I am back at the hospital today to change my drain that’s been leaking the last couple of days. I didn’t think much about recovery after surgery and in part it’s been quick, but quite slow in other aspects. Four days ago I got the last stitches taken out of my toe, but the part around the sentinel lymph nodes near my groin has been a slow process. I had stitches there, but last week they were removed due to the beginning of an infection. I was put on a course of antibiotics and the wound was opened and a drain was attached. Until then, the liquid was trapped underneath the skin and caused a large bulge from the accumulation. That liquid was removed at the hospital and I would need to do it every couple of days. It meant spending as many hours as possible with my legs raised up to help my body absorb these fluids naturally.

Since the drain was attached and I started antibiotics, the liquid is captured in a bag and it seems to be speeding the healing process. It’s also allowed me to work more which is a topic for another post about working under these conditions when I should be resting – but that’s what you get when you work for yourself. When I thought about people that have bags glued to their body for strange fluids, it always made me feel quite squeamish and now I have one myself! It’s actually no that bad. It’s a bag attached to an adhesive that is glued over your wound and has a little plug for you to empty it out. When they attach it, they put a metallic mesh in the wound which is made of silver nitrate or something, that prevents infection and helps the liquid flow out.

Looking forward to not having a bag on my leg and to start recovering and learning to walk again. I thought losing the toe was no big deal, but it is. I get really tired from walking and my feet and legs hurt probably because I am compensating incorrectly. I have tried to read up about people in my condition that have lost a toe and what their recovery was like, but didn’t find anything. I have read that losing a toe does not impede you from walking, but it doesn’t say if you will walk again without limping. The thought of running seems like an impossibility at the moment. It feels like the remaining toes are just too fragile to take the weight and feel like they will snap if I bend them. I guess it is all a question of time, but I will be very happy if I get to run again!

Back at the hospital to check on the bandages. I come here every 3 to 4 days. My toe is healing well but is super sensitive while the stitching around the lymph nodes is taking longer to heal because it keeps swelling. It has a tendency to accumulate liquid which forms a large bubble under the skin that ruptures occasionally. Not painful but just uncomfortable.

Needless to say, that the progress is inspiring! Our body fights so much to get well it’s incredible! I limped out of here on crutches and today I walked in unaided! Still limping slightly, but what a difference and better is how happy you get just to be able to walk again!

I should have gone on that last run before the surgery! It will be a while before I can do that again. That’s the thing about this…I was always making excuses for myself why I wouldn’t run on a particular day. Today I look back and think….how silly….you can run! I never thought that that simple truth can be taken away. Life is about rejoicing and being thankful that you have legs, lungs and a heart that function to run! Next time I run, I will remember just how something so simple is such a massive privilege And how fortunate I am to just…run!

I don’t remember when exactly, but a thin grey well defined stripe appeared under my big toe on my right foot. It was perfectly parallel and ran the length of my toe nail. It was about 4mm wide and I didn’t make much of it. It looked like I had taken a wide marker pen, and ran a stripe along the length of my nail.

When I noticed it, I thought that something must have dropped on my toe, or I must have kicked something without noticing it and got the dark stripe which I associtated to a bruised toe nail. I think everyone has at one stage banged the car door on a finger or accidentally hit it with a hammer. You usually get a bruised nail and over time as the nail grows, it gets pushed up and goes away. That is what I thought I had, so I made nothing of it and let time pass by, thinking it would go away sooner or later. I do recall, that the perfect stripe also made me think that it might not be a regular bruising, for being so well defined, but once again made nothing of it. I didn’t photograph it at the time, but I found a picture on the internet that looked very similar to what I had when I first noticed it. It’s the perfect stripe, mine was slightly wider and more towards the right side of my toe.

Some time did go by and it didn’t go away. I thought it was strange but ignored it and also didn’t think that it warranted a visit to the doctor. It didn’t hurt, looked slightly different but no reason to get it checked out as it seemed to be purely cosmetic. That is the problem with Acral Lentiginous Melanoma. It is a very rare form of Melanoma and more aggressive and with porter prognosis than common skin melanomas. It isn’t caused by sun exposure and usually appears on soles of feet and on skin that is hairless and also appears under your nails. It’s dangerous because it goes undetected for long periods of time, many times being misdiagnosed and when you do get to do something about it, it may be too late. Late in the sense that this is a malign tumour, a sheep in wolves clothes, looks harmless, but then spreads to other parts of your body through your lymphatic system.

It’s dangerous, because there is a risk that you look for help once it has already metastasised to other parts of your body and be more complex to treat. Apparently this tumor has a tendency to Metastasise on organs like liver, lungs and brain. How crazy is that? You would never think it would have started on a grey stripe marked on your toe nail! The irony and fragility of life…how can something apparently so innocuous be something that could actually cut your life short?

Anyway, one day while getting out the shower, I pressed on my toenail and a bit of blood seeped out below. I still thought it was a bruised toe nail, so it wasn’t until the summer of 2017 that my wife who had been insisting with me before, insisted even more that I see a dermatologist about it. By now the mark under my toenail was starting to look darker and the toe nail had begun to soften around it. That seemed to convince me that maybe it was just a fungus I had caught somewhere*. I kept forgetting to call the dermatologist and did it more because my wife insisted. When I did finally remember to call him, he only had an appointment in late November which for me was ok, since I wasn’t dealing with anything that was urgent. It’s a good thing I did call and that I listened to my wife…like a very dear friend of mine says “married men live longer” and I hope to be a testimony to that phrase!

When the appointment finally came around which was Wednesday the 29th of November 2017, the doctor suggested I come back on the following Monday for a biopsy. Since a biopsy sounded serious, I asked him what that meant and he told me that there was no reason for alarm. I was told it would be important to understand what type of cells were under my nail so that the doctor could know what we were dealing with. I came out thinking it was a type of birthmark that had started growing under my toe nail and that there was no reason for alarm.

The next week, on that Monday 4th of December, I went in for the biopsy. Feet and toes have a lot of nerve endings and are pretty sensitive so it wasn’t a pleasant experience at all. The samples were sent to the lab and we waited for a few days. The dermatologist mentioned in his request to Pathology what his suspicion was, but I shrugged it off, thinking that it was just protocol, didn’t apply to me and frankly didn’t lose any sleep over it.

On the 13th of December 2017 I got the results from pathology. I received the email confirming Acral Lentiginous Melanoma. I showed it to my wife and when she read it, she burst into tears. Probably because being a Doctor herself, she understood what that meant while me on the contrary had no idea what I was dealing with. The following days went by pretty quickly between getting referred to between Doctors and ending up at the Portuguese Institute of Oncology in Lisbon. If it wasn’t for my wife insisting that I get this checked out by a proper specialist in this area, I would never have gone to the doctor for this. I would still be here, oblivious to what was going on in my toe, while the tumour would keep growing and likely spread to vital organs that are key for survival. How screwed up is that? I know I am going to beat this and get well.

From here, things started moving quickly, but literally felt like an eternity. The first two or three days you are still in denial and caught by surprise while taking in everything. It slowly starts sinking in that you are dealing with something serious. You start searching for photos to understand just how long you have had this for, since it is a determining factor foro a good prognosis. When you look at the photos, there aren’t many summer pics with flip flops and at an angle that you can see your toe nails. We worked out that I have probably had this for about about a year and half as we don’t recall having noticed it on our honeymoon. As the days go by, so does your anxiety level, you start looking for answers to the gizillion questions running through your mind. That first appointment took forever to happen and it was just a week away!

I have been blessed with health. I am a 45 year old male and between having had my appendix taken out, I have never had any health problems. I am an architect and run a successful practise in Lisbon and my only ailment until now was working too much. I live in the city of Lisbon in Portugal and consider myself fortunate to live in a country with free healthcare. I was referred to the IPO (Portugueses Institute of Oncology), a hospital that deals exclusively with cancer and where my first appointment took place.

My wife is a doctor, currently specialising in Pulmonology and during her training she spent a few months at the IPO in the lung cancer division. On a few occasions I picked her up from there at the end of her day or to take her out for lunch. While I sat in the car and waited for her, I saw patients going in and coming out of the hospital. I thought of them and imagined how challenging it must be to be diagnosed with cancer.

I never imagined that I could get cancer….it was something that happens to everyone else. It is still difficult for me to say it today that I have it. I push it to the back of my mind like it doesn’t exist or it doesn’t apply to me. But it does. Unfortunately it does. It changes your perspective of things. I sat in my car at the gates of the cancer hospital and as much as I could have tried, I truly couldn’t relish that moment that you appreciate that you are healthy and fortunate you are. You do, you inadvertently think how lucky you are to be healthy, but it is only when that is threatened to be taken away from you, that you understand just what a big deal it is.

Little did I know, that one day it would be me, walking in through those same gates to get treated for cancer.

Notes:

* it wasn’t a fungus but in actual fact, it was the tumour increasing in thickness below the toe nail. That thickness is key in detecting the state of the tumour, where the thicker it is, the worse the prognosis is. I will know what thickness my tumour was on the 30th of January and understand how far it developed.

It’s been a week since I last posted something here. Having difficulty to move around and having a 3 month baby leaves little time during the day to write. I would like to write more and maybe just need to prioritize to make time for it.

The reason I am writing this blog is actually for two reasons. The first reason is that I searched for people who had my condition and didn’t find anything specific in regard to this type of cancer. I had a lot of questions and didn’t find any answers. Not medical stuff, but more the kind of experiences people were feeling while going through this process. You have so many questions and sometimes the waiting for answers can be quite daunting. So for that reason, I thought maybe if I share this, that maybe someone out there that is going through something similar to me, might find this useful. Every day there is something new, so I will try and post as much as I can still remember while it is still fresh.

The second reason I am writing this, is my own personal journey of what all of this is teaching me. I have to come out of this a better person, a stronger person. I need to take some time out, put on the brakes from all the stuff around me, collect myself and think about all of this that has been happening and  process it. If I treat this as a another episode we need to deal with in life, then it will be a lost golden opportunity.

Writing helps me organise my thoughts and hopefully learn from it. I am looking at all of this from a positive perspective, but that doesn’t make it and less scary. I am convinced that there is something good about this…and don’t get me wrong, I am not selling the “you need to be positive” narrative when in actual fact reality is different. Having cancer is scary. But having cancer is also something that puts life in a completely different perspective. It has already shown me things, that otherwise I would never have seen and right in front of my own eyes. It makes you understand that what we take for granted is limited, that life is in fact fragile. It makes you feel like you have been on a winning streak until now, and someone’s dealt you with a bad hand. You muster strength to deal with it, but you also understand that there might just be another bad hand around the corner. Life is unpredictable. I have been living in a bubble. I have seen things I never imagined I would see. The future is scary. Living is scary. But right now, everything is perfect. It could be so much worse. Rejoice and enjoy it and let it sink deep down in your memory chip. I have never been so greatfull in my life and never felt so loved.

Right now, I have more questions than answers, maybe those answers will come with time, but for now they are just questions. Cancer has changed something in me. It was similar to when my baby was born 3 months ago, where you just know, that from that moment on that your life is going to change forever

Picture of my son with me in the waiting room before I got my bandages changed

Was diagnosed with acral lentiginous melanoma in 1977 and unfortunately passed away on 11 May 1981 in Miami at age 36.

An interesting comparison of two sisters with cancer and how they were treated in their countries. One lives in Canada and didn’t pay a cent, while her sister in California was another story…

Here is a link to a youtube video

Story of two cancers

I was treated by a fantastic team of professionals. Friendly and always smiling and they all took great care of me.

I am so fortunate to live in a country that values a national health system with modern equipment and excellent doctors. I won’t be billed a cent for any of the treatment I have received. I think about the many people in the world that may be in a similar situation with no access to healthcare.

I am also so lucky to have the support of a loving wife who as been with me through this all the way. I had her scarf with me during the night. She has supported me and dried my tears in moments of fear.

You are the color of my life Krispeta!

Today the surgeon will save my life.

I have been diagnosed with acral lentiginous melanoma. It is a rare tumor and is caused by genetic mutation. This tumor which appears on the skin, is not caused by sun exposure.

I had a dark spot under my big toe nail on my right foot which when I first noticed, thought it was a bruised toe.  I thought something must of fell on my toe or I might have kicked something and not noticed I had hurt myself. When I was a kid, I like playing with hammers and now and again I would hammer a finger that would darken from the bruising and eventually go away. I thought this was the case and since it takes quite a while for bruising on a nail to go away, I thought nothing of it.

It was my wife who insisted I see a dermatologist. I booked and appointment in July and had an opening in November. Since I thought nothing of it, I waited for the appointment.

When I saw the dermatologist, he booked a biopsy for a few days after. A sample of tissue was taken and a week later, pathology results confirmed acral lentiginous melanoma. When my wife saw the results, she burst into tears and maybe because I am an architect, I didn’t make much of it.

I later found out that these type of tumors can be tricky as they are usually not diagnosed and by the time they get your attention, it’s late and the cancer has spread. Hopefully, I will find out in the next days if I got this early enough. Fingers crossed that I did

This afternoon my big toe will be amputated with a margin to ensure that any cancer cells around it will be removed with it.

As I write this, I am waiting to be called in   at the nuclear medicine where a radioactive substance will be administered and will help the surgeon find the lymph nodes that communicate with my toe. These lymph nodes will be removed in surgery and hopefully they will be cancer free.

Its a small trade off, my toe for my life. Makes all of this easier to accept.

 

 

 

I am gulping down a plastic cup of red liquid, one after the other. One every ten minutes and by the seventh, they will call me in to have a full body CAT scan.

I was diagnosed with Cancer two months after being a father for the first time and on the exact day we were having my company Christmas Party.

I created this blog as a personal diary for myself where I can register my own thoughts and maybe it might resonate with someone out there going through something similar.

Today is the last of my tests and tomorrow I will be checked in for surgery.