Thursday, May 3, 2012

Skin-Graft Diary

Many months ago I had trouble with my main blog Rinkly Rimes and I started this one as a back-up. I found I didn't need it but it's been lying dormant waiting for my........


I am writing this diary because I have spent a considerable amount of time 'Googling' the subject in the last three months and I have discovered that 'shared experience' blogs have a following. I certainly found them helpful.

First of all, here is a picture, taken a few months ago, of the face I like to present to the world. The hair could be improved! But I've chosen this shot because the rough patch above my left eye-brow is clearly visible, and the brownish patch low on my right cheek is also slightly so. Nothing much to worry about, so I thought. I went to the skin specialist because of a suspected basal cell cancer which formed on my left eye-brow. This he dismissed (although he's now excised it) but he pounced on the other two areas and, before I knew it, I was lined-up for quite extensive skin-grafting!
As you can imagine, I was appalled. I am 81 but I'm still vain and I am also an amateur entertainer. (I tour local clubs reading my humorous poetry and I run a melodrama group as well) so I was anxious that I shouldn't look too hideous. (Follow my light-hearted poetry on )  Also, I am a coward. I put-off the operation for a couple of months, partly because we had our 'big' annual show coming-off and partly because Malcolm and I had already booked a holiday in Tasmania. Looking back, I think this was unwise, not because my condition deteriorated in that time, but because I became very anxious and lost quite a lot of sleep picturing the whole thing. (Sometimes a vivid imagination is no boon!)
My skin problems took me by surprise. I have a typical 'English' skin, rather pale and freckly, and so I have always had blemishes. Also, I lived in England till I was 25 and so excessive sun wasn't a problem! (Here, in Australia, women of my age are paying for teenage years spent in blazing sun on the beach, unaware of the problems ahead,) However, I moved to Zimbabwe, and I think I can pin-point the reason for my present problems. I lived in a small town two hours drive from the nearest town of any size. Being young I used to drive to the 'city lights' very often, either on my own or as a passenger in a car. The cars were not air-conditioned and so the windows were always wound down. I can actually remember the sun beating on my face. How I loved it after England's grey skies! And skin-cancer was an unknown. Some people used to actually 'fry' themselves by putting cocoa-butter (I think it was) all over themselves and tanning a deep dark brown. But I never sun-bathed because I merely went red and peeled.  Once I moved to Australia (with a husband and two toddlers) I never sun-bathed. Although I must admit, I never put-on a sun-screen either! I thought I was 'past the age'. I sometimes wore a hat but that was all. I rejoice when I see my grandsons dutifully donning sun-screen. Now, I suppose, I'm a 'dreadful warning'!
My specialist was concerned about a small dark spot amid the brown on my cheek. So, a few days before the 'operation' (maybe too dramatic a word!) I had to have a biopsy. Here, I have to say that maybe we shouldn't Google too much about our situation! I say that even as I write my blog! On the whole I think the 'shared experience' approach is beneficial. But someone wrote on a blog 'I don't think I can take another biopsy!' and I took this to heart, expecting a real trauma. The only trauma was my nervous imagination. The anaesthetic needle was just a prick and I didn't feel the excision at all. And it was a melanoma. Fortunately for me it was very small and hadn't spread at all. Just a reminder.....if you're heading for a biopsy don't take any blood-thinning medication. I stopped mine a week before the biopsy but I still bled rather more than the Dr expected. However, pressure stopped the flow. After that it was just a case of a rather bulky plaster (with cotton-wool under it). But it was all quite painless.
Fortunately for me, I have no problems with anaesthetics and I asked for a light one for my 'processes'. The anaesthetist said I would be half-awake and maybe even hear voices, but, in the event, I was completely 'out' and have no unpleasant recollections at all. I merely woke up looking like this.........


I can't say I was 'shocked' because I think I'd actually expected worse. But I was certainly surprised by the enormous amount of plaster! 

The Specialist had decided to take a flap of skin from under my chin to graft onto the cheek. I discovered that 'flap' grafts heal more readily than 'donor' grafts from a completely different part of the body, because there is a continuous supply of blood. Having fondled my double-chin (and it's a long time since that's happened!) he declared that I had 'plenty to spare', which I found slightly tactless! However, I did raise a slight, gruesome, laugh, which eased things. Then he asked me whether I would prefer the brow graft to be taken from my chest or my inner arm. (There was no available skin for a graft on my forehead.) I like wearing lowish necklines in the summer and my inner-arm skin looked dubiously pale so I, half-laughing (what a brave woman!) said 'Why not take the excess off the other side of my chin too?' So that's what he did!  This cancer was not malignant but it was 'aggressive'. I had ignored it because it disguised itself as rough skin, but evidently, it was a type of skin-cancer which spreads inwardly. I may need some radiation at the site. I hope not. I don't think the effect will be 'plastic surgery' beautiful, but at least the scars will be hidden, nestling among the wrinkles! I hope! Then, of course, there was the initial little basal cell 'thingy' to deal with too.

This week has been pain-free! This has certainly been a surprise. I have taken pain-killers but only because I have had head-aches. I rarely suffer from head-aches so I think they may have been caused by the pressure of the dressings. Anyway, they have gone now. No pain at all! But this is not to say that I haven't suffered from discomfort!!!! For one thing my eyes, though not directly affected, have been 'hooded' by plaster, so my vision has been impaired. And my neck, for the same reason, is 'stiff'. My hair, not washed for a week, itches like mad, and the dressings seem to have got tighter and tighter as the week has progressed! The wound under my right cheek is certainly tender but not unbearably so. I worried about sleeping arrangements, but I've slept reasonably well and the wounds have had no arguments with the pillows! I was very concerned the day after the 'op' when a trickle of blood ran down my nose! But my husband read the Specialist's instructions which said 'In case of bleeding, apply pressure' which I did and everything settled. I held an ice-bag (wrapped in a towel) to my face as I watched TV at night, and that gave me a lot of comfort.
I haven't emerged from the house this week. I even told friends that didn't want visitors, but I have met one or two at the door when they've delivered the very much-appreciated flowers. I have been amused by the different reactions of the sexes. My very dear 'girl' friends say 'You don't look bad at all!' Malcolm's friends reel back in mock horror, saying 'Oh my God!' I filled the stock-cupboard before this 'event' so I've felt quite organised, and I've actually enjoyed  giving myself permission to sit at the computer and try to get my photographs in working-order. From 2001 to 2008 they are in perfect order, but I started blogging in 2008 and since then, for obvious reasons, recent photos are in a mess!
Today I have my stitches removed. I am not looking forward to this as there must be rather a lot of them and I have no experience of stitches at all. I also hate the thought of all the plaster being ripped off!!!! However, with delicate wounds underneath I'm sure I'll be treated gently.

I wonder why I'm smiling! Maybe it's because I can now turn my head! It's not because the visit to the Clinic today was perfect bliss! I had expected to come home with some small flesh-coloured plasters on my face, but, instead, I look almost the same as before! And I had some bad news. After telling me that I was healing nicely Alister Lilleyman said ' But the bad news is that we have to take some more!' I have to have another 'operation on July 6th! This is to shave off a little more from the cheek and the brow, both of which cancers proved to be more extensive than first thought! I said 'But I'm 81! I might die at 82 and then all this would have been a waste of time!' He responded 'Ah yes! But you might live to 92.' As my mother died at 97 I suppose that's possible.
I'm sorry to tell you that the plasters were 'ripped off' but that wasn't nearly as tooth-gritting as I'd expected it to be. And most of the fifty (!!!!!!!) stitches came out with ease. However, a few under my chin, were rather painful to extract. This area has always felt sore and the nurse told me that it was quite bruised and swollen.
I asked about hair-washing and I was advised to go to a hairdresser to get it done so I've made an appointment for next Tuesday. I have to visit the clinic again on Wednesday for another examination. (I can't remember why!) I'm certainly glad that we're fully covered by insurance!
Maybe I'm smiling because of today's GOOD news. I don't have to have radiation treatment because the cancer hadn't reached the bone of my forehead. However, the flesh excised contained a nerve so I may lack some feeling there.
What really gets me is that I'll be missing more 'gigs' (poetry and melodrama) than I expected to. I've worked-out that it will be September before life returns to normal, allowing eight weeks (the Dr's estimate) for healing each time! I don't know who invented blogging but I'd like to say a big Thank You to them!
The area under my chin is still quite sore, but, other than that, I feel much more 'myself' now. I actually went up to the Corner Store yesterday; I'd been skulking indoors until then. I'm far from being a retiring, shy person and I don't mind being looked-at, but I like it to be for the right reasons, not because I look odd. Only one person remarked on my face and she was an older woman who was sympathetic and had gone through similar procedures. I also invited a friend to coffee yesterday so things are looking up! She brought with her some soft-centred chocolates because I'd mentioned that swelling on the inside of my cheek had caused me to take bites out of it! How thoughtful! I was delighted to get some responses to this diary, too. I know one can 'Google' too freely, but I was certainly looking for something like this during my weeks of anxiety. One thing I hope readers will take-on-board is that pain is not a great element of the procedure; not in my case, anyway.
Today my husband has gone to an MG Car Club meeting and I'm going to spend some time re-organising my life...... more 'gigs' will have to be cancelled in July now!! Damn!
Another milestone today. Some of my Merry Mellows friends were rehearsing a new play at Bev's house and I went round to join them for lunch. Talk centred around my predicament for a while, but we soon began to chat about other things and it was nice to get away from the subject. Most of them went on to Choir Practice but I'm not quite up to that yet. My 'bad-stitch-corner' is easier, but the bridge of my nose now feels tender. I suppose un-felt spots appear as the swelling becomes less.
I had my hair washed today. What a relief after eleven days! The Dr had told me that I must on no account get the graft site wet so I was dubious about washing my hair myself. I went to my hairdresser and she only charged me $5 for the wash. I said 'Just towel it dry' so I left the salon with bandages all over my face and wet hair sticking-up on end! Thereby hangs a tale..... When I go out to 'do' my poetry I always take trouble with my looks and clothes. I put on make-up more carefully than I normally do, I make sure my hair is neat (it can never be anything more than neat!) and I dress appropriately. I had house-clothes on today when I went for the hair-wash, and, as I've described, I looked both hideous and comical as I emerged. And a lady coming in said 'Why! It's Brenda Bryant! I've been hoping to meet you to order some books!' And I thought I was virtually in disguise! 
I'm feeling a bit nervous about tomorrow's clinic visit. I now know they DO rip the plaster off!  It's only momentary but it's quite a shock to the system!
Day 12! And I look like this! Almost normal!

The skin-graft area is quite livid and abnormal, but I normally wear my hair over that side anyway, and I know it will fade in time. I was utterly gob-smacked when the doctor took off the dressings (no 'ripping' this time) and declared that I could look-after it all on my own from now on! I bought some Bio-cream which I have to rub in three times a day to facilitate healing. I can't believe that I've reached this stage after twelve days when I worried about it for sixty!

Now for close-ups........

The skin-graft is rather confronting and I felt a little queasy massaging the oil into it knowing it was really part of my neck! The eye-lid is still droopy as well, and I'm not certain I'll have an eyebrow eventually. Just under the tuft of hair to the left of the scar (in the picture) is the tiny red mark left by the excision of the original basal cell cancer.  Almost nothing at all.
This is the donor site for the forehead graft. It is already hardly noticeable among the wrinkles!  It amazes me that such a round piece of skin, for the forehead, came from this area and left such a slight scar! The donation has done nothing for the double-chin, though!
This scar is the largest because it includes the 'flap' as well. I can see now how skin was harvested and coiled back from my neck on to my cheek. In the end I think this scar will be less obvious than the forehead one, because the blood supply was unbroken, but the sore area near my ear is still very tender, and I'm still rather bruised.  Even the jaw-bone is tender to the touch and my cheek is still slightly swollen inside. This is rather scary, I admit; it's as though I've been in a duel! It's easy to see why I had a bit of pain with the area near my ear!

I'm certainly not complaining, though! I feel reborn! The words 'hideously scarred' need no longer hammer in my brain! (O.K.! I love a touch of melodrama!)

I went out for lunch with friends today. I still feel rather self-conscious and I feel the need to explain my face to everyone I converse with, but I'm becoming more relaxed. Oddly enough, my sores 'worry' me more now than they did when they were covered! I'm more concerned about accidentally scratching or bumping them and I didn't sleep so well last night because I couldn't find a 'safe' spot on the pillow. They also feel more like to the air. The Bio-Oil helps, but I don't enjoy applying it. The graft worries me most as I am aware that it is concave and I feel as though I'm massaging oil into a tiny dish! However, the social aspect is something I'm rapidly coming to terms with. And it's still less than two weeks since I 'went under the knife'.


We went to watch Blake, our grandson, play soccer today. (His team won). I took a thick jacket, because it's May, after all, but I neglected to take a hat or parasol. And the sun blazed out of a cloudless sky and it was hot! I soon became very aware of my 'wounds'. In fact, the sun, which I have worshipped since my teens, feels like an enemy these days! I bought a cap at the kiosk, with 'Wildcats' written on it! Even this didn't shield me enough, because the sun is winter-low, so one of Rebecca's friends lent me a scarf! I think the image is that of Mata Hari or, at least, some famous star travelling incognito! Definitely mysterious.

As you can see in the above photo, I have a rather unsightly scab on the end of my nose! This has nothing whatever to do with my treatment! I've had an irritating, but slow and benign 'thingy' there for ages and the Dr said it's so slow-growing that I don't need to do anything about it. I first noticed it eight years ago! Anyway, I decided that I'd zap it with Effudix while I was 'hideously scarred' from the hospital treatment. Unfortunately, the resulting scab is the most prominent 'scar' now and I wish I'd left well-alone.
My great blogging friend, Kat, who lives in India, said I look like Lord Shiva because of the circle on my forehead ! I responded that I'd rather look like Lady Shiva and I asked him if there was one. His reply was 'Yes! And she lives in Australia!' I must be the only Anglo-Saxon lady of 81 who has ever been likened to an Indian Goddess! I'm off to Bollywood!
Nothing much changes. I suppose the healing process is so slow it's not noticeable each day. But I think the skin-graft has altered a bit. Most of the time I forget about it, but wisps f hair sometimes blow across it and irritate it. Last night, as I was massaging it with the bio-oil, some transparent flakes of skin came away and I think it's less prominent now. I think the colour-match will be pretty good in the end. This is after 17 days.

The 'flap' is still as noticeable as ever (except that it's not in an important part of my often has to be pointed-out to people). It's still tender, lumpy and rough to touch. And that's strange, because the area to which it was transferred, my cheek, is beginning to fade and is much less 'alien'.
A group of my friends went down to Sydney for the day yesterday. I didn't put my name down for the trip because I thought I'd still be bandaged! I regretted it, as it was a glorious day and they visited two historic houses and then went out to lunch. In my case, I think I only needed to withdraw from society for two weeks. If that. 
Just starting week four. I am very happy with the progress, although it upsets me to think that I'm healed and yet I have to go through it all again (on a much lesser scale) in a few weeks time. I had a tiny set-back regarding the forehead skin-graft. Most of it has healed miraculously, the skin being a perfect match, but a sort of blood-blister has formed.  It felt quite sore for a while and I actually thought I might be infected in some way. However, my husband said 'Is it hot?' and it wasn't so I realised I was being melodramatic........again! I'll be glad when it fades like the rest though. Maybe I bumped it in some way. It no longer hurts.
 As you can see the majority of the graft has taken perfectly
The 'flap' is healing well, too and I no longer have any discomfort in that area. 
While the graft 'donor' area has always been miraculous.

This photo (I'm back left) was taken at a luncheon party last Friday. I deliberately turned my head so that my neck-scars were on show, and it's easy to see why I'm happy. In close-up the wounds still look pretty gruesome, but, in everyday life, few people notice them.
Tomorrow I start Week Five and I couldn't be happier. I was merely worried about a small basal cell, but my real problems were discovered, and now I'm free from two quite threatening skin cancers that I'd treated casually! I'd crossed through all my May social engagements since I'd thought I was going to be grotesque, and yet, in the event, I've been out and about since Week Two! 
This is the version of me that people see now. No oil-painting, but it never was! (If only Dr Lilleyman could have given me a complete face-lift  at the same time!)
The cheek area still has a way to go. It's healed but the skin feels a bit sand-papery (even with lashings of bio-oil)  and there is still very slight bruising and discomfort. It's still miraculous, though and I'm hoping to have a new dimple to add to my charms!
I brushed my hair back from my forehead for this one. Isn't it a superb match! After four weeks! The original little basal-cell scar can be seen on the left.

Finally, this is the view that fellow-shoppers in the supermarket see! As my mother used to say 'You wouldn't stop your horse and cart for that!'
Unless something dramatic happens, I won't blog again until Week Six. I do hope this account can be of comfort to fellow-sufferers. Had I known how things were going to turn out I would not have endured so many sleepless nights before the event! A imagination can be a curse!
Well, nothing to report, really. The scars continue to fade and people actually have to search for them! The scars are still lumpy and rough to the finger-tips, when I'm massaging with my lovely Bio-Oil, and the areas which suffered the indignity of being 'plastered are still dry and slightly sand-papery, but all in all it's like a non-event. I hope my readers are cheered!
I was rather too sanguine about the touch-up operation today, July 6th. I had imagined that the little 'slices' needing improvement, and the one 'new' basal cell (which I could hardly locate), on my neck, would be a doddle to deal with. So I entered the hospital quite gaily, having had no nightmares at all. In fact I hardly thought of it in the intervening weeks.

However, I found today more traumatic than the day of the initial operation on April 23rd. I arrived at the hospital at 7.45 a.m. and I didn't get home until after 2.00 o'clock in the afternoon! The first setback was the fact that Dr Lilleyman found yet another basal cell lurking in my temple when he was surveying my skin! He then declared that, because my cheek operation in April had pulled the skin rather tight in that area, a mere stitching would not suffice, nor would a 'flap' be possible. Another skin-graft was necessary! I then learned from the anaesthetist (a different one from last time) that he didn't favour a full anaesthetic, so I would be conscious throughout! My heart sank!.

In the event, there was no pain. I followed the chitchat about the medical staffs' family lives -, interwoven with 'Scalpel please' (I think), quite clearly and I had complete recall of the day's proceedings at the end of the day. What was upsetting was the fact that a specimen had to be sent to the lab, mid-operation, and I had to wait until the result came back, about two hours later.

So I'm virtually back to square one with regards to healing! I look just as weird as I did in April, but, unfortunately, in the present situation, I haven't pre-cancelled any of my social activities, not expecting to be another 'gargoyle'! I feel irritated, more than anything. I'm certainly not despairing of the outcome. Things began to improve after only two weeks last time and I'm sure I'll be equally lucky again. And I'm delighted I didn't know how disappointing today was going to be beforehand.

I'm sorry that this blog isn't entirely optimistic for those of you who are reading it before facing similar surgery yourselves. Concentrate on the miracle of my previous healing, being aware that I'm almost certainly expecting a similar outcome this time around.

This photo is better of me than it is of Banjo, my daughter's dog! He refused to let-go of his ball for a portrait! As you can see, I'm back to Square One. But experience  now tells me I'll be OK in two weeks time. So that's why I look cheerful! (Incidentally, both Banjo and I are wearing warm clothes; it's July, mid-winter in Australia.)
I have been lurking indoors all week, not wanting to 'frighten the horses'! But I ventured out today to go to a play rehearsal, and nobody fainted at the sight of me, so I intend to face the world bravely next week. I have a very social time coming-up and I don't want to miss any of it. I'm still fed-up at having to put up with all the inconvenience twice, but it will soon be over.

The following photo is a bit deja vu but I thought I'd better include it as this is a sort of scientific treatise! I had the bulky dressings stripped off today. The ones involving my hair were a bit sharp, but, on the whole I didn't suffer. I learned a couple of things from the nurse.....when I enquired about the amount of blood loss during actual facial operations she told me the ends of the blood vessels are burned to prevent bleeding! She also told me that much of the dressings I'm now wearing are non-stick. (That was something that concerned me during my 'first round') I thought it might be concerning you, too.

I was told everything is healing nicely. I was surprised to learn that there are no external stitches in the neck donor area. This is an area that was cut before so maybe that's the reason.

My Doctor wasn't at work today. The last two weeks have been School Holidays and he's taken some time off with his family. But I'll see him next week, hopefully for the last time. 

A slightly different pose, but a face very much in need of make-up!!!
Having stayed at home for a week I was ready for some entertainment today and it's surprising how one can forget ones self-consciousness in good company. I went to my friend Roslyn' house for a delightful convivial lunch and here are the ladies posing after the meal. I'm hopeful that my next entry may be sans bandages!


Well, NOT without bandages, unfortunately. I still have one remaining by my temple. This is the area that has caused me to have such a prolonged treatment. I was really back to normal by week four but this extra basal cell area was discovered and that has been the set-back. Unfortunately, it needed a skin-graft because the skin on my cheek had been pulled tight by the initial operation and there was no spare flesh left to facilitate a suture. So the area on my neck had to be opened-up again to supply the graft, and this neck area has been very tender. The Dr described it as 'bruised', but it feels more 'sore' than anything to me, and it catches on the collars of winter clothes. The actual area of the skin-graft hasn't taken as well as hoped, because, as the Dr says, my temple-area has thinner skin than my neck-area......I suppose he means there's a sort of ridge. Luckily, it will eventually be covered by hair and I do feel more free. I can see the proverbial light at the end of the tunnel.
The right side of my face is still a disaster zone.

But the area over my left eye has hardly been damaged by the repair job that was necessary.

And the general effect isn't too bad. (The unwashed hair feels worse than it looks!)
I'm due back at the clinic next Monday. Maybe THEN I'll be bandage-free!
This will probably be my last entry as I don't expect an adverse report when I return for the final examination next week. The Dr was still uncertain about my latest graft when last I saw him, but it seems to be healing well now. These are the two latest wounds after three weeks.

The area adjacent to my ear is hardly noticeable.
The neck area is extensive but pale.
And, if you study the very first picture in this series, you'll realise that I am, to the casual eye, back to normal.

I am planning a six-monthly visit to Dr Lilleyman from now on. He says that I must watch my skin carefully, having had one melanoma (on my right cheek). Incidentally, only today my daughter-in-law said 'You skin looks better now than it did before the surgery!'

So here's wishing all my readers as much luck as I have had. I hope reading my blog may have given some of you confidence. I certainly needed it before I started this journey!