Stitched

With Trent's gracious consent, I am going to fill you in on his skin cancer surgery. As you know, anyone can experience skin cancer. When many of us were younger, sunscreen wasn't really much of a thing. I remember tv commercials for suntan lotions to help achieve a bronze glow. I also remember people slathering themselves with baby oil trying to develop a nutty brown skin. What I don't remember as a child is hearing about sun protection. Nowadays we hear about the aging and cancer and other problems associated with the benign neglect, or even outright abuse, experienced by our skin. I shudder at the memory of the many blistering sunburns of my childhood and youth. 

Trent has a double whammy as far as his risk for skin cancers. He was a lifeguard and aquatics director for many years, and had plenty of sun exposure. Another factor is being a transplant patient. Because the immune system is suppressed post-transplant to prevent organ rejection, a transplant recipient has less ability to fight off all sorts of diseases. We often joke that Trent could catch a cold from across the street, but it's sort of true. Unfortunately, one of the disease types that can often occur in transplant recipients is cancers.

In the hospital transplant program of which Trent is a patient, patients routinely have skin cancer assessments once or twice a year. When we go, Doctor Theresa usually finds several pre-cancerous spots that she freezes off with liquid nitrogen. There are also often spots that need to be biopsied. Trent's right ear has had a recurring issue, and the biopsy in late November showed skin cancer. A surgical procedure was scheduled for Monday, December 18th. He's had this procedure two other times on different areas of his face, so we felt like we knew what to expect.

The procedure is named Mohs, after Frederic E. Mohs, the surgeon who created the technique in 1938. In my opinion, it's a brilliantly simple but effective technique. The cure rate is generally above 95%. The procedure goes like this: the patient is given a local anesthetic, along with Valium if desired. A thin layer of affected skin, and underlying tissue, if necessary, is removed. The surrounding margin is very small so that no more skin is removed than absolutely necessary. While the patient is in a waiting area with family and/or friends, the excised skin is marked for its orientation on the skin - top, bottom, right, left - and sent to the lab. If there are cancer cells on any of the edges, the process is repeated. In Trent's previous Mohs surgeries, one time he was called back once, and another time he was called back twice. This time around, they cut five times before they got it all. 

When Trent's ear was finally stitched up, they let me in the room so that I could see it before it was bandaged. I must say that I was totally unprepared. At first glance, it looked like Trent was laying there with a major chunk of his ear gone. Do this for me, please, so you'll know what I'm talking about. If you hold your finger parallel to the floor with the fingertip touching the entrance to the tunnel that directs sounds, your finger will be covering the area on the outside edge of the ear where Trent's cancer was removed. 

Since a goodish amount of skin was removed, something had to be done to protect the ear and keep blood flow going to the edge of his outer ear. Now take that finger and feel the crease behind your ear where the cup of your ear meets up with your noggin. The doctors cut down that line and pulled the skin over the outer curve of his ear, so his ear was sort of tucked under a flap of skin from the head/neck. There were quite a few stitches, and he was bandaged up and sent home with instructions to do nothing to the ear except come back in a couple of days.

Needless to say, Trent started having pain and discomfort fairly soon, and we were relieved not to have to irritate the ear by re-bandaging the area. When we went back for wound care, I had to get a lesson in how to do the special dressing of the area. Not only did it need to be cleaned and kept moist with petroleum jelly, there was a tunnel of sorts behind his ear where the skin had been lifted and moved. This had to be treated as well so that the skin didn't grow shut, making the reversal difficult. The treatment included threading a strip of cloth pre-treated with a petroleum jelly based ointment through this tunnel.

I've done post-surgery wound care for more than 20 surgeries for Trent. I've dealt with back surgeries and transplants and all kinds of stuff. In other words, it wasn't my first rodeo, but that threading the strip through the tunnel step was something that filled me with dread. The time came for me to change the dressing for the first time. I removed the dressing and the cloth strip. I mixed baby shampoo with water for cleansing with cotton swabs. I carefully cleaned the areas around all of the stitches and covered the incision with petroleum jelly. I swabbed extra on the cloth strip per the nurse's advice and wrapped it around the edge of the swab to thread it through the half-skinned tunnel. And hit a roadblock. Yes, the strip went nowhere. I broke out in a hot, burning sweat from the stress. I just couldn't get it in there. To at least do something, I tucked one end in the top and the other in the bottom, but it was pretty pathetic. I made sure that there was plenty of ointment there and we went back to the hospital a few days later.  

I was a nervous wreck. Not only was Trent in pain, pain which increased when I tried to dress his wound, but I wasn't even doing a good job. I didn't even want to go back to the treatment room, telling Trent that I was going to be fired by the nurses. The nurses, angels of mercy that they are, were very kind and said that I had done well enough that they would be glad to hire me to bandage their patients. Then they gave me magical swabs, long ones on wooden sticks and with cotton only on one end. The next time I changed the dressing it took me about five seconds to get the strip in place. What a relief.

About ten days after the surgery, we went for something that the doctors and nurses referred to as a takedown. We had no clue what to expect. In a nutshell, since I've talked so much my fingers are getting tired, the skin was cut at the outer edge of the ear. The stitches in the cup of the ear were removed and more stitches placed where the newest incisions were made. Then the neck/head skin was stretched back to where it originally came from, although there was now less of it than before, and sewn back into the crease behind the ear, along with stitches in an incision about an inch long going into the hair behind the upper part of the ear.

All in all Trent has probably had a good one hundred or more stitches go in and out of his ear and scalp. All of the stitches are gone now, but there's still an area about an inch long and maybe a quarter of an inch wide that needs to grow some skin. It still needs to be treated and bandaged daily, but we're both relieved that the tunnel is gone. So after 40 days, a couple of courses of painkillers, and a few courses of antibiotics, we're hoping for the healing to be complete soon. Trent, who tends to sleep on his left side, is looking forward sleeping on his right side again. His body is aching from always sleeping in the same position. And me? I'll just be glad when it's not hurting any more. His ear might end up looking like he defended my honor in a bar fight (my suggested story if anyone asks what happened to his ear, because it's a bit more polite than saying none of your d--- business), but I won't have to be causing him more pain.

So, now that you know that there are some great procedures related to skin cancer removal, I hope that none of us have to experience them. Sure, it's not the most horrible procedure you might ever experience, but it's not necessarily a picnic with a big bowl of potato salad either. Which brings me back to something I mentioned in my last post. Take care of your skin. This amazing envelope your body is in is the only one you get. Wear sunscreen. Hats and umbrellas are your friends. And don't be scared to have weird things on your skin checked out. Lots of them can easily be frozen in the doctors office, followed by short-term pain like those sunburns from days of summers past. No big deal. Be well, friends!



***************************************************************

The Tip Jar:

As always, I am happy and honored to write for you. It brings me great joy, and I hope that it gives you joy and/or food for thought. If you'd like to support the cause, please visit:

https://www.paypal.me/TheLunatic




Thank you for reading!