Sunday, February 28, 2010

Skin Cancer Anxiety: Fear, Vigilance and All or Nothing Thinking

About 10 years ago, I noticed a small bump at the top of my ear, under the helix, and I'd fool with it, and it would bleed and then scab over. With my selective OCD hypervision, since the bump was hidden from my sight, I went at least 6 months before I started to worry about it. I did acrobatics with a mirror, but couldn't get a good view. I'd had several moles removed over the years, none of which were malignant, and I felt ashamed of my vigilance, and sad about the little white scars. But it was bleeding and never completely healed, and this was unusual. This was one of those things on a public health warning poster.

After a deluge of anxiety and indecision, I made an appointment. I'd seen this doctor several times before for anxiety symptoms--a gland I thought was swollen, a bladder infection that turned out not to be one, and had asked for a referral to a psychologist. I will credit him with telling me I'd done the right thing in coming to have him check it out, but then he said, "I don't know what it is, but it's benign. Maybe it's an infection." He put a dab of antibiotic ointment on it, told me not to traumatize it, and said if it changes, come back in.

This only stoked my anxiety, and my OCD need for certainty. To be told "I don't know what it is, but it's fine" was enough to cause a firestorm of fear. I felt too ashamed of my anxiety history to assert myself and say, "It's bleeding. I'm not gouging it, it just bleeds at the slightest provocation. I've had it for over a year." I may have mentioned some of these things, but I don't remember doing so. I decided after much angst to get a 2nd opinion from a dermatologist, but I never went. In the interim 3 months until I could get an appointment, I found a therapist, and my anxiety level went down, and I assumed that it was my anxiety causing me to second guess my family doctor, and rather than risk more humiliation, I canceled my appointment.

For the next 5 years, I kept checking the bump. It didn't change or get bigger. It just kept bleeding and scabbing. I'd go as long as I could without touching it at all, and feel sinking disappointment when it was still there. Finally, I decided that I wanted a second opinion, that it was ok to want this, in spite of my health anxiety history. I'd done massive research, reassured myself that I had very few risk factors. I was young, stayed out of the sun, and the bump wasn't exposed to the sun anyway, hidden in the curve of my ear, but I realized that my research couldn't diagnose it, and the research was sucking up my time.

I went to dermatologist who said, "I don't know what this is. But it's kind of odd and I'm going to biopsy it." A couple days later she called me to say it was Stage 1 Squamous Cell Skin Cancer, and that I needed to have it surgically removed with Moh's microsurgery. She was truly surprised that it was cancer. It's an odd location, and I have very little sun damage. Every follow up appointment she tells me what a freak occurrence this was.

My OCD was all over this in a flash. "See I saved your ear! You have me to thank. Keep obsessing. Don't let up." But after careful thought, I know that it wasn't my obsessing that protected me. My all-or-nothing thinking, common in OCD, said "I must always be right about my diagnosis before I go to the doctor or I am defective. Just keep researching."

It was my struggles with OCD in the past that made me second-guess my decision to get a second opinion. I felt I wasn't reliable, that in fact I was crazy. Part of being human though, is not knowing exactly what is happening in your body, and guessing wrong. And doctors, being human, sometimes assume that anxious patients don't actually have anything wrong with them, even when they do, and there is research that family doctors aren't necessarily good at identifying non-Melanoma skin cancers. I haven't researched my ear lately. The health anxiety kicks up every so often and insists I need to research, but research wouldn't have saved my ear. That is an illusion.

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