Medical musingsPosted: November 14, 2012 | Author: pinkunderbelly | Filed under: breast cancer, infection, Surgery | Tags: DIEP, DIEP flap failure, ER, George Clooney, melanoma, micrometastesis, micrometastesis in breast cancer, Mohs surgery, mycobacterium fortuitum, nosocomial infection, post-mastectomy infection, rosacea, the Big Dig |22 Comments
If not for the priceless blog fodder, I’d be pretty steamed after my visit to my dermatologist yesterday. I’m ever so grateful for my sense of humor, especially after last week’s doctor’s appointment on a day that went from bad to worse to are you freakin’ kidding me??
My dermatologist is lucky I have this little blog as my outlet for all the things I’m compelled to rant about, to rail against, to bitch & moan about in general.
A little background: she’s a fantastic doctor. She embodies many of the traits I’ve come to appreciate and insist upon while spending time in an exam room. She’s punctual, no-nonsense, very thorough, and more than ready with the prescription pad. Her office is staffed by all women, with nary a male doc in sight, which thrills me to my feminist bones.
She is, however, not going to win a prize for compassionate bedside manner. She is not the most compassionate doctor I’ve ever met, and this was on full display yesterday.
Perhaps it’s my bad for scheduling a first-thing-Monday-morning appointment. Maybe she had not had her RDA of caffeine. It’s possible that her personality pills had yet to kick in at that early hour. Whatever the reason, she didn’t waste any time with pleasantries. I’m cool with that, and as much as I enjoy having a comfy relationship with my health-care practitioners (especially those who see me naked), I’m good with the all-business appointment that gets me out of there and on with my life.
I sat on the paper-covered exam table in my thin paper gown precariously close to shivering — yes, people, a temperature of 52 degrees in South Texas does count as c-o-l-d, and I’m aware of the fact that 52 degrees could be considered a heat wave in some parts of the country at this time of year. I was awaiting my doctor to come in and do my annual mole check. Because I had melanoma several years ago, I take my mole checks very seriously, and as much as I hate stripping down to have every inch of my flesh examined, it’s a necessary evil and one I never skip out on.
My melanoma showed up on the inside of my right foot, on perhaps the one and only body part without any excess flesh. A number of specialists were consulted on how best to excise the infested tissue in such a delicate area. Opening the area and excising the melanoma weren’t the problem, but closing the incision was. Little did I know that that experience would be the first of many “think of the most complicated scenario” scenarios in which I would find myself. Post-mastectomy mycobacterium, anyone? In case you’re wondering, the solution to the flesh-less foot melanoma was Mohs surgery in which the surgeon used a zig-zag shaped incision to allow him to close that incision with limited flesh upon which to draw together. I have a now-faded zig-zag scar that predates Harry Potter’s lightning bolt on his forehead. I had a lightning bolt scar before lightning bolt scars were cool.
Anyhoo, back to my terse and not-so-warm-and-fuzzy dermatologist. The first thing she said when she walked into the exam room was, “What are you doing about your rosacea?”
Um, I didn’t know I had rosacea. My face gets red when I exercise and when it’s cold outside — and again, 52 degrees does count as cold — but I certainly have never had the bright red spots that I associate with rosacea. Great, now I’m feeling self-conscious.
I asked her what she thinks I should do about my rosacea (and I want extra credit for not asking it in a smart-assy way; I mean, she is the doctor, after all). She shrugged and said there aren’t any creams on the market that really help, although there are a couple in FDA testing that should be available in a few years. Meanwhile, she thinks I should go for several laser treatments, which start at $600. Out of pocket, I’m sure. She suggested that I figure out what my triggers are and avoid them. Since she didn’t go into any detail on the common triggers, I looked them up myself and found that they include stress (not gonna get away from that one anytime soon), spicy food (I do like my jalapenos and Frank’s Hot Sauce; I put that beep on everything!), hot beverages (I’m a two-cup-a-day coffee girl), sun exposure (did I mention I live in South Texas?), exertion in hot weather (again, South Texas), oral antibiotics (so I’m guessing that 267 days of two different oral abx would factor in here), and drumroll please…the last trigger for rosacea is…alcoholic beverages.
Ok, I’m out. I’ll just have to figure out a way to live with my extra-rosy cheeks because every item on the list is a factor, but the last one is a deal-breaker.
Moving along, she examined me and made notes of the normal-looking moles scattered here & there on my body. Because of being inducted into the pink ribbon club, I’ve spent plenty of time mostly naked in doctors’ offices. I’ve had my flesh poked & prodded and examined quite intently enough times that I don’t even think twice about it; in fact, I got so used to the weekly follow-up exams after the mastectomy, the multiple surgeries to rid my chest wall of the mycobacterium, and then the Big Dig reconstruction that it seemed weird to not take off my clothes at the doctor’s office.
However, none of my previous time spent in my birthday suit with a doctor prepared me for her question: Why did you have a mastectomy?
Ummmmm, because I had breast cancer?
Why else do women undergo such a physically and emotionally taxing surgery? What kind of question is that???
I wondered for a sec if I’d heard her right, then answered “Ummmmm, because I had breast cancer.”
She then wanted to know why I had a bilateral mastectomy; was the cancer in both breasts? I replied no, at least not that was detected by the multiple mammograms, bone scan, or PET scan, but that was the right decision for me. Once I heard I had breast cancer, I took a slash-and-burn approach. Good thing, too, because my post-mastectomy pathology showed a large and scary smattering of micro-mets that were likely just waiting to organize into a full-blown tumor, with a bonus of Paget Disease to boot.
She complimented my reconstruction and said it looks good, that they see a lot of it, and mine is better than most. I replied that I was very fortunate to have such skilled surgeons, yadda yadda. It never seems like the right time to mention that while my surgeons did an incredible job with my reconstruction (especially considering how wrecked my right chest wall was after the infection), it’s still reconstruction, and I was perfectly happy with my breast before I had to have them chopped off and rebuilt using another body part. It never seems appropriate to talk about how the reconstruction restored some mass to my previously scooped-out chest, but it’s not the same and will never be the same as it was before. I never feel as if the conversation will meander toward the topic of how no matter how skillful the reconstruction, there’s no way to escape the constant and visual reminder that I had cancer. I’ve yet to find a way to say that the myth of getting new boobs after breast cancer is just that, a myth. Yes, they’re new, but they’re not really boobs. I can’t ever figure out how to say that while I’m very grateful to have had access to the best docs in one of the best medical facilities in the world, and yet my reconstruction still leaves me feeling less viable. It’s certainly not considered polite chit-chat to recount how grueling the DIEP surgery is, how precarious the transplanted blood vessels are, how unbearably uncomfortable it was to be in the ICU with heaters blowing to warm those blood vessels, or how the stress of flap-failure can bring on some serious PTSD.
All that from a sincere compliment about my reconstruction. Sheesh, what a head case I’ve become.
Just as I was talking myself down from the myriad ledges my brain landed on and working hard to get back to the present moment, which was a simple mole check, my dermatologist asked another question: Where did they get the flap from for my DIEP? From my belly, I replied, and braced myself for the inevitable comment about how nice it must be to get a “free” tummy tuck. Before she could utter that platitude, I launched into a distrationary tale about how I had to gain weight to create enough belly fat to make a good flap; ha ha ha, I said, it was so funny that I had plenty of fat in my hips & thighs but not in my belly. As I lay on my belly and she examined my back, she asked why they didn’t take it from my back (because apparently there was plenty available, and she was staring right at it). Well, because I didn’t want to lose my tennis serve, I said, resisting the urge to ask for a mirror so I could see just how fat my back is.
The coup de grace, though, came when she said how lots of people probably envied me having to gain weight for the surgery, and then delivered the final crushing blow to my already-battered ego by saying, I guess you’re still working on losing that weight, huh?
Yep. Still working on it.
And I’ll keep working on it. Right after I find a new dermatologist.
I wonder if this guy is still in practice.
Wow. No bedside manner. Wonder what she tells people who have melanoma on their back? “Lucky you, at least you’ll get rid of that ugly back fat?!” I agree. Time for a new dermatologist.
She sure went a long way just to call you fat! I think you should be allowed to see her naked and make snarky comments about her. Or maybe follow her around for a day and critique everything she does. Wow. But hey, no problem moles right? So there is that. Tell her a prescription for something fun and all is forgiven.
What an awful experience! My goodness…she surely needed a “happy pill”–definitely look for a new dermatologist!
I’m laughing with you, not at you. Honest.
Seriously, I think she and my Med Oncologist went to the same charm school, though I’ve never been flat out insulted.
How insensitive! That is crazy. Get yourself a new dermatologist, and fast! xo
what the hell is wrong with people?
With comments like that, I’m actually surprised she’s able to keep the same staff around. Time to build up a little more rosacea. Cheers!
Wow. Where was I? Them’s fightin’ words!!
Thanks for once again putting into words what goes through my mind usually several times a week when people say thoughtless things to me. I’ve been toying with the idea of saying yes I had a DOUBLE DOUBLE mastectomy (that’s the joy of diep flap failure–two digs!). I’d love to see the gasp. Although many women either don’t know what a mastectomy is, or they see it through those “pink” glasses and think it’s not that bad, no big deal. As long as it isn’t happening to them, of course. Today I stopped myself from bopping a woman who said “When you chose to have the mastectomy”. Yeah, right I chose. That or death; staying alive but mutilated vs absolutely not getting the chance to see my son graduate from high school—and I’m almoooost theeere, Skywalker— what a “choice”.
I’ve talked to enough other women who’ve had the diep on the tummy and they all say that the fat you lose comes back–in your back mostly (also backsides of arms, legs, etc), because you still have the fat cells back there, while most of them on your lower tummy, and all of them on your chest, are gone. So the body changing results of mastectomy are all over your body, not only your chest. I was once hourglass and despite some efforts to try to keep my hips, I am becoming more and more straight up and down and “blocky”. Let me know if you’ve heard of a way to get rid of excess skin around the armpits where I once had tissue beneath the skin…. I talked to Dr. S, but they don’t want to cut into the armpit because it may further damage that huge brachial nerve down the arm. Massive lymphedema, anyone?
Gee, nobody told us about all this, did they?
Get a new Dermatologist !!!! When i got to the question of why you had a bilateral mastectomy i nearly fell off my chair. What the hell did she think you had it for ? Talk about bedside manner and making her cancer patients feel good about their bodies after going through such surgeries. I’m surprised that you didn’t get up off that table and tell her a thing or two. I must admit i did laugh when i got to the last item to do with out on the Rosacea. I thought,”Oh, no she can’t cut down on her alcohol intake with me coming for thanksgiving” So glad you have your blog to rant on. But I am looking for a good rant from you on my visit. Love you!!!!!!!
Wow good to know about the back fat!! I just had the diep on Oct 26th, then it failed, now healing boobie skin grafts, never would hv thought I’d be doing this!! Part of mine wrinkled under my armpit, really irritating.
Some ppl are so heartless and stupid in their comments. I can’t wait to enter the real world after months of healing here in my home cocoon.
Failed flap??? Ugh. Michelle, that’s awful. I hope you’re healed up by now. Thanks for reading!
Gawd you’re good.
I thought it was just me–a hormonal, menopausal l biatch–who was offended and turned off by her. Glad to know I’m not alone! Sorry you had to deal with her though.She obviously skipped the bedside manner classes in med school!
Oh my goodness! This entire post is just crazy. It’s crazy. I’d rather wait an hour in the waiting room than put up with that mood altering garbage. Wow. Yes, thank gooness for the blog, otherwise I suspect that doctor might have gotten a tongue lashing. ~Catherine
Wow! I can’t believe you had to deal with that! I had to find a dermatologist in Houston when I felt a lump on my face a few months ago, and I absolutely love her. Dr. Rani Cooper is at Methodist downtown at Houston Dermatology Associates. She treated me and a friend of mine with melanoma. Just thought I’d throw that out there. I know it’s a drive from Sugarland but she is worth it!
George Clooney would make anything better:) He’d have your back…
I have met more than my fair share of doctors lacking in bedside manners and this post really resonated with me. Also, I love that cartoon 🙂 Hilarious!
Oh really, they should have classes in bedside manner in med school and make them go for refresher courses every year! I love your sense of humor about it! The cartoon is priceless; sounds like a doctor I went to. He kept slipping in comments, like when I asked him about my cholesterol, “Well if you live 15 years to have to worry about it; you have a pretty good doctor.” I responded that I thought I did. What are these doctors thinking?! Thank God there are some good ones out there.
“Why did you have a mastectomy?” She is definitely not a rock scientist. Or human.
My ego is bruised for you. Geesh! Amazing how doctors’ brains are so full of knowledge but sorely lacking in sensitivity sometimes. On the plus side, you are hilarious. Handling that doctor’s appointment with humor deserves a big ol’ shiny trophy 🙂
Thank you I needed to hear something real!! I just had the diep Oct 26th, it failed the skin rotted off both breasts underneath, the flap looks great lol. Oh the irony and fun I’ve been able to enjoy. Currently healing skin grafts that were taken from my hips.
Your dermatologist sounds a bit heartless, but I guess you really don’t understand until you’ve been there.