If Jeffrey Petersen hadn’t become a dermatologist, he might have become a private eye. What does investigating shady dealings have to do with steering patients to the shade?
“With dermatology, you may not know the diagnosis, but you can see there’s a problem,” says Petersen, M.D., assistant professor of medicine. “Then the challenge becomes to find out what you’re looking at. You get to do a little bit of sleuthing, and that’s fun.”
Petersen’s patients and colleagues are thrilled he chose a scalpel over a fingerprint kit.
“Jeff is one of the most talented and humble physicians I know,” says James B. Lowe, M.D., chief of the Section of Cosmetic Surgery at the School of Medicine. “He is so warm and friendly, and he always empathizes with his patients, no matter what their situation or their disease process.”
Although Petersen knew he wanted to be a doctor since he was 4 years old, he didn’t discover dermatology until he was in medical school at Indiana University.
“Dermatology had a really nice feel for me; there was just the right mix of patient involvement, surgery and pathology,” says Petersen, who practiced medicine in Kenya as a medical student and ran a free health clinic in Indianapolis for several years.
Lynn Cornelius, M.D., chief of dermatology, appreciates Petersen’s sleuthing talents as well as his compassion for patients.
“Some people may be talented or intelligent or compassionate, but for Jeff it is the combination of these qualities that sets him apart,” Cornelius says.
Petersen has become the go-to guy for rare and unusual skin problems, which also appeals to his Sherlock Holmes side.
For example, Petersen sees the most cases of necrobiosis lipoidica diabeticorum, or NLD, in the St. Louis area. NLD, a disease process that is poorly understood, results in terrible skin wounds in the lower extremities.
There were no effective treatments, but it is somewhat related to leprosy, so Petersen started treating his approximately 20 patients with thalidomide (a commonly used drug to treat leprosy), which is working.
“That is so rewarding to find a treatment that reduces the pain and helps the ulcers heal,” he says.
As gratifying as that type of work is, rare skin diseases are just a small part of Petersen’s practice. He spends more time treating problems related to varicose veins and skin cancer surgery.
Varicose veins are not simply a cosmetic issue; they are symptomatic of venous insufficiency, which occurs when the valves that prevent the blood in the veins from flowing backward fail and blood pools in the surface veins instead of returning to the heart. This venous insufficiency can cause serious pain in the legs, feet and ankles, and even the groin. It also can cause ulcers, especially around the ankles, that are difficult to heal.
While varicose veins typically occur in women over the age of 60, Petersen has treated people as young as 18 and as old as 97.
“Venous ulcers are a hard thing to cure because they keep coming back,” Petersen says.
But Petersen realized that often, after performing a “VNUS closure procedure” to remove varicose veins, the ulcers didn’t come back.
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Jeffrey Petersen University position: Assistant professor of medicine Family: Wife, Lori; children, 18-month-old Amber and 3-month-old Tyler. “I love changing diapers. When I hit the door in the evening, those babies are mine!” College: Petersen majored in French and chemistry at Utah State University. Other activities: Petersen is lay minister for his church, The Church of Jesus Christ of Latter-day Saints; he gets up four days a week at 5 a.m. to work out with the Whitfield wrestling team, for which he serves as team physician — “Exercise helps me stay sane”; he grew up watching Quincy, and now he tries to make time to watch CSI. |
The VNUS procedure is normally used to close down malfunctioning surface veins. It involves inserting a catheter in the varicose vein and essentially cauterizing the damaged vein (the patient receives local anesthesia). Patients are able to walk away from the procedure.
Stripping the vein, a more traditional procedure, involves physically pulling the vein out of the patient’s leg, which is far more painful and has a longer recovery time.
Petersen is one of the few people in the St. Louis who uses the VNUS procedure to treat leg ulcers.
“I’ve had many a doctor tell me I have no idea what I’m doing when it comes to veins,” Petersen says. “It’s not from their ignorance; it’s just that the correlation between the ulcers and varicose veins has never been done.”
Petersen has two papers coming out shortly on this relationship between VNUS closure and healing of leg ulcers. He hopes to spread the word so more patients can get relief from their suffering.
“It’s very time-consuming to treat leg ulcers,” Petersen says. “But the reward is, my patients are very grateful when you heal their ulcers. They come in using wheelchairs because of their leg pain, and by the time we’re done, they’re walking out.”
In the course of treating venous problems, Petersen has become an expert in wound care.
His approach? Keep it simple.
“A lot of stuff people recommend putting on a wound can in fact cause an allergic reaction,” he says. “And an allergic reaction in a wound doesn’t look like an allergic reaction on the normal skin. It looks like it is red and healthy and healing, but the skin doesn’t move over. It will be very hard for the wound to close.”
Petersen also specializes in the Mohs micrographic surgery procedure for skin cancers. “Mohs technique” refers to the way the tumor is cut out and then viewed.
Instead of taking slices of the tumor to look at, the Mohs technique looks at the outside.
It’s like examining the entire crust of bread for a spot of mold, rather than checking some sample slices, Petersen says.
In addition, the excised tumor is marked with color coding, so if more tissue does need to be removed, it is easier to go to the exact location.
Mohs has a 99 percent cure rate, which is higher than other techniques.
Petersen immediately examines the tumor under a microscope. That way the patient might wait an hour or two in the waiting room to find out if the whole tumor was removed, rather than going home and waiting for a week or more for a pathologist’s report.
If more tissue does need to be removed, it can be done during the same visit. When patients go home that day, they know they are tumor-free.
Petersen is clearly energized both by the detective-like aspect of his job and by interacting with his patients.
“You can look at the skin, think it is one thing, then do a biopsy and it comes back another thing. It can be very humbling,” says Petersen, who reads Arthur Conan Doyle to relax.
He remembers finding a small, clear bump that didn’t fit with the patient’s other moles and spots.
Petersen decided to biopsy it, and found out it was an amelanotic melanoma — a melanoma with no pigment.
Amelanotic melanoma is usually caught late, when the melanoma is 2 or 3 inches across and bleeding, with involved lymph nodes. It is typically fatal.
While it doesn’t happen often in dermatology, Petersen does sometimes have to give his patients the bad news that their number is up.
“I don’t have a problem telling people their time here is limited,” Petersen says. “I don’t mean that in a negative way, but I’m a very religious individual, and I believe we are not just here for a moment.
“We do a lot of hand holding and crying together, but I also try to tell them they have a unique opportunity to take advantage of every moment to its fullest.
“It doesn’t make it any easier, but it changes how they enjoy things.”
“Some people may be talented or intelligent or compassionate, but for Jeff it is the combination of these qualities that sets him apart.”