Live for Today, and Wear Sunscreen
by Joy Koenig, M.D., M.S.
Board Certified in Preventive Medicine
Originally published on www.ourmaine.com (1999 - 2000)
© Joy Koenig 1999-2008 All Rights Reserved
(Internet links may no longer be operational)
It was still pitch dark, except for the soft yellow-orange light breaking on the horizon. The air was cool and misty, without a hint of the summer heat that was just a week or so away. I felt out of place, dressed in casual shorts and a blouse, while those around me milled around in warm-up suits and Nike flip-flops.
My older sister had told me that there were a lot more men here than women. In the dim light it was sometimes difficult to discern the women from the men. The athletes talked among themselves in hushed, excited voices while sucking on oranges and nibbling on bananas. I watched men almost three times my age stand proud and half-naked, while sleepy-eyed volunteers wrote "62" or "59" on their well-shaped calf muscles using black permanent ink markers.
I found myself ashamed, that at age twenty-two, I was only standing on the sidelines at 5:30 AM -- cheering my sister on, not doing this half-ironman triathlon with them. My sister must have seen the disappointed look on my face. She tucked her blonde-turning-green hair securely under her bright pink bathing cap, then looked me squarely in the eye and said, "Just because you're the smart one in the family, doesn't mean you can't also be a jock."
I smiled. She could read my heart. Her role in the family had always been the "jock" and mine the "brain." In the breaking light of dawn, she was offering to share her family spot with me. I was enchanted with her then, and still am now.
This is the first year in fifteen that the anniversary of her death has come and gone, and I didn't notice or mark the day. I'm surprised, and feel guilty yet relieved. On one level, I think I should be over her death by now. On another level, I know that I never will be over her death, and that it is okay if I always miss her.
She died when she was only 29 years old. She had a form of skin cancer called malignant melanoma that spread to her liver, lungs and brain. The incidence of malignant melanoma has increased considerably in the last few years - more than any other cancer in the United States. During 1973-1992, the death rate for melanoma increased 48% among men, representing the highest sex-specific increase of all cancers.
About 1 in 70 people will develop melanoma during their lifetime. About 300 people in Maine are expected to be newly diagnosed with melanoma in this year. Read the story of one Maine resident 's ongoing battle with the disease -- Laurie Milan
To measure public knowledge of melanoma, the American Academy of Dermatology (AAD) conducted a nationwide telephone survey in 1995. Respondents were asked, "Can you tell me what melanoma is?" Only 55% knew melanoma is a type of cancer, 34% knew it is a type of skin cancer, and 42% did not know about melanoma at all. In the Northeast, the numbers were even worse -- only 19% knew that melanoma was a type of cancer, 32% knew it was a type of cancer, and 45% did not know about melanoma.
At first pass, I was not surprised that we New Englanders were not as familiar with this type of cancer, since one of the major risk factors is exposure to the sun and we do tend to think of places like Florida and Texas, not Maine. However, the type of sun exposure associated with melanoma is severe sunburn occurring in childhood -- something that commonly happens here in Maine, since we tend to overdo it, enjoying every drop of sunshine since the summers are so short.
Another important thing to remember is that melanoma isn't just "skin cancer" -- it can show up on the back of the eyeball (the retina), in finger and toenail beds, and on mucousal surfaces, such as the inside lining of the mouth, and the internal walls of the vagina. People who have received chemotherapy or radiation therapy for other types of cancer are also at increased risk for developing melanoma as a long-term side-effect of those therapies.
Are you glancing down at your bare arm, and wondering if that mole or freckle has always looked that way? Good! Then I'm doing my job. Next, go to ABCD and learn what melanoma looks like, so you know whether you need to schedule a trip to the dermatologist for a professional opinion.
Think you know all there is to know about skin cancer? Click here and take this quiz on preventing skin cancer. You might find some surprises. Are you doing everything you can to protect your children from the risk of melanoma? Find out here.
Kate's Foundation, www.melanoma.org and www.onconurse.com have good, comprehensive information about melanoma, including links to related sites. Another good resource is the American Cancer Society's Melanoma Skin Cancer Resource Center.
The Melanoma Patients' Information Page contains information on each stage of the disease, including diagnosis, treatment, and recommended readings. It also has a patient network, so you can communicate with other people who share your diagnosis.
I carry almost every risk for getting melanoma -- I have red hair and blue eyes, fair skin, moles and freckles, a family history of melanoma, and had more than my fair share of blistering sunburns as a child, vacationing on East coast beaches. I may not be able to change those risk factors, but I can still reduce my risk of getting the disease or dying from it. Here's how to do it:
- Reduce direct exposure to the sun, especially from 10 a.m. to 4 p.m.
- Wear a broad-brimmed hat and clothes that protect sun-exposed areas of the body.
- Use sunscreen with a sun protection factor (SPF) greater than or equal to 15 as protection against ultraviolet A and ultraviolet B radiation.
- Get annual check-ups from a dermatologist, and have any suspicious looking lesions removed immediately.
All the experts said my sister would probably be fine. Eighty percent of people with her stage and type of melanoma become long-term survivors, living happy, normal lives. After all, she was young and athletic, and most importantly, they'd caught it before it reached the surrounding lymph nodes. They only looked at her physical health. They didn't know that she wanted to die. She had been struggling with bulimia and suicidal thoughts since she was a teen-ager. Instead of fighting death, she gratefully gave in to it.
Sometimes when I talk about her, I leave people with the impression she's still alive. I guess that's because she's still in my heart every day. She loved her Outward Bound experience at Hurricane Island, including swimming naked in Maine's icy ocean waters. Her words of encouragement and support continually replay themselves in my mind, and carry me to greater goals and happier places.
If you're struggling to find the joy in your life, do the "Walking Down Memory Lane" activity I recommended for one of clients at the Cancer Action Center in Rochester, N.Y.
The most important thing I learned from my sister is to enjoy today because we don't always have a tomorrow. Her best friend lives in Biddeford, and sometimes we get together and remember all the things she loved, especially crisp fried clams and hot fresh lobster.
A tribute to Irene Janet Volodkevich (1958-1988)
melanoma, skin cancer, skin cancer prevention, malignant melanoma, personal story
Design, Content and Images © Joy Koenig 1999 - 2008 All Rights Reserved. 
