SKIN CANCER

BY ROBIN AYLOR


"I don't think that I am significantly more vain than the next person.  I may be significantly less vain that many I see."

   

September 4, 2014- upon my return from a vacation with my son and his girlfriend in Yucatan, ME,  I went to see my dermatologist, a sweet and gentle woman who had been treating me for several months for a spot that developed on my face.  After several months of first removing the spot and then treating it with liquid nitrogen, Dr. Tinkle decided that she did not like the way the spot on my face was behaving and decided to do another biopsy of the area.

It was after this that I first got the diagnosis of Basal Cell Carcinoma, nodular and microdonular smack dab in the middle of my face.  I must admit that I felt some kind of shift in my life force.  At first I didn't cry.  I was, in fact, very brave, almost stoic talking about how I thought scars added character to a face.  My dermatologist would refer me to a surgeon for a procedure referred to as Moh's Surgery, named after the surgeon who developed it.  I did not start to get anxious until she told me that I was probably going to have lots of tiny little stitches on my face, maybe even 100, but that they would be teeny tiny.

I was planning to be married in December, and did not want to have a scar on my face in the wedding photos.  My dermatologist while encouraging me not to wait, was also confident that we had caught this very early, and that is a very slow-growing Cancer, so she thought we would be safe to wait.

I was a bit sensitive leaving my dermatologist's office that day,  The Front Desk Attendant, a friendly and talkative Russian-born woman named Irina, who is usually very kind to me was having a hard time making eye contact and did not want to schedule any further appointments with me until after I had completed the surgery.

The first thing I did when I got home from this appointment was to get on the internet to research the procedure (Of course!).  I am not sure this was a good idea...

As much as it was a good  thing to educate myself,  the photos of the procedure are very gruesome.  The procedure is conducted in a series of steps.  The surgeon first excises the area where the biopsy was performed and then freezes the section to make it easier to examine under the microscope.  This is done to make certain that all of the margins are clear of cancer cells.  Sequentially, sections of dermal tissue are removed until all margins are clear of cancer cells. Read between the lines, they do not know how infiltrated the cells are until they remove them and examine them under the microscope! ...cut, examine, cut, examine, cut, examine...

This is a face we are talking about, and in my case, it is my livelihood!  I work with people everyday and have to be able to look them in the eye.  This is something I wear EVERY DAY.  My face has to read kindness and compassion.  If my patients are hesitant about looking me in the eye or looking at my face because I have a scar that makes them feel uncomfortable, then my business in in jeopardy.  I am hesitant to make too big of a deal about this as I am aware that there are people in the world who have it much, much worse than I do, but this is my blog and I should be able to express all of my innermost feelings, otherwise, why bother?  One reason I want to do this is so that other people going through the similar things can experience these sentiments being shared openly and realize that they, too, can verbalize their own feelings.

There are many types of skin cancer:  malignant melanoma being the worst, I was lucky not to have melanoma.  A good friend of mine is undergoing treatment for this and I did not learn about it until I opened up to her about what I was going through.

I was diagnosed with  Basal Cell Carcinoma (BCC), the good news about this type of cancer is  that it is not malignant and is very slow growing...that is the good news.  The bad news is that there is Nodular (think a small lump or bump that can be easily excised or even treated with a topical cream that would only attack the cancer cells and Micronodular (while micronodular may sound better because it sounds smaller- think of it like an almost invisible (to the naked eye) root system that travels underground and can grow any which way- it can be much, much, more invasive.  I had both nodular and micronodular.

Sometimes, looking at the holes the surgeons had to make in people's faces were HUGE!   This is incredibly scary!  It seems that with the degree of technology currently available to us today, in which we can detect many cancers and their locations as small as the tip of a pencil point, that there would be some means of identifying the boundaries of a skin cancer before you start hacking away at a person's face.  Although this is purported to be state of the art medicine, it felt very barbaric to me!

The photos of the recovery, especially when conducted by a plastic surgery were a bit more reassuring.  Of course, with Photoshop, it is possible to make any photo look good, I am trying to trust that these photos were unretouched with the exception of cosmetics.

We also live in a relatively small community, and I was concerned that our doctors may not be as good as the doctors who took the "good" photos and that I might be left with one of the "bad scars,"   There are also some very bad photos or recovery from Moh's surgery, most notably one on SKINCANCER.org.  I am going to write the editors of that website, because I did not find the photos on their website reassuring, at all!


October 16, 2014-  I met with Dr. Herten, the Moh's surgeon.  Just so that you can get a feel for his office, it is designed in "early horseman" motif,  His office may have been the location of a PONY EXPRESS stop.  There are saddles in the waiting room and in the hall on the way to the restroom. There are photos of people riding horses, I imagine some of them must be Dr. Herten.  The seating area is primarily composed of simple benches that wrap around the waiting room with some green chairs in the center of the waiting room.

I had done my research and began to suggest to him why I thought that the kind of procedure I wanted did not involve cutting but was called Photodynamic Therapy (PDT).  It involved the use of a chemical reagent that would then be activated by a laser or other light source.  The chemical only reacts to cancer cells, and healthy tissue is not affected.  Sounds good, right?

Well, you know that Doctors do not want to be told how to do their jobs?  I thought he would be open to it as he does Laser therapy in his clinic already!  Nope, he didn't go for it!

José was with me at the appointment and as I began to cry, all I could think to do was to plead with José to help me.  Poor thing, he was more helpless than me.  Dr. Herten, at this point, tried to explain to me how he would refer me to a plastic surgeon who would do the closure of the opening, and that he would give me medication for the anxiety if I felt I needed that.  José tried to explain to me that Dr. Herten is the expert and that I should just go along with what the expert tells me to do.  He promised not to stop loving me even if I did end up with a big ugly scar on my face, and I know that is true.  This man has loved me through Fat and Thin, so I know he is not going to give up on me, but I still wanted to wait until after the wedding!  I was not going to have even a very lovely scar marking up my wedding photos!

I was able to put the surgery on the back burner, not completely out of my mind but at the bottom of the worry priority list as the next few months were filled with the installation of hard wood floors disrupting the sanctuary of my home and home office and then getting ready for the wedding...I didn't have a lot of time to worry about me or my face.  I was glad that the wedding was as soon as it was and then I would not have too much time to worry about the surgery between the wedding and the surgery.

January 7, 2015-   I find my concentration at work is tanking.  I am not sleeping well.  We made the mistake of watching "The Dark Knight Rises" and I don't know if you saw this Batman film or not but one of the characters, Harvey Dent, gets extremely badly burned, so much so, that his cheek is completely gone.  After watching this film, I realized that this was my fear. Now I had an image to go with the fear.  I start calling the Doctor's Office asking for those anxiety medications that were promised me.  They don't get back to me.  I call again and the office is closed for the weekend.  I keep calling...to no avail.

January 13 2015-  I finally reach the doctor's office.  I am angry that they have not gotten back to me.  I use my official voice.  I am angry!  "This is Dr. Aylor and I have left you several messages asking for a prescription for anxiety medication and you have not gotten back to me."  They informed me that they could not understand my message or the name on my message and that is why they did not get back to me. This is a reason for them to say that I did not call.  This infuriates me more!!!  I don't understand this, and I am angry.  A woman named Zenaida calls me and tells me that my Potassium Levels are "dangerously high" and that Dr. Herten wants my primary care doctor to re-order my labs and have a repeat blood draw.  Still no prescription for anxyolytic medication!

January 13, 2015-  I receive a call from the Plastic Surgeon's office that my Primary Care Physician has not sent the required forms to the surgery center yet.  I start calling the Primary Care Physician's Office at 3:00 p.m. only to find out that the doctor's assistant is gone for the day!  I call again and leave a message with the front office staff, I call again and leave a message with the answering service.  I am angry!

January 14, 2015-  I haven't slept.  Of course, I am angry that my blood was drawn on January 9th and it was only yesterday that anyone communicated with me that there may be a problem.  Of course, I got on the internet to find out what the cause of high Potassium levels could be an now looking at things like Addison's Disease and Hemolytic Anemia.  My heart is racing all night long and I still have a day of work ahead of me and I am a basket case!

I start calling my Primary Care Doctor's Office at 7:30 a.m., I am angry and leave another message with the answering service. Before I can even go into work, I have to get to my primary care doctor's office, ask to have my blood levels re-drawn, and demand that they get the paperwork to the surgery center today.

I call the surgery center, to tell them that I have just been to my doctor's office and that they have now faxed my Physician's Assessment of my health and my EKG results to the Surgery Center.  I am informed by Joni at the surgery center that they want me to continue drinking clear fluids, so that it is OK for me to have coffee without milk and apple juice or water, any kind of clear fluids up until the time of the procedure.  

Although I did not think this is necessary, I am relieved as it's a long day!  I will get up for my 7:45 a.m. procedure with Dr. Herten and then have to wait until 1:00 p.m. for Dr. Stallman, the plastic surgeon.  I remember previously, that I found white grape juice to be a godsend when I was having another procedure and thought, this would be fantastic to be able to have at least this...

I call Dr. Herten's Office and tell Zenaida that I had my blood redrawn and that my Potassium levels are not "DANGEROUSLY HIGH" but only at the high end of the reference range and are not a contraindication to my surgery.  

I ask AGAIN, that they please phone in something for anxiety.  They inform me that Dr. Herten is with patients and will not be available until 12:00 p.m.!!!  I have patients scheduled at my office from 11:00 a.m. until 6:00 p.m. without a break in between.  The pharmacy that I usually use near my home closes at 6:00 p.m.!  I try to impress on Zenaida that this will not work.  I agree to use a pharmacy by my office, that is open until 9:00 p.m.  I am fully aware that I will not be able to go to the pharmacy until 6:15 p.m. and I have a 6:30 p.m. hair appointment, that I am unwilling to miss...

I get to the pharmacy at 10:45 a.m. on the off chance that Zenaida's cold little heart has softened and that she has found a way to get me something to help me through the day...no luck!

6:25 p.m.:  I am rushing!  I know that my time in the chair with my hair stylist is the only THERAPY that I am going to get all week long!  I do not want to miss it.  I rush to the pharmacy, to find a prescription waiting for me. 

One tablet of Lorazepam, 2 mg. that I am supposed to take 90 minutes before the procedure.  What!!!!  I have been asking for anxiety medication for a week and this is what I get????!!!!  OMG, OMG, I am going to kill someone!

January 15, 2015-  Surgery Day!  I am up at 5:30 am...although I actually had a good night's sleep the night before, I woke up before the sunrise feeling rather optimistic. At 6:30 a.m., I had my one (!) Lorazepam that I needed to take 90 minutes before the procedure.   I took the dogs out and then went to wake José.

7:00 a.m. : I am ready to get in the car.  José is being a bit of a Nervous Nelly, tracing and retracing his steps as though he has lost something.

7:30 a.m.:  We arrive at the Doctor's Office.  The office staff have not even arrived at this point in time. I asked José to take some last minute photos of my face, the last photos without a scar.  I will include some of the photos here.

  

After being escorted into the doctor's office the staff made sure that I was comfortable.  They put me into the exam room and I was happy to get an extra blanket.  They were sorry that they did not have blanket warmer like the larger offices and surgery center have, but they were sweet about it.  It's really hard to be upset when someone is being sweet with you.

Dr. Herten came in.  I like him, he is a very humane and kind man.  Dr. Herten  gave me the topical anesthetic.  I wasn't watching what he was doing but there was a very tender way that he applied the anesthetic.  I knew that he was being very sensitive.  By the time that he did the actual procedure, I was pretty much unaware of what he was doing. I can't say that it was because I felt so safe with him or whether it was because of the lorazepam, all I knew was that is was soon over and José was being called in to wait with me.

Dr. Herten explained that the sample had to be placed in the freezer before they could examine it and then 45 minutes later he came in to tell me that everything was fine and I was good to go!   This was fantastic news!  That meant they had gotten all of the cancer cells in the first round and no more hacking away at my face would be necessary!

I was extremely early for my 1:00 p.m. appointment at the surgery center.  José wanted to go back to our house to try to do some work in the time we had between leaving Dr. Herten's office and arriving at the surgery center...this was all pretty much a blur to me. I knew that I needed to go to the bank and to the post office and I also needed to make my car payment in between. but the day began to blur on me...Somewhere, I believe we went back to our house and still managed to make it to the surgery center in time.  I have no idea what I did at our house...

The time came to go to the surgery center and we arrived on time.  We walked into the center and were greeted at the desk by a nice woman who told me how wonderful Dr. Stallman was.  She showed me the scar on her forehead where he had operated on her and there was absolutely no scar visible!  I loved this woman in this moment!  She could have absolutely been lying to me, but who cares!  In this moment she was showing me exactly what I wanted to see!  A scar that was no visible!  She did more for me in that moment than she could ever know!  

I proceeded into the Surgery Center when my name was called.  I met with a lovely nurse who began processing my papers only to be replaced by another lovely nurse and I remarked on how beautiful all of the people who worked there were!  I think the nurse who was taking care of me was embarrassed by that, but i think she also knew that it was true.  

The anesthesiologist arrived soon and began asking me questions.  When I told him that I was informed that I should be continuing to rehydrate myself, he seemed a little upset.  Turns out that I had been given a bit of misinformation.  No general anesthesia for me, I would be awake for the procedure...Dr. Stallman arrived shortly thereafter and also learned that the surgery would have to be done under local anesthesia.  

Whether it was because I was so relaxed by that one Lorzepam, or that it did not matter to me one way or the other...I just continued to joke with the nurses and Dr. Stallman to the point that I even cracked up the plastic surgeon at one point in time when they were trying to figure out how to put the bandage over the rounded surface of my cheek and nose so that it would stay adhered for two days.  They were talking about using a staple gun...maybe to see how conscious I really was...and I suggested that they just drill a hole through my nose and tie a knot on the other side.  Literally he had to stop working on me because he was laughing so hard at the idea!

And then it was over.

Now I just have this massive bandage that is apparently superglued to my face. I won't know how extreme the scar is until Saturday when I can remove the bandage.  I am hoping for the best!  Thank you all for your support and for reading my rather verbose blog!



I am hopeful that all of my sun-loving friends will take heed and recognize that tiny little bump, barely visible in the photos, was the start of something that could have potentially been something much more severe.  

Had I not been proactive in getting it treated and had my dermatologist not been as sensitive and attuned as she was, I might still be incubating a cancer on my face.

If you look at the early photos, we are talking about a bump that was barely visible.

In April, I went to my primary care physician (NOT THE ONE I HAVE NOW) and sat in front of him with this bump on my face and he was completely oblivious to it.  I saw my Nurse Practitioner in the hall the same day and she commented on it and said that I should have that looked at by a dermatologist "oh yeah", she said, "that needs to come off."  That was the day I decided to change primary care physicians!  By May, I was having the "bump" removed.  The first biopsy was negative.  

So friends, don't be callous about your health!  Take a look at your body and notice the changes!  Use sun screen!  Remember this was not available when we were kids!  Unlike many of my friends, i stopped tanning at a fairly early age!  Every cosmetic I own  has an SPF of 15 or greater.  In the Summer, I have a sunscreen with microzinc in it!  I might as well be walking around with Desitin on my face!  But in spite of this, i was the one to get skin cancer.  Let me be your early warning system!

I tried to get my son into the dermatologist the week that he returned from his travels in Central America... I am still waiting to hear that he followed up with someone in San Diego.  

Even my lovely, sweet and kind dermatologist did not think that my "bump" was skin cancer.  The first biopsy was negative.  If things had not persisted above the surface, we may have let it go at that...how many people allow skin cancer to go undetected until which time it enters their blood stream?  I can't say that I know the answer to that...just don't be one of them.  Don't become a statistic!