CONTACTS 

SUBJECTS
Nose Minor Outpatient Surgery Remove Cancer Blemish Mohs Procedure E

1603 -
1603 -    ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 63 0000. ref SDS 62 0000.
160502 -
160503 - Surgery was performed in the Dermatology clinic.  Excellent work and
160504 - good guidance for follow up.  Stopped at VA in Martinez and scheduled
160505 - follow up examination for 080311. ref SDS 0 MJ6R  There was some
160506 - swelling and minor bleeding in the evening.  This was resolved using
160507 - instructions from Doctor King. ref SDS 0 PSQQ
160508 -
160509 -     [On 080229 changing the bandage worked well. ref SDS 64 0001
160510 -
160511 -
160513 -  ..
1606 -
1607 -
1608 - Progress
1609 -
160901 - Travel to VA Sacramento Dermatology Clinic Building 801
160902 -
160903 - Follow up ref SDS 63 HS6G, ref SDS 62 HS6G.
160904 -
160905 - Lisa's letter on 071223 gives a building number where work will be
160906 - performed at the VA facilities in Sacramento. ref SDS 63 WM9Y  Driving
160907 - instructions are shown in the record on 060125, ref SDS 40 EG36, for
160908 - work done at the VA Sacramento facilities on 060330. ref SDS 47 446F
160909 -
160910 -
160912 -  ..
1610 -
1611 -
1612 - 0705
1613 -
161301 - Arrive at Building 801 Dermatology Clinic.
161302 -
161303 - The door was locked, but an attendant had arrived and let us in the
161304 - building.
161306 -  ..
161307 - Millie walked over to the main hospital building to get breakfast in
161308 - the cafeteria, waiting until the meeting at 0830.
161309 -
161310 -
161312 -  ..
1614 -
1615 -
1616 - 0809
1617 -
161701 - Preparation Surgery and Consultation
161702 -
161703 - Lisa did the setup.
161704 -
161705 - Met Lisa and Doctor King; they were professional, competent, and a
161706 - delight to work with on the project.  The doctor explained each step
161707 - of the surgery.
161709 -  ..
161710 - Vitals:  BP - 120 72; Pulse - 68.
161712 -  ..
161713 - Lisa connected grounding equipment for an electronic cauterizing
161714 - procedure.
161716 -  ..
161717 - Lisa and the doctor accomodated the achalasia condition, allowing some
161718 - vertical elevation, rather than lying completely flat, which is
161719 - normal.  It turned out the Mohs surgery procedure is very fast,
161720 - lasting less than 20 minutes, so this does not present a significant
161721 - problem for achalasia.  I actually vomitted prior to seeing the
161722 - doctor, so this helped reduce the risk of problems from lying flat.
161723 -
161724 -
161726 -  ..
161727 - Surgery Mohs Procedure Remove Cancer Blemish from Nose
161728 -
161729 - Doctor King explained the procedure, which aligned with documentation
161730 - received from Lisa on 071229. ref SDS 63 7T6M
161732 -  ..
161733 - This will remove an approximate .25 inch diameter area of skin tissue
161734 - on the left side of the nose.
161736 -  ..
161737 - The doctor asked how long the condition has persisted?
161739 -  ..
161740 - Duration is hard to estimate, because rosacia has caused various bumps
161741 - over the past 3 years.  Treatment has caused these to subside;
161742 - however, the current problem has persisted.  It is difficult to
161743 - differentiate when the cancer occurred.  Perhaps 1 - 2 years, maybe
161744 - less.
161746 -  ..
161747 - The doctor seemed to indicate the current condition is small and mild
161748 - compared to severe cases.  He indicated that not treating the problem
161749 - risks losing the nose over time.
161751 -  ..
161752 - The anesthetic is a painful experience that lasts about 20 seconds or
161753 - so, when a needle is used to inject numbing agent.
161755 -  ..
161756 - Surgery is performed immediately after the injection for anesthetic;
161757 - which takes effect quickly.
161759 -  ..
161760 - The doctor uses a curet to scrape the cancerous tissue.  He also
161761 - explained using scissors at one point, possibly to apply a temporary
161762 - bandage/dressing.
161763 -
161764 -
161766 -  ..
1618 -
1619 -
1620 - 0828
1621 -
162101 - Released to the waiting room while tissue removed by surgery is
162102 - analysed to assess clear margins, called out in the literature on
162103 - 071229. ref SDS 63 7T6M
162104 -
162106 -  ..
1622 -
1623 -
1624 - 0858
1625 -
162501 - Lisa reported additional surgery required to accomplish clear
162502 - margins.
162504 -  ..
162505 - A drawing prepared by the analyst of the initial surgery shows there
162506 - is a very small amount of cancerous tissue remaining on the lower
162507 - rim of the .25" cancerous area.  This would be approximately .05 x
162508 - .05 inches.
162510 -  ..
162511 - Doctor King did another injection for anesthetics.  This was barely
162512 - felt, indicating effects of first injection were still active.
162514 -  ..
162515 - The doctor used the curet again, which takes only seconds, and then
162516 - used the electric cauterizing tool again.
162517 -
162518 -
162520 -  ..
1626 -
1627 -
1628 - 0911
1629 -
162901 - Waiting for assessment of clear margins on 2nd pass of surgery.
162902 -
162904 -  ..
1630 -
1631 -
1632 - 0942
1633 -
163301 - Called back for further work.
163302 -
163303 - Clear margins achieved.  The doctor decided the wound can heal on its
163304 - own rather than perform a skin graft.
163305 -
163307 -  ..
163308 - Pre-cancerous Conditions Require Avoiding Sun Exposure
163309 -
163310 - The doctor reported observing a number of pre-cancerous areas on the
163311 - nose.  He feels this may be a genetic condition of long-term exposure
163312 - to the sun.  He recommends staying out of the sun.  Related experience
163313 - in Vietnam of being hospitalized for severe sun burn, with the face
163314 - very bloated for a week.
163316 -  ..
163317 - The doctor wants follow up examination in 3 weeks.  This can be done
163318 - at the VA in Martinez to save a trip to Sacramento.
163319 -
163320 -        [...below, scheduled follow up for 080311. ref SDS 0 MJ6R
163321 -
163322 -
163324 -  ..
163325 - Post-op Instructions
163326 -
163327 - The bandage should stay for 2 days.
163329 -  ..
163330 - Ice the wound area with the bandage in place for 20 minutes about 3 or
163331 - 4 times per day for 2 days to reduce swelling, and speed healing.
163332 - Put a cover over the bandage to prevent the bandage from getting wet
163333 - by the ice process.
163335 -  ..
163336 - The doctor explained there may be some minor bleeding of the wound.
163337 - He recommended keeping the head elevated above the heart for several
163338 - days.  Doctor King demonstrated a pinching procedure to stop bleeding,
163339 - if it occurs.  He said to get treatment at the VA for any problems
163340 - stopping bleeding or if continual pain is experienced.
163342 -  ..
163343 - Minor pain can be treated with aspirin.
163345 -  ..
163346 - On the 3rd day, take a shower and remove the bandage.  Pat the wound
163347 - area dry.
163349 -  ..
163350 - Apply treatment received today that keeps the wound continually moist
163351 - with a bandage.  Lisa provided a supply of ointment and band aids.
163352 -
163353 -     [On 080229 changing the bandage worked well. ref SDS 64 0001
163354 -
163355 -     [On 080311 0830 follow up examination indicates surgery to remove
163356 -     minor cancer on the nose was successful. ref SDS 65 HS6G
163358 -  ..
163359 - Avoid bending over for a few days that causes blood to flow to the
163360 - head, which could cause bleeding of the surgical wound on the nose.
163362 -  ..
163363 - Lisa submitted written instructions to confirm verbal explanations
163364 - during the meeting today.
163365 -
163366 -
163367 -
163369 -  ..
1634 -
1635 -
1636 - 1143
1637 -
163701 - Schedule Follow Up Examination at VA in Martinez
163702 -
163703 - Driving home, we stopped at the VA in Martinez to schedule follow up
163704 - examination, per Doctor King's instructions shown above. ref SDS 0
163705 - WX9I
163706 -
163707 - Scheduled meeting for 080311 0830.
163708 -
163709 -     [On 080311 0830 follow up examination indicates surgery to remove
163710 -     minor cancer on the nose was successful. ref SDS 65 HS6G
163711 -
163712 -
163714 -  ..
1638 -
1639 -
1640 - 1205
1641 -
164101 - Minor Swelling and Bleeding Surgical Wound Resolved
164102 -
164103 - Arrived home.
164104 -
164106 -  ..
1642 -
1643 -
1644 - 2021
1645 -
164501 - Had some delays configuring an ice application to treat the wound per
164502 - recommendations. ref SDS 0 MJ90
164504 -  ..
164505 - Eventully got this working.
164507 -  ..
164508 - The nose became noticably swelled by about 1700, but subsided with
164509 - icing.
164511 -  ..
164512 - There was some periodic bleeding.  This was stopped using the method
164513 - of pinching the wound, as demonstrated by the doctor. ref SDS 0 6G4M
164515 -  ..
164516 - Bleeding and swelling seem initially associated with activity, e.g.,
164517 - jarring from walking up and down stairs, even eating seems to cause
164518 - bleeding; so will have to take it easy for a day or two.
164520 -  ..
164521 - Submitted record to Lisa for comment to clarify or correct
164522 - understandings.
164523 -
164524 -
164525 -
164526 -
164527 -
164528 -
164529 -
164530 -
1646 -