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My PI Cancer Adventure – Part 4

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Part 1

Part 2

Part 3

Part 5

Part 6

Part 7

It’s been two months since my last blog posting and a few readers have asked for an update, which I really appreciate.

Last night was a sleepless night. I spent part of it thinking of my mother and grandfather and the cancer treatments they went through. I know why this all came up last night.

Two months ago I came home from my surgery in Manila. Janet and I were allowed to quarantine at home and I started the process of healing. For five weeks I had a large scab covering my surgery and the skin graft. But at five weeks the scab came off, showing that what was left behind wasn’t too bad. Better still, the remaining wound began to heal rapidly. I sent my surgeon a weekly selfie of my nose progress.

The progress was important for the obvious reasons but also because the surgeon had told me that once the nose was 100% healed I was to get a CT Scan, MRI and a round of radiation for any stray nasty cancer cells left behind. So while I was happy to see rapid healing I was perfectly fine to delay things for a few more weeks.

But last Monday I got a message that I was good to go and ready to proceed with the CT Scan and radiation; she said to forget the MRI. One thing down – I liked that.

The truth is if you look at my nose now you would have to know that I had cancer surgery two months ago otherwise you’d see nothing but a less than beautiful old nose. Skin grafts are amazing!

I’d enjoyed the last month. I’d come to the conclusion that the nose was healing and yet I knew I had time until the next medical stuff; so I relaxed, at least a little bit. But now I was back into reality. I had to make an appointment with my local dermatologist, find an oncologist to order and evaluate the CT, and find a radiation oncologist for the radiation step – the part I was most scared about.

So last Thursday I walked into Silliman Medical Center for an appointment with an oncologist. The doctor was at least as old as me – maybe a bit older (Janet estimated she was close to 80 but I’m not sure about that). Now I am not an agist – considering my age that would be silly. But still it gave me pause; I know how good my memory is nowadays. Worse still the doctor pulled out a magnifying glass to read the order my surgeon had written. Still she seemed pleasant enough as I told her the details of my surgery and after all I just needed her to order the CT Scan and imaging medication.

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The next day Janet and I came back to have the scan done. Now I’ve seen the large CT Scanners on TV doctors shows but that’s about all I knew. We paid for the scan (about P8.3k) then wandered around trying to find the pharmacy for the imaging medicine, designed to light me up for the chest scan. We found the place, got the bill, then had to go back downstairs to the cashier to pay for it, then return upstairs to pick it up. Cost? A less than modest 5k.

At that point we went to the Imaging Department. The imposing machine looked just like it did on TV. Where was Dr. House to run this thing? I met the young technician and asked her what would be happening and what possible problems or side effects I might have. She ran through a long list of effects the medicine might cause. I am sure the blood drained from my face. “So how do we avoid those side effects?”

“We will give you a test dose and wait five minutes to see if you have a reaction. If not we will proceed with the scan.”

“How long is the scan?” I asked. “Less than 20 minutes,” she said.

I got on the CT Scan table and they ran a machine test. The machine pretty much yells at you to “Take a deep breath and hold it.” Then after a moment “Breathe normally.” The thing was so loud Janet could hear it all from outside the treatment room.

The technician asked if I was Ok and I admitted I was nervous. I think this made her nervous. Janet speculated afterwards that she was intimidated because I am a foreigner. Not sure if this is true but she was very nervous about installing the IV for the imaging medication. Eventually she brought in someone else to put in the IV. She injected a small amount of the medicine to see if I would have a reaction. When I had no reaction we were ready. While I am not claustrophobic I was bracing myself for the 20 minutes under the machine. The table slid under the machine, the machine yelled at me to “HOLD MY BREATH” which I did, the table slid back out and the technician said over the microphone,”the test is over.” “What! That was it?” 30 seconds tops.

Later I realized that when I had asked her and she had said 20 minutes she was talking about the entire process, not the test itself. The communication gap strikes again.

After the test the technician asked me to wait for 20 minutes in case I had a reaction because “we’re right here at the ER.”

So I’d survived the test and was told I wouldn’t have the results until the following Wednesday. And now on Tuesday night I couldn’t sleep. What would the test – a test ordered to see if the cancer had spread – show?

Testing of all sorts in the Philippines is different. When the results are available you pick them up and then make an appointment with your doctor. So after picking up the results Janet and I scanned the papers to see what the results were. Yes there were several concerning issues – issues not uncommon for a 68 year old – but my medical eye saw nothing about spread.

At that point we went to the oncologist’s office and waited. She and her assistant were late; pretty common here. Eventually she arrived and began reading the report to me and explaining it, and surprisingly without the use of her magnifying glass. Yes, she wants a couple of follow up tests, which can happen during or after the radiation. And yes, we will probably do another CT in a few months to compare. And yes, she said at my age I should visit a cardiologist regularly. But nothing seemed to worry her too much.

So at that point, feeling more confident, I asked her about the radiation and admitted that my notion of radiation was what they did to my mother and grandfather over 50 years ago. She told me it was just like a light and I would feel no pain. Soon I will find out whether this is true or not.

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MY PI CANCER ADVENTURE – Part 2

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Part 1

Part 3

Part 4

Part 5

Part 6

Part 7

Once the decision had been made I acted as quickly as possible. I had an online meeting with the surgeon in Manila. She explained the procedure, quoted the success rate and her staff scheduled the surgery for the following week. This relieved me a little bit since the thing on my nose was noticeably growing almost by the day.

Since Janet had already had one experience leaving Negros Oriental during this pandemic, we were familiar with the process: permission to travel from the Barangay Captain, sign off from the Mayor and the police, and a health document. We had it all in a day or two and I booked a flight. Then the unexpected fun began.

I had promised Janet (and promised myself too) a nice hotel, great restaurants and shopping to compensate for the ordeal. I went onto Agoda and booked a hotel close to the hospital. The next day I got a message from the hotel that they were currently allowing quarantine guests only – guests coming from out of the country and required to quarantine – and therefore my booking was rejected.

I quickly discovered that many hotels in Manila were quarantine only. I was annoyed that none of the hotels published any such information on their websites, nor did Agoda. Others were government approved for “staycations” but those staycations were only available to residents of Metro Manila. I emailed a bunch of hotels and one by one they apologized but would not allow our booking.

I then got the bright idea to book an AirBNB. Perhaps they wouldn’t have the same restrictions. But one by one they too got back to me that they could not accept my booking for a variety of reasons. I was panicking and not thinking straight. Finally I contacted an upscale hotel, the Edsa Shangri-la, and they asked for documentation from my doctor confirming why I had to come to Manila. I submitted my doctors orders and they approved me. I nearly cried in relief and will forever be grateful to the Shangri-la, which is the best damn hotel in Manila!

Janet and I flew to Manila. The process at the Dumaguete airport wasn’t too horrible; just submission of the documents giving us permission to travel. BTW, the Dumaguete airport has never looked so clean! Normally it’s a shabby, dirty little airport. OK it’s still a little shabby, but pretty spotless. The flight to Manila was at most half filled.

Contrary to my usually cheap ways, we paid for the car service from the airport to the hotel. Upon arrival we were escorted to what used to be the hotel’s Spa (now closed), where a rapid test was performed. It was only after our negative test results came through that we were allowed to check in and go to our room.

The next day the real fun began. I was required to have a swab test to perform the procedure, as well as 3 other blood tests, an ECG and a chest X ray, followed by an exam by a cardiologist. I guess they want to make sure that, you know, you’re not going to kick off during the surgery.

The testing procedure at The Medical City in the Ortigas area of Metro Manila, was surprisingly efficient. Fall in line, show the doctor’s orders, pay for the tests, and then get the tests. Within a couple hours I’d had the swab test plus the 5 others completed.

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However I was then told that the cardiologist, whose approval I required, would not be able to see me after 12:00. This meant that we rushed back to the testing area and begged for the results to be given to us early. Fortunately I was able to get all the results (except the swab test) and rushed back to the Cardiologist’s office at 11:45. Naturally blood pressure had to be taken first. “You gotta be kidding. I’ve been running all over for 4 hours. My BP will be off the charts.” And it was! But 5 minutes later, after closing my eyes and breathing deeply and slowly to calm myself, it was closer to normal and the cardiologist saw me. Cool guy who acknowledged when I asked that his practice was way up. “There are Covid deaths and non-Covid deaths caused by the pandemic,” was his simple statement of fact. He certified that my heart was fine for the next day’s procedure, and we breathed a sigh of relief.

At that point we did what anyone unable to travel for a year would do; we hit the local mall! SM Megamall, right around the corner from our hotel, is the 2nd largest mall in the Philippines and 9th largest in the world. This place makes Dumaguete’s Robinsons Mall look like a 7-11. Significant shopping, followed by a nice Japanese dinner occurred, keeping my mind a little bit off the next day’s surgery.

Are we having fun yet?

The next morning we went back to Medical City and proceeded to what was called the Wellness Institute, a suite within the hospital. It was pleasant and upscale and could easily be confused with an American counterpart.

After paperwork, the doctor and her nurses arrived. We asked a few questions and the work began. I am certainly no expert but it all appeared very professionally done. The US-trained doctor had performed thousands of these procedures and it showed. She was very attentive to my comfort and must have asked a dozen times whether I was OK. BTW, the surgery was done with local anesthesia – lots of it.

The surgery was performed and the tumor sent to the lab, which is the advantage of MOHS micro surgery; they can get the results between 30-60 minutes and then decide whether to cut more. In this case I waited over an hour; I was to find out why later.

After a lot of waiting I just padded out to the waiting room in my surgical gown to be with Janet. The doctor arrived and told me she proposed using the skin under my eyes, aka the bags, for the skin graft. Basically I’d be getting two surgeries for the price of one; essentially an eye job. Lol.

What I found out later from Janet was that the doctor was unhappy with the samples the lab sent back and yelled at them over the phone to do it again and do it the way she wanted. Janet told me, “she’s tough.” When the revised samples came back the doctor found a small amount of additional cancer left, requiring another cut.

My doctor then showed me a photo of where the graft would go. I was stunned and for the first time scared and muttered, “Oh my God.” There was a nearly dime-sized circle on the right side of my nose. The reality of what had occurred set in. Janet was wonderful and calmed me down, reminding me that we had acted quickly and done everything possible.

“We won’t be able to use the eye skin. It’s too thin. We’ll have to be a bit creative,” said the doctor, scaring me again. So I got more anesthesia and another cut. That sample came back quickly and the doctor proclaimed there was no more cancer.

The doctor proposed taking skin from under my arm where she said “the skin was a bit sagging.” “I used to have more muscle there, doctor. But my weight lifting days are over.” So more anesthesia, a cut for the graft from the arm, stitching up the arm (first stitches in my life) and stitched the graft to my nose. The doctor proclaimed that the shape of my nose (never a particularly pleasing shape) had been saved.

A gigantic bandage was placed over my nose and the doctor gave us prescriptions and general orders and said she’d see me in 3 days.

At that point, since this is the Philippines, we were left with the need to pay. For those of you who want the numbers, this was not an inexpensive procedure. The doctor’s fee was 70k Pesos. The hospital and lab fees for Medical City were about 39k Pesos. BTW, my doctor also has privileges at a hospital in Makati and I was told that hospital’s fees would have been about double. I have PhilHealth coverage and while many expats complain about the price increase for expats that started a few years ago, PhilHealth paid about 30% of both the doctor and the hospital fees. In addition, the day before, PhilHealth paid for most of the swab test fee. So you will not hear me complaining about Phil Health! In the end I paid out of pocket about 79k plus a little more for the tests from the previous day. Thank goodness the stock market’s climbing.

More to come…

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My PI Cancer Adventure – Part 1

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Part 2

Part 3

Part 4

Part 5

Part 6

Part 7

Early in the pandemic last year I speculated to several friends, “What if you got genuinely sick with something other than Covid? What would you do?” You see, the way the heath care system works in Dumaguete (and similarly throughout the Philippines) is that the local hospitals handle the basics, and so far I have been reasonably impressed with medical care in Dumaguete. But if you need something major – heart surgery or sophisticated cancer treatments, for example – they send you to Manila or Cebu City. No big deal; a quick flight or longer ferry ride. So that was my plan when I moved to the Philippines. Who could have imagined when I made those prognostications, that they would impact me so directly?

I just turned 68 and have been pretty damn healthy my whole life. Not a broken bone or a stitch on my body. Never a surgery other than something that was done to me when I was an infant.

For these reasons it was easy to be somewhat cavalier about my health. Sure, I started going for an annual physical before age 50 but generally in the US that is little more than blood work and taking your vitals.

Nonetheless there are three things I keep some track of and worry a bit about. My PSA test, which checks prostate health (my father and uncle both had prostate cancer and survived it). Secondly, colonoscopies; those fun little things that I have had 4 times already, mostly because I have a brother who died of colon cancer. I am due for my 5th one of these later this year – can’t wait. BTW, if anyone watched the AFI Lifetime Achievement Award given last year to Diane Keaton, Woody Allen did the greatest joke about colonoscopies ever. Go watch it on YouTube. https://youtu.be/S8AAYTDf87Y

And the final area of concern is – my skin. I’m fair skinned, used to be red-headed, and burned often as a kid. As an adult I discovered that sunscreen actually works and became addicted to the highest SPF I could find; usually 100 or more. Because of burns I hated the beach as a kid. Ironic that I would move to the Philippines and now very much like swimming in the ocean.

Nonetheless when I had my last physical exam in the US before moving to the Philippines I asked the doctor about the spots on my face and whether they were just age or what. I don’t think he would have said anything if I hadn’t asked, but I did so he recommended a visit to a dermatologist. So, for the first time in my life I went to a doctor who I believed mostly existed to cut off moles and pop zits. The dermatologist explained that the small spots were pre-cancerous and could readily be removed by freezing them off with liquid nitrogen. It was quick and not too painful. The doctor also took a small sample for a biopsy which came back negative. When I told the doctor that I was moving to the Philippines she recommended finding a dermatologist and getting an annual exam and freezing.

About six months after I arrived in Dumaguete I found a dermatologist and went for a checkup. The office at Tru Dermotologie was clean and upscale, the staff bright and knowledgeable. The doctor, trained in Canada, had me strip and examined all my skin. After that she froze off spots on my face and top of my head, where the red hair used to protect me. All quick and professional, though by Philippines standards a bit pricey. I have come back annually.

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Last year I noticed her office opened and closed often because of Covid. Finally they re-opened in November and I decided I’d better go before they closed again. The routine was the same: strip, examine and freeze off those pesky spots. The total price, between the examination and the spraying, was somewhere close to 7k. Nonetheless I felt good about doing the right thing for myself.

Now, once the spraying is done the spots scab over and the highly attractive scabs take 7-10 days to fall off. But this time there was one on my nose that didn’t seem to want to come off. It looked weird and felt weird for a scab and it grew out of a small bump on my nose that I’d had for perhaps 5 years; something that I’d previously been told was common and not to worry about.

But after a few weeks I did worry and returned to the doctor. “This scab isn’t falling off and seems to be growing,” I said. “It’s not a scab,” she said and gave me a Latin term for what it was.

The next day I returned to have the thing suctioned out. Because of Covid the doctor was dressed in an outfit that covered her head and was sort of a cross between a bee keepers mask and something NASA would have invented. The devices used to suction were modern and sort of reminded me of what you might see in a dentists office. No cutting – just suctioning and then cauterizing the wound left behind. The doctor took material to do a biopsy but touched the area and told me she was pretty confident based on feel that it was not cancer. A sample was sent to the lab and I was told 4-6 weeks to get the results. That didn’t concern me because I was so confident it was nothing.

I should have known that something was very wrong when the results came back in 2 weeks. I went back to the doctor only to be told that the results were inconclusive; it might or it might not be a squamous cell carcinoma. The doctor was torn with whether to ask the lab to do another test. She actually was worried about spending my money or perhaps worried that I would think she was taking advantage of me. I assured her I could afford the tests and to please do whatever was best. In the end she decided I should come back in two weeks by which time the scab would be gone and she could examine the wound and perhaps take another sample of the affected area.

But in 2 weeks the scab was not gone. I had soaked it a couple times a day as asked and even rubbed it to get the scab off. Some of it did come off but then to my dismay it grew back. When I returned in 2 weeks and showed the doctor my nose she knew it was skin cancer. “Don’t we want to get another biopsy?” I asked. “I’m 99% sure,” she said.

We discussed the options. I could get it cut out by a plastic surgeon and perhaps that could be done in Dumaguete or I could go to Manila and have modern microsurgery, called MOHS. “Manila? There’s nowhere else?” I asked. “No.”

The outpatient procedure was explained to me. They take a small slice and exam it under a microscope right then and there. They continue to take tiny slices until there is no more cancer. This is much more effective than the cut off a bunch and hope for the best procedure which a plastic surgeon would do.

The doctor knew I did not want to go to Manila since it would mean quarantining upon our return and poor Janet had just gotten out of quarantine. One thing that is good about me is that when it comes to major decisions which are unpleasant, I don’t hesitate. “I guess we’re going to Manila. What do I do?”

This is Part 1 and there will be more to come. I debated about whether to share this now, when it was all over, or not at all. In the end I opted to share because I fear (and have felt this throughout the pandemic) that there are millions of people who will avoid going to doctors or hospitals and have necessary medical procedures, treatments and tests done. In my jaded opinion this is due to the geniuses telling us what not to do and scaring the crap out of us so we don’t take care of other health concerns. And in some cases doctors and hospitals are flat out closed or not available for non-Covid treatment. Thank goodness my dermatologist was open. My encouragement to all of you is to take care of your health and not just your Covid health!

BTW, I am gonna make this Manila thing a fun holiday with a great hotel and the best restaurants and a serious mall shopping budget. So Janet and I expect to have fun!

Addendum: My purpose here is to: document my experience; describe medical experiences and costs here in the Philippines; and perhaps encourage people to take care of all their health issues. It is not to do a “woe is me” – so if you hear me doing that give me a gentle kick in the ass. Nor should anyone else proclaim “poor Dave and Janet” – or I’ll give you a gentle kick in the ass!