CONTACTS 
0201 - Kaiser Medical Center              415 929 4000
020101 - Dr. Kory Zipperstein, M.D.; =415 202 2307 (advice)
020102 - Department of Dermatology =415 202 2000

SUBJECTS
Dermatology - face blemish, 920810
Dermatology Exam Face Blemish

0504 -    ..
0505 - Summary/Objective
0506 -
050601 -
050602 -
050603 - Doctor Kory Zipperstein diagnosed Rosacea.  Got prescription for
050604 - medication and appointment for follow up in 6 weeks, on 940805 at
050605 - 0915.
050606 -
050607 - I placed an order for the medication; however, the line was too long
050608 - to wait, so will get the prescription next week when I get a physical.
050609 -
050610 - Received claim check #33 for the prescription.
050611 -
050612 -     [On 940628 received medication. ref SDS 3 0877]
050613 -
050614 -     [On 000124 inquire about possible conflict with Glucosamine and
050615 -     Chrondoritin treatment for knee cartilage problem. ref SDS 4 1680]
050616 -
050617 -
050618 -
050619 -  ..
0507 -
0508 -
0509 - Symptoms
0510 -
051001 - Blistering on forehead, nose, eyelid.
051002 -
051003 -     These are common symptoms of rosacea shown at ref OF 1 line 19.
051004 -
051005 -
051006 -
0511 -
0512 -
0513 - Discussion
0514 -
051401 - Kory feels based solely on my appearance that the symptoms are likely
051402 - caused by a skin disease called:
051403 -
051404 -                        rosacea
051405 -
051406 - I advised this condition seems to have begun to appear about 4 months
051407 - ago, and has fluctuated in severity.  Within the past several weeks,
051408 - it got worse, and now seems to be receding again. I expressed a sense
051409 - that there seems to be a general correlation with consumption of a
051410 - coca cola and lemon drink, perhaps creating an excess of acid and
051411 - sugar which my body is less able to accommodate now that I am older.
051412 -
051413 - Kory said rosacea seems to be associated with increased blood flow to
051414 - the face.  Caffeine can be a contributing factor.  I did not draw from
051415 - this that the softdrink and lemon drink is a likely factor.
051416 -
051417 -
051418 - Kory prescribed two types of medication:
051419 -
051420 -       1.  Pills to be taken several times a day.
051421 -       2.  Ointment to be applied twice a day.
051422 -   ..
051423 -   I indicated during our brief visit, that I want to defer this
051424 -   treatment for a week, to see if a change in diet and conduct will
051425 -   favorably impact this condition.
051426 -
051427 -   After our discussion, I went to the pharmacy and submitted the pre-
051428 -   scription.  There was a considerable line waiting to have prescrip-
051429 -   tions filled, so decided to pick up this stuff when I come back next
051430 -   Tuesday for the physical exam.
051431 -
051432 -
051433 -
051434 -
051435 - Kory submitted a brochure published by a manufacturer of medications
051436 - for rosacea. ref OF 1 0001
051437 -
051438 -      It says there is no known cause. ref OF 1 0005
051439 -
051440 -      Theories point to bacteria, mites, a fungus, a malfunction of
051441 -      connective tissue under the skin, or psychological factors.
051442 -      Heredity, skin color, skin structure, etc, make some people more
051443 -      susceptible.
051444 -
051445 -      There is no cure. ref OF 1 0078
051446 -
051447 -      Self-treatment is not recommended. ref OF 1 9752
051448 -
051449 -      Non-prescriptive medications can exacerbate the problem.
051450 -
051451 -          Comment
051452 -
051453 -          The brochure does not comment on the impact of change in diet
051454 -          and/or conduct, on the disease, except to note it tends to
051455 -          fluctuate naturally in severity. ref OF 1 0046
051456 -
051457 -          It says hot liquids, spicy foods, alcohol, sun, stress can
051458 -          make rosacea worse.
051459 -
051460 -
051461 -
051462 -
0515 -
0516 -
0517 - Analysis
0518 -
051801 - Will take a look at change in diet and behavior.  The problem has
051802 - receded in the last two days.  Will see if that trend continues.
051803 -
051804 -
051805 -
051806 -
0519 -