Gout? MOHS Surgery

 Gout? Mohs Surgery

  Vacation was great. We had sunny warm weather. We did some small hiking and sat at the beach a bit-don't worry I wore a hat, zinc sunblock, and a rashgaurd. My ankle wasn't too bad. I wore the brace I was given and it seemed to help a lot. My ankle does feel a bit better but still hurts a bit.

That brings us to today, I saw the ankle doctor I had wanted to see in the first place, unfortunately he had been booked three weeks out. I'm glad I went to the other ankle doctor before vacation and got that brace though. This doctor wanted another set of x-rays done. I guess that's my fault. I should have brought the x-rays that were taken at the last doctor's office. The x-rays did not show any fractures or breaks but he did see a white spot on the ankle and when he pressed that area, it did hurt. He wasn't sure what it was and he said he's never seen anything like it before. There were also some darker spots on the bones and he said that's most likely due to the prednisone eating my bones. He examined my ankle and foot as well as my healthy ankle and foot. He said, in his opinion, it was mostly likely gout, that you didn't need to be in excruciating pain to have gout and he would know as he's had gout many times. I also told him I had kidney disease and elevated Uric acid levels after he mentioned that I might have gout. I had suspected it could be gout which is why I mentioned it to the last doctor. So, he said I should get in touch with my lung transplant doctor and ask if I could do 10mgs of prednisone instead of the usual 5mg as that is the treatment for gout. I would take that for 7 days. If the pain goes away, great. If it's mostly better but still there, ask for another 7 days of 10mg prednisone. If it's not getting better at all, we will need to do an MRI. He said it also looked like it could have been a bug bite, but I don't recall any bites or it looking like a bug bit me.

    Yesterday I got the skin cancer removed from my ear. I had to come at 7:30 am because somehow even though I called the office to cancel the appointment that was set for the Monday before I left for vacation, AND I made an appointment for 9:30, none of these changes were recorded in the files. I got a call confirming my Monday before vacation appointment and I hit the proper number to cancel. Then, a few days later I got a call asking if I would like to reschedule. So I had no choice but to go at 7:30am or wait another week. My ear was already quite sore and I didn't want to wait. I get it, humans make mistakes. No one is perfect. But, 7:30 was a bit early for me. My mom accompanied me in case I would be in great pain afterwards like the situation with my eyelid, though just from the biopsy alone, I felt this wasn't going to hurt as much, even though the bump was quite big. I felt two insertions of the lidocaine needle. It stung a bit but was nowhere near the pain of the eyelid injection. I'm not sure if there was only two injections or if i just didn't feel anything after that. I didn't feel him cut the lump off, though I could sense a sawing like motion was happening on my ear. I waited in the waiting room for an hour. When I was called back, they said they needed another layer taken off. I was bummed. Again with the lidocaine shots, though I felt absolutely nothing this time. He cut deeper, I could sense a feeling of cutting into the cartilage a little but no pain. We waited an hour and a half an then we were told the borders were clean. YAY! I was sooo tired. So, the doctor proceeded to sew up the ear with stitches and then we were on our way. A few hours later I had a little pain in my ear that lasted the rest of the day but by the next morning my ear did not hurt at all. I made it the whole day without any pain. It only hurts if I accidentally touch it. Right now it's covered in a bandage. I will take the bandage off tomorrow and put cream and a band-aide over it.

 

 

(updated, I took the bandage off)

 

    I also went to CVS and picked up a cream for under my eye as I have been having a dry flaky patch of skin there for years and I get it frozen every time I see the dermatologist. I had two biopsies done there and they both came back precancerous. I asked the MOHS surgeon if there was something more I could do and he suggested a cream that I had to be super careful putting on as it would be very bad to get in my eyes. I also picked up doxycycline to ensure no infections set in with the ear surgery. This means I also need to take oral Vancomycin to prevent C. Diff as I have a history of C. diff.

Skin Cancer, Ankle Pain, and Pacreatic Cysts

 Skin Cancer, Ankle Pain, and Pancreatic Cysts

    The skin biopsy of my ear came back as skin cancer, squamous type. I was going to have a MOHS procedure this Monday, but I was worried that because I was going on vacation this Saturday, the stitches might've been in for too long, should they be needed. Because of this, I had to move my appointment for MOHS to the Monday I come back from vacation. I definitely would've preferred getting the MOHS before I left and in hindsight, probably could have. My dad said that when he gets stitches for MOHS they leave the stitches in for about 10 days, and I would've just had to have left them in slightly longer, at two weeks. I do regret not doing it but sometimes you make a decision and it's not the right one. Unfortunately, the doctor only does MOHS on Mondays so I couldn't have gone anther day.

    About a week ago I noticed my ankle starting to hurt. I thought if I just waited a while the pain might go away, which has worked in the past for my ankle pain. My right ankle had become mildly swollen, red, and a touch warm. I could still walk on it so I knew it wasn't a bone issue. I figured I must've hurt it during one of my walks, although I could not pinpoint any such moment where I noticed the pain beginning. I thought perhaps I might have torn a tendon, although I think I'd've been in greater pain than I was, which is not to say that there hasn't been much pain, because there has been. I thought perhaps it was gout as my Uric Acid levels were mildly elevated in February when they were last tested. My mother went to get her hip checked out and said that the place she went to had signs saying people could walk in between 3pm and 6pm and get things like their ankle injuries checked out. I decided for peace of mind, especially with going away for a week, I should go and get it checked out. I waited 'til 3pm and then I was off. After getting a set of X-rays, I saw the doctor. He palpated my ankle and moved it in different directions, and he checked the films of my X-ray on the computer. He could see no fractures on the X-rays, and after moving my foot in various directions, and pressing on the area that was red and swollen, he ruled out infection, gout, and said most likely this was not a tear of any kind. He didn't have an answer as to what was wrong other than to say I might have hurt it walking but it didn't seem to be a serious. He recommended I get fitted for an ankle brace and try wearing that for a week, and then come back. If the problem wasn't gone by then, he said we'd need to further investigate and do more tests, such as an MRI. I asked why he didn't think it was gout, and he said that gout usually presented in the big toe, or other places. Besides that, he said patients with gout are usually in severe pain. He recommended taking NSAIDS but I can't due to having had two transplants. He then recommended a higher dose of Tylenol but I told him that I'm on antifungals and I really don't want to take a higher dose of Tylenol. Besides, my ankle only hurts when I walk.  I still have an appointment with another ankle doctor the week I come back from vacation. I will keep that appointment and I also made a follow-up to see the doctor I just saw also on that same week I come back. Hopefully it's nothing to be concerned about and it goes away on it's own. 

    I had an MRCP, which is an MRI of the pancreas about two weeks ago. It showed one of the cysts in the tail of my pancreas had grown. This warranted a trip to the GI doctor. On Wednesday, which was yesterday, I saw said GI doctor. I wasn't asked to bring in the MRI disc and I didn't think to do so as my coordinator had access to the films and sent them over. For some reason they didn't have access to the films when I got there. I was told that I probably wasn't going to need an Endoscopic Ultra Sound but that it would depend on the films, which would need to be reviewed by a team of surgeons and doctors. It was up to them to evaluate whether or not my cysts seemed to be benign and were just the usual cysts someone with CF gets, or if they were of the mucinous type which had the potential to develop into cancer. I would've preferred that they definitely did the procedure just for peace of mind. I'm not sure how they determine if a cyst is benign or mucinous just by looking at films but I'd rather know for sure. My coordinator re-sent the films and they were reviewed today, Thursday, and they decided they wanted to do the procedure after all. I was already tentatively scheduled as the GI doctor is leaving in a month. Of course there are other doctors in the practice so if I should need to followup with someone else after the procedure, there will be other doctors to see. My appointment for the procedure is May 1st.