Part 2

Part 3

Part 4

Part 5

Part 6

Part 7

Early in the pandemic last year I speculated to several friends, “What if you got genuinely sick with something other than Covid? What would you do?” You see, the way the heath care system works in Dumaguete (and similarly throughout the Philippines) is that the local hospitals handle the basics, and so far I have been reasonably impressed with medical care in Dumaguete. But if you need something major – heart surgery or sophisticated cancer treatments, for example – they send you to Manila or Cebu City. No big deal; a quick flight or longer ferry ride. So that was my plan when I moved to the Philippines. Who could have imagined when I made those prognostications, that they would impact me so directly?

I just turned 68 and have been pretty damn healthy my whole life. Not a broken bone or a stitch on my body. Never a surgery other than something that was done to me when I was an infant.

For these reasons it was easy to be somewhat cavalier about my health. Sure, I started going for an annual physical before age 50 but generally in the US that is little more than blood work and taking your vitals.

Nonetheless there are three things I keep some track of and worry a bit about. My PSA test, which checks prostate health (my father and uncle both had prostate cancer and survived it). Secondly, colonoscopies; those fun little things that I have had 4 times already, mostly because I have a brother who died of colon cancer. I am due for my 5th one of these later this year – can’t wait. BTW, if anyone watched the AFI Lifetime Achievement Award given last year to Diane Keaton, Woody Allen did the greatest joke about colonoscopies ever. Go watch it on YouTube. https://youtu.be/S8AAYTDf87Y

And the final area of concern is – my skin. I’m fair skinned, used to be red-headed, and burned often as a kid. As an adult I discovered that sunscreen actually works and became addicted to the highest SPF I could find; usually 100 or more. Because of burns I hated the beach as a kid. Ironic that I would move to the Philippines and now very much like swimming in the ocean.

Nonetheless when I had my last physical exam in the US before moving to the Philippines I asked the doctor about the spots on my face and whether they were just age or what. I don’t think he would have said anything if I hadn’t asked, but I did so he recommended a visit to a dermatologist. So, for the first time in my life I went to a doctor who I believed mostly existed to cut off moles and pop zits. The dermatologist explained that the small spots were pre-cancerous and could readily be removed by freezing them off with liquid nitrogen. It was quick and not too painful. The doctor also took a small sample for a biopsy which came back negative. When I told the doctor that I was moving to the Philippines she recommended finding a dermatologist and getting an annual exam and freezing.

About six months after I arrived in Dumaguete I found a dermatologist and went for a checkup. The office at Tru Dermotologie was clean and upscale, the staff bright and knowledgeable. The doctor, trained in Canada, had me strip and examined all my skin. After that she froze off spots on my face and top of my head, where the red hair used to protect me. All quick and professional, though by Philippines standards a bit pricey. I have come back annually.

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Last year I noticed her office opened and closed often because of Covid. Finally they re-opened in November and I decided I’d better go before they closed again. The routine was the same: strip, examine and freeze off those pesky spots. The total price, between the examination and the spraying, was somewhere close to 7k. Nonetheless I felt good about doing the right thing for myself.

Now, once the spraying is done the spots scab over and the highly attractive scabs take 7-10 days to fall off. But this time there was one on my nose that didn’t seem to want to come off. It looked weird and felt weird for a scab and it grew out of a small bump on my nose that I’d had for perhaps 5 years; something that I’d previously been told was common and not to worry about.

But after a few weeks I did worry and returned to the doctor. “This scab isn’t falling off and seems to be growing,” I said. “It’s not a scab,” she said and gave me a Latin term for what it was.

The next day I returned to have the thing suctioned out. Because of Covid the doctor was dressed in an outfit that covered her head and was sort of a cross between a bee keepers mask and something NASA would have invented. The devices used to suction were modern and sort of reminded me of what you might see in a dentists office. No cutting – just suctioning and then cauterizing the wound left behind. The doctor took material to do a biopsy but touched the area and told me she was pretty confident based on feel that it was not cancer. A sample was sent to the lab and I was told 4-6 weeks to get the results. That didn’t concern me because I was so confident it was nothing.

I should have known that something was very wrong when the results came back in 2 weeks. I went back to the doctor only to be told that the results were inconclusive; it might or it might not be a squamous cell carcinoma. The doctor was torn with whether to ask the lab to do another test. She actually was worried about spending my money or perhaps worried that I would think she was taking advantage of me. I assured her I could afford the tests and to please do whatever was best. In the end she decided I should come back in two weeks by which time the scab would be gone and she could examine the wound and perhaps take another sample of the affected area.

But in 2 weeks the scab was not gone. I had soaked it a couple times a day as asked and even rubbed it to get the scab off. Some of it did come off but then to my dismay it grew back. When I returned in 2 weeks and showed the doctor my nose she knew it was skin cancer. “Don’t we want to get another biopsy?” I asked. “I’m 99% sure,” she said.

We discussed the options. I could get it cut out by a plastic surgeon and perhaps that could be done in Dumaguete or I could go to Manila and have modern microsurgery, called MOHS. “Manila? There’s nowhere else?” I asked. “No.”

The outpatient procedure was explained to me. They take a small slice and exam it under a microscope right then and there. They continue to take tiny slices until there is no more cancer. This is much more effective than the cut off a bunch and hope for the best procedure which a plastic surgeon would do.

The doctor knew I did not want to go to Manila since it would mean quarantining upon our return and poor Janet had just gotten out of quarantine. One thing that is good about me is that when it comes to major decisions which are unpleasant, I don’t hesitate. “I guess we’re going to Manila. What do I do?”

This is Part 1 and there will be more to come. I debated about whether to share this now, when it was all over, or not at all. In the end I opted to share because I fear (and have felt this throughout the pandemic) that there are millions of people who will avoid going to doctors or hospitals and have necessary medical procedures, treatments and tests done. In my jaded opinion this is due to the geniuses telling us what not to do and scaring the crap out of us so we don’t take care of other health concerns. And in some cases doctors and hospitals are flat out closed or not available for non-Covid treatment. Thank goodness my dermatologist was open. My encouragement to all of you is to take care of your health and not just your Covid health!

BTW, I am gonna make this Manila thing a fun holiday with a great hotel and the best restaurants and a serious mall shopping budget. So Janet and I expect to have fun!

Addendum: My purpose here is to: document my experience; describe medical experiences and costs here in the Philippines; and perhaps encourage people to take care of all their health issues. It is not to do a “woe is me” – so if you hear me doing that give me a gentle kick in the ass. Nor should anyone else proclaim “poor Dave and Janet” – or I’ll give you a gentle kick in the ass!