The Saga Continues

One week after my January 6th surgery, it was back to the dermatologist to get my stitches out and get the results of my second biopsy. Not good. He still didn’t get it all. So, he scheduled another surgery for the next week. I was really disappointed. Of course, there was nothing I could do about it. My second procedure was the same routine as before, he numbed my head and explained how he was going to proceed. I asked what would happen if the wound was too big to cover. He gave me four options (none of which were appealing) and said he wouldn’t know until he “got in there.” He put a cloth around the area and started cutting. As I’m sitting there listening to him do his thing, I wondered what the skin/meat was like – was it like cutting into raw chicken or pork? Sick, I know, but what else did I have to think about? When it was time to stitch up the area, he really had to pull the skin to get it to close. I could feel the skin tighten on the right side of my head. Now I have a slight idea of what it is like to have a facelift. When he finished, he left so the nurse could clean up the area. I asked her my question about chicken or pork and she said “No one has ever asked me that before. Now every time we do this, I will be thinking ‘chicken or pork’!” She assumed it would be like chicken. When Doctor returned, I asked him. He didn’t hesitate and said pork.

I had more pain this time. Mostly because of the taught skin. Not only did the top of my head hurt, but I had pain in my right ear. Ear pain is one of the worst pains there is. I took the prescribed pain pills this time, and it only cut the pain in half. So, I took Ibuprofen too. I also massaged the right side of my head trying to loosen up and stretch the skin. It helped. I was so glad to get the pressure bandage off, they make it as tight as they can to stop the bleeding. I must admit I didn’t wait the full 24 hours like I was supposed to.

My follow-up to remove the stitches was scheduled for the 27th. Then came the bad news, he still didn’t get it all. Seems my cancer has been growing for a long long time and grew down and out to the side. Since he had taken what he could in the office, he referred me to another dermatologist who does the Mohs procedure.

Mohs differs from other techniques in that microscopic examination of all excised tissues occurs during rather than after the surgery, thereby eliminating the need to “estimate” how far out or deep the roots of the skin cancer go. This allows the Mohs surgeon to remove all of the cancer cells while sparing as much normal tissue as possible. The procedure entails removing one thin layer of tissue at a time; as each layer is removed, its margins are studied under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is ended. If not, more tissue is removed from the margin where the cancer cells were found, and the procedure is repeated until all the margins of the final tissue sample examined are clear of cancer. In this way, Mohs surgery eliminates the guesswork in skin cancer removal, producing the best therapeutic and cosmetic results.

There are a limited number of Mohs surgeons, so it takes some time to get in. I’m going to the same doctor that worked on my doctor’s nose. How’s that for a recommendation. My head still hurts a little, as does my ear. When I scheduled the appointment, I talked to the nurse about the options for covering the area. I asked where the skin would be taken if I had to have a graft. She said probably my thigh. I said “So, I’ll have a bald spot.” She said not necessarily, to which I replied “Well, I don’t have any hair on my thigh.” She said the doctor would discuss all the options with me. I’m not looking forward to this – it’s worse when you know what to expect. But at least I know I won’t leave there with any cancer remaining.

March 5th procedure

I arrived at the doctor’s office at 7:30 a.m. and sat down to wait. It wasn’t long before I was called in. The nurses were very pleasant. There is only one doctor at this facility and about six nurses. They do the prep and the cleanup and the doctor goes from room to room, doing procedures and then analyzing the skin. I hate to say it is like an assembly line, but….

The doctor came in and introduced himself and explained what he was going to do. He was very pleasant and I didn’t feel “hurried” at all. He then proceeded to numb my head and shortly said, “Okay, I’ll take this to be the lab” and out the door he went. I was surprised, I thought he would numb the area and come back, but the nurse said that the anesthetic is very fast acting. And since he takes such small amounts, it doesn’t take long. Nurse cleaned up the area and cauterized the wound so it wouldn’t bleed while I waited for the results. If you don’t know what cauterizing is, it is the burning of the skin or flesh with a heated instrument or caustic substance, typically to stop bleeding or prevent the wound from becoming infected. They used a heating instrument and the smell started to get to me after a while. Thank goodness the area was still numb, because we all know how badly a burn hurts. Then I was sent back to the waiting room.

I had my iPad with me and worked jigsaw puzzles while I waited. I didn’t feel like making idle chit-chat with strangers. The music in the waiting room was awful, not really classical, more new-wave-contemporary-supposed to soothe. After listening to it for a while, the “soothing” became annoying. I only waited about 45 minutes before I was called back in to get the results. Doctor handed me a clipboard with my information and a drawing of the wound. The drawing had little red dots where the skin cancer still remained. He asked me to hold the clipboard so he could see where to cut. Same as before numbing, cutting, cauterizing, waiting, being called back, holding another “map” of the wound. He did three cuttings before getting all the cancer. If I hadn’t already had two sections cut out, it probably would have taken most of the day, but I was done by noon.

The wound is quite large and deep–all the way to the bone. In order to cover the wound, he had to enlarge it on both ends and then rotate the skin around to cover the biggest area. Then, since the skin where he made his additional cuts was still stretchy, he was able to pull it together to close it. There are only two small areas where the skin didn’t cover and are open. He put in 37 staples, no stitches. It literally sounded like he was using a staple gun. They use staples so I won’t have to wait 10 days to wash my head/hair. The nurse then did more cauterizing – a lot. She said that the numbing medicine contracts the blood vessels and as it wears off they expand. So the cauterizing is necessary to stop the bleeding. It is possible for it to bleed some and I need to keep an eye on it. She and another nurse put on a pressure bandage and I went on my way.

As before, once the numbness started to wear off, I was in a lot of pain. I took the prescribed Tylenol 3 with Codeine. An hour later, I felt awful, like someone punched me in the sternum and I was very nauseous. I started to sweat and get clammy. I called and the doctor switched me to OxyCodone and also gave me an anti-nausea drug. I’ve been doing a lot of sleeping. The doctor told me that my wound is so deep that it will take a long time to heal. He’ll have to keep an eye on it for infection or other complications. He said we are going to get to know each other very well. So once again I’m urging all parents to teach your children to wear hats in the sun. Sunscreen is great, but you don’t put it on your scalp. Dark hair protects the scalp more than light hair does, but it is still a good idea to wear a hat if you’re going to be in the sun a lot. I wouldn’t wish this on my worst enemy.  I’ll forgo a picture – it is really ugly.

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