Saturday, December 08, 2007

Why Do Doctors Say these Things?

I do not know if it is me, or if everyone has stories like this, but here is an example of what NOT to say to a patient:

I decided to go to the walk in clinic two days ago because I was unable to get in to see my GP until mid-January. I went because about a 10 mos to a year ago I got this small bump on my right eyebrow. I had no idea what it was, but it did nothing until about 4-5 weeks ago when it began growing rapidly. It had also become very itchy. I looked at it the other day and wondered if it was ring worm, although it didn't quite look like that because it wasn't exactly round like ringworm is. It was more uneven around the edges. Anyways, I had ringworm from my cats years ago and I didn't want it again, so relatively unworried, (because it's completely curable), I went to the clinic.

The doctor looked at it and said it definitely wasn't ringworm and that she wanted to get a second opinion; so she asked another doctor to come look at it. He looked closely at it and said: "There is a type of skin cancer that is very deadly, and it kills a person very quickly". He then paused for what seemed like an eternity.

During that pause I think, "Great, I have found medication to stop my depression and suicidal thoughts, only to find out I am going to die in the next few months". The irony of this situation is not lost on me.

As my panic begins to build he pipes in, "...but this isn't that type of cancer". I think: "WTF?" He leaves and I cannot remember what he said after he said it isn't the deadly cancer. All I still hear is "deadly cancer" and "kills very quickly". This phenomenon, not hearing things after devastating news, happened when my Mom was diagnosed with pancreatic cancer. I used to carry a notebook to my Mom's Dr's appointments, because I'd leave the appointment and not have a clue what had been discussed.

I asked the initial Dr. what the consulting Dr. said. She said, "it is either Basal Cell Carcinoma (BCC) or it is a wart (although it does not really look like a wart)". She said it does not matter because BCC is a very slow growing cancer and the treatment for both is the same...freeze off with liquid nitrogen over a period of 4-5 weeks. I let her freeze it and booked another appointment, but when I got home I felt really angry at myself.

Why had I not insisted on a biopsy? What if it was cancer, how am I going to know if it is gone? She seemed really unsure about what to do if it was cancer. She even asked the other doctor if she should refer me to a dermatologist. I do not feel confident about the projected treatment.

I also have read that BCC can be really disfiguring if it is not dealt with in a timely manner and can metastasize if not treated properly. The growth is on my face, on the far right of my right eyebrow. I do not want a huge scar on my face. Something happens when I am faced with an authority figure. I shut down and do not have the ability to stand up for what I want.

I got home and decided I needed to see my Family Doctor. I phoned and told them what had happened and I have an appointment late next week. I am going to ask for a biopsy and a referral to a dermatologist. Even though I really trust and like my Family Doctor this request will be so hard for me, because it means questioning the original Doctor's authority. A task I dread.


jcat said...

Hey A, would be about the first one if I didn't call tdoc or - very unlikely - pdoc. Because I know you know....

Meds are currently Inderal (beta blocker) 30mg TID, Remeron 90mg at night, Neurontin (gabapentin A/E) 800mg at night, Mirapex (anti parkinsons) 1mg TID and Ambien 15mg equivalent. Just dropped Manerix 900mg in morning. Adding Eldepryl from Mon, also an a/p. As you can see, most are off-label uses, and he's a bit nervous about the Mirapex and Eldepryl together. Last thing that worked though was Eldepryl and Lithium, so he figures it's worth trying again. And doesn't want to drop the Mirapex yet.

Had to shave my legs before massage yesterday. So one less gym excuse. Am going to phone personal trainers from gym list on Mon, see if I can get into gym habit by paying through the nose for someone to hold my hand. And am casing large amounts of vodka this weekend, with the plan being that from Mon I will try to give it a break for the rest of the month. Good theory, at least...!!

Brain damage scares me too. Have always figured that losing 30 IQ points would probably improve my life, but the thought of other damage is scary. Which is why I need to be sure. When I get there, which seems inevitable a lot of the time, I have to know that it will work. Thus...the collection. Some of enough different types that I could be fairly certain of the combo. Planning it sucks, I know, but can't take the chance of screwing up....

Meantime though, it's hanging on by the fingernails time again. Whatever works, hey?

BTW Prozac worked well for me a couple of times - major S/E was shaky hands. Livable with compared to the alternatives.


jcat said...

PS...the skin cancer thing? Get your family doc to refer you to a plastic surgeon, ASAP. I have had BCC on my nose twice now - it often reoccurs close to the original because of the underlying skin changes, even if totally removed. 1st one was left side, removed about 6 years ago. Reoccured on left/centre beginning of the year, and also, ignored it for ages.

The way your doc handled it sucks. Even if its common, it's still disfiguring, because the excision needs to be quite deep and wide. And it's the Big C thing, so the tendency is always to ignore as long as possible. BCC is very common here because of the sun, especially us fairskinned whiteys who spent our entire childhood outside or in the swimming pool.

Even with reoccurence risks, it's still a 'good' one. Very low risk of going systemic, or of popping up in unrelated places.

So go see doc asap, get it cut rather than frozen, and get it done by plastic surgeon to reduce scarring.

Aqua said...

Thanks Jcat,
I will be sure to get the BCC treated properly. I'm going to e-mail you so you have my e-mail address if you need to reach me. I know the "S" thoughts and plans go through your head, but know that I would miss please keep them as thoughts!!

Dr. Shock said...

You know what is best for your self. Let them come up with adequate arguments for their suggestions. And if your not satisfied by their answers or suggestions you have every right to ask another GP or specialist.
Regards and take care. Dr Shock.