I had a "slow Mohs" in 12/00 after being diagnosed sm
Posted By: had Mohs in 2000 on 2008-01-15
In Reply to: Anyone familar with Mohr procedure? - trose
with melanoma in situ on my left cheek near my eye. I had about 8 shots and I didn't feel a thing. I guess it was called a slow Mohs' because the procedure was about 4 hours long. The wound was open for 1 week until results came back that he got it all out. So for a week I was doped up, as I had a hole in my face that I could put my finger in. I barely have a scar there, he did an excellent job. And so far, no return of the cancer.
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Slow-Mohs versus regular Mohs
I am a patient, not a doctor, but my understanding is this:
A regular Mohs procedure takes many hours but is finished the same day you start the procedure. The doctor cuts out the visible tumor, then makes either vertical or horizontal slices from what she has removed. Those slices are made into frozen slides (not literally frozen) and analyzed by the doctor while the patient waits in the office. This allows the doctor to "map" the tumor. If a part of a slide doesn't show a clear (tumor-free) margin, the patient is called back in to a little more tissue removed. Again, that tissue is made into frozen slides and the doctor looks for clear margins. The patient will keep being called back in to have more removed until all the slides show clear margins. This can take many hours, but once the margins are clear, the wound is closed and that is the end of it.
Slow-Mohs is when the wound is left open for a day or two (and up to a week) while the slides are analyzed. That is why it is called "slow" (the time you spend in the office on the first day of surgery should be about the same as if you had regular Mohs). The reason it takes so much longer to analyze the slow-Mohs slides is because the doctor uses paraffin-embedded slides instead of frozen slides. Paraffin-embedded slides are of much higher quality than frozen (my doctor said it's the difference between a huge HD TV and an old black and white TV with bunny-ear antennas).
For most of the malignant tumors treated by Mohs, frozen slides (and thus regular Mohs) is sufficient. But there are some types of tumors that have long, finger-like extensions (like roots) that are hard to see on frozen slides. If they are removed with regular Mohs than these roots could be missed and lead to a recurrance of the tumor. So that is when Slow-Mohs is usually used.
Sometimes Slow-Mohs is called Modified Mohs, but I have also heard Modified Mohs refer to a regular Mohs procedure with other variations. So if a doctor says they are going to do Modified Mohs, ask them exactly what they mean by that.
You should also ask if your doctor will be using vertical (bread-loafing) slices, or horizontal slices. I think vertical is the norm, but horizontal is better for tumors with irregular boarders.
Also, sometimes after doing regular Mohs with frozen slides, the doctor will take a final slice for paraffin-embedded slides to be analyzed just in case. This final paraffin-embedded slide isn't the same as Slow-Mohs. In the rare instance that the final slide comes back with a positive margin, the patient will be brought back in for another Mohs procedure, but usually regular Mohs is a one-day affair.
Overall, Mohs and Slow-Mohs are a great alternative to a wide surgical excision that could result in greater (and unnessesary) tissue loss. I think it is widely accepted for skin cancers, but more controvertial in other cancers like sarcomas.
I have a very rare sarcoma called Dermatofibrosarcoma protuberans (DFSP) and while most of the literature I read says Mohs is at least equal to or better than wide excision (but with less tissue loss), I have seen 2 sarcoma specialists that are strongly opposed to Mohs for DFSP. However, their reasons are that vertical slices and frozen slides are inadequate for DFSP. However, it doesn't seem like they are aware of the horizontal slicing options and the ability to do paraffin-embedded slides in Slow-Mohs (and doctors don't respond well to any implication that there is something they don't know). So I am trying to arm myself with as much knowledge as possible...and I suggest you do the same if you have one of the more controversial tumors.
Here is a good (technical) article about Mohs and DFSP that describes the different types of Mohs:
"Modified Mohs Micrographic Surgery in the Therapy of
Dermatofibrosarcoma Protuberans: Analysis of 22 Patients" http://www.annalssurgicaloncology.org/cgi/reprint/11/4/438
Mohs, not Moh's. nm
x
More info in Mohs procedure.
The reports I edit, the dr. does the procedure, inks and maps specimen for frozen section and sents to path with pt still on table. Based on path results, procedure either done or excise more tissue from area that still shows cancer cells. Sometimes takes 2-3 more specimens. When procedure done, that dr either does repair or if wound too big, a plastic surgeon is scheduled to do repair same day or day or 2 later.
no, was diagnosed 8 yrs ago but have had...
I have had it since my 20s, I remember my LFTs were crazy then, they had no test for this in the 70s-80s. I didn't KNOW I had it. My husband had it (ex) and he was tested in 1992 and many friends had it and all told me to get tested, but I felt/feel like a million bucks so I laughed them off or poo-pooed the issue
In 1998 I decided ok - get tested and my case was so mild that it looked like I was only a *carrier* but on further testing I had it. Last year I went to that GREAT specialist (who really specializes in C and is an older MD-I like that, not *green*) who confirmed my suspicions. My tests are excellent and for decades now, I take care of myself.....and I don't eat raw fish...(my ex did and still does and another MD told me he's nuts to do so), and I will NOT die from it - because I have had it forever....
I also read that online years back......that if you've had it for 30-40 years and doing great, you'll die from something else......but if one continues to drink and drug - well, then, you will die from the disease.
My dad has been diagnosed with
a bacterial infection that is very rare. The word sounds like Narcartia but I am not able to find anything on this bacterial infection so I'm probably spelling it wrong. Does any one have any suggestions or know where I can go to get this info?
He became very sick, had a couple of episodes of losing his sight. When I found out about it (a week later) and he went to the ER, the initial diagnosis was spinal meningitis. This diagnosis eventually "evaporated" for the lack of a better word. CT scan revealed a lesion on the brain. This was not able to be identified. Brain surgery ensued and this biopsy was sent across the nation to multiple labs. One lab finally made an association with "agriculture, ground, farming." About six weeks ago, my dad had spread chicken manure on his garden. What complicates the matter is that he has arthritis and is on Remicade with a depleted immune system. This is probably why this affected him. They are treating him with an antibiotic IV every six hours around the clock. There is only one antibiotic that will treat this bacterial infection. This is making him very sick. The antibiotic does contain sulfa and I don't know that he is allergic to that but I have heard that sulfa medications can make some people very sick.
One other note to help in getting info on this. This must be something that is sometimes seen in AIDS patients because of the depleted immune system. I have tried to Google it in conjunction with AIDS and still cannot come up with info.
That's the story and any info that anyone can help me with would be appreciated!
They are probably diagnosed with
lung cancer because either they had it when they quit or because they are susceptible to it because of the smoking. My dad quit and died 2 years later. Either way something is going to get you. When it is your time, it is your time--that has always been my philosophy.
Anyone diagnosed with shingles and if so
how long had you had before the diagnosis and have you had any complications from it, such as constant pain, etc. Thanks
I have been diagnosed with fibro but
I have fatigue sometimes and don’t know if from that or from the hypothyroidism that I have, double duty so to speak. I have appointment this week to see what exactly is happening with me. Terrible, terrible pain for days on end- thought fibro, now not sure. I have some hydrocodone and take 1/2 pill of that when severe pain with fibro, supposed to start rehab for mild exercises but too much pain involved now with ?? I had a boss 1 time and she said she started exercising and that was the only thing that helped her. I just have had some setbacks to where I have not been able to start yet (including shingles!!). Hurt so much with the fibro and think the shingles started because of that. I can sleep at night, no problem there but some mornings unable to stay in bed because of hurting. I will give a follow up when I visit my physician this week and see what he has to say about if this is fibro, what does he think is problem, things you might do for fibro, etc.
Yes - i've been diagnosed
for many years now - just was not aware of this somatization disorder and its correlation with fibro and CFS. I would skip the rheumatology route and go straight to pain management - you will save yourself a lot of time and money. I live in a large metro area and have access to many very good doctors, but until I went to a pain management group of anesthesiologists, I never got any relief. My internist who I fired kept me on prednisone for 8 years and he actually got mad when I told him I was taking control and going to a PM specialist - that I was tired of him jerking me around and I resented having bought his car and put his kids through private school because of his inability or unwillingness to treat my pain issues. Yes, I am on narcotics - don't let that deter you - they work and not everyone that takes them becomes an addict. My life has been much better since I have been out of pain and am mostly bothered now only by the CFS - which no one has found anything really to help that. I sleep a lot and have learned my limits - I would just really hate for you to waste your time with a rheumatologist - they are for people with arthritis and inflammatory conditions. Fibro is not an inflammatory process and the rheumies don't offer any real treatment for what ails you.
Just reread your post - I would be interested to know what treatment the rheumie has planned for you -
Yes. I was diagnosed 10 years ago
with early stages of cervical cancer. Had a cone biopsy done which showed that the cancer did not spread or in situ. I decided to have a total abdominal hysterectomy, kept my ovaries, because I did not want to go back to the DR. every 3 months for testing and the chance that the cancer could return. No chemo or radiation. I was very lucky.
What makes you think you might have cancer?
Have to get those PAPs every year ladies. This is a very treatable disease.
Has she been formally diagnosed?
I get an outbreak on my nose every now and then, and the doctor prescribes Acyclovir. Don't know if it's the same when it's on the lips. Acyclovir works great, and you can use it either prophylactically and take it every day so you won't get any outbreaks, or you can use it when an outbreak is coming on and it's gone within a day or so, and it never has a chance to get bad. Again, I don't know if the lips are different than outbreaks on other body parts. My husband gets one on his leg and he takes Acyclovir too.
I have been diagnosed with fibro about 9 SM
years ago. You mention the pain is in your ribs. When I was diagnosed that was not one of the key points, of which there are many. I have pain all over, really. I have very much pain in my neck, wrists, elbows, shoulders, lower back, etc. I have terrible burning and pain in my muscles in my arms and legs as well. I have advanced osteoarthritis and chronic fatigue, which can also accompany fibromyalgia, as I am sure you know. Symptoms can certainly vary from one patient to another. I wish you luck and success in your efforts to control pain. I wish I had the answer for everyone suffering daily with chronic pain.
Anyone here diagnosed with Lupus?
I've been getting worse and worse physically and am in the process of being ruled out for all sort of stuff and this (Lupus) is one of them...some test came back positive but it's not definitive and I may have to see a specialist. I should really pay more attention but it's so hard to focus when a bazillion things are racing through your head while you're sitting nekkid freezing your hiney off on a paper-lined table.
So, yeah, anyone got this disease and, if so, how are you dealing with it? I'm just bummed out with the amount of pain and fatigue I have. I mean, I'm all crippled up and can't even sit here at my desk for more than an hour at a time anymore and chores that used to take 20 minutes or so now take up to 2 hours. I actually was so exhausted and in so much pain I curled up in a ball on my living room floor in front of the wood stove and slept for almost 2 hours before my husband found me and got me up on my feet. I'm only 35 and this just ain't right! Any advice is much appreciated.
While I've never been diagnosed with
lupus, I sometimes think I do, but when my rationale kicks in, I realize it is the wear and tear my body has taken over the past 40+ years, in addition to overwhelming perennial stress. Stress can cause lots of symtoms that mimic other diagnoses.
I do wish you the best and hope you get to the bottom of it and feel better. You are a delight to have on this Board.
she's been diagnosed as bipolar
of course, that's according to the press.
My dad is bipolar and has s/a and alcohol problem. I know how heart breaking that can be. It's like people who overeat. We all feel sorry for fat people but if you chose drugs then you are such a bad person but it's the same thing, really. A compulsion is a compulsion, no matter what you are taking into your body.
Diagnosed with this since the late 80s,
in fact I went in and told the doctor what to check for, had the classic symptoms, intense itching (waking me at night with urge to scratch), terrible coldness all the time, having to sit under blankets. Mine now has turned into Hashimoto's thyroiditis, I was told just a few months ago, thyroid totally gone. Now with the Synthroid, I told my physician did not want to take any more, loss of hair really bad, heard Synthroid noted for that. I asked and now on Armour thyroid and seems like loss is not as bad but still some. People on here have posted against Synthroid.
I was diagnosed 11 years ago and that along with SM
other physical conditions is why I cannot do a full day. I support myself and still have to do it without benefits, etc. I have tried different things for pain, but they either upset my stomach or were even taken off the market. I know exactly what you are going through. Sometimes I feel so bad I can't even put it into words. Good luck to you.
some people never get diagnosed at all because they
x
i was just diagnosed with diabetes
No insurance. Went to the doc yesterday to go over lab work I had done in November. My blood glucose was 127 (upper limit of normal being 126). I am 45 yeard old and overweight, but I never had this happen before. He then did a glucometer reading (after I had had three cups of coffee, each with two sugars, of which I was still sipping on as he took the reading). He then ordered new lab work as a recheck, but stated he had to put NIDDM as a diagnosis on the requisition form. I don't feel a diagnosis can be made that simply. What's really upsetting is the fact that he informed me that now since I had been diagnosed with NIDDM that I would probably never be able to get health insurance with a pre-existing condition such as this. I feel that through correct diet and exercise over the next few months I can easily lose ten or more pounds, and that this more than likely will change the status of my next lab values. I feel so very sad about this. What do I do??
My mother was diagnosed back in her 40's..
Hers came on after a stressful injury, as I've read this tends to come on after a very stressful situation, injury, or illness, and she got progressively worse. She hurt all over, was so tired she could barely move, was trying to work while this was going on and it was about to make her crazy. There would be days she would cry she hurt so bad all over and then would fall asleep into exhaustion. This did go on for several years and then began going away little by little. She just has a flare now and then, but mostly under stressful situations. My doctor did tell her that she should continue to exercise, force herself to do what she can, and then she definitely needed to rest, get enough sleep, eat a proper diet. He said there could be a day or two flare, weeks of a flare, or years, as in her case.
To answer your question, she did get much better and doesn't hurt all over all the time. She was just so tired she couldn't function, which I had never seen in her before.
I have been diagnosed wth fibro about 10 years ago SM
and know what you are going through. I read somewhere that it is impossible do describe the pain, and that is how I feel. It is a gnawing, pulling, burning, aching, fatigue all the time. No one has helped, and what meds I have tried gave too many other bad side effects, stomach upset, etc.
My daughter was diagnosed with ADD in 2nd grade
We took her to 3 different doctors who did a bunch of different tests and all three said without a doubt she has ADD (without hyperactivity). So, we put her on medication. The medication made her VERY cranky and she was a holy terror to live with!!! So, we went back to the doctor and he switched her medication. This medication made her mood better, but her appetite was virtually nonexistant. My husband and I read every book and website we could find on ADD to see if we could help our daughter. We ended up taking her off the medication and changed her diet, making sure she eats every 2-3 hours. We eat pretty healthy anyway, but we really have to make sure that we don't let her eat too many carbs or junk. She also has to eat pretty frequently to keep her attention span up. It has been 2 years now and she is doing great at home and at school. She just started a new school this year and this teacher is excellent at letting the kids have a healthy snack during class so the kids stay focused all day long.
In other words, before you even think about medication, I would monitor his diet and make sure that he's eating healthy and then make sure he's eating every 2-3 hours (if possible at school) and see if this helps.
Adult ADD? Never diagnosed but wondering (sm)
So all my life I have been disorganized, first it was papers hanging out everywhere from my notebook, now it is everything in the world stuffed in my purse. My mind wanders all the time. I do transcription but flip back and fourth between here and my work and my e-mail and other things on the net that interest me. And i have to have background noise while I do all this. My house gets very cluttered and than I have to work like a maniac to get it cleaned up but still things are kind of in haphazard places, not really organized. I just always feel overly busy, overly tired, and behind on everything. So....could I have ADD? Or am I just too busy, bored with sitting in front of the computer, and disorganized??
My cat was just diagnosed with lymphoma last night.
She is 10 years old. I noticed that her back hind leg looked very swollen last Friday. When I felt it, it was a huge lump. She has not been eating and not drinking any water at all. I think it has been there a long time and just did not notice it until last Friday. I was given the option of amputating her leg, which I cannot do. Give her prednisone and start chemotherapy, but how much time will that give her? She looks so sad and sleeps all day and it not using the litter box, about once a day.
I had to make a very hard decision this morning, and I am having her put to sleep. It makes me so very sad, but I do not want her to suffer. I am going to bring her home today and place her to rest in my garden under a park bench I have out back. I could not think to just leave her there. I am going to miss her greatly.
Just needed to talk as I have been crying all morning and trying to work. I am not going to get much done.
I was diagnosed with GAD in 2005. I think everybody's different as far as meds go. SM
I am on Effexor XR 150 mg a day and it works wonderfully for me, although when I forget to take my pill, I do get that strange dizzy, buzzy feeling that someone below described. I also have Klonopin if I need it. It's not as strong as Xanax, but it takes the edge off and helps with sleep.
I'm curious what was the catalyst for you being diagnosed? I have always been a "worrier" ever since I can remember. I bite my nails, but it was always manageable worrying. Then in the fall of 2005, I had a full blown panic attack. It was the worst experience of my life and I hope that I never have to go through it again. I had a gallbladder attack. I new it was my gallblader. I knew I wasn't have a heart attack and yet it was like one half of my brain could not convince the other half. I started feeling lightheaded, dizzy, and like I was in a tunnel. I was at work and someone told me I should go to the employee health nurse. I did and my BP was through the roof, my pulse was 130, and the nurse just ripped that BP cuff off my arm and said you need to be seen in ER and made sit in a wheelchair and wheeled me down there!
The irony is the more urgent she acted, the worse my panic got. Finally, it was established that I was not having a heart attack, but still my body was freaking out. I could not calm down. Then I started crying and cried for two weeks straight. I couldn't sleep at night. I didn't want to be home alone. I didn't want to go out in public. I just basically sat in my house, on my couch for two weeks straight crying and fretting. My doctor tried me on several different medicines including Lexapro and Zoloft, both did nothing for me but make feel nauseous. Then he wanted to prescribe an antipsychotic which made me freak out even more. Being a medical Transcriptionist and knowing about drugs, side effects, etc. was NOT conducive to my anxiety disorder!
Finally, I found a female nurse practitioner who was wonderful. She new exactly what I was feeling. Told me her daughter had the same issues and started me on Effexor. I have been panic attack free going on three years. I get what I call mini panic attacks where I can feel myself starting to freak out, but I've taught myself relaxation and breath techniques that calm me down.
I'm just jazzed to meet people who have the same "disorder" as me, ya know. When I've described my anxiety and panic attack to my family and friends, they just look at me like I should be committed and when I was going through it, my family didn't have a clue what to do with me or to say to me. They were afraid of me, really. My mom kept saying "you need to snap out of it." Yeah, ma. If only it were that easy!
My lab was diagnosed with an allergy to pine needles and had the same
symptoms you are describing. Now, I live in North Carolina where pine trees are as common as grits, so I thought the poor things was doomed!! My vet suggested a cortisone injection in the early part of the season before it got to really take off and then 2 tablets of Benadryl twice daily, which seems to have worked great for the past 6 years, but if I delay that darn shot and she starts that itching then I run into problems because not only is she itching from the allergy, but from the irritation caused from the scratching.
I studied the disease back in 98 when diagnosed
and thank goodness for the web!!! I continually get educated all the time from being online. I love it. Glad you're feeling well!!!! Attitude has much to do with it.....
Hope you aren't diagnosed with fibro
because no one believes you anyway. I had heard about before, did not know really much about, if I typed on it paid no attention, diagnosed in 2004 and not having fun yet. This is so far uncontrollable for me-mine might have been better controlled if diagnosed with rheumatism- I would suppose rheumatism feels a lot better than being over the entire body.
Have any of you been diagnosed with generalized anxiety disorder?
I have within the last week or so. Just wondering what meds your doc put you in and if it is helping and how long it helped all of your symptoms. I guess I was expecting "a feel-good feeling", too, but not really. The anxiety is definitely better. Had gone to the ER 3 times in less than a week, thinking it was my heart, but not.
Any help would be appreciated.
My husband diagnosed 1 time with diabetes, get this
he ran 1 high blood sugar and was diagnosed. He did have elevated blood pressure but for years and years controlled his blood sugar and the elevation was always and I mean always low- the insurance company would NOT cover him because of that 1 only diagnosis. I tried talking to them- they told me 2 counts against him- unable to get life insurance on him. This diagnosis was made on a job entry and for 7 years he kept his blood sugar average or below, made no difference. I have been there.
I read MRSA first diagnosed in 1961
There are things that unless you pick them up, may never know. I have an example: Had carotid ultrasound done. I asked for and got the report (I save any and all that I can including lab work) and the neurologist said ok. Well, happened to have 50% stenosis of the left carotid artery. I asked is that a concern to you and he said well, it should be watched ever so often. Another time, going to have elective surgery done, got EKG and lab done ahead for that. The EKG read abnormal (this was one I was picking up from a previous appendectomy surgery I had). I then asked my internist about it. Never mentioned to me at all. Needless to say when I see abnormal on something, only surgery is a have to surgery, not elective. I see mistakes all the time on my records, not sent out but diagnosis for a scan- had it showing me having hypotension and I have hypertension. Even when the people in the office doing the click and go reports before seeing the doctor, have found errors there. These are not outsourced reports, done right here in the USA. I always get copies of everything.
I was diagnosed with fibro but the rib pain, front and back
started 2 years ago when I got back from vacation and has been there off and on since. Sometimes horrible pain, sometimes just there but never completely gone. I went for 1 acupuncture but it is $70.00 out of pocket for each treatment, insurance does not pay so instead I am doing the 70% chocolate, 2 pieces a day because read that might help because of the antioxidants and flavinoids. As long as I am not touched anywhere around the ribs do pretty good. Have tried the chocolate for a week now, cancelling doctor appointment this Tuesday and will see if that holds the pain. The chocolate lot less costly than the treatments. I have found absolutely no assistance with any physician I have gone to, none including pain specialists, rheumatologists, ortho, etc. I sometimes have extreme fatigue, can lie down for a while and it seems to go away. I have hurt all over with the fibro but now my pain issues are the ribs (oh, forgot about the feet but too long story on that). Did your physician give you anything for the costo? I do not take anything for the fibro nor the costo. I had to dust my fatcat today and I thought she weighed a lot, she is only 20 but still had to pick her behind up and put her in the bathtub.
How funny! I have clinically diagnosed my hubbie as Bipolar too!! LOL! We really are in the wrong fi
s
Senator Kennedy diagnosed with malignant brain tumor.
He has to have radiation and chemotherapy. Hopefully he can recover from this.
Yeah, tons of info online. I have a friend diagnosed
nm
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