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I thought I’d start this last post with a picture of me at a happier moment.  It was 2 years ago and it is amazing what hair, makeup and a pretty dress can do when you compare this photo to what is about to come 🙂
You will also note that I am happily white, no suntan, no sunburn, and no need for it.

a smiling, happy, very white and NO TAN, me!

 If you have been keeping up with this series, you will recognize the next photo from Part I   HERE.
This is how my MOHS surgery was left and if you recall from Part II   HERE, my journal left off with me leaving for the ocular plastic surgeon, ready for the next part of my journey and his part in closing up the ugly hole left by cancer.

 Nasty, huh?


the second go round of MOHS, bruising and swelling and discoloration is starting to happen

And so when 2:30 rolled around, we left for the plastic surgeon’s office which is 45 minutes away.  Why did I have to have this procedure done in 2 different offices?  The first surgeon does not close up eyes, that is for a specialist to do, so that is why I was referred to the plastic surgeon and finding myself en route to this office.  Mind you, the local anesthesia has worn off by this time so I was pretty uncomfortable and just wanted to get there.  Also, I did not know what to expect but had a terrible hunch a skin graft was in order.  EEEK!
I remember being called back and sitting in the chair and watching the doctor remove the patch to unveil the hole.  I knew he wasn’t expecting it to be this big and was trying to read his expression as he removed the bandage.  He was REAL good.  No look of surprise or shock even though he did say he wasn’t expecting it to be this big.  Trust me, neither was I.  I think inside he was saying WHOA BAAAAAABY! 
So he told me to close my eyes and he starts pinching my eyelids and feeling for how much skin would be needed.  It was at this part that I started getting grossed out.  (My father later told me he was really hoping this was not going to be the way I got the extra skin).  I asked him if he was going to take the skin from my eyelids.  He said normally that is where it is taken from because it matches the skin under the eyes.  He was also trying really hard to find extra skin at the corner of my eye as he was pushing it over toward the hole, but to no avail, it was too taut.  Ah yes, the joy of youth but in this case, it was working against me. 
You need to know that I was getting grosssed out by the second, AND, my mind was racing because I had promised a delivery of draperies and cornices to be installed on the 22nd of December to a new firm I have just contracted with.  I could work with one eye no problem, but to not have both for who knows how long?  I couldn’t do it.  So I suggested to him if we didn’t have enough skin from my eyelids, which was turning out like that might not be an option anyway, could we take the skin from my ear area?  I told him I had no problem hiding the scar with my hair.  He took a look and said that was definitely an option if I had no problem with it.  I told him no and to proceed.
So, his instructions to me were:  before we get started if you have to go to the bathroom now is the time because when we get started, there is no turning back.  Now, I’m at the age where the bladder has been playing tricks with me and when I gotta go, I gotta go!  Uh oh I thought, I am cooked because I had a cup of tea before coming and with my nerves being what they are, I’m doomed.  So I took a deep breath, went to the bathroom and hoped it would be the last time I had to go in an hour or so. 
Turns out that fear and anxiety are great pee stoppers!  It worked for me.
I laid down on the gurney and his assistant prepped me for the surgery.  She made sure I was very comfortable, draped my hair away from the face and ear area with those paper sheets and secured it tightly, cleaned the area well and disinfected it and then shaved me at my ear area because of the hair.  There is no hair in the skin right under the eye.  *remember this point because later on I had a revelation. 
He started numbing me up at the ear area real well.  Then as I lay there not feeling anything but tugging, all of a sudden I heard what I thought were scissors cutting something.  And then it dawned on me:  he was cutting my skin away after the intial incision! And it was at this time that I wished I had earplugs in so I wouldn’t have heard it.  I had to talk to myself again because I can’t go pee if I had to, and now I think I’m going to throw up because of what he was cutting.  I couldn’t help but think of that movie where the guy skins all his victims and makes a suit for himself with their skin!  Yes, amazing where the mind goes and now here I am being skinned alive!  AAAAHHHHHH!
After he cut the skin off, I heard him drop it in a jar of liquid to wait till he was ready to use it on my eye.  Then he proceeded to sew me up.  I asked him what kind of needle he uses since I sew too.  I told him I have curved needles to get into hard places and was that what he was using?  He confimed and so we had a discussion about the different threads.  Only his needles have the thread attached and that is why I could feel him stitching and then knotting off after every stitch.  Good thing he didn’t need to rethread the needle every time.  This took about a half hour and I could tell he was very thorough about his stitches. 
Didn’t he do an awesome job?

ear incision where skin was taken to form graft for eye directly after surgery

Next came the eye.
 He disinfected me real good again even though his assistant did a fantastic job before him.  I liked that because it told me he was real careful about contamination.  And I am a germ- o- phobe.  He proceeded to numb me up real good and I knew this was going to take longer than the first procedure.  He then took the skin he removed from my ear area and again I heard cutting.  So I asked if he was cutting the graft to size.  He explained to me that the skin at the ear area is thicker than the skin at the eye so he was cutting away at it, removing the fat and making it thinner.  Hmmmmm…I say and then tried to focus on the lavender field in Provence that I toured.  Anything to get me away from what I was laying here experiencing now.  Fat?  Being trimmed away from my skin?   Too much to digest.  I’m smelling the lavender…….I’m back in the field…..I’m bending over and taking a rock for a souvenir….
He had to cut the graft in two sections so he was placing the first graft at the bottom and sewing it down, then I heard him snipping away and fitting the top piece of skin to the top.  He sewed that into place then he sewed the two sections together in the middle.  I was getting really restless at this point and was moving around trying to get into another position, keeping in mind he had a needle at my eye.  His assistant asked if I was ok which she did on a regular basis and I was fine.  (Keep telling yourself that Tammi, it will get you far my girl)  And then he was done!  Whew!
Didn’t he do a great job with the graft too?  If he ever gets tired of skin, I could use him in my workroom but I don’t think I could pay him what he is used to getting.  Or maybe I should raise my rates……

full skin graft directly after surgery


full skin graft at eye directly after surgery

So after getting the wound care instructions and a prescription called in for an opthalmic antibiotic ointment, we are on our way.  By this time, rush hour traffic is in full form and the local is starting to wear off to the point that I’m squirming and very uncomfortable but trying to grin and bear it.   The stinking patch was uncomfortable as my eyelashes were getting caught in it and the sutures.  Almost an hour and a half later I arrive at home.  My day started at 8:30 am and my arrival at home was 6:30 pm, a long day indeed to not be on anything to calm the nerves a bit. 
 Two of my friends were providing dinner for me, so I sent them a text to let them know I was home but in all honesty, I wasn’t that hungry.  However, once they got here and I saw what dinner was, suddenly I had the urge to eat.  I showed them the pics of the surgery and then they were on their way.  I had a delightful dinner and then went to bed because I just knew I was going to sleep like a baby!  I was exhausted mentally, physically and emotionally!  Or so I thought.  I had to sleep sitting up because of the eye needing to be elevated which isn’t a problem for me but I was experiencing a fair amount of pain.  Betweeen the cutting and cauterizing of the skin, then needle punctures and sutures, I was a sad kitten and Tylenol was what I could take for pain.  Hindsight says get the good stuff next time. 
It turned out that I got NO sleep at all, I couldn’t find a position and the pain was making me want to scream.  I toughed it out that night but was not a happy camper when I awoke, or wait, I was already awake, wasn’t I?  And then it hit me:  OH NO!  I HAD SKIN TAKEN FROM MY HAIRY EAR AREA SO DOES THAT MEAN MY GRAFT AT MY EYE WILL HAVE HAIR STICKING OUT OF IT?  *remember that little footnote I told you to remember?  This is why!  So I made the best out of a crappy situation and put the frozen peas on my eye like the doctor said to reduce the swelling and keep the area from bruising as badly.  I was warned I would be turning all sorts of colors but thankfully, the only color I turned was yellow.
I had grandiose ideas of reading since I was bedridden for the next two days but that backfired on me because  1) I wear glasses which did not fit over the patch  2)  I’m blind as a bat!  3)  I could not focus because of the pain.  So much for that.  Now I’m really bored and going nuts because there is nothing for me to do.  I have no TV but I do watch some TV on my computer but I got a serious headache trying to type on the laptop because I couldn’t see.  Then, I had to hold the screen right up to my eyes to see what I had just typed, which resulted in the headache.  Forget it!  I’ll choose to be miserable.  Then a friend on Facebook suggested audible books.  Oh duh, why did I not think of that beforehand?  Too late now. 
This is me the next day at lunchtime.  I mustered up a smile for the camera.  I’m such an actress aren’t I because trust me, smiling was not on my agenda.

me with the patch on my eye and at my ear the next day at lunch

 I was really looking forward to getting this patch off my eye.  On the second evening, a dear friend and her husband came to visit.  I was so miserable because my eyelashes were getting caught in the sutures and the patch was in the way.  I rarely complain or show just how miserable I am, but she told me later that she felt so bad because she never heard or saw me that miserable before!  What did I tell you?  She was seeing the ugly side of Tammi, fortunately I felt way ok letting her see that side of me 🙂
48 hours after surgery the patch was to come off.  I could not wait.  So for me that meant 5:00 pm on Dec 9.  During the course of the past two days, I could feel my wound weeping, yet I could not cry because the tears stung too bad.  It would only be 3 weeks later that I could cry about it.  I enlisted my mother’s help since I wasn’t sure what to expect.  She removed the bandages but the non stick pad actually stuck to my graft so she had to cut away at it little by little.  Needless to say, that REALLY hurt!  After the bandages and tape were totally off, I got up to go to the mirror and see what my new face would look like.  I was all ready to wash it off and put on the antibiotic ointment myself. 
Let me tell you, I got so nauseaous I almost passed out!  I got light headed and had to lay down on the bed.  My cat who is super sensitive to what is going on with me, jumped up on the bed and got right on my chest and looked at my face and started rubbing her head on me.  She stayed right with me as mom cleaned it up and put the ointment on it.  We had to clean the ear area too and it had steri strips on it so I wasn’t too grossed out about it.  Then, as if this wasn’t enough excitement during all this, my dad, brother and nephew came up (I forget why now, but there was a real reason) and my nephew who is only 11 yrs old had to leave because it was making HIM sick.  How funny I thought that at the time.  He had no qualms about telling his dad they had to go.  I will give him a gold star for actually wanting to look at it because my other brother and sister had no desire to look or even look at the pics.
 You can see that my eye is swollen and discolored and the graft is raspberry red.  That is what grossed me out because I was hoping it would not stay this color.  Look how tired my eye looks! 

eye graft 2 days after surgery after removal of patch

 I’m allowing time to elapse between the pics even though I took pics every day to chart the progress.  My next visit with the doctor would be one week later on the 14th to remove the stitches from the ear graft and the eye.  Ouch!  As it turned out, the sutures at my eye were too sensitive to remove so because they were the dissolving type I decided they could dissolve on their own when THEY were ready to come out.  The sutures at the ear were not, so they had to be removed. 

ear graft at 1 week out after suture removal

 What I realized during the first week was that I couldn’t laugh too hard or smile too wide because of the incision at the ear.  I did in effect have a mini facelift and could definitely feel the tightness and pulling.  I also became more sensitive to the cold and if only out for less than a minute, ached for hours.  It took me a couple weeks to realize the sensation was that of a burning ice cube starting at my left temple and running all the way down to my jaw.  Most unpleasant indeed.  However, I did get that drapery job done and installed!
 This is what the eye graft looked like 9 days later.  Only one suture was able to be removed a couple days earlier at the 1 week checkup.  It looks real good I think but it was starting to get a little hard.

eye graft at 1 week and 2 days

This is the ear graft 17 days later.  Healing up very nicely thus far and easily hides under hair.

graft at ear at 2 weeks and 3 days out

We are now 3 weeks out with the eye graft and some of the sutures have come out on their own. The bottom half had a thin scab that fell off but the top half still has it and the color is coming along quite nicely although I’m starting to be a bit concerned about the raising of the graft itself.  Should I be concerned?  I didn’t know.
So what does any inquiring mind who wants to know do?  They Google!  So I googled skin grafts and skin cancer and found these two blogs:  Things Happen and Efudex and Me.  I really enjoyed reading them and it gave me some comfort to know I wasn’t alone in my struggles.

graft 3 weeks out with some stitches remaining in center

 And yes, my concern grew because this graft indeed turned out to keloid on me and I saw the doctor because I knew it was NOT a good thing.  I got keloids from prior pre-cancers being removed but never thought that this would happen on the face!  After my visit with the plastic surgeon he confirmed my fears and we started putting a steroidal ointment on the graft 3 times a day with massaging for 5 minutes at a time.  It turns out that I am 1 in 10,000 that this happens to and keloiding usually doesn’t happen on the face much less at the eye.  Well, guess what?  My dad said he knew I was 1 in 10,000 but darn it, not this way!
So because I was my surgeon’s first patient to keloid like this at the eye, he had to special order the combination of steroids to be injected and I would be called when they came in.  It so happens that on Friday Jan 13, I got a double dose injected right into the graft.  It included a fast acting and a slow acting steroid so I sure am hoping that this does the trick but if not, the possibility of a re-do is not out of the question.  I made sure he numbed me up first because I have had these before and to say they hurt is an understatement.  I couldn’t imagine having this done at my eye. 

keloid at eye 5 weeks out and day before steroid injection

I’m watching my ear incision closely now too but all in all, it looks good.

graft at ear 5 weeks out

Here I am after the injection on Friday afternoon.  I remember 5 sticks with the needle to numb me all around the site and then 3 or 4 sticks into the graft with the steroid.  Again, I was talking to myself to not pass out.  I’m so glad I could close my eye and not have to watch it happen.  I will say this, even with a local anesthetic, once it wore off, I still experienced pain and am still feeling it.  Especially when the cold air hits, I feel that burning sensation and aching. 

keloid after injection

This is how bad it is raising on me.  It is also pulling the skin tight too and makes me feel like I am winking or feel the need to wink to give it some slack.  My eye is dryer now too. 

the keloid after iinjection on the first day

Now at 4 days after injection, I’m getting a nice yellow bruising.   

4 days after steroid injection. Mild yellow bruising.

However, I still have to smile because it can always be worse.  I have my eyesight and fortunately while I have work, I am not having to be in and out of the cold so I have been staying put, inside my humble little abode and making the most of the situation I have.
SERIOUSLY?  no makeup and no hairdo?  I can’t believe I’m posting this pic!  I guess I have come to terms with this, huh?  I will update as time goes on to see how well the injection works.  I know it will take time now so I will keep you in the loop!

6 weeks after surgery with yellow bruising, no makeup and a smile on my face.