A Bit About Cancer

Back in March I went into a dermatologist office because a very small spot on my left cheek had slowly been loosing pigment over a 3 month span and i just wanted to make sure it wasn't anything serious. Naturally, it was. As soon as the doctor looked at it with her instruments she told we she was almost sure it was Basal Cell Carcinoma. I was surprised but I was even more surprised when moments later then came in with a scalpel and needles....two of my least favorite things. The numbed the area with five lidocane shots and dug a chunk of skin out to test and confirm it was cancer.
   On my drive home I thought about the only option I was given, Mohs surgery and how glad I was that I went in as soon as I was worried about something.
   Over the next month I did lots of research, I felt very educated on the procedure and i understood how it all worked. I understood how important a confident surgeon was. especially with the cancer being in the middle of my face. I also learned that there were other options, like radiation in its different forms so i wanted a few opinions. The surgeon I was referred to initially was a horrible fit. He practically told me he wasn't going to make me happy with his performance. He explained that he hadn't preformed Mohs on someone in their twenties since the 70's and he would remove the cancer and then I would have to find a plastic surgeon to reconstruct the area, he wasn't comfortable rebuilding skin with that still had elasticity and collegian. From what I understood, that wasn't uncommon but I also knew that some surgeons are trained in the Mohs procedure and trained as professional plastic surgeons so after a few more opinions, i found my surgeon at Desert Sky Dermetology. Dr. Rkien, he was recently certified as a trained plastic surgeon and had been doing Mohs surgery for 6-7 years, it was the only think he did all day every day and he was young...very young. So much so that it worried me a little but after talking with him and asking my long list of questions i knew he would do a great job and that the office itself was professional and very highly rated so I scheduled my surgery for 2 weeks from my consultation.

My last tired faced, no make-up, stressed for surgery face. Here, it just looks like a blemish scar or a discoloration at best but i had no idea how deep rooted and wide spread this little guy was.

 Chad took off work for a couple days just in case I wasn't up and about after the first day so he was there with me at the derm office. I got NO sleep the night before because I was so nervous about it all but I was grateful knowing that my angel mother would watch my boys and things would be taken care of. Also, just a few days before the surgery we found out that Gail would be coming in the day after so my care needs were filled before I even needed them to be. I'm grateful for a wonderful family that loves and supports my family.

 So the way that Mohs surgery works is the patient get numbed with local anesthetics so that they can be awake and informed through the whole procedure. They are numbed with shots of lidocane around the area and the surgeon slowly removes sections of skin and then carefully lays it flat on a study dish and has it sent to the lab room where they study its perimeter and see if it has cancer cells. It takes roughly 40 minutes to an hour to study the skin sample so they cover the patients open wound and send them to a waiting room until the results are back. Then if the skin sample has no cancer around its edges, its considered clean and the patient is sent to reconstruction that can take upwards of an hour to complete depending on the size of the hole that was cut to remove the cancer. If the sample comes back positive for more cancer around the edges of what was removed, they re numb the patient and dig out more. Each time they go in to remove the cancer, it called a stage. This process continues until the perimeter is clear of cancer.
   With how small my cancer appeared and how little and few the symptoms I had, I assumed it would be one stage, then reconstruction and follow up. Its what the doctor alluded to as well but he was sure to remind me that the cancer can look totally different once they open me up and get a better look.

It was different.

   Before they began, the surgeon asked if his research team could observe because he was training 2-3 doctors. I almost always say yes to stuff like that. The more experience doctors get the better they care for me and my family, right! A sweet nurse came in and asked me if I wanted to be featured on his instagram page, I laughed and agreed and she took a picture of my cheek and told me she'd be taking photos throughout the process to document my recovery. She was so excited and kept mentioning how great it would be to have someone so young in thier portfolio because she hoped it would inspire more young adults to get thier skin checked. She was so wonderful, kind and encouraging. The whole staff was.
  The shots were very painful but just like any other shot, the pain goes away and in this case, turned to strange numbness. They covered my face with a piece of surgical paper with a hole so they could still work on the cancer. I closed my eyes and listened. I listened to the scalpel, the scissors, cutting my skin and the sound of something being cauterized. The smell made me sick and scared. The covered the area with a pressure bandage and sent me to the waiting room were Chad sat, sleeping. I wanted to look but wasn't brave enough to lift the gauz. I waited anxiously (and quietly, Chad always needs sleep so I let him rest) and 45 minutes later they came in and asked me to come back to the surgery room, there, they told me they need to go into the 2nd stage and extract more. the perimeters were still greatly cancerous. I was discouraged but they went in, gave me 6 more shots and dig around some more. I went back to the waiting room and woke Chad up to tell him what was going on. we waited together and about an hour later, the nurse came in with a frown and asked me to return to the surgery room. We went in for stage 3 and they gave me even more lidocane I could feel it going in now and it created lots of uncomfortable pressure with each shot. The dug more out and sent me back to waiting.

   I walked into the waiting room and just started crying. we were now the only ones in the waiting room since everyone else who had been worked on that morning only had 1-2 stages. I could tell it was a big hole because the gauz they covered it with got bigger and i would feel less and less of my cheek. There was so much lidocane in my face at this point that i could physically push it around with my fingers and hear it moving. It added to my headache as I felt it move to my temple. (I think my lack of sleep made me more emotional than normal too, but i was grateful to have the room to myself to let our my fears and anxieties to Chad, who listened and struggled to comfort me...he doesnt like tears). They came back in a hour later and apologized, i needed another stage. They continued to pump my face full of lidocane and dig. After the 4th stage I asked Chad to go get me some food, it was 1:30 and when I'm sad, I eat so all signs pointed to lunch. I ate, and laughed at some of Chads corny jokes, called the kids and told them I wouldn't be back til that night and asked the doctor if Chad could come in with me for the next stage. They said it had come back clear. Hallelujah. I was headed to reconstruction! And Chad got to come with me!
   When I sat down they removed the bandage and I studied Chads face to see how bad it looked. Chad was a stone wall. Dr. Rkein handed me and mirror and asked if I wanted to see it, i didn't but he said I wanted me to understand what they were going to do to piece it back together.

 It was much deeper than i thought but otherwise, i had felt them moving wider and wider so I wasnt too surprised. He drew all over my face and explained that he would have to remove twice as much skin in order to create a good seam along a natural crease. The triangle on top and the triangle on bottom would both be cut out and the lines would be brought together to create a scar lin from the corner of my eye to the middle of my cheek. He had such a great plan and assured me that I would be very happy with the scar and how well it would heal. I truted him, he was just wonderful.
    They brought in somemore lidocan and I hit a wall. I was exhausted, scared, discouraged, sore and in spite of the lidocan i started to feel everything, it shot hurt more and more and I had to flag down the nurse twice bacuase the pain was too much. she was sweet and sympothetic and told me she would do her best to spread the lidocane so that I would have a minimal amount of shots during surgery. I want aware at the time but recunstruction is a great deal more traumatic and because it takes a couple hours i would ned shots all throughout the surgery.
    They started to cut the skin and about 2 minutes in i told them i could feel them snipping. I probably had another 8-12 shots throughout the reconstruction and by the end i felt like I had just ran a marathon. My body was done, my whole head was throbbing and i felt so nauseous. my skin was pulled so tightly and i felt like what i imagined it would feel to have a dramatic face lift.

 The big pale puffiness by my eye is the lidocane resting in my depressed eye socket. And yes, my eyes are red from crying. I'm a baby. I got in the car and layed back trying not o focus on how nauseous i was but by the time we got to my moms to pick up the kids, i could be in the car another minute. I jumped out of the car and almost without communicating at all I just walked to my parents bedroom and collapsed on her bed. I took some tylonal and was asleep in seconds. Poor Chad, he tried to talk me into going home so he could take care of me but I didn't even respond, i was a zombie.
  After some rest I felt much better and in spite of not being able to see well from my bandage or close my mouth fulling because of the pull on the cheek. I was ready to go home. My mom sent me home and the healing began.

 I kept it covered as much as I could the first 2-3 weeks.. i was just a little more...approachable that way. This was the first 2-3 days.

   Over the next few weeks the swelling got much worse and my face turned all the colors of the rainbow but each day was better. The first week was full of frustration as I realized how important it was for me to lay down and stay rested. Ibuprofen was all i needed to manage the pain but the tight skin and sensitivity was just something I needed to get used to. Not even the puppy filter could make me look cute...ok just kidding i look adorable.

Once i got the sutures taken out 3 weeks post-surgery, it looked so much better. with constant care, buckets of sunscreen and shade and beautiful, wonderful time, Its looking better everyday. Its been about a month and a half and i still don't have feeling in a good part of my cheek that i'm not sure if its nerve damage or if thats just how scars feel but I'll be able to get that treated. Dr. Rkein assured me that if i want happy with any part of the scar in 6 months he could laser it to make sure i get a good, smooth finished product.
    Liam was so sweet, after a week or so, he saw me washing my face and I thought it would be good to show him. he saw it, thought for a minute and said "Mama, why don't you just leave the bandage off and lets go play" He didn't even see the scar. He just wanted his mama to play with him. Which has been a little harder in the summer, in AZ. I couldn't get in the water and I was scared of the sun but as the weeks have passed, i'm experiencing a little less anxiety about being in the sun and I'm able to swim with him now.

This is me after a month and honestly I'm just so happy with my experience with Desert Sky. He did a wonderful job and I'm so grateful i had a concerned friend who encouraged me to get my skin checked. I hope in reading this, whoever you are, that you'll get your skin checked, you have nothing to loose and everything to gain.
 This whole process has made me so much more aware of my health. I'm grateful for my body and its resilience. I recognize that things could be far worse and I'm just humbled that I had cancer, its gone and I'm walking away with a little scar and a lot of awareness.