Hand Me My Black Ribbon - Part 1

As a person who considers herself relatively responsible in the area of maintaining her health, I've always had a small stack of business cards from doctors riding around in whatever purse/wallet I was using at the time.  There's traditionally been one from a general practitioner, and midway through college, that also came to include one from an OB/GYN (emphasis on the GYN part more than the OB for me).  As the years drew on and various injuries and maladies cropped up, the pile gained cards from assorted physical therapists, gastroenterologists, cardiologists, and most notably for the purposes of these blog posts, dermatologists.

On this Very Special Episode of the blog, sh*t gets real

I've lived my entire life in the Sun Belt, growing up and going to college in Florida (central, then northeastern), and moving straight across the 10 freeway to Phoenix; Chris and I stayed there for 12ish years, did three in Long Beach, CA, then moved back to the Valley of the Sun, where we are today.  In thinking about it recently, the furthest north I've ever lived for longer than a six-week stint (one summer in Maryland, when Dad lived there decades ago) was Peoria, Arizona, roughly 20 miles north of the 10.  My hobbies, with the exception of reading, are almost all outside - running, hiking, walking the dogs, and so on.  In addition to a very specific sense of humor and abiding love for Jimmy Buffett, I also inherited a combo English/Irish/Welsh/German skin tone from my parents; it's on the medium-light side and covered in freckles.

Some of the said English/Irish/Welsh side of the family in Cleveland for a wedding back in 2017

Detailing all this is my way of saying that, yeah, having a good dermatologist is important to me.  There's quite the history of skin cancer that runs through both the Ashley (Dad) and Fryar (Mom) sides of my family; growing up, I remember visiting my grandparents on Mom's side and often seeing Granddad missing new chunks of nose or ear or wearing a set of bandages from a recent skin procedure.  Given both the history of my family as well as my own, I started going for skin checks in my early 30s.  When we lived in Peoria, I hiked all the way to northeast Scottsdale to the Mayo Clinic for my first and second ones, and they went fine.  In Long Beach, I visited a local derm, and while she took a biopsy of a spot on my back, the lab results showed that it was benign.  You're supposed to get an annual skin check, and I'd been pretty consistent until this point, what with moving back to Arizona, finding a new house, and enduring a global pandemic, time slipped away from me; one day, I realized I hadn't had a check in a good 5 years, which meant I was more than due.  

Getting ready to run the Aquarium of the Pacific 5K in Long Beach in 2021

I made an appointment with Phoenix Skin, about 10 minutes away from the house, and in early October, I saw Dr. Nichelle Madden.  My experience was fantastic - the office was clean and relatively new, the front desk staff was prompt in greeting me and getting me checked in, Tatiana, my tech, really listened to me and had a great sense of humor, and Dr. Madden was on time, thorough, friendly, and compassionate.  During our time together, Dr. Madden asked about a beauty mark on my left check, a few inches below my eye and near the side of my nose.  I responded that it had been with me for at least a decade, and while it mostly just hung out, every now and then (generally when I accidentally scratched it), it would get bloody/scabby, fall off, then grow anew.  That worried her, so she took a biopsy and sent it off to the lab for analysis.  That was the only spot of worry, so we finished our session together with me gaining a prescription for pharmacy grade retinol cream, you know, to help with the getting older business.

The first pre-biopsy picture from my initial appointment with Dr. Madden

The spot in 2015 - I'm spectating as Chris completes the Marine Corps Marathon in Washington D.C.

Fast forward almost two weeks, and I received a call from the clinic; they stated that my biopsy results were in.  They weren't great. My beauty mark turned out to be basal cell carcinoma, aka skin cancer.  It's always jarring to receive news like this - thankfully, I haven't had to experience it that often in my life so far - but the clinic staff was fantastic.  They very quickly moved on from what the results were to what we did now, leaving me little time to worry about the diagnosis.  By the time I finished my phone call, I had an appointment in two days to come in and have Mohs surgery with Dr. Madden, which occurred on October 25th.

In the days after the surgery, I realized that I wanted to document my experience, both so I can look back on it someday and in case it helps anyone else.  Cancer is a scary, scary word, but it's remarkably common these days, and skin cancer is the most prevalent type of all.  I'm certainly not alone in earning my black ribbon (yes, the ribbon color for skin cancer is black.  Were all the other colors taken?  At least it goes with everything...), and as we all continue to age, more of us are going to join this not-very-exclusive, pretty-darn-lame club.  I'm not generally a keeper of a day to day journal - I think the last diary I kept was in 4th grade - but I thought it might be a fun conceit to use for this set of blogs as I work through this experience.

Here we go!

Monday, October 23

I'm minding my business, just working like normal, when my cell phone starts to flash (we keep our phones on silent almost all the time - that thing hasn't actually rung in years).  The caller ID reads PHOENIX SKIN, so I figure I should answer it.  Ah, my biopsy results!  I was wondering about those.  The female voice on the other end of the phone introduces herself, but of course, I've forgotten it by now; after dispensing with pleasantries, she mentions the biopsy results came back and it showed basal cell, so I'll be coming in for a Mohs surgical procedure.  I think, uh, okay, yeah, I guess we're doing that (there's obviously no choice - I can't have cancer growing in my f'ing face.  Well, at least any MORE cancer growing in my f'ing face), and I pull up my work calendar to see what my availability looks like for the next few weeks.  The voice on the phone says that 8:30am this Wednesday is an option, which shocks me a bit, but hey, sooner is better in this case, right?  I make the appointment and get somewhat blasted with information about 1) the procedure, 2) the aftercare, 3) what to do ahead of time, and 4) etc.  I make sure of the most important thing - that I'm allowed to eat beforehand (I have priorities, y'all) - and we hang up the phone.  I text Chris, who yes, in the house with me but is on a work meeting, letting him know I need a few minutes of his time after his meeting ends.  I also text my boss James through Teams (I still haven't figured out the right verb for this - Teams'd?  Teams Texted?  There are no good options), letting him know of the situation and my need to take this Wednesday off.  I don't have any un-missable meetings that day, and he's amazingly awesome, so of course he tells me it's no problem at all, letting me know that he hopes it goes really well.  

Once I have a chance to talk with Chris, he clears his Wednesday calendar as well, so he can drive me to/from the procedure and take care of me as needed.  He doesn't have to do this - the surgery is done with just a local anesthesia, so I could drive myself - but it is most appreciated and one of the reasons why he's the best.  (Also why he's the best: because he laughed appropriately when I ran into his office later singing "Cut my face into pieces/this is my cancer spot!" to the tune of Papa Roach's "Last Resort").  I text Mom to let her know about the diagnosis and surgery, and she's supportive, too.  She's had her own battles with basal cell and has friends who have undergone the Mohs procedure, so she understands what I'll likely be experiencing.

After talking with Chris and thinking about the procedure for a bit longer, I have a few more questions, namely, is it okay if I exercise that morning, should I still put on my normal moisturizer/sunscreen that day, and will there be scarring, so I call the clinic back and am put through to Tatiana.  She's friendly and helpful again, and she addresses my concerns (yes, yes, and probably not a super visible scar, given the location and Dr. Madden's expertise).

Overall, my mental state is pretty sound.  I'm not excited about having my face dissected, but I know that the spot can't stay there.  I'm also not really worried - as I mentioned above, I have multiple family members who have survived skin cancer just fine, including Mohs procedures - and I trust Dr. Madden and her team.  Mohs procedures have been done for years, and since part of the process is scanning the cut layers of skin for additional cancer, I feel pretty confident that the surgery will address the full problem while I'm there in the office.  I guess I'd categorize my feelings as "optimistically resigned" - if you know me, you know that optimism is generally my default setting, and I'm often rational to a fault, so the research I've found reassures me that this should go well.

Tuesday, October 24

Still feeling optimistic about things.  I talk to my girlfriends Kelley and Courtney on our normal Tuesday afternoon coffee chat to tell them that I'll be a bit rough looking when we see each other Saturday night (after weeks of not partaking in very many social activities, of course the surgery occurs a few days before I'm going out with them, attending book club on Sunday morning, and going to the Japanese Garden with Chris on Sunday evening).  While I'll be sporting a face band-aid to cover the site itself, I will have several stitches in my cheek at that point, and I might still have some bruising and swelling.  They're supportive as always, and Kelley takes a moment to ask me how I'm feeling about all of this, which is greatly appreciated.  

I also talk with Mom later in the day, and she mentions how she called a friend of hers, Niki, who's had four different Mohs procedures on her face in the past; Niki passes along great advice from her experiences, and it heartens me to know that, even though there's not really a choice when it comes to this (again, you can't keep cancer in your f'ing face), she hasn't been so put off by her experiences that she refuses to have yet another Mohs the next time it's needed.

I search through our pictures folder on the computer, just to reassure (?) myself that my memory is correct and that this "beauty mark" has been with me for quite some time.  Our current PC only has pictures back to 2015 (the older ones are on external hard drives in the safe), but even in those, there it is.  The spot's not big (it looks like a particularly prominent freckle), but it's absolutely there.  It makes me wonder why my derm in Long Beach didn't catch it, or perhaps if it wasn't a big deal back then.  I question my sanity a bit - did it get bigger and I didn't notice?  Why didn't I go see a derm right away the first time it started to crust up and bleed? - but ultimately, I fall on the side of, "well, we're here now and here's what we're doing about it and here's what we're going to do better moving forward."  Like I said, rational and optimistically resigned.  Get your skin checked, people!  (Also - it totally got bigger throughout the years - look at the two pictures above from 2015 and 2021 - it's much more noticeable in the more recent shot.)

Chris and I spend our evening at home, watching the Lightning beat the Carolina Hurricanes 3-0 during the Frozen Frenzy (on this day, every single NHL team was playing - that never happens!) and more consequentially, the Diamondbacks win Game 7 of the semifinals in Philly and head off to the World Series!  Huzzah and double huzzah!  With a few false starts - I keep jumping out of bed to put more items in my "to take with me" pile on the table (what if it's cold in the office?  Grab a hoodie!  I need my Kindle!  Ooh, don't forget a water bottle - better write a note...) - I eventually fall asleep.

Bea and I watching the Lightning game - go Bolts!

She really enjoys the movement on the screen, so hockey was awesome,

while baseball was slightly less exciting for her (for me, as well).

Wednesday, October 25

Well, the whole sleeping deal didn't last long.  I woke up at 1:30am and despite trying different strategies (relaxation breathing, reading my book, etc.), I couldn't go back to sleep.  My brain was whirring with anticipation of the upcoming events of the day, including reminders and what if's.  While I still wasn't worried per se, I could feel a light sense of dread creeping up on me; my rational mind knew things would likely go perfectly fine, but I still wasn't looking forward to the procedure itself and the subsequent recovery.  I have a pretty high tolerance for pain (all those years of training for marathons helps in that regard), but after so many falls, breaks, twists, and other injuries, I'm fully aware that the days after are often much worse than the experience itself.  

I read until 5:30, then changed into workout clothes and hopped on the exercise bike for a 30 minute spin to nowhere; I wouldn't be able to work out for at least 48 hours after surgery, so I wanted to get in some calorie burning before the day started - I figured I'd be up anyway, and boy, was I right.  Chris woke up as I finished, and we took the girls for our normal morning stroll, after which I showered and ate breakfast.  Eventually, I couldn't put it off for any longer, and it was time to leave for the clinic.  I tried offering to allow Chris to go in my place, but he pointed out that wouldn't really work.  Stupid beauty mark!  Stupid family history!  Stupid sun!

We arrived at the clinic about 10 minutes before my scheduled appointment, and after checking in at the front desk, I was promptly ushered back by Ann, the tech who'd be assisting Dr. Madden with the first part of the procedure.  She complimented me on my choice of apparel - a Firestone Walker 805 t-shirt - made sure I was comfortable in the room (it was nice - a super comfy reclining chair, good temperature, tv set to a YouTube video of an aquarium), went over the procedure again with me, asked me for questions, and then had me sign a set of forms.  Dr. Madden came in to say hello, go over the procedure (they did this a lot, which was appreciated), and draw on my face with a marker to indicate the site and its borders.  Ann gave me the anesthesia shots, which honestly, were the most painful part of the surgery; while the needles are small, as the meds go in, they sting a bit, and it brought a tear to my eye.  Once I was nice and numb (about 5 minutes), Dr. Madden returned; they laid me back in the chair, put a drape over my face, and turned on the bright overhead light.  Although the drugs ensured I couldn't feel pain as she used the scalpel, I could still feel the pressure of Dr. Madden making the incisions and moving my cheek/nose area around as needed.  

The spot all marked up - you can see the dots here that correspond to a clock.

As the doc takes skin out of the spot, she notes what came from what region.

That way, if further cancer is detected, they know which section needs more cutting.

With the initial incisions done, my skin slices were placed in a petri dish and whisked off to the onsite lab.  One of the neat things about the Mohs procedure is that the samples are analyzed right there for any further cancer; if that is detected, you're already sitting in the chair, and the doc just keeps cutting until the skin comes back as cancer free.  The results would take about 45 minutes to come back, so after Dr. Madden cauterized the open blood vessels in my face hole (it really was a small hole in my face, a few millimeters deep and about as big around as the diameter of the tip of my pinky finger), Ann applied a temporary dressing.  She ensured I was settled comfortably in the chair and gave me the remote for the tv and a bell bearing a smiley face, in case I needed to summon the butler and request any vittles (she did say they would bring me a snack, but I had just eaten breakfast, so I was good to go), before heading out to help with other patients.

My interim bandage

While I waited for news, I read my book (Blue Highways by William Least Heat-Moon) and surfed my phone, tracking Chris' progress on his bike ride (he made good use of his day off, also completing several house projects and playing video games in between taking care of me).  After about an hour, Dr. Madden came back in to tell me that the lab results were back, and they were great - no more cancer was detected, so they didn't need to cut anything else out of my face.  Hooray!  (A few family members, including my great aunt Mary Alice and Chris' Dad Hugh have experienced needing to have more cut during a Mohs procedure, and it's not fun - this is why you try to catch these spots early, if possible).  Tatiana, the tech I spoke with on Monday, came in to numb me up once more, to ensure I wouldn't feel the stitching that was about to come.  

Zoe lounging in the back yard while I was having a hole cut in my face

In order to close the incision, Dr. Madden ended up taking out two more triangle-shaped chunks of skin, one above the hole and one below.  This ensured that when she pulled my cheek back together over the new gap in my face, things would eventually knit together well with a minimum of scarring. 

The small hole in my face with the additional triangles marked in pen.

The hole is super dark due to the earlier cauterization of the blood vessels beneath.

The stitching then began in earnest - first, the doc installed a row of subcutaneous stitches; they'll dissolve on their own, in about 3-4 months, and apparently the skin will look a bit lumpy until they're totally gone (super stoked about this, I'll be honest).  After that, the surface layer skin was pulled together and a row of external stitches were added; these are the standard black ones, and I have an appointment in one week to have them removed.  During the stitching, I was draped once more, and I kept my eyes closed; while I don't have a fear of needles, the idea of them coming right toward my eye area was unsettling, and the overhead light was so bright, keeping my eyes closed was more pleasant anyway.  (Also taking my mind off the consistent tugging was the sound of a baby crying somewhere in the clinic - a woman had brought her little one along with her while she was getting a chemical peel - for her, not the baby, I hope - and the mom was getting pretty insistent that the doctor hurry and finish up with me to take care of her.  I am not in the habit of judging people for how they choose to spend their money, but I didn't feel a lot of compassion for the lady whose 100% voluntary cosmetic procedure was being moderately inconvenienced by the doc STITCHING UP THE PREVIOUSLY CANCER-LADEN HOLE IN MY F'ING FACE - also, Dr. Madden was totally on schedule for both of us; it's not like my fellow skin enthusiast was delayed past her expected appointment time.)

Frankenstein's monster Halloween costume: acquired!

These pictures are so weird - I never know whether to smile, make eye contact with the camera, etc.

With the surgery bit now over, Dr. Madden bid me adieu; she made sure I had her cell phone number, in case I needed to text her with any questions, updates, and the like.  She was extremely positive about the procedure and how well it had gone, which reassured me.  Tatiana cleaned me up and then applied a pressure dressing, which would remain in place for 24 hours; it covered my left cheek and expanded across my nose, making me look a bit like I'd gone in for rhinoplasty instead (much more glamorous).  By this time, Chris was back, so Tatiana went over discharge instructions with both of us; we checked out, me making an appointment in a week for stitch removal and Chris making his next annual skin check (yes, folks, I'm going to be a nutter about this now, just FYI).

The bulkier compression bandage

Be sure to scope out the random fleck of blood dried on just below my eyebrow - 

didn't find that until I got home - very glad Chris did the run into Walgreens on my behalf.

We were free!  We celebrated by heading first to Walgreens for extra strength acetaminophen and then to local spot Vovomeena for a take home lunch (Chris had their biscuits and gravy, which are to die for, and I had a great BLT wrap).  Although we'd released the monsters from their kennels when we walked in the door, it wasn't until we finished lunch that I really got a chance to engage with them while bearing my new face adornment.  Bea wasn't really into it - she stared at me from across the room while hiding behind Chris, slowly wagging her tail like, I think you're still my Mom - but Zoe was extremely concerned.  I sat down on the couch, getting closer to her level, and she moved toward me, stopping a few inches from the dressing, gently sniffing the area and whining at me.  She kept a close eye on me the rest of the day, which mainly consisted of watching me watch tv, watching me nap, watching me sit outside in the shade (it's finally nice here), and then watching me watch tv some more.

My hall monitor - she says I'm clearly feeling well enough to play fetch with her bone

Bea was not interested in me, but she was happy to squirm at the back door

Once the anesthesia wore off, the wound started to dully ache, but a few more rounds of Tylenol took care of that.  The worst thing I was dealing with was the pressure dressing; since it was applied across most of my nose (leaving my nostrils clear, thankfully), it was hard to blow properly, and I was stuffy most of the evening.  It also obstructed my downward vision just enough to make eating off a spoon or drinking from a cup a challenge - good thing straws exist!  (Chris asked me if I was a trip hazard - or more of one than normal - but that wasn't an issue.)  When bedtime rolled around, I grabbed an extra pillow from the spare bedroom to prop myself up a bit (the clinic said this would reduce swelling in my face), and I read for about 30 minutes before sacking out.  

In upcoming blogs, I take off the pressure bandage and consider my options for Halloween costumes greatly enhanced, enjoy time with great friends while looking like a ghoul (also seasonally appropriate), and continue to heal!

Later!

Amy