Thursday 27 August 2009

Read this--it could save your life

The Serious Stuff
I decided to post this personal experience on my blog as I believe reading it could save someone's life.

The story begins with the death of my brother, John, when I was 46 (he was three years younger than me)--I am now 62. John died from cancer a few years after having a melanoma removed from his leg.

From John's death on, I've made a point of having regular skin checkups to make sure that if I get a melanoma it can be removed before it starts spreading.

About 10 years ago, what appeared to be a freckle just above my wrist, seemed to me to be getting bigger. I went to the doctor and was told it was nothing to worry about. At that stage it was about 1cm across. Very, very slowly, it kept getting bigger. I kept going for my regular skin inspections at my local GP, whenever I received a reminder in the mail. Each time I was told my slowly growing (horizontally, not vertically) freckle was nothing to worry about, "it's just an old age spot"--whatever that is, I never bothered to ask.

By the time my freckle was 1.5 cm across and had got a bit darker, others started to notice it. Friends would ask, "what's that? Did you get a tattoo?" "No," I'd reply, "It's just an old age spot." Strangers would just ask, "What's that?" my reply would be the same.

As it got even bigger my wife and friends would say, "You should get that checked, it doesn't look right." To which I'd respond that I get skin checks each year and it's just an age spot. "Nothing to worry about."

A few weeks ago when I phoned to make an appointment to see my GP in response to her annual skin checkup reminder letter, I was told my regular GP was not available at a time which suited me, would I see another Doctor. "Yes," I replied.

I went for my checkup. Seeing my freckle, "how long have you had this?" the Doctor asks. "About ten years. It's just an old age spot. It's growing very slowly." The Doctor replied, "I don't like the look of it. Is it OK if I take a biopsy and have it checked." "OK," I reply. After taking the biopsy he tells me to come back in 7 days to have the single stitch out.

When I go back to get the stitch out he has the biopsy results. It's a Hutchinson's Melanotic Freckle. "What's that," I ask. The Doctor explains that it's probably not life threatening but may start to look more ugly as it could just keep growing (at this stage it's already the size of a 50 cent coin). "What's the treatment?" I now have to wait for ages while he looks it up on the Internet. "I'll have to send you to a specialist, " he replies, "as the only way to remove it is by surgery. It's too big for me to do here." I joke with him that I know an alternative way to get rid of it. I tell him how, in the early 60s, in fig season, I would help my family pick figs for the Golden Circle Cannery (sometimes as much a 3 tons a day)--they make it into fig jam. If we picked with bare hands, within about 1 hr, the white sap from the fig stems causes the tips of our fingers to bleed. Dad, an agricultural chemist, said this happened there was an enzyme in the sap which dissolved skin. Needless to say, we always picked figs with gloves on, but not before we discovered the sap was a great way of removing wharts--it magically dissolved them away. So after recounting this story to the Doctor (a bit briefer than this version), I joke that I can get rid of my freckle with fig sap. He gives me a referral to a skin specialist.

As soon as I get home I make an appointment with the specialist. I don't take the first available appointment, I have more important things to do. We agree on 18th August, 2009. On that date I duly arrive 15 mins early for my checkup. I am told I'll have to wait because the Doctor is running behind schedule. Almost two hours later I get to meet him.

I duly flash my freckle with the fancy name in front of his face as he reads the biopsy report. "I've had this for years," I say, " It's growing so slowly..." He stops me mid sentence. He explains to me that my freckle has to be removed ASAP and launches straight into a description of how he will do it. I start to protest the innocence of my poor freckle, sure it might be ugly, but it's not life threatening. Again he interrupts me, "it's an insitu melanoma," he explains, "it may not be malignant now, but when it turns malignant, and it will, you'll be dead in a few months."

Sensing that I am not grasping what he's saying, he pulls out this very thick illustrated text book. Before it even reaches the desk, I exclaim, "It's OK. I know what you are saying. I don't need to see!" My words fall on deaf ears. Stage 1 of the Melanotic Freckle/Insitu Melanoma looks like a very very small version of my freckle. Stage 2 looks dark & fiery. Stage 3 looked so gross I felt like puking--"surely the person who had that must already be dead," I thought. Then he says, "I'll book you in tomorrow to have it removed." Startled, all I can utter is,"Tomorrow!" "Yes," he reiterated, "and you should buy the Doctor who sent you here a carton of beer and tell him he's just saved your life."

Well it didn't end up that I had the Melanotic Freckle removed the next day because he was unable to book an anesthetist at such short notice. So the appointment was made for 4th September 2009. "What! I've just taken on board that it will be done tomorrow, and now I have to wait two-and-a-half weeks!"

When Susan (my wife) gets home from work, I tell her the good news. She's both shocked and pleased. Susan never liked the look of that damn spot. The next day, Susan organises to take the day of 4th September off work. I'm running a workshop starting 10th September. I'll be fine by then. I've got two-and-a-half-weeks to get everything organised. No problem.

Then the very next Monday (24 August) I get a call, "We've rescheduled you 11am Wednesday 26 August. Is that OK?" I gasp, "That's in two days? Yes that's great. See you then." I hang up the phone and literally have a panic attack. I head for somewhere to lie down for a while. When the attack is over, I compose myself and frantically SMS Susan the details so she has time to try and re-arrange her day off. About an hour later I receive an SMS from Susan confirming her changed day off has been approved.

The next day. More drama. Another phone call, "Can you make it for 7am tomorrow? You will be the first cab-off-the-rank." "Fantastic," I reply. No panic attack this time.

Well, some time between 7am and 10am yesterday, my beloved Melanotic Freckle was removed and sent off to a pathologist to begin the next chapter of this saga.

The moral of this post?
  • If you have a spot on your skin you don't like the look of, have it checked out.
  • If they say it's fine and you are still concerned, get another opinion.
  • If you are still uncomfortable, especially if it's growing, get someone to do a biopsy to find out what it really is.
  • Heed your own instincts and those of your friends and family.
  1. If it's removed when it's small you won't end up with a 30 cm scar on your stomach where they remove the skin they use to make a 3 cm diameter patch to graft into the hole left from removing the little-become-big spot, and
  2. It may save your life.
The Cool Stuff
For all you joggers/runners or people with medical backgrounds out there in blogger land, I want to share some cool experiences I had yesterday.
  • At 7am I arrive as scheduled to await my surgery. After going through the usual weigh in and checklist I change into my gown. While taking off my Rugger shorts I manage to pull the cord too far so one end only is poking out. I start to fix it but give up. I'm led to a room where the surgeon greets me. He says he'll be taking the skin to use in the graft from my leg. He asks me to lift my gown so he can show me where he's taking it from. Glancing at my legs he instantly asks, "are you a jogger?" "Yes, " I reply without asking how he figured that out. "Well we won't take skin from your leg then," he says, "It will affect your training. We'll take if from your stomach area instead." How cool is that--a Doctor who matches his surgical procedures to my life-style.
  • He then goes on to explain how to minimise the healing time to the wound made in harvesting the skin for the graft, he will be cutting out one long rectangular strip. Then stretching the skin, sewing it up to cover the gap. How cool, a bonus tummy tuck. Soney, if you are reading this, 'Buddha belly' is now a bit smaller.
  • If you are wondering how a ruler like strip of skin becomes a 3 cm diameter patch of skin to graft in where that damn spot was, just imagine making a circular patch-work quilt out of bits of the strip. I have to wait 'till Friday to see his patch-work quilt making handiwork.
  • I awoke at 9.30 am. After a bit of chit-chat, the recovery room Nurse left to get my clothes for me to change back into. While he was away (I think they must have given me some sodium pentathol because I couldn't seem to shut up) I was telling the theatre Sister about my accident with the cord which holds up my trousers. When the Nurse returned with my clothes the Sister immediately grabbed my shorts and tried to fix the cord. It wasn't working so she put them down, went into the operating theatre, returned with a pair of forceps, and Viola, my cord was fixed. How cool!
  • One week later, the pathology results are in, it was a level 2 Melanoma, & they think they got it all--which I gather means I'll be OK for at least 10 years--provided I visit the doctor for a check-up every three months to start with, then every year, and then every two years. Apparently, once you've had one melanoma you are highly likely to get another within a few years.

Last week (10 February, 2010) it was confirmed that they did not cut out enough in the first operation. On 30 March, an extra 1mm is to be cut out all around and another nearby spot about the size of a 5 cent piece is to be removed. C'est la vie.