Mile 14 with Basal Cell

I am attempting this without the aid of my glasses as they will not sit on my face.

Left eye one week post op

My left eye one week post op and prior to removing stitches.

Stitches were removed from my left eye yesterday. More below

Right eye marked for Mohs

 

 Only 5 tumors on right eye. Out of the five only one requires two stages.

Right eye only 5 tumors to remove

 I am already swelling in this picture. There is some bruising starting as well. The discoloration on outer edge of eye is leftover iodine solution from cleaning the eye pre op. 




The next day I have reconstruction on the right eye and my surgeon removes most of the stitches from the left eye.

Twenty four hours past reconstruction. You be the judge.

Bridge of my nose is too swollen to hold glasses

I am swollen from my forehead to my upper lip. They had me prepared to lose my upper and lower eyelids on the left eye. My upper right eyelid was iffy too. The cancer on other places on my head when presenting like my eyelids actually had tumors joining together under the outer skin layers. That is where I get the phrase "sharing a basement condo".  No condos on the eyes. So I get to keep the eyelids!  Thank you Jesus!! 

I have to keep Erythromycin, an ointment on both upper an lower eyelids for a few weeks. It makes me look really oily. The graft done on my left lower eyelid has taken great. You have to be within kissing distance to see it. Yes, the eyes are so swollen this is wide open for me right now.  Not very pretty but the cancer is gone and I have eyelids. Whoo Hoo!



Take Away Nugget: Be thankful for everything your senses show you.

Mile 13 with Basal Cell

With my vision impaired from surgery I will keep this short and sweet.

In My Happy Place Thursday 12-12

Marked for Mohs Surgery

10  Tumors Removed

After Reconstruction Surgery Friday 12-13

Five of the tumors required only one stage. The other five were clear after the second stage. No basement condos.  A lot less cancer than we thought. 



Reconstruction used graft from behind my left ear. Upper and lower eyelids were saved.  The white at lower edge of eye is gauze surgeon sewed in to hold graft in place.  It will be removed next Thursday. As you can see the other sites were sutured. 

To date without my eyes I have had 12 surgeries including 22 sites and removing over 210 square cm of tumors off my head, face and neck. Put all the masses next to each other and that is the size of an average dinner plate.

Thank You Jesus I could not have done it without you.

Take Away Nugget: Paths without obstacles don't lead anywhere.

My Trip Deep in the Heart of Basal Cell, Part Two

Saturday morning proves that whomever is at the hotel can stay and whomever has not made it will not get there. Ft. Worth has been hit by a weather system the likes of which they have not seen since 1998. I was pleasantly surprised that the hotel had put up all the staff in rooms both Thursday and Friday evenings. In these situations the hotel feeds their employees as well.

Our speakers for the day are from Texas Children's Hospital in Houston. I was not sure how this was going to be informative to me. We had a pediatric dermatologist and a Child life specialist. I was pleasantly surprised at their presentation. With the small number of us that made it in they turned a lecture into a general discussion about services available to children with BCCNS. They included personal stories from children who had been to camps for children with skin disorders.  Another part of their presentation was regarding helping children get through the daily trials of BCCNS.

In both of these presentations I realized most if not all of this related to the adult patient as well as the child patient. First, by replacing the word child in the lecture notes it takes on a more personal meaning for me. 

1) Although I have the disorder, I am NOT DEFINED by this disorder. BCCNS members say I have BCCNS but BCCNS does not have me.

2)Doctors do not always know best. I have to be my own advocate. I have to be a teacher.

3)Patience and a positive attitude will get me far. Do what I can to support others and get the external support I need.

4)Be a good listener and a good friend. You are not just a caregiver or example to just yourself.

5)Don't underestimate the power of touch. We all need reassurance  and touch is the most profound way to express caring.

The other part of the morning lecture regarded the child's point of view during the various procedures and treatments for the syndrome. Children are little people.  They are sensitive to what's going on and when they have the syndrome become wise and sensitive to procedures very quickly.  So many times doctors will address all or most of the conversation to the adults, only addressing the child when they want them to lie down for examination, treatment, etc.  They don't consider whether the child feels out of control lying down and would rather sit up or stand.  It made complete sense to me to find the position for the child during the procedure where they felt in control, supported by family and safe. No one wants to be ignored and talked about or above their level of understanding. Who wants to be forced to sit or lay in a position that makes them uncomfortable and vulnerable? And do we want someone to ask our opinion when they ignore it? These are things to consider when treating a child. Wording and body language are everything.

hedge hog family

Our afternoon and evening sessions were altered by the weather. Activities were canceled. This gave us the opportunity to go over the latest information on Hedgehog Inhibitor Drugs.

The drugs available so far have been in double blind studies. This is where neither the doctor nor the patient know if they are receiving the drug or a placebo. 

The goal to date for these drugs is to prevent new surgically eligible basals (SEBs).

Side effects vary. The cons to the drug do not out weigh the benefits for most people. There were 3 people in our group who are actively taking one of these drugs. Another person there was on the drugs but had to stop as their basal had mutated and become resistant to the drug.  All 4 had experienced varying levels of discomfort with the drug. So out of the 4 there one could not take it due to their basal resistant to it. One has been taking it for the 7 month starter dose and in Jan. begins the  year at 3 months on and 3 months off.  And 2 others have been taking the drug in cycles for a few years with very pleasing results. The side effects are not pleasant. All have some level of muscle cramps. Gatorade seems to be the going thing to help those. Taste disturbances vary with each person. Weight loss varies with each person. Hair loss or thinning varies with each person. And symptoms of depression are noted yet these same symptoms are noted in persons having repeated surgeries and other treatments to remove the basals.

I found the before and after pictures very interesting and intend to speak to my team as soon as I return to check into studies in my area.



Saturday also brought news of flight cancellations so we joined forces to try to get home. Part of our crew made it to the airport Sunday morning  and only half of those people made it home that day. Two of our group spent Sunday evening at a hotel closer to the airport.

This is our group plotting escapes for Monday.

l-r Subrena, Pam, Blake, Elvira her husband Adolfo and Nichole

I stayed at the hotel until Monday with my mom and after 2 shuttles and 2 taxis canceled on me I got the car service from the hotel and made it to the airport. My flight was to be in St. Louis at 7:15 pm. Due to delays waiting on flight teams, luggage carriers and the like I got into my vehicle in St. Louis at about 10:35 PM. By the time I got to bed it was technically Tuesday. I would not change anything. 

The time spent with the BCCNS Life Support Network was priceless.

Take Away Nugget: What you see depends greatly on what you look for.

My Trip Deep in the Heart of Basal Cell, Part One

I was blessed to be invited to a conference hosted by BCCNS Life Support Network. There was to be an intimate group of about 30 there.  I had yet to spend any length of time with someone who has dealt with this condition longer than I so I was really excited.  I was pumped for two plus days of back to back activities and speakers.

I flew in Thursday, Dec. 5. There were several of us due in at the about the same time. The plan was to meet and share a taxis to the hotel in downtown Ft. Worth. Before I even left the airport in St. Louis weather on the east coast had eliminated a research team from being able to join us. On the flight in I was seated next to a copilot flying in to DFW airport to begin his next 4 day rotation. He was flying out to Arizona on his first leg. I said that was awesome he would be flying away from all the weather. But alas he was to be flying back into DFW about 10 o'clock that same evening. I told him I would pray for normal conditions.  He agreed normal/boring would be great. Casual conversation came to a halt as we landed and he noticed the deicing machines going full bore. He turned to me and said, "So normal looks like it is out of the running shoot up you prayers for SAFETY". I learned more about weather and planes in the 15 minutes it took us to taxi to the gate than I had learned in the previous 45 years of flying.

Arrival at DFW brought more news of cancellations, delays and the like. I shared a taxi with Sheila and Jenny. What was normally a 40 minute drive was over an hour and a half. Once we arrived to the hotel we realized too many people had yet to arrive to have the meet and greet we had planned. Everyone agreed to meet at breakfast the next morning as planned. 

Wine and dessert at Thai Tinas

Lucky for me they had allowed my mom to meet me for the weekend. She had already checked in and was waiting in the lobby for us when we arrived. So I joined her for dinner in the Thai restaurant at the hotel. Weather lead to almost private dining and lots of conversation with the owner. Ms Tina treated us to a dessert sampler. What a way to start the weekend. My mom and I had a wonderful visit and could not wait to see what the next few days would bring.


If you are ever in downtown Ft. Worth do stay at the Embassy Suites. Sure they cost a little more. You have to figure your meal budget when you were deciding. They offer continental and made to order free breakfasts.  All rooms are suites and will sleep up to six with the queen sofa sleeper. In the evening they have a managers reception with chips, dips and other crudites. To go along with your snacks you may have all you can drink of the beverage of your choice. This includes their house wines, sodas, liquors and beers. Think about it sodas alone are $2 each on average now.

Tree outside our meeting rooms

 
The hotel was decorated for the holidays. It was very peaceful and elegant. I have used several hotels in the St. Louis area for different functions I have hosted. I will be paying a visit to our local Embassy Suites to compare apples to apples as they say.



The BCCNS Support Network hosted the event. There was abundant information available from brochures they provided to the presentations given. My mom had brought a book assuming she would not be interested in the sessions. The book went unread. For the two days of sessions we had our table covered with hand outs, pens and note books.

class in session

We learned in more detail the manifestations of the syndrome we all share. These types of sessions are priceless as BCCNS is an orphan condition.  Less than 100,000 are affected with it. We learned the latest information on the patch gene, the hedgehog inhibitors used to combat the dis function of the gene. This helped us to better understand our own genetic family. 

The guest speaker for Friday was Chaya Murali, a Genetics medical student with Baylor College of Medicine. She lead us in her program "Get It Write".  She uses this in her classes with children of all ages. We count as kids in the broad spectrum of things.  She uses writing to get people to come out of their shell. She initiates a written conversation with questions like"who do you most admire and why?" or "describe a time when you were brave".  If I remember correctly there were 10 questions over her 2 sessions. We had an allotted time to write for each question then were asked to share. I found this very insightful. These are things you might think to ask someone else going through a crisis, but neglect to ask yourself or the caregivers of people in crisis. Puts a whole different spin on things.

The hotel served a catered lunch of pastas, salad, tea and tiramisu. YUM.

After lunch we were blessed with a presentation by a young man only 18 years old. He has been dealing with the affects of the condition since he was 8. This first person story opened my eyes to several things I had not even thought of. One being this syndrome creates all sorts of emotional road blocks. This raises questions regarding how I am dealing with my fear, self esteem, anger, helplessness, etc. The second being who I have on my medical team. I have a General Practitioner, Dermatologist, Mohs Surgeon, Ocular Surgeon and Maxiofacial Surgeon. Based on conversations with several attendees regarding ways BCCNS manifests itself, I believe I need to consult an Orthopedist, Cardiologist and a Neurologist this next year. I will be discussing necessary additions with my dermatologist and surgeon over the course of the next few weeks.

Me and Mom on western night

Friday night was western night. The meal was BBQ Texas style,awesome, and fellowship with other attendees was great.  And that was just day one.

Take Away Nugget: You cannot find something until you define it..

Headed for Mile 13 with BCCNS

I can't believe I have had three weeks between surgeries. I am still healing great. I have been cramming a lot of events in a short amount of time. Tomorrow, Thursday Dec.12, I begin part one of Mile #13 removing the cancer off my left eyelid. Part 2 will be the reconstruction of that eyelid will be Friday, Dec. 13. Here are a few pictures to show the progress of healing so far.

Left Side 11-27-13

Rear 11-27-13

Right View  11-27-13

Crown 11-27-13

As of 11-27 everything is gellin nicely. Everything along my hairline is going naked. I trimmed more hair off after the 11-27 pictures to make bandaging easier.

Left Side 12-11-13

Rear 12-11-13

Right Side 12-11-13

Crown 12-11-13

In just two weeks time all wound sites are visibly changed. Lots of new skin showing. Wounds as a whole are less irritated looking more healthy bright pink. New skin is almost fully filled in at the hairline.

It is my intention to give you information about the conference I just returned from. I have my first eye surgery in the morning. I will do my best to complete the posts regarding the conference. It is my understanding from the surgeons that I will be sight impaired for a few days after each procedure. Surgery on my other eye is next Thursday. We shall see how it goes. No pun intended.


Take Away Nugget:  Pick a challenge bigger than you.

Mile #12 with Basal Cell Nevus Syndrome

It is surgery day. November 19 and the decision is made to leave the area over my ears until after the cancer is removed from my eyelids in December. The areas over my ears will be done in January, 2014. 

The new patient I mentioned earlier had her first Mohs today. Her cancer was over 3.5 cm long before surgery. She did great. I was able to be with her through the procedure and as large a her cancer appeared it was all bark and no bite. One stage and she was done for the day. She started after me and left 3 hours before me. I am very thankful that I could be there for her. My husband and I enjoyed visiting with her and her brother. I believe we have made two new life long friends.

The last 3 spots on my scalp appear innocent enough. Out of the three only one is raised enough to feel it with my fingers. As the saying goes, "a picture is worth a thousand words".

Here are the next three sites in my journey.

Spot one is the only one that I could feel. It's located on the left parietal scalp. This area took 2 stages and is clear. The wound ended up being 1.3 x 1.5 cm.

Mile #12 Spot 1 After 

Mile #12 Spot 1 Before

 

Mile #12 Spot 2 Before

Mile #12 Spot 2 After

Spot two is not raised at all. The before picture shows only a slightly discolored area located on the left occipital scalp.
                                             
















 This spot also took 2 stages and is clear. The wound ended up being 1.2 x 2.1 cm.      







                                    

Mile #12 Spot 3 Before

Spot three was barely raised. I could only feel it when I pushed at just the right spot. It looked like a pale freckle. Isn't that an understatement. It's located on the occipital scalp.

Mile #12 Spot 3 After

 This spot took 4 stages. It was not nearly as deep as most cancers on my scalp but wide under the surface. The wound ended up being 1.7 x 2.5 cm. 

The pink in the lower section of the picture is the new skin from Mile #9. Literally a hairline separated the two areas of cancer. 

I do not sleep well the night before surgery. This time was no exception. I usually have to pray and work to get into my happy place. Today I woke up with a warrior attitude. I even had Ephesians 6 on my mind. 

That being said...


Take Away Nugget:  Always be dressed for success. Especially with your attitude. 
                                             

Headed for Mile #12 with Basal Cell

I have been a little out of touch in the aftermath of Mile #11. My head resembles what I believe the moon's surface to look like. Somewhere in the mix my body is back at riding the tilt-a-whirl. My nausea has returned and brought dizziness to the party. The medicine I have for nausea does not help. I have not been in pain since 2 days post op. Yet the pain pills help the dizziness that in turn eliminates the nausea. Go figure.

I am used to working full time plus some this time of year. However, I have to say keeping busy is a chore while dealing with dizziness, nausea, etc.  My librarians and I are on a first name basis. I am reading a book every 2-3 days by authors I have not read before. The downfall is I  am getting authors, story lines and characters all mixed up.  Maybe I should write a novel myself. Although having vampires take over viking ships in the reign of King Alfred and get shipwrecked in South America only to raid wagon trains headed for the gold rush in California doesn't seem too convincing.

The big bonus for me at this point is all miles are healing great. All miles that have new skin now have new hair coming in if they are supposed to.  I am often asked if my hair will come in differently than it was before. At this point I am not on any medications that should alter my hair. However, the depth of several of my miles may have destroyed the ability of new hair follicles to form.  Time will tell.

Here are updated photos of Mile #6 through Mile #11. Mile #8 is not pictured as the suture line is not really visible in a photograph. My hair is still damp from the shower. At this point I can shower without any bandages. These photographs were taken 11/12/13 one week after Mile #11.

Mile #6 with remnants of Mile #2 at top

Mile #7

 Mile #6 is healed enough to be naked. I cover when going out and at night to keep it protected.















Mile #7 is gellin nicely and has little fuzzy hair just coming in at it perimeter.

Mile #9 Left

Mile #9 Right

On Mile #9 both sites are gellin and stay covered most of the time. If I am not going out I will clean both sites and leave them naked until I go to bed in the evening.

Mile #10 is the 4 spots on my neck. All have healed. I had almost 12 inches worth of stitches with the four spots we did for Mile #10. Two sites have puckered. My surgeon and I are watching those to see if with time (and cocoa butter) they smooth out. My camera does not show it as clearly as the camera the surgeon uses. I will have my nurse take a  picture to share with Mile #12.

Mile #11

Mile #11 is the reason I am going to scarves. This is why I think of the moon scape. All three are healing great and still require bandages 24/7. That is Mile #7 in the left portion of the photograph. The other thing my surgeon did for me in Mile #11 was remove 13 skin tags from under my arms.  Out of the 5 on the left and 8 on the right two have come back basal cell and will get excised later. Yes this was a vanity move on my part. Go figure all the nonsense visible on my head and I wanted my under arms clear.  I want to wear some sleeveless tops next summer. I have to have something to look forward to right?

I will spare you the photographs of my armpits except for the two that turned up basal. Once I see the maps Tuesday I can crop the pics to show only the bad guys. 

Maps? Yes, I heard you. Mohs surgeons have nice little body outline drawings (maps). Enlarged ones for the head, left side and right side. They mark and number all surgical spots and also update each one to accurately show each stage as needed.

Every surgeon may be different in how they mark. This is the first time I have gotten involved with looking at all my maps. They draw the area on the map that they remove with each stage and mark lines through it something like a compass. The stage removed is then placed in a dish with matching makings and taken to the lab. Then the stage is frozen and put onto slides. The technician knows exactly where each slide comes from based on its marking on the map.

Another question I get frequently is related to the size of the sites before and after the surgery. I flunked my due diligence there and have not documented that information. So Tuesday I will have my notebook in hand and have my nurse pull my chart. The surgeons always take a measurement before they begin and before they close or bandage the site at completion of surgery. 

So here I sit a day away from Mile #12. This is my last surgery for November. I still have the areas around my ears to do and one maybe two small spot on my scalp to address. My eyes have been scheduled for December.  There is no way to finish my head, face and neck before we welcome 2014. What is the saying, "we gave it the old college try".

Thanks again for all your prayers and support. I am still learning all the technology of our century. If you are trying to reach me please use myjourney.bccns@gmail.com and I will get back to you.

Take Away Nugget: All external motivation is temporary. Talk to yourself. Say only good positive things. Chances are you are the only person you truly believe anyway.

Mile #11 with Basal Cell

It is amazing the questions that surface with this cancer. I was having my eleventh surgery session this past Tuesday and was asked by a fellow patient "Why would you put yourself through this?"

Why indeed. Ignoring this condition is not an option. In 2005 I had only 3 spots on my back. Two of which I had removed. None of those were larger than a pencil eraser and they were limited to my right shoulder blade area.  The spot on the far right was the only one remaining in 2005. This is what I have to look forward to in 2014.

The sadder truth is I am guilty of ignoring my body. I was unaware of most of these spots as they are flat. I cannot feel them. They are all cancer and some are probably sharing basement condos.

In my last post I discussed my eyes. It looks like my Christmas present to me will be my eyes. The surgeons have decided they can do both eyes and my forehead in 4 procedures. So Thursday Dec. 12, I will have my left eye Mohs performed and Friday Dec. 13, I will have the reconstruction done. The following week I will repeat that schedule with my right eye and forehead. With that in mind and another surgery on Nov. 19th. I could meet my goal of having my head and face clear by the end of the year.

 For Mile #11 we shaved more of my head and got rid of three more lesions across the top. The tuft of hair in the top of the photo is the remains of my bangs.

Mile #11 Pre op



The spot on the top left required only one stage to clear. The spot on the bottom required two stages. The spot in between the two required three stages. All three are clear of cancer. 

Mile #11 post op

My scalp now resembles the moon's surface. My mom and my aunt blessed me with some scarves. So scarves it will be for a while. The bright side is there is evidence of new hair growth on all the previous miles on my head. That is cause for a happy dance. No, You Tube is not prepared for all this happy dancing. 

I cannot thank my friends and family enough for their support. I have had the pleasure of meeting some incredible health care professionals. I have been able to speak to parents with children newly diagnosed with BCCNS. 

God has put me in the path of a woman that has this same type of cancer and is paralyzed with fear. I will be with her for her first surgery in 10 days. She calls me her angel. I do not see myself as an angel. I am outgoing and can be loud. Yet until recently I would have said I was mild mannered even complacent. Now I see myself as a warrior. Ok so some of God's angels are indeed warriors. This is a war no one can afford to loose. If I loose this war it will not be from lack of knowledge or the use of the power gained by knowledge.  I also intend to fight for anyone put in my path that is affected by skin cancer.

Take Away Nugget: People don't care how much you know until they know how much you care.

Where do I stand with BCCNS?

The eyes have it. I met with another specialist this past Tuesday. This surgeon is an eye reconstruction specialist. He is one of only 300 in the US. 

Now I feel really special. I have had a few days to brew over my discussion with him. So today I can objectively look at what needs to happen. Tuesday night through Wednesday not so much. 

Here's the deal. Every surgery I have is using local numbing agents. I hate needles. I try to stay in my happy place while enduring the 30 -50 sticks it takes through out the procedures to keep me pain free. 

Now we are talking about removing cancer from my eyelids. Due to the progression of the disease on my eyelids we will have to do one eyelid at a time. My forehead will have to be a separate procedure. Each eyelid and my forehead will also have to undergo independent reconstruction procedures as well. That is six surgeries to deal with my eyes. In the photograph, you cannot even see all the basal cells. Some are so small they will get the laser treatment during reconstruction. Another new discovery. On my left eye there is that pronounced bump. I assumed that was basal. Of course not. One of the symptoms all be it rare to BCCNS is this cyst type growth in the eyelid. The one that is pronounced is calcified and will get surgically removed from the inside of my eyelid during reconstruction. There are 3 total that will be dealt with at the time we do reconstruction.

 

 

Wed. am after not much sleep

The goal in May was to get my head and face clear before the end of the year. In doing the math I have four surgery days left. However, my eyes require 6 procedures and I still have 6 areas on my scalp that need attention. This all came to me in a mental overload Tuesday evening. 

I am a woman of faith. Yet I managed to break all my own rules. I took my eyes off all the blessings I have had so far and landed in a self induced valley full of fear, doubt and anger over my situation.

Thank God my eye specialist is pleasant mannered and nice to look at. No worries my husband is the one that told me to count this as a blessing. If you have to be nose to nose with someone for 30 minutes at a time it does not hurt.

Take Away Nugget: When you find yourself in deep water. God doesn't intend for you to drown. He expects you to be cleansed.

 

10 1/2 Miles of Healing With Basal Cell

I have chosen to continue my education courtesy of the web. I like to understand what is going on with my body. I have had this article on the phases of wound healing for some time. Being close to midway in my marathon seems a good time to share it. I've noted how I've renamed each phase in my blog.  Following the article I will take a look at where my past 10 miles are today. A reminder the pictures may be graphic. Reality is truly more real than fiction.

This is surgery day stuff
Hemostasis:
Once the source of damage to a house has been removed and before work can start, utility workers must come in and cap damaged gas or water lines. So too in wound healing damaged blood vessels must be sealed. In wound healing the platelet is the cell which acts as the utility worker sealing off the damaged blood vessels. The blood vessels themselves constrict in response to injury but this spasm ultimately relaxes. The platelets secrete vasoconstrictive substances to aid in this process but their prime role is to form a stable clot sealing the damaged vessel. Under the influence of ADP (adenosine diphosphate) leaking from damaged tissues the platelets aggregate and adhere to the exposed collagen. They also secrete factors which interact with and stimulate the intrinsic clotting cascade through the production of thrombin, which in turn initiates the formation of fibrin from fibrinogen. The fibrin mesh strengthens the platelet aggregate into a stable hemostatic plug. Finally platelets also secrete cytokines such as platelet-derived growth factor (PDGF), which is recognized as one of the first factors secreted in initiating subsequent steps. Hemostasis occurs within minutes of the initial injury unless there are underlying clotting disorders.


This is what I call "swellin"
Inflammation Phase:
Clinically inflammation, the second stage of wound healing presents as erythema, swelling and warmth often associated with pain, the classic “rubor et tumor cum calore et dolore”. This stage usually lasts up to 4 days post injury. In the wound healing analogy the first job to be done once the utilities are capped is to clean up the debris. This is a job for non-skilled laborers. These non-skilled laborers in a wound are the neutrophils or PMN’s (polymorphonucleocytes). The inflammatory response causes the blood vessels to become leaky releasing plasma and PMN’s into the surrounding tissue. The neutrophils phagocytize debris and microorganisms and provide the first line of defense against infection. They are aided by local mast cells. As fibrin is broken down as part of this clean-up the degradation products attract the next cell involved. The task of rebuilding a house is complex and requires someone to direct this activity or a contractor. The cell which acts as “contractor” in wound healing is the macrophage. Macrophages are able to phagocytize bacteria and provide a second line of defense. They also secrete a variety of chemotactic and growth factors such as fibroblast growth factor (FGF), epidermal growth factor (EGF), transforming growth factor beta (TGF-__ and interleukin-1 (IL-1) which appears to direct the next stage.


This is what I call "gellin"
Proliferative Phase ( Proliferation, Granulation and Contraction):
The granulation stage starts approximately four days after wounding and usually lasts until day 21 in acute wounds depending on the size of the wound. It is characterized clinically by the presence of pebbled red tissue in the wound base and involves replacement of dermal tissues and sometimes subdermal tissues in deeper wounds as well as contraction of the wound. In the wound healing analogy once the site has been cleared of debris, under the direction of the contractor, the framers move in to build the framework of the new house. Sub-contractors can now install new plumbing and wiring on the framework and siders and roofers can finish the exterior of the house. The “framer” cells are the fibroblasts which secrete the collagen framework on which further dermal regeneration occurs. Specialized fibroblasts are responsible for wound contraction. The “plumber” cells are the pericytes which regenerate the outer layers of capillaries and the endothelial cells which produce the lining. This process is called angiogenesis. The “roofer” and “sider” cells are the keratinocytes which are responsible for epithelialization. In the final stage of epithelializtion, contracture occurs as the keratinocytes differentiate to form the protective outer layer or stratum corneum.

This is well into what I call "getting to go naked"
Remodeling or Maturation Phase:
Once the basic structure of the house is completed interior finishing may begin. So too in wound repair the healing process involves remodeling the dermal tissues to produce greater tensile strength. The principle cell involved in this process is the fibroblast. Remodeling can take up to 2 years after wounding and explains why apparently healed wounds can break down so dramatically and quickly if attention is not paid to the initial causative factors.

Facts courtesy of Curad Products.

I am going to recap all my previous miles.  This will be the last we focus on Miles #1 to #5.

Mile #10 Surgery date October 22, 2013

Stitches are always awesome to deal with. Pain is normally a two day ordeal requiring prescription pain meds. After that regular Tylenol is fine. This is how it looks today.

Mile #10 left and back

Mile #10 right

Four spots all with stitches. Had a resident in the office that stitched me for the first time.  All other surgeries where stitches were an option were done by my regular nurse. Not sure whyI have puffiness and gaps on the sites. Hopefully it is just because the neck is always moving and not due to a different "stitcher". Not entirely happy with this look. But hey it is naked and that is always a blessing. I use a thin layer of antibiotic ointment on these for the next week. At two weeks post op I switch to cocoa butter cream on my sites that had stitches.

Mile #9 Surgery date October 8, 2013

This is how it looks today. Both sites are gellin nicely and the one on the left is close to being naked during the day. My wound care is petroleum jelly, non stick gauze pads and regular gauze for padding. I completely enclose the bandage with tape to seal the sites until they can go naked.

Mile #9 right scalp

Mile #9 left scalp behind ear

 For some reason no matter what angle my husband uses the picture of the left side comes out grainy. I still think it is because he thinks the wound site looks like Mick Jagger with a mustache. He can't even look at it with a straight face.


Mile #8 Surgery date September 24, 2013

There were two sites for mile #8. The first being under my left eye. That site is not recognizable in photographs. WooHoo. The second site is my left jaw area pictured below.
The faint line from my side burn down is all that remains of Mile #8. Good makeup and you won't know its there.

Mile #8 along the front of ear

Mile #7  Surgery date September 10, 2013

This wound site is still gellin. You may recall it was very large compared to other sites. When we tackled this area it was a solo act due to its size. It has not produced much new hair along its edges.  This concerns me. 

Mile #7 right scalp towards crown

Mile #6 Surgery date August 20, 2013

This site is naked during the day and is healing nicely. I use antibiotic ointment day and night and cover this site with a nonstick pad at night. According to my husband, Mile #2 at the top edge of Mile #6 makes the site look like a paisley. The temple area of this site is growing new hair. The area above my ear not yet. We will be looking closer at the area with hair over my ear as there is something there the surgeon may want to biopsy. At first this site had my brow line raised but it has since relaxed.

Mile #6 bottom of site & Mile #2 top of site

Mile #5 Surgery date July 30, 2013

This site is only partially visible now. I use cocoa butter cream on it. No I do not know of any scientific evidence of this helping to lessen scarring. To me it appears to make the skin less tight and stiff. Mile #5 is the two dimpled areas on my cheek the third site you can no longer see in pictures. The long suture line in front of my ear is the second part of Mile #2. There is  more cancer remaining in front and over my right ear that is visible in this picture. That will be a future surgery mile. The scar on my right side almost mimics my left giving me a mini facelift. Thi is an unforeseen bonus.

Mile #5 dimples in cheek & Mile #2 suture line

Mile #4 Surgery date July 16, 2013 

My chin. It is no longer visible in pictures.

Mile #3  Surgery date July 2, 2013

My right forehead goes naked during the day. I do cover this site at night with antibiotic ointment and a nonstick pad. There is new skin visible between Mile #3 and Mile #7.  There is however, no new hair growth visible between the two.  To date there are four areas on my head that may or may not grow new hair due to the depth of the wound sites.
Yet another reason NOT TO IGNORE ANYTHING ABNORMAL ON YOUR BODY.

Mile #3 showing Mile #7 at the top

Mile #2 Surgery date June 18, 2013

See pictures from miles #5 and #6. Both of these sites have been naked for some time and get the cocoa butter cream treatment.

Mile #1 Surgery date June 4, 2013

Mile #1 right side of my nose

Mile #1 was my nose. As a reminder, only one of the three marked areas was even discolored or raised  before surgery. 

 

The area between the bottom two spots is the deepest and wrapped slightly into my nostril. That area is what is pulled taught today and will require reconstruction in the future. All three of these spots shared what I call the basement condo. Without removing a stage at a time and doing the pathology you cannot tell how far the cancer goes. With a Q-tip in my nostril I could see a small area where it went all the way thorough. Lovely. My co workers told me I should have taken advantage of the situation and gotten a diamond stud for my nose. I just did not see diamonds on this.

Take Away  Nugget: Happiness is not something you postpone for the future; it is something you design for the present.