how painful is it?
what is PDT
What is PDT
after no pain after stiches where removed no pain just odd numbness
I had Mohs surgery three days ago on the right side of my nose. It has been interesting reading the varied responses. My own experiences:
- my initial numbing shot(s) did not give me any pain. I barely felt these at all. I probably had 15 different shots during my entire procedure but could not feel anything at all after the first one. I am convinced that injection pain or lack of it (also based on dentist experiences) has everything to do with the skill of the person adiminstering the shot.
- the actual removal of the cancer takes very little time. I was the "winner" of the day at our office with three different sessions to get complete removal. These were really not an issue.
- I was not quite ready for the 80 minute suturing session to finish the process. There is a good bit of pushing/pulling and it is tough to stay completely calm with someone all over your face for that amount of time. I will say, however, that this part was not painful but jus uncomfortable.
- I did have a good bit of pressure or pain after the procedure. It was hard to tell whether it was from the pressure bandage, swelling or whatever. I am usually pretty good with pain (no novacaine for fillings) but did take my Vicadin for the first day. Now I seem to be OK with no meds for pain. My nostrils do seem a little constricted but I think that may be from swelling.
- your first "viewing" of your surgery site may be a little unnerving. My nose is red right now. I hope this is normal and we'll see how things progress.
- overall, right now I feel pretty good about everything but based on reading the comments of others know that I have a ways to go.
- thanks to many of you who have supplied comments so others can see where things might be headed.
I'M SO SORRY FOR BAD EXPERIENCE, BUT THANK YOU FOR LETTING US KNOW.
MY MOM HAS GONE THROUGH PROCEDURE AND HER NOSE LOOKS HORRIBLE VERY DISFIGURING.
THE DOC ACTED LIKE THE SURGERY WAS NO BIG DEAL....BUT IT WAS!
I WISH THE DOCS WOULD READ THESE BLOGS
Im due for my second mohs surgery tomorrow so ill write tomorrow but i know it was ok enuff and im not prtrified to have it done again im just so tireddd of these darn sureries i had like 14 now 3 tumers melenomas on breasts hip, buttock,belly, back 3 or 4 on fac a melanoma on nose and a basal skin and this tommorrow quarmis cell which thye have anesthesiolalaist all on standby for noon as Iv been overhearingthing Idnth think they want me to knowand that is that they may be rebuilding the nose? wt? all i know it iss 7 m and im going to sleep soon and and wil wake felling like crap..as i just cant go through this any loner but what r my choices? a horrible death of skin cancer or 22 surgeries..send me out a prayer im a 52 yr old attractve stil, lol, female, but wont be much longer..hha shellycemt
I'm glad I didn't read any of this before having a squamus cell carcinoma removed from the left sideof my nose. Numbing is painful but that pain doesn't last long. No external stitches, internal dissolving kind. Pressure bandage and imitation skin. Hurt enough to take oxycodone that night and the next day. Swelling, black eyes went away soon. A week after the nurse was amazed at how well it had healed. Two weeks after that I have kind f an odd sensation on that side, like my nose is a little stuffed up, but that's it. And I can hardly see the scar.
10 months past MOHS then separate reconstruction surgery to remove basal cell cancers on scalp and side of nose. MOHs was a breeze other than my anxiety around having facial work. I worked with a therapist before & after surgery and HIGHLY recommend it if you're feeling anxious.
The cancer on my scalp left a bald spot that the plastic surgeon didn't think the hair would return, but it did! My hair is almost as long as my bangs & most of the time I don't even think about it.
I'm going to share my experience not to scare, but to inform. I received excellent care and have wonderful doctors that I would recommend to others. My wish was that they had been brutally honest about how painful facial surgery is. I'm the sort of person who would rather expect the worst & be pleasantly surprised when it's better. I was led to believe this would be a piece of cake.
Hardest initial part was pain, and swelling, bruising, and the look of the repair.
The puffiness has persisted. The doctor wants to do a reconstruction of the original repair to the side of the nose, mostly for cosmetic reasons. I've been reluctant because most of the time, I can ignore the itching and pins & needles I still feel, and my friends tell me they can't even tell it's swollen. I'm considering it now because for some odd reason, it will randomly swell & make breathing difficult. Hate waking up in the night feeling short of breath.
I really hated having to sit up for 6 weeks in order not to disrupt the grafts. It's so hard to sleep that way. The nose had the deepest cancer, and a hole was left in the side of my nose (what, a new nostril?!?) after the MOHs and to reconstruct it, the plastics dr filled it in with cartilage from my ear and a skin flap cover from my cheek. The ear hurt like the dickens and actually caused a lot more pain than I would have expected.
I'm pretty good with pain, had babies with no meds and major abdominal surgery with minimal narcotics. In the first week post surgery, I went through 2 prescriptions of oxycodone (60 tabs) and that was spacing them out to not experience the side effects of sleepiness & nausea.
Would I do this again? Absolutely! In retrospect, life is far more valuable than the change in my appearance.
I'm told that since I've had multiple basal cells removed, I'll have more, and that the surgeries were to stop the cancer in those specific areas. A little disappointing. At least now I know what to expect.
I had it on the bridge of my nose last week. The day of the surgery there was some pain, however the Dr had me get some pain pills and after taking a couple of them I am fine. I can still feel the pulling of the stiches, but not where it is really painful. I am to have my stiches removed on Wednesday and from the looks of things I am going to want to keep my nose covered for a few weeks while it continues to heal. I did not have graft since they were able to pull skin something like a facelift job. I felt my surgeon was very thorough and explained the entire process prior to doing the surgery. I went for the Moes since it was Melanoma and I wanted it all removed.
I had Mohs surgery 13 days ago and the part that is not healing properly is closer to the tip of my nose. I keep an ice pack in the freezer and have continued to apply it ever since I came home. I had 3 internal stitches and 8 external stitches, which were removed after a week. I was told by my Dr. that the skin on the tip of the nose is thicker and heals differently than the skin higher up, between the eyes on the septum. I also was not prepared for the swelling and thick appearance of the area around the incision. I have a follow up appt. in 5 weeks. My Dr. mentioned something about steriods in case the swelling is not going down. I have also read info on dermabrasion to take down the thickness of the scar. I asked
my Dr. if I could massage the area and I was told NO. Not until 6 weeks post op. Same for topical ointments like Mederma and such.
Day #15 now, I have to admit that the healing is beyond amazing. I am on my seconds fresh pineapple (maybe does some good?). The redness is still present along the long incision and at the tip, though...each day it dminishes slightly. I have also had mixed days with some yellow, purple, and redder too. I tried to stay calm during these, as they only lasted 12-24 hours, so I only thought the bruise is changing. MY right nostril is tigher (cancer removal wound was on right). I can breath, but right is "narrower, tighter. Maybe its still swelling? I can't help think that the TENDERNESS of the tip is something wrong, though they keep reassuring me that "that is normal". Each day it seems, though minimal, that the tender area shrinks a tiny bit towards the center. After day #12, the incision line that was not so tender, now is, and I feel much more "pulling" than previously. I assume both are related to nerve healing and feeling returning.
There is no question that it appears Standard Operating Procedure is to send the patient home with a post op sheet (generally basic vague instructions), call if there is a concern. This is only my 2nd major surgery in 50 years and I was not prepared to be my own would care specialist. Maybe I need more medical directions and reassuring than most? Based on the MULTIPLE unusual sights and sensations I have experience in just 14 days, I think that it would take 5 pages to just summarize post op care. I am sure each patient is different, but that is no excuse for what seems to be "you are mostly on your own". This is likely a common complaint for most surgical patients.
Thank heaven that the ITCHING has subsided 75% (still comes and goes). On day #14, in the tip area, I had 4 short bursts of intense pain during the day (took 1000mg tylenol). Again, I attribute this to healing, though during the pain I had other thoughts. The scabbing is from just above the tip to the tip, it is minimal, but visually annoying. I got mixed messages from post op care, one saying "let it dry out" the other two saying "keep it moist". I have opted for the MOIST choice most the time, alternating from putting the antibiotic ointment on 2X/day to cleaning it with Qtip, or pad with 50% peroxide/water and letting it air out a few hours. I have also used Betadine/Providone (OTC fro CVS) 3X the past 2 weeks, and some Silvadine cream I have 2X. (I mentioned both to doctor who seems unconcerned. I also had to take OTC decongestants 3X/day the past 2 weeks and my BP shot up to 148 (not a shock). I still use my nose spray sparingly.
The nostrils do not seem perfectly even, maybe this will equal out. (or maybe its not a valid expectation). The incision between the nostrils (gross) has also healed to almost not visable. I get scared any time I touch any part of the nose, adding to my medical insanity. I have also sneezed about 8 times the past 2 weeks, without incident, never holding it in. I also lost 8 pounds during the 2 weeks, though 3 came back the past 2 days. My energy is bordering on cronic fatigue (now I know what others mean about this). My sleep pattern is very disturbed and I continue to use the Ambien or OTC PM before bed to help (and it does!). The only down side, is that while the actual Mohs 3 layers was easy, nothing to fret about, the repair and recovery has me now in a mindset, NEVER to do this again (wife says never is a long time). Meaning when another skin cancer is found, its scrape & burn, freeze, or chemo cream for weeks or months. I suppose it's fair to say the location of the skin cancer would effect my next decision (I.E. not on the face).
PS, my digestive system is still out of wack too. The anxiety and Vacdin for a week cause constipation. This has continued in week#2, still using PTC stool softenres 2-3X/day. MY backside is still recovering from the extreme episode on Day #4.
Another huge issue for those of you in Winter in cold weather...if possible this is NOT an optimum time for sugery. Even short exposure to the cold on my nose, causes discomfort and concern, and warming up that area (or my damaged nerves) seems to take HOURS after just a few minutes cold exposure. I now can cover my nose with a scarf (though still hurts when ANY pressure is applied, though I could not do this until about 2 days ago. Maybe I should have waited for Spring?
The entire recovery trauma has also set my general anxiety issues back about 5 years. this is not good, not the surgeons fault, though many peers think that I was not prepared for the post procedure issues. Without question I would have been out of work for 2 weeks, and still very fatigued and mentally not all there for week 3. I do not know if it is a vanity, medical phobia or reasonable concerns looking in the mirror. I see the surgeon in another week, though as I understand normally, you are just DONE until 6M dermatological check up. I still leave it open to change my positions down the road.
Please update us on how it looks, feels now & whether you would do this if you'd known the course of recovery. I have an anxiety order also, and though I've had surgery before, my vanity is showing up because I don't want to look like a freak.
IT's been 6 months now post surgery. The recovery was tramatic for me. I was NOT prepared for how bad it looked at all. Everyone says, it looks amazing, whihc is true considering how bad it looked for 2 months. I still see the entire vertical scar, though others do not. I had numbness at the tip and nostrils until almost the 6th month, very maddening. Now the numbness comes and goes, codl sensitivity, dryness, and the small red spider like veins are only now about 80% gone. My nose does NOT feel the same, though breathing and air flow have returned to normal on both sides. In hindsight, I would have chosen the "SKIN GRAFT" option absolutely. Even more annoying, my nose after more than 24 internal and external stitches is slightly thinner, but just as long as before. While the small skin cancer spot on right is gone, it was not worth it. I also might have mad emore effort to try laser or chemo options first. Maybe had I had the skin graft, VS reconstrructive major surgery, I might feel different? HAd I been preped much more about the recovery, I might have either rejected the surgery altogether or done better post surgery. I have been told by others that 18-24 months is more typical to get full feeling back, if ever. I would advise any that MOHS itself was not the issue, but the post MOHS repair. I am considering posting ALL the post surgical pictures and timeline so that others can have a MUCH BETTER idea of what is possible. I think that my MOHS/Plastic surgeon was very skilled, but...I would think carefully if giving the choice after MOHS of skin graft or reconstruction. I currently regret my choice while heavily drugged and not prepared for the outcome. While it did set my anxiety back years, it also set the bar higher too for my own expectations, as NO KIDDING, 3 months after the MOHS thyroid cancer was found and I had to end of having total tyhroid removal and radiation scans and treatment protocol. My 2 inch would on neck was a breeze compared to the nose...so maybe, it was all meant to be put things in perspective for me? Some say the 2nd cancer might be trigggered from the extreme stress of the MOHS reconstruction? I think that might be contributory, BUT, not the cause. Just ask more questions about the post MOHS process, and they should show you actual pictures like mine. MY wife says if they did then you would not go through with it? Good Health.
I have to have Moh's Surgery on August 27th on the right side of my nose for Sequamus skin cancer. The dermo did a bioopsy and nothing has returned. She just wants to be certain that all is gone. I'm a nervous wreck, as I'm a whimp when it comes to needles but can be made to be brave when need be. I've been doing a lot of reading on it and no one can tell me how long I'll need to be out of work...I don't have that much sick leave and really don't want to delve into my vacation time...
See my 18 month post surgery post.
Would I do it again? Sadly, I would say yes, though, I might choose the skin graft VS the reconstruction. As far as the MOHS and the needles, I assure you that was really very minor, maybe it was the valium, or the overall fear numbing my mind. I only felt a very minor pain the first 2 pokes, and then 1/2 way through when I requested more numbing. I assure you to be awake, mostly alert and talking to the doctor during the 90 minute reconstruction amazes any I tell and me too. I did look like a freak after, and for about 2-3 weeks, but....I assure you I went to work on the 3rd day and no one said anything (good co-workers I guess). Anyone who knows you had cancer surgery, face or anywhere takes pity on you (ha, that it is not them). I did FREAK OUT after, and for about 10 days. I went back to the doctors 2X and called 2X, they were understanding and courtious, never made me feel funny. I also took xanax and that helped. Looking back, though I hope you can avoid it, I am much stronger for the experiece and what I now know that I can endure now to survive.
See my new 18 month post surgery post. I am sure you heard the one "90% are negative". I laughed after I had heard that 3X, and fell in the 10% group each time. the needles (I am needle phobic) were almost less trauma than a immunization or blood draw, maybe the Valium? The MOHS was also a breeze. Just read the info and be knowledgable about the post MOHS choices you could be presented with. (hopefully you did not have any surgery). I was at work the 3rd day and you could be to, if needed. Pain meds were only needed a few days. I purposely had the procedure on a Friday AM (lasted till 3pm), so I could recover at home on the weekend. I was at work Monday and was easily able to due my job, in fact the distraction was good medicine. To this day my wife can't beleive that I was awake during the 90 minutes post MOHS reconstruction. I did have them cover my eyes and I also (on a trusted recommendation) choose NOT TO SEE THE MOHS WOUND when the doctor offerred. That was one of my good decisions. Each case is so different it's hard to generalize. My surgeon was a MOHS and Plastic combined. Some have to have the 1st step, then go home, then to another doctor for step 2. That would have been hard for me. In closing, the would looked as bad as I could imagine, at times I thought that I had ruined my face, but...the body is amazing and except for the business about them rubbing OFF the scabs intentionally (I had to admit it looked 3Z better after they did) I would have never thought that I would look normal again, yet...I have even had 2 other surgeons in my face and not notice, amazing, really. If any of us are alive to share these experiences, we are the lucky ones. This did teach me that my vanity was much bigger than I thought. It also taught me that I can do so much more than I ever thought too.
I had SCC on my nasal tip and did not opt for Mohs surgery. I used a product called Perrins Blend. Btw, I understand you feeling "isolated."
Please update ASAP. I would like to know how you are doing.
September 6, 2014
Dear Fellow Mohs commenters,
My name is Shar, and I just had Mohs surgery 2 days ago at UCSF. I am writing to get your feedback, just as I read your comments prior to surgery, especially Jeff's story.
Two weeks ago I had a biopsy for a spot on my nose (right side middle) that I had shown to both my primary care physician and the High Risk Skin Care Clinic at UCSF earlier this year. It wasn't until two weeks ago that they took a second look after I described a non-descript flesh coloured bump that turned into a little scratch that healed, then didn't, then healed again, then opened up. It was Basal Cell Carcinoma ("bcc" as I have now learned the lingo.)
Like some of you below, especially Jeff, I was very anxious. Strange because I have already gone through a kidney transplant! I knew there was a 100x increased risk of cancer, but have had not problems (that I was aware of) in the last 9 years post-transplant. I could not take a Valium because I have what is called a paradoxical reaction to it, which means it makes me more nervous!
UCSF has an excellent surgical team, however for me, the informational prep was wholly inadequate. I read the info. packet from UCSF cover to cover, but it did not answer all of my questions, especially regarding reconstruction. The actual procedure began at 8 in the morning, and it was two stages. The hardest parts (aside from the diagnosis) were
1) Fear and Anxiety -- will this return? Will they get it all?
2) the waiting after the first stage and
3) the stitching. It took much longer than the actual tissue sampling. I had 25 external stitches and a bunch of deep layer stitches. I did have my sister-in-law with me, who is a scientist and shared my interest in the procedure. I did look at the open wound with a mirror before being stitched up. Having watched a bunch of youtube videos I knew about the potential for a skin graft and had hoped I didn't have to have the forehead vertical line, or any for that matter. But I did...
My surgeon, who I think is very skilled, took a triangle from above the wound out, and cut a crescent moon shape next to my right nostril, and placed that on the wound and the triangle above my nose. It is a very tribal looking L, for Love, Laughter and Life. Yup, vanity is alive and well in me, but the overarching concern is did they get the cancer.
I am still experiencing what I hope is a psychological reaction or neurosis fearing that they didn't get all the cancer. I had asked to take a peek at the patholigist's slide sections, before and after clearing the bcc. Ot wasn't clear to me from the purple-stained die "designs." They showed me a cluster of BCC cells on the slides, which looked like purple outlined bubbles. The after still looked weird, and I am hoping to get more info. on it when I go back to get the stitches out next Thurs.
Swelling and black eyes: I don't have a black eye, but I am swollen with purplish reddish orange bruising, like a swatch of color wash on my bony cheek. My nose is all swollen like the characters in Avatar, and it is stuffy, like having a bad cold on one side. It hurts to bend over, such as to pick up something from the floor. I feel vulnerable. I took the pressure bandage off yesterday after 24 hours, revealing many steri-strips along the side, and in the crescent by the nostril.
I also feel whoozy but I am no longer on any pain meds. I may take a Tylenol soon, because it just generally aches in a stuffy sort of way.
I have a few pictures, before, during and after surgery. Anyone have any ideas where should I post them? I don't have a Facebook page, and am fairly sure I'd scare away all of my Linkedin contacts!
Sending good thoughts to all.
Recipient of a Gift of Life
[UPDATE] at almost 18 months, from MOHS Nose Basil spot (3 layers) and extensive nose reconstruction (top to under the tip & across the tip) back in Jan 2012. Doctor and staff said 3-6 months full recovery. Relaible sources said, 18 months is the magic number, not 3, not 6, not 12. Sure enough my nose is feeling about 90% normal again approaching the 18th month post surgery. I still have some numbness, hypersensativity and tenderness along the ridge of the nose if I squeeze it and at the tip. No infections, no trauma, just a long healing. I clearly see the encision site (a light line), but most do not. I have also had a touch up sesison of electro cautery on the many blood vessels that appeared on the nose surface after the basic healing. That has helped the skin look more normal. (gets rid of the fine red lines) I will get one more touch up next time I am at the docs for another reason. Again, the MOHS part was a breeze, it was the recovery from the reconstruction that was tough. I can't comment on alternative choices (like a skin graft) since that choice was not taken. I still think, in hindsight, I would now choose the skin graft (with slight discoloration possible) over the resconstruction, but that thought will be for some of you heading into MOHS or for me another time in the future. All of us seem to agree that having the cancer gone is primary, the rest we will live with. My nose was "healed" in a few weeks and looked OK (to others) in a few months, but... just be aware with serious reconstruction or a good size incision that my experience is 18-24 months for the area to feel mostly normal again. I am not complaining, but sharing, so that those of you getting surgery can ADJUST your expectations VS what you might be casually told. I think that some minor feeling loss, and nose tip feeling colder is going to be permanent and is the price of fighting cancer today. OF course your experience, cancer, doctor, treatment and procedure make direct comparisons difficult.
I had MOHS surgery 2 days ago for basal cell from the bridge of my nose almost to the tip. The surgery was not painful at all, even after the anesthetic wore off. I went yesterday to the plastic surgeon and was overjoyed that I didn't need a forehead or cheek flap. The stitching seemed to take forever and the pulling and tugging was very uncomfortable but not painful. However, about 2 hrs. later after the local anesthetic wore off, my whole face was throbbing. My nose started running and it hurt a lot just to touch it with a tissue. I took advil and the pain lessened. I woke up about 5am and had to take more advil. My doctor said to watch for redness but it looked red as soon as the stitching was over. I'm so worried about infection since the Mohs surgeon said there was an infection under the cancer which he cleaned out. After reading some posts it seems that the most pain was after the repairs. If I don't get some relief by tonight, I'm going to call the plastic surgeon tomorrow.
I had MOHS surgery for basil cell on left tip if my nose 5 days ago. The next day I had plascic surgery repair with nose flaps. As I understand it, one flap was used to cover the MOHS wound down to the tip. Another one, above it, was then used to cover the flap wound. That second cut was then sutured closed as it was higher on the side and thus stretchier skin. I woke with no pain. My nose was packed both sides with gauze but I could breathe through it . I had a stiff plastic like "nose cast" over some dressings. The tip of my nose was still exposed and sutures showing.
Ive had swelling and under eye bruising which is now starting to fade. Ive had little actual pain. Itching and dull ache are the best descriptiion for me. I apply antibiotic ointment to the expose sutures to keep it moist . There is some crusty blood the first couple days but thats all gone now. Its a bit ugly, my nostrils are kind of turned up Miss Piggy like. I assume when the cast comes off in 2 more days that will go away. Its probably pulling on them.
Fortunatly I can use PTO and disability time for work. Theres no way I could face the public looking like this. I was surprised by the amount of bruising and swelling and the rigid cast thing.
Im curious to see what the sutures look like and how long they will be in. I have great faith in my doctor's skills.....hope Im not disappinted. I am vain enough to care about that.
In any case, it needed to be done. It's cureable, it's not life threatening.
I was told last week that the basal cell cancer on the left side of my nose, the lower right eyelid and the part line of my scalp require Mohs. I watched videos on youtube, however, was unprepared for the long term reconstruction & healing photos. I'm a nurse, love surgery views, but am COMPLETELY freaked out about this. I've had surgery in the past but think it is scary because it will be so obvious after. There is no way I can take even two weeks off work, and I am so anxious about how my patients will view it. I work in close proximity on patients, so I'm worried they'll be freaked out when I lean over them.
PLEASE, please share with me any knowledge about the alternatives to Mohs.