A Cautionary Summer Tale

health and wellness, Medicine 6 Minutes

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I have a few friends who are medical nihilists (several of them are married to physicians). They avoid medical care whenever possible, rarely see a physician, and when they go, generally ignore the physician’s instructions.

I am cut from a different cloth. I go to the doctor for preventive care, get my flu shot every year, and seek medical guidance if I’ve had a problem for more than a few weeks.

I do have several chronic conditions and a bionic knee and wrist. However, I am fortunately, at this point, in good health. (Cue my late mother’s voice here, making clucking sounds to ward off the evil spirits.)

I tend to be super vigilant about medical matters. In fact, as I’ve written previously, I tend to catastrophize. That sudden pain in my leg? The one that’s probably a pulled muscle? Well, it feels hot, so it could be a blood clot, couldn’t it? (I also meditate, but sometimes the worry forces overwhelm the calmness regimen.)

And, having worked as a medical writer/editor in the past, I realize that I possess just enough medical knowledge to be a danger to myself and others. (I do, however, refrain from prescribing–and for the most part avoid misdiagnosing my friends and family.)

Although it’s gotten worse in recent years, as those around me have died—or narrowly escaped death—this tendency on my part to focus on all things medical has been ever so.

I think I’ve known the seven warning signs for cancer since I learned to read. For those who don’t share my fixation, the first sign is “Any sore that does not heal.”

But the tiny mark on my nose seemed insignificant—certainly not a sore as I understood the term. Occasionally, a little dry skin flaked off and the skin beneath looked slightly pink; then it quickly returned to its previous state. I found it curious, but not at all alarming. This went on for months.

One night, when the spot looked pinkish, I dabbed it with a little cortisone cream that my dermatologist had given me for a previous condition.

Shortly thereafter, I stepped into the shower. When I stepped out, I caught a glimpse of my face in the mirror, and blood was gushing from that tiny spot on my nose—it seemed like several tablespoonfuls.

My dermatologist saw me the next day. “It doesn’t look like anything,” she said, poring over it with her magnifying glass. “But whenever there’s bleeding, we do a biopsy.”

The biopsy was definitive for carcinoma, but wishy-washy as to type. At varying times I was told it was a basal lesion with some squamatization, a squamous lesion, or a “collision lesion” of both cell types. The latter made me envision two small bumper cars packed with differing cells, going at each other at high speed.

One point was certain: the innocuous looking thing had to go. I was referred to a Mohs surgeon for a procedure in which the lesion is removed layer by layer while the patient waits for the biopsy report stating that the margins are clear: the cancer is gone.

At the pre-op visit, the surgeon’s nurse drew a fairly large circle around the lesion with a green marker pen. That should have alerted me to what was ahead; it did not.

The surgeon explained her procedure and then said, “I think we should have a plastic surgeon on standby to close the wound.”

I was puzzled. It was so small—surely a few stitches would do. Then she said, “You have a fine aquiline nose; I think it’s wiser to have a plastic surgeon do the closure.” OK. The plan was that I would see a surgeon she works with on such cases; she’d complete her work, bandage me up, and he’d close the wound later that day. Seemed reasonable.

But when I met the plastic surgeon pre-op, he began describing what sounded like pretty dire procedures. “We can take a skin graft from another part of your body that’s close to the color of your nose,” he said. “Or we can do a flap from your forehead.” All of a sudden, this tiny lesion was wreaking outsized havoc on my face.

I spoke with the Mohs surgeon’s nurse, who assured me that the plastic surgeon gave “worst possible scenarios.” I felt better—for a time. I had agreed to the graft, if needed, because the plastic surgeon said if I didn’t like the results, he could always do the flap. But once the flap was done, no revision would be possible.

Fast forward: the cancer was gone after a single layer’s removal: very good news. The plastic surgeon told me to come right over. He looked at the wound and said, “We’ll take a graft from your clavicle; do you mind a scar?”

I was willing to forgo a pristine clavicle for a chance that my “fine aquiline nose” wouldn’t be seriously disfigured. I will acknowledge that my attachment to it has been more than physical and utilitarian.

I was awake through the surgery, and we all laughed at the surgeon’s stories of his parents’ youthful indiscretions. Not sure why he raised that issue, but it did pass the time and take my mind off the snipping and sewing.

He had warned me the healing would take about a year, so I’m more than three-quarters of the way there. There have been bumps along the way—just recently, one quite literally.

I was walking through a revolving door and, certainly not practicing my mindfulness, stepped ahead before the opening had reached me—like a tiny bird ramming into a window. The only part of me that hit the glass was my nose—straight on.

I began icing it as soon as I could and called the plastic surgeon’s office to see if I should do anything else. He returned my call in minutes—an unusual attentiveness that suggested concern.

“In a battle between a door and a nose, the door always wins,” he said brightly. (He’s a good surgeon, but I didn’t need the wisecrack.) “Do you think it’s broken?” he asked. I said I really didn’t think so; it didn’t hurt that much and was simply quite red. “Keep icing it on and off all day,” he responded. “It should be OK.”

The next day, when I awakened to find the skin graft in place and not beside me on my pillow, I appreciated how fortunate I was not to have damaged myself seriously.

Now that I have a portion of my clavicle attached to my nose, I’ve thought about whether it’s still appropriate to call it a nose. It seems more like a hybrid of two heretofore autonomous body surfaces, finding their way to peaceful coexistence.

It’s a strange phenomenon, but I profoundly recognize that in the scheme of things, so many people struggle with far worse medical conditions for many years. I’m very grateful for my situation and do, mindfully, appreciate every day.

Some mildly annoying lifestyle changes go with this new territory. I’ve had three squamous lesions in less than two years (two were in situ—precancerous), of which two were on my face. Thus, I’ve been warned by both the Mohs surgeon and my dermatologist that although the skin damage happened years ago, I must now take extra precautions: sunscreen (more than 30 SPF) all year round, rain or shine; hats with brims; sunglasses; and long sleeves.

In this 90 degree heat, I get some strange looks, but so be it. A woman of mystery–perhaps a secret agent, who has traded her traditional trench coat for UPF (ultraviolet protection factor) garments.

So ends my cautionary summer tale for you—especially those who are young and carefree. Just one or two bad sunburns can do a lot of damage, and mine occurred before we were worried about losing the protection of the ozone layer.

Don’t be cavalier about your exposure to the sun. And please: don’t ignore any small lesions, no matter how innocuous they may appear, if they hang around for a while.

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One more thing: if you’re even thinking about going to a tanning parlor, fuggedaboudit!

Your thoughts, experiences…?

Annie

Published by annieasksyou

I've been a nonfiction writer for many years, exploring diverse topics that pique my curiosity, as noted in my first blog posting (Greetings!). I'm seeking dialogue with others committed to joining me in this exploration, sharing my conviction that different views can be exchanged in a respectful, civil discourse where we can learn from one another and be agreeable, even when we disagree. These postings depend for their enrichment on your participation: your ideas, insights, knowledge, opinions, and personal stories.

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31 thoughts on “A Cautionary Summer Tale”

  1. All good advice. I went through the same thing myself about 4 years ago, though not heavy duty as you did. I never got to a bleeding stage before my Mrs nagged me into the doctor, and needed no graft. But the inch-long scar was trauma enough for me. And WOW did it hurt for the first few days after the anesthesia wore off.

    So now I get to wear a brimmed hat outside. I think it makes me look like Humphrey Bogart but everyone else says it doesn’t. And then I bought a convertible. Yeah, I know. At least I don’t drive it a lot (and never without a baseball cap).

    The graft you got sounds fascinating. Are you now able to keep your nose to the grindstone and your shoulder to the wheel all at the same time? 🤔 Me, I just have a teeny little scar on the bridge of my nose that allows me to look tough without a tattoo. It completes the Bogart look (except that Al Pacino and Paul Muni played Scarface and not Bogart. But Pacino never looked great in a hat).

    Anyway you have performed a public service and I will back you all the way in telling folks to get in to have this recurring pimples looked at.

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    1. “Nose to the grindstone and shoulder to the wheel at the same time,” indeed! That is both hilarious and very witty. For a while I was referring to my “nosicle,” but the word conjured up those orange or raspberry ice and ice cream treats from my youth.

      And what did the Mrs. say about the convertible? I feel obliged to tell you that the baseball cap won’t prevent the kind of cancer a friend who golfs got on his ears.

      I think Pacino looked pretty good in hats, but definitely not Bogart quality.

      Thanks for sharing your story and encouraging my public service work.
      And cover those ears!

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      1. Nosicle does indeed take the mind to places it should not go.

        We don’t drive the convertible much in the daytime, and with it being a teeny Mazda Miata from the 90s, and with her beginning to experience some knee issues, she is finding it to be more of a chore to get in and out. This may be the summer to let it go. And at least I don’t play golf! My inclination to stay in the cool indoors is finally paying dividends. 👏

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      2. Will you write a parting-with-the-Miata post?

        I forgot to mention that although I was able to respond to your German farmer redux piece, I wasn’t able to like it, which I did.

        Joni and I connected via her liking my comment on that post, and we are now following each other’s posts, which is nice.

        I no longer feel the sun is my friend, so I also prefer the cool indoors.

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  2. I don’t have a similar experience to share—not yet, anyway. But I spent many years basking in the sun and running around tennis courts without bothering to slather myself with sunblock. So your story and advice are much appreciated. Here’s hoping that your dermatological problems are over.

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  3. I think you’re wise and your piece is a bit of wake up call to FINALLY see a dermatologist instead of simply worrying about little bumps, as I have been. As for the fine acqualine nose . . . no hope of that, but at least I can protect what I own!

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    1. This is an interesting development due to my failure to carefully research. I had assumed that the surgeon was referring to the fact that my nose is fairly straight. But today I actually looked it up, and aquiline refers to “eagle,” as in with a beak on the bridge. I don’t have that at all. I’m glad she was a better surgeon than wordsmith.

      I’m also glad you’ll see a dermatologist instead of worrying…

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  4. That was an interesting post, and timely as our summers seem so much hotter now. I have fair Celtic skin and could never tan, but had some bad burns in my foolish teenage years so am vigilant about sunscreen most of the time, although I do find it difficult to find a nice stylish hat with a wide enough brim. It’s good they didn’t have to take too much of a margin around it. My friend had to go back and have it repeated as they didn’t get enough, although several years later it has healed so well you can’t even tell. I have always hated my nose so am envious of you “fine aquiline nose”.

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    1. I wish I could send you one of my hats: I am gathering quite a collection.

      Yes, I was very fortunate that one layer was all that was needed.

      We all exaggerate our flaws more than reality dictates—or at least other observers—

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      1. Sorry—accidentally cut myself off: was about to write “discern. I’m sure your nose is fine. And as I mentioned in response to Denise, above, I just did what I should have done when I first saw the surgeon: look up the word “aquiline.” It means eagle-like, as in with a large beak. Not quite accurate, after all.

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  5. Hi Annie,
    It probably wasn’t easy for you to disclose this part of your medical history, especially in such detail. But you’ve done a good public service by making us more aware that in addition to supplying us with Vitamin D the sun can have its negative effects.
    But there’s one part of your saga in which detail is lacking. I don’t mean to be nosy, but when you bumped into the revolving door what were you doing at the time? One guess is that you were talking on your cell phone and weren’t concentrating on the door. If so, we should also be aware of the many hazards of cell phone use.
    Don

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    1. After writing about my colonoscopy, this one was fairly easy. One of my writer friends has said there’s a crusader spirit in my blog, and I guess to some extent she’s right. If I can help other people avoid illness or other unpleasantness via my experiences, I’m happy to do so.

      I have written about some of the potential hazards of smartphone use early on. In this instance, I was on my way to my gym and distracted about

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      1. (Cont-) an imminent meeting with a dear friend. But you’re right: I am often appalled to see people crossing busy streets while oblivious to the traffic because they’re deep in conversation on their cell phones. Another thing to watch out for in addition to too much sun and questionable lesions.

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  7. Since I moved to south Florida, I’ve had two bouts with squamous cell carcinoma, both of which I self diagnosed. One on my right ear and the other on my right forearm. Since I’ve drowned my self in sunscreen (SPF 50) I was kind of shocked by these revelations. My dermatologist told me that both were probably the result of long ago bouts with the sun. Having been a golfer among other outdoor pursuits, as a young person, I was more concerned with getting a good tan than I was thinking clearly. Bain de soleil orange gel was my favorite “sunscreen.” I think that, in fact, this product was more like UVA and UVB enhancers.
    I was lucky, MOHS on my ear and closed by a plastic surgeon an hour later and the forearm deal was literally roto rootered out by the dermatologist.
    Annie should have warned me in the early 60’s not to go to work at Camp Kinder Ring. Should have stayed in NJ and found a safer job. 😀🏌️‍♂️🏌️‍♂️🏌️‍♂️

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    1. Annie couldn’t warn you because she was too busy dousing herself with Bain de Soleil or baby oil and “resting” on the beach with an aluminum reflector (remember those?) Ah, youth!!

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  8. Hi Annie.
    You’ve provided some really useful and practical advice. Other than bike riding, most of my youth was spent playing indoor sports so I never used sunscreen or spent a lot of time on the beach. I thought that black people didn’t have to worry about sun cancer. The fact is that people with dark skin tones are susceptible and stand the chance of having squamous cell carcinoma, or melanoma.
    Diagnosed in late stages can be life-threatening. The survival rate for melanoma for blacks in the US is 65%. Skin cancer is not a frequent occurrence in African Americans, but survival rates can be a lot better if we develop better sun protection habits. Thank you for giving us all food for thought.

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    1. Darnell, I really appreciate that input. I try to use my experiences to offer info that’s useful, even important, and I’m always grateful when comments enrich the dialogue, as you’ve just done.

      On another note, with your encouragement, I’ve just posted another Drabble—and I’m enjoying the exchanges with new blogger acquaintances in the fiction community.

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  10. I had a squamous growth on my forehead removed a few years ago via mohs surgery. They got all the cancer but I didn’t have a plastic surgeon fix me up. The mohs surgeon just stitched me up and now I have a big dent in my forehead. Oh well. My wife tells me it adds character to my visage. 🙄

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  11. No doubt it does—though I can’t imagine you needed to add character!

    So I have this smooth white patch of clavicle skin sitting in the middle of my nose. Fortunately, there’s makeup, which I now apply only pre-zoom sessions.

    Have you considered silly putty for your dent?

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