The toe must go on

I am so glad that I went to see Dr. Dermatologist.  He echoed everything that Dr. Podiatrist said, but with a few more details that really helped me to feel comfortable with the discoloration under the nail of my left big toe.  He said that sometimes toes detect trauma that might not register in our brain, and that even extreme temperatures can cause weird toe things.  He also said that inflammation around the nail bed, such as I had in mid-February, can cause a release of serum into the nail plate, as visualized by discoloration under the nail.  Once inside the nail plate, the serum cannot get out.  It simply has to grow out until it eventually gets clipped off.  Together these sound like reasonable explanations for what happened to my toe because 1) I recall no trauma, 2) the whole thing started with inflammation around the nail plate and only later became discolored, and 3) the discoloration is very slowly traveling outward with my nail.

When a patient leaves the office, doctors often state that the circumstances for a subsequent visit should be a set amount of time or "if anything changes".  Clearly as my nail plate serum grows out, there will be constant gradual changes in the appearance of my toe.  So I was grateful when Dr. Dermatologist explained other types of changes that should inspire me to make a follow-up appointment:  asymmetric, irregular, or sudden changes in the pattern or color of the discoloration.  That should be easy enough to spot.

So...I'm officially free of all bodily worries until the next PET scan at the end of May!  Huzzah!

I feel surprisingly liberated, even though I had become fairly confident that my toe problem could be explained by non-cancerous phenomena.  It is invaluable to have a medical professional officially hand down the reassurance.

This liberation is very timely because I will have a very busy April at work.  I am trying to finish and submit a research manuscript, write and submit a review article, hire two people, and attend a mandatory training in Peoria for half a week at the end of the month.  I don't like stress or unattainable goals, so hopefully I can actually make this all happen in the next 3 weeks.  I might have to take some work home, which is a line I hate to cross because once crossed, it is hard to go back.  We shall see.

Time to relax in the fragrance of the lilacs that Ian put in vases this evening.  I can't believe it's April 4th and I have lilac blossoms in my house.  A treat, to be sure.  

Okay okay, I made the toe appointment

This was possibly the most difficult appointment I've ever made, but I finally made an appointment with a dermatologist to get my toe looked at.  I know this is all part of my master plan of being proactive and taking care of myself while Dr. Oncologist is absent this month, but it was hard to enact.  It is not fear that made this difficult, but normalcy.  Uninterrupted, springtime normalcy.  I have had a two-week break from appointments, and it is hard interrupt that stretch with a problem that is painless and often hidden from view.  A problem that a person with no history of inflammatory breast cancer would ignore for months.  A problem that almost certainly will turn out to be a common bruise.  But it is also slightly inflamed, and it has been persisting for over one month, so it is time for yet another professional opinion.

My toe appointment is for next Wednesday (just over a week from now).  I can't help but feel a little bit ridiculous compared to some of the other pains and scares that have sent me to a medical professional.  But here we are.  It's my year of extreme caution.

I also have an eye check-up this week.  Talk about normalcy!  I haven't had my eyes checked since I moved here three years ago.  I used all of my time off on pregnancy appointments, then maternity leave, then taking long lunches to breastfeed the baby, then cancer appointments, then cancer appointments, and still cancer appointments.  My time off is still precious, but my nighttime reading habit has not been kind to my glasses and they are looking mighty crooked these days.  Time to get my eyes checked and buy some new frames.  It's exciting to have a normal doctor's appointment, but not really since I could use a break from having any doctor's appointments at all.        

Also normal is that it was yet another great family weekend.  We took the girls to the Shriner's Circus.  I hadn't been to the circus in ages, and it was pretty fun.  I appreciate the athleticism of the aerialists more than I did when I was a kid (woa those folks are strong!), but I appreciate the tamed wild animals less (poor tigers!).  Azalea absolutely loved all of it, but Eleanor is still a bit little for this sort of thing.  She covered her ears every time the audience applauded, and after every act she asked if it was over.  We compromised their opposing wishes by staying only until intermission.

Other big news is that we bought a bike for Azalea!  It is purple with training wheels and she is the happiest kid in town!  I think I smell a new series for Simply Bike this summer on learning to ride a bike.  I will begin taking photos in preparation.

Have a great week, everyone!
 

Toe watch 2012

To recap:  the skin around my left big toenail is slightly reddish and inflamed, and there is some discoloration akin to bruising under the nail.  The podiatrist had no answers but warned about melanomas that start under the toe nail.  The oncologist prescribed a course of antibiotics.  Tomorrow is the last day of oral antibiotics; have they resolved my mysterious toe issue?   

I am having trouble deciding if it's getting better, so the good news is that it is certainly not getting worse.  The reason it is hard to assess improvement is because visually it looks the same.  Everything is still discolored, at approximately equal magnitude.  Also, it is still tender to the touch but otherwise painless.  In short, the original phenotype was so weak and the resolution is so slow that I am struggling to evaluate improvements.

But I emphasize that it is not getting worse.  Huzzah!  I'll take it!

My plan is to give it 2 weeks to get significantly better, if not clear completely.  Then I will go see a dermatologist.  I have made this decision because the podiatrist used the word "melanoma", which puts my possible condition into the realm of a skin doctor.  I will not wait any longer, though, because I recently learned that Bob Marley died of toe cancer.  Well, his cancer started as a toe melanoma before metastasizing to his lungs and brain.  Another important detail is that he chose not to treat his toe cancer.  I assure you that I will choose to treat my toe cancer if I do end up having toe cancer, but the story of Bob Marley's demise has inspired me not to sit (or stand) on my toe problem.  Thanks, Torey.

In other health news, can I just mention how wonderful it is to have hair?  I still hate my haircut and pine for locks long enough to pull out of my face, but I am so glad to not be bald anymore.

Today I drove home from work with the windows down because it is unseasonably warm in the midwest.  The wind was whipping through the car, from driver's side to passenger's side, and taking my hair with it.  I wasn't worried about messing up my hair because I lack so much confidence in my hairdo to begin with.  Besides, I don't recall ever being the type of girl who would worry about her hairdo.  So I simply enjoyed the feeling on my follicles as I executed my daily commute.  

Also, on Monday night I went on a 4-mile walk around a nearby pond.  This was the most exercise I had gotten in weeks and it felt great.  The best part was that I think I could feel my left lung be less constricted.  Perhaps I wasn't working as hard as when I bike, but I didn't experience the shortness of breath that I usually do as a result of the chest wall radiation.

Let's perk this post up with a song!  College friends, I'm sorry I didn't like Ben Folds when you first introduced me to him.  I was naive and foolish.  Please give me another chance, and here's a token of my appreciation:  "Zak and Sara" with an orchestra!!!!  Ian found this on YouTube the other day and I'm momentarily addicted to all of the songs from this set.  But especially this one.

Get with the program, Toe

I met with Dr. Oncologist on Friday to discuss the results of the colonoscopy.  She too was delighted that there was nothing to biopsy.  My elation faded, however, when she answered my question, "what happens if my colon is still glowing on the next PET scan?"  She said that that is when things get more complicated.  Either we continue to watch it, or if the region has increased in metabolic activity there might be some exploratory gut surgery in order.  Ugh!  I don't actually believe that this will be the outcome, but one never knows, does she?  So we'll just hope that the glowing colon will go the way of the glowing spine, lungs, and chest wall and stop glowing in time for the next PET scan.

My next PET scan is at the end of May.

In the meantime, a body part from the peanut gallery has decided to participate in the post-cancer fun times. I have been having an issue with the big toe on my left foot.  I wasn't even going to mention it in the blog, because I thought it wasn't cancer related, but the podiatrist has mentioned certain possibilities that close the gap between my big toe and cancer.  Gulp.

One day before we left for Santa Fe, I noticed that my big toe was hurting around the nail bed.  I thought nothing, literally nothing, of it.  It's a toe.  Also, sometimes things hurt periodically and then they stop hurting.  Right?  Surely you all have experienced some random pain somewhere in your body, and you don't know what caused it, and when you wake up the next morning it is better if not resolved entirely.  This was me and my toe.

Well, in Santa Fe it got worse:  redder, angrier, more painful.  ("More painful" is not a comment on the pain level itself, just a comment on an increase in pain.  I was not limping or anything).  So I soaked it in epsom salts and smeared neosporin on it.  No resolution.  As a side note, it is not an ingrown toenail because 1) I have good toe hygiene! and 2) the reddness is around the nail plate at the base of the nail, not the sides of the nail.  Also, there was no injury or incident that I remember between me and my toe.

Darn it if the thing hasn't been getting worse.  The pain has stayed at the same low level, but it is now a little bit black-and-blue under the nail bed while being red and inflamed on the nearby skin.  I took my audience with Dr. Oncologist on Friday as an opportunity to get her medical opinion on this 2-week-long toe issue, and she in turn sent me to Dr. Podiatrist.

Dr. Podiatrist has an excellent bedside manner, a soft spot for microbiology, and a gift for explaining the possible causes of and outcomes for my problem.  In short, I am a fan.  (Why couldn't HE have gone into gastroenterology?)  Unfortunately, my toe doesn't fit any textbook phenotypes, so he couldn't make a conclusion without a biopsy.  We agreed that it is a bit too soon to rush into a biopsy.  So I am on a course of antibiotics in case it is an infection, and I am to watch it for changes.

And here's where the connection is made to cancer:  his concern is that it could be a melanoma (skin cancer) that just happened to develop under my nail bed.  It happens, albeit rarely.  So if it suddenly becomes irregularly shaped or continues to increase in size, a biopsy of my toe and toe nail is in order.  I forgot to ask if this would have showed up on my PET scan a month ago.  Are my feet even scanned?  I have no idea.  

Also, who on earth has to worry about melanomas under their big toe nail?  Apparently the girl who had inflammatory breast cancer.

My preferred hypothesis is that it is an infection.  Cancer is still to blame for this possibility, I think, due to a continued weakened immune system.  Please join me in cheering on the powerful antibiotic cephalexin (I used this antibiotic to make discoveries in graduate school!) and hoping is makes it all the way down to the toe peanut gallery.