It has been nearly 3.5 years ago at this point, except this time around I have an actual diagnosis. Superficial Basal Cell Carcinoma. Not a life sentence, but a small scare, and a rather unsettling few weeks ahead as I have to take time off from work due to its location (under my eye). This time around, it wasn't me telling my Dermatologist of my family history, telling him what I was certain I had, and him effortlessly prescribing Aldara without hesitation or doing any further diagnosis, no biopsy, or follow up. This time- I had answers. And thanks to my persistence I pushed for a biopsy after my new dermatologist's freezing attempt of the spot (back in May) did virtually nothing, because she thought it was simply a reoccuring AK which is basically pre skin cancer. Alas, The spot kept returning. And I pressed on to find answers. That's the funny thing about persistence and the health care system. You need a big dose of persistence and a gallon of patience to accomplish anything, and don't expect anything to be done in an efficient manner.
Let me backtrack here- I intended on talking about my skin cancer journey but to be honest, my frustrations go beyond my diagnosis, the root of my frustration stems from how damn long it takes to actually accomplish anything with the healthcare system options out there. It is absolutely disheartening and I feel for those who have much worse situations than me.
I am an artist, an independent contractor, a small business owner if you will, and for this wonderful life I am so thankful for my flexible lifestyle and ability to follow a path that many do not get to, BUT I have been paying out of pocket for private insurance since 2014- and up until I moved to California- my insurance though expensive- was PPO and I had a choice. Now that I am in California- I am basically forced into HMO plans because PPO plans are so outrageous and with COVID closing down most of my industry- and so with it most of my income-I am thankful I opted for a "reasonably" affordable plan. BUT and there is always a BUT- as much as I am grateful that I have insurance- It has taken me from January of this year with my initial primary care appointment, where I learned with HMO you have to make individual appointments to take care of individual needs- and you have to get a referral for every single thing- and you have no choice which person they send you to. Unless you switch a new medical groups or sub-groups (which mind you the insurance company doesn't even know much about so its like throwing a dart and hoping it lands with a decent medical group) and when you switch you start over the entire process again. Then I learned I had to beg my doctor to refer me to a dermatologist because of my spot- which she said looked like absolutely nothing. I had to explain to her I already treated this spot in 2017 but had it since 2015, it has reoccured, I have a family history, the whole shabang of my reasoning. She finally agreed..........the referral took ages to get- I went in February to the DERM- she was lovely-she did a full body scan- told me my spot looked like normal but she wanted to do a biopsy first on another spot- and she also explained that we had to get approval for each service, and each service required individual appointments. That means- instead of going in and getting biopsies on multiple spots in one go- I literally have to wait for approval for a single biopsy, then make an appointment, after said appointment, wait for another approval, and then make another appointment, and so on. My first biopsy on my shoulder- was negative thankfully. So fast forward to May- we decide to freeze this spot on my face- YAY Finally I thought but unfortunately.....the spot came back a few weeks later. I decide to hold off on any other follow ups as I had a couple big jobs booked for June and July and couldn't risk having a biopsy on my face- so I called- I explained the situation and requested I come in to refreeze the spot. I finally made it in August when they could get me in AND my insurance approved. She said since the freezing wasn't successful she would have to do a biopsy- so at that appointment she just did some random laser treatment on a burst blood vessel and put in another request for a biopsy 2 weeks later. This approval came faster and I immediately made the appointment. My biopsy results came in within the next day of the biopsy- she promptly called me and sure enough- BCC and thankfully it was superficial which means "hopefully" easily treatable.
My 2 options for treatment:
1. Surgical Excision which would definitely leave a scar
2. The same topical treatment (Imiquimod) but with better instructions and follow up biopsy in 3 months after treatment is up.
Now being that I am still actively modeling and acting- Option 2 is/was the best option for me. I know there are some great cosmetic surgeons out there that could likely help make my scar less noticeable- However, I really don't trust that my health insurance- which doesn't even cover the costs of a Night Guard to prevent my teeth from cracking due to teeth grinding- I HIGHLY doubt they'll approve a cosmetic fix for a scar on my face as it directly affects my work. So if it returns again (fingers crossed it never does) the surgery option will be there.
So here we are- October 13th, 2020. I am 7 full days into my topical treatment. I have a scab under my eye, it has irritated the inside of my eye so it feels like something is stabbing me when it gets wet, the lymph nodes on my cheek are swollen (normal I am told,) and I have turned down work for the upcoming weeks. (Big bummer but definitely a priority to take care of me first) The Treatment: You basically apply the topical cream every night for up to 2 weeks until scabbing occurs. Then you stop. And the scab eventually falls off and hopefully with it- all the cancerous cells. I got the go from my DERM today that my skin has scabbed well enough and I can quit applying. So here's to hoping- that after all the headache, after nearly 10 months of back and forth appointments, approval letters, etc. etc. etc. That I won't have to go down this road ever ever again.....
The upsetting part about this all, isn't that I can't physically work right now or that I have a gross scab on my face, but that is it so outrageously difficult to get in to a simply specialist without the approval of a complacent doctor. If it weren't me, and it were someone else too shy to speak up or maybe they just trust their doctor so much, then what? The problem will still exists and the cancer could spread, worsen, etc. etc. etc. all because of one awful system that makes you believe that because they are the doctor, they are the professional, that they are always right. And that just isn't the case, with anything, at least not all of the time. Of course there are amazing doctors out there, and I'm sure my Primary Care Doctor is FINE-but would I recommend her to anyone-absolutely not. I have had that complaint from the beginning about my doctor- she has always made me feel like I am crazy for asking the questions that I ask- because I'm certain she is not used to someone who does their research, who pays attention to their bodies, and says NO this isn't right. I've stuck around because I love my dermatologist and if I leave this medical group I would have to get another referral to a different dermatologist in a different medical group. So I stay.To avoid the headache. And to avoid losing my dermatologist. So I stay at least through this process....And I hope that when the new year comes around- that maybe a PPO might be accessible again and I will choose that DERMATOLOGIST because she is thorough, and patient, and listens.
I'm sorry if anyone has had to deal with these headaches and frustrations when trying to take care of your health- I am sure that because of COVID the processes are delayed in some sort. I do understand that these times are different. But there is already enough anxiety behind health why do we need all these extra steps and hoops to jump thorugh? When we all just want to know we are going to be okay.... and we want to trust that the doctors who care for us have your best interest at all times- but it is okay to say "no I don't agree" and move on to a better fit. It is okay to stick up for your health and what you want- because in this experience- I've learned sometimes the doctor isn't always right. Trust your gut. And take care of yourself.