Sat with Nat

Nat is thankful for Canadian Universal Healthcare

The inciting incident

It started as a tiny spot above my right eyebrow about a year ago. At first I thought it was a recurring blocked pore.

Over time the dot grew into an uneven mole. I kept checking it. It was growing, slowly, but constantly. I decided I’d take the time to get it looked at when I retired.

Taking Action

It took a month to find an appointment with one of the new doctors at my family doctor’s clinic as my guy is retiring and working part time. I choose the same new doctor I had seen last year to get continuity of care.

Validation

My appointment was at the end of May. My new doctor had a look and she agreed the mole should be removed because it was changing, had ill defined boundaries and different colours.

I was relieved. I was prepared to be told I was worrying for no reason. Since faces are tricky to biopsy, she referred me to a clinic specializing in dermatology and facial surgery.

“If you don’t hear from anyone in a month call us and let us know.”

Waiting

I marked the date in my calendar. In three weeks my doctor’s clinic called to check in. Since I hadn’t heard from the original referral my doctor sent out multiple requests and asked me to let them know when I heard from anyone. This would allow them to cancel the outstanding referrals.

Moving forward

A week later I got a call from a clinic minutes from my home. The Attending physician was going on holiday but he wanted to see me right away. I got an appointment within 3 days. I let the referring clinic know I had an appointment.

Punch Biopsy

I showed up and found out it was a teaching clinic and I was so happy. Maybe it is watching The Pitt or living in a university town but I’m thrilled to see the next generation of doctors in action.

The Resident had a medical Student with her. They took time to explain their analysis. They too agreed the mole should be removed. I was informed of all aspects of the procedure. I felt confident that a punch biopsy was the right choice.

The Resident left the room to confer with her Attending. They both came in and all 3, the Attending, Resident and Student looked at my mole, palpated it and discussed it.

“I’m a 4 or a 5 of worried out of 10. Not extremely worried but a little to a bit.”

That was enough for me to feel confident getting this off my face was the right decision.

Quick Action

The prep, freezing, biopsy and single stitch took less than 10 minutes.

I went back a week later to have my stitch removed. Another week later I got a call saying my pathology report was ready. I opted for an in person rather than a phone call. I’m glad I did.

Outcome

In my mind there were 3 outcomes:

1 – no cancer, no further action

2 -Basal Cell or Squamous Cell cancer with a clear margin, no further action

3 – some type of melanoma, lots of further action required

Turns out there was a fourth option. The pathology report confirmed it was a Basal Cell Carcinoma and the sample had clear margins.

The Resident took time to examine the site and palpate the edges. She left to confer with the Attending. They both returned and re-examined the biopsy site. The Attending did not like the edge on one side and recommended freezing with liquid nitrogen, aka cryotherapy, to get rid of any suspicious skin cells the same day.

Cryotherapy

I have to say, the freezing was daunting since the site was so near my eye. After 4 rounds the Resident was satisfied all offending cells would slough off.

The Waiting Game

I get to go back in 3 months for a follow up to see if any other interventions are needed.

Thankful

The next day my family doctor’s staff called me for an update. I let them know I had two procedures to remove the mole and the diagnosis. I also asked to pass on my thanks to my doctor. Her following up on the referral and having a sense of urgency meant I got timely treatment.

I’m so grateful for the excellent care I got both from my family doctor and the whole team at the teaching clinic. Total cost to me? Zero dollars. Even the parking was free.

In the end it was 4 months from the moment I decided to take action until I had the results of the biopsy and a full resolution of my chief complaint.

Wait times in our universal healthcare system are often criticized but I have found that when urgency is needed the staff find a way.

Next steps

So now what?

An image of a note that says “don’t skip the sunscreen”

Wear sunscreen. Wear a hat. Limit time in the sun in the afternoon.

I have not always been good about wearing sunscreen. I feel properly motivated to do it now.

Better late than never!

Hey you!

A finger pointing from the page to you.

Ya. You. If you see a mole on you or someone else that is changing get it checked out. Don’t wait. If my diagnosis had been a more rapidly growing cancer I might be having a very different outcome because of my reluctance to get it looked at.

equality · gender policing · men · Uncategorized

Just wear the damn sunscreen?: Men, gender roles, and skin cancer risk

image

What’s the biggest single factor that puts you at risk for ignoring your health? Being a man.

Sociologist Lisa Wade, interviewed in New York Magazine, says that “some scholars argue that being male is the single strongest predictor of whether a person will take health risks.”

Men like risk it turns out. Most of them also hate putting lotion on their skin (too girly) and being afraid of things (not manly). They are also more likely to have outdoor jobs and do household tasks that involve being outside the house. Think lawn mowing and BBQ-ing. They also pay less attention to their skin and so don’t catch early warning signs.

Women, generally speaking, don’t mind lotions, do pay attention to changes in our skin, wear sunscreen to avoid premature aging and wrinkles, and often also wear make up year round that contains ingredients that protect skin from the sun.

Male socialization in this case leads to bad results for men. Women, thanks to a different set of gender norms, fare better.

This combination of factors is part of the explanation as to why men between the ages of 15 to 39 are more than twice as likely to die of melanoma than women of that age. According to the American Academy of Dermatology melanoma will kill 6,470 men this year — and half as many women.

The NY Mag, Why are men more likely to get skin cancer?

“Advocates and researchers are currently trying to figure out how to better get the message across to dudes that they really need to slather on the SPF, and last week Wade came across an unlikely solution: the marketing teams that create what Wade calls “pointlessly gendered products.”Usually, Wade writes about such products — like gendered packages of mixed nuts, glue sticks, and even vegetables — with a mixture of snark and incredulousness. But when she came across Banana Boat sunscreen for men last week, she couldn’t help but write a “reluctant defense” of the product.

“Sunscreen is a category of lotion and so putting on sunscreen is equivalent to admitting you’re the sun’s bitch,” she writes. “In fact, thanks in part to the stupid idea that lotion carries girl cooties, men are two to three times more likely to be diagnosed with skin cancer. So, fine, dudes, here’s some sunscreen for men. For christ’s sake.”

Maybe for my teen boys they need an Axe of the sunscreen world? I was amused to see they know have sunscreen especially for tattoos. See http://www.coppertone.com/products/speciality/tattoguard/spray.aspx  even though the Canadian Cancer Society says any full spectrum, high SPF sunscreen will do the trick. The “just for tattoos” stuff looks cooler and I’m sure ounce for ounce, it’s pricier. But whatever.

The sunscreen avoidance and skin cancer risk isn’t the only health problem men face.

National Public Radio: The Unsafe Sex: Should The World Invest More In Men’s Health?

“On average, men aren’t as healthy as women. Men don’t live as long, and they’re more likely to engage in risky behaviors, like smoking and drinking. But in the past decade, global health funding has focused heavily on women. Programs and policies for men have been “notably absent,” says Sarah Hawkes from the University of London’s Institute of Global Health.”

“It’s cool to be a man that smokes and drinks — who drives a fast motorbike, or fast cars,” she says. “If you were really serious about saving lives, you would spend money tackling unhealthy gender norms” that promote these risky behaviors.”

See also 10 bad health habits of men. The list includes the usual: smoking, drinking, fast food, not seeing a doctor regularly, stress, keeping everything bottled in.

Men lead shorter lives than women and some moral philosophers think we ought to be more concerned than we are about this inequality. There are a number of ways in which men’s lives lead to early deaths, stress, yes, but also death in war time, and dangerous jobs such as mining and construction. Men are disproportionately represented in the prison population as well.

(I’ve written a bit before about men’s health. See The unsafe sex where I address some of these arguments.)

When thinking about inequality moral philosophers like to divide up inequalities that are the result of circumstance and luck, from ones that follow from choice. We think individuals are responsible for inequalities that are their own choosing. Sure smokers die young, for example, but that’s a trade off they’ve made.

It’s tempting to put men’s deaths from sun related skin cancer that category.

“Don’t be an idiot! Just wear the damn sunscreen!”

That I can hear cry in my own voice is part of the reason that married men, or men with female partners anyway, live longer. They’re nagged into healthy habits and visit the doctor more often. Now I should say that the person I’m in the best position to nag on this front doesn’t need it, not where sunscreen is concerned. As the result of a scare in his twenties, after growing up a fair skinned, freckled redhead, racing sailboats on the ocean, he was an early adopter of hats, gloves, long sleeves, and serious sunscreen.

Maybe it’s that I’m now parenting teenage boys but I can see how strong gender role socialization is for boys. It’s okay to wear a helmet because “my parents are crazy when it comes helmets. They’ll ground me forever if I ride without one” but not okay to do it because you’re worried about hitting your head.

Note that when young women acquire unhealthy habits, dieting, for example, as a result of female socialization feminists aren’t so quick to dismiss it as a matter of individual choice. Feminists can, and should, take male gender role socialization just as seriously. Indeed, I think feminism offers the best explanation of some of the inequalities that hurt men.

bright sun peeking through a palm tree