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Archive for March 8th, 2013

Velveteen Rabbit

Tom’s skin cancer IS under watchful eyes, skilled hands, and caring nurses’ hearts at the University of Michigan Cancer Center and Mohs surgery clinic.

His last procedure was a little-more time consuming than the first few, so as he sat in the waiting room to return for final stitching, his early morning breakfast fuel ran out. So I dashed a floor above and got him a blueberry doughnut to hold him over, returned the elevator to the wrong floor, regrouped and got back to the original starting point, he had been taken back to the operating room.

After some time, the nurse came out to tell me it would be a little while yet, he was doing fine, but had to wait on the doctor (they were doing numerous procedures on many patients throughout the morning), I asked her to tell him his treat would be awaiting him.

She said, “Oh, I will take that back to him. He can have it now.” Tom was pretty grateful for that.

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All the professionals who have treated Tom tell him it is his “early days” in the sun that are responsible for the ongoing challenge he has to keep the skin cancers off him. The times on the baseball field. The times playing outdoors in the hot Michigan summers. Perhaps, the golf course entered into it too, but he wasn’t on the golf course as much as he’d like to be.

That is, until we bought a golf course and tried to make a living from it. Then he was on the golf course a LOT, but not usually with a club. He was busy fixing a plumbing leak, fertilizing the greens, cutting down tree branches in front of one of the ladies’ tees after a sizable feminine insurrection and possible threat to the membership total we needed to hold.

Then there was also that first trip to St. Thomas, Virgin Islands, and sailboat trips to Virgin Gorda, and times on the beach on St.Croix.  Worst sunburn — best tan in all our lives in that winter of 1970.

Since the advent of sunscreen, however, Tom has been meticulous to be protected by it and use hat and clothing protection and seek the shade when possible.

But the damage had already been done. Now it is up to the best medical care to keep him safe from the spread of this on his skin and in his body. Tom and I are both committed to help stop the growth of this disease.

Ireland from the AirEscapist Waiting Room Literature

The last four weeks have been an aggressive time of diagnosis, treatment and surgery with a two hour travel to the University of Michigan Cancer Specialists who are now in charge of his care. He’s had five spots removed, three of them on his face and side scalp.

He’s been a good patient, and like his father, he always has a little joke or tease for the attending medical personnel.  Plus a word of encouragement to another “first time” patient who seems alarmed at the size of the patch he comes back to the waiting room with.  He assures another woman whose husband has had his first spot removed from his nose, and is sporting a bandaged wound, that he has had several on his nose, and that it is basically all right. She seems comforted. Her husband  just wants to get out of there.

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Me, waiting during surgery.

New treatments for skin cancer are appearing and evolving rapidly in recent years. However, one surgical technique has more than stood the test of time. Developed by Dr. Frederick Mohs in the 1930s, Mohs micrographic surgery has, with a few refinements, come to be embraced over the past decade by an increasing number of surgeons for an ever-widening variety of skin cancers.
Today, Mohs surgery has come to be accepted as the single most effective technique for removing Basil Cell Carcinomas  and Squamous Cell Carcinomas  (BCCs and SCCs), the two most common skin cancers.
It accomplishes the nifty trick of sparing the greatest amount of healthy tissue while also most completely expunging cancer cells; cure rates for BCC and SCC are an unparalleled 98 percent or higher with Mohs, significantly better than the rates for standard excision or any other accepted method.
Last week, a woman having the surgery, told me during her waiting period, that Dr. Frederick Mohs came to the University of Michigan to train the technique personally and so that is one of the reasons it is rated so high as a point of preference.

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Overheard in the UM Skin Cancer Mohs Surgery Waiting Room today: As Tom and I were seated awaiting his surgery, they wheeled in a patient on a hospital transport bed. The man was asking, “Did you say call the nurse or call the hearse? There’s a big difference you know.” To which someone else waiting surgery said, “I have a hearse outside. I’m prepared for anything.” And then a woman responded, “These things are too important to take seriously.” I felt there was great healing and humor energy present in that room. Tom’s surgery was a little involved but completed successfully and we are home doing the healing part.
 
IMG_0722Happy to be done, showing good side, other side bandaged.
The reason for the technique’s success is its simple elegance. 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.
The waiting part in between for all the patients sitting with patches in various places, visible from the head and neck area, reminds me of the short wait time a woman has at her annual mammography exam….hoping the tech comes out announcing, “All set, you can go.”
It seems the surgeon must be as conservative and compassionate as possible, for more people get called back for a second removal before the all clear happy announcement is made.  Tom got two “one-time’s enough” surgeries, but this last one was a “two-timer.”  He was ready to go home.
But first!  A  stop for lunch, once we hit the highway outside of Ann Arbor.
Exit 169 — Zeeb Road, he awaits his treat. After lunch……PIE!
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Out of the car in no time!
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Hurry up, Sue.
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Peanut Butter Chocolate Pie.
Now relaxing at home with intermittent ice bag periods on the bandage.
Efforts to improve the Mohs surgeon’s ability to identify melanoma cells have led to special stains that highlight these cells, making them much easier to see under the microscope. Thus, more Mohs surgeons are now using this procedure with certain melanomas. With the rates for melanoma and other skin cancers continuing to skyrocket, Mohs will play an ever more important role in the coming decade.

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