Supplement for The Scleroderma Foundation

Volume 6 number 3
summer 2012
SDPA News and Current Affairs
dermatology pa news and notes
clinical dermatology
surgical dermatology
cosmetic dermatology
Professional development
ent
Supplemoderma
ler
for The Sc ation
Found
Official Journal of the Society of Dermatology Physician Assistants
Vol. 6, No. 1 WINTER 2012
1
Publishing Staff
EDITORIAL BOARD
Travis Hayden, MPAS, PA-C, Editor in chief
Joe R. Monroe, MPAS, PA-C
Patricia Ferrer, MPAS, PA-C
Gordon Day, R.Ph., PA-C
Nancy Primo, MPAS, PA-C
Lauren Zajac, MHS, PA-C
Michelle DiBaise, MPAS, PA-C
P. Eugene Jones, Ph.D., PA-C
Mark Archambault, DHSc, PA-C
Kristine Kucera, DHS, MPAS, PA-C
Jennifer Winter, PA-C
Mark Hyde, MMS, PA-C
Jennifer Connor, MPAS, PA-C
Jeffrey LaDuca, Ph.D., MD
Alan Menter, MD
DEPARTMENT EDITORS
Clinical Department Editors
Susan E. King-Barry, MPAS, PA-C
Karen Graham, MPAS, PA-C
Drugs in Dermatology Editor
Stephen Wolverton, MD
Surgical Department Editor
Christy Kerr, MPAS, PA-C
Cosmetic Department Editor
Nancy Primo, MPAS, PA-C
Prof Dev Department Editor
Abby Jacobson, MS, PA-C
SDPA Board of Directors
PrESiDEnT
John Notabartolo, MPAS, PA-C
PrESiDEnT-ElECT
Jennifer Winter, PA-C
iMMEDiATE PAST PrESiDEnT
Keri Holyoak, MPH, PA-C
ViCE PrESiDEnT
Jacki Kment, MPAS, PA-C
SECrETAry / TrEASurEr
Joleen Volz, MPAS, PA-C
DirECTors AT lArGE
Matthew Brunner, MHS, PA-C
Greg Buttolph, MPAS, PA-C
Jennifer Conner, MPAS, PA-C
Vicki Roberts, MPAS, PA-C
Society of Dermatology
Physician Assistants, Inc.
4111 W. Alameda Ave. Suite 412
Burbank, CA 91505
1-800-380-3992
[email protected]
www.dermpa.org
Publisher Travis Hayden, MPAS, PA-C
Managing Editor Jennifer M. Hayden, M.Ed
Copy Editor Douglas Morris
Art Director Angela Simiele
Website Design Terry Scanlon
SALES Office
Physician Assistant Communications, LLC
P.O. Box 416, Manlius NY 13104-0416
Phone (315) 663-4147
[email protected]
www.pacommunications.org
editorial missioN: The JDPA is the official clinical journal of the Society
of Dermatology Physician Assistants. The mission of the JDPA is to improve
dermatological patient care by publishing the most innovative, timely, practiceproven educational information available for the physician assistant profession.
PUBLISHED CONTENT IN THE JDPA: Statements and opinions expressed
in the articles and communications herein are those of the authors and not
necessarily those of the Publisher or the Society of Dermatology Physician
Assistants (SDPA). The Publisher and the SDPA disclaim any responsibility
or liability for such material, including but not limited to any losses or other
damage incurred by readers in reliance on such content. Neither Publisher
nor SDPA verify any claims or other information appearing in any of the
advertisements contained in the publication and cannot take responsibility for
any losses or other damage incurred by readers in reliance on thereon. Neither
Publisher nor SDPA guarantees, warrants, or endorses any product or service
advertised in this publication, nor do they guaranty any claim made by the
manufacturer of such product or service.
This Issue: of JDPA includes articles that have been reviewed and approved
for Category I (Preapproved) CME credit by the American Academy of
Physician Assistants. Approval is valid for 1 year from the issue date, and
participants may submit the self-assessment at any time during that period.
Category I CME articles included in JDPA are planned and developed
in accordance with AAPA’s CME Standards for Journal Articles and for
Commercial Support of Journal Articles.
Since its inception, the JDPA has utilized eco-friendly printing
practices. The JDPA is printed on paper obtained from sustainable
forests that meet strict environmental standards. Soy-based inks that
have a low environmental impact are used during printing of the journal and
the journal is printed using 100% renewable energy. SDPA members may join us
in our efforts and opt to receive the JDPA in digital format.
JDPA/Journal of Dermatology for Physician Assistants (ISSN 1938-9574) is published quarterly (4 issues per volume,
one volume per year) by Physician Assistant Communications, LLC, P.O. Box 416, Manlius NY 13104-0416. Volume 6, Number 3,
Summer 2012. One year subscription rates: $40 in the United States and Possessions. Single copies (prepaid only): $10 in the
United States (Include $6.50 per order plus $2 per additional copy for US postage and handling).
Periodicals postage rate paid at New York, NY 10001 and additional mailing offices.
© 2012 Physician Assistant Communications, LLC. All rights reserved. No part of this publication may be reproduced or
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Postmaster: Send address changes to Society of Dermatology Physician Assistants, Inc., 4111 W. Alameda Ave. Suite 412, Burbank, CA 91505,
1-800-380-3992.
THIS ISSUE IS SPONSORED BY
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Journal of Dermatology for Physician Assistants
TM
From The Patient’s Perspective
Eight years ago, Amber Paris and her husband
daughter Jacelyn, now eight years old, was born nine
believed they would never be able to have children.
weeks early.
Amber has lived with scleroderma since she was a teen.
“This Disease Isn’t a Life Sentence”
She had suffered through renal crisis, digital ulcers and
Today, Amber is a stay-at-home mom living in
other complications from
Watauga, Texas, just
the disease. The couple
outside the Dallas-Fort
“The picture for us is that
discussed their options
Worth area. She’s active
it always gets better.
for starting a family with
with the parent-teacher
No matter what we’re
a rheumatologist, who
association at her daughter’s
going through, it will
classified their chances to
school. She also volunteers
conceive as high-risk. So,
always get better, and
a lot of her time for the
they decided to adopt.
we will have good times
Scleroderma Foundation’s
Soon after starting
Texas Bluebonnet Chapter.
again.”
the adoption paperwork,
Amber’s goal is to jumpAmber had a big surprise.
start a juvenile support
At a doctor’s appointment, she learned she was
system for younger scleroderma patients and their
pregnant. “We were so concerned about the pregnancy
family members, a service that wasn’t around for her
being high-risk, we weren’t even trying to conceive,”
when she was diagnosed at 14.
Amber recalled.
At 13, Amber’s hands began to get horribly cold.
Women living with scleroderma are at a higher risk
She tried to warm them under warm water, but it felt
for some complications during pregnancy, particularly
scalding hot. Amber and her parents knew something
renal crisis and cardiopulmonary issues. Some research
was going on, and shortly thereafter, she was diagnosed
indicates that women should delay conception until
with Raynaud Phenomenon. Then, came the ulcers on
their disease has stabilized. As is the case for many
her fingers and a scleroderma diagnosis.
chronic illnesses, especially autoimmune diseases,
As a teen growing
pregnancy may relieve some of a woman’s symptoms
up in Colorado, Amber
(remember, each pregnancy is different. Be sure to check
tried to ignore the disease.
with your doctor about what your individual risks are
She wouldn’t take her
as it relates to pregnancy and conception). Pregnancy,
medication and tried to live
however, caused Amber’s system to go haywire.
the normal, teenage life. “I
“The pregnancy
was a cheerleader. I would
exacerbated my symptoms.
cheer out in snowstorms,”
The doctors were really
she remembered. “I don’t
worried about my kidneys
recommend it. But, it’s
Amber as a teen growing
up in Colorado
since I had previous issues,”
difficult having scleroderma
she said. “While my kidneys
as a teenager. The hardest
didn’t crash, my tests were all
thing when you’re growing up, especially at that age, is
borderline during the entire
that you don’t want to be different from anyone else.”
Amber, along with her
pregnancy.”
“I kept the disease to myself. I would tell a few
daughter, Jacelyn
Amber’s doctors ordered
close friends, and I remember one in particular. Her
her to go on five weeks of bed rest because her amniotic
mom called my mom saying that she was crying
fluid was so low. “Our doctors were afraid that the baby
uncontrollably. She had looked up the disease online
would sit on the [umbilical] cord and suffocate,” she
and it said that I only had five years to live. My mom
said. The amniotic fluid eventually started to rise again
had to explain that some of the information out there is
but it was a scary moment for the parents-to-be when
old and that this disease isn’t a life sentence.”
Vol. 6, No. 1 WINTER 2012
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CLINICAL Dermatology
Amber Paris: Not Alone in the Lone Star State
CLINICAL Dermatology
“Then, as I was getting older, I started to tell more
people, especially those who had other illnesses. It
made us feel less alone, and it helped me open up. I
found that it was actually good to talk about the disease
because I could let people know that there are others
struggling with scleroderma, and there’s hope. There
is a way to live a normal, great life even with a chronic
illness.”
Amber went on to college and got married in
1998. By then, her doctors began to question why she
was still living in the cold Colorado climate. She and
her husband decided to move to Texas for the lower
elevation and warmer temperatures. That led to a slight
reprieve in her symptoms for about seven years.
Hope for the Future Ahead
“Amber was a normal teenager who had to
sometimes deal with serious issues because of her
disease,” said her mom Debbie Hinson. “Like a lot of
other parents, we were told about support groups but
were advised not to involve Amber in them because of
the age difference. A lot of the patients were in the later
stages of the disease, and it could be discouraging or
frightening to her.”
“I talk with parents today, and doctors are still
discouraging kids from support groups,” Amber said. “I
felt alone and didn’t have anyone else to talk to about
scleroderma.”
“During the past year, the Texas chapter has been
contacted by several parents whose kids are suffering
from the disease,” said
Cindi Brannum, the
chapter’s executive director.
“These parents didn’t know
where to turn to or how to
find a place of support for
their kids since the groups
they had checked out were Amber, along with her mother,
Debbie Hinson
mostly geared towards
adults. As a result, I started
calling and sending emails to Amber and her mother.”
Together with her mom, Amber is heading the
effort to form an innovative online support group for
juvenile scleroderma patients and their families living in
Texas.
“We want to give kids and their parents a sense of
home. They are not alone. There are other patients who
have grown up and gotten through scleroderma. We’ve
had children, we’ve gotten married. I want to provide
an environment where kids can talk to other kids about
what they’re going through. There’s hope and a bright,
wonderful future ahead for them,” said Amber. J
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Journal of Dermatology for Physician Assistants
Amber Jo Paris from Watauga, TX was diagnosed with
scleroderma at the age of fourteen. She is now thirty-seven and
has been married to her husband Eric for nearly fourteen years.
The couple has an eight year-old daughter, Jacelyn. Amber is
a stay-at-home mom who previously worked as a high school
English teacher and a mortgage loan processor. She has been
a board member of the Scleroderma Foundation’s Texas
Bluebonnet Chapter for two years and has led the Chapter’s
Tarrant County Support Group for almost five years. She and
her mother, Debbie Hinson, are in the process of beginning a
Juvenile Scleroderma Outreach Program for the State of Texas.
This article originally was published in the Summer 2012 issue of
“Scleroderma Voice,” a member magazine of the Scleroderma
Foundation. The Scleroderma Foundation currently has 23
chapters and more than 150 support groups across the U.S. For
more information, please visit www.scleroderma.org.
Take Home points
for derm pas:
By Steven K. Shama, MD, MPH
1. I know I have said it once before and probably
twice, and I will say it again. Our patients like
Amber are messengers from the universe trying
to teach us a lesson.
Perhaps the lesson is that, “Despite my disease
beginning as a teenager when I most wanted
to fit in with my friends and to look perfect, I
must now live my life, to grow, to want to have
children, to contribute to this world, to embrace
others, and to give hope. And no one can tell
me it cannot happen.”
2. Personal risks aside, Amber decided to continue
her pregnancy. What a brave person, to want
to be a mother, raise a child, and tell that child
how beautiful life can be, even though she
has a debilitating disease which could be life
threatening.
3. Amber is giving the great gift of hope to young
people with scleroderma by establishing a
juvenile support group. She is a great example
of why we should never give up on patients.
We can never place a value on our patients’
quality of life. We must always remember the
anonymous 15th century expression: to cure
sometimes, to relieve often, and to comfort
always. To always believe in, to give hope, and
to honor our patients might be other good
lessons we can embrace.
Dermatology Physician Assistants
Physician Assistants (PAs) in dermatology
play a number of varied and vital roles.
PAs are medical providers licensed to practice medicine with
physician supervision. From patient care and education,
to skin surgery, treatment of chronic skin conditions, and
cosmetic procedures, PAs are dynamic members of the
healthcare team. PAs practice in every medical and surgical specialty and have been collaborating
with dermatologists for 30 years, providing a wide variety of services. These include diagnosing,
prescribing medications, ordering and interpreting lab tests, wound suturing, and medical or
surgical treatment of a wide variety of clinical diseases. As with all PAs, dermatology PAs are
legally and ethically bound to practice only under physician supervision.
PAs are trained in intensive, accredited education programs.
Because of the close working relationship that PAs have with physicians, PAs are educated in
the medical model designed to mirror and complement physician training. PAs take a national
certification examination and to maintain their certification, they must complete 100 hours of
continuing medical education every two years and take a recertification exam every six years.
Graduation from an accredited PA program and passage of the national certifying exam are required
for state licensure.
How a PA practices dermatology varies with training, experience, and state law. In addition, the
scope of the PA’s responsibilities corresponds to the supervising physician’s scope of practice. In
general, a PA will see many of the same types of patients as the physician. Referral to the physician,
or close consultation between the PA and physician, is based on the dynamic relationship between
the physician and PA.
The Society of Dermatology Physician Assistants (SDPA) is a non-profit professional
organization, composed of members who provide dermatologic care or have an interest in the
medical specialty of dermatology. Fellow members provide medical services under the supervision
of a board certified dermatologist.
More information can be found at www.dermpa.org and www.aapa.org.
Vol. 6, No. 1 WINTER 2012
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