Surgery Dates Scheduled

After some careful consideration regarding how to continue treatment for Jim, we decided the best fit option for our family was to pursue a civilian doctor.  We are quite grateful to the dermatologist at the VA hospital who finally figured out what was going on with Jim's hands, but had to make the choice between traveling for surgery or checking out our civilian Spokane options.  

Today, we saw Dr. Sears (thank you for the many recommendations!!) and have two surgeries scheduled for June - 9th and 25th.  Dr. Sears recommended proceeding with the "Mohs" surgery.  We had been researching that procedure, as Jim's VA doctor had mentioned it as well.  If you are really curious, the site http://www.mohscollege.org/about/ has good information.  His first surgery will be on the spot on his left hand, between his pinky and ring fingers.  In addition to the surgeries for the two confirmed SCC spots, Jim will be starting a medication (acitretin) to hopefully slow the growth of the SCC cells and clear up some or all of the precancerous cells. 

It was interesting (and relieving!) to learn that Dr. Sears has seen this type of thing before - mix of cancer cells and actinic keratosis covering a larger area.  He agreed with the G.I. that the immunosuppressant drug (imuran/azathioprine) is probably the culprit.  He said it happens sometimes when patients have been on immunosuppressants for an extended time period and also agreed that stopping that medication was a good call.  So, overall, we both are feeling very relieved to be in the right hands moving forward and to have a plan in place.  Thank you for the well wishes and positive thoughts.  We both are feeling very positive.    

Some Good, Some Bad

Finally, the biopsy results are back.  Jim learned that the biopsy at the base of his thumb is squamous cell carcinoma (SCC).  The other biopsy is "hyperkeratotic hypertrophic severe actinic keratosis" - which I believe is like a precancerous spot/condition, often found with squamous cell carcinoma.  So, the good news is that this is still SCC and NOT melanoma, and only one of the two new biopsies was cancerous.  Whew.  The bad news is that there is another positive SCC biopsy (one on each hand now) and that the margins were again not clear.  Jim's dermatologist did cauterize the biopsy location fairly aggressively and is hopeful there are no longer SCC cells present there.

At this point, we have some questions to address with the dermatologist and then need to explore Jim's treatment options, including requesting a referral to a civilian doctor.  Jim will need surgery on his previous biopsy site and possibly this current spot by his thumb as well.  Our only VA surgical options would require traveling to Seattle.  Both of us would much prefer to work with a physician in Spokane.  Jim does have medical insurance, so this option is looking promising for us.  Thank you for your referrals, we have a couple of names of doctors we will look into contacting.

Jim's sores from his latest biopsies are healing well.  He has finally shed his daily hand wrapping, as the skin is finally not as sensitive as it had been.  We both are doing very well.  I think our biggest frustrations stem from things moving slowly, but we are hopeful and positive regarding our next steps and how this will continue.  Thanks for your support and well wishes.  We will definitely get through all of this.

Some Interesting News

We might have figured out a major factor that has led to Jim's skin cancer.  Last week, his dermatologist requested that Jim visit his G.I. doctor to discuss discontinuing his Crohn's medication.  This med comes with a strong warning about increased sensitivity to the sun and much higher risk of sunburns, even after just a short amount of time in the sun.  Thankfully, Jim's G.I. doc was able to work him into his busy schedule today.  

Jim has been with this doctor for well over a decade.  He has always been a blessing to us - from helping me understand this disease that had sent my new hubby to the hospital, to overseeing his resection 9 years ago, to the continued care in the years since that surgery.  We have always felt extremely confident that Jim has received the best possible care for his Crohn's.  True to form, his G.I. began researching Jim's situation, medication, and history, as soon as his latest medical files crossed his desk.  He believes, beyond a shadow of a doubt, that the medication Jim has been on for quite some time is the cause of the skin cancer.  The research he did concluded that long-term use of this medication can lead to skin cancer.  Starting today, Jim is discontinuing that medication.  It will stay in his system for about three months, so hopefully his Crohn's disease will handle the change well.  In addition to monitoring his Crohn's symptoms carefully during this time, Jim will also have to be extremely vigilant about sun exposure as those side effects will also take time to wear off.  I suppose his wife's extra nagging has been appropriate!  And, that sun hat he bought years ago is suddenly no longer hideously unattractive. :)

We have not heard from Jim's dermatologist regarding the latest two biopsies.  While it absolutely stinks to wait, it doesn't necessarily mean bad news.  Jim did learn his dermatologist is out of the office this week, so we cannot read anything into the length of time for results.  She is scheduled to return Monday.  Hopefully we will hear something soon.  In the meantime, his biopsy sites are healing well. 

The spot near the base of Jim's thumb is one of his most recent biopsy locations.

Jim's hands 5/1/14