Wednesday, November 14, 2012

Losing Face: Layer One.

Before
The dermatologist has been breezily freezing off spots on my face for years. There's not a lot of chit-chat. He gives me a glance, blasts my spots, asks me if there's anything else I want him to look at. There's about half of me that I've never even seen, and I thought he might have volunteered to have a look, but the fact that he asks makes me feel like there's something sort of unseemly about it. So I say I guess not. Then he hands me a brochure about actinic keratoses and packs me off for another year. This summer he looked at my nose and said, breezily, "well, let's put some cream on that this year," and waved a photo of some violently pink people at me. "You might look a little sunburned for a while," he explained, "and then you'll have skin like a baby's bottom." Which can be good or bad, depending.

"I don't care how I look," I told him. "Is this spot precancerous or something?"

"Okay," he said, breezily. All righty then. Cream it is. Do I need to stay out of the sun?

"If you want," he said. "Whatever. My nurse can give you the details." And he's off.

One week
She said if I have a wedding to attend or something I could put this off until October, and I did, so I do. In the intervening months, my friend Vicki, who is doing the same basic treatment, clues me in, and I spend some time on the internet. Where I find out that the treatment, ideally, is supposed to turn your face into a flaming, pulpy, oozing mass of fried nerve endings and reduce you to hammering your fingers to distract yourself from the pain before it starts working. Various victims have posted progress photos on the web. Not much happens for the first few days and then spots light up here and there, mass together, and erupt. Helpless villagers flee. After a few weeks it is hard to distinguish between the eruptions and the marks left by attempts at self-strangulation. In the final photos the patients can be seen licking out the inside of the Oxycontin bottle. 40% can't bring themselves to continue to that therapeutic level. Sleeping is impossible, because of the screaming. The cream is called Efudex, or F.U. for short. Oh boy!

I put on my first application of cream. Twice a day for fourteen days, my doctor says. I know from my research that most people go three or even four weeks. I stare nervously at my face. We have started something here, and only great pain will resolve it. It is like finding yourself pregnant with a really ugly baby.

By day five, when most people begin to see spots and blotchiness, I look normal. I feel normal. Not until three days later do I begin to see the dawn of disfigurement. By day fourteen, when  I am supposed to quit, I don't look good, but nothing has erupted, nothing is oozing, nothing is crusting over, and--even according to my instructions--I have not reached the level of "therapeutic effect." I'm not even uncomfortable, just a little chapped. The doctor doesn't take calls. He's got a nurse for that. I call her.

"Yeah, you should probably keep going," she says, "but let me message the doctor. I'll get back to you."

Two weeks
She gets back to me. Nope: fourteen days it is. I should quit. He'll see me in six months.

"Are you sure?" I say. "I  mean, I've gone to all this trouble, and I'm willing to keep going. Am I supposed to lose all this time in? What if he tells me next time I have to start over? I'd have to murder him, and that wouldn't be good for either of us."

"I'm sure," she says. "It's right here in black and white." Well then. Can't argue with those colors.

So there it is. My dermatologist wants me to march right up to the edge of cancer with spears and cauldrons of boiling oil, and then stop short of the fortress and go booga booga booga. If my actinic keratoses are as easily startled as I am, it just might work.

To be continued.

86 comments:

  1. Gosh!Is there any redeeming feature of this treatment? Like for example, does it work? "booga, booga, booga" sounds good ...

    ReplyDelete
    Replies
    1. Trouble is, I'm easily frightened. Even I don't like booga booga booga.

      Delete
  2. Wow... had to go to google to find out what you were talking about. Almost looks like the cure is worse than the problem here. Good luck!
    And, just sayin', is this the only dermatologist in your neck of the woods?

    ReplyDelete
    Replies
    1. He is one of a cartel of dermatologists I've run through at Kaiser, where I'm happy with EVERY OTHER DEPARTMENT. That said, I think he knows what he's doing, but he's not very informationy.

      Delete
  3. All my friends were getting things cut off their bodies, so I went to the dermatologist, too. But he didn't do anything like that! All the ones I have are "cosmetic," meaning I have to pay extra to have them burned off. I want some of that cream, it looks like the perfect solution. Then people would feel sorry for ME, too! :-)

    ReplyDelete
    Replies
    1. Just because all your friends are doing it, it doesn't mean you need to do it too, Missy!

      Delete
  4. I have used that and my reaction is so quick and so severe that the dr. switched me to Aldara, which is an immune system booster originally created to treat genital warts. So every time I go to the pharmacy to get an RX for it filled, I feel compelled to say to the pharmacist, and anyone else within hearing distance, "Isn't it great that the FDA has finally approved this stuff for pre-cancers and basal cell cancers???" Just in case they think....well, you know....
    I suspect that if they thought I was using it for the original purpose, they would think....that old lady????

    ReplyDelete
    Replies
    1. I, on the other hand, just get my Special Diaper Cream and go for a look of nonchalance as a proxy for dignity.

      Delete
    2. "look of nonchalance as a proxy for dignity" Well put. I've done that, more than once.

      Delete
  5. A perfectly kinda normal face reduced to the insides of a squashed water melon with the bonus of pain? Shee-ite as my people say.

    I had that keri thing on my thigh but it had the importance of a surgeon dealing with it. Slice, dig, scoop.

    Serious looking scar.

    XO
    WWW

    And good luck with the non-eruptions....:(

    ReplyDelete
    Replies
    1. Slice, dig, scoop. I do not like the sound of that. And--wait, did you say "perfectly kinda normal face?"

      Delete
  6. Please believe me, this treatment is far preferable to having MOHS surgery. I have had four procedures on my face involving flaps/grafts! Skin cancer is serious and it's great to see you stopping it in its (oozing) tracks!!!

    ReplyDelete
    Replies
    1. Thanks for the vote of confidence. I definitely do not want Mohs surgery. If I had more time I'd tell you all the other things I definitely do not want.

      Delete
  7. This sounds awful. Now you have to either trust your doc, or worry about that scary overload of information on the internet.

    ReplyDelete
    Replies
    1. The good thing is, the scary overload of information includes the fact that the stuff works pretty good.

      Delete
  8. First things first,you really need to find another Derm guy !
    I can't believe he can't be bothered to do a full body check.
    And yes, you should probably go another week-especially since you aren't really reacting in a painful way.
    Otherwise he will be telling you to repeat in a year.
    Aldara is a good option for those that refuse to use Efudex ( and I am one of them).
    Even my fair skinned Oncologist,an Aldara man,agrees that Effudex is a barbaric drug.
    On the other hand, I prefer the immediate burn of the "blue light" tx (photo dynamic therapy).
    after a lovely acetone wash, you go straight to "Holy Crap this burns!" and then are healed within a week. Much preferable to Mohs or scars....
    But really, you need a new Derm guy!!!

    ReplyDelete
    Replies
    1. Stay tuned for Part Two, Myamuh! And to be fair, I have been known to exaggerate. But making me ask for a full body check brought back some of the more painful early-adult memories. ("Shouldn't you WANT to?")

      Delete
  9. Murr--if I remember correctly, Vicki had another cream that was STRONGER even than FU. I too am prone to these actinic keratoses, and have a tube of said cream in my cabinet. Thus far, no such spots on my face.
    Good luck with the new face possibilities. How about the bagel treatment mentioned in your prior post?

    ReplyDelete
  10. Your dermatologist has a rather poor bedside manner.

    ReplyDelete
  11. oh my...if my dermatologist even thought I was going out in the sun he wouldn't see me anymore. I was going to say get a good woman dermotologist but I see you are restricted by Kaiser...

    ReplyDelete
    Replies
    1. Yeah. Well, I do have choices. He was the derm I went to after I didn't like the first one, who was a woman, and who (breezily) gave me a tube of retinol for free because it would get rid of wrinkles. I wasn't worried about my wrinkles.

      Delete
  12. I took that treatment and fared far worse. (I didn't publish on the web but count me among the screaming, pill-popping, pox ridden patients you described.) I was given a special soothing cream to use once my 14 days were up and I ran through the tube in two days flat! Count yourself lucky and hope you stay in black and white mode for eons to come!

    ReplyDelete
    Replies
    1. See Chapter Two on Saturday. How did it work, by the way? Did you get rid of your suspicious spots?

      Delete
    2. The majority of suspicious spots were gone but now, four years after that treatment, I'm still getting "new" suspicious spots burned off or dug out. The doc has suggested another full face treatment but I'd have to kill him and that just wouldn't be good for either of us.

      Delete
  13. I've had a couple of skin cancers removed by scalpel (local anaesthetic in my doctor's surgery)and I keep an eye of various bits of me. So far, nothing new to bother me.What you're undergoing sounds brutal.And I do agree that a good doctor should check other areas beside the face. Keratoses are not limited to the physog!

    ReplyDelete
    Replies
    1. Seriously. You know you're old not when your solar lesions show up, but when you have to beg someone to look at your butt.

      Delete
    2. Doesn't your town have street corners where this is the norm?
      If not...what are husbands for?

      Delete
    3. In theory, you do not have to pay your husband to say your ass is nice.

      Mine once told me (in the Louvre) that mine was a lot like the Venus de Milo's, only smaller. He stamped his ticket for life.

      Delete
  14. I go for a look-over once a year, which usually results in the Dr. saying "hmmm" and zapping one or more spots with his liquid-nitrogen-shooting device. The blistering sores are gone in about a week. Years of this has left me with lots of brown blotches. I'm looking into the possibility of some sore of laser treatment, but the doctors aren't very helpful.

    ReplyDelete
    Replies
    1. I have some of this cream left...

      Delete
    2. Great post, Murr. And as always, wonderful follow-up discussion. That full-body look-over once a year is important and your guy should insist! More than worth having to bare your butt. (I tell myself that the doc has seen flabbier butts than mine, though it seems unlikely...) Barbara, I had the laser treatment on the brown spots & on an old surgical scar (from the one time I had a spot "scooped out"), and am very pleased with results. Skin definitely not made perfect but laser made treated areas less sensitive & less prone to instant irritation from tiny amount of sun or wind exposure. Insurance didn't cover it though - but worth the $200 out-of-pocket cost.

      Delete
    3. It's weird because I'm not shy about baring anything--I was just startled he didn't look automatically.

      Boy, sounds like I got a spotty group of commenters!

      Delete
  15. How do you know the baby is ugly until after the delivery? Or has ultrasound really improved since this was last relevant to me?

    ReplyDelete
    Replies
    1. You know, sometimes you just know.

      Delete
    2. But I thought in case of a legitimately ugly baby a woman's body has ways to just shut the whole thing down.

      Delete
    3. Hahahaha! Good joke, but your election is over.

      Delete
    4. We shut the whole thing down, all right!

      Delete
  16. As a former employee of a Surgery Department, I knew you were talking about fluorouracil as soon as you mentioned the "cream". Isn't "FU" the perfect abbreviation for it?

    ReplyDelete
    Replies
    1. "Cream" is the lovely name for any number of things I'm supposed to apply to myself these days, and I think I'm going to go with "goo" or "ointment" or just "shit" from now on, lest I be moved to start drinking my coffee black.

      Delete
  17. That would freak me out, if the dermatologist just breezed in and out like that without ever throughly checking me, and sent me to the nurse for questions and details on that crazy cream.

    "In the final photos the patients can be seen licking out the inside of the Oxycontin bottle." that made me literally laugh out loud.

    And you poor thing, your face looks so painful.

    "My dermatologist wants me to march right up to the edge of cancer with spears and cauldrons of boiling oil, and then stop short of the fortress and go booga booga booga. If my actinic keratoses are as easily startled as I am, it just might work."

    That whole paragraph is just brilliant.

    ReplyDelete
    Replies
    1. Well Meleah you're just as nice as pie. At this point my face didn't hurt much at all. ("...because it's killing me..." bada BOOM.) Stay tuned.

      Delete
  18. I will never, ever, ever again complain about sunscreen feeling hot, sticky, slimy, and uncomfortable on my skin! As a matter of fact, you might as well buy stock in sunscreen, because I'll be buying vats of it.

    ReplyDelete
    Replies
    1. Yeah, you know? I still plan to complain about that.

      Delete
    2. Serious note here ( I could have just emailed you, Murr, but think others need to check this)
      A friend had had a piece of her lung removed and would always get one of us at tennis to smear lashings of high-factor sunscreen on her scar. Someone asked once why bother, because the scar ALWAYS was white.
      Apparently, her doctor said it was very important to make sure it never burned, regardless of how it looked.
      No idea whether there has been new evidence for this, but certainly in places like Northern Australia, we take it seriously.
      Could be a washout in Oregon!

      Delete
    3. We definitely don't get much sun here for a lot of the year, but what I've learned is that even one good burn can do you in. See upcoming post! (cue shark music)

      Delete
    4. The most elucidating comment I ever heard from a dermatologist was, "That's why they call it sunBURN."

      - Col

      Delete
    5. I'm pretty good with smearing away when I'm really going to be out in it, but it sure seems like I should be able to get casual sunshine and whip up some good ole vitamin D without having to wear a helmet and shin guards all the time.

      Delete
  19. Your friend Vicki here. The one whose face looked like Mt St. Helens 24 hours into the treatment. The one whose nose looks like Michael Jackson's, the one who is using the new experimental form of FU (Carolyn is correct)...
    I think you must be very thick skinned, Murr. Tough. As in, when the skin gets rough, the tough get, um, whatever. Making progress here in NC, determined not to have that flappy forehead/nose transplant; better living through chemistry and the nose is improving at a rapid rate. Still doesn't remotely resemble a baby's butt. I'm glad you haven't turned into the towering inferno and have a great Thanksgiving! Can't wait for Chapter two.

    ReplyDelete
    Replies
    1. And then chapter three, when the dermatologist sees me in five months and says, hmm, we really didn't accomplish much here, let's try THIS...yes, I most definitely have had it much easier than most, and I hope that doesn't mean I didn't do the job.

      Delete
  20. Yoicks! I googled "actinic keratoses" and there were pictures. As a former lifeguard back when the ozone layer was still fully functioning, I'm hoping this gives me a miss. Have him check your back, Murr. The cat theory of "I can't see you, so you don't exist" doesn't work with humans.

    ReplyDelete
    Replies
    1. But my butt is on that end. And I'd have to, apparently, pay him to see that. Oh yes, I already do pay him.

      Delete
  21. Husband has a general lack of "coverage" at the top. So at the last dr. appointment, the young guy asks him quite earnestly "Do you wear sunscreen there?" Nope. So, he had about 6 of those suckers zapped with the liquid nitrogen "cream". Took a couple of weeks to settle those down, too. Now he keeps a hat or sunscreen at the ready.

    ReplyDelete
    Replies
    1. I hate hats and sunscreen. And I guess I'll hate them for the rest of my days.

      Delete
  22. Ouch - waiting for Part 2!

    But what I'd like to know is how you managed to look so innocent - angelic, almost - in that first picture!

    ReplyDelete
    Replies
    1. This is simply my inner nature shining through.

      Delete
  23. Hiss and spit. Which I had thought was my mantra for October, but sadly seems only too relevant for November as well.

    ReplyDelete
    Replies
    1. We are soldiering on! My worries are insignificant. Now to get you a new mantra.

      Delete
  24. Doctor calls off the process before your face has a chance to self-destruct? What a kindly soul! Still, looks like you've suffered enough damage. Condolences.

    Also Blessings and Bear hugs.

    ReplyDelete
  25. What a good read...I even read all the comments that followed. I am terrified of skin cancer and have had a few things, zapped, frozen, other. No surgery yet. But I do look like spot.

    ReplyDelete
    Replies
    1. Well, this stuff is supposed to work really well, and it's interesting to see where the spots are, as it works on its seek-and-destroy mission.

      Delete
  26. That sounds like a pretty grizzly treatment. Glad I don't suffer from unsightly facial spots, only inflamed worry lines on my forehead. Which are only calmed down with - yes, sticky, slimy sunscreen.

    ReplyDelete
    Replies
    1. So which version is that? The DIY spackle or the extremely rude spackle?

      Delete
  27. I agree with Native...get a new derm! No full body check? Scary. They are just one of the indignities that surviving into middle age makes us endure. There will be more to come. Glad to see you can find some humor in it, though. Dark, but funny, too.
    I can't wait to read what you write about...oh never mind.

    ReplyDelete
    Replies
    1. I don't mind baring my body, but I like to see a little enthusiasm, you know?

      Delete
  28. Sounds like they give you bubonic plague to cure you. It probably works if you survive. Then again, You might want a second opinion.

    ReplyDelete
    Replies
    1. But if I didn't like the first one, why would I get another one? Oh.

      Delete
  29. You're paying good money for this, aren't you?

    I feel your pain, although mine's not as visible. Am having all kinds of issues over here, and my doctor suggests it's something I rather instinctively feel it's NOT...

    But who am I, huh? We'll let it ride for a bit...

    Best of luck to you,

    Pearl

    ReplyDelete
    Replies
    1. That's not many hints. I am in favor of trusting your instincts, especially when they're well-informed. Unless you're a magical thinker, which I don't get the ideea you are.

      Delete
  30. I had to use flourouracil (Carac rather than FU) for four weeks about a year ago. I only used it on about two square inches of my face, and that was bad enough, thanks. I'm one of your spotty readers; have to go in every six months and always have something that needs removal. I get an upper body check and also knees to ankles; apparently I sunburned my legs and shoulders often as a kid.

    ReplyDelete
    Replies
    1. Well we are just a measly bunch, ain't we? Does my audience trend older? Shoot, we baby boomers did nothing but bake out.

      Delete
  31. That sounds nasty. I can't believe how many of your readers have had issues and concerns. I don't think I've even been to a dermatologist. Now you're scaring me! I'll check back with part two.

    ReplyDelete
    Replies
    1. You DO have the coloring, dear...it's good to get a check-up. After all, they're not treating cancer in me. They're trying to prevent it. Not such a bad thing.

      Delete
  32. Pre-medication we look like we could be sisters.
    I have a friend who is a redhead (or was before the gray surge) and she says according to her doctor redheads are more prone to skin cancer. She has had about 20 melanomas remoed in the past few years.

    ReplyDelete
    Replies
    1. Redheads score worst. I like that you typo-ed "melanomas remoed," since the Mohs surgery is the next step.

      Delete
  33. I've had quite a year having had a vulvectomy and radiation to that area. I was licking out a few bottles of pain pills too. I swear I never sunbathed nude.

    Love your writing!

    ReplyDelete
    Replies
    1. Thanks! I definitely did sunbathe nude. And I don't even want to look up "vulvectomy." Nothing about that sounds good. Nothing whatsoever. Hugs to you.

      Delete
  34. Replies
    1. Well, I'm one of the least brave people I know, so I'm thinking you should get out more, Mr. C!

      Delete
  35. Second to what Mr. Charleston up there said. Fingers crossed for you in your continuing saga.

    As the daughter of a red-haired freckle-faced momma, I know someday I will be paying for the sins of running around in the sun practically bare butt nekkid most of my childhood with no sunscreen. So far no suspicious things having to be zapped, but I know my time is coming, having had to sit with momma for her to have a melanoma removed.....

    ReplyDelete
    Replies
    1. Remember lying out slathered in baby oil with reflectors on either side of you?

      Delete
  36. So sorry to hear of your 'brutal treatment!' I think (along with several others) you should get another doctor!!! I'm a little over half-way through with radiation treatments, (following chemo) but love both my oncologists. (Kaiser) Surely there is someone out there who is proactive and sensitive! Good luck! Alice

    ReplyDelete
    Replies
    1. Ugh. Well, this guy is proactive all right, trying to ward off cancer, and he must be sensitive, because it didn't hurt him a bit.

      Delete