March 26, 2010

A PSA break from my regulary scheduled blog post

Three years ago I was diagnosed with melanoma. We caught it early. Stage one is easy to fix. The problem is when you are diagnosed with melanoma before your 40th birthday the possibility of recurrance is very high. Which means I get my skin checked every six months.

Today was my check-up, and as the Doctor went over my skin I heard her inhale sharply. I knew what was coming next before she said it. I had a mole that looked bad to her. She said if she were me she'd have it removed immediately. She'd skip lunch to do it.

For $1500 pesos ($125) I got to experience the Mexican medical system; compassionate, unhurried, careful treatment. I had a full checkup and a cone biopsy. In ten days I'll know my results.

My request of anyone who reads this blog is if you don't get regular skin checks, please do. If you haven't ever gone, go now.

And if you want to know more about melanoma round one for me, keep reading. This essay was originally published in one of those parenting mags that has since gone belly up:

I think I expected the call. But when it came a cold weakness still clenched my legs. I looked for somewhere to sit, but with the phone pressed to my ear, listening to words that explained the mole I had just had removed was melanoma, I couldn’t sort out how to walk to the chair.
“It looks like we caught it early.”
I tried to concentrate on the Doctor’s words, but a conversation that begins with your name and moves on to cancer, tends to become abstract pretty quickly.
“We” – I believe that includes me.
“Caught” – Do you catch cancer?
“It” – I guess cancer doesn’t have a gender…
“Early” – I wonder if I’m going to be late for picking up my daughter from kindergarten.
“Do you understand?” his voice asked, again.

Until that moment all I knew about melanoma is my friend, Mark had a mole on his arm. His doctor said it was probably nothing and didn’t think he needed it removed. By the time he had it removed, it was something. Then his lymph nodes were removed. Then I began to drive him for radiation treatments. He lost his appetite and lost weight. We talked a lot about how to live well and what he still dreamed about doing.

He quit the job he hated. We spent the summer working together, varnishing the bright work on sailboats. When his stomach rebelled I would bring him pureed food and call it milkshakes.

Then he decided that the radiation was too hard on his body and it was time to start traveling. He headed off for Guatemala, and when he returned brought me a gift from a little village I had once told him about over mango milkshakes. Then, with him happy and well, and me and my husband Evan eager to take to our new daughter home to Canada, we said goodbye. He died a few months later.

“What do you know about melanoma?” my Doctor asked as I sat across from him in his office, staring at information pamphlets in my hands.

I know I can die from it, seemed like an excessive answer. I know I can die even after having parts of my body sliced off and poisons injected into my system. I know I can die – even if I’m really careful.

“I understand that early treatment is very successful,” I told him.

I am fair, with reddish hair, loads of freckles and a handful of moles. As a child I wanted to tan like my sisters did. Instead I burned. I have light scaring across my shoulders, lower back and on the tops of my ears from blisters. When I was a teenager I started sailing and as I reached adulthood I became a fanatical sunscreen user. But now I understood my devotion to sunscreen may have come a little too late.

According to statistics, 1 in 56 Caucasian Americans will develop melanoma in their lifetime, as will approximately 1 in 250 in the Asian and Hispanic populations and 1 in 1000 in the African American population. 7700 Americans will die from melanoma this year.

As I watched quietly, the surgeon drew lines on my leg. “What made you get your skin checked?” he asked, flexing my leg so he could see where my muscle was and adjust the cut lines a little wider.

I explained that I had made a promise to a friend to get checked every year. But six months after my last check-up I noticed that the small round mole above my shin had begun to look like Pac Man. It also itched slightly. But it looked so cute and benign, so much a part of my leg – I felt silly mentioning it to my family Doctor. She told me it pays to be diligent and sent me to the skin clinic. The doctor inspected my leg and said it was probably nothing, but told me you can never be too careful.

The surgeon agreed about the importance of caution and drew the cut lines a little longer, right through a curve of muscle that I felt oddly attached too.
“The scar will fade,” he said. “But you’ll need to come up with a good story.”
“Shark attack,” I suggested.
Neither of us said my leg would be ugly. It was a shallow complaint. But I wondered if my Capris would cover the scar.

After my surgery I sat with my leg elevated and tightly bandaged. The surgeon had explained that the area had low blood flow – bad from the perspective of healing, good from the perspective it slowed cancer growth. I told my husband the Doctor said he was, “optimistic.”

My five-year-old daughter, who brought me some paper and crayons so I could draw while I healed, asked me in a small casual voice if I had the type of cancer that could kill mommies. I drew her a picture of us, way in the future, holding hands in the sun. Then, looking hard at the stick image of me, I wondered out loud if I should have skipped the sun.

I told my friends about my diagnosis in a chatty email that reminded them to get regular skin checks. I also included a link to the warning signs of melanoma. If they knew what melanoma was, they phoned, offering to baby sit or bring casseroles. If they didn’t know what melanoma was, they called with casual reassurance. Both reactions annoyed me. I wasn’t sick enough for sympathy but I was unprepared for optimism. I stopped answering the phone.

I didn’t register any relief when the surgeon read my report to me. I was lucky, he said, the margins were clear but my risk factors were now more elevated. As he slowly examined my entire body, he stopped to look closely at each of my remaining moles. He explained to stay healthy I would always need to be diligent, and then he drew new cut lines on my skin.

Diligence began to feel like violence. I went for more surgeries and stared bewildered by the scars that had appeared on my skin. When friends offered sympathy or support I shrugged them off. In the grand scheme of cancer, I said, I had it easy. I joked that my only worry was I would need to keep modifying my wardrobe to cover the scars. There was never a good moment to admit that my deepest fear was I would eventually need to modify my attachment to having a future. That seemed melodramatic.

Apparently I have to be diligent, I told a friend in my most casual voice when she asked about my scar.
“You must be afraid,” she said.
I shrugged, then the tears came.

Sometimes, I said, I believe I might be very, very afraid.


Seven C's said...

Thank you so much for the information in the article and this post.
I truly hope that the results come back completely clear.
When I was younger, I never felt the need to go to a dermatologist. When I was a kid, I was the original boy who wore nothing but shorts all summer long. My hair would turn from brown to white blond in the summertime and my skin from white to dark brown.
Now I am an adult (my wife may disagree with this :) ) and I go to the dermatologist regularly (yearly). I did have one mole removed from my back that was clear. The dermatologist was not going to remove it, just "watch" it. He was not concerned about it, but said that we should watch it.
I asked him to remove it anyway and happily it was benign.
I very truly hope this one is benign for you also.

boatbaby said...

I actually got the name of a good dermatologist last week and plan to make an appointment soon! Now if I can just beat that husband of mine into coming along for a check as well... he seems to think his dark complexion makes him immune no matter how many articles I show him to the contrary.
I am hugging you thru the ten day wait and I am glad they took care of you!

Caz said...

Thank you for sharing your story. I hope the test results are clean as a whistle.

Here in Australia, we have just about the highest rates of skin cancers in the world... I am super careful ot sunscreen my boys (and myself!) whenever we are out.

Our GP's offices does regular and FREE skin checks here and my husband is a freckly, moley kinda guess where he's going soon!?

Marijke Vroomen-Durning said...

Although I've not been in your shoes, I look at my husband's zipper scars (as I call them) and his multiple "zapping" scars from liquid nitrogen.

I'm sorry that you are frightened, although it would be difficult not to be. I'm just glad that you continue to be so thorough, even while living the adventure you are living.

Many people are thinking about you.

karen said...

Did you go to a doc here in La Cruz? I wouldn't mind getting our skin checked, too, before we head across... I had a friend of mine diagnosed with melanoma at 23 and it's freaked me out ever since so I try to be more careful, but probably not as careful as we should be. Anyway, would love to know where you went for the tests and we are EAGER to hear good results for you!

Diane, Evan, Maia and Charlie the cat said...

I went to Dr Alma Vargas in PV - near Costco (in fact we coordinated a Costco run with the appt;)
She's easiest to reach by email:
almavar at yahoo