A simple yet tasty and versatile recipe that can be used as an appetizer or main dish. This was created by my friend Mark. He showed it to my friends and I in the early 2000’s. And we now eat it quite often, and have adapted it to be a main course in addition to the appetizer it was originally intended to be. As an appetizer it is typically served with Club Crackers or crusty Italian bread. We adapted it to be a main dish by ladling it over top of ditalini pasta. Over top of it sprinkle generous quantities of parmesan cheese to your taste.
These are all beautiful fresh peppers. The red color means they ripened longer on the plant. It doesn’t make them hotter nor change the flavor. Pick peppers that are firm with a nice hollow sound when you tap them with your finger. Peppers that have a soft wrinkly texture have been sitting on the shelf for a while; don’t buy those ones unless they have nothing else and you’re dead set on making the recipe.
I typically use either of these two brands of stewed tomatoes. Either one is a fine quality product
You can actually use any type of white or yellow onions, but I am just very partial to Vidalia Onions.
6Cans Italian Stewed TomatoesUse the 14.5 ounce cans(any brand).
3LargeVidalia OnionsYou may use any type of sweet onion you like or that is available.
2PoundsHot Bananna PeppersYou may want to use gloves when chopping these peppers.
1CupGranulated SugarYou will need at least 1 cup for this 4 quart recipe. Taste along the way as you may want to add more as suits your palate.
WaterAdd enough to bring the liquid to within 2 inches of the top of the 6-quart stock pot.
Peel the onions, slice off the ends, and chop them into pieces of any shape that are roughly 1/2″ to 3/4″ in size. Set these to the side.
Rinse the peppers in cold water. You may want to put on gloves before chopping these peppers. Slice off the tops of the Hot Peppers. Remove the guts and set them to the side in a bowl. They are going to be added to the stockpot. Again shape does not matter. You can cut the peppers in 1/2″ rings if you like. Or cut the peppers lengthwise and then 1/2″ pieces. Whatever you desire.
Now that you have cut the peppers and onions. You can start filling the stockpot. First add all of the stewed tomatoes.
Toss in the onions and stir in with the tomatoes as well as is possible. No strict requirements here, or on the peppers.
Add in the peppers and fold in with the tomatoes and onions. Pot is going to be very full. This will cook down greatly.
pour in your water and add the sugar in any order.
Simmer over medium heat until the mixture is cooked down to about 4 quarts. There should be a decent amount of liquid. The process will probably take about 2 hours. Add sugar along the way to get it to your desired sweetness. This is intended to be a very hot and very sweet dish.
All human beings are granted at birth the inherent rights to sovereignty and pursuit of health, happiness, independence, and prosperity. Whomever the god you observe it does not matter. All gods create humans equal and afford them the same basic rights. This basis principle cannot be rejected by any well intended, unselfish, good-hearted person.
I subscribe to the ideology that the meaning of life and reason for our existence is to love and help one another. No human could survive alone. Humans need other humans for survival and growth. We are social animals designed to work together in groups/communities to make our lives better. Our communities are living organisms themselves. We rely on each other for love, hate, joy, anger, work, financial prosperity, and help during times of sadness or need. Humans are no different than an ant colony. Although, once these groups, these colonies, these communities are formed, the negative side of humans manifests. We start to immerse ourselves in our own world. We begin to think others are lesser people because they are different. We want what others have. We threaten or attack those who threaten us. Examples of this behavior are glowingly evident today in Eastern Europe. Russia has advanced its armies into the Ukraine. At one time the Ukraine was itself Russia. After the collapse of the communist ruling party led by Mikhail Gorbachev at the end of the 1980’s, Eastern Europe drastically changed over the ensuing decades. Many regions of Russia’s giant territory separated themselves from the Kremlin and formed their own sovereign states. Some still holding their allegiance to the communist regime and others somewhat distancing themselves. The Ukraine happens to be one of the new sovereign states who distanced themselves from Russia. The turmoil in the Ukraine has been simmering this whole century. Ukraine likes their independence, but Russia does not. Their intention was to let Ukraine have its own country if they are subservient pawns of Russia. In short that obviously has been a problem and the world is in this debacle currently with no end in sight. Sound familiar? Just look back to the late 1700’s.
Both ends of a spectrum are represented in this awful predicament. The evil side and the compassionate/loving side. No one can deny that the evil side is Vladimir Putin. Not the Russian people but solely, Putin and those who willingly support him or choose to selfishly protect themselves by being subservient to the fascist. There are several groupings you can separate the Russians population into.
Those who are subservient and supportive to Putin for financial reasons. There are so many oligarchs and their wealth is beyond an opulent classification.
Those who are subservient and supportive of Putin to sustain their status in the authoritarian/military regime and their associated financial status. Although it’s in another category when compared with oligarchs, they still enjoy a luxury lifestyle. The generals and other officers of lesser rank have gained their perpetual status and frankly kept themselves alive by obeying like a loyal canine.
There are citizens of the general population who have been brainwashed by a totalitarian government by hearing lie after lie since birth with no comparing experiences available from democratic alternatives. These people fall in line because of fear and blindness.
Then there are citizens of the general population who have seen these democratic alternatives and can easily see through the state’s continual propaganda. These are the class represented by thousands of demonstrators who have risen and protested their country’s unwarranted attack on the sovereign state Ukraine. Russians in this category have risked and probably ended their lives as a consequence of their actions and “arrest”.
The Russian General Infantry cannot be forgotten. They have been forced into this war without even knowing why they are there. Hearing lie after lie as to Putin’s reasoning for this plan of lunacy. They too are victims of Putin.
The compassionate side includes the myriad of countries hosting the millions of refugees fleeing this orchestrated chaos. Also, those who supply money, armaments, and food are of compassionate intent. Despite the irony of giving weapons to kill, those countries are acting out of good intent. Thousands of people acting on sympathy for the Ukrainians have come from nations around the world to join the actual violent combat. Seeking vengeance for the destruction of the Eastern European nation.
ALL CALL TO ACTION
The looming elephant in the room revolves around the appropriate time for NATO to act. No right or wrong exists in this instance. There is no mythological oracle presidents can visit for advice. In this real world the independent actions of all the moving parts in this out of control machine determines the eventual fate of our world. There are so many permutations and combinations of future scenarios but only a few outcomes. When does NATO or any team of nations enter the conflict with military action on their own behalf. There seems to be no way to avoid a conflict with the Russian federation. The growing sentiment is it is merely a question of when the United States and Russia collide. Based on the principles described earlier it is the duty of Ukrainians fellow humans to intervene. No human has the right to invade any sovereign nation unprovoked. One could even debate the appropriateness of retaliatory action to unprovoked aggression at minor levels. We should not just be an observer of the destruction of a country and slaughtering of innocent men, women, and children. The consequences of intervening are a Third World War or much worse a nuclear confrontation. I am not in favor of standing by and watching the murderous incursion. Yes those consequences are frightening and disastrous, but the lives and torture of the Ukrainian people are worth that risk. It is the worlds duty as a team of humanity to help the Ukrainians. Allowing this to happen without recourse is akin to separating the world into multiple factions working against each other. Each hoping for the others failure. What kind of world is that to live in. No god that is observed by any religion in this world approves of this behavior. No well intended human believes in this behavior. Only humans who are acting on their own selfish hateful, ignorant emotions act like this. Yes one of humans most basic and even beautiful traits are our flaws. An egregious lack of perfection. That must exist. Failure of being perfect helps us learn lessons. Appreciate our successes. But that imperfection is useless if we fail to learn from it. Involving the world too late is a travesty. Trying to put ourselves in their position imaginatively is as close as we can get to feeling their pain. It’s not close enough but is enough for us to realize we would be begging for help. Be at our wits end. Is it better for someone to die or survive. Surviving traps you into a hard life of mental anguish. PTSD for decades to come. A sense of emptiness for those who lost parts or all of their family. If you have the ability to prevent this situation, then you must. It is your duty as a human to love and protect others. Just as you should expect it in return. We would not be a country without the help of France. The colonies were losing or barely holding our own until France helped with manpower and training. So reminiscent of today.
LEARNING FROM EXPERIENCE – KNOW HISTORY
One of my pet peeves is the history curriculum in our schools. Personally, I was taught almost nothing about World War II, the Korean War, or Vietnam. There are other parts of history not covered too. The Civil War, slavery, the migration of people to our country for opportunity in the early 1900’s. All extremely critical events in forming our republic.
A very young United States was once in this very same situation as Ukraine. Colonies formed by British people developing their own territory and land. The huge power to the east (the father country) trying to retain control over the people. The large parent nation sends military service to forcefully gain a stronghold over the once nationalized population. The colonists were completely overmatched except for one area. Their steadfast hearts. The colonists held their own until receiving help from France. Both property and human life losses were substantial to the United Colonies, but they retained enough strategic points by way of a great civilian militia backing the small undeveloped army infantry. Marquis de Lafayette is widely popularized as the first French supporter. Lafayette injected himself into the fray by enlisting in George Washingtons Army. He and the French army proceeded to provide invaluable training, leadership, ideology, 63 naval warships along with 22,000 serving sailors, and 12,000 infantries. This European support and the emergence of the many great leaders who would become the fathers of our country led the people of the colonies to form the greatest country on this earth. The Ukranian people deserve the same hope and opportunity given to the United States of America. in fact, every man and woman on this earth deserves those same simple rights.
Gaze at the moon through a telescope, and you’ll experience the amazement of an object you can’t touch or feel. It’s our closest celestial body, yet it’s so far away. Think about our vast universe. We are just a miniscule spec in comparison to its infinite size. Try to dream of what might be going on far beyond the capabilities of the human eye. This infinity defines the boundaries of what humans can achieve. One day we will be able to explore and learn, by visiting the universe’s most distant reaches. Right now doing that is just a fantasy. Yet the long-term suggests it’s not only possible, but that we will indeed succeed in doing just that. In fact, our future is not here on earth. If we want to continue the existence of mankind, then we must rely on our ability to move beyond our planet’s atmosphere. That same vision relates to all parts of life.
We evolve and learn so quickly. That is why I always try to think of my thoughts as ending with the phrase “right now”. When you lose a loved one; you’re heart broken and sad…….”right now”. You may lose your job, and become financially buried….”right now”. However, the job loss may push you into the best you’ve ever had. I’ve always felt that way about my illness and the lack of a diagnosis or physician consensus on my condition. For instance, in my mind there is no diagnosis nor viable treatment. This has resulted in me being unable to do the things I want to do in my life…..”RIGHT NOW”. I never stopped looking and won’t. Each time that I hit a wall, I just go back to the drawing board and try harder. I read more. I learn more. I think more. You can do just about anything if you don’t allow yourself to get discouraged by failure; AND JUST KEEP TRYING. Failure is nothing but shrinking the list of possibilities by eliminating bad options.
It’s odd how beautiful it always seems to be on my days of surgery. This day did not disappoint. I think it was a Wednesday and the month was June. I love May and June. They’re the best months of the year. It feels so nice to leave behind the dismal, depressing, dark, wet, and cold winter months. Feelings laced with energy grow as each refreshing day stretches longer, and temperatures creep higher. Refreshing cool mornings warmed by beautiful blue skies and a bright glistening sun. I love it. It was one of those days. I was a later morning case; therefore, I didn’t have to be at the hospital super early. My prior experiences were at smaller surgery centers, but this one was at a larger university hospital. Hospital pre and post operating rooms are much larger and busier. Beds are lined up one after another, and typically there are light curtain dividers between each patient bay. This room is like organized chaos. Personnel scurrying around like ants; each with different responsibilities. The nurses and doctors are so focused on completing their individual duties in such a precise manner. This is how such complicated processes having so many independent pieces get performed flawlessly and safely. Without the batting of an eyelash, patients are taken to the brink of death daily with the administration of drugs. It’s really an amazing thing to see and experience. I can’t talk about this without mentioning one thing that seems to get overlooked far too often. Nurses are so underappreciated. Despite the atmosphere in pre and post op rarely will you fine one that isn’t caring, pleasant, and loving. They make a difficult experience much more pleasant.
I remember certain parts of this very vividly; yet other things have been subconsciously blocked from my memory. I recall this day’s pre-op setting very vividly. As I began to describe earlier, patient bays separated by curtains. A narrow walkway in front of the beds. At least ten of us lined up in our beds simultaneously. At least, that is all I was able to see. I’m sure that there were many beyond that number of ten. Further down to the right of my bed was the nursing station. Right where they’re usually located. A rectangular area in the middle of the room. Clinical people buzzing in and out of the walled off area constantly. A chaotic dance like bees working at their hive. The room entrance/exit was on my left side just past the two patients next to me.
This was likely to be my first overnight hospital stay resulting from surgery. I was told I might be able to go home, but not to expect it. It just depended on how the procedure went, and what was encountered after my neck was cut open. I remember the pre-op visit from my surgeon, but I currently have no other recollection of events until waking up back in my hospital room. I remember being conscious when i arrived in my room, although I was unable to keep my eyes open. I was holding my dad’s hand and squeezing it. I was a little uncomfortable because this was my first encounter with a Jackson-Pratt drain. The purpose of this type of drain is to remove serous fluid and blood from the inside of a surgical wound. The drain consists of a length of thin, flexible, plastic tubing which is stitched into the site of surgery. The opposite end is a bulb/reservoir where the suctioned out bodily fluids gather for measurement and color observation. The drain remains sutured into the closed wound until less than 2 tablespoons of fluid is produced within a 24-hour period. This is typically for just a few days. Blood dominates the reservoir for the first day or two. From that point forward the drainage becomes clearer and thinner in consistency. Of course, this can vary based on the severity/size of the surgical wound, and its location on the body. If fluid were to build up inside the closed wound that could present serious problems; including pain from the pressure created with that accumulation, and infection. Also, observing the type of drainage from a wound (consistency and color) is a valuable tool to catch an infectious process early. Jackson-Pratt drains aren’t painful, but they really are an uncomfortable nuisance. That is how I felt at this point. Even though I really wasn’t in a very conscious state. My dad’s hand was a comfort.
It took another two hours or so for me to really become aware of myself and my status. That’s when I felt the JP drain. Pinned to my hospital gown neckline right below the wound on the lower part of my neck. The surgeons typically do what I think is called a “flap technique” incision for a tumor at this location. Modified Blair incision is the actual name I believe. They start cutting with the scalpel right below and behind your ear lobe. The incision directs straight downward until you’re within an inch or so of the bottom of your neck. It then makes a 90 degree turn in towards the center of your neck extending for about 3 – 4 inches. At least, it does if you have a neck as chubby as mine 😊. They have created a cut similar to the bottom corner of a sheet of paper. As if a sheet lies flat on a table and you fold the bottom right corner up towards the middle of itself. That is how they peel back your skin. It gives the surgeon a nice open area to visualize the inner anatomy of your neck. There are many intricate aspects to this area. Parts of vital importance. One of the biggest hurdles is for the doctor to complete the process without cutting the trunk of the main facial nerve. I touched lightly on this subject earlier. The nerve that controls your face comes out of the cervical (neck) vertebrae at a level roughly in line with the bottom of your ear. It passes through the center of your parotid gland. Which is the specific anatomy my tumor was attached to. Therefore, he had to be very careful. They try to identify the nerve and attach probes to it which will alert them if a break in the nerve conduction occurs. A compounding factor in my case is that I’d already had surgery in this area, and that means scar tissue was present. No different than the process on your outer skin. Everywhere there is a deep enough incision, you will develop a scar internally. Physicians have described to me that there is not a very discernible difference between nerve, tumor, and scar tissues. It certainly makes you respect their craft even more than you may have prior. It must be an ugly mess because you get blood dried all around and inside your ear canal. Dried blood comes out with a Q-Tip for a few weeks afterward.
EXAMPLES OF WHAT A BLAIR INCISION MAY LOOK LIKE
I’ve attached another visual aid to help readers understand the human anatomy around the location of my tumor. Seeing these diagrams will help you in understanding the complexities this procedure presents to the surgical team.
DIAGRAM 1: ILLUSTRATING THE LOCATION OF ALL THREE SALIVARY GLANDS
DIAGRAM #2: ILLUSTRATING THE LOCATION OF THE FACIAL NERVES
The trunk of the nerve tree presents at the ear lobe and immediately branches throughout the face.
My tumor was located in what is referred to as the “tail” of the parotid gland. This “tail” would be identified as the area in Diagram #2 where the arrow coming from “Parotid Gland” is pointing. Probably just a little bit lower and forward. Diagram #2, also, gives you a little better perspective of how delicate and precise the surgeon must be. That facial nerve does not lie on top of the gland as it appears in the picture. It is penetrating through the middle of the gland. Like the stick of a candy apple. Just one of the reasons they need an incision creating such a wide opening.
Hospital purposes do not include providing patients with a comfortable atmosphere to sleep. That is to be done at home. They are meant to promote and foster curing and recovering. So, don’t ever expect to sleep well in a hospital. The beds are awful. The mattresses are only like 6”-8” thick. And, they’re not constructed for comfort. You are constantly getting tangled up in IV tubing. Nurses are giving you medicine or taking blood samples from you every two hours. Don’t forget that you might get stuck with a roommate too. UGH!!! I can’t remember specifically, but I’m thinking I probably had morphine in my IV that night. Morphine is so dangerous because it makes you feel so fantastic. It burns when it is put in through your IV. You get an intense burning sensation up your arm and through your chest internally. Not on the outside of the skin, but inside. Its really such an odd feeling. But after that it’s great. The level of relaxation is unparalleled. Nothing can upset you. Usually in this state it feels like I don’t sleep. Rather, I slip into a twilight. Eyes closed, but my brain very active, and I’m very conscious of it. I’m not trying to portray this in a negative light. Because, I do feel very rested by morning. Thank god the government at least tries to control narcotics the best that they can.
I did have a relaxing night. I was woken up by a visit from a gaggle of residents at 6:00 AM. I was groggy, but I really wanted to wake up enough to ask a question or two. What was it that you removed I asked? The head resident’s response: “It was really weird”. That was all he said. I was still half asleep and didn’t want to banter about his response; therefore, I just accepted that and closed my eyes again. I never did see the actual operating surgeon that day. The resident ended up being the one to discharge me. This was a bit odd to me. A few hours after I spoke to the resident; a nurse came in to remove my Jackson-Pratt Drain. She tugged on it just a little bit. It hurt slightly at that point. The actual snipping of the stitches holding it in place within the wound was totally painless. I knew she was “messing” around there, but that was it. No pain was felt. The next thing you know the drain is out. It wasn’t in very deep, so I don’t recall any feeling as the tube slid out. My hospital discharge officially happened in the later morning hours.
The next step of my adventure led to an Eye and Ear Hospital at a local health system. It was a teaching facility that is a well-known part of a local university. I’ve developed the opinion that if you are a complicated patient, then the teaching setting is usually the best place for care. This is for a couple of reasons. First, resources are at an abundance. Resources refers to equipment, clinicians, and time. When you have an appointment at a University location you will assuredly first see a physician who is doing a fellowship. They will be responsible for gathering information and presenting it to the teaching doctor. They will discuss things, and then at this point the teaching physician will come in the room and repeat the examination process. He or she will then give you their thoughts and plan of care. Sometimes you will even be assessed by a Physician’s Assistant or Certified Registered Nurse Practitioner (CRNP). You’re essentially getting double or triple the time with clinicians compared to a local independent community hospital or clinic. That doesn’t necessarily mean that the community doctors are not good. It just means that physicians practicing in a university setting have a lot of help, and it allows them to provide better care. Moreover, many of the offices are equipped with diagnostic equipment and blood drawing capabilities. Therefore, you get one stop shopping. A lot of care can be provided in one location. If the offices don’t have the equipment, then quite often they are located within a hospital or facility which does have the resources. A second reason teaching facilities are better for complicated patients is experience. Years ago, for the most part you picked your doctors by location. You went to practitioners you were close to or could get to easily. Today it’s a lot different. Mainly because of the options available in two key areas. Specialized physicians are much more available as well as transportation assistance to their offices. Many health systems have reached out to communities with the building of outpatient clinics and diagnostic centers. The more complicated care is referred to the system’s hub at the teaching locations. If you are a complicated case these are the people you want to help you. They have vastly more experience with the more complex, less common cases.
I remember that my appointment was later in the morning on a Friday in early May. This ended up being a marathon day. The doctor was late, so it was at least an hour past my scheduled time when I got in the exam room. A nurse took all my vital statistics, and then a fellow was the first provider to pay me a visit. He took a detailed history and did a thorough examination. I didn’t have a huge history, but the forehead was a rare occurrence, so it made things a little more involved. The physician was next up to visit me. After examining me, he told me to head to another floor of the facility where I would have a CT Scan. I followed his instructions, and after about another hour wait I was getting the scan. CT Scans are quite fast. Even if you are receiving contrast material. You do need an IV to introduce the dye, but overall its only like a 20-minute event from IV insertion to scan completion. By the time I was finished and headed back up to the doctor’s office it was like 6:00 PM. This is a perfect example of the advantage of the University setting. All in one building you have the physician’s office, and all the needed diagnostic tools. The ability to have testing done spur of the moment on a physician’s request is such a great advantage. In this instance my doctor ordered the results “stat”, hence they were available to him immediately upon radiologist reading. I was soon back in the exam room waiting for the results. There was a lot of conversation with the doctor when he presented, but I vividly remember his comments as to what the swelling may be. He remarked: “I think you’re a 41-year-old man with something in his neck that shouldn’t be there, and it needs to be removed.” The list of things it could be was too big, and not enough information was known to narrow it down to a diagnosis of any type. I inquired if a biopsy might be done. He said if I wanted one he would certainly order it, but biopsies in this area still have a 25% chance of false negative results. Because of this fact, he wasn’t going to put me through the aggravation of sticking a needle in my neck. It was going to still be the same plan of care regardless of the results. And that was going to be: excise the irregularity from my neck. Therefore, I agreed to moving forward with surgery. It was scheduled for about three weeks later which took me to very early June.
My boss wasn’t at all in favor of the surgery option at first. The trunk of your main facial nerve exits your cervical vertebrae in the back base of your skull, passes by and below your ear, and through your parotid gland. It then branches off in small arms feeding to all the different areas of your face, and making it function. Her concern was that my facial nerve would be cut during surgery resulting in either temporary or permanent facial paralysis. She was in favor of waiting a bit longer to see if the swelling dissipated in any way or presented other symptoms giving clue as to what might be causing it. I totally understood her position, and I certainly was leery of having damage done to my facial nerve. Over the ensuing few weeks we talked about this several times. Eventually she conceded that because it was going to continue to be such a diagnostic problem, she agreed surgery had to be the best option. It was comforting to have her approval going into this situation. Especially because this was going to be a bit more complicated procedure than my previous year’s. I was now heading into my second summer of dealing with head and neck surgery. At least it was a short wait for the surgery date.
I had the surgery in the month of June and resumed golfing a few weeks later. Per my physicians, there was now a much higher risk of getting a repeat occurrence of melanoma. Because of this, I was advised to completely protect myself from the sun. My boss even used the phrase “You can never get sunburnt again”. Since I was a walker on the golf course using a three-wheeled push cart, I purchased a wide-brimmed farmer type hat to protect my face. Walking for golf exposes you to the sun much more than riding in a covered motorized cart. I even tried wearing pants a time or two in the beginning. Coming back to play in this manner was just weird and uncomfortable.
Along this whole journey I’ve seen and experienced so many fascinating and odd events with my body. For example, walking along a golf path on the edge of a dense tree line I noticed my longtime buddy was staring at me. He stopped me to take a closer look and said to me: “your forehead isn’t sweating above your scar”. The rest of my face was soaked with sweat as it was a hot July day. My incision was in the dead middle of my forehead; about 1 inch above the bridge of my nose. The doctor closed the open chunk of missing skin by pulling the skin above the cut line down and inward like a “V”. So, you could see a “V” outline almost like how the fabric of fitted sheets pucker on the four corners of your bed. He was accurate. There was no sweat in this “V”. I was only perspiring on each side of the tightly pulled skin and below. For a few years the whole area was also numb. This skin texture is no longer visible today, as the skin has stretched out naturally over the years. I say laughingly that this was like a mini facelift for me. My receding hairline was helped an inch by this surgery. The hair on the top of my forehead was about an inch lower than before surgery. In the beginning I even would get sprouts of hair growing near my incision in the dead middle of my forehead. It was comical if nothing else.
The remainder of that summer was uneventful. I recovered fully, and all of my energy returned. I even started a major house remodeling project that fall, under the guidance of my friend. My basement was being converted from concrete block walls to a living/game room and small fully equipped kitchen. A lot of very physical work was completed. Most of it was being done on weekends. At some point around late October or early November I noticed something odd. I don’t even recall what made me notice this. I found a lump in the right side of my neck. It was under the hinge of my jaw (below my ear lobe). My face is very chubby, so it certainly wasn’t anything easily noticed. From the outside it appeared to be the diameter of a golf ball. It was hard to notice it without me craning my neck by raising my chin upward and back. Whatever this thing might be, it was causing no noticeable pain in the area. I rationalized it as a swelled lymph node from fighting a cold or flu bug. Something we can all surely identify with.
A few weeks passed, and I hadn’t thought very much about my neck. Although I do recall that I never developed any substantial flu, and the lump was still present. I figured that this couldn’t be anything alarming or uncommon, and that if I asked my boss she would know what it was immediately. She examined me very well. By palpitating the whole area. It was a bit perplexing to her. Not what I had expected. She was suspicious of a “reactive lymph node”. This meant that the node was swelled because of an infection near the wound, or because it was actively healing the wound. The odd part of this scenario was that surgery was months ago. It was fully healed, and there were no signs of infection. So why a lymph node would still be reacting now was the question? But, there really was no other explanation. A few more weeks pass by, and now it’s the winter months. Nothing had changed regarding the lump in my neck. It did not get larger. It did not get smaller. There was still no pain. Unsure about it, my boss advised me to call my surgeon. It should have passed by now if it was anything acutely minor.
I got an appointment to see my surgeon in late January 2011. He too was very unsure what was happening. I remember his first comment after he examined me, and as we were discussing the reactive lymph node scenario. “No…..That’s not from me. I wasn’t in there” was his reaction. His cutting was an inch or two behind the location of the current growth. He was effectively ruling out the lymph node possibility. Because of his lack for an answer, my doctor ordered a radiologic testing procedure called a PET Scan (Positron Emission Tomography). A PET Scan is based on a very complex yet ingeniously simple scientific theory. I was told it was originally used as a way of tracking either the progression of malignant conditions, or to monitor treatment therapy for results. It wasn’t necessarily used as a diagnostic radiological procedure. The basis of the test revolves around the cellular use of sugar for energy. Malignant cancer cells have a higher metabolic rate than normal cells, and therefore use much more sugar to function. You are given a fruit flavored drink which contains sugar that has radioactive isotopes attached to it. In addition, there is a contrast material injected into your body. These two substances are what allow for the detection of malignant cells. The malignant cells and areas of higher metabolic activity will absorb the radioactive sugar isotopes. You can have three areas light up on the subsequent scan. Your brain, your heart, and your bladder should be seen. The brain and heart show up because they are areas of high activity using more energy, and your bladder for obvious reasons. Anything else that shows up needs further diagnostic work. After you’re given the drink and the contrast material, there is a half hour or so wait until you lie on the CT Scan table. It may be a faster scan with today’s technology, but for me it was about a 3.5 hours on the CT table. Remember that this is a full body scan.
My results came a few days later via a call from my doctor’s nurse. They were pretty good for the most part. The phrase used to indicate spots of concern are called “areas of uptake”. Adjectives are used to describe it such as “area of intense uptake”. I had a few mesenteric lymph nodes show up weakly. Those are in your abdomen. Mesentery refers to a layer of “fabric” that holds your organs to the inside wall of your abdomen. These weren’t a concern to doctors, but they were to be a foreshadowing of looming events. The most important thing was that my neck had no areas of uptake, although there was one spot that did. That area was my butt. Yep, that’s right, my butt. I told the nurse that it must have been because of a pilonidal cyst I had on my tailbone. It still had to be checked out visually. I thought to myself. Are you kidding me? So embarrassing. I went back to see my surgeon for a review of the results. I told him the cyst had been infected in the past so that must have been the source or reason for the uptake. He examined me and couldn’t find any infection or area where an abscess had manifested. It was decided that the cyst must be the source of the uptake, but since there was no serious infection it did not need treated. Subsequently, I was referred to an ear, nose, and throat doctor for further evaluation regarding the oddity in my neck.
Work was a pretty good place for me to be on a daily basis. I received wound care as needed. My boss and one of the wonderful nurses checked me regularly. At this point, two events occurred which in retrospect were foreshadowing my future. First, as time progressed, my forehead stitches became a nuisance. Because of the type of incision and its aesthetic location; my wound closure entailed first suturing the tissue inside, and then merely applying Steri-Strip dressing and compound to the outside. For those who haven’t experienced these, the Steri-Strip dressings are thin rectangular super sticky strips of tape. The compound is a sealing/binding glue spread over the incision to both stabilize and protect the opening. The internal sutures will dissolve and the outside has less scarring since no thread is used. The hang up was that my internal sutures weren’t dissolving; rather my body was rejecting them, or “kicking” them out of my body. My nurse friend at work was pulling on little “nubs” of thread sticking out of the incision. On the other end of these nubs were tumbleweeds of thread, for lack of better words. This happened multiple times for the next few months. My body was rejecting the sutures before they had a chance to disintegrate. Secondly, after chewing, the left side of my face would swell rapidly. The swelled area was right in front of my left ear lobe where the hinge of the jaw is located. It would grow to the size of a golf ball. I showed it to my boss who said it was actually my parotid gland filling up with fluid as I chewed. The fact that it was my parotid gland is somewhat important for future chapters. This gland is the largest of your three salivary glands. At its highest point it starts on a level with your ear opening, and extends wrapping just under the hinge in your jaw. She called my surgeon to make sure he was in agreement with her draining it as it swelled. He of course was fine with it. So each time this happened in her presence she would stick a needle in my face/neck and suck out a yellow tinted, but clear fluid. It was a very effective technique left only to the most experienced of head and neck surgeons. The trunk of your main facial nerve passes through the middle of the gland. Therefore she had to get the needle in the gland, BUT NOT IN THE FACIAL NERVE. She did it with precision each and every time. This was done for a few weeks until it stopped filling up with fluid.
Now on to the most intriguing part of this whole mess I got myself into. The pathology of the skin and lymph nodes. Was the lesion completely removed this time? Did my lymph nodes come back clean? It took about a week to find out. The relieving and most important part was that my lymph nodes were clear of melanoma cells. Spic n’ span clean. That meant this episode was brought to an end. I would need no further treatment. My surgeon explained that he thought the lesion had been caught just as it was changing into melanoma at the cellular lever. If it had been left longer I would have been in a very bad position. But I wasn’t! To an extent it will always be shrouded in mystery since the spitz nevus and melanoma look identical at the cellular level. That was irrelevant anyway since I was in the clear. Now I can be relieved and move on with life back to normal. At least that’s what I thought….
The events of my surgery day are stored vividly in my memory. I recall arriving at the surgery center, talking to the reception workers, and filling out paperwork. Never having surgery meant not knowing what to expect that day. Having had 21 surgeries since this; it’s all “old hat” to me now. I was nervous while lying in the Pre-op area and waiting to see my anesthesiologist and surgeon. They both speak to you and get your consent before your visit to the operating room. It was about an hour wait in pre-op before being taken back to surgery. Once I did go, I remember the most incredible feeling as my bed was rolled to the operating room. I had been given me some of the drugs which are part of the anesthesia cocktail. It felt like nothing in the world was wrong or could go wrong. Complete ecstasy. You don’t always get those drugs on the way to the OR, but I think they sensed my nervousness, so they injected them a few minutes early. I was thankful. I remember coming out of the anesthesia. Waking as they were removing the intubation tube from my throat, and choking for a few brief seconds. The staff was talking to me. Asking me to wake me up; open my eyes. After that rough first few minutes, I regained my faculties fairly quickly.
Upon leaving it was a bright sunny summer day. I could hardly see anything between the blinding sun, bandages, and anesthesia. There was no pain. I soon found out how difficult sleeping with an incision on each side of your neck and one on your forehead was going to be. You sort of just lie there like a mummy. Recovery was fairly fast. At first the swelling was severe; lasting several days. When the swelling was at its worst, there was some pretty intense pain from all of the pressure. I remember taking ibuprofen, and then seeing serous fluid actually leak out of the pores of my cheeks as it relieved the swelling. It looked like my cheeks were crying. Little teardrops everywhere. That’s how much pressure was being exerted on my skin from the inside. Once that swelling went down, I was well on the way to recovery. I returned to work about five days later.
The weekend and Monday passed by, and Tuesday brought the results from the clinic as follows: NOT likely to be melanoma,rather it is“favored”to bea severely atypical dermalSpitz nevus. What the hell is that? Answer is….. it’s a whole lot of craziness. I ended up at a melanoma specialist at a local cancer center. He had gone to school with my boss andthey are stillfriendsto this day. Incidentally, I still see him occasionally.He is one of the greatest physicians I’ve ever met,and an even better person. So, what is aSpitznevus? I was very confused whenhe first explained this to me.If you have aSpitznevus at birth, or develop one as achild,they are totally harmless. But, if you acquire one later in life as Idid; it’satotally differentset ofcircumstances. My lesion developed over a span of about three months during my late thirties. Its maximum size was aboutthatof an eraser on the end of a pencil. It had been thereroughly4 years at the time of removal. Unlike aSpitznevus that has developed early in life, one occurring in mid-life is atrisk of converting into melanoma. A problem with Spitzoid tumors is that under microscopic observation the cells of a melanoma andSpitz are essentially identical. The difference lies in their behavior. Spitz nevus cells are benign; while melanoma cells areaggressive, metastatic, and deadly. My specialist at the cancer center said the only way to truly know if mine had converted to melanoma would be to donothing andsee if I was alive in five years. He was that frank with me,and I appreciated it. The protocol for treatment of this type of tumor involved a second forehead surgery to excise a largerfootball shaped piece ofskin. About 1.5” wide at its maximum point, and 1” from top to bottom atits largest. In addition, I needed to have lymph nodes removed and checked for melanoma cells. If melanomacells were to show up in my lymph nodes then it was going to be a bad prognosis. If my nodes proved negative for the cells;that was good. It meant that either it had not yet changed into melanoma, orithad changed but not spread.
Surgery was scheduled for 6 weeks later. Ugh. That’s a long wait! That was the tough part. Myfirst experience with this type of thing,andI mustwait that long to find out what my future was to hold. I recall the weekend before surgery being the toughest. I wasnervous. Not even just about what I was going tofindoutregardingthe lymph nodes, but maybe even moreaboutthe cutting into my forehead and neck (lymph node location). The procedure involved a two-day event. Tuesday of that week was something called a lymphoscintigram, and the actual surgery was the next day. A lymphoscintigram is done for finding to which lymph nodes my forehead “drains”. Those would then need to be removed the next day. A lymphoscintigram isnot an awful procedure by any means, but it’s not very pleasant either. The patient lies on a table;which is part of a scanning device. A syringe is then filled with contrast dye. Contrast dye is a substance that shows up on radiological testing. Six injectionsof the dyegointo the forehead. Not just injected subcutaneously (just under the skin), but the needle firmly pushed against your skull. A bit painful. You are warned of this so you’re prepared. There can’t be any sudden movements. The scanning device then tracks the dye to the lymph nodes which the forehead drains. The sight of myforeheadlesion happened to drain to lymph nodes on both sides of my neck. Located just about an inch forward of my ear lobes, and one inch below my jaw. Therefore,I was facingthree total incisionsthe next day. I remember being mentally exhausted after the lymphoscintigram. This was all such a new disconcerting experience to me. One which I will soon begin to accept as a regular part of my life.
Now….whatwas malignant melanoma? Again, not being tooknowledgeable; I knew it wasn’t good, but I really didn’t know how bad it could be. This being the case, I showed it too one of our nurses. Wow, did that cause a ruckus! Within three minutes there were four co-workers around me looking at the results. The one nurse was even crying. What the heck!I still didn’t quite understand their reaction, but Iknewnow that itwas nota favorable pathology report.The surgeon (our boss)was leaving Saturday, May 8thfor a cruise out ofaport inGreece.Therefore,she was not planning to come in that day.Well, she did end up coming in. They called her.
I’m thinking this sounds more dramatic than it really was. It’ssomewhat hard for me toknow sinceI lived it. I don’t feel like anobjective judge of that. Regardless, this is how it happened. After my boss arrived,I remember seeing her sitting cross-legged up on the counter in the reception area holding my report. A little bitteared up. She was upset because she was trying to figure out where she had gone wrong. The lesion did not at all look like melanoma, nor do I fit at all into the high-risk categories for it. The reason she was concerned now was due to the size of the lesion. In melanoma the size of the lesion when discovered is very important. They arevery aggressive and metastatic. A lesion caught before exceedinga size of7 millimeters likely has not gotten into your lymphatic system. The lymphatic system is its pathway to spread throughout your body. Being that the size of my lesion was overthat thresholdshe had concerns. However,my case had been forwarded to a specialist in the pathology department at the Mayo Clinic, andthat meant there was at least somedoubt as to what theaccurate diagnosis might be. I had to wait for the Mayo Clinic to issue their report andmoveon from there.
I vividly remember the day my life changed forever. May 7, 2010 was a beautiful sunny spring day. It was a Friday. Golf season had just begun a few weeks earlier. I was very excited for that season because I had surprised myself and won the championship of our golf league the prior year. I couldn’t wait to get out and play that weekend since it was going to be great spring weather. I worked for a surgeon at the time, and I had gotten to work just before 8:00 AM. That day the front office receptionist was coming in late, so I had agreed to cover for her until she arrived. Before I detail the upcoming events; lets jump backwards to Tuesday, May 4th of that week. The surgeon I was working for removed a lesion from the center of my forehead that day. She didn’t like how it looked cosmetically and had been asking for some time if she could remove it. The doctor didn’t have any concerns that the lesion was posing any danger to me medically; she just thought it was unsightly. That wasn’t untrue; so, I agreed to let her take it off. Bouncing again to thatFriday, May 7th, I arrived behind the reception desk and walked over to retrieve the documents which had come overnight on the fax machine. I rifled through the papers and saw a page with my name on it. It was a pathology report. Now, at this point in my life I was not very knowledgeable of the process for my type of surgical case. Heck, to this point in my life (I was 39 years old at the time) I hadn’t even had stitches. Anyway, it’s protocol to always send excised lesions for pathological examination. This was the report on my forehead tissue. “Malignant melanoma and forwarded to the Mayo Clinic for further examination.”