Prairie Doc Perspective Week of January 8th, 2023
​“The Other Skin Cancer”
By Jill Kruse, DO


When people talk about skin cancer the type that most people think about is melanoma.  This skin cancer follows the ABCDE rules for diagnosis.  A – Asymmetry, B – irregular Border, C – more than 1 Color, D – Diameter more than 6 mm, and E – expanding in size.  However, these rules will not help find the most common type of skin cancer called a basal cell carcinoma.  
Unlike melanomas, basal cell carcinomas are often symmetric with regular borders in the early stages.  They are usually one color, being the same as the surrounding skin, but with a pearlescent sheen, although they can also be reddish or bluish in color.  On darker skin tones, they may appear lighter or darker than the overall skin tone.  They often start off as bumps with a rolled border or can have a warty appearance.  They are also fairly slow growing and can be smaller than 6 mm when forming.   As you can see, the ABCDE rules are NOT helpful for diagnosing this type of skin cancer.  
Basal cell carcinoma accounts for nearly 80% of all skin cancers and is the most common type of cancer in the world.  However, they are rarely fatal, tend to grow slowly, and do not tend to spread to other areas of the body, although, if left untreated, may grow deep and spread out from where they started.  They are commonly found on sun-exposed areas of skin – such as the neck, arms and face, especially on the nose and ears.  Basal cell carcinomas are most common in elderly males, especially in fair skinned people with blonde or red hair. One example is farmers, who typically spend many hours out in the fields working in the sun. They often wear baseball hats which protect their foreheads and scalps but leave their neck, arms, nose and ears exposed to the sun where they are more likely to have a basal cell carcinoma occur.  Another example would be truck drivers, they would most likely have a basal cell carcinoma on the left arm or the left side of their face versus the right due to that side more frequently being in the sun. 
 As a basal cell progresses, they can develop a central depression that often scabs and bleeds.  Oftentimes there are thin red lines visible on the edges of a basal cell carcinoma.  Those thin red lines are small blood vessels that can bleed when bumped or scratched.  When someone comes to the doctor and describes having a sore that does not seem to heal, a basal cell carcinoma is often on the list of possible causes to rule out.  
Do not just follow the ABCDE’s for skin cancer detection.  No matter what the spot on your skin looks like, if you are concerned, tell your doctor to take a look.  It just could be one of the other types of skin cancer.  Your skin will thank you.  

Prairie Doc® Perspective Week of January 1st, 2023
​“Grief and Love” 
by Joanie Holm, CNP


Writing about grief is like writing about life—huge! Where does one start? It is like describing love: basically impossible. The comedian and late-night host Stephen Colbert lost his father and two older brothers in a tragic accident when he was young, and said, about grief, “It is a gift to exist, and with that gift comes suffering. If I am grateful for life, I must be grateful for all of it. I hope that grief stays with me because it is all the unexpressed love I didn’t get to tell you.” 
So even though grief may be difficult to describe, I’m working to do what Rick taught me: to share my grief publicly, as he did his death. As I’ve sought to live with my grief, I have found tips and ideas that have helped. Not every tip will be pertinent to every person, so use judgement as you address someone in grief. 

• Talk about the one who has died. They are generally the grieving person’s favorite subject
• Contact the person in grief frequently. Loneliness can be consuming. Remember birthdays and anniversaries, which can be emotional triggers for the one grieving. 
• Include the grieving person in activities. Sometimes getting away from the grief can be a relief. 
• Offer to help a person in grief with household chores, as these tasks can become overwhelming. Better yet, just show up and help! 
• Be aware that grief can be like a roller coaster, high one day and low on another. Grief can be exhausting. Realize that a person in grief may need extra rest. 
• Consider the vulnerability it takes for a grieving person to ask for help. The grieving person may suffer in silence rather than admit defeat. 
• And last for this incomplete list: grief has no right or wrong and no timeline. Every individual is different. 

The songwriter Nick Cave said “It seems to me, that if we love, we grieve. That’s the deal. That’s the pact. Grief and love are forever intertwined. Grief is the terrible reminder of the depths of our love and, like love, grief is non-negotiable.” 
Rick showed us, courageously, how to face death while honoring life, with love and joy instead of dread. Now maybe those of us who grieve can see the shape of our love in our grief. The poet John Roedel wrote: “Your grief is a temple in your heart that honors that love.” 
I hope that I continue to find wisdom in this grief as I continue my journey.