Sunday, June 23, 2019

the thing(s) on the back of my neck

I've had these bumps on the back of my neck for several years, now. They'd often itch a little, so I'd pick and scratch at them. They never went away, so I knew they weren't acne, although some of the bumps occasionally behaved like acne. They'd sometimes enlarge, but then they'd shrink back to their original size. Picking at the bumps would sometimes lead to a little bleeding; again, there were no consequences more dire than that.

So I ignored the bumps, dismissing them as annoyances. A few months ago, while I was visiting my #3 Ajumma, she saw the back of my neck and exclaimed that I needed to see a doctor about my problem. "That's so close to your brain!" she said.

A few days ago, I looked up "bumps on nape" on Google, and I got several results, the most prominent of which was folliculitis keloidalis (FK). You can read about the condition here at DermNet NZ and/or look up "bumps on nape" for yourself. If you visit that DermNet page, you'll note that the entry says, "[F]olliculitis keloidalis is more common in dark-skinned people than in whites, and most often affects adult Afro-Caribbean males with black curly hair. It is 20 times more common in males than in females." Last I checked, I wasn't an Afro-Caribbean male (and still am not), so it could be that I'm just some freak of nature.

There's some debate as to the cause of this condition. The DermNet entry says this:

Some researchers have concluded that folliculitis keloidalis may begin with an injury during a close hair cut or use of a razor. It is thought to be a mechanical form of folliculitis, in which ingrown hair shafts irritate the wall of the hair follicle resulting in inflammation. This completely destroys the hair follicle and results in scarring.

Others argue that folliculitis keloidalis is a primary skin disease unrelated to either ingrown hairs or bacterial infection.

An association with obesity and metabolic syndrome has been observed in some patients.

So either I've had bad barbers (certainly possible in Korea), or I'm fat and/or have metabolic syndrome (a distinct possibility, given my diabetes). Or both.

All of this assumes my unprofessional self-diagnosis of FK is correct. Which it might not be.

Anyway, even after reading the DermNet entry, I didn't take my condition seriously. But this past Friday, Mother Nature gave me a strong tap on the shoulder, and I woke up to a large and painful swelling on the back of my neck—painful enough to make swiveling my head difficult. There are about seven or eight distinct bumps back there, from what I can feel, but this swelling seems to have moved underneath five or six of them. I wasn't able to sleep much Friday night, so on Saturday morning, when I ended up visiting a friend in the hospital, I'd had almost zero sleep. Saturday night wasn't much better: the swelling covers the left half of the back of my neck, so to keep any pressure off it, I sleep on my right side. That helps a little, but the pressure inside the swelling ensures that there's a constant throbbing ache.

There seem to be slight cognitive effects as well: focusing on the keyboard has suddenly become a bit of a chore (I'm making typo after typo as I write this, necessitating constant proofreading); I have something like a headache that's concentrated around my occipital lobe (back of the brain, just above the cerebellum; see a map of the brain here), but seemingly outside the brain and skull (the brain itself has no pain receptors, so the brain itself can't ache); coordination and balance, while not serious issues yet, feel as if they might soon become issues. This whatever-it-is is also doing a pretty good job of dulling my appetite—a sure sign the world is coming to an end. Lastly, the pain and pressure from the swelling are causing me to feel a weird sort of detachment, as if it's not entirely "I" who am typing this blog post right now. Very strange.

Whenever I have weird problems related to my body, I automatically jump to Is it cancer? I doubt this is cancer, but I'm no expert, so I can't rule cancer out. Tomorrow (Monday), I'll visit the skin clinic that's in our building. If their diagnosis lines up with what I saw on DermNet, then I can look forward to some combination of:

• Making sure clothing and equipment, such as high collars and helmets, do not rub the back of the neck
• Avoid a short or razor hair cut.
• Wash the affected area using an antimicrobial cleanser to reduce secondary infection.
• 2 to 4–week courses of topical steroids are useful if the papules are less than 3 mm in size
• Steroids injected into the lesions (intralesional injections) are more suitable for large papules and plaques.
• Oral tetracycline as an anti-inflammatory or other antibiotics for secondary infection
• Laser-assisted hair removal has been shown to improve folliculitis keloidalis. Best results occur if treatment is started early before significant scarring has developed.
• A three-month course of clindamycin and rifampicin antibiotics if infection persists
• Surgery to removing large thickened plaques or nodules
• Laser vaporisation or excision and electrosurgery are alternatives to surgery
• Oral isotretinoin
• Radiotherapy

Yay. Let's assume I am looking at FK as my condition. If so, then maybe my cognitive and somatic symptoms are due to the pressure being exerted by the swelling. Reduce the swelling, and my problems disappear. If it turns out that I've allowed something that started as a melanoma to creep inside my brain, then I guess we'll see where we go from there. That said, I've never been a big fan of Korean health care, which, from what I've seen, often tends to give up too easily on cancer patients. If it turns out that I do have the Big C, and it has gotten into my brain, I'm going to opt for no therapy so as to get this process over with as soon as possible. I don't want to suffer a long time, and I don't want my friends and loved ones to suffer a long time, either. I'm not the suicidal type, but I am the type to prefer minimal, as opposed to maximal, suffering.

But the above paragraph may be a lot of melodrama for nothing. We'll see what the skin clinic says tomorrow, and I'll keep everyone posted.

ADDENDUM: the suddenness of the problem makes me think it's just a simple infection.

No comments: