Archives for category: medical issues




I recently experienced my first “Mohs” surgery, a “minor” procedure to remove basal cell skin cancer from a spot above my right temple.  Two weeks earlier, when the dermatologist had found the offending spot at the end of my routine, annual check-up, he exclaimed, “Wow, 99.5% done with the examination and there it is!”  His enthusiasm was somehow lost on me.  It was as though he’d found a missing wallet or keys, as always, in the last place he’d thought to look.

First, let me acknowledge clearly a patch of basal cell skin cancer is not in any waycomparable to “real” cancer, the type that kills or debilitates.  My “suffering,” if I dare use that word, is infinitesimal compared to that of numerous friends, relatives and millions of other cancer patients around the world.  Still, the first time one hears “CANCER” in a doctor’s office in connection with oneself, it is a bit of a shock.




The young doctor followed up his diagnosis by explaining my two options:  first, since the spot appeared small and largely covered by hair, he could scrape it off at his office, and patch me back together, leaving a small scar.  “That will almost certainly take care of it,” he said.  “Of course,” he added, with a nod towards my age appropriate receding hairline, “you might not always have hair there.”

Second, he could refer me to a Mohs surgeon who, as I understood it, undertakes the same procedure, but with greater precision to make sure “it’s all gone,” and who repairs the resulting wound in a manner less likely to leave a scar.  Though irrelevant in the scheme of things, it is interesting to note the cost of the first procedure, barring complications, is in the realm of $300-$500; the second procedure costs $1,500-$2,500, the variable largely based on whether all the cells are deemed gone after the initial scrape or if several scrapes are necessary.

“Take a week or two to think about it,” he said.  “No rush.  This cancer grows very, very slowly.”




My wife, Katie, who is wise and efficient in these matters, searched reviews of local Mohs surgeons within ten minutes.  “It might take awhile to get scheduled,” she said,  “And we can always cancel if you just want to let the dermatologist handle it.”  She was right, as usual.  The first appointment with “the best one around” was two months away.

What price vanity?  The internal debate proceeded as follows: Each morning for a week I looked at myself in the mirror.  On one hand, my forehead already has a few scars from a college soccer injury and a childhood fall.  And it would be nice to just visit the doctor I already know and have him “take care of it” expeditiously.  On the other hand, the idea of a “specialist” handling the situation seems prudent.  And, yes, though there surely is a point at which vanity is tooexpensive, $1,000-$1500 isn’t too much to avoid another scar.  I’d hate to feel compelled to do a comb-over – Commander Bone Spur in Washington has made that distasteful.  What to do?



My telephone soon vibrated with the answer.  A cancellation at the surgeon’s made it possible for me to undergo Mohs on half an hour’s notice.  No more waiting, no more walking around with cancer cells growing, however slowly, in my scalp, and no scar.  I drove to the office with as much enthusiasm as I could muster for the prospect of someone applying a scalpel to my skin.  In two or three days, I thought, I’d take off the bandage and be done.

Boy, was I naïve.  Again, Mohs surgery is minor in every respect compared to “real” surgery, but to my surprise, it’s a lot more than “a scrape and a band aid.”  First, after the customary twenty minute wait in the chilly room, the nurse arrived to review my medical history.  Next, my vital signs were taken.  Then, after another multiple-minute interval, the surgeon entered and introduced himself along with an assistant (resident doctor) to look at and touch my temple.  “Hmmm,” said the surgeon.  “Yes,” said the resident.  “Should be okay this way,” said the surgeon.

The doctors took photographs.  They drew a diagram on my head of the planned incision, a slightly ticklish sensation.  They injected me with local anesthetic.  They told me they’d be back in “a little while,” and left.  After half an hour to assure the anesthetic worked, the team reassembled.   My effort at humor in regards to being a “numbskull” fell flat.  Perhaps, it was not the first time they’d heard that one.

Finally, excavation began.  And continued… and continued.  I pictured myself ending up like Jack Nicholson in “Cuckoo’s Nest.”  After a few particularly decisive scrapes (I felt no pain, but could feel pressure) the doctor and his assistant pronounced themselves satisfied, took some photographs, and explained that I could go to lunch and return in 60 minutes, by which time they would know if they had “gotten all of it, even the roots.”  The surgeon used an instrument to temporarily cauterize the wound and left me in the care of the nurse who placed a massive gauze bandage over it.




I stopped in the restroom to wash my hands and glanced at the mirror.  Ugh.  I looked like I’d truly had a lobotomy.  Could I really be seen in public?  Fortunately, my self-consciousness receded when I arrived at the local sandwich shop and noticed three other people with roughly the same appearance.  Apparently, the surgeon’s offices are in a hotbed of Mohs activity.  The procedure is practically a rite of passage for people “of a certain age,” an age I have now attained.

When I returned to the waiting area at the appointed time I waited for an additional hour.  Apparently, said the receptionist, someone’s surgery became “much more involved” and the surgeon was running behind.  “Hmmmm,” I cringed to myself, “I hadn’t considered the possibility this procedure could become ‘much more involved.’”

To my relief, the nurse came out shortly thereafter and informed me the examination of my cells indicated all the cancer was removed, and I would not need additional scraping.  “We’ll bring you in in a few minutes for stitching,” he concluded.

“Stitching?” I said.

“Just two layers,” he responded.

So much for a couple of days with a Band-aid.




Two layers of stitches helped me realize the procedure was a lot more than just a scrape.  The surgeon and his assistant seemed to take turns tying and snipping and pulling.  The process probably took ten-fifteen minutes but I perceived it took hours.  When they finished, a relatively smaller bandage covered the incision. I received three pages of instructions for “wound care.”  Basically, after the first week, one must change the bandages every day after a thorough cleaning with a Q-tip (sort of a contradiction in terms), slathering of Vaseline, and placement of a fresh bandage.  The doctor’s final words were:  “Don’t be too active for two to three weeks and try to minimize bending over.  Also, don’t sleep on that side.”




Three weeks have now passed and all seems well.  The outer stitches have fully dissolved and the instructions indicate the inner stitches should be dissolving also.  Some sensations are returning to my right temple.  I’m back to athletic activities after a period of extreme antsy-ness.  And I have resumed sleeping on both sides, which is a relief.  I have a new respect for wearing a hat when I go into the sun.  Also, though fully aware my procedure was not major and unworthy of excessive self-pity, an appreciation for what should be a proverb:  “Minor surgery can only describe surgery that occurs to someone else.”













For thirty hours, I consumed the prescribed yellow glop, and almost nothing else, in preparation for undergoing a colonoscopy. The AARP should include a coupon for the procedure, a classic rite of passage into life’s second half.
Unfortunately, the five-year interval between procedures keeps passing and the promised end of the preparation ordeal never seems closer. It’s like the 100-mile per gallon cars that are always five years away. They remain there, elusive, out of reach.
By the morning of the procedure I am completely without energy, without content and without charm. My wife, Katie, has long since found something to do, somewhere, anywhere else.
“Um, I have to go see if the public library needs help alphabetizing,” she said yesterday, when I was halfway through the liquid. This morning, she said, “I have to check on the bird-feeders.”
“But ours is full,” I said.
“I mean the ones in the rest of the neighborhood,” she said. I heard the door close behind her before I could reply.
I don’t usually consume large amounts of liquid. I force myself to sip water between games when I play tennis. I’m not a coffee drinker and I’ve never chugged a beer or even iced tea from top to bottom of an eight-ounce glass. Sixty-four ounces is a long, slow slog.
The first time I did this, ten years ago, the purgative tasted and looked like chalk. In a modest measure of progress, it now hints of lemon. While the taste is slightly better, the visual and physical challenges of consuming a gallon of vaguely yellow liquid persist.


When I arrive at the hospital, I’m given a remarkably threadbare hospital gown. Why are they called “gowns” when that sounds so substantial? How about “rags” or “shmattas?” Anyway, the “gown” is open at the back. At a normal medical appointment, this is okay because the patient is sitting, facing forward, his cold feet dangling, as the doctor thumps and harrumphs around him. With a colonoscopy, however, the open rear is the access point, the field where the ball game is played. In fact, it’s the entire disgusting stadium.
The doctor, nurse and an assistant or two stand behind me gaping with attitudes of practiced professional distance. But I know they are just one small fart away from laughing hysterically. I wonder if I’m being compared favorably to other patients; I consider whether I’d like to hear what they say as soon as they’re in private.
To the horror of the assembled professionals, I’ve opted to endure the procedure without sedation. Having already ruined two days preparing, I’d rather suffer pain for several moments than spend the rest of the day in woozy non-comprehension.
“Are you sure?” asks the nurse.
“Absolutely,” I say.
“It can be uncomfortable,” says the doctor.
“I’ve done it before,” I say.
The actual procedure takes about forty minutes. The doctor inserts a prod and manipulates it through the lower intestine revealing cave-like images on the screen before me. Mostly, it’s merely unpleasant. But at two or three turning points, the feeling is intensely nauseating; my insides being kneaded like dough.
“Hmmmm,” says the doctor.
“What is it?” I want to cry out, but remain silent, in order to preserve a tiny shred of dignity, while laying in front of a room of people with my ass exposed and occasionally dribbling yellow liquid.
“Hmmmm,” he says again.
I think he’s forgotten I’m awake. I picture hearing about polyps and biopsies and similar words I never want to hear concerning my body.
“What is it?” I finally blurt.
“Mnnnnn,” he says. “Hang in there a little longer.”
The suspense is torturous. The minutes go by like hours. Finally, it’s over. I release my hold on the metal bar in front of me. I think I’ve made an indentation.
“Everything looks good,” says the doctor, doling out the words like fine jewels.
I breathe deeply and reach for a towel.
“Will this procedure ever become simpler?” I ask.
“Sure,” says the doctor, as he always does. “Within five years, I‘m sure we’ll be able to do this without the prep.”
Is he serious? I can’t tell.

P. T. !!!

My wife, Katie, is diligently subjecting herself to variations of Medieval torture as part of post-shoulder surgery physical therapy. The house is outfitted with ropes, pulleys, weights and rubber bands a thousand times larger than the ones that hold a pony tail in place. Moans and groans intermittently form an auditory back-drop, and they don’t indicate satisfaction.
Increasingly, at social gatherings among middle-aged people, maladies and therapies dominate the conversation, and more medical information is exchanged than I wish to acquire. My personal accumulation of unwanted medical knowledge commenced twenty years ago, when I was thirty-seven, and awoke to find a burning arrow wedged in the lower section of my back. Not a literal burning arrow, of course, but it may as well have been. I had never felt anything like it as I tried to stand up. I fell to my knees and crawled, ashen, towards the bathroom.
“What is it?” asked Katie.
“I don’t know,” I said through clenched teeth. “But it’s, it’s, it’s amazingly painful.”
“What does it feel like?” she asked.
“Indescribable,” I said, honestly, for I could not find words to do justice to the distress calling from a part of my body I’d never contemplated.
“What caused it?” she asked.
“Um,” I said. “Maybe lifting the children yesterday? Maybe ice skating last week? Maybe playing soccer fifteen years ago? Does it matter?” I didn’t intend to be snippy, but my mood was darkened by agony.
After pulling myself up with the help of the sink I found that standing ramrod straight provided some relief. Laying flat on my stomach, too, merely yielded pain, several steps down from anguish. Any position in between was excruciating.
“I’ll drive you to see Keith,” said Katie, referring to a client of mine who was a chiropractor. “He’ll know what to do.”
“I’m not sure I can sit in the car,” I said.
“We’ll use the station wagon,” she said. “You can lie flat in the back.”
“Like luggage?” I asked.
“Like a pair of skies,” she said.
“Wonderful.” I grimaced.

Keith needed only to look at my facial expression to take me in ahead of a full waiting room. After he elicited several unnerving cracks from my lower back, he declared: “It’s a strain of your gluteus maximus, a large butt muscle. It’ll loosen up as the day goes on.”
“Well, I’m certainly skipping my tennis game tonight,” I said.
“No, you can play tonight; it’ll be good for it.”
I looked at Keith incredulously, but he appeared confident. “Call me tomorrow,” he said, “to let me know how you feel. Then, if you come three times a week for a month or so, we can make sure this doesn’t happen again.”
With his “adjustments” and several Tylenol I was able to work that day, standing. Katie drove me home in the rear of the car.
“Should I really play tennis tonight?” I asked.
“Keith seemed to think it would help,” she replied.
When we arrived home, I shook my head as I gingerly changed for my weekly doubles game.
“This seems crazy,” I said.
I drove myself to the courts holding my body straight like a plank to reach the pedals. I hobbled onto the court and took a few warm-up swings. Immediately, the pain erupted like a volcano. I could barely utter apologies to my playing partners before staggering back to the parking lot. The drive home was luckily without incident as I drove in a haze of pain. Once there, I brushed past Katie at the door and fell, clothed, onto my bed for a largely sleepless night.
Before I could call Keith in the morning, he called me, which made me wonder how confident he felt about his diagnosis.
“How’s your back?” he asked.
“I’m really suffering,” I croaked. “Tennis was NOT helpful.”
The line was silent for a moment. Perhaps, Keith was reviewing his malpractice insurance policy.
“Um, let’s schedule you for an MRI,” he said, finally.

My first lifetime MRI was memorable. I had no problem with claustrophobia, as some do. And the odd, metallic clunking noises didn’t bother me. But lying flat on my back meant I was directly on top of the pain source.
“I think I know what childbirth feels like,” I said afterward, recalling Katie’s facial expressions during those events. Having seen me crawl out of bed, she didn’t disagree.
The radiologist immediately declared my condition to be a herniation of the L-5 S-1 disk, for those keeping score. Newly familiar with such descriptive terms as “lumbar” and “thoracic,” I told Keith, and he said: “Come in for some adjustments and electrical stimulation. I’ve fixed many a herniated lumbar disc. It might just be a bulge.”
For nearly a month, I worked standing all day at my law practice and traveled prone in the back of Katie’s station wagon or in the back of accommodating realtors’ or clients’ cars. I avoided sitting, even at closings, though that made me the subject of intense curiosity, and subjected me to other peoples’ sore back stories which, to my surprise, nearly everyone had. Keith “manipulated” and “adjusted” and “stimulated” my lower back every other day. At a minimum, Keith’s efforts served to pay his mortgage that month.
“The difference between how a herniation presents and how a strained gluteus maximus presents is subtle,” he started to explain one day.
“Unh,” I grunted in unsympathetic skepticism.
“If it’s just a ‘bulging’ disk, it can recover,” he reassured. “You definitely don’t want surgery.”
He was right about not wanting surgery. However, at Katie’s insistence, we sought a second opinion from an orthopedist. “If it’s merely ‘bulging,’ the chiropractor is correct,” said Dr. Bellotti, after probing my lower back for a brief instant, sufficient to nearly make me scream. “But I think yours is fully ‘extruded.’”
“What does that mean?” I asked.
“You know how when an egg breaks, you can’t put the yolk back in the shell?” said the doctor. “That’s fully extruded.”
Dr. Bellotti referred me to Dr. Quain, whom he described as “the best neurosurgeon around.” Katie drove her human cargo across the George Washington Bridge to his office at Columbia Presbyterian Hospital the next day. There, Dr. Quain, a bald, sixty-something man of imposing girth and booming voice, banged my kneecap for a reflex that elicited no response and declared, like in the movies: “you’re not going home tonight. We will operate at dawn.”
“But the chiropractor said…” I started
“Chiropractors are merely one evolutionary step above slime,” he said in a tone that allowed no disagreement. “Your extrusion is extreme. Your sciatic nerve is completely blocked, so we must remove the disk material. When there’s no reflex, effective use of your leg is at risk.”

Sciatic nerve? Worse and worse. I was learning additional new vocabulary, and now I was slated for emergency surgery. The situation had only one consolation: my room on the twelfth floor at Columbia Presbyterian had an unobstructed, priceless view of the George Washington Bridge. I gazed at it all evening from my unmoving position in bed while I awaited the excavation of my lower back. I recall being delighted the bridge’s lights danced like fireflies, but I’m sure painkillers had something to do with my enchanting vision.

I recall little from the day of surgery except that Katie told Dr. Quain sternly: “You’re going to perform the surgery, right? Not an intern.” In this instance, her tone of voice allowed for no disagreement. The doctor agreed.
When I awoke after surgery, I felt instant relief, as though the herniation had never occurred. Once painkillers wore off, I experienced spasms for several days while the sciatic nerve reverted back to its old route down the spine. (More acquired knowledge!) But the interesting part of the experience was that the doctor did not visit me the next day.
“Does the scar look okay to you?” he asked Katie on the phone.
“I guess,” she said.
“Then he’s okay for discharge,” said Dr. Quain. “Come see me in a month. Meanwhile, have him take it easy.”
“That’s it?” she asked.
“He’ll be fine,” said the doctor. “Good-bye.”

One month later, now totally pain-free, Katie and I visited Dr. Quain. He looked at his handiwork briefly, and concluded: “Looks good. Now, nothing but walking or swimming for you.”
“For how long?” I asked.
“For life,” he said.
“But I play tennis, and soccer,” I said. “I want to play with my children, too.”
The doctor shook his head.
“What about physical therapy?” asked Katie.
“Not necessary,” said Dr. Quain.
Katie was not convinced. “I’d like a physical therapy prescription, in case he feels up to it.”
The doctor shrugged and wrote out a sheet. “Twice a week, if you insist,” he said. “But not before six months. Just remember, I’m not in favor of strenuous activity.”

Taking the doctor’s words to heart, I treated my lower back like a Tiffany egg. I didn’t touch it. In accordance with suggestions from “bad back” magazine articles (practically an entire genre) I made sure to exit cars with both legs first, to never twist around to reach behind, to roll out of bed without abrupt movements. I warded off physical contact with the kids, and let my racquets gather dust in the closet with my golf clubs.
Exactly six months after surgery, Katie scheduled a physical therapy appointment for me.
“Are you sure this is a good idea?” I asked.
“No,” she said. “But you’re going to try it. You can’t just give up all activities in your mid-thirties.”
She was right. I had to try, but how could a stranger touch my lower back? I barely ran my fingertips over the scar when I took a shower. I pictured it as a hot-spot of total disaster, like the button for a nuclear weapon.
When I arrived at the office for my appointment, I was relieved to see my randomly assigned therapist, Susan. She was a petite blonde, about five-foot-two, and clearly not capable of inflicting pain. I wondered if she worked with adults or only small children. Her hands looked too small for her profession.
“So, what have you got?” she asked.
I lifted my shirt to show her my small scar just above the belt-line.
“How does it feel?” she asked. “Does it hurt?”
“I don’t know,” I said. “I never touch it.”
“Never?” she said, “for six months?”
“Doctor Quain said to ‘take it easy,’” I said, sheepishly.
“Ah, Dr. Quain. He’s ‘old school.’ Doesn’t believe in therapy and, incidentally, he believes his ‘cure rate’ is better if his patients never move. Lie down and lift your shirt,” she said, with a smile in which I thought I detected a glint of sadism.
Apprehensive, I arranged myself carefully on the therapy table. “Are you going to touch…?”
Before I could finish my sentence, Susan plowed into my scar with her knuckles, as though she were kneading the toughest cookie dough in history. In my shock, I almost screamed in anticipation of the tsunami of pain waves that were rushing at me. Then I realized, I felt… nothing at all. My back was totally healed.

For two months, I visited Susan twice a week. She provided a regimen of stretches. I commenced performing them daily to keep my back in shape. It is fair to say that my lower back is now the strongest part of my body; it’s the only part that has been exercised at least 350 days a year for twenty years.
I resumed playing soccer with the children shortly after therapy ended, and I play vigorous tennis now. I am still careful to “bend my knees” when I lift something, to avoid excessive sitting, and to walk every day. I am a BELIEVER in physical therapy, which will doubtless be necessary again. Let’s see, occasionally clamoring for attention these days are the right elbow, the left knee, and the right wrist. Time does not go backwards.


It has been said that “surgery is minor so long as it happens to someone else.” But if that “someone else” is your spouse, on the major-minor continuum, even if the physical slicing of flesh is happening to a different individual, it’s major. Believe me.
This past week saw my wife, Katie, operated on for repair of her rotator cuff. Because her pain level was manageable when she initially visited the orthopedist last month, she expected he would detect a minor irritation in need of treatment, followed by a week of physical therapy. She was shocked when an MRI revealed a major tear. Apparently, years of tennis had separated three crucial ligaments from the bone. Without repair, explained the doctor to our astonishment, her arm would be ruined. He was so convincing I didn’t express my habitual suspicion that he simply desired a new Lexus.
One month later, when we finally arrived for surgery at the ACC (Ambulatory Care Center, though everyone at UNC thinks of the Atlantic Coast Conference) the receptionist said: “We don’t have you on the list. Are you sure you’re scheduled for today?”
Since Katie had had innumerable confirmations from the surgeon’s office, the question barely merited a quickening of our heartbeats. After a few minutes of panic by the receptionist and her assistants, (the ACC is fully staffed, to say the least) the appointment was confirmed, and we proceeded to “intake.” There, an assortment of doctors, interns, nurses, anesthesiologists, ombudsmen, and their respective assistants and adjuncts, proceeded to introduce themselves while we sat dazed.
“They may kill you with kindness,” I whispered.
“Shhhh,” said Katie.
After fifteen minutes of meet-and-greet, I was ushered to the waiting area while the surgery took place. I returned to the recovery unit three hours later to find an understandably bedraggled and bedrugged wife, babbling cheerfully thanks to pharmaceutically-induced relief. It would be twenty-four hours before she had sensation in her left arm. By the time of discharge, the next morning, major doses of Tylenol and oxycodone, accompanied by a “pain ball” filled with narcotics, were keeping the pain in check.
“This is going so well,” said Katie, in a rare moment of naiveté.
“Wait’ll that pain ball is empty in two days,” I said, in a customary moment of doom-and-gloom.
Unfortunately, I would prove correct in that regard. Still, the recovery was going well, and we were sent home. Upon arrival, Katie took control of the living room like Russia took control of Crimea. Her domination became absolute from the staging area of the lounge chair. An ice machine squealed 24-7 while she sat/laid/lounged (not in the fun way) the days away. A huge sling, like a medieval contraption of war, immobilized her left side. Somewhere, beneath its straps, pads and levers, was her newly excavated shoulder, healing.
There was a surge of pain on the third day when the “ball” was empty, but the next two days showed marked progress. Now, the oxycodone has been almost eliminated from the routine and Tylenol is lessening. The stronger, morphine-like back-ups were unnecessary. After visiting the doctor yesterday, to celebrate the progress, we treated ourselves to a quick biscuit breakfast at Hardees.
More disposed by temperament to Nurse Ratched than to Florence Nightengale, I am doing my best to provide water, food, fresh ice, blankets, encouragement, foot-rubs, reading materials, television and music. So far, my efforts have proved satisfactory, if I say so myself. But it’s only been five days; the sling is on for five weeks, so “mission accomplished” cannot yet be declared.
One of the nicest aspects of this experience has been the kindness of our neighbors. They have provided an abundance of meals, snacks, flowers and visits. I’ve had to manage traffic at the front door.
“Perhaps, we should periodically fake a surgery,” I suggested, “just to find out who really loves us.”
Needless to say, Katie did not indulge me with a response. She has been admirably stoic throughout this experience. While I would be wallowing in self-pity in her position, her complaints have been largely confined to imbecilic responses received from service providers, like the resident who, when asked about colace-resistant constipation, suggested a name-brand product that drew a belly-laugh from the pharmacist, since it consisted of the exact ingredients as colace. In the same vein, three nurses at the ACC warned Katie of likely reactions from doses of the pain-killer neurontin, though Katie’s records indicated in block letters she is allergic to it. Each time, Katie patiently, but incredulously, directed them to the drug-allergies section on the chart.
Surgery has allowed us to ponder the likely-related subject of aging. Is this a one-time event for this decade, as were my back and knee surgeries in my thirties and forties, respectively, or is this a harbinger of frequent procedures as we travel the back-nine of life? I sure hope it’s the former because, while we enjoy spending time together, this is NOT the way to do it.