Don't touch the pregnant lady!

Last week, I finally saw a surgical consult for that basal cell carcinoma I was diagnosed with back in March. I had been dragging my feet on it, because (1) I've had other things to think about, and (2) I thought it would be better to handle while not pregnant...and so expecting I would any time find myself un-pregnant again, thought I would wait a bit to see if I miscarried.

But no miscarriage. Which is a really good thing. Really, really good, mindblowing-ly good thing.

But it meant I needed to see someone about this lesion, since the derm who biopsied it said it was a no-go to wait until after delivery.

So last week, I saw a Mohs surgeon in private practice who came highly recommended. It was a strange appointment in that at the beginning he was telling me all about the procedure but about halfway through seemed to change his mind and suggested I see the one Mohs surgeon at my hospital, because really I should be seen in a hospital setting, not that anything adverse would happen, but well, just because it would be best to be on the safe side. It was very strange to watch him switch gears mid-Mohs-pitch. When I went to pay, the admin said that the surgeon had said there would be no charge for the visit.

Wow...he was glad to get rid of me. Funnily...I didn't even tell him about the recurrent pregnancy losses. Can you imagine how fast he would have had me out of there in that case?

So, I went to the one Mohs surgeon here at my medical center Monday. She was very nice. Said the case was very interesting (which made me think that her job must be seriously boring, because this is really not very interesting...we're talking about something between the size of a pencil eraser and a dime...on my back...non-malignant even).

But anyway...She begins with the idea that we should wait until I deliver (still hard not to balk that that word "deliver," as in "to deliver a baby," might ever have anything to do with me). That if we wait until after delivery, it will be easier then. It will be a little bigger, so I'll have a slightly larger scar, but no big deal. I shouldn't wait long after delivery, though, because, well...the longer we wait, the more it is growing...Of course, she said, if the lesion starts growing more quickly than expected, I should come right in. Because it can always be taken care of, no problem! I reminded her that this lesion is on my back, so if it starts growing  more quickly, I probably won't really know it, it being on my back and all...hmmm....

She then went into a big explanation about how after the procedure, because of the lesion's location, I'll need to avoid lifting anything for a few weeks or it will pull open the incision, and also will need to rest a lot for the first four days or so to ensure it heals properly. I asked her, by rest a lot, do you mean get up every two hours to feed a newborn? (no, apparently not). By not lift anything, do you mean to not lift a baby?? (hmmm...turns out she hadn't thought about that either).

We'd reached some major snags in her plan.

Me: Is there any problem with doing the procedure now? Is it unsafe or risky for my pregnancy?

Her: Oh no. It's perfectly safe! It would just be easier later.

Me: Mmmm.... (since we'd already outlined in detail how it wouldn't really be easier later at all).

Me: I could stop the Lovenox, just the night before, to reduce the bleeding, since there's no real medical indication for me to be on it. And then just take it after the procedure is over.

Her: Oh no! You can't stop the Lovenox!!!

Me: Mmmmm....

Me: Well, how about I ask my OB if it's ok by her if you use a small amount of epinephrine to control the bleeding? Since that will only go into local tissues, right?

Her: I won't use epinephrine even if she says it's fine. What if it somehow gets into a blood vessel, travels to your placenta, and clots off the blood flow to your baby?

Me: Mmmmm...ok, then, no epinephrine.

We ended up with scheduling the procedure for next week. It was either then or in July. Sooner seemed better, because I'll have to lie on my stomach for a few hours during it apparently, which already sounds pretty uncomfortable, but soon - if I am lucky - may be impossible.

Her: I can do the surgery with you lying on your side, but the outcome won't be as good.

Me: Mmmmm...

The only big difference to doing it now versus later is that she won't use epinephrine, which is used to reduce bleeding. Between the lack of that and the addition of lovenox and aspirin, this whole thing may look like a blood bath. But not really. I hope.

I told Will about the interaction when I got home, and he said, "What is this, open heart surgery? What's the big deal?"

My thought exactly. The whole consultation - well, both of them actually - was weird. Like they were saying it's fine to do the procedure, but then also saying they didn't want to go forward. Strange contradiction. Hard to try to read between the lines. And also confusing: why did the first derm say absolutely not to wait, and now the surgeons want to wait?

Puzzling. I've become the pregnancy version of the hot potato for dermatological surgeons in New York City. Or at least for two of them.

I'll see what my OB says about all this tomorrow when I see her.

Mo

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