It Ain't Over

One of the questions on my list was "what about the splotches near the site where I've been diagnosed with melanoma"?  (OK, the question just said "what about the splotches," but I felt I needed to elaborate).  I explained to the surgeon that my dermatologist had done a biopsy somewhere in that splotcy area over a year ago, and the results came back negative, but now the splotches were starting to look a bit scary.  He explained that the margin he would use in cutting out the cancer would include some of the splotcy area, and that the lab would be able to determine whether that area also had cancer.

So my surgery isn't done--he gave me a temporary stitch until Tuesday, when I have to go back in.  He said he should have the lab results back--probably with only a few hours to spare--but wanted to move quickly either way.  If the splotchy are also is cancerous, he will do more cutting; if it's not, he will stitch up the original wound.

But I didn't realize he was asking me to come back this Tuesday--3 days from now.  I had in my mind the "5-7 days" for the return visit, and assumed he was allowing a little more time.  It wasn't until the third time the date was mentioned that I indicated I thought he was talking about a week from Tuesday.

This matters because we were supposed to go to the beach this morning.  I didn't mention to the doctor that I was planning to be in a car for several hours less than a day after my surgery--I knew what he would say.  But having to go back in for surgery on Tuesday clearly threw a wrench into everything.

So we've been discussing as a family what to do about the beach.  For one thing, I don't feel well, although am getting slightly better.  For another, the would extends to one corner of my lip and covers a fairly large area of my cheek beyond that, and I can barely open my mouth.  The assistant had said not to eat anything like a burger for last night's meal.  I had trouble eating tuna fish and spaghetti.  Basically had to eat with my hands to shove the food into a small area.  And brushing and flossing my teeth was tough on the left side, where the would is.  If I open my mouth too much or too wide, I think it increases the bleeding.

The reality seems to have set in more for my husband and son, seeing me with a bandage over half my face.  My husband was confused about the whole Tuesday issue ("I thought it was supposed to be 5-7 days"); I had explained it, but explained it again.  I may have more cancer.  They may have to cut more.  I didn't mention the other thoughts that are in the back of my head--what if the splotchy stuff is melanoma, but not in situ?  And how much will he have to cut, since the splotches are spread out?  I'm trying not to think about that.  But it's there.

My son's having difficulty dealing with the uncertainty of the trip, but is trying to be adaptable.  And before he left this morning he said he loved me and hugged me--very long and very tightly.

 

Are We There Yet?

This week is inching by.  I wake up and try to remember what day it is, and whether it's a yoga teaching day, and if so which one, so I can orient myself to the class time and location.  But this week it seems like it should be later--today should have been tomorrow, or Friday.  Friday, when I have my surgery to remove the melanoma on my face.  Friday, when the cancer that seems to grip my cheek will be scraped away.  I keep thinking ahead to all the things I want to take care of before the surgery, since I'm not supposed to bend over, lift anything, or do anything strenuous for a couple of days.  Here's what the surgery center website says:

If your wound site is located above the shoulders, you should be cautious not to stoop or bend over for the next 48 hours. For example, we urge you to lift your foot up to you rather than bending over in order to change or tie your shoes. No lifting, straining, or exercise should be done over the next two days. Any of these activities or anything that rapidly raises your blood pressure will put pressure on the healing blood vessels causing them to bleed. Also, keep your head elevated while sleeping.

I know it's only 2 days, but staying upright and doing very littie will be a challenge, since we're planning to travel the day after my surgery.  Who goes to the beach the day after they have melanoma removed?  Oh, well, I didn't want to disrupt the family plans.  But I also didn't want to wait any longer to have the surgery.  Waiting until Friday is already too long.

Why am I eating eggs?

I had eggs down on my shopping list, because I decided I should eat them more than once a week (when we go to Sunday brunch).  But now I can't remember why I'm supposed to eat them more often.  Oh- I found it--the yolk has carotenoid, the same substance that's found in deep yellow/orange fruits and orange and dark vegetables.  And that may help prevent development and growth of melanoma.  Which is why I bought a mango (deep yellow); tried to buy apricots but realized I have no idea what they look like, or whether stores even sell them fresh; had broccoli last night and will have carrots tonight.  Not to mention rosemary (somewhere someone said something about herbs and preventing melanoma).  And purple grapes and red wine (for the resveratrol, which may inhibit formation of melanoma).

I had a stomach ache this morning--not sure if it was something I ate yesterday, or anxiety over my impending surgery, or both or neither.  I was worried about teaching yoga feeling that way--unlike an office job, where you can still function when you don't feel well, yoga requires one to be "on"--guiding the practice, demonstrating poses, answering questions.  I took a Pepto Bismol and was fine for the class--felt very comfortable, in fact.

Maybe it's my body adjusting to more fruit, or different fruits.  Melons!

It's all right, Ma

My son asked me today how I was feeling about the surgery and everything.  I thanked him for asking; it gave me an invitation to speak slightly openly about my fears and concerns.  I said I was more curious than concerned about the surgery--how much beyond the cancerous splotch will they cut out; what kind of would closure will they opt for--open, stitches or skin graft.  But I said I was focused more on the future--since the research says once someone gets melanoma they're likely to have it elsewhere.  I said I was researching what I could do to prevent future occurrences, to the extent that prevention is possible at this point.  Hence the focus on diet--eating the melons and grape in the fruit medly that comes with our Mexican food, for example, instead of the pineapples and strawberries (I can't eat everything).  And I mentioned that I'm wearing a stronger sunscreen on my face.  But I also said I look at all the spots on my skin and wonder which ones might become cancerous.  I don't really know how much he took in, and I stopped before I started to sound to obsessive and worried.  But I was glad he asked.

A whiter shade of pale?

I use Neutrogena spf 55 for my sunscreen, at my dermatologist's recommendation.  But I've been using CeraVe a.m on my face (also at her recommendation).  CeraVe contains ceramides, which are supposed to be good for the skin, and is available at drug stores for around $15--quite a bargain compared to the expensive department store products.  But CeraVe a.m. doesn't say it's broad spectrum, so I thought I needed to switch to something that would block both UVA and UVB rays.  (According to Wikipedia, UVA rays can increase the rate of melanoma--and many sunscreens do not block UVA rays.)

CeraVe has a new facial sunscreen product that's SPF 50 (CeraVe a.m. is SPF 30) and the tube says it's a broad spectrum sunscreen.  I'm looking at the two products side by side--the difference is that CeraVe sunscreen face lotion has more zinc oxide (4.7% vs 3.5% for a.m.) and also has titanium dioxide; CeraVe a.m. does not have titanium dioxide.

According to WebMD, the following ingredients protect against the melanoma-causing UVA rays:  ecamsule, avobenzone, zinc oxide and titanium dioxide.  (Neutrogena has avobenzone.)  So the CeraVe sunscreen face lotion has better  UVA protection than CeraVe a.m.  I tried the sunscreen face lotion this morning--I looked like I was making up to be in a Noh drama--I got that "ghostly white" look that one website said used to be a problem, but no longer was with newer versions of products containing zinc oxide.  Oops, they were wrong.  The CeraVe instructions on the back of the tube say the product "...spreads easily and dries with a clear finish..."  Clear white, that is.

I'm not giving up on the CeraVe sunscreen--I really like CeraVe products.  And if the sunscreen face lotion helps protect against (more) melanoma, then I'll just have to look a bit ghostly.

They drink ouzo, don't they?

The Mediterranean diet--that's what one web site says can help prevent cancer.  But what does that mean beyond "eat more fruits, vegetables and nuts"?  Are they including pizza?  After all, Italy is on the Mediterranean, isn't it?  I don't see much reference to the types of carbs people eat--I didn't think Mediterranean countries were big on whole grains.

Red wine, apples, broccoli, tomatoes, avocados, citrus fruits when consumed in large quantities (?).  Did I mention red wine?  That's what one web site says can help prevent melanoma.

Most skin cancer-related websites don't even mention diet--they just focus on protecting the skin from the sun.  But I'd like to do more--it hopefully can't hurt and may help.

Here's the dietary run-down after scanning several websites and articles that do mention diet and melanoma:

Antioxidants can help protect the skin from harmful sun effects--foods include fish, beans, carrots, pumpkin, broccoli, green tea.  I'm leaving out foods I'm not going to eat, like chard.

Apegin (a flavenoid, whatever that is) may help prevent melanoma from forming, according to an article on Livestrong.com; foods with apegin include onions, broccoli, celery, tomatoes, apples, cherries, grapes.  Tea and wine also contain apegin.  (Article wasn't specific--green tea and red wine?)

Resveratrol is a flavonoid, also found in red wine, which may inhibit the formation of melanoma (according to the same Livestrong.com article, written by Sara Ipatenco (June 12, 2011).  "Adding a glass of red wine to your daily diet is one way to increase your consumption of this beneficial antioxidant."  I'm already on the case--switched from one glass of white to one glass of red each day.

Tumeric, an ingredient in curry, has certain anti-cancer propertie.  Same Livestrong article--she in turn is citing the University of Maryland Medical Center (UMMC).

Carotenoids are found in deep green and yellow/orange foods--carrots, sweet potatoes, cantaloupe, as well as dark green vegetables.  May help prevent development and growth of melannoma.

The one rigorous study I found (googling "diets that prevent melanoma") says the most consistent result was that "greater intake of carotenoids are associated with decreased risk for melanoma, while greater alcohol intake may increase the risk for the disease."  So there you go--supporting my assertion that the more research you do, the more confused you'll get.  (The study is "Diet and Melanoma in a Case-Control Study" Amy E. Millen et. al. (Cancer Epidemiology Biomarkers and Prevention June 2004 13; 10420.

I only read the abstract of the above study, but I see no indication that the authors controlled for the type of alcohol consumed.  So I'm holding out hope that the red wine drinkers may have had different (better) outcomes than the beer drinkers (for example).

And the UMMC website (last updated May 7, 2013, so much more current than the 2004 study) cites resveratol as a substance that may help protect the skin from sun-related damage.  In addition to apigenin, curcumin (tumeric), and resveratrol, the UMMC website also cites Quercetin--a flavonoid (there's that word again!) found in apples and onions--as a skin-protecting substance.

Guess I'll start eating those cantaloupe chunks they give me with my quesedilla.

Wrists and knees and table balance

I specialize in teaching yoga to seniors, and strive to help improve their strength, flexibility and balance.  But I also have to modify poses and moves based on who's in the class.  One of the sequences I really like to do is table-child-table balance (where you balance on one knee and hand, while the opposite leg and arm are extended.  The pose improves balance and strength, but since you're close to the floor, it's a safer way to practice balance than standing.

But especially in two of my classes, people either have knee or wrist issues that make table and table balance difficult.  In another class, one lady has rheumatoid arthritis, and her wrists are swollen and painful.  I've offered modifications to people--for wrist issues, they can rest on their fists, for knees they can do poses and moves in a chair or near a wall.  For the arms, people can also balance on their forearms, but that is more challenging for the low back, especially if they aren't able to keep a firm low belly.

I'm thinking I should eliminate table and table balance from my senior repertiore--but then I need to add other poses and moves to compensate.  I may still try to do low plank and puppy/down dog, which start with table but don't stay there.  We'll see.  I'll need to add more seated work, and more standing (including at the wall).  Chairs aren't an option in two classes--the chairs they have are too big and cumbersome.  And I tried the folding chairs in another class, but they seemed to get in the way more than anything.  And I don't think people will want to sit in chairs--I think they pride themselves on being able to do "real yoga"--once they start sitting in chairs, it's "chair yoga".  For old people who can't do "real yoga".  Or maybe I'm just imagining that.  They all are able to get up from the floor to standing and back down again--a big plus.  I just need to be creative.  With senior yoga, the range of poses may be more limited than with a regular class, but there are more options for creative warm-ups, stretches and balances.

I wish I had a network of senior yoga instructors to consult with and learm from; mabye through Yoga Alliance we can develop that.