A Chance to Restart

Nearly everyone knows of someone who has been affected by cancer. At times, there’s no rhyme or reason as to why it affects a person while other times it’s the direct result of personal habits or environmental exposure. In the golf course profession, we can be subjected to an array of carcinogens; from simply inhaling topdressing silica dust to contact with the chemistry we so carefully apply to the turf. Fortunately, with augmented training and safety practices, we minimize these hazards. But one of the most commonly overlooked perils is the threat of ultraviolet radiation from sunlight, a known environmental human carcinogen.

The first sign of sun damage comes in the form of the precancerous cells of actinic keratosis (AK); when discovered there is seldom just one area of damage. If left untreated, it can advance into any of the forms of skin cancer: basal cell carcinoma, squamous cell carcinoma or even worse melanoma.

Now the purpose of the article isn’t to get too comprehensive with regards to skin cancer symptoms and treatments. With a simple keystroke or Google search, all the information you’ll need is at your fingertips. The point is to shed some light into my own experience with the treatment as I was diagnosed with widespread AK and basal cell carcinoma this past off-season.

Shortly after Christmas, I went to see my physician for my annual check-up when he noticed dry, flakey red areas on my face. Being the typical male, I thought nothing of it as I had been dealing with these spots for at least a couple of years. He suggested I see a dermatologist and within a few weeks I went in for a skin cancer examination. The doctor immediately identified extensive sun damage to my facial area. Essentially the majority of my face displayed actinic keratosis with areas that had progressed into basal cell carcinoma. I was prescribed a 30-day program of Fluorouracil (5-FU) which is a topical chemotherapy applied daily. At first, I thought nothing of it, although that quickly changed when the nurse shared with me images of what to anticipate.

Upon getting back home, I began my own research, scouring the internet and found a whole host of photos and blogs of patients’ experiences with the treatment. Needless to say, I was less than thrilled to begin this whole endeavor. The mode of action with any topical chemotherapy is to destroy all mutated skin cells while leaving the healthy, normal skin cells unscathed. One’s experience with this treatment will vary as it is dependent upon the level of sun damage.

After a week delay with our health insurance (due to being prescribed chemotherapy), I began my daily applications. From the information I’d gathered, I knew there would be approximately two weeks before things would take a turn for the worse. During that time, I informed my club owners and employees of what to expect and the likely need for a couple of weeks once the treatment was effectively at work.

Just as the research indicated, the first couple of weeks were effortless; the only noticeable areas were blotchy, red areas afflicted by carcinoma. But as the 14th day arrived, the true level of sun damage became quite evident when all areas afflicted with actinic keratosis and carcinoma became red and discolored. After meeting with my dermatologist, he assured me that everything was proceeding as normal and to continue on with the treatment.

The schedule for the last two weeks involved applying the topical chemo in the evening; gently washing my face in the morning and applying Aquaphor (i.e., Vaseline) for the remainder of the day. The degree of misery became quite apparent by the 16th day as my skin started to burn and swell. I would best describe the experience as having the worst sun burn, times two.

As each day progressed, the worst sections developed blisters and became ulcerated while any afflicted area became increasingly red and sore. It was at this point where I couldn’t sleep, became extremely irritable and sought isolation. During the final week, the blisters and ulcerations began to excrete a fluid as the skin began “the weeping phase.” Finally, as the 30th day arrived, the cancerous cells had hopefully been destroyed as my body began to heal and generate new, healthy skin cells. At this point, there was a sense of great relief realizing the treatment was over even though discomfort continued for a number of days following the last application.

Once finished, the dermatologist provided a topical antibiotic to help fend off infections and to diminish the chance for scarring. He also reiterated the importance of embracing the healing process. This not only includes utilizing antibiotics and moisturizers, but, more importantly, keeping your whole self healthy and minimizing stress levels. In our profession, this can be difficult as we often place work ahead of our own health.

If I could offer any advice, I would first recommend being proactive with protecting your skin from exposure and getting an annual skin cancer screening. Dermatologists truly are the only ones who can accurately define any potential concerns. Keep in mind actinic keratosis can evolve into carcinoma or melanoma; left untreated it can advance into a much greater variant.

Secondly, if your doctor suggests this treatment, it’s a necessity to plan it in the off-season. Once the topical chemo begins to work, the skin becomes extremely sensitive to temperature, sunlight and wind, and exposure to containments such as dust or pollen should be avoided. Most importantly, this will permit you the necessary time away from work to reduce stress and ensure proper healing.

Finally, I would suggest preparing your family by showing them images of what to expect. This is especially important with young children as they’ll have difficulty understanding the circumstances. Inform them you’ll be tired and irritable or that they’ll be unable to give you a kiss goodnight. Your loved ones will offer you help when in reality there’s not much they can do but support you. At the height of the chemotherapy, you’ll be less than willing to be out in the public eye. Not only do people tend to stare, but you’ll constantly feel the need to explain your situation. In my own case, I was very uncomfortable attending my five-year-old’s “Daddy Daughter Dance” in the midst of my procedure, although I was very proud she insisted we still attend.

In the end, I found this event enlightening and insightful. This procedure reversed 45 years of neglect and offered me a second chance at doing things right; it gave me a small perspective into what some individuals experience on a daily basis; it shattered my own invincibility; and, most importantly, it drew me to appreciate my family and life even more.

Chad Palicke, CGCS, is the superintendent at Gowanie Golf Club in Harrison Charter Township, Mich.