Dear Dr. Roach: I am a 78-year-old woman who, in my early years, was exposed to many sunny days at the beach. Sunscreen was still a new product in 1954 and not formulated to the standards required to prevent skin cancers the way today’s strong sunscreens are. In those early years, sunblock was not widely used by the public, or me.
As a result, I see a dermatologist twice a year to identify and prevent the spread of skin cancer and its damage to the skin. What I want to know is what should I expect from a dermatologist’s full-body scan. In the past, I have stood a few feet from the doctor with just my underpants on and a medical tissue gown opened in the back. Meanwhile, I had a friend tell me that her dermatologist checks “where the sun doesn’t shine.” Another person said the doctor feels their arms for signs of cancerous cells.
With a tissue gown on, the area between my chest and waist are not exposed to the doctor’s view. I am not sure I have confidence in the full-body check I am receiving.
A.J.
Melanoma is the most dangerous skin cancer, and the one that doctors most want to find early. The correct technique for a skin cancer check is to examine the whole body under strong light and with magnification if needed. The gown has to come off for a proper exam. The scalp should definitely be included, as it is very hard for a person to examine it themselves, but genitals are typically not, unless the person has a specific concern. The thighs and legs are particularly important in women, and the back is particularly important in men. But, any sun-exposed areas should be carefully examined.
Dear Dr. Roach: My wife is a Type 2 diabetic and takes metformin twice a day. However, her new primary doctor said that metformin deprives the muscles of sugar, which they need for energy; therefore, muscle wasting will slowly occur. Should she continue taking this medicine?
R.I.
That’s not correct. Metformin works primarily by reducing the amount of sugar the body makes. Blood sugar can either come from what you eat or by the liver producing and releasing sugar into the blood. With less sugar in the blood from the liver, the insulin a person with diabetes has relies on the sugar from the diet.
Insulin is needed to bring sugar efficiently into the cells, so when your insulin is working more efficiently (metformin actually helps muscle cells get and use sugar through a second mechanism), your muscles work better. Metformin does tend to help people lose weight, but they tend to lose fat, not muscle. Metformin remains one of the most important medicines for Type 2 diabetes.
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