3 nights at TMC Clark

[RBM]

Like all best wishes, have also had similar how ever mild compared to yours. Feel sure your  just gona be fine.  

[OnMyWay]

I can type with both hands!  Saw the doc for my six day follow up and everything is going well!  I will probably get my staples out next Friday after 13 days elapsed.  I still have to avoid movement, to avoid stress on my skin graft, so I am still wearing a sling.

I'm going to post more history with pictures just to encourage others to do everything they can to avoid this.  Kind of like the gross pictures on cigarette packs!  Take care of your skin!

As I mentioned in the previous post on the "history" of the problem, I blundered my way into this problem with the help of some docs who did not do their jobs right.

Like Tommy, I also have a history of needing to see a dermatologist for pre-cancerous or small basal cell carcinomas.  I was seeing a dermatologist in Kentucky before I moved here, on a regular basis.  I had a spot on my shoulder (among others) that he treated but no testing was done.  After this shoulder treatment, the scar, it seemed, started growing.  Everything I read seemed to indicate I was getting a Keloid scar.  The pictures I saw on the internet looked similar.

Unfortunately this was the time when I was getting ready to move and I never went back to that doc.  After my move, I found a derma in Olongapo and asked if she could treat Keloid scars.  First mistake.  Don't tell a new doc what you think the issue is.  If she just saw it without my mentioning Keloid, she probably would have order a biopsy.  So she treated the "scar" for about 3-4 months with steriod injections, which did not help.  That was mid-2013 and i don't have any pics from that time.  It was still only about an inch across.

So it kept slowly growing and I was still thinking it was a keloid.  In mid-2015 I found a laser specialist in Angeles and had him start treating my "pre-cancerous or small basal cell carcinomas" with his laser equipment.  I had one bad one in particular on my cheek.  A biopsy was done and it was basal cell.  He removed it with his lasers.  More later.

So after going to him for small stuff for a while, I asked him if he could treat my "scar".  (same mistake made again) Sure, he has treated them before but nothing is 100% with keloids.  Which is what I had read.  Especially on areas of the body with high movement, like a shoulder.  They often come back.  This guy talked the talk and supposedly had his laser training at Harvard.  So I decided to let him have a go.

This pic is the first I have and is from August 2016.  It has grown quite large.

So this laser doc first treats with steroid injections every two weeks to "soften it" before removing it.  They were not cheap.  I think this next pic was still long before he started treating it.  The pic is January 2017.

I don't know how long he kept up the steroid injections.  The this next pic is the first test laser.  8/1/17.

On 8/20/17, he lasered about 1/2.

On 8/23/17 he lasered it flat.    No tests were ever done of the tissue removed.

Ok, great, let's see what happens.  I was hopeful.  He continues steroid injections to keep it from "healing too fast" and becoming a keloid again.

January 2018.  You can see the edges are growing.  The inside is still open.  The dark part is due to anti-biotic powder that is supposed to be good for wounds.  Still, no tests were done.

September 2018, around the last time I saw the laser doc, and over 1 year since it was lasered flat.  Needless to say, I do not recommend him anymore.  I think I might have here on the forum, years ago.

April, 2019, I'm looking for a plastic surgeon.  Still thinking it is a keloid gone bad.

Found a plastic surgeon who seems good.  Took one look and immediately ordered a biopsy.  It is a basal cell carcinoma gone crazy.

This the last picture before surgery.  June 27th, 2019.

June 29th, 2019, tumor removed.

I don't have the pictures he showed me from during the surgery, but first he cut it out and it was where the circle is in the top left of the pic.  It was a nice clean perfect hole.  He cut about 1 cm outside the border of the tumor.  Underneath, he scooped it down deep.  It was all tested using the "frozen section" method.  The pathologist said he got it all, but recommended going just a bit deeper for a better margin of safety.  So he did.

Before the surgery, he said he was considering 2 or 3 methods for the repair.  "Flap" and "graft" were the two main ones.  He ended up using both.  The big circle you see in the pic was a flap cut out of the skin and fat of my bicep area where you see the staples going down the my arm.   They cut it, leave it attached, then twist it up and place it in the hole, filling it nicely.  Luckily I had the skin and fat there to do this.

He tried to finish with just the flap but found that the skin was stretching too much and might have died.  So, in the middle section where you see that gauze,  he grafted skin from my thigh and put it there.  That was the most sensitive area of the recovery, as you have to be careful with a graft and not stress it.  He said it is fine now and removed the gauze you see there.  I still need to be careful with it until it thickens.

Back to my cheek.  The laser doc treated my cheek three times more after testing it as basal cell and the initial removal.  It kept coming back.  The plastic surgeon did a small piece for a biopsy during my table time, and it came back positive.  So he then cut it out and did the frozen section testing on it.  He got it all on the first try and stitched it up.  I'll have a scar but not too much.  The laser treatments had already left scars in that area.  He took the stitches our yesterday and it looks fine.

So, take care of your skin!  Don't use lasers to remove carcinomas!  They need to be cut out and tested to make sure all the cancer cells are removed!

Hope this helps someone.

 

 

 

 

[Tommy T.]

34 minutes ago, OnMyWay said:

Hope this helps someone.

 

Thanks for sharing your horrible experience, OMW!

Just an aside here.

Two years ago, exactly, I was in Seattle for a visit and did all the doctor and dentist things because I still knew them for many years.

However I wanted to see a derma to examine and remove the various "tags" and little lesions and spots. I made an appointment at Swedish Medical Center. I went in to see this doctor - a nice guy. Then he proceeded to tell me all about how he traveled around the world and to some of the places I had been to aboard my yacht. Well...that was nice, but let's get on with the skin, please? So he took a look and asked if I wanted any of several things he saw (all fairly small) removed. I said, yes, of course. So he burned off maybe six lesions. All in all, I was with him for about 30 minutes during which he talked for 20, then burnt off the lesions with liquid nitrogen - the standard treatment I had always endured. About a month later, I received my doctor bill and it was over $250!!! I don't remember the exact amount, but it was shocking. And I was very unhappy about the treatment session.

As said before, I have a great state-of-the-art derma here in Davao. Before I met her, I also found a very good one in Manila at St. Lukes... Not only is she also an outstanding derma, but she's beautiful too! That made it easier to take the 20+ burn-offs and even two warts removed! And all of that for about $100 and over an hour. She charged me Filipino rates and even gave me a discount! The one here gives me a discount too - so I am paying $30/lesion or a bulk rate if there are several in one particular area - like one arm or on the back. Yeah... I know that is expensive but, anyone who has read some of my previous posts - get used to hearing the same thing...you get what you pay for!

[OnMyWay]

1 hour ago, Tommy T. said:

All in all, I was with him for about 30 minutes during which he talked for 20, then burnt off the lesions with liquid nitrogen - the standard treatment I had always endured. About a month later, I received my doctor bill and it was over $250!!!

$250!  That is a bargain!  That is so similar to a story I told before about my derma in Kentucky!  I'm not sure if it was the same visit as my shoulder visit, but I saw him for 15 minutes and 10+ shots of liquid nitro.  The bill was $800!!!!

I was on a high deductible HSA plan at the time and had not made my deductible at that point, so I had to pay the whole thing.  I went to the office at sat with the billing lady, who probably had training in grief counseling!  "Yes, it is correct.  It is so high because of ???"  I forget.

A good part of why those bills are so high in the U.S. is because a lot of it goes to line the pockets of insurance companies and lawyers.

[Tommy T.]

4 minutes ago, OnMyWay said:

I was on a high deductible HSA plan at the time and had not made my deductible at that point, so I had to pay the whole thing.  I went to the office at sat with the billing lady, who probably had training in grief counseling!  "Yes, it is correct.  It is so high because of ???"  I forget.

 

Like I said, I don't really remember the actual bill, so it may have been lots higher than that. I just remember my reaction to it was shock. However, as medical facilities seem to always do, they reduced the bill by a fairly large amount too - which I, also, had to pay 100% due to high deductible. My insurance company just knocked down the original price and then I paid. But it wasn't the cost that got me, it was really the lack of service. It was really a bullshit appointment and I was angered even while I was there by all the talking and little doctoring.

[Jack Peterson]

3 minutes ago, Tommy T. said:

It was really a bullshit appointment and I was angered even while I was there by all the talking and little doctoring.

Then Tom, you will not be disappointed with the PI Health Agenda but they will of course take a few texts and Phone calls during your appointment. Such is life anywhere I guess, or so it seems, I thought it was just here but........... apparently over there too 

[Tommy T.]

5 minutes ago, Jack Peterson said:

Such is life anywhere I guess, or so it seems, I thought it was just here but........... apparently over there too 

Yeah... thanks for the heads up, Jack. I have already had that experience here. I guess I wanted to point out what you just said - that even in the Land of the Big Smoke, things are not as, in my opinion, they should be - and it all costs a whole lot more than good quality care here - when I find it! Having said that, however, my GP that I used to have in USA was wonderful, caring, efficient and reasonable. My dentist in Seattle - the same. But things are looking up here because of this derma I found and also the dentist here in Davao. Maybe some day I will share my $10,000+ tooth debacle that began at St. Lukes, Manila and ended in Seattle...but I don't want to get any more depressed today.

I am just happy for OMW that things seem to eventually have worked out for him!

[jimeve]

I avoid the sun like a plague, I still can't get my head around why so many are that vain they put their lives in danger by deliberately sun bathing.   

The sun gives out UV (ultraviolet) radiation which is harmful to your skin and eyes. So glad to see the rain.  

[Tommy T.]

3 minutes ago, jimeve said:

I avoid the sun like a plague, I still can't get my head around why so many are that vain they put their lives in danger by deliberately sun bathing.   

 The sun gives out UV (ultraviolet) radiation which is harmful to your skin and eyes. So glad to see the rain.  

Yeah, Jim... I stay out of the sun most of the time. When I was young I did sunbathe - especially on Easter trips to Florida a few times. Ignorance was bliss!

Now it's a bit too late. While sailing, I got burned some times, even with sunblock (either sweated off or not strong enough?). Apparently the damage has already been done and many of the current effect of that stem from exposure 20 and more years ago. So now I am literally paying the price. I go twice a year to the derma and, so far, everything is cool. I had to play catch-up after not being treated, so now it is just maybe 10-15/session, or less, that get treated. I also self-treat using a cream on my face (Aldera) that is like a miracle. It actually helps activate my own skin cells to attack and destroy damaged cells. Causes some bumps, red spots, even a bit of a sore or two, then they are gone! Maybe once every other year I do that treatment - at doctor's direction.

By the way...don't forget that UV does penetrate clouds so be careful, even on overcast or lightly rainy days - just a suggestion...

LIke OMW, I am just sharing my experience to try to help others.

[jimeve]

1 minute ago, Tommy T. said:

LIke OMW, I am just sharing my experience to try to help others.

Likes wise. Unfortunately the human skin has a long memory, like you Tommy in my younger days I would sunbathe. I'm almost confined to the inside of my house just to go outside to go in the car.