The intergluteal cleft

The return of the peach emoji

The holidays were pretty rough.

I finished my second cycle of chemotherapy on Friday, December 23, just in time for Christmas, and my last radiation treatment on Tuesday, December 27. I had to return for one radiation treatment after Christmas to make up for a missed treatment due to equipment maintenance.

I tolerated both cycles of the chemo very well. After my last day of chemo they painlessly pulled out the PICC Line. I was looking forward to having my first shower in five weeks but they applied two dressings, which I could not get wet. The first dressing came off December 24 and the second dressing came off Christmas day … then I got to shower … aaahhhhh!

It was the radiation that made life difficult.

Over the Christmas weekend the radiation burns became extremely painful and by Tuesday I dreaded returning for the last treatment. The pelvis burns started out as red in the third week but over Christmas the redness became a deep burgundy, the skin blistered and then began to peel.

The same things were going on in the intergluteal cleft, aka the “butt crack”, my massage therapist taught me the proper medical terminology, however in this case I was also having issues with bowel movements and diarrhea. I was taking Imodium daily to control my bowel movements and in turn the pain associated with going to the bathroom.

On the morning, of my last radiation treatment I wanted to check something quickly on the computer. I wasn’t dressed yet and I didn’t want to sit on the rough fabric of our desk chair so I laid down a bed sheet folded many times over for extra padding and comfort. When I stood up ten minutes later the bed sheet came with me. The sheet was stuck to the seeping mucous and scabs in my intergluteal cleft … ASS CRACK!

In the other room, my husband, Bruce, had no idea what was happening. I screamed in agony as I pulled on the sheet ripping the scabs from my ASS CRACK like a kid trying to get his tongue off a metal post in the deep cold of winter.

Holy F*^&$#G $h|#!!!!

So, after my last radiation treatment, tender and traumatized, I visited the walk-in Radiation Nursing Clinic and had them do a skin assessment. I was pretty sure everything was normal for having just had 25 daily radiation treatments without a break but I wanted a professional opinion and I certainly didn’t want a repeat of earlier that morning.

The nurse congratulated me and told me my skin looked pretty good, it could have been a lot worse, and she said that I must have been taking good care of my skin throughout the treatment.

The nurse gave me some suggestions on how to improve what I was doing. She taught me a way to apply dressings to my pelvis and provided special padded gauze with anti-adhesive protection for my derriere. YEAH!

I have to continue applying the dressings for 2 ½ weeks. It makes it difficult to go to the toilet but the dressings keep all of the lotions and potions in place and prevent my skin from rubbing against my clothes … and my intergluteal cleft from accidentally sticking to something.

By New Year's Eve I was already starting to see some improvement and my skin is getting better each day.

I planned to return to work on January 16 … I secretly hoped that I would surprise everyone and return a week earlier but given all of the self-care I need to do; taking baths and applying dressings twice a day, and the difficulties I continue to have with going to the toilet, and the constant itching as things heal, it is best that I focus on the healing and not try to be the super hero I think I am. I will most likely return to work Jan.16.

The good news and the bad news

The good news is that the skin tag/lesion that was removed in mid-September, which we now call a tumour, was very small; less than a millimeter deep (stage T1), and was completely excised.

The bad news is that the pathology of the area around the tumour shows superficial squamous cell cancer, Anal Intraepithelial Neoplasia (AIN), to be exact.

AIN is the name given to the appearance dysplasia, abnormal cells, in the skin just inside or immediately outside the anus. There are very few symptoms of AIN and it will often go undetected. The cause is of AIN is not known but it is often associated with the human papilloma virus (HPV).

AIN has the potential to become anal cancer and/or invade the lymph nodes.

The risk of developing anal cancer from AIN increases in people who are immune-compromised, including HIV, and when it occurs, the AIN to anal cancer progression may happen faster.

There are different grades of AIN (1, 2 and 3) depending on how they look under a microscope.

Typically in a healthy person the body can completely heal itself from AIN1. AIN3 is more serious.

I have AIN3 and it is located on the skin outside the anus.

I was given two treatment options.

Option 1. Close follow up and monitoring of the affected area.

Option 2. Radiation therapy to the affected area and the lymph nodes of the pelvis and chemotherapy.

The good news is that the tumour and the AIN were found very early and the prognosis with treatment is excellent, over 90%.

The bad news is that because I am HIV positive and because I already had a small tumour removed option 2 is the favoured and recommended course of treatment.

References

Anal Intraepithelial Neoplasia (AIN) Information for patients

The Christie NHS Foundation Trust

http://www.christie.nhs.uk/media/2617/697.pdf