[00:00:10] Speaker A: The Michael Hatfield Re Max team presents real estate and more.
[00:00:15] Speaker B: Bay Area real estate is different than in all of America. And why? What's up with homebuyers? What's on sellers minds? How is the market? And much, much more.
[00:00:27] Speaker A: Now here's your host, Michael Hatfield. Well, welcome to the real estate and more show this morning, and thank you for tuning in. We have an interesting guest on today, someone that I respect tremendously, someone that has helped both Nancy and I with our skin issues from time to time. But she's the best of the best. Her words today, taken from considerable experience, will undoubtedly help others and with their own skin in the game, in the avoidance of the dreaded skin cancer. Our guest, Miss Patricia Lu, is a physician's assistant. I'm wrong. She's a PA. They call them physician's associates. That's because they do so much. She works not only in preventative skincare, but also on the surgical side as well. Ask me, she's well known in the John Muir health environment, working with Golden State dermatology. I can personally say she is amazing. Welcome to the show. Patricia Liu.
[00:01:29] Speaker C: Thank you, Michael. I'm so excited to be here.
[00:01:31] Speaker A: Oh, it's great. It's super to see you. For our listeners, Patricia Liu, pa extraordinaire, please tell us, how did you ever become interested in skincare?
[00:01:42] Speaker C: Well, Michael, I think this happens with a lot of people, but my interest in skincare developed from challenges with my own skin when I was a child.
I ended up having a lot of severe and debilitating eczema, and I did not have a very good experience as a child in healthcare. So, thankfully, I eventually controlled my eczema and learned how to take care of my skin. And that experience led me to an interest in helping others.
[00:02:15] Speaker A: Wow.
[00:02:16] Speaker C: So throughout high school and college, I volunteered and I worked in healthcare offices. And eventually I found that I love working with skin cancer patients. I love being able to walk with patients through the diagnosis, the treatment, and the recovery, the whole process, and then follow up with them throughout continued follow up visits. And I found that I was able to get to know really interesting and intelligent people through kind of a potentially challenging period of their lives. And that just brought, brought a lot of joy into my life and sparked a passion for not only working in dermatology, but specifically with skin cancer patients.
[00:02:58] Speaker A: Well, our history is a little bit interesting, so to speak, and I certainly welcome, you know, I'm welcome sharing it. Back when I had retired from the airline, I'd had a lot of radiation because, believe it or not, folks, when you're up at 37,000ft, you're getting radiated from everything from the sun to radiation, from the equipment to everything. And inside, inside the ear, where my headset was for so many years, there had grown, I think it was a basal cell and it spread throughout my ear. And so I asked Nancy, my wise one back then, I said, well, who is the greatest person for dealing with cancer? Because I believe I have it in my ear. And she says, well, that would be Jeff Bortz. You know, the guy is really short, though. You got to look up to him because he's only six foot eleven or something like that, but really amazing. So went and saw them at Golden State dermatology in Walnut Creek. They removed through using the Mohs treatment. And Patricia Liu, lord and behold, she was the one that sewed my ear back up. And Nancy's not afraid to kiss it once in a while. And it's okay. 40 years with that lady. So I feel real blessed to have met you and Doctor Bortz and had your service. And also we do continual checkups because my skin is higher risk being from whatever countries that I may have been from, who knows?
So tell me about this thing about physician's assistant. It used to be physician's assistant, and it wasn't really descriptive of your job. What you do is everything from prescriptions to sewing up ears to helping the physician in every way. So you are a physician's associate now, right? Right.
[00:04:55] Speaker C: Yeah. So ever since the physician assistant profession started and developed way back might have been in the sixties or seventies, when it was actually military professionals who came out of the military and had all these healthcare skills from being a medic. And I, they wanted to use their skills, but had no way of becoming a professional in the civilian world. And so the physician assistant program was developed, but the name assistant just didn't seem to really encapsulate the profession. And it kind of has this connotation of not being able to prescribe medication or perform minor procedures or order blood work and things like that. And so the name physician assistant has been talked about being, you know, changing it over the years. And finally, one year ago, the name was officially changed by the American Academy of PAs, and now it's called physician associate. So we can still say pas for short, but it's technically physician associate.
[00:06:17] Speaker A: Yeah. And it's more applicable, I think, to what you do. You do everything.
When we go for our checks and I have to go for my skin checks far more often than the wife does. But you do a lot. I mean, it's a very demanding profession. So with that in mind, let's just jump right into this. Skin cancer. What is skin cancer?
[00:06:39] Speaker C: Well, you know, just like other types of cancer, you know, skin cancer, a cancer of the skin is when we have cells that are dividing uncontrollably, and they form tumors. And there's different types of skin cancers. There's, you know, the three common types of skin cancers, basal cell carcinoma, squamous cell carcinoma, and melanoma. And each one forms from the different cells in the skin. So there are basal cells in our skin. They're at the base layer of the skin. And when those cells turn into cancer and start growing uncontrollably, then it's called basal cell carcinoma. When the squamous cells, which are more on the surface of the skin, start growing uncontrollably, those ones are called squamous cell carcinoma. And then when the melanocytes, kind of deep in the skin as well, grow uncontrollably, those ones are called melanoma. And they all, for the most part, are DNA changes in those cells caused mainly by sun exposure, uv radiation, but sometimes by other types of radiation or chemicals, trauma to the skin.
And then they all have different.
[00:08:01] Speaker A: Characteristics, so to speak.
[00:08:03] Speaker C: Characteristics, yeah, and different prognoses.
[00:08:06] Speaker A: Do you know, when I grew up, it was a different time, a different generation. We didn't know any better, but we would always take this baby oil and just lather up a baby oil and go lay on the beach. It didn't matter if it was down at the equator or up, you know, here in the Bay area, it didn't matter, but we just didn't know. And the problem is, is that these cancer cells may be there and you not even know it until later years. And there's some definite concern if you don't take care of yourself, because they have to excise or treat these things accordingly. And some of it's not so pretty, you know? So skin cancer is threatening to human life in some cases, is it not?
[00:08:50] Speaker C: It absolutely can be. And thankfully, basal cell carcinoma tends to be less life threatening, whereas squamous cell carcinoma and melanoma can be very life threatening. So we definitely, our aim with all cancers and skin cancer specifically, is to catch these things early or prevent in the first place.
[00:09:11] Speaker A: Is there any connection between cancer of the skin and cancer internally?
[00:09:17] Speaker C: There's all sorts of different types of cancer, and in general, the skin cancers are not connected to the other kinds. But skin cancer can spread to other body parts. So if you have an aggressive squamous cell carcinoma and it grows deep enough, it can break off into the larger lymph vessels or blood vessels and then spread to other body parts and then seed in those organs and cause damage.
[00:09:47] Speaker A: You know, I wasn't in the air force or military, but I'm understanding that people in the military are at higher risk for these cancers. Is that not so?
[00:09:59] Speaker C: Absolutely. Really? Anybody who spends a lot of time outdoors or at high altitudes is at a higher risk to develop skin cancer. And certainly in the military, whether you're in the army, in the navy, or flying like you were up high in the sky, you have these exposures chronically, you know, over quite a bit of period of time, that make you at a higher risk, especially if you have a skin type that is more prone to it to begin with.
[00:10:33] Speaker A: I always felt that people talk about jet lag, but I think being that you're higher in the atmosphere, a lot of what happens on the earth's surfaces, it rises to the atmosphere. And when you fly through it, you're getting exposed to a lot of that radiation. And I think jet lag, in my view, and this is a personal view, I think there's a lot of it that comes from being exposed to radiation.
[00:11:01] Speaker C: Absolutely. I treat airline pilots who fly for commercial airlines, as well as, you know, the stewardess, flight attendants, flight flight attendants that also are at higher risk.
[00:11:20] Speaker A: Just ignore the beep. I'm not sure exactly what that is. Outside. Yeah, there we go.
Just recently, on the subject of detection, it was reported from Stanford Medical that there's a new non invasive virtual biopsy that may soon allow physicians and physicians associates to scan a spot to determine if it contains cancer cells. This method measures how light waves from a laser bounce off human tissue. It's brand new, a little like ultrasound, uses sound waves to visualize organs. You know, that would be, you know, helpful to just using pathology slides, I would think, and may possibly show more.
[00:12:04] Speaker C: Absolutely. You know, the technology in medicine is advancing, and it's really an exciting time, especially in the field of AI, artificial intelligence. And there have been multiple methods of detection using computers, using ultrasound. There's even little kind of sticker tests where you can pull off a little bit of the surface DNA and send that DNA in so that you don't actually have to cut into the skin.
So lots of great technologies coming our way. And I think that, you know, if we can have the insurance companies and, you know, Medicare and things, adopt these to pay for them, will really be able to start utilizing them in medicine.
[00:12:59] Speaker A: You know, folks, when you go in for a scan, you may think that, you may think that this is just a little pimple or a little bit of something, but this lady, when she looks at it, she says, oh, I'm not sure about that one. And they, you know, excise a poor portion of it, it does not hurt, and they send it off to pathology to determine exactly what is inside there that could save your life. So what do you think about skin? Can scans of the skin? How often should a person actually do those?
[00:13:31] Speaker C: Well, just like when you go to the dentist, you know, they might want to see you more frequently if you have a lot of cavities, you know, same thing with withdeze your skin. If I have a patient who is at high risk, they have a skin type that is lighter and they've been exposed to a lot of sun exposure or chemicals over the course of their lifetime. Maybe they've had a history of skin cancer, especially, you know, an aggressive type of skin cancer, then I'm going to want to see them more frequently than somebody who maybe has a darker skin tone type at lower risk for skin cancer, then I would see them less frequently. So I always recommend to patients to at least come in and have a baseline skin exam, and then we can talk about all the different risk factors and how frequently that particular person should be seen.
[00:14:25] Speaker A: I got to tell you, folks, this lady leaves no stone unturned when it comes to taking care of her patients. And as I had said earlier, very, very grateful. Both Nancy and I, Nancy came over. You know, I'm so happy that we have this type of medical care. From Golden State dermatology, ladies and gentlemen, we're speaking with Patricia Liu. She's a physician's associate, a PA with Golden State dermatology in Walnut Creek. And surgery. They do the Mohs treatment as necessary. They excise. And c and daughter, I don't know what that is, but we're enjoying here our conversation, and I'm just hoping she'll explain what C and D is regarding a type of treatment.
[00:15:12] Speaker C: Sure. So we've already kind of talked about the three common types of skin cancer briefly. And so if we can talk about some of the treatments now, there's, there's the two non melanoma types of skin cancer, basal cell carcinoma and squamous cell carcinoma. And there's multiple ways that we treat these, depending on the depth and the size and the location of the skin cancer. And when these basal and squamous cell skin cancers are on the very surface of the skin, especially if they are located on the torso and extremities, we can treat the skin cancers in more of a superficial nature.
One way is sometimes to treat the skin cancers with a cream, and there are a couple different creams, either immunotherapy type of creams or chemotherapy types of creams, which is great. Then you don't have to cut into the skin. And then there's this CND procedure which is stands for curettage and electrodesication. And that's where we anesthetize or numb a small portion of the skin and we use a little tool called a curette and we are able to just scrape away the portion of the skin that contains the skin cancer. And what's interesting about the skin cancer is, you know, the skin cancer cells don't adhere to each other like normal tissue cells do. So they fall apart really easily. So we're able to just scrape away the bad cells and then the good tissue stays there. And then we electrodesicate or cauterize the cells to also destroy the cancer cells. So those are some of the superficial ways that we are able to treat skin cancer when it's caught very early at the superficial stage.
[00:17:09] Speaker A: We're going to take a short break. We'll be right back.
[00:17:15] Speaker D: Welcome to the real estate minute with re Max expert Michael Hatfield. Michael, what traits should we look for in selecting an agent?
[00:17:22] Speaker E: Look for a deal maker with a positive attitude who will work tirelessly for you. An agent who is adept in multiple offer situations, drafting contracts, marketing and advertising a client's home is familiar with multiple cultures experienced in mortgage financing, inspections and escrow is a huge asset to his client.
[00:17:42] Speaker D: What can you do as a plus for clients?
[00:17:44] Speaker E: Your agent is your eyes and your ears. One who works behind the scenes on your behalf. A great attitude, working well with others and keeping clients priorities. Number one is a given for us.
[00:17:55] Speaker D: Call 925-32-2775 now to schedule an appointment or complimentary home analysis. For excellence in real estate. Call the Michael Hatfield remax team at 925-32-2775 or go to michaelhatfieldhomes.com dot now.
[00:18:12] Speaker E: Let'S get back to real estate and.
[00:18:14] Speaker A: More with your host, Michael Hatfield. And that's why we do those scans quite often, in my case, every two weeks. Right.
[00:18:22] Speaker C: I do have some patients who I'm.
[00:18:24] Speaker A: Very frequently, you know, interesting. We were talking about this a little bit earlier. Reported in February, the US FDA is approved the first cellular therapy drug to treat the solid tumor of cancer, melanoma. That's the tough one. The drug, called EntaGV, works by using a person's own immunocells to treat it. So a surgeon removes some of your own cells, and they grow immune cells in the lab, and then I. They're infused into the patient where they attack and kill the cancer. That's pretty wow stuff. This is just incredible right out the beginning. Are you looking forward to working with something like that, Patricia?
[00:19:08] Speaker C: Absolutely. So, you know, about ten years ago when, you know, I've been in practice for 18 years, and when I first started practicing, a diagnosis of metastatic melanoma was like a death sentence, and it felt just. We felt kind of helpless and hopeless, you know, of course, you could enter into a drug trial. We could try some of the drugs that we had available at the time, but the cure rate was low and the prognosis was poor. And in the last ten years, we have these new medications that really give us quite a bit of hope for patients with metastatic melanoma.
Thankfully, I, as a dermatology pa, I'm trying to catch these skin cancers much sooner so before they break off and spread to other body parts. And so for the most part, I don't have to work with these medications. But if I do have a patient with a very aggressive melanoma and it has spread, we refer to oncology, and the oncologists do prescribe these medications. And I've had many, many patients that were able to start on the newer medications, and they're still with me today, years later, after a metastatic diagnosis. And so I'm excited for yet another new drug that is going to save lives.
[00:20:28] Speaker A: That's just absolutely amazing. You know, we talked earlier, what are really the worst skin cancers that you have seen in your career?
[00:20:38] Speaker C: I have seen some.
[00:20:39] Speaker A: Don't be too graphic.
[00:20:41] Speaker C: I've seen some pretty bad skin cancers in my lifetime, and thankfully, fewer the longer I'm in practice, I'm finding that I think patients are becoming more educated and care is becoming more accessible. However, earlier in my career, I have seen some pretty significant, severe cancers.
I always remember an elderly lady who had a very large skin cancer that involved almost her entire scalp, an older gentleman who had a skin cancer that involved his entire nose and out to his cheek and onto his upper lip. And, you know, we had to remove these skin cancers surgically. And thankfully, these patients are okay now. But, yeah, it's kind of sad sometimes when you see some skin cancers that go untreated for a long time for multiple different reasons. Patients don't have access to care or they don't listen.
Sometimes there's a fear of coming in to see a provider, to have these things taken care of.
We're here in May during skin cancer awareness month, and so I'm really hoping that the word can get out to our community that it's important to get in and have your skin examined and get these skin cancers treated early. The earlier, the better.
[00:22:15] Speaker A: Patricia, what are the basic ways that a person can be proactive in preventing skin cancer?
[00:22:23] Speaker C: Well, there's multiple ways. And, you know, first and foremost, we always talk about sun protection because the vast majority of skin cancers are caused by. By chronic or severe intense sun exposure. And so we, we talk about protecting, first and foremost, from the sun, using clothing protection. So things like hats. And the broader the brim, the better to protect the ears and the sides of the face, long sleeves, long pants to protect the arms and legs, and then avoiding the peak hours of the day. So trying to perform your outdoor activities earlier in the morning or later in the evening, one way that tells technology has helped us is that we all have these phones that have the weather on there, and you can actually check the uv index. And so when the uv index is low, you know, it's a safer time to go outside and enjoy the outdoors. And when the uv index is high, we know it would maybe be better to stay indoors or stay in the shade, or you might need extra protection.
[00:23:36] Speaker A: You know, what's amazing is that, so we're always here, that vitamin D from the sun is very good, but you got to balance that out. You can't go out there and become sunburned four and five times in your lifetime, because when you do, doesn't it just double your chances of getting the cancer?
[00:23:53] Speaker C: Absolutely.
We know from research that having five or more severe sunburns can drastically increase your risk of developing melanoma, the one that is the more aggressive type of skin cancer. And so we absolutely want to avoid sunburns, but we also want to avoid chronic daily sun exposure, as that can also lead to skin cancer development as well. So we can also do that by using sunscreen and avoiding the sun.
[00:24:30] Speaker A: So you're a big proponent for sunscreen.
[00:24:32] Speaker C: You know, I am a proponent of the mineral sunscreens especially. I think all the sunscreens are helpful, but I do especially love the mineral sunscreens that have the zinc oxide and titanium dioxide in them. They're healthier for our skin and then also for the environment.
[00:24:51] Speaker A: You see a lot of people in the islands when you go on vacation, vacation and holiday, they wear this white, bright white paint. It looks like, but that's the zinc oxide, so to speak. And it protects children, really. Children don't care what they look like, you know, not like us. You know, people that are more attuned to what we look like. But didn't you just recently take a vacation? So let me ask you now, you took a vacation and you're. You went to Hawaii, you. You took your children, you had a great time. How did you not just constantly fret over the potential for skin cancer?
[00:25:27] Speaker C: Well, just like all the fun things in life, too much of a good thing can turn into a bad thing. Too much cake and sweets and, you know, chocolates can harm your health. But we want to enjoy the outdoors and nature, and so we do that all we say in moderation and with the right of. And so when we go on vacation to a, you know, a sunny location, we use rash guards. We again try to avoid the peak hours of the day. We use, you know, large hats and sometimes even swim caps when we're in the ocean. And then that mineral sunscreen, which is reef safe, so not harmful to all the ocean animals and to the plants.
And so I very much encourage everybody to get outdoors and enjoy vacations, enjoy nature, but just do so in a responsible way.
[00:26:24] Speaker A: What can be done to reverse years of sun damage?
[00:26:28] Speaker C: Yeah, well, thankfully, we have some medications nowadays that can really help reverse some of the damage that was done ago. So a lot of my patients come in and they say, you know, I abused my skin. And just, just like you were telling me earlier today, you spent a lot of time outdoors.
And some of my patients say, oh, I was outdoors with baby oil and iodine on my skin, and we just fried ourselves.
[00:27:00] Speaker A: Well, we can only laugh about that now. We're laughing because we, we were so stupid at the time.
[00:27:06] Speaker C: And in my generation, there were tanning beds and we were laying out in the sun as well. And so, thankfully, our bodies have this amazing ability to heal. And so if we give it the right tools, we can actually reverse some of the sun damage. And so we can do that by creating or supporting our immune system and keeping our immune system as strong as possible through healthy diet of, you know, lots of fruits, vegetables, plant based, as well as low stress and getting enough sleep. All those things that we know are good for us. But then there's also medications. So we were talking about imiquimod, cream and the fluroururacil or the chemotherapy creams, as well as retin A or retinoids. Those medications can help proactively treat the sun damage and precancers and actually reverse some of the sun damage that we have done.
[00:28:07] Speaker A: Wow. All great to know. So, in conclusion, Patricia Liu, physician's associate, Golden State dermatology in Walnut Creek. She's extraordinary. Nice person. Super. In conclusion, what words do you have of wisdom for our listeners?
[00:28:24] Speaker C: Well, I love the skin because not only, you know, because of all the reasons that we mentioned before, but it's so accessible. We can see it right there. All we have to do is look. Whereas some of the other cancers inside our body, it can be very difficult to get to. We can just examine our skin on our own, and you can start doing that right now yourself. You don't have to be a professional to look at your skin and see if there's something that doesn't look right. And so I always recommend just start by being aware of your skin, perform some self exams, and of course, I'm here for you. And we have many professionals in our community that are here for you, and we would love to help you by scheduling an appointment and I getting at least a baseline skin exam. So we'll put a link in the show notes or get you some information about how you can get in touch with our office or your local dermatologist wherever you're at.
[00:29:24] Speaker A: Sounds good. All good to know. When we consider how much our own skin plays into the game of our lives, we realize we need to regard it with increased importance. Thank you so much, Patricia Liu, golden state dermatologist, for being on the show today. It's time for a short break.
[00:29:42] Speaker C: It's been a pleasure. Thank you, Michael.
[00:29:44] Speaker A: You've been listening to the real estate and more show great people, interesting topics, and we talk about Bay Area real estate. Listen to archive real estate and more
[email protected]. radio and also, please, if you want to pull up the show on demand, you can go to Spotify, Amazon, Apple, iHeart, Pandora and most other majority podcast platforms as well. I'm your host. We'll be right back with our next special guest. Stay tuned.
[00:30:13] Speaker B: The views and opinions expressed are based on current economic and market conditions and are subject to change. Information on the show provided for illustrator purposes only and does not constitute professional or legal advice. Information from sources deemed reliable, but accuracy and completeness not guaranteed. Michael Hatfield and the Michael Hatfield remax team have no liability for information discussed on the show. Consult with qualified professionals prior to taking action.
