get some lidocaine we actually have a bit of shortage of lidocaine with
epinephrine right now and we've been saving this little bit of lidocaine with
up in different we're going to use for Gill and we'll draw it up here and this
is it this is a hold of it and then something else that I do yes I use some
sodium bicarbonate to buffer it so that it doesn't sting as much when it goes in
so get that and what I put in is about 10% of what the volume is I already have
of the anesthetic out of a multi-dose vial and a small needle and then we're
gonna walk right back and hopefully Gil will be ready and be numbed up wouldn't
that be funny somebody else walked into the frame dr. Blaine what are you doing
on my live video which we don't even know okay here it is right here here's
the light of King with epi I told you before about the aspirin I'm gonna
explain that in a moment that right there okay I have to explain this thing
about the aspirin so if a patient is on aspirin normally we'll ask them to stop
it for well I'll just do it for three days before doing a procedure like this
but we just scheduled this procedure yesterday and you know there wasn't the
three days to stop the medicine so we're going to use lidocaine with epinephrine
because we're you know injecting close to the temporal artery that's kind of
important so I'll have Leanne switch cameras while we give you guys back to
Ian so he can carry you
and I'm about to put in the anaesthetic I was just explaining to the people at
home that we didn't have you stop the aspirin for anything other than just
overnight so I'm using some epinephrine in this to help to decrease the risk of
bleeding why is it not walking for market so once you get it in there then
you lock it right here and come back around over here so uh well I'm numbing
you up yield did you have any questions or comments
Lian do you have any questions or comments from our friends at home so I'm
sorry I'm going to give you a shot here
Gil do you know dr. Greene he's the tall
this is chill Gil
what we're seen as as the medicine goes in it kind of pushes the lesion upward
away from the head which makes it easier of course to do a shape biopsy and the
medicine also makes the surrounding skin a little paler in color as it pushes
blood out and also as the epinephrine takes effect on the blood vessels to
constrict them that even makes the anesthetic last longer because it
doesn't get taken away by the circulation as quickly we got a little
bit dripping down because it's coming down putting so much in that it's being
pushed out by some hydrostatic pressure does that hurt and Gil okay we're
actually using just a fraction of what I got I got two three cc's we've only used
two so I'll put this away using a one-handed recapping technique of course
you're never supposed to recap but I'll use the one-handed technique here then
once I get the cap on secure it in place and then we'll move right on to doing
the procedure so I'm changing out of the non sterile gloves into the sterile
gloves not on this one no there's a number of reasons we don't one is with a
30 gauge needle there's not as much need for a cold spray another one is the
location it's very close to the eye and I don't want to to get the cold spray
all over the die I'm gonna use my non sterile hand to
grab the tray and bring it over behind us over here and also I need the
specimen container you know I'll just have even put that right here probably
right here would be a good spot so Gil we actually have the container for the
specimen behind you so I need you not to kick girly wildly flail about during the
procedure yeah yeah we we sometimes ask patients not to kick him
we flail about so this is one of those I hope that doesn't concern you okay all
right so using a couple instruments we want to kind of stabilize the lesion
that we're taking off and get a good sample of it and Gail what are you gonna
do after this something reward yourself somehow for having gone to the doctor's
office and had a painful procedure done
yeah you know concerned about when we get started no no I'm just gonna put
this here because there's a little bit of blood and then put the specimen
container put that there put that there there and then the wound seal is
available so I'm going to put that in my what is now not a sterile hand and take
a look at what we have so there's a little bit bleeding because we are right
right on the temporal artery see if putting pressure on approximately helps
does it hurt when I press ok and what I'm seeing is I did not take the entire
lesion off and we have options here we can go ahead and finish the procedure if
that tiny little speck still there and if it turns out to be benign that's fine
I could if you want go ahead and get the instruments again get sterile gloves
again and take that off also and that way the thing is completely gone but it
means having kind of an irregular shaped and larger place to heal out ok we'll do
whatever you want their guilt do I have your permission to share the results of
the biopsy on the description of the video sure then we will have the results
after we inform Gil in let's see what today's today Wednesday I'm gonna say by
Monday why I'm not shouting no Gil I guess he doesn't have a reason to show
yeah ok I'm gonna pour this in push on it pour it and then push down with my
hand for about 60 seconds can anybody track 60 seconds for me does anybody
have something that shows seconds nobody I can do in my head
maybe we could have you read some comments well many years I'm sorry my 12
years there you go Gil went for 12 years yeah yeah this is
the boring part as I count in my head oh
okay a recap for those who are just coming in because this is a live
procedure Gil came in with a strange lesion on his forehead you'll have to
review back after this is put up again like maybe Friday afternoon to see what
it looked like and it was starting to have some strange behavior it would kind
of flake right they mind getting that right yes it was very black and so this
changing skin lesion that had strange behavior needed to go needed to get
biopsied so we just now shaved it off and it's in a specimen container over
here we just poured on some wound seal to help the the wound to stop bleeding
and to have a scab on it you guys go ahead and take a look really close there
I am now getting out of my sterile gloves and gonna throw away the sharps
and prepare the specimen because we were just about done here before I do the
specimen container let me throw away sure so now we're reaching that part of
the procedure where we're going to I'll actually switch and take the camera from
a inch in a moment and take questions as Ian does the cleanup on Gil that's kind
of way we split things up here so we do still have an estimate there there are
some contaminated things there just put this right here and I'm gonna hand the
patient off to to Ian so I'm sorry yeah you want your hand
alright so I can actually answer questions while Ian's works on Gil get
another view of Moon steel yes it is the temporal artery is right under the skin
there you go too deep and that is really gonna bleed so that was part of the
reason that I used our our last supply of lidocaine with epinephrine until we
get some new I'm not sure why there's such a probably guess the manufacturers
not keeping up with the demand yeah it's coming in now with a little spray he's
going to spray off with air yeah we don't want to get in the eye you see the
powder just kind of goes off onto the the Chuck's we have interim the paper on
the table guilt can I have you sit upright we just did a shave biopsy on
Gil's left temple and we put on some wound seal Ian is now just cleaning up
around the wound seal and we'll get though the results on the pathology I'm
gonna come around to this side and how are you feeling guilty feeling fine is
it great yeah so I'm much closer than it can focus I know that I'm sorry I'll try
to come back here and instead zoom in because that's way this lens works
better in wound seals the name of a commercial product that essentially acts
like a scab it flim arises on contact with the blood oh yeah we can well I
don't know do we want to be that commercial yeah well show you what the
box looks like it just looks like that box wounds heal and I guess that we'll
go ahead and now kind of do a bit of a sign-off
what about you ian has been here for 22 months 20 19 months 19 months and I'll
go ahead and hand the the camera to Ian for a I guess for a sign-off unless
there's more questions or even for the questions let me hand that to you have
you spin that around all join join Gayle here on the table of honor thanks a lot
for doing this yeah appreciate it any other questions here as we wrap up
any any final comments that LeAnn can read and we can say out loud okay thank
you so much for joining us this will probably go out be available again
Friday afternoon at 4:00 in in place of our Friday procedure video and I know it
depends on how good the procedures are between now and then may actually be
left out and put something else out on Friday we'll see we want to especially
thank for individuals on patreon booboo Kitty Lindsey Ann twine Prechter
Rosenberg and Meg light bone thank you ladies very much for your support to
help make this possible for people learn about medical procedures gill again
thank you you've done this a couple times and it's it's been good until next
time dr. mark Vaughn telling all of you I'm about to sign off but I appreciate
your watching stay in good health