Monday, November 14, 2016

Cancer Part 1

About a year or so ago I started to notice a pain under the fingernail on my right middle finger. At first I thought it was a sliver under the nail. It bothered me, but only occasionally. A few year ago I definitely had a sliver under that same nail. So this seemed like it either happened again, or the sliver from last time was still there and coming back to bother me.

Fast forward a few months and the pain under the nail was now a bump under the skin at the very tip of my finger, close to the nail. I again thought it was the sliver, now being pushed out of my skin. The pain was worse, but only when I hit the very spot on something.

A few months went by and now the skin on the tip of my finger changed color. The skin changed from the normal, semi transparent color, to a more off-white opaque color. Now I was more concerned, as this obviously was not a sliver.

In May 2016 I went to a dermatologist. The growth on my finger was really starting to get painful. The slightest touch could send a jolt up my hand. When I called for the appointment the doctor I saw last time, for something else, did not have any available appointments for over a month, so I booked an appointment with her physicians assistant. 

May 5th I met with the dermatologist and her physicians assistant. Each of them looked at the growth and agreed it was a wart. I was only a little surprised. I've had warts on my feet before, and this did not look like a wart to me. But I never really challenged the diagnosis. They were the doctors, and what did I know?

The physicians assistant froze the growth with liquid nitrogen. She told me to wait a week and treat it with Compound W wart remover. I did, and did. I had a follow up appointment scheduled in one month just in case the wart persisted. 

On June 8th the growth was still there. The physicians assistant was surprised to see me back, but said it's common for warts to be stubborn, especially in hard to treat places, like under a fingernail. She treated it with nitrogen again and gave me the same directions, wait a week and treat it with Compound W. We scheduled another follow up, just in case.

July 7th I returned to the office, we finally seemed to be making headway. The growth was still there, but much smaller. The physicians assistant froze the small spot that was left and gave me the same instructions, wait a week and treat it with Compound W. We scheduled a follow up for August, but she seemed confident we wouldn't need it.

I waited the week, but before 4 days had even passed the growth was as big as ever. In hindsight I remember thinking that even though the growth was small on the surface, I could feel a large lump underneath. I kicked myself for not telling her at the last appointment. I think this is the month I hugged my wife and gasped in pain when my finger touched a fold in her shirt.

In August our family was getting ready to travel to London, England and the growth was really bothering me. My next appointment was weeks later and I was dreading traveling with my finger in that shape. I called the office but was told there was no way they could see me before we left. So the trip to London was spent pasting Compound W on my finger every night, and keeping it covered with a bandage at all times. The smallest bump was excruciating. But generally speaking, it was a minor annoyance.

I returned to the office after the trip, August 23rd, really frustrated. I was so tired of this ordeal. I wanted the physicians assistant to try something new. Clearly freezing and Compound W was not working. I wanted her to burn or cut it out. She wanted to give it one more try. I agreed, but asked her to make sure she froze it completely and deep. I definitely mentioned that I felt it deep under the skin. I said "I don't care if you have to freeze the entire tip of my finger, I want this thing gone.“

She froze it more than any prior visit. My hand entire hand hurt for an hour after the appointment. I began to wait the week before treating it with Compound W. Each previous time the growth hardened and turned a light brown color. It either peeled off or was absorbed into my skin. This time a large scab developed. At the end of the week the scab partially peeled off around the edges. In the center though it didn't seem to be healing. It wasn't drying up the way scabs usually do. Eventually it opened up in the center and started oozing blood. But when it did, it wouldn't clot the way I'm used to. It would just ooze blood until I covered it.

It would bleed anytime I changed the bandage, or banged it on anything, which I did 10 times a day. At work I would shift the car into drive and clip the radio receiver. I would smash it doing yard work, or just about anything else. Eventually it began to morph from an open scab into a bloody growth. My wife recognized it immediately as granulation tissue, or a granuloma.

When I returned to the dermatologist on September 20th, she confirmed what my wife suspected, it was a granuloma. She seemed to genuinely feel bad about the diagnosis and my ordeal. She advised me that unfortunately she could not treat it. She referred me to a hand surgeon.

I saw the hand surgeon, again a physicians assistant, a few days later. He confirmed the diagnosis of a granuloma, but would not perform any procedures in his office, as I begged him to do. He treated the growth with silver nitrate sticks. He gave me a week's supply and told me to come back. 

The silver nitrate sticks turned the tip of my finger black and burned the granuloma. After a week my finger looked like charcoal. My mother was horrified by it when I showed her one morning. I went back to the hand surgeon on September 29th. He said the granuloma was pretty much gone,  but they can come back. Also it looked like the silver nitrate was burning down into the wart tissue. He scheduled me for surgery the following week to remove the entire thing.

I was elated that the ordeal finally seemed to be ending. On October 4th I went into the Buffalo Surgery Center where I met the hand surgeon for the first time, about 15 minutes before surgery. He explained that he was going to remove the main growth, which they would send for biopsy, just in case. He would then scrape out the rest of the wart tissue. I could expect a stitch and not too much pain.

They surgery was fairly quick. I was awake, under a local anesthetic. He informed me when he removed the biopsy portion, and moved onto scraping out the rest. After a bit he said he was scraping the bone, which horrified me. I almost passed out and a nurse came over to try to keep me awake. In the end the doctor removed over a centimeter of tissue from the tip of my finger and had to use three stitches to close it up. 

I had a large bandage on my finger for two days. It was uncomfortable, but not too painful. Motrin at night was more than enough. When I took the bandage off for the first time I was pretty shocked at the appearance of my finger. The tip was flat and had 3 stitches running side by side, and through the nail. The stitches were disolvable. The doctor said he wanted to see me in 10 days, but I hadn't yet scheduled the follow up. 

On Monday October 10th, Columbus Day, I got an automated call from the the hand surgeon reminding me of an appointment for Friday October 14th. I didn't remember making this appointment, and still think I never did. On Tuesday I called back to reschedule the appointment for Thursday afternoon, a non-work day. It was scheduled for 3:30 p.m., after I pick my daughter up from school. But as the receptionist said "bring your daughter. It'll only take 10 minutes." 

I brought her in and we waited longer in the waiting room, and then in the examination room, than I did in any of my previous appointments, including the surgery. Again the physicians assistant entered. We talked while my daughter sat next to me, playing on my phone. He looked at the incision, which was in decent shape. The stitches had all come untied and I snipped them at the nail and skin with nail clippers. He poked and prodded it for a minute while I asked him how it would fill out and return to its previous appearance. He said it most likely would.

Then he rolled his stool over to the computer screen and said "I want to show you something." When I came close his whispered "I didn't want to say it out loud with your daughter in the room." With his right hand he was pointing at the screen which displayed my biopsy results. Just above his finger were the words "papilary digital eccrine adenocarcinoma."

I was stunned. I said "is that what I think it is?" He said "yeah, I'm sorry." My hand went up to my face and I sat down on the examination table. I asked "what do we do now?" and he said something about consulting with the doctor. I asked "do I need to see an oncologist?" And he said "I don't know. I've never heard of this cancer. I was just reading up on it for 5 minutes before I came in here to talk to you."