by Robin Aylor
“I don’t think that I am significantly more vain than the next person. I may be significantly less vain than many others I know. The intent of this blog is to bring awareness and empowerment to individual’s struggling with skin cancer and pending surgeries and, hopefully, to encourage early screening and diagnosis.”
I was concerned about a small red spot that was developing below my left eye. It wasn’t huge, and was easily disguised with cosmetics. It was virtually impossible to get an appointment with a dermatologist in San Luis Obispo. I called everyone on my insurance’s panel to no avail. None of the dermatologists were accepting new patients. I finally started visiting Doctor’s offices in person. My assumption was that they would have a harder time saying “no” to my face. I was wrong.
I remembered a woman I met at a party at my friend Michele’s house. Someone I enjoyed speaking with and thought that if I needed to do so, I would ask Michele to contact her for me. I called her office and was informed that she would be able to see me, but that she did not take insurance. I scheduled an appointment.
I met with Dr. Tinkle in her office in Atascadero, CA, approximately a 30 minute drive from my house. She remembered me from our mutual friend. She is a sweet and gentle woman with an extremely calm and reassuring demeanor. I showed her the spot on my face, and she checked me over thoroughly. There was another irregularly shaped mole on my back with which she was a bit more concerned.
She asked me how I wanted to proceed and we agreed to first treat the spot on my face and that I would return to have the spot on my back excised. That one would require a few stitches.
I was pleased to learn that the biopsies of both spots had returned negative for any carcinoma. I scheduled a one month follow-up with Dr. Tinkle.
I went to my scheduled appointment. The spot on my face had returned. Not as pink as the earlier spot, but clearly elevated and approximately the same size. Dr. Tinkle was not too concerned, but a bit puzzled. A little zap with the liquid nitrogen, sun screen and hat admonishments and I was off! Another appointment for a re-check in one month.
Back again! After returning from a wonderful vacation with friends, it was time to return for a re-check. Off to Dr. Tinkle, I go! The spot was really persistent! Now, instead of one rough and bumpy looking spot, there was a small smooth spot, but it clearly was not gone. Dr. Tinkle expressed concerns about the way that this bump was healing. I had another vacation planned and would soon be departing, so we agreed to wait until after my vacation. Sunscreen & hat advisements, another zap of liquid nitrogen and I was off to see my son, Evan, and his girlfriend, Janeth in Yucatan, Mexico.
September 4, 2014-
Upon my return from a vacation with my son and his girlfriend in Yucatan, several months after first removing the first spot and then treating and re-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 (BCC), 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. Cancer was not something I expected to happen to me. 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 and that based on her experience with me she was sure that it would heal up nicely.
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 and non-metastatic 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 happy and enthusiastically friendly and talkative Russian-born woman named Irina, someone who is usually very kind to me, appeared to be having a hard time making eye contact with me 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 itself 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. 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, my face! It is also my livelihood! I work with people everyday and have to be able to look them in the eye. This is something I have to 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 I felt that my business could be 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, and I feel a bit shallow and vain complaining about this little impact on my physical appearance, but this is my blog and if I an unable to express all of my innermost feelings, why bother?
One reason I want to do this is so that other people going through similar scares can experience these sentiments being shared openly and realize that they, too, can verbalize their feelings. It’s not about whether or not I compare myself to others who have it worse, it is more about being vigilant, having my (or your) feelings; but at the same time not allowing feelings to hinder getting the required treatment.
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, while perusing the internet, looking at the holes the surgeons had to make in people’s faces was really, really traumatic! Even in the smallest cases, the holes appeared HUGE! This is incredibly scary when I thought about it happening to my face! It seemed to me 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 should 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 un-retouched 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 of recovery from Moh’s surgery, most notably one on SKINCANCER.org. I wrote the editors of that website, because I did not find the photos on their website reassuring, NOT at all!
October 16, 2014-
I met with Dr. Herten, the surgeon who would perform the Moh’s surgery. Just to 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 and magazine covers 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 leather standard chairs arranged back-to-back in the center of the waiting room.
I had done my research (again, of course!) 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, as even I am aware, most Doctors do not like being told how to do their jobs! I thought he might be open to this form of treatment as he does Laser therapy in his clinic already! Nope, he didn’t go for it! Apparently PDT does not go deep enough to safely extract all of the cancer cells and without the microscopic examination of the tissue, it would be impossible to know if it was all treated.
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 as helpless as I. 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 trust and 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 this much I know 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 scheduled surgery date. My anxiety and lack of comfort was stuffed along with an overabundance of comfort foods, so that in lieu of losing weight as most future brides will do, I gained to the tune of twenty (20!) pounds!
I do want to say, however, that this anxiety was with me constantly. It affected my sleep for the next couple of months and my interpersonal relationships. I was easily angered about things that, on most days, would seem inconsequential. I contacted only a couple of my closest friends to let them know what was going on when I was the most upset. I also had an impromptu meeting with my office-mates on a particularly difficult day to let them know that I was diagnosed with skin cancer and would require facial surgery. I explained to them that I was extremely anxious after looking at some of the worst case scenarios and that I was aware that I was not operating on all cylinders and that I hoped they would both understand and keep an eye out for me. They were all very understanding and sympathetic.
December 22, 2015- Our Wedding Day
3 weeks prior to 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 it. Not reality based, I now know, but scary nonetheless.
January 9, 2015-
Everyone is calling me to ask for a copy of my insurance card.
Getting married meant that my insurance changed as of January 1st. It is the same provider, just a different policy. It takes them forever to find my policy, because they keep pulling up the old one which is no longer in effect. 88-minutes on the phone with different representatives until I finally have a copy of my temporary insurance card.
Off to the lab to get my pre-surgical blood levels run with my new insurance card.
I start calling the doctor’s office asking for those anxiety medications that were offered to me by Dr. Herten. They don’t get back to me. I call again and the office is closed for the weekend. I leave a message and ask them to get back to me knowing that, in all likelihood, it will not be until Monday. I know I will have a sleepless weekend.
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 inform 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. Don’t most people have Caller ID these days? I would think a medical office would, I know I do!
At this point, I explain that I have called several times and left several messages. The woman on the phone states that I only called twice. I tell her that I have now called three times. She tells me that I only called twice, “the first time doesn’t count” because they couldn’t understand me. Really? Is this kindergarten? I am infuriated!!! This is a reason for them to say that I did not call. I don’t understand this, and I am angry. I still don’t know why they have not returned the last two calls or why they are taking my anxiety so lightly. This woman even suggests that I call the Plastic Surgeon’s office to ask for the anxiolytic medication. I explained to her, in a not very nice way, that the reason I am calling Dr. Herten for it is because it was Dr. Herten offered it to me.
A side-note here: I am that kind of person. I do not like to take medication. I don’t like taking anything other than herbal remedies for most things, including sleep. I never ask for pain medication, for medication for anxiety or feeling sad when I would likely perform better. I do not like to feel that I could be vulnerable to anxiety. It is a matter of pride. Yes, I know I need to get past this, and learn how to ask for and accept help, and maybe even predict that I will feel vulnerable in the future.
I did not do this in this instance. I am aware that I had several other physicians I could have asked for a few pills to get me past the roughest days leading up to the surgery, but again, my pride got in my way. My message to readers undergoing this type of procedure is to ask/allow your physician to prescribe a small dose of medication, at least a week’s worth, but only take it only as really needed. Individuals with a history of substance abuse or addiction, should let their doctors know in order for them to prescribe the safest and non-addicting medications.
January 13, 2015-
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 (Why could Dr. Herten’s office not put in the order for an additional lab draw but instead make me travel to my doctor’s office to request this?) Still no prescription for anxiolytic medication!
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!
I cancelled all of my own patients for Thursday the 15th as well as all of next week! This is a substantial loss of income for someone who is self-employed. I am now concerned about whether or not this surgery is even going to happen.
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 might be a problem. Of course, I got on the internet to find out what the cause of high Potassium levels could be and now looking at things like Addison’s Disease and Hemolytic Anemia. My heart is racing all night long, I can’t sleep and I still have a full 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.
10:00 a.m.: 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, and expected that I would not be able to eat anything after midnight as is the case with most surgical procedures, I am relieved as it’s a long day! Assuming that I sleep at all, I will get up at 6:00 a.m. 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 the last time I was having an unpleasant surgical procedure, that I found white grape juice to be a godsend and thought that it 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, myself, have patients scheduled at my office from 11:00 a.m. until 6:00 p.m. without a break in between. Recall that I have been asking for this medication for almost a week now. 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 choose 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 hairstylist, surrounded by my women, 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.
The doctor’s office has prescribed 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 the photos here (barely awake and without a stitch of makeup):
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. A kind of gentle giant. 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 the lorazepam was kicking in, all I knew was that is was soon over. Dr. Herten’s assistant was cauterizing the capillaries so that they wouldn’t bleed. She was talking to me calmly and I felt relaxed with her. They took a photo of the hole in my face, bandaged me up and then 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 did not want to see what the hole in my face looked like. It was bandaged and cauterized, so it wasn’t bleeding, but on my way out of the room, I saw the iPad that had a photo of the hole that had been cut in my face. It was oval with dark marks around the edges where the capillaries had been cauterized. It appeared to be roughly about the circumference of a dime only a bit larger than one of my contact lenses. I took a photo of the iPad photo and for those of you desirous of seeing it, I will post it on the next page. It was about 10:30 a.m.
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…(side note: I had no memory of going into the bank to make my car payment, until I was reminded by my husband that I made the final payment on my car! I don’t know how anyone functions on these drugs! Thank goodness I wasn’t driving! I also realized somewhere along the way that I wrote the doctor’s office a check from the wrong checkbook. We had to return to the office and write another check! Hopefully, that was from the right checkbook!)
The time came to go to the surgery center. We walked into the center and were greeted at the desk by a nice woman who told me how wonderful Dr. Stallman was and 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 not 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. It turns out that I had been given a bit of misinformation. No 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 Lorazepam, 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 made the plastic surgeon laugh 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!
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 lengthy & 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. Had I given up, trusted my primary care physician to notice these things, or just quit treatment after the first biopsy came back negative who knows what may have happened.
So friends, let this be a lesson, 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 chose to stop tanning at a fairly early age, the first time I saw a woman in Florida with a dark, dark tan and wrinkles, wrinkles, wrinkles! Every cosmetic I own has an SPF of 15 or greater. In the Summer, I have a sunscreen with microzinc in it (SPF 60)! 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. Remember, 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!
Healing from Moh’s Surgery
Warning: The next page will show photos that are slightly graphic, and could be upsetting to some people who may need this surgery. I know that I was more than slightly upset with the photos that I saw on the internet. I am, however, posting them because I think that it provides an accurate portrayal of my particular surgery and the results. Unretouched. No cosmetics unless that is specified.
If you would like to proceed to the next page, be advised there is a photo post-surgery with no bandage covering the opening.