My Brush With Melanoma

A few months ago, I had a dream that I was dying of skin cancer. For me, it is unusual to remember a dream and this one was so vivid that it disturbed me long after I woke up.

In the dream, the cancer started from a dark spot on my cheek. It was a mark that really existed and had for at least six years. The mark had become something of a joke because it resembled a gangster’s teardrop tattoo. (You can see it clearly in the picture above.) I had been getting regular checkups from dermatologists for several years. As we moved around the country, two different dermatologists had assured me that the spot was nothing to worry about, but that I should call them if it grew bigger or darker.

I already had my next checkup scheduled for the following month, but then things suddenly changed. I decided to accept a job offer which would require a move and, of course, new insurance. As I started the new job several states away, I had to look for a temporary place to stay as well as find a permanent home and get my family ready for the move. Through it all, as I waited for my new health insurance to become effective, the memory of the dream never left me.

It took longer than I wanted, but after we closed on our new home and moved in, one of the first things that I did was find a dermatologist. I didn’t really think that I had cancer since two dermatologists had examined the mark, but I wanted the peace of mind of another checkup, especially since one of my cousins had died from melanoma several years ago.

About three months after the dream, I went in for an exam. When the physician’s assistant walked in, he immediately noticed the mark. “How long have you had it?” he asked. “Has anyone ever done a biopsy on it?” The answer to that was no, so we decided to do one. A few minutes later, the nurse was scooping out a piece of my face to send to the lab. I left the office thinking that the biopsy would ease my mind.

Fast-forward to the next week when the PA called me with the test results. It was melanoma. Fortunately, he told me, it was small and seemed to be shallow. Nevertheless, they recommended having it removed and quickly.

If you don’t know, melanoma is the most serious type of skin cancer. Although melanoma makes up less than one percent of skin cancers, it is the cause of most skin cancer deaths. It typically spreads slowly, but if left untreated it can be deadly. In my cousin’s case, the cancer spread before it was discovered.

No one knows exactly what causes melanoma, but researchers have found certain risk factors that increase the likelihood. In my case, several of these risk factors apply to me. I have fair skin and got sunburned as a child. I have a lot of moles and, as I mentioned earlier, there is a history of melanoma in my family.

My primary occupation as a professional pilot also accounts for some additional risk. The risk factors of living at a high elevation or near the equator didn’t apply to me, but I have spent thousands of hours at high altitudes. The atmosphere protects people on the surface from much of the ultraviolet light and radiation from the sun, but jet crews and frequent fliers get a lot of exposure to solar radiation during high altitude flight.

It is telling that my melanoma was on my right cheek. I spent 10 years as a first officer sitting on the right side of the cockpit with my face near the side window. The melanoma was just below the area that my sunglasses cover.  

Earlier this week, I went back to the dermatologist and the doctor used the Mohs technique to remove the cancer. With this outpatient procedure, the doctor removes one layer of tissue at a time until all the cancer is gone. In my case, the cancerous tissue was sent to the lab to ensure that none of it was left in my body. At this point, I’m still waiting for those results before I go back to have the wound closed with stitches, but the prognosis is good.

The actual surgery was almost painless. The staff used a local anesthetic that didn’t require fasting before surgery. I could have even driven myself home. The prescription for pain pills went largely unneeded and unused. I was able to return to the cockpit for a trip the next day, jokingly explaining my bandaged face by saying, “Don’t mess with a redhead.” (My wife is a copper-top.)

After I get patched up, I’ll make frequent visits to the dermatologist for the next few years until we are certain that the melanoma won’t recur. Even after that, I’ll keep going back for checkups. My wife and I will also keep an eye out for suspicious moles or marks on my skin. The mnemonic “ABCDE” tells you what to look for:

A - Asymmetric or irregular shape

B - Border that is irregular, notched or scalloped

C – Changes in color, such as uneven coloring or different shades

D – Diameter of new growth larger than ¼ inch

E – Evolving to meet the other red flags or to develop new symptoms such itching or bleeding

You can bet that I’ll also be wearing more sunscreen and hats than I did in the past. I accumulated a couple of cowboy hats while we lived in Texas. Cowboy hats aren’t as common in Georgia, where we now live, but they are ideal for protection from the sun.

I’ll also be thanking God for the bad dream I had, which now seems prophetic, as well as the new job that led me to the new dermatologist. If I had stayed in my old job, I would have gone back to my last dermatologist and the melanoma might have gone undiagnosed and spread. Without the dream, in the chaos of changing jobs and making a 700-mile move, I might not have made another appointment until it was too late. If events had not unfolded as they had, the end result might have been very different, especially since I learned later that the melanoma was already deeper than the doctor originally thought.  

I’ll also be warning others about the dangers of skin cancer. Take the precaution of wearing sunscreen and covering up when you’re out in the sun. Don’t go to tanning beds. And if you or someone you know has marks on their skin that look like this, go see a dermatologist. Stat.

Originally published on The Resurgent

Pilots face increased risk of skin cancer

“I’m referring you to a dermatologist,” the doctor said. “It’s probably nothing, but I don’t like the looks of this mole on your back.”

My employer’s insurance company was requiring employees to get preventive physicals. After the revelation of my mother’s sudden diagnosis with colon cancer a few months earlier, the idea of a physical to get a clean bill of health actually sounded like a good idea. With no health complaints, I didn’t expect any problems to arise. After all, I was seeing an AME twice a year for my first class physical and if there were any serious problems, he would have found them. Right?

I didn’t hurry to the dermatologist. I had a few moles, but didn’t really worry. They weren’t irregular and they didn’t get larger. A couple of months later, I found time to make the appointment.

When the doctor looked at the mole on my back, a mole that my AME had seen at least 12 times, he promptly announced, “We’re going to take that off right now.” He said that the small, black mole could be an early stage of melanoma. Literally before I knew that he had removed it, the mole was gone and I was going home to wait on a biopsy.

As I waited, I learned that there is a strong link between pilots and skin cancer. In 2000, Yahoo News reported on an Occupational and Environmental Medicine study that found that airline pilots have up to 25 times the normal rate of skin cancer. The most common type of cancer among pilots was malignant melanoma. Melanoma represents about ten percent of skin cancers, but accounts for 75-85 percent of skin cancer deaths. The scientists at the University of Reykjavik in Iceland who authored the study found that Iceland Air pilots flying international routes had skin cancer rates 15 times higher than expected. For pilots who typically flew across more than five time zones, such as flying from Iceland to the United States, the rate was 25 times higher than expected.

There have been a number of similar studies, the most recent published in 2009 in Occupational Medicine surveyed members of the Air Line Pilots Association in the United States. Many of these other studies also show an elevated skin cancer risk for pilots, but not as high as the University of Reykjavik study.

It seems to be common sense that pilots would be at an increased risk for skin cancer. Pilots spend a lot of their working lives in the sun. Airports are almost devoid of shade and the sun can beat down mercilessly on a pilot performing a preflight inspection. When pilots are flying, they are above much of the atmosphere that protects surface dwellers from harmful solar rays. Few, if any, airline pilots slather on sunscreen before climbing into the cockpit.

As with the general population, there are other factors that lead to an increased risk of skin cancer. These risks apply to pilots as well. The Skin Cancer Foundation lists five factors that increase the risk of melanoma. First, both blistering sunburns as a child and cumulative exposure to the sun can increase risk. The more moles a person has, the greater the risk of melanoma. Dysplastic nevi, atypical moles, can be precursors to skin cancer. People with fair skin are more prone to skin cancer. A personal or family history of skin cancer also means an increased risk for future cancers. People with weakened immune systems, from chemotherapy or HIV/AIDS for example, also have an increased risk. As with other types of cancer and heart disease, smoking also dramatically increases the risk of skin cancer.

Among pilots, flying at higher altitudes and the higher latitudes near the poles presents the greatest risk. According to the Health Physics Society, the amount of cosmic radiation at the poles can be two to three times greater than the radiation at the equator. This is because the Earth’s electromagnetic field helps to block this radiation. The field is strongest at the equator and gets progressively weaker towards the poles. Science Daily notes that the radiation is on par with an x-ray or CT scan, but frequent exposure by flight crews that fly hundreds of hours each year can lead to increased effects. Solar storms, like the one that diverted flights in 2012, also mean increased dosages of radiation. The ionizing radiation of solar flares cannot be avoided by flying at night or wearing sunscreen.

Robert Barish, a physicist and author of “The Invisible Passenger: Radiation Risks for People Who Fly,” told Science Daily that professional flight crewmembers are exposed to more radiation than any other occupation, even nuclear plant workers. “People who work in the nuclear power industry on an average basis are getting 1.6” [milliSieverts of radiation per year], he said. “There are people who fly in airplanes who are getting 2 or 3 or 4 milliSieverts per year. So they are truly radiation workers.”

The fact that the University of Reykjavik study examined Iceland Air pilots who customarily fly in far northern latitudes may explain the extremely high incidence of cancer among these pilots. Flying at high altitudes near the North Pole for the long time periods associated with oceanic flights, Iceland Air pilots would be subject to all of the highest risk factors associated with skin cancer.

Other factors might be at work as well. Several of the studies indicate that some of the increased risk for pilots may be due in part to disturbed sleep patterns. “The excess of malignant melanoma among those flying over five time zones suggests that the importance of disturbance of the circadian rhythm should be taken into consideration in future studies,'' Dr Vilhjalmur Rafnsson said on Yahoo News. Rafnsson speculated that the disturbance of circadian rhythms could affect the production of melatonin by the body.

The American Cancer Society notes that recent studies have shown that low melatonin is linked to higher risks of some cancers, but that some studies have shown that melatonin supplements were beneficial to cancer patients while others show that it made no difference. Melatonin is available over the counter as a natural sleep aid. According to the FAA website, melatonin “appears to be beneficial in alleviating jet lag” and its use “is not proscribed” but “care should be taken to avoid entering duty status with any residual effects.”

Pilots are not the only people at risk from high altitude radiation. Flight attendants and frequent flyers share the same risk factors. Travelers who fly more than once or twice per week are at the greatest risk according to Science Daily. Occasional airline passengers or general aviation pilots who typically fly at altitudes of less than 6,000 feet do not have an elevated risk.

The risk of radiation is not limited to skin cancer. As far back as 1992, the FAA published a report, “Radiation Exposure of Air Carrier Crewmembers,” that addressed the possibility of genetic defects to a child whose parent had been exposed to high altitude ionizing radiation. The unborn child of a pregnant woman who is part of a flight crew is at the greatest risk of severe health problems ranging from mental retardation to childhood cancers. Women are also at high risk for breast cancer according to WebMD.

To minimize their risk of skin cancer or other radiation-induced problems, pilots should follow the prevention guidelines of the Skin Cancer Foundation. Avoid sunburns by wearing hats and sunglasses and seeking the shade, especially between 10 a.m. and 4 p.m. (Indoor tanning booths are also bad.) Use sunscreen with an SPF of 15 for everyday use. For extended outdoor activity, SPF of 30 or higher should be used. Sunscreen should be applied 30 minutes before going outside and reapplied every two hours (or immediately after swimming or sweating). Self inspections of your skin on a monthly basis and yearly medical checkup are also recommended.

Pilots can also avoid taking heavy doses of solar radiation by flying at lower altitudes or taking more southerly routes (in the northern hemisphere) to remain at lower latitudes. An FAA report, “What Aircrews Should Know About Their Occupational Exposure to Ionizing Radiation,” sets a recommended maximum level of radiation and gives estimated dosages for a number of typical flights.

My dermatologist also recommended Heliocare, an oral over-the-counter sun protection supplement available on BetterSkinByMail.com. Used with sunscreen, Heliocare helps to prevent sunburns and repairs previous sun damage to skin.

In the end, my skin story has a happy ending. The biopsy revealed that the mole was not a melanoma, but an atypical mole. Nevertheless, I will have several smaller moles removed as well and will incorporate routine visits to the dermatologist into my health care routine.

 

Originally published on Aviation Examiner

Seek medical care now–before Obamacare takes effect

Last year, my mother found out that she had colon cancer. A few weeks later, my wife was determined to have an early stage of cervical cancer. While it is never good to hear a diagnosis of cancer, they were fortunate to receive their diagnoses when and where they did.

My mom was diagnosed in October with stage three colon cancer. Within a week, she was undergoing lifesaving surgery in one of Atlanta’s top hospitals. She was fortunate have access to care in an American hospital. The colon cancer survival rate in the United States is among the highest in the world.

According to a study quoted on Web MD, the United States, Japan and France have the highest survival rates among 31 ranked countries for four types of cancer including cancer of the colon. In spite of the fact that Obamacare was yet to come, the United States ranked at the top for survivability of all four types of cancer.

This may be because of the ready availability of health care in the U.S. In 2002, a Commonwealth Fund study cited in Politifact that showed that only five percent of Americans reported waits of longer than four months for surgery compared to 23 to 38 percent in the other nations ranked, all of which had government health insurance programs. The wait time for my mom was only a matter of days. With the cancer already at stage three and in her lymph nodes, waiting longer might well have cost her life.

Scant weeks after my mom’s surgery, my wife was found to have precancerous cells in her cervix. A hysterectomy was scheduled for about four months away. When a subsequent biopsy revealed that the cells had progressed to stage one cancer, the surgery was moved up to early January, at the time less than a month away.

At the same time that my wife was waiting for her surgery, I read how Canadian women were dying while waiting for the same operation. Global Montreal reported that the wait times for Quebec women with similar cancers were three times as long as government benchmarks. Instead of less than a month, Quebec women often had to wait three months for their surgery. Thousands had to wait as long as six months. The long wait times led some patients to forego their free government health care to seek treatment at private clinics.

“This should not happen,” Lucy Gilbert, director of gynecological oncology at McGill University Health Centre, told Global Montreal. “No matter how good your surgery is, no matter how good your chemotherapy is, if you delay the surgery there could be a problem. The cancer grows. The cancer spreads.”

In my wife’s case, the hysterectomy removed the entire cancer, which had been caught at an early stage. With an aggressive cancer such as this, especially one that is detected late, as ovarian cancer often is, a delay of three to six months can be a death sentence for the patient.

My final recent brush with cancer was my own colonoscopy. After my mom’s experience with colon cancer, my doctor recommended that I be screened. The only delay to my colonoscopy was working around my busy schedule. I could have had my screening two days after my initial consultation if I could have worked it in.

The procedure was painless. When people tell you that the preparation is the worst part, believe it, but even this isn’t any worse than a case of bad diarrhea.

In my case, it was worth the hassle. When I woke up after the procedure, the doctor told me that they had removed two polyps from my colon. A phone call several days later informed me that one of the polyps was benign but that the other likely would have become cancerous. Thank you, Dr. Sanford and thank you, mom!

The lesson to be learned here is that important health tests and procedures should not be delayed. In the best of times, while you delay a procedure, the cancer inside of you could be growing and metastasizing. Cancer is best treated early before it has a chance to spread.

Now there is another reason not to delay taking charge of your health. The Affordable Care Act, better known as “Obamacare,” became law in 2010, but it has not been implemented fully. Many aspects of the law will become effective in 2014 according to Healthcare.gov. In 2015, the site ominously promises that physician pay will be “based on value not volume.”

This column and many other conservative voices have warned that the centralized control of health care will inevitably lead to shortages, rationing, and long wait times. Nevertheless, President Obama’s reelection victory was the death knell for any chance to repeal or reform the law in a meaningful way before it is implemented.

Obamacare will soon be a reality for all Americans. The precise effects of the law are still largely uncertain and controversial, but early indications are that they will not be good. This week health insurance companies warned that premiums for individuals and small businesses could increase by more than double their current rate. The country already faces a shortage of doctors and this will likely be made worse by the influx of insured patients under Obamacare. This is typically the result of an artificial increase in demand for a product.

No one can know how Obamacare would have impacted my mom or my wife, but there is no doubt in my mind that if the law had been in full effect, there would have been a much greater chance that I would have lost both my mother and my wife to cancer in 2013. For me, that is reason enough to fight for the law’s reform and eventual repeal. Repealing Obamacare is vital to save lives that might otherwise be lost while patients sit waiting for vital surgeries or treatments.

Obamacare won’t crash the American health care system overnight, but it is likely that it will become increasingly difficult to see a doctor or get necessary medical care in a timely manner. The safest course of action is to take charge of your health and get any necessary medical tests or procedures done before the law can take effect.

Originally published on Examiner.com:

http://www.examiner.com/article/get-medical-treatments-and-tests-now-before-obamacare-takes-effect?cid=db_articles