Wednesday, November 13, 2024

Mohs - the procedure...

The thing I was most dreading about the mohs procedure were the numbing shots. After three cutting sessions with my dermatologist in the past two years, my experience was that shots in the nose are an awful, if short-lived, little torture. At least the first shot is. And each shot gets less and less painful until you can't feel them anymore. At that point, if your eyes are closed, the only indication you're still getting shots is liquid lidocaine dripping down your numb check.  

I've tried to explain the experience to my husband, and this is the best I can come up with... It's like getting a punch in the nose without the punch. It's just all pain delivered in a concentrated spot at the end of a needle. It's short-lived, but it's the longest 15 - 20 seconds of your life. At least, that's how I've experienced shots in the nose.

Anticipating that, I mentioned as the surgeon pulled out the needle, "This is the worst part, I know."  To which he replied, "It shouldn't hurt too much."   Yeah, yeah yeah...  I've been gaslit about pain enough in the last few years, I should be glowing like a neon sign.

Not believing him, I braced myself and held my breath until the tiniest little sting landed on the side of my nose.  And then it went away. 

"Was that it?" I asked cautiously, sure that the worst was yet to come.

"That was the first shot"

"Wow. I barely felt it!"

"We pride ourselves on being as pain-free as possible."

"Wow," was all I could say in stunned disbelief.

There were more shots. Lots of shots. One of them, I did feel deep in my nose, but by that time I was so numbed up, it was mostly just annoying. Not pleasant, but not exactly painful.  

Done with the shots, I relaxed a bit as I thought, "Okay, this is going to be easy, because I know I shouldn't feel anything once I'm numb. "

After a drape (with an opening for surgery) was put over my face, I started to settle more into the chair.  I didn't even flinch when I felt a tiny sting move down the side of my nostril.  It was so tiny and so slow, it didn't register to me, at first, what it was.  But I must have made a noise, because the doctor asked if I was okay.  I casually said, "Yeah, I just think I feel a little burn." and he immediately got the needle back out.  "We don't want you to feel any of this."  Another shot or two later, he was at work slicing.  It was only then I realized I had felt his first slice.  It didn't hurt, exactly, but it makes me squirm a tiny bit to think about that.

I couldn't see or feel anything that was happening, but his surgical assistant was responsible for keeping my nose out of his way. She started by just gently bending it to the side, but eventually, it felt like she was using both hands and putting all her weight into flattening my nose to the opposite side of my face from where the surgeon was working. The pressure got so intense I asked with all sincerity, "Is it possible that you could break my nose?!?" She assured me she wouldn't break my nose, but there was no more relaxing for me!

I don't doubt that another tiny groan must have come out when the doctor told me to breath with my mouth, and to breathe deeply.  I tried, but with a drape covering my face (and mouth), breathing (at all) wasn't very satisfying.  Trying to breathe deeply didn't do anything to help - except for maybe it gave me something to think about while my nose was literally being bent out of shape. I guess that was really the goal.  Him cutting on me was nothing. Her pressing my nose to the side for the duration was...  well, I already said it - intense!

I'm sure mohs is a different experience depending on where the skin cancer is being removed from.  Not to mention differing skills and techniques of surgeons and assistants will likely create different experiences.  

I have no idea how long it took, but finally he had done all he was going to do, then he left to go on to the next patient while a nurse put a temporary dressing on my nose.  When I felt ready, I headed back out to the waiting room.  As I walked out, heads turned and I suddenly felt eyes on me.  I wasn't wearing my glasses with the dressing on, so I couldn't see anyone's faces, but I felt their eyeballs following me to my chair where I would sit and wait for who knows how long until I was called back again.

By this time, the waiting room was packed.  Assuming about half the people there were drivers for someone getting mohs, I estimate that there were at least 10 patients in the waiting room, and I have no idea how many were back in rooms.  And at some point, I heard the check-in person telling people they could wait outside - meaning out in the hallway.  Finally, putting my glasses on-ish to look around, I noticed everyone else had cute little bandages on their foreheads, noses, and ears.  A couple of people looked like they had little paper ketchup cups on their foreheads.  Thankful I wasn't sporting one of those, a glance around the room told me I was probably the funnier-looking one with my whole nose enclosed in gauze and tape.


Now that I look at the picture, I betcha there's a little ketchup cup under that bandage.

An hour or so later, and after watching many others go back to surgery and come out again into the waiting room, I was finally called back. As I got back into the surgical chair, I told the assistant, "I'm pretty sure I had the biggest bandage of anyone out there."  

She laughed.  

But she didn't deny it!  

She got me ready for the doctor, and I sat there nervously waiting for the verdict - prepared for the doctor to have to do more carving. But when he walked in, he announced, "We got it all!" 

"Really?!?"

"Yep.  I'm just going to stitch you up and you'll be able to go home". 

"How big was it?"

"About the size of a nickle, and about 3/4 inch deep."

"That deep?"

"Yep. I almost had to go all the way through."  I understood he meant making a hole right through side of the nostril.

Taking a deep breath, I sighed my relief as he explained the repair he was going to make.

Another drape, and I have no idea how much time passed as he worked on me again. First, he sliced down the entire length of my nose and about a half inch below my nose (about four inches in total, he said) and pulled cheek skin over to form a flap to cover the wound and he stitched me up.  I think he might have given me some instructions about getting right in for mohs if I should ever have another skin cancer show up before he left the room.  It was pretty anticlimactic.

Only thinking then to ask how many stitches were put in, the assistant said typically 6 stitches were used inside the wound, and she, right then, counted twenty stitches on the outside.


I happened to have my phone on my lap at this point, so I pulled it out to look at the situation with my phone camera.  I wish I had taken a picture of it at that moment before a bigger bandage was put on, because it was a beautiful stitching job. Before swelling commenced, all I could see was a nose that didn't look like anything had happened to it.  

But I'm getting ahead of myself.  Back to before the surgeon left the room... I asked about pain management. I started to tell him my normal M/O is to suffer, and I paused trying to think of the next words to say - with clearer head, those words might have been something like, "only to find out later I didn't actually need to suffer".  But I didn't get anything else out.  He took the opportunity the pause gave him to say, "Most people do fine with just tylenol - and ibuprofen once the bleeding stops."  By that time, I was exhausted and a bit dazed by the whole experience, and I accepted what he said - hoping it would be true.   

He left the room, on to the next patient or biopsy, and his assistant bandaged me up good and tight.  Giving me at-home instructions, she did tell me if I had pain into Friday to be sure to call them before they closed for the weekend.  Again, I was in a daze at this point, just wanting to go home and maybe take a nap.  I didn't question that those instructions could have been clearer. I was just relieved to be done with this thing I'd waited 10 weeks for. 

As I walked out into the waiting room, once again heads turned, and I imagined the looks I was getting now that I was sporting an even larger bandage.  Greg told me after we exited the building a little girl (who was at the entrance with her mother, he presumed) just stared at me with an open mouth as I passed.  Poor thing. I didn't even see her.

Next in the series:  the recovery

15 comments:

  1. Goodness me it sound horrific but at least they got it all and fingers crossed that’s it done forever. I hope you are always in a brimmed hat or have moisturiser with a good SPF on daily, you don’t want any more of this. Your posts keep reminding me to use my spf moisturiser..

    ReplyDelete
    Replies
    1. Horrific is a little strong, but it was definitely intense. And as much as it's in my power to not have to go through this again, I'll be trying to prevent it, but it's habits when much younger that are likely the reason I'm dealing with skin cancer today. That is the case for most people, I've learned. Anyway, this is a topic for a later post in this series. Stay tuned, Liz.

      Delete
  2. I had this procedure done on my face just under the eye. The nearness to the eye worried me, and there was a lot of repair to do, but now there's a scarcely perceptible white line. Almost no pain at all, very adept surgeon. But it's such a long tiring day. I waited alone between sessions in a consulting room, still observing covid precautions back then. You'll be happy once it's healed and you can get on with your life!

    ReplyDelete
    Replies
    1. Liz, I can imagine how worrisome it would be to have a skin cancer near the eye. Interestingly, the most uncomfortable part of my procedure was the surgical assistant bending my nose to the side. It was uncomfortable physically, but imaging my nose getting broken from the pressure she was applying was distressing psychologically. I have actually wondered if my perception of the pressure she was applyjng was exaggerated by half of my nose being numb.

      Delete
  3. How nice thay the lidocaine injections did not sting like normal. Those things can bring a tear to the strongest persons eyes. The ones in my neck for my thyrpid biopsy were quite painful. He sounds like a very skilled Dr. Is this a fairly bloodless procedure? From the depth he went I wouldn't think so.

    ReplyDelete
    Replies
    1. Marsha, I was shocked at how little I felt the injections. He must have used very small needles, but I also wonder if the dosage of lidocaine in each shot was smaller than normal. I do know the numbness didn't last very long. Just sitting out in the waiting room, I could feel the effectiveness of the the lidocaine wearing off. He had to give me multiple shots again right before he started stitching me up.

      Delete
  4. Thanks for being willing to share, Becki. Based on the number of people you saw there, it sounds very much like a shared experience for many people, yet it almost never talked about beyond the circle of people it impacts (like most things).

    And to the point above, a great reminder for sunscreen and wide brimmed hats.

    ReplyDelete
    Replies
    1. Thanks, TB. Mine is a cautionary tale - probably not as helpful for the demographic that is currently reading my blog, but if someone starts much younger than I am to protect themself from UV rays, they'll hopefully not find themself in a mohs surgeon's chair in their 60's, or even later.

      Delete
  5. Replies
    1. So glad you asked, Liz. Yes you were, but I got your comment above out of there! Blogger keeps us on our toes.

      Delete
  6. You are a brave soul. thank you for sharing your experience with us. I pray it was all very successful and that soon you will heal and be good as new. Praying for you to not be having too much pain or discomfort from it.

    ReplyDelete
    Replies
    1. Thank you, Pam. For your kind words and prayers.

      Delete
  7. Your descriptions were, well...... I couldn't read every word. Glad you not only survived the procedures but that they got it all. May your recovery go smoothly with no recurrences.

    ReplyDelete
    Replies
    1. I tried to not be too graphic, but I totally appreciate you knowing yourself, Barbara, and what might bother you. My hope in sharing how "intense" this procedure was to have on my nose - in the spot that the skin cancer was - some may be inspired to take more care of their skin. Then again, gauging by how many patients were in the surgeon's office just in the 2 1/2 hours I was there, I'm thinking most of humanity has to learn these things for themselves.

      Delete
    2. I went back and read the post a couple of days later, and I can see where I did get a little more graphic than I normally might - describing the surgery. I might have been bothered reading that if someone else had written it. ;^)

      Delete