Cog in the wheel - when your routine doctor visit isn't.

What happens when your routine doctor visit turns into something "interesting and urgent"?

Three weeks ago today I went to my regularly scheduled annual skin check up. With a history of melanoma in my family and a squamous cell carcinoma removal from my left temple (via MOHS procedure) four years ago, my annual skin check up has become part of my regular routine. Each time it has gone pretty much the same way - quick check in and then I stand and lie while the PA goes over my skin inch by inch. I feel sort of like a horse on an auction block with potential bidders giving me the careful once over.

This visit was no different until the very end. I happened to mention that I noticed a small bump in my left axilla which I had first seen two weeks prior to my skin check up. The PA's ears perked up and she carefully palpated my armpit (which was soon to see more attention and action that it has in years...)

This was followed by a "hmmm" and "Let me see if I can get the MD on duty to give me a consult". The MD (who I had never met prior to this visit) then came in and thoroughly palpated my armpit again. My routine visit was about to get both interesting and urgent.

It turns out that when skin cancer metastasizeit frequently follows the lymph system and causes tumors to appear along the lymph draining system nearest to the original site. In my case it made the appearance of an unknown lump on the same side of my body as the original cancer a cause for concern. This quickly led to "do you have a primary care physician that you can get in to see tomorrow?" and "we'll go ahead and schedule an ultrasound for Friday" and "you'll probably go in for surgery next week".

What I was to quickly learn was that as soon as something with potential serious consequences is observed you lose control over your schedule. The next three weeks would be filled with ultrasounds, scheduled (and cancelled) surgery appointments and finally the successful removal of the lump. For me it was the loss of control (as well as the uncertainly of it all) that was hardest to deal with.

In my case the surgery was over quickly and the surgeon was encouraged by the appearance, location and make up of the lump. It it most likely completely benign (it turned out to be a lypoma - harmless). I can only imagine the schedule and total loss of control that happens when you test positive for cancer and the medical establishment takes over. I'm hoping to never find out first hand.

One of the challenges associated with all this was simply getting myself to and from the hospital. For patients actively undergoing treatment the simple act of driving is challenging. For that reason I would encourage Vermont readers to visit the volunteer driving opportunities organized by United Way. I'm putting this on my list of to do's when this is all behind me.

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