Monday, August 19, 2013

met with the plastic surgeon today.

Today we met with Dr. Jason Miller, a plastic surgeon in Omaha who also works at UNMC.  In the photo, he is with Charlotte because he is the doctor who performed the posterior vault reconstruction on her skull back in March.  He is a respected surgeon at Children's Hospital, the Med Center and the Aesthetic Surgery Center, so he was a logical choice for our consultation today.

We learned today that:
-the incision is still a little red and a little bumpy
-the size of the sutures used were a bit big for the face
-the bumps are scare tissue
-Mike should massage the bumpy scar tissue because it can disperse the collagen
-it may flatten out after a year and "it might be OK"
-an 'acceptable' scar is thin, flat and does not draw attention

The nurses and Dr. Miller were a bit surprised that Dr. Heibel chose the closure that he did (the large jagged "T") for an elliptical defect. Doctors are always very gracious and guarded with their comments about another doctor's work, but he did say "there are some things that could have been done differently" and "I personally wouldn't have put that big of suture on the face".  He also commented that "the hematoma (bleeding) was unfortunate".   These were my sentiments exactly, and somehow it was comforting to hear them.

Of course we couldn't help asking how he might have closed the 'eliptical defect' or quarter-sized hole in Mike's head after the cancer was extracted.  He drew a little diagram showing a 'cat eye' as one option and a rhomboid flap as another option... very interesting.  I think Mike felt a little better hearing that "the hallmark of a hematoma is exquisite pain".  Mike had happened to mention how painful it was when they had to unstitch and re-suture the area because of a bleeder.

Maybe the best part of the day is that we secured the names of three excellent MOHS certified dermatologists in Omaha - that don't hesitate to send cases to a skilled plastic surgeon for closure when needed. One of these men will be Mike's new dermatologist, and we are thankful for that.

Dr. David Watts
Dr. Anthony Griess
Dr. Scott Debates

Tuesday, August 13, 2013

skin cancer blues.

Sometimes I blog for the sheer pleasure of it.  Sometimes I blog for my sanity.  Sometimes I blog hoping that somebody out there will learn something helpful from something we have been through.

It continues to be a bit of a mystery to me why this skin cancer trail ride has been so distressing for me. But in the process I have learned a few things.

1. It is important for me to use a doctor that has good communication skills.
If I had done my research a little more carefully I would have discovered that Dr. Mark Heibel does not score high on communicating procedures and expectations with patients.  If I would have known that there was even a remote chance of an incision longer than a quarter of an inch, I would have aligned my expectations accordingly and I would have secured plastic surgeon closure options. 

This skin cancer scare with Mike prompted me to make a visit to my own dermatologist, Dr. Peter Hino in Dallas.  And guess what?  I learned more about Mike's procedure from Dr. Hino than I heard from Dr. Heibel's mouth.  I learned that 90% of the time, basal cell carcinomas don't need a MOHS extraction.  I learned that the kind that Mike had was called Sclerosing Basal Cell, which is the kind that has tendrils, and thus needs a deeper incision for a clean margin.  I learned that most dermatologists do their own closures, but most have plastic surgeons that they work with.

I realized that I prefer a doctor who is not so arrogant that they cannot discuss pro's and con's of using a plastic surgeon for closure.  It is never wrong to do your own research, to ask thoughtful questions, and to expect a respectful dialog.

2. Stick to your guns and pursue a plastic surgeon if you require stitches on your face or hands.
If there is anything I have learned over the past ten years it is that you must be your own advocate - or your patent's advocate - in the medical community.  Always follow gut.  Always take extensive notes.  And never leave a loved one in a hospital alone.

And if you need stitches on your face or hands, insist on a plastic surgeon for the closure.  You might have to wait a bit and you might even have to go to another hospital emergency room, but you won't be sorry. 

On Monday, August 19 Mike and I will be going to see Dr. Jason Miller, a plastic surgeon in Omaha, to get his thoughts on the power "T" on Mike's forehead.  I am looking forward to hearing what he has to say.

This is a good time to remember "If money can fix it, it is not a real problem."