I Might Need A Victorian Fainting Couch (and maybe a new doctor, too)

About a month ago, as I was brushing my teeth and getting ready for bed, I noticed a rather large lump on the left side of my neck. Note: I know in the pic I've posted, it looks like it's on my right side, but that pic was taken in the mirror, so everything is reversed. I was going in for my regular 3-month diabetes check-up in a few days, and as I looked at the lump in the mirror, I thought I really should have my doctor check that out, but then I reconsidered. I currently have a doctor who, although he's a GP, prefers no physical contact. 

I'm old enough to remember when at the very least, every doctor visit included palpating your throat and jaw line for tumors, and once a year, there'd be a breast and pelvic exam, but those days are long gone. Several years ago, when I was still working, the health program at work was sending me regular emails reminding me I was overdue for a pelvic exam, so when I called to schedule my annual check-up I specifically requested a pelvic exam be included. But when it came time for the annual exam, my GP refused to do the pelvic. You would have thought I was asking him for a date. He told me I'd have to make a separate visit to an OB-GYN for that. So when I went in for the 3-month check-up, I didn't mention the lump on the side of my neck, and he didn't notice it. 

Fast forward 3 weeks to Mother's Day, when my son Chris, who happens to be a paramedic, came over to have lunch with me. After lunch he said, "Hey Mom, what the heck is that thing on the left side of your neck?" I said, "Oh, so it IS visible!" He replied, "Hell yes it is, and you need to get it checked out, right away." I told him I would, and that night, standing in front of the mirror before I brushed my teeth, I used my phone to take a picture of it. 

Two days later, I was back in my doctor's office, waiting for him to examine me. "What are you in for again?" he asked, even though I'd been very specific on the phone with the reason for my visit, and I'm sure it was written on my chart in front of him. I told him I'd found a lump on the side of my neck and wanted him to check it out. He looked at me and said, "I have to tell you, I can't see a thing!". I told him it was on the left side of my neck, and showed him where. Standing in front of me, he poked around a bit and said, "I can't feel a thing either! Do you think this is something that has just disappeared?" At which point I pulled out my phone and showed him the photo. His eyes got big and he said, "Holy cow! I can see why you called me! If you'd just sent me this picture, looking at this and considering your age I'd say oh yeah, that's probably CANCER! I can't see or feel it, but based on the pic, I'm gonna send you for an ultrasound, to rule out anything serious." 

After mentally giving him an "F" in bedside manner, I felt relieved that at least I was getting referred to someone who might be more interested in determining what this thing was. He specified on the order that he wanted an ultrasound for "lymphatics/venous/artery/jugular" and told me to be sure to show the tech the photo. The Imaging Center was able to schedule me for late in the afternoon the same day. To my relief, the technician had no trouble seeing the lump, and she spent a good 10 to 15 minutes mapping it with ultrasound. When she finished, she told me the results would be sent to a "neck specialist" who would write a report and send it to my doctor within 24 hours. I went home and against my better judgment, I Googled "ultrasound for lymphatics/venous/artery/jugular". Uh, yeah, not a good idea to do that. 

This morning I got a phone call from my doctor's nurse, reporting the results. It seems the lump is something called "A Prominence of the Jugular" (capitalization by me). Hahahahah! Does that sound Victorian or what? Thus my thought that I might need a Fainting Couch. If this was on the right side of my neck, a good doctor would be looking for signs of congestive heart failure, but apparently the prognosis is not nearly so grim when it occurs on the left side. I asked the nurse to send me the report, so I can read it myself and decide whether I want follow up. In the meantime, I'm thinking it may be time for me to find a doctor who's a little more interested in me as a patient.

You Gotta Love Frozen Peas

Yay! The bandage is off, and to my great relief, my eye is not stitched shut, so I can see out of both eyes again. Depth perception is BACK!

 

The dark long line beneath my eye in the pic is surgical thread, which appears to be anchoring the tiny stitches in the graft, which was taken from the outside edge of my eye. I feel much better now, but at about 3 AM this morning, with my face hurting quite a bit, I decided to open the Swiss Eye Masks and attempt to get some relief by cooling my eye through the bandage. First of all, I've gotta say, whoever thought that printing the instructions for a mask to be used after eye surgery in pale grey ink in a tiny font on a shiny white background should be fired. When I finally got one of the mask packets open and picked it up to put it on over the bandage, I realized why I was told I could "just use a bag of frozen peas" instead. The masks are SLIMY and totally disgusting, to the point that I'll pass on using them.

 

I like peas, but in a lifetime of eating peas, I've never been so happy to see a bag of frozen peas in my freezer at 3 AM as I was last night. The bag of frozen peas inside a clean wash cloth provided some instant relief from the pain, even through the bandage, so that's what I'll be using to ice my eye for the next two weeks.
 

I Survived!

I was at the facility from 11 AM until 4 PM. The two surgeries (removal of the BCC and then reconstruction of my eyelid) took just over 2 hours. I had a general anesthesia during this time, which included insertion of a breathing tube. They told me to expect a sore throat. The recovery room nurse asked me if I've ever been diagnosed with asthma. Yes, when I was in my early 50s, and for about a year I took Singulair, but I’ve never had a severe asthma attack, so I discontinued that and just keep rescue inhalers on hand, which I occasionally use. Apparently, I had some problems tolerating the breathing tube, and she appeared to be a bit alarmed with my perfectly normal (for me) post-op cough, so she sent me home with an inhaler. I was told I have deep stitches, which will dissolve on their own, and surface stitches, which the surgeon will remove in a couple of weeks. Dunno what they look like though, because I have what appears to be a MaxiPad covering my right eye. I’ll remove that tomorrow. Some people who've had this surgery said they had no pain, but I’m not gonna lie, my eyelid and the area below it HURTS…really hurts. I was told to take Tylenol for pain, and I took 2, which haven’t have any effect whatsoever. They also sent me home with something called "Swiss Eye masks", which are currently cooling in the refrigerator and which I've been instructed to use for treatment of pain and swelling, or, if I don't like those, I've been told I can use a bag of frozen peas. I also received an antibiotic ointment which I'll start using tomorrow, once I have access to my eye.

 

I’d fasted before the surgery, of course, but I wasn’t really hungry afterward. Nevertheless, I was instructed to eat something, so when I got home I heated up some Trader Joe’s tomato soup, and had that and some ginger ale, after which I brushed my teeth, inserted a new set of Invisaligners, and went to bed, where I slept soundly for a couple of hours. I'm so relieved the actual surgery is OVER.

 

Oh, and one other thing. I'm not driving (of course). I'm writing this using my left eye, in which I have an IOL (intraocular lens) for distance only. So I must wear eyeglasses to be able to see anything up close, like my laptop screen. But another effect of having just one eye to use is that my sense of depth perception, which has been on shaky ground since the 2 surgeries on my left eye anyway, is just pretty much gone for now. Attempting to put toothpaste on my toothbrush really illustrated this for me, because when I tried to load my toothbrush, I discovered I was nowhere near it. I actually laughed out loud when I realized the toothpaste was going all over the sink. Sheesh.

 

 

 

Results: Basal Cell Carcinoma

This afternoon the surgeon called and told me that the results of the biopsy showed that I have BCC, or Basal Cell Carcinoma of the eyelid. BCC is the most common form of skin cancer, and although a cancer diagnosis is never good, if one has to have some form of cancer, this is one of the best forms to have, because it's rarely life-threatening and is generally quite treatable. BCCs can become locally invasive and can cause disfigurement and permanent skin damage if left untreated, though, so prompt treatment is important. The only tricky thing about this BCC is the location: it's on my eyelid. That sounds so innocuous, doesn't it? When the PA at my dermatologist's finally agreed with the self-diagnosis that I'd made almost a year ago, I didn't understand why she immediately referred me to an oculoplastic surgeon. So when I got home, I Googled "lower eyelid cancer surgery" Images. Oh. Well then. OK. I see the need for the referral to an oculoplastic surgeon, because basically, the oculoplastic surgeon has to reconstruct the eyelid after the tumor is removed. 

I'm trying to balance out the positive and negative aspects of this. One of the negative things is that I've had this growth for well over a year, but one of the positives it that it seems to be nodular rather than flat and diffuse, and I think that's a big plus in terms of removal. Because I've had this so long, apparently it's more likely to recur, however, now I know what to look for. I'm grateful that I live in a place where I have access to excellent doctors who have experience doing this type of procedure.

I've been going to a dermatologist's office for annual skin cancer checks for over 20 years. I've just learned that eyelids are one of the most common sites for skin cancers to occur in fair skinned people, but not once in the 20+ years I've been going for skin checks has anyone thought to examine my eyelids. You've seen the pics of my eyelid. This BCC is just a tiny, pearly lump on the surface of my lower eyelid. It never bled or crusted over. It didn't hurt. The 2 main symptoms for me were loss of eyelashes where the tumor was growing, and a noticeable blood vessel going to the center of the tumor. It looked so innocuous that even when I made a special appointment 2 months after my annual visit and said the reason for my visit was that I'd been a bad patient and spent time on the net and was pretty sure this was a skin cancer, no one took me seriously, and it took 7 more months for anyone to believe me and biopsy it and confirm that it was indeed a BCC that must be removed, and the sooner the better. So, please, monitor yourselves.

Biopsy

15 September 2020 - So today I had the biopsy. I was told they'll have the results in approximately one week, at which time if it’s benign, I can decide whether I want it removed (YES) and if it’s malignant, there's no choice, I’ll be scheduled to have it removed.

 

I drove myself to and from the biopsy with no problem. For the biopsy, I did not wear the contact lens which I normally wear in that eye for reading. I was given an ice pack to hold against my eyelid for about 5 minutes before I went into the room where the procedure was done. Both eyes were then numbed with an anesthetic eye drop, after which the surgeon administered an anesthetic injection into my lower right eyelid. That stung a bit, but the eyelid became numb almost instantly. Then, keeping my eyes wide open, I had to stare up and to the left the entire time the biopsy was being done. That was actually rather difficult to do, because it meant that the very bright light which the surgeon wears on his forehead to do the procedure shone directly into my eyes the entire time. He had to go in twice to remove enough tissue for the biopsy. There was a slight stinging and tugging sensation as the tissue was removed, but really the most unpleasant part of the procedure was after the biopsy was over, when he cauterized the incision, because I could feel the heat and smell my flesh burning as that was done. Ugh. But the whole thing was over very quickly: 30 minutes from start to finish. Immediately afterward, my eye felt dry and my eyelid was so sore that I didn't even think about putting my contact lens in for the rest of the day. I turned down an eye patch, preferring the incision to be exposed to the air to heal. After I got home, I instilled Systane preservative-free dry eye drops in both eyes whenever they felt dry. Fingers crossed for the results.

Oculoplastic Surgeon Visit 1 2020.09.09

 

I like the oculoplastic surgeon. I met him on September 9, 2020. He asked me to state in my own words why I was there. He then carefully examined the lump on my eyelid and gave me some good news: he said it may not be BCC after all. He said it’s right on the borderline, in terms of characteristics. He said, “If this isn’t malignant, I won’t be surprised. But if it IS malignant, I also won’t be surprised. That’s why it’s got to be biopsied." I was momentarily surprised to hear this, because the Physician's Assistant at the dermotologist's office had FINALLY diagnosed it as Basal Cell Carcinoma. But then I thought back to when I'd worked as a clinician in pediatric psychiatry, about all the patients sent to us by other psychiatrists who had diagnosed them as Bi-polar, but whom we determined, after we'd examined them, had been misdiagnosed, and I realized that until a biopsy is done, diagnosing skin cancer by simply looking at the physical characteristics of the growth isn't really any different from that. So I’m going back on September 15th for the biopsy, but in the meantime I’m feeling optimistic.

 

Beware of bumpy eyelids

 

Sometime last year, I developed a small bump almost in the center of my lower right eyelid (see selfie above). At the time I thought, "Damn. I'm getting a stye, and I HATE styes!" I was so sure it was going to turn into a stye that I checked my medicine cabinet to be sure I had some ointment specifically for treating styes, which I did. 

 

But it never turned into a stye. It didn't get red, or sore. It was just this tiny pearly bump, right on the surface of the eyelid, almost at the center. When it didn't turn into a stye, I thought maybe it was a blocked Meibomian gland. Can you tell I worked with a bunch of ophthalmologists at an eyecare company for 10 years?

Being fair skinned and living in Texas, I have a standing annual appointment for a full body check for skin cancer every December. It's supposedly a "thorough" skin check. The PA even goes through the hair on my head, to examine my scalp. But she's never examined my eyelids and I didn't call her attention to the bump at that visit, so she didn't notice it. I've since read that a thorough skin cancer check should always include careful examination of the eyelids, which are a common site for skin cancers. 

 

In early February, two months after my annual visit, when the bump still hadn't gone away, like all bad patients I looked it up on the internet and learned it could be skin cancer. "Nah", I thought, "no way!" But to be on the safe side, I called the dermatologist's office and made another appointment. At that visit, on February 26th, I mentioned that I was worried it might be skin cancer. The PA scraped the bump. She did not take tissue for a biopsy, but said she didn't believe it was skin cancer, but thought it was some sort of milia cyst. She sent me home with instructions to treat it with warm compresses, assuring me it would go away.

I did as instructed. But it didn't go away. And my eyelashes stopped growing in that area. And if you looked at it closely, in a 10x magnifying mirror, like I did at least once every day, you could see a rather fierce looking, spidery red blood vessel, like a flower stalk, going to the center of it. 

 

So in early July I called to make another appointment. Asked for the reason for the appointment, I told the receptionist that a bump on my eyelid for which I'd been seen in February hadn't gone away, had in fact grown, and that I believed it might be skin cancer. None of which impressed the receptionist. Mid-August was the first available, she said. I took it. 

 

At the August appointment, which was on a Monday, the PA examined the bump again. This time, she noticed the missing eyelashes and the blood vessel, two tell-tale signs of BCC. She measured the bump and said it's 3 mm across (tiny, right?). But she looked rather somber when she said, "This appears to be a BCC (basal cell carcinoma)". She referred me to an oculoplastic surgeon, and then, brightening up, she said cheerfully, "He'll remove it and put in a couple of stitches", leading me to believe this was no big deal. She did say if I hadn't heard from the oculoplastic surgeon's office by Friday, I should call them. She also said if they couldn't see me right away, I should come back to the dermatologist to have it removed.

Uh huh.

On Friday, not having heard from the oculoplastic surgeon's office, I called them. They told me the reason they hadn't contacted me was simple: they hadn't received the referral. In fact, they hadn't received any referrals at all that week from my dermatologist's office. The woman who took my info was very nice. She said, "The way it works is your dermatologist will remove the BCC, and then you'll see the surgeon for reconstruction of your eyelid." That was the first time I'd heard the word "reconstruction" regarding any of this. It sounded rather ominous, but also, that was not what I'd been told, and I said so. I told her that the PA had told me that the oculoplastic surgeon would remove the BCC and repair the eyelid. She paused for a moment and then said, "OK. Well, that means it's either too big, or in too critical a location for the dermatologist to remove it. But don't worry. Dr. A does this all the time. You're in good hands here." First available appointment was second week in September. Needless to say, I took it.

 

To be continued.