I’m feeling better. I've learned that surgical removal of early stage melanomas like mine is extremely successful and that the long–term survival rate is extremely high, so much so that one academic source called surgery a ‘cure.’ However, that was the only time that word has appeared anywhere in the literature I’ve reviewed.
Ignorance is most certainly not bliss. At least not all of the time.
I cannot completely relax. Melanomas do frequently recur: witness my mother’s three. And I’m even more fair–skinned than her. So I have to remain super–vigilant. I have to be extra thoughtful about my sun exposure. And I will be seeing a dermatologist quarterly. That alone will serve as a potent reminder.
Monday, October 31, 2011
Out, Damn Spot!
The results are in. The two spots on my back are nothing to worry about. One was just a dysplastic nevus, basically a gross–looking mole, while the other was simply a harmless discoloration of the skin.
Then there was the patch on my arm. It’s skin cancer, an early stage melanoma. Specifically it is a superficial spreading melanoma. Melanomas are the most deadly of all skin cancers and among the most aggressive of all cancers; they frequently and rapidly metastasize. However, my eighty–year–old mother has had three and is still around (although her leg was nearly amputated for one); that knowledge alleviates some of my anxiety. Just 3% of all skin cancers are melanomas.
Fortunately mine was just 0.45mm in thickness, which classifies it as a thin melanoma (anything under 1.00mm is ‘thin’) with no ‘secondary factors,’ which, according to Dr. Moskowitz, my dermatologist, means it has the “best prognosis.”
I am truly a bit unnerved by having to apply that classification to myself. I am used to using terminology like ‘prognosis’ as a result of my mother’s, father’s, sister’s, aunt’s, mother–in–law’s and friends’ bouts with cancer, several of whom, including my dad and aunt, died from it. And my sister right now is undergoing a course of surgery, radiation and chemotherapy; ‘prognosis’ comes up frequently in talks with my mom. (Jennifer’s prognosis is ‘fair.’) My ‘treatment plan’ is benign by comparison. Still, and not to sound self–centered or narcissistic, we’re talking about my prognosis here.
The plan currently amounts to extensive lab work to establish baselines, a prophylactic chest x-ray (melanoma and various lung cancers are apparently reciprocal metastases) and minor surgery to remove a 2.5cm diameter area of the tissue surrounding the site, which will then be stitched closed. This is to effectively create a moat around the malignancy, minimizing the chance that the cancer has spread to the surrounding cells—which is never evident from just visually inspecting the adjacent skin in situ. An assay will be performed on the excised tissue. These steps are usually all that are required for treating thin melanomas.
I have now moved into a high risk category; melanomas are very likely to recur. Previously I wrote that, during the original examination, I began to consider monthly mole checks after Moskowitz identified three areas of interest that he wanted to immediately excise. Well, now I am on the official ‘melanoma booking list’ and will be seeing Dr. Moskowitz or a colleague every three months for the foreseeable future. I am awaiting a scheduling phone call from the dermatology clinic, as well as calls to set up the surgery and chest x–ray. There is a standing order for the lab work. And I’m daydreaming about bathing in a bathtub full of sunblock.
And so it is cancer. It’s not immediately life–threatening and my prognosis is the best it could be. Nonetheless, it is absolutely nothing to take lightly and its presence in my body is deeply affecting me.
P.S. Notwithstanding my dialogs with dermatologists concerning the merits of biennial mole checks, the Skin Cancer Foundation recommends annual examinations for anybody over 40.
Then there was the patch on my arm. It’s skin cancer, an early stage melanoma. Specifically it is a superficial spreading melanoma. Melanomas are the most deadly of all skin cancers and among the most aggressive of all cancers; they frequently and rapidly metastasize. However, my eighty–year–old mother has had three and is still around (although her leg was nearly amputated for one); that knowledge alleviates some of my anxiety. Just 3% of all skin cancers are melanomas.
Fortunately mine was just 0.45mm in thickness, which classifies it as a thin melanoma (anything under 1.00mm is ‘thin’) with no ‘secondary factors,’ which, according to Dr. Moskowitz, my dermatologist, means it has the “best prognosis.”
I am truly a bit unnerved by having to apply that classification to myself. I am used to using terminology like ‘prognosis’ as a result of my mother’s, father’s, sister’s, aunt’s, mother–in–law’s and friends’ bouts with cancer, several of whom, including my dad and aunt, died from it. And my sister right now is undergoing a course of surgery, radiation and chemotherapy; ‘prognosis’ comes up frequently in talks with my mom. (Jennifer’s prognosis is ‘fair.’) My ‘treatment plan’ is benign by comparison. Still, and not to sound self–centered or narcissistic, we’re talking about my prognosis here.
The plan currently amounts to extensive lab work to establish baselines, a prophylactic chest x-ray (melanoma and various lung cancers are apparently reciprocal metastases) and minor surgery to remove a 2.5cm diameter area of the tissue surrounding the site, which will then be stitched closed. This is to effectively create a moat around the malignancy, minimizing the chance that the cancer has spread to the surrounding cells—which is never evident from just visually inspecting the adjacent skin in situ. An assay will be performed on the excised tissue. These steps are usually all that are required for treating thin melanomas.
I have now moved into a high risk category; melanomas are very likely to recur. Previously I wrote that, during the original examination, I began to consider monthly mole checks after Moskowitz identified three areas of interest that he wanted to immediately excise. Well, now I am on the official ‘melanoma booking list’ and will be seeing Dr. Moskowitz or a colleague every three months for the foreseeable future. I am awaiting a scheduling phone call from the dermatology clinic, as well as calls to set up the surgery and chest x–ray. There is a standing order for the lab work. And I’m daydreaming about bathing in a bathtub full of sunblock.
And so it is cancer. It’s not immediately life–threatening and my prognosis is the best it could be. Nonetheless, it is absolutely nothing to take lightly and its presence in my body is deeply affecting me.
P.S. Notwithstanding my dialogs with dermatologists concerning the merits of biennial mole checks, the Skin Cancer Foundation recommends annual examinations for anybody over 40.
Sunday, October 30, 2011
A Shitty Weekend
I'm prone to melanocytic nevi: moles on my skin. I have a lot of them, too. And I’ve probably had more removed (somewhere north of 27 at last count) than many people will ever have in their life in toto. I used to have a whole galaxy of them on the left side of my face as an adult, until my mother’s chronic need for aesthetic perfection overwhelmed her and she coughed up many thousands of dollars to have them and several others excised by San Francisco’s top dermatological surgeon, Seth L. Matarasso. Admittedly, I don’t miss them.
Many years ago, I was advised to have a ‘mole check’ every year or two, as a guard against cancerous lesions: Many types closely resemble normal moles, which to my untrained eye might not warrant medical review. Further, being used as I am to having a diversity of irregularly colored dermal excrescences, I might overlook even a not–so–mole–like growth. And so: mole checks.
Since then, I’ve had several different dermatologists emphasize the need for the checks, including Matarasso, who strongly suggested he should do one—free of charge—after removing three moles during one of my visits. His attitude in that moment changed the tone of our interaction from what had really been a business association, he providing a simply cosmetic service to me in exchange for payment, to a true doctor/patient relationship, wherein he was expressing clear concern for my continued good health. His earnestness conveyed to me his belief in the importance of mole checks and thereafter I was far more conscientious in their scheduling.
Interestingly enough, a few years later another dermatologist informed me that long-term studies hadn’t shown significant benefit in regular mole checks and that I probably didn't need to have them anymore. But he gave me one that day anyway.
Two years later I scheduled another check, albeit with a different dermatologist, Dr. Moskowitz. I admit to have felt slightly sheepish in doing so. Moskowitz, however, was very glad to see me, and spent seven or eight minutes, with an illuminated magnifier, carefully examining my skin head to toe, while providing a detailed commentary to the resident physician who was accompanying him that morning. During our subsequent discussion he made it very clear that he felt that biennial mole checks were a very good idea and that he looked forward to seeing me in a couple of years.
Two years later, I dutifully scheduled another appointment. I was glad to get to see him in part because of an irregular reddish flat patch on my left forearm that was clearly not a mole. My internet researches had suggested it could be a malignancy, unlikely but potentially very nasty, or a precancerous lesion, more likely but certainly not an outcome that would alleviate all of my apprehension. The appointment was for October 18th.
As I lay there on the examining table, I nonethless couldn’t stop thinking about the earlier dermatologist’s admonishment against regular mole checks—even as Moskowitz once again carefully scrutinized my skin with his illuminated magnifier. Everything was fine as he looked at my legs, my chest, my face. He stopped when he came to the patch on my left arm: “I really want to take that off today,” he said. “Absolutely,” I responded with no hesitation. In that moment, my latent doubt as to the importance of regular mole checks was severely undermined. He added that he didn’t remember the patch from my visit two years earlier, which impressed me.
Then he had me roll over onto my stomach. I could roughly follow where he was looking out of the corners of my eyes: My left shoulder and left upper back. Okay. My right shoulder and... “I really want to take this off, today, too,” he said. He touched a spot on my right shoulder blade. Instantly I was very happy, well extremely glad, well, really some kind of strongly positive feeling that I was getting regular mole checks. That I had two thises that he really wanted to remove right then and there was a bit unnerving.
He touched a third spot, this time on my lower left back. “And I really want to take this off, today, too.” I had been lost in thought. I jolted. I was up to three thises. “I know this isn't what you came in for, today,” he continued. Then he argued again for immediately removing all three of the thises, and threw in at least a couple more “reallys” for good measure. His aggressive use of that damn adverb and his enthusiastic desire for immediacy added to my anxiety. I began to think about annual mole checks. Perhaps even monthly ones. Okay, so maybe I was overreacting a bit.
Not once did I raise an objection or even ask any questions. I just encouraged him to go ahead and within ten minutes he had performed three nearly painless ‘shave biopsies’ and I had three little roughly circular divots in my body, each dressed with astringent, a dab of salve and a small round bandage. (The areas removed ranged between 3.0 and 5.0 millimeters in diameter.)
As I put my clothes back on, in typical medical fashion he calmly told me that there probably wasn’t anything to worry about and that he would call me with the biopsy results most likely within a week, perhaps even within three or four days, though sometimes they could take up to two weeks. But that was very uncommon. I thanked him, shook his hand and left.
Three days passed. Four. Five. A week. No results. I grew a little nervous, imagining additional lab work being done to verify a diagnosis of something hideous. Finally, on the tenth day after the my appointment, I received a phone call on my cell phone. Well, more correctly, a voicemail notification appeared on my iPhone: where I live I have really awful cell service and cellular calls made to me while I’m there usually go straight to voicemail because my phone can’t stay connected to the cellular network.
The voicemail was from 510-752-1000. It arrived at just after 4:30PM on Friday afternoon and I discovered it on my phone a few minutes after that. I looked at the number. I recognized the number. Well, sort of. I knew I’d seen it before and that I should know it. But I work with a lot of headhunters and recruiters that have numbers like it, with lots of zeros; I thought it might be one of them. I tried to listen to the message, several times, to no avail. I couldn’t connect to the network. I went back to work. Very little business could get done at ten–to–five on a Friday, anyway.
Several minutes later it struck me: 510-752-1000. That was the master phone number for Kaiser Permanente's Oakland Medical Center. Moskowitz! It had to be. The results of my biopsy were just a voicemail away. I wanted to hear it immediately so I could let go of my latent anxiety.
I couldn’t play the damn message. I kept trying. I went outside my home and started walking around my neighborhood. One bar. Two bars. Connected! Barely. But I still couldn’t get the message to play. The little indicator that the iPhone displays when it is fetching a voicemail just kept spinning ’round and ’round, even as I paced down blocks, even with my briefly–attained maximum of three bars.
Now, I’m not superstitious but I am imaginative and I couldn’t help but romaticize my technical problems into a bad omen. The phone didn’t want me to hear the results, I joked to myself. I finally accepted I wasn’t going to be able to listen to the message until I could venture beyond the limits of the telephonic black hole that sucks in all of the wireless signals in my neighborhood. And that couldn’t really be until about 6:30, when I was to pick up my wife. It was already after 5PM; I'd spent the more than twenty minutes trying to get my message. It—and I—could wait another seventy more.
As I was driving to pick up Kate, I held my cell phone in my left hand. (But I did have my legally required “hands free’ headset plugged into the phone.) I’d opened the phone to its voicemail feature before leaving my driveway. My thumb was poised to click the message. As I drove, I couldn’t help but glance briefly at the phone every few seconds, waiting for those four or five signal strength bars that would indicate a strong connection between my phone and my cell carrier’s network. ...Bingo! My thumb descended. And I listened.
“Hello Mr. Howell, it’s Dr. Moskowitz from Kaiser. I want to talk with you about your biopsy results. My direct line is [number]. I’ll be in my office for about another hour. If I don’t hear from you by then I’ll talk to you on Monday.” I compulsively looked at the clock in my car, even though I knew it’d been 6:30 when I’d left my home, already an hour after he’d left his office. Damn.
Couldn’t Moskowitz at least have said that “everything is basically okay but I’d like to talk to you about a few things?”
My mind has been racing all weekend. Just about eleven more hours until I will finally know.
Many years ago, I was advised to have a ‘mole check’ every year or two, as a guard against cancerous lesions: Many types closely resemble normal moles, which to my untrained eye might not warrant medical review. Further, being used as I am to having a diversity of irregularly colored dermal excrescences, I might overlook even a not–so–mole–like growth. And so: mole checks.
Since then, I’ve had several different dermatologists emphasize the need for the checks, including Matarasso, who strongly suggested he should do one—free of charge—after removing three moles during one of my visits. His attitude in that moment changed the tone of our interaction from what had really been a business association, he providing a simply cosmetic service to me in exchange for payment, to a true doctor/patient relationship, wherein he was expressing clear concern for my continued good health. His earnestness conveyed to me his belief in the importance of mole checks and thereafter I was far more conscientious in their scheduling.
Interestingly enough, a few years later another dermatologist informed me that long-term studies hadn’t shown significant benefit in regular mole checks and that I probably didn't need to have them anymore. But he gave me one that day anyway.
Two years later I scheduled another check, albeit with a different dermatologist, Dr. Moskowitz. I admit to have felt slightly sheepish in doing so. Moskowitz, however, was very glad to see me, and spent seven or eight minutes, with an illuminated magnifier, carefully examining my skin head to toe, while providing a detailed commentary to the resident physician who was accompanying him that morning. During our subsequent discussion he made it very clear that he felt that biennial mole checks were a very good idea and that he looked forward to seeing me in a couple of years.
Two years later, I dutifully scheduled another appointment. I was glad to get to see him in part because of an irregular reddish flat patch on my left forearm that was clearly not a mole. My internet researches had suggested it could be a malignancy, unlikely but potentially very nasty, or a precancerous lesion, more likely but certainly not an outcome that would alleviate all of my apprehension. The appointment was for October 18th.
As I lay there on the examining table, I nonethless couldn’t stop thinking about the earlier dermatologist’s admonishment against regular mole checks—even as Moskowitz once again carefully scrutinized my skin with his illuminated magnifier. Everything was fine as he looked at my legs, my chest, my face. He stopped when he came to the patch on my left arm: “I really want to take that off today,” he said. “Absolutely,” I responded with no hesitation. In that moment, my latent doubt as to the importance of regular mole checks was severely undermined. He added that he didn’t remember the patch from my visit two years earlier, which impressed me.
Then he had me roll over onto my stomach. I could roughly follow where he was looking out of the corners of my eyes: My left shoulder and left upper back. Okay. My right shoulder and... “I really want to take this off, today, too,” he said. He touched a spot on my right shoulder blade. Instantly I was very happy, well extremely glad, well, really some kind of strongly positive feeling that I was getting regular mole checks. That I had two thises that he really wanted to remove right then and there was a bit unnerving.
He touched a third spot, this time on my lower left back. “And I really want to take this off, today, too.” I had been lost in thought. I jolted. I was up to three thises. “I know this isn't what you came in for, today,” he continued. Then he argued again for immediately removing all three of the thises, and threw in at least a couple more “reallys” for good measure. His aggressive use of that damn adverb and his enthusiastic desire for immediacy added to my anxiety. I began to think about annual mole checks. Perhaps even monthly ones. Okay, so maybe I was overreacting a bit.
Not once did I raise an objection or even ask any questions. I just encouraged him to go ahead and within ten minutes he had performed three nearly painless ‘shave biopsies’ and I had three little roughly circular divots in my body, each dressed with astringent, a dab of salve and a small round bandage. (The areas removed ranged between 3.0 and 5.0 millimeters in diameter.)
As I put my clothes back on, in typical medical fashion he calmly told me that there probably wasn’t anything to worry about and that he would call me with the biopsy results most likely within a week, perhaps even within three or four days, though sometimes they could take up to two weeks. But that was very uncommon. I thanked him, shook his hand and left.
Three days passed. Four. Five. A week. No results. I grew a little nervous, imagining additional lab work being done to verify a diagnosis of something hideous. Finally, on the tenth day after the my appointment, I received a phone call on my cell phone. Well, more correctly, a voicemail notification appeared on my iPhone: where I live I have really awful cell service and cellular calls made to me while I’m there usually go straight to voicemail because my phone can’t stay connected to the cellular network.
The voicemail was from 510-752-1000. It arrived at just after 4:30PM on Friday afternoon and I discovered it on my phone a few minutes after that. I looked at the number. I recognized the number. Well, sort of. I knew I’d seen it before and that I should know it. But I work with a lot of headhunters and recruiters that have numbers like it, with lots of zeros; I thought it might be one of them. I tried to listen to the message, several times, to no avail. I couldn’t connect to the network. I went back to work. Very little business could get done at ten–to–five on a Friday, anyway.
Several minutes later it struck me: 510-752-1000. That was the master phone number for Kaiser Permanente's Oakland Medical Center. Moskowitz! It had to be. The results of my biopsy were just a voicemail away. I wanted to hear it immediately so I could let go of my latent anxiety.
I couldn’t play the damn message. I kept trying. I went outside my home and started walking around my neighborhood. One bar. Two bars. Connected! Barely. But I still couldn’t get the message to play. The little indicator that the iPhone displays when it is fetching a voicemail just kept spinning ’round and ’round, even as I paced down blocks, even with my briefly–attained maximum of three bars.
Now, I’m not superstitious but I am imaginative and I couldn’t help but romaticize my technical problems into a bad omen. The phone didn’t want me to hear the results, I joked to myself. I finally accepted I wasn’t going to be able to listen to the message until I could venture beyond the limits of the telephonic black hole that sucks in all of the wireless signals in my neighborhood. And that couldn’t really be until about 6:30, when I was to pick up my wife. It was already after 5PM; I'd spent the more than twenty minutes trying to get my message. It—and I—could wait another seventy more.
As I was driving to pick up Kate, I held my cell phone in my left hand. (But I did have my legally required “hands free’ headset plugged into the phone.) I’d opened the phone to its voicemail feature before leaving my driveway. My thumb was poised to click the message. As I drove, I couldn’t help but glance briefly at the phone every few seconds, waiting for those four or five signal strength bars that would indicate a strong connection between my phone and my cell carrier’s network. ...Bingo! My thumb descended. And I listened.
“Hello Mr. Howell, it’s Dr. Moskowitz from Kaiser. I want to talk with you about your biopsy results. My direct line is [number]. I’ll be in my office for about another hour. If I don’t hear from you by then I’ll talk to you on Monday.” I compulsively looked at the clock in my car, even though I knew it’d been 6:30 when I’d left my home, already an hour after he’d left his office. Damn.
Couldn’t Moskowitz at least have said that “everything is basically okay but I’d like to talk to you about a few things?”
My mind has been racing all weekend. Just about eleven more hours until I will finally know.
Friday, June 10, 2011
Ping Pong with AT&T and Yahoo!
I’ve had a Yahoo! ID (email address) for many years. Later, I linked it to my parents’ then new SBC Global (now AT&T) DSL account. I no longer remember why I did this but SBC and Yahoo were in a promotional partnership and there was some benefit. I think it was so I could receive my parents' DSL account notification messages, too, since I managed their DSL service for them.
My mother changed her Internet provider to Comcast several years ago. My Yahoo! ID was unaffected by the change, though by that time I was using GMail for email. My Yahoo! ID languished, save that I still used it for Yahoo! Chat. The rarely monitored email account became a cesspool of spam.
A while back, my Yahoo! ID was hacked. That is, someone or something figured out the account’s password (amazing, since it’s rather esoteric) so that they could use the address to send spam emails. To all of my contacts. And they started doing it regularly. Daily.
When I became aware of this I naturally wanted to stop it. That has been easier said than done.
It should have been as simple as changing my Yahoo! ID password: With a new password, the spammers would no longer be able to log into the account to send spam. But changing the password has proven to be all but impossible.
When I went to Yahoo!’s password–change web page, it in turn sent me to AT&T’s DSL account management login page; the password change apparently has to be made from within AT&T’s web pages. But there is no longer a DSL account associated with my Yahoo! ID. Notwithstanding that I no longer had the account login information, anyway.
So I contacted Yahoo!’s technical support. After a protracted exchange with an on-line Yahooo! customer service representative, I was told that AT&T was the owner of the account and I would have to contact them. You can guess what happened next: That’s right, after another lengthy dialog, this tim with AT&T technical support, which included time spent digging through my email archives to find my mother’s old AT&T email address (the main one for the DSL account), I was told that I would have to contact Yahoo! for help with my Yahoo! ID.
The AT&T CSR did note that my Yahoo! ID had been changed to a free AT&T account, which I find rather humorous, since it implies that, yes, AT&T still holds primary responsibility for my Yahoo! ID.
And so it goes. I’ve gone around this loop a couple of times now, to no avail. I’m investigating my next move, which, obviously, has to be more aggressive. In the meantime, my associates continue to receive daily spams from my Yahoo! email address, their opinion of me probably dropping just a little lower with each one received.
My mother changed her Internet provider to Comcast several years ago. My Yahoo! ID was unaffected by the change, though by that time I was using GMail for email. My Yahoo! ID languished, save that I still used it for Yahoo! Chat. The rarely monitored email account became a cesspool of spam.
A while back, my Yahoo! ID was hacked. That is, someone or something figured out the account’s password (amazing, since it’s rather esoteric) so that they could use the address to send spam emails. To all of my contacts. And they started doing it regularly. Daily.
When I became aware of this I naturally wanted to stop it. That has been easier said than done.
It should have been as simple as changing my Yahoo! ID password: With a new password, the spammers would no longer be able to log into the account to send spam. But changing the password has proven to be all but impossible.
When I went to Yahoo!’s password–change web page, it in turn sent me to AT&T’s DSL account management login page; the password change apparently has to be made from within AT&T’s web pages. But there is no longer a DSL account associated with my Yahoo! ID. Notwithstanding that I no longer had the account login information, anyway.
So I contacted Yahoo!’s technical support. After a protracted exchange with an on-line Yahooo! customer service representative, I was told that AT&T was the owner of the account and I would have to contact them. You can guess what happened next: That’s right, after another lengthy dialog, this tim with AT&T technical support, which included time spent digging through my email archives to find my mother’s old AT&T email address (the main one for the DSL account), I was told that I would have to contact Yahoo! for help with my Yahoo! ID.
The AT&T CSR did note that my Yahoo! ID had been changed to a free AT&T account, which I find rather humorous, since it implies that, yes, AT&T still holds primary responsibility for my Yahoo! ID.
And so it goes. I’ve gone around this loop a couple of times now, to no avail. I’m investigating my next move, which, obviously, has to be more aggressive. In the meantime, my associates continue to receive daily spams from my Yahoo! email address, their opinion of me probably dropping just a little lower with each one received.
Kitchen Sink
Most people when they write a blog have a central theme, such as politics, technology, climate change or adorable kittens. If they have multiple topics to write about, then they typically have multiple blogs. However, I have too many interests but not enough opinions about any one of them to justify separate blogs so I'm just going to throw everything into one. Hence the “kitchen sink.”
Subscribe to:
Posts (Atom)