Mohs Nose Woes – Part 2

Well, it’s done.

The dermatologist did the Mohs procedure on Thursday morning. It took 3 passes to get all the cancer out, and I was left with a defect about the size of a dime on the lower left part of my nose. Sort of like this –

Despite what was being done to me, I had a good time at my Moh’s surgeon’s office. We talked kids, and schools and family and money – and then I hung around his little back Mohs waiting room for a few hours till my plastics appointment, returning patient calls and checking labs on my laptop (one of the curses and advantages of an EMR). I left feeling relieved and upbeat.

Until I saw the plastic surgeon.

The Closure

Where my dermatologist is an upbeat, everything is going to be fine kind of guy, Dr Plastics is an empathetic, caring, almost rabbinical kind of guy who really understands how women feel about their faces. So when he entered the room and saw the size of my defect, he looked at me with those dog-eyes of his, looking so sorry for me that I started to cry. He told me the defect was larger than he had expected, and that he would not close it in the office, but under anesthesia at the surgi-center the next morning.

I walked home crushed, sure that I was going to be deformed for the rest of my life. And the fact that I had to spend the night with this hole in my face did not help. What if something happened and I couldn’t get to the surgery tomorrow? Suppose there was a fire, or I got hit by a car, or one of my kids got sick? I’d have to decide between them and closing the hole in my face.

Somehow I got through the night, and next morning went to the surgi-center. What a place – an Upper East Side townhouse that, when you enter, looks for all intents and purposes like a private mansion. Until you head into the back, where the place looks just like any recovery room and OR suite you’ve ever been to. Runs like a well-oiled machine, wonderfully friendly staff and anesthesia, high quality care. A real New York kind of place.

I waited for several hours in a gown on a gurney, listening mostly to my neighbors letting go of gas after colonoscopies while I finished almost all of the Friday NY Times crossword, a feat worth mentioning in any post. My nurse had had two surgeries similar to mine in the past, a fact I did not notice until she pointed out the faint scars. This made me feel hopeful.

Then my surgeon appeared, apologizing profusely for keeping me waiting due to his previous case that had gone longer than expected. I felt oddly reassured by this, figuring that he would take as long as he needed to give me the best cosmetic result he could.

So to sleep I went, the Fentanyl and Versed doing their job quite nicely, and awoke some 30 minutes later, finally done. Dr Plastics had performed a bi-lobed flap and used about 20 tiny stitches to close. So I have an incision running from near my inner eye down the side of my nose that looks like a half of a flower. Sort of like this –

Nice, Huh?

Post-Op

In addition to the incision, I have a black eye and my nose is swollen and red. The pain isn’t too bad during the day, but has kept me up a bit at night, and my stomach is a bit upset from the antibiotics.

Now I just have to wait. Wait for the sutures to come out next week. Wait for the swelling to go down and the scar to fade. It will be sometime before I know how I am going to look, but at least this thing is done.

I find myself embarrassed thinking about having to see patients over the next few weeks with a big bandage on my nose. I wish I had taken off a little more time from work, but everyone said I could go back pretty much right away, so I’m going back on Tuesday. But I feel like it’s all going to be about the nose for sometime. And I am anxious for the point when I can cover the incision with some makeup until the scar starts to fade.

Most people I talk to are remarkably supportive and no one seems particularly worried about how I’m going to look. But somehow their comments haven’t helped. They only make me feel as if I am over-reacting.

And in some respects, I am. I think about Patrick Swayze and know that I am so, so lucky that this is all I have to deal with. And truth be told, I haven’t thought about my nose too, too much today, as we are now on the 7th episode of the first season on The Wire.

But then, I look at myself in the mirror, and get upset all over again. It makes no sense, I know, but this thing has really hit me hard. I think it was the combo of the big hole, the unexpected wait and and then the Frankenstein sutures, and I expect I’ll feel much better about things in a week or so. But right now I’m feeling pretty darned sorry for myself.

After all, it is my Nose.
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If you want to see photos, go here. I’ll be posting updates periodically as I heal. I warn you, it’s not pretty……

Part 3 here

Mohs Nose Woes – Part 1

It all started sometime this summer when the skin on the side of my nose bled spontaneously as I was drying off after a shower. I looked – nothing there, just a spot of blood. I figured I scratched myself and didn’t give it much more thought.

Till it happened again a few months later in the exact same spot. Still nothing to see, but on careful palpation, I noticed the skin there felt just a little raised and irregular.

Now, I’m a girl with my Mom’s Irish skin and a baby oil adolescence who has had four basal cells on my back scraped off in the past 5 years. So I knew before I even saw the dermatologist that this was another basal cell.

But this is not just another basal cell. This one’s different.

This is my Nose.

And that means I need Mohs.

What is Mohs?

Mohs surgery is a special procedure designed to remove skin cancer with the least chance of recurrence and the least removal of healthy tissue.

Skin cancer can grow along the planes under the top layer of skin, so the cancer is often larger than it initially appears on the surface. So when the cancer is removed, the dermatologist will want to take a wide margin of healthy-appearing tissue around the edges of the visible lesion to be sure the cancer is all out.

But on the face, there is not the luxury of wide open space for big margins. And so the procedure of choice is Mohs surgery.

Here’s how Mohs works – The dermatologist shaves off what he thinks is all the cancer, then you go into the waiting room and he goes into the lab and looks at the specimen to see if all of it was removed. If the cancer is growing all the way to the edge of any part of the specimen, that means there’s probably some more still back there on your face. So back you go into surgery to have a little more removed – but just in the spots where the margins are positive. Then it’s back to the lab to see if that’s enough, and so one, till the whole lesion and every last bit of cancer is removed. Each subsequent specimen is smaller and smaller, leaving healthy tissue where it is and just going after the “legs” of the cancer, till finally it’s all out and you’ve got the smallest defect to repair that you can possible have.

But now you have a hole in your face, and it’s got to get closed up somehow.

Closing the skin after removal of skin cancer

After a skin cancer is removed, one can leave the defect to fill in itself. This is how the cancers on my back were treated – They were scraped off, then left to fill in on their own, and in a few weeks, I was left with red round scars that fade with time.

On the face, if the lesion is small, you can do the same thing.

But for the cancer on my nose, this method will not work. That’s because this kind of healing is accompanied by contraction of the skin, which in my case would lead to the nostril pulling up and out on one side.

So I need to have a flap, wherein the skin above the defect is rotated downward to cover it.

But it’s my Nose!

Mr TBAM had a similar surgery this past summer for a small cancer on the tip of his nose – a Mohs procedure followed by a flap. Now he has a sort of Raggedy Andy patch there that you don’t notice unless he points it out to you, at which point you can’t not see it, until you forget about it again.

Now that I am having to have the same procedure, all I can do is stare at Mr. TBTAM’s schnoz and worry about my own. I mean, he looks fine for a guy, but I’m sorry, I don’t want that scar on my nose.

So I asked my dermatologist if plastics could do my closure. He said of course, but that in fact he’s done many more of these than they have. His nurse confirmed that he does 90% of his own closures, and that other dermatologists send their difficult ones to him for that very reason. At that point, what I really wanted to say was “If I was Julia Roberts, would you do the closure or call in plastics?” but that seemed rather rude. So instead I just said that he could do the closure.

And then I spent the rest of the week silently freaking out. And staring at Mr TBAM”s nose.

Three days before my procedure, I happened to mention this to a nurse I work with, who was shocked that there was even a dilemma. Why wouldn’t I want plastics? She then regaled me with stories of deformed faces she’d seen on the subway, wondered how those poor people got through the day, and reminded me how in America appearance is everything. I then called a female colleague who I’d seen as a patient several times. “What, are you nuts? Of course, plastics is closing you! This is your nose, for gods sake! You’re seeing the best Mos dermatologist I know, but he’s a dermatologist, for god sakes! Of course he’s going to tell you you’ll look fine – He’s a guy, they don’t even notice when we get our hair cut half the time! End of discussion. Here’s the name of the plastic surgeon who’s going to do your closure…”

I made the call, dropped my name and I was in.

I have no idea if using plastics for the closure is going to make any real difference in how I look after my Mohs procedure. I adore my dermatologist, and he really is the go-to man for this surgery. But suddenly I’m calm. Not because I don’t think I’ll have a scar, but because I know I will have done everything I can to be sure it’s the best scar I can get.

After all, this is my Nose.
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Part 2 here

Pastry Politics

In my last post, we discussed whether or not Obama was like a popover and why. (Hat tip to Valentine Bonnair for the comparison.) Of course, one must now ask – If Obama is a popover, what are the other presidential candidates?


Obama = Popover.Very quick to make, fast rise in a hot oven; be careful not to take it out before it is done or it will collapse. Delicious flavor alone, but really needs a little butter and jam to make it perfect. Everyone loves popovers.


Hillary = Sourdough bread. Needs a starter from a previously made bread to get going. Slow rise, punched down halfway and risen again. Has a wonderfully complex flavor, but can be a little tough and chewy. Not everyone likes sourdough bread, but those who do adore it.


McCain = Biscotti. Dry, hard, slowly baked and twice-cooked. Will keep for long periods of time in a can without losing flavor, making biscotti a favorite among soldiers and sailors. If a biscotti loses crispness, it can be put toasted in a low oven until crunchy again. Best eaten dunked in wine or strong coffee to soften.


Nader = Fruitcake. Has lots of fruits and nuts, all of which are good for you, and yet for some reason not many people like it. Can keep for years in a tightly closed tin. The same unopened fruitcake will get recycled year after year with no one ever eating it. Europeans appreciate fruitcake more than Americans do.

Discuss.

Pretty Near Perfect Popovers

I figured that if I was going to criticize the popovers at Popover Cafe, I’d better be able to make a pretty darned perfect one myself.

Given that I’d never done it before, I was a little nervous, so I scoured the web for recipes and advice before starting. And thanks to the Joy of Cooking, Mark Bittman, Ina Garten and all the great food bloggers out there who have preceded me on this adventure (see links at the end of this post), my popovers turned out to be pretty near perfect, and to my mouth, at least, much tastier than the ones at Popover’s Cafe.

Pretty Near Perfect Popovers

1 cup flour
1/2 tsp salt
1 cup whole milk (I used lowfat mixed with a little half and half)
2 large eggs
1 tbsp melted butter, plus another tbsp to grease the pan
A little flour or sugar to dust the pan

Preheat oven to 450 degrees Fahrenheit. Heat popover pan on a baking sheet in the oven for 5 minutes or so while combining the ingredients.

Make sure the milk, eggs and butter are at 70 degrees. (I heated the milk in the microwave then cooled in to around 70 or so degrees Fahrenheit).

Whisk flour and salt together in a bowl.

Whisk milk, butter and eggs together in a larger bowl.


Add flour to wet ingredients, whisking just enough to combine. It should be thin like cream and small lumps are okay.


Take popover pan out of oven and brush inside of cups with melter butter. Sprinkle a little sugar or flour on the cup inside walls. Pour in batter to 3/4 full. Place in oven so that the tops of the popovers will end up in the middle of the oven (My gas oven has the heat on the bottom).

Bake at 450 for 20 minutes. Do not open the oven door to peek (But if you have a glass door and a light, do look through the window and watch them pop!)

Lower heat to 350 and bake another 20 minutes. Remember, no peeking except through the glass!

Remove from oven and immediately from pan. Insert a sharp knife into popover to let the steam escape (And don’t worry – if they are done, they won’t collapse).

Serve warm with butter and jam.

Popover Thoughts and Questions

1. Should my popovers have popped a bit more? The little dent in the middle makes me think so, but my god, they were delicious!

2. I think may have over-filled the cups, since I ran out of batter before the last cup. That may be why I didn’t get that last “pop” on my popovers.

3. Does the manner of combination of ingredients matter? For instance, Joy of Cooking has you combine everything but the eggs and then beat in the eggs. Another recipe has you beating the eggs first till they are a light color and then adding the milk and melted butter. I wonder if it makes a difference…

4. I’ve read that sifting the flour makes for a better pop. Some recipes call for bread flour instead of all purpose. (Don’t use cake flour, though – it won’t make enough strong gluten to keep the popover risen.)

5. Most commercial popover recipes (Such as those from Jordon Pond Restaurant and Nieman Marcus) rely on baking powder, probably so they have a guaranteed pop. I think that’s contrary to the magic of popovers – the fact that they rise without leavening. The rise comes from the steam produced by the high proportion of liquid ingredients in the batter, supported by a sidewall strengthened by gluten.

6. This recipe from Apartment Therapy uses 1/4 cup more milk than mine, and what a gorgeous pop they got! It makes sense that more liquid might just help. So next time I will be sifting the flour, filling the cups only a little more than halfway and using a bit more milk (whole milk this time). Will post the results.

Popover Links

  • The Perfect Popover by Lynn Bonnett– Everything you need to know is here.
  • Joy of Baking – This apple popover looks delish!
  • Christy at All Recipes– Nice photos and great comments
  • Chowhound– Nice discussion on technique in the comments section
  • One More Moore— Another blogger inspired by Popovers Restaurant. Gorgeous popovers!
  • Popover Science– Answered a lot of my questions.
  • Popover variations – Try Lemon-Scented, Cheese, and Gluten-free.
  • Michael Pollen uses whole wheat + white flour, and still gets a pop.
  • Obama is like a popover. Discuss.

    Of course, since this is an election year, I can’t ignore this post from Valentine Bonnaire comparing Obama to a Popover…

    That thin crispy shell on the outside and nothing but a cavern of hot air inside. Popovers — another example of something with all of the audacity of nothingness. They taste good while you are consuming them, but there just isn’t a whole lot there is there?

    I beg to differ. A popover is not a lot of nothingness – it has lots and lots of delicious flavor. And if Obama is like a popover, well, then it’s because he is taking politics to a higher level. A popover has to have a strong crust to hold itself up there, and he’s got that. And if he needs a little butter and jam to make him perfect, well that’s just fine with me. We’ve got plenty of that.

Blogroll Update

I’ve cleaned out the blogroll, removing some links to blogs that sadly, have closed, and added some links to new blogs I have recently discovered. It’s bittersweet to say goodbye at last to those who have already left the blogosphere (but hopefully are still lurking), and always fun to make new friends. Here are some new blogs I’ve discovered.

Just Up the Dose – A fascinating blog from a female doc South Africa, where it’s still bit like the Wild West when it comes to healthcare.

Anatomy on the Beach – I’ve taken to reading med student blogs lately, and am starting a category for them over on the sidebar. I find it’s always good to go back to your roots once in awhile and remember what it was like and why you got into this business in the first place. Not to mention this one’s a singer as well, a man after my own heart…

Dose of Reality – The University of Michigan is sponsoring these medical student blogs. I think that’s great – I wish our place would do the same for employee blogs. I might actually come “out of the closet” from my anonymity.

The Accidental Scientist – A food blog from a scientist “noshing and fumbling her way through the food world.” Substitute “doctor” for “scientist” and that pretty much describes me, too.

If I accidentally deleted you active blog, drop me a line.

Vote for Your Favorite Female Blogger

Women’s Voices, Women’s Votes is an organization whose goal is to increase participation in the political process by unmarried women, a group historically under-represented among voters.

WVWV is honoring female bloggers and is asking you to nominate your faves by March 21st for inclusiion in their top 10 bloggers list.

To nominate your favorite female blogger, go here. (Hat tip to the Well Timed Period for the link)

Blogroll Update

I’ve cleaned out the blogroll, removing some links to blogs that sadly, have closed, and added some links to new blogs I have recently discovered. It’s bittersweet to say goodbye at last to those who have already left the blogosphere (but hopefully are still lurking), and always fun to make new friends. Here are some new blogs I’ve discovered.

Just Up the Dose – A fascinating blog from a female doc South Africa, where it’s still bit like the Wild West when it comes to healthcare.

Anatomy on the Beach – I’ve taken to reading med student blogs lately, and am starting a category for them over on the sidebar. I find it’s always good to go back to your roots once in awhile and remember what it was like and why you got into this business in the first place. Not to mention this one’s a singer as well, a man after my own heart…

Dose of Reality – The University of Michigan is sponsoring these medical student blogs. I think that’s great – I wish our place would do the same for employee blogs. I might actually come “out of the closet” from my anonymity.

The Accidental Scientist – A food blog from a scientist “noshing and fumbling her way through the food world.” Substitute “doctor” for “scientist” and that pretty much describes me, too.

If I accidentally deleted you active blog, drop me a line.

There Goes the Neighborhood…

We had brunch last weekend at Barney Greengrass the Sturgon King, the famed Upper West Side restaurant and fish emporium. We were shocked to find that there was no line, and they sat our group of 6 almost immediately. By contrast, the line at Popover’s Cafe, a nice enough but undistinguished place down the street, was out the door.

No line at Barney Greengrass?

Could it be due to the influx of Neaveau Riche to the now toney, high-rent Upper West Side? Types that don’t appreciate a good plate of Nova and eggs or a bit of creamed herring? Do they really prefer an overbaked popover to a cheese blintz, which, by the way, Mr TBTAM’s cousin Maureen declared was the closest she’d ever tasted to Aunt Eleanor’s homemade?

Mr TBTAM says I’m over-reacting, and it was just that we ventured out so late that day. (It was almost 2pm).

I sure hope he’s right…

Tom Yam Goong (Lemongrass Shrimp Soup)

I had the most wonderful lemongrass shrimp soup last week at a little Thai place called Spice on 2nd Ave near 74th st. And only $3 a bowl! Add some crispy spring roll, a bowl of equally delicious coconut chicken soup, some Pad Thai (not the best I’ve ever had, but certainly acceptable), a glass of wine and a beer, and you’ve got dinner for two for around $20. Best cheap meal I’ve had in this city in a long time.

The next night, I found myself craving that shrimp soup, and found a recipe in Thai Home Cooking, a great cookbook that I had picked up in the used book store in Park Slope but had yet to make anything from. The pages for this recipe were wrinkled and stained, a sure sign that this recipe would be a keeper.

And it is. I’m looking forward to making it again after I’ve had time to scout out the right kind of mushrooms and chilies. Because I used canned tomato instead of fresh, my broth was not as clear as I’d like, but it sure was delicious!

Tom Yam Goong (with shrimp)

Lemongrass can be tough to find, even here in New York, unless you live in Chinatown. So be sure you know where to get it before planning this meal. Kaffir are easier to find, and you can store them in the freezer. Once you have the ingredients, this is one of the quickest soups you’ll ever make. Add noodles or serve it over some jasmine rice and you’ve got a really easy dinner. You could also make this soup with chicken if you’d prefer. Cut boneless breast into thin strips and cook in the broth till opaque, about 1-2 minutes.

12 oz jumbo shrimp (king prawns)
3 cups broth or water
2 stalks lemongrass, white part only, cut on a diagonal into 2 inch pieces
6 cloves garlic, crushed
3 tbsp coarsely chopped shallot, preferably pink
1 inch piece galangal or ginger, thinly sliced
2 firm tomatoes, cut into 8 wedges
1 cup straw mushrooms, rinsed and halved (I used button mushrooms)
10 small fresh green chilies, stems removed and halved lengthwise (prik khee nou) (I didn’t have these, so I used chili paste)
2-3 tbsp fish sauce, to taste
5 kaffir lime leaves, coarsely torn
2 tbsp fresh lime juice
1/2 cup coarsely chopped cilantro

Shell and de-vein shrimp, leaving tails intact and reserving shells and heads for broth. Cover and refrigerate till ready to use.

In medium saucepan, combine shrimp heads shells and broth or water, and bring to a boil. Using a skimmer, remove the shells and heads and discard. Bring back to a boil Add lemongrass, garlic, shallots and galangal to the broth, then tomatoes, mushrooms, fish sauce and kaffir lime leaves. Simmer gently till mushrooms are soft, then increase to a boil.

Add shrimp to broth and boil for no more than a minute.

Remove soup from heat and stir in lime juice. Transfer to bowls for serving, garnish with fresh cilantro and serve.

(Note – Don’t eat the galangal, lemongrass, kafir or chilies – just push them to the side of your bowl. According to this video I saw, you can leave the chilies out of the broth and put them into individual bowls before serving. Crush to increase spiciness. )

How To Get Pregnant, Part IV – Mom’s Medals

Dinosaur Doc has a very amusing little post about how an aunt’s advice can be the magic a patient needs to conceive. (You’ll need to read the post yourself to learn what to do, but I will tell you that it requires a good strong Southern accent…)

I love the family tales and the old time advice. And like Dinosaur Doc, I, too, sometimes use them in my practice.

When we were growing up, Mom always prayed to Saint Gerard, the patron saint of mothers. In fact, when my parents moved into their first house, Mom buried a St Gerard medal in the yard. Ten years later, pregnant with her 6th of 9 children, she and Dad moved us all to a bigger place. Mom told the woman who bought our house about the medal in the yard, and told her St Gerard would watch over them as he had done us. Five kids later, that woman rang up my mother – “Where’s that damned medal buried? I need to dig it up!”

Now I’m not religious, but I do love my Mom, and I’ve always loved this story. Some years back, I told the story to a patient who was trying to get pregnant, and she asked if my Mom had any more medals (which of course she did). After I asked my Mom a third time for a medal for a patient, she gave me a stash of my own, which I keep in my desk drawer.

I still hand a medal out occasionally, usually to a patient undergoing assisted reproductive technology and looking for a little extra something to help the process along. I have no idea if the medals work, but when you’ve maxing out all the scientific options, what’s wrong with adding in a little hope? (and a little bit of family voodoo…)

The last patient I told this story to was a physician herself who is scheduled to start her third IVF cycle next month. We both figured it couldn’t hurt if she wore the medal on the day of the egg retrieval…

I’ll let you know how it goes for her.
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Read previous posts in this series.

HPV and Breast Cancer? Interesting, but too soon to say

Read a fascinating post in Aetiology regarding the potential role of HPV in the etiology of breast cancer.

Although we are nowhere near proving a direct causation, studies have found HPV DNA in anywhere from 20-85% of tumors studied. (Types 16, 18 and 33 most commonly) However, some studies have found HPV DNA in normal breast tissue as well. So is HPV a cancer-causing agent in the breast or just a bystander? It’s too soon to say. Lots more work is needed on this one, folks.

The data are at odds with known risk factors for breast cancer, such as never having been pregnant. And if there is a link, one should see that breast cancer risk is increased with number of sexual partners, which as far as I know, is not the case.

So be careful before making the leap between hypothesis and recommending HPV vaccination for breast cancer protection. It’s way, way to soon…

The Contestosterone – Amateur Science at its Worst

This week’s This American Life radio program on NPR is devoted to the topic of testosterone. In addition to first person accounts of life at low and high testosterone levels, the show features a contest (Called Contest-tosterone – cute!) in which the program’s staff members have their testosterone levels measured and then try to predict the results according to the personality characteristics of the participants.

The results of the contest surprise everyone. The male with the highest testosterone levels is “a slightly femmy” gay, and the woman with the highest levels is 5 months pregnant.

Ira Glass, the show’s host, then concludes that the test was a dumb idea, because knowing their testosterone levels changed how members of the staff felt about themselves and each other. The men with low levels felt they were less manly, and the woman with the highest level felt “really bossy and aggressive”.

Well, Ira, I agree. The contest was a dumb idea. But not for the reasons you state.

Why the Contest was a dumb idea

Comparative testosterone levels, especially saliva levels, are meaningless in the normal range.

Number one, testosterone levels are not even replicable between labs.

Number two, testosterone levels fluctuate within the same individual, especially in women during the menstrual cycle.

Number three, saliva testosterone levels say nothing about testosterone levels in the brain, which is the place you seemed most interested in noting its effects.

And finally, circulating testosterone is just a piece of the picture. There are enzymes that activate testosterone, enzymes that convert testosterone to estrogen and hormone receptors whose activity is regulated by testosterone. All of these things affect a hormone’s activity in the body as much as overall levels do. So trying to describe a person by their testosterone levels is like trying to describe the Mona Lisa by measuring how much paint Da Vinci used.

But most importantly, the reason the contest wasn’t such a great idea was that the number of individuals was far too small to make any statistically meaningful conclusions regarding tesosterone leves. The contest’s results were destined to be meaningless from the start.

Bottom Line

Ultimately, at the extremes, testosterone levels can carry meaning. A woman with a sky-high level virilizes. A man without any testosterone is impotent. And in an individual, variations in one’s own levels can have an impact, as the first person stories in the program showed.

When large groups of individuals are compared, some meaning can be found in comparative tesosterone levels (perhaps). But trying to find meaning comparing tesosterone levels in a small group of people is a pointless exercise. Not to mention confusing for the public who listen to This American Life.

By the way, pregnancy raises testosterone levels. Check Julie’s levels again in 6 months while she’s breastfeeding and her levels will be much lower. But I’ll bet she’s still bossy…

An Inflammatory Video on Inflammatory Breast Cancer

An email with an absolutely frightening You Tube Video attachment is screaming its way across cyberspace to your inbox with the subject line “For all women – watch this video. It is no joke!” The video is a news story called “Inflammatory Breast Cancer – the Silent Killer”.

The news story first aired in 2004, as a response to a Seattle woman’s personal campaign to make sure every woman in America knows about this cancer that afflicted her daughter. Since then, according to the station that originally aired the story, the video has made its way to over 10 million women via the internet. The response has been an upswing in information about IBC both on the web and in conventional media, the creation of a foundation that is raising money for IBC research and treatment, and the opening of the first Center for IBS treatment and Research.

And that’s a good thing.

What’s not a good thing

What’s not such a good thing is the tone of the news story. It has all the makings of a viral scare campaign, not the least of which is the “Silent Killer that strikes without warning” phrase. If you didn’t know about IBC before, you sure as heck know about it now, and probably, like me, were up till 3 am scouring the web to learn more because you were convinced that you had it. And that’s what’s wrong with this latest “tell someone” campaign. It’s knowledge predicated on fear.

You need to know that the medical facts in the video are correct. But the context is not. Statements like “Hope for millions of women” give the sense that this is a very common cancer, when it is just not.

IBC is rare. So rare that docs typically never see a case in their entire career, or like me, see one or two cases in twenty years. But instead of having that knowledge reassure you, the news story uses it to scare you. Because if your doctor never sees a case, they are sure to misdiagnose it, so you’d better be sure that you know how to diagnose it yourself.

Would that it were so simple. The problem with IBS is that it’s early symptoms are so common – breast itch, rash, redness, pain. I’m sure all of us have had these symptoms at some point in our lives. And when it presents, IBC looks a heck of a lot like mastitis, a condition that many, many of us (including me) have had at some point.

Thus, another very important fact this that the video doesn’t tell you is this – If you have the symptoms they describe, the odds are overwhelming that it is not IBC.

Some Context

If you read this blog, you know that I applaud anything that empowers women, and I do believe knowledge is power. But knowledge packaged with hype and fear is the wrong kind of knowledge.

So, let me try and do what the video did not. Let me try to give you some context.

The incidence of breast cancer in the US is 100 per 100,000 women per year. Compare that to the incidence of IBC, which is 2 per 100,000 women per year. That’s about 3000 cases of IBC occurring annually in the whole country.

Now, note that 4.3 million Americans are injured and 40,000 more die in auto accidents every year.

I’ll bet you’re really scared now, aren’t you?

That’s okay. There’s always the subway.
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If you want to learn about IBC in a way that will not frighten you, skip the video and visit MayoClinic.com or the National Cancer Institute Website.

Thanks to Linda for tipping me off about this video.