The power to save and transform lives
Life sends us serendipitous encounters at the most unusual moments. It drops little surprises into our laps. Some are problems that come in every now and then, but rewards come, too. That’s grace! And who offers these graces? God, the universe, dumb luck, a metaphysical entity that occasionally rigs the outcome of what you are currently doing. Whatever the answer, one thing is certain: the world is marvelously mysterious.
Grace shows up now and again to remind us of this. Some events are so uncanny, that they force us to question whether life is random or if something magical is at play. Other marvels are quieter, but still have the power to transform our lives. These coincidences are a blessing that can’t be earned, only received. You’d get nothing done if you went around watching for miracles all the time. But you’d do well to stay alert enough to see them out of the corner of your eye and realize that our God is always there to watch over us and make sure we are okay.
So here is the story of three patients of mine. The first is a woman whose family cancer was a dominant genetic trait. Both of her parents died of cancer. Ten years prior to her consultation with me, she noticed an unusual growth in her genital areas.
In our country, it is common to see patients with ailments that have persisted for many, many years without even an expert consultation either because they are embarrassed by their condition or they are financially incapable of seeking such help.
Warts the matter?
In the case of Anna, she never took the time to go to a doctor to seek medical help. Ten long years elapsed before she asked for help and was taken to me. At first, I thought that she had a problem with her lower extremities (in the legs, thigh, or hips) as she was walking oddly with a weird gait. But then as I went through my usual interview with the patient, I learned that she was hiding something on her genitalia.
She complained of pelvic pain and discharge, bleeding, painful urination, and fatigue. So I proceeded to my physical examination. I was horrified at first by what I saw since cases like this happen once in a lifetime, though I considered myself lucky to see it. There was a huge, cauliflower-like mass dangling from her mons pubis and labia majora, plus another huge mass of the same description that appeared to be pasted on her anus. The mass had grown very slowly to reach its size after almost 10 years of neglect.
I took a small chunk of this massive mass and sent it to pathology. The result was not only what I was thinking, but it also revealed the presence of cancerous cells (squamous cell carcinoma). Her complete diagnosis was squamous cell carcinoma in a giant condyloma of Bushke-Lowenstein tumor (GCBL) secondary to human papillomavirus infection (in simpler terms, genital wart with cancer).
She was referred to an oncologic surgeon for surgery and for further treatments that might be needed. GCBL is a slow-growing, wart-like growth commonly seen in people with low immune systems, multiple sexual partners, alcoholism, smoking, and those with a family history of cancer.
In our country, it is common to see patients with ailments that have persisted for many, many years without even an expert consultation either because they are embarrassed by their condition or they are financially incapable of seeking such help.
It is usually considered a rare, well-differentiated variety of squamous cell carcinomas that seldom metastasize (known for its oncogenic potential). Mostly affected are males, with two-thirds of cases seen before the age of 50. Frank malignant changes occur in 56 percent of cases. The mortality rate is at 20 to 30 percent.
Don’t take those dark spots for granted
The second case involves a man who also presented with an unusually large, slightly pedunculated mass on the right side of his face near the corner of his lips. The duration of the mass was eight to nine years.
It all started as a small dark spot, which the patient did not really bother about. Although his relatives keep telling him to consult a doctor, he remained wildly unreasonable about it, keeping his bad habits unrestrained. He continuously drank alcohol, got exposed to the sun, slept late, and did not really care about his health. Years passed and it grew into a golf ball-size mass, which prompted him to make a consult at my office. Pathology result: basal cell carcinoma (BCC) nodulocystic, pigmented.
BCC usually occurs where the skin is most exposed to the sun, especially the face, ears, neck, scalp, chest shoulders, and back. They may present as follows: an open sore that does not heal, a reddish spot or irritated area, a shiny bump or nodule (“bukol”), a small pink growth, and a scar-like area that is flat white, yellow, or waxy in color.
Almost all BCCs occur on parts of the body excessively exposed to the sun. Occasional extended, intense sun exposure that leads to sunburn and cumulative sun exposure over your lifetime are the main causes of skin damage that can lead to BCCs.
The more time you spend in the sun, from beach vacations to walking the dog, the greater your likelihood of developing BCC. If your occupation requires long hours outdoors or if you spend your leisure time in the sun, your risk increases even more, as it did with this patient, a tropical fish breeder. On rare occasions, BCCs develop in areas unexposed to UV radiation.
In very rare cases, exposure to other forms of radiation or certain chemicals, chronic inflammatory skin conditions and complications of burns, scars or infections can be contributing factors. The real concern about this patient, however, was not only the presence of cancer but also the deformity that a second surgery might do to him.
Your doctor nose
The third case is a Filipino overseas worker who was on vacation in the Philippines. In 2019, he underwent rhinoplasty.
At the time of his visit to me, he was not really sure of what kind of implant was used on him during his rhinoplasty.
His main concern was about a blister that had formed on the bridge of his nose. Upon checking, there was a protruding 1x1-centimeter bubble-like lesion on the left side of his nasal bridge.
I immediately recognized the presence of infection. I told him that we had to remove whatever foreign body was placed in there to allow the healing of the tissues and to treat the infection, but first I asked him what type of implant was used by his rhinoplasty surgeon.
I showed him pictures of the different possible implants that were used and he concluded that it was the silicone rubber, which would be easy to remove. We pushed through with the surgery, but I could not hold on to the implant on his nasal bridge.
I repeatedly undermined the skin hoping I would finally get hold of the silicone but, to my dismay, there was no silicone. Finally, I thought I caught something, but it was not the feel of a silicone material. It felt like I was pulling tissues since it was a “blind procedure” (meaning you cannot visualize the field or areas you are operating on so you need to depend on experience and skill to find out what you are really pulling). Lo and behold! God is really good as I was able to pull out a thin elastic. A long, thread-like material came out. The implant was, indeed, a Gore-Tex implant.
