Medical Advice Please

Posted by: max in hampshire on 07 March 2005

Hi

Can any of the medics out there help me please?

I am looking for some help with a medical problem. It concerns my 87 year old Dad.

All of his life, as far as I can remember, he has enjoyed the sun and would get his shirt off and lie out in it at every opportunity. He has never used any form of sun protection – it probably wasn’t around in his earlier years.

About five years ago he noticed a black lump on the back of his arm but did nothing about it, and told no one. His GP spotted it at a blood pressure check last year and said he could arrange for it to be removed.

In September he had surgery under local anaesthetic and was asked to return for a check up in a month. At the check up he was told that they had intended to remove a little more but could not as it was infected. He has had a couple more check ups since then but there is now no talk of removing more. Last visit he had a spray applied which made his arm very sore. It appears that the wound has not healed since the original surgery in September as he has had a nurse come in twice a week every week since then to dress his arm which is bandaged for virtually all of its length. His nurse’s notes say he has a lesion. He describes the arm as getting more sore. I have not seen the offending lump nor what is under his bandage.

My Dad is of the era where you do not ask questions of a doctor so he has not. He has however been told that his problem was caused by the sun.

Not surprisingly, I am guessing that he has some form of skin cancer. His GP will not discuss it with me, which is something of a surprise as in our part of the world GPs are only too ready to discuss things of this nature with sons and daughters.

I know that remote diagnosis over the internet is not easy but can anyone tell me if my opinion is likely to be correct? Given that he has been told his lump was caused by the sun is there anything else the sun could have caused? If it is a form of skin cancer and has been clearly visible for five years what is the likely prognosis.

He has been very lonely since my Mum died about four years ago but he has had a good life so I can accept that it may be coming to an end. I would just find it helpful to know if my thoughts are likely to be right and how his illness will progress and how rapidly.

Thanks for any help anyone may be able to give.

Max
Posted on: 07 March 2005 by Martin D
Max
I'd take him back to the GP and be with him in the appointment if it were me.
martin
Posted on: 07 March 2005 by Deane F
I agree with Martin D. Perhaps explain your concerns to your father and ask if you can accompany him on a doctor's visit.

As for the skin cancer fear, would a GP be handling that? Or would he be more likely to have referred your father on to a specialist by now?

I can remember my grandmother having a sore on her leg which would not heal when she was in her mid eighties. She called it an ulcerated sore. To my knowledge it never healed and she died with it but it was certainly not cancer.

All the best Max. It must be difficult to care for your Dad and be in the dark as well.

Deane
Posted on: 07 March 2005 by max in hampshire
Hi Martin/Deane

Thanks for the suggestions. I should have added that he is also very much a head in the sand guy. I am totally sure that he would rather not know that he has cancer if he does. In fact I have to appear very casual about the whole thing.

It doesn't help that it is a thre and a half hour journey to his house!

Max
Posted on: 07 March 2005 by max in hampshire
I just want to add something to my last post re head in the sand.
I guess it is typical of his generation not asking questions of doctors etc. Also to be fair if he is coming to the end I guess that living on his own it would be quite difficult to come to terms with knowing he had say a year to go and sitting there alone counting the months off. I have had relatives go with cancer who only knew for a matter of days that the end was approaching. I think that if I lived on my own and was 87 ignorance would probably be bliss.

Max
Posted on: 07 March 2005 by oldie
Max,
I can undrestand, and sympathise with your situation, Have you asked the Doctor why he will not discuss your fathers problem with you. It may well be that your Father has informed the doctor that he does not wish his medical situation to be discussed with anyone.This was the very same scenario that I was in a few years ago, when my Mother found she had Breast Cancer, and unfortunately informed her Doctor she didn't want to talk about it, orfor her case to be discused with any of the family or unfortunately receive treatment[ she had a morbid fear of hospitals]. If thats the case, then I'm afraid that there is very little you can do in the circumstances,apart from giving your Father the best support you can.
My Mother in Law had a similar lesion to your discription It was removed and treated just the same way as you also discrbe, that was about 10 years ago she is now 87 and still doing fine ,apart from suffering from dementure. So the best advice is try not to worry to much if you can possible do so, and just leave it in the very capable hands of his Doctor and nurse
I wish you the very best of luck in what is very awkward and worrying situation.
oldie.
Posted on: 07 March 2005 by Bruce Woodhouse
A coupe of points.

Firstly about consent and confidentiality. You should ask your Father for his permission to discuss his care with the GP, he has a right to total privacy otherwise. Attending together without explicitly discussing this first may put the GP in a difficult position about implied (vs coerced) consent. Ideally his consent should be written, or he should tell his doc himself that he is happy for his care to be discussed with you.

You could write to the GP explaining your concerns too, just becaause they have been unable/unwilling to discuss his care does not mean that your involvement is not useful. If nothing else it may help the doc to know what family members are around to help if needed. It just could be that your Father has been given more information and he is choosing not to share it.

Bruce
Posted on: 07 March 2005 by Berlin Fritz
quote:
Originally posted by max in hampshire:
I just want to add something to my last post re head in the sand.
I guess it is typical of his generation not asking questions of doctors etc. Also to be fair if he is coming to the end I guess that living on his own it would be quite difficult to come to terms with knowing he had say a year to go and sitting there alone counting the months off. I have had relatives go with cancer who only knew for a matter of days that the end was approaching. I think that if I lived on my own and was 87 ignorance would probably be bliss.

Max


I couldn't agree with you more Ampshire, assuming of course that there's no unnessesary pain involved, and that the person young or old can actually live comfortably on their own, as in my experience the majority of people can't, and the quality of life is the essence of it all, irrespective of income and personality (and mental & physical capability naturally).

Fritz Von The power of suggestion is a strong old drug, one must remember what motives lie behind it, and who it serves most, innit ? Winker
Posted on: 07 March 2005 by david needham
Max

Bruce is spot on about the confidentiality issue - if your Dad is OK about it, there is no problem. Otherwise your GP could be in serious trouble.

With regard to diagnosis, there are two lesions that can look surprisingly similar, and sometimes can only be differentiated by being removed and examined under a microscope.

Melanoma's are skin cancers that can be very nasty. They can be cured if caught early enough. They are caused by excess sun exposure. However, almost all such patients would be referred on for specialist assessment and possibly further wider excision - unless this was refused by the patient.

Seborrhoeic Warts can look very similar to melanoma's but are innocent. They are not caused by excess sun. In an older person, with poor healing, it is possible that excision of such a lesion (by the way, this can mean both cancer and benign) could result in a chronic wound that could be slow to heal.

Other things caused by sun (such as rodent ulcers and solar keratoses) are not black.

So I'm not sure what your Dad has had removed. See if he will let you talk to his GP. If not, it would be reasonable to assume that it was benign (non-cancerous) if no specialist referral has been made.

Hope this helps

David
Posted on: 08 March 2005 by Rockingdoc
Not much to add to what had been posted by Bruce and David. Relatives are often surprised when older people seem to choose high risk strategies or denial with regard to their own health, and often ask doctors to intervene. Unless mentally unfit, older patients have every right to take any options they choose, even when it causes worry for those who care about them.
Posted on: 08 March 2005 by max in hampshire
Thanks for all the input. I rather think though that I have failed to get across the situation and what I am trying to achieve.

My Dad appears to have no concerns about his arm and I have no wish to introduce any, far from it. As I have said I am very low key about it all so as not to introduce any.

Knowing my father I would be amazed if he knew any more than he is telling me though obviously I could be wrong.

I was trying to see if the one piece of information I have ie the hospital doctor told him that whatever he has was caused by the sun plus my description would enable anyone with medical knowledge to hazard a considered guess as to whether I might be correct in my assumption that it is skin cancer and further guess at what the way forward is for him.

I totally respect the confidentiality point in fact I have been very surprised in recent years at the way in which GPS and hospital doctors have volunteered medical information about my in laws.

Thanks again.

Max
Posted on: 09 March 2005 by david needham
Max

quote:
I was trying to see if the one piece of information I have ie the hospital doctor told him that whatever he has was caused by the sun plus my description would enable anyone with medical knowledge to hazard a considered guess as to whether I might be correct in my assumption that it is skin cancer and further guess at what the way forward is for him.


Sorry if you've been more, rather than less, confused by my reply.

A black thing on the skin, caused by sunlight, strongly suggests melanoma (skin cancer). However, seborrhoeic warts (non-cancerous)are much more common, particularly in the elderly, and can look similar.

In my practice, all suspected melanomas are referred urgently for specialist assesment and removal. Anything removed in my practice-based minor surgery clinic, which subsequently came back as being a melanoma, would also be referred on urgently. I had assumed (wrongly) that the surgery had been performed in the GP's minor surgery clinic.

As regards to having a
quote:
guess at what the way forward is for him
this obviously depends on the underlying diagnosis. Melanoma cure rates depend on the depth to which the cancer has penetrated at the time of removal (the Breslow thickness), which gives some indication as to whether the cancer has already spread to other parts of the body and therefore whether chemotherapy is indicated.

See http://www.ubht.nhs.uk/eDerm/Guidelines/malignant_melanoma.htm

Before geting into all that, however, you need to be sure about the diagnosis. So you need to try to get his permision to speak to his GP. You could reasonably say that this was because you were worried about the time this thing is taking to heal, rather than mention skin cancer, if you don't want to upset your Dad

David
Posted on: 09 March 2005 by max in hampshire
David

Thank you for the additional info. Also it is a helpful suggestion that I try to get approval to speak to his GP on the basis that I am concerned about how long this arm is taking to heal. I will give it a try.

Thanks again.

Max
Posted on: 09 March 2005 by Gianluigi Mazzorana
Dear,
your worries about your old father make you a kind and sensitive person.
The fact that old parents don't like to show their afflictions is a part of their age, i think.
My 64 old father was an officer in the army.
You can imagine how hard is to try to know something about exactly how he feels!
Think.........i discovered only one year ago that, when he was 30, he got half of his face congealed during a winter exercise in the mountains!
Takin' care of him is a very hard job, but with a good amount of patience you can get there.
Getting older they get scared about blood exams, pressure up and down, strange losts of memory.
They basicly need to be reassured!
So be kind.
But ask firmly to talk with the doctor, because sometimes you have only half of the truth.
My father is not allowed to drink much: "..only 4 glasses fo wine a day, the doctor said...!"
I called the doctor and the glasses were 2!
hehehehheheheeh
The old general cheating in the storeroom!

Good luck

Gianluigi