The END (My End, rear end) is in sight?

Posted on November 2, 2009. Filed under: The 'C' Word |

Puns, being one of my favorite comedy elements (simply because they are typically very subtle, are usually intelligent, and are something the people closest to you get) have found their way into my daily vocabulary.  Much like the title above does not speak to any demise, but (no pun intended) to my own derrière… On which, the surgeon will be working on.

I guess that you could say, in car parlance, I’m getting a new rear end.  Eventually, at least.  I am scheduled (Finally!  Something is moving forward!) to go into the hospital and have the tumor removed. In technical terms, the procedure that I SHOULD have is called an LAR, or a lower anterior resection.  For those of you that aren’t interested in going to Wikipedia and searching around, reading the details, it means that the surgeon will go in, remove the tumor (and the surrounding large intestine) and then put me back together. However, with all things medical (remember this post….) nothing can be predicted with 00% accuracy, except of course, for death and taxes.  Those are inevitable.

There is the possibility that Dr. Shashidharan (He goes by Dr. Shashi and he’s from Hyderabad, the garden spot of India –a truly a beautiful city in the south of India with history going back 1000’s of years, and one of my personal favorite cities that I visited during my 2 year stint doing international travel with the Microsoft Vista SWAT Team.  His first name is Maniamparampil – sure, go ahead and pronounce it. ) might just find that the tumor has done too much damage or is too close to the anus to allow a complete resection and normal function.  In that case, he will need to do what is known as a APR, or Abdominoperineal resection.

The APR results in a lower quality of life, simply because it involves removing the sphincter muscle and the anus, resulting in a colostomy from the rest of the patient’s (in this case, me) life.  Regardless of which procedure, LAR or APR, I will have a colostomy from some 8 – 10 weeks.  Not a big deal – I think I can handle that.

My confidence is further buoyed by a guy whose acquaintance I’ve made though other friends.  He has Crohn’s disease and as a result has had many resections of his colon. He has a permanent colostomy and has pretty much assured me that his quality of life is pretty darn good.  He told me that there has yet to be anything that he’s wanted to do that he couldn’t because of his condition and his colostomy.  He’s also been very forthcoming on discussing anything with me, including the care of a colostomy and what I should expect.  It’s people like Marc who I most appreciate – as he has reached out to me to help quell some of my jitters and unease as I go into this long process.  Obviously, the biggest concern is the unknown.  And, when talking with your doctor you are often not educated enough on your condition and the upcoming surgery to know what questions to ask.  It’s the old quandary of How can I ask a question on something I don’t even know enough to know what to ask?

Now, the interesting thing is that – as mentioned – through all three biopsies, no cancerous cells were detected.  Only pre-cancerous cells.  So, this does mean one of three outcomes:

1. The tumor is removed, biopsied completely, and is found to be fully contained and no or minimal follow up treatment for cancer needed

2. The tumor reveals cancer in the tumor that has penetrated the wall of the colon, but has gone no further.  This might require some follow-up, such as chemo, but maybe not radiation

3. The tumor exhibits exactly what was diagnosed some 6 weeks or so ago – that it has gone past the colon wall and has involved a few small lymph nodes.  This would involve a full regiment of post-operative chemotherapy and radiation therapy.

In the end (again, no pun intended) the chances now seem to be better for #1 and #2. But, if it does turn out to be #3, then we are only doing the recommended treatment in reverse order.  The suggested treatment is to do radiation, chemo THEN surgery.  But, it is what it is.  I’ll get the tumor out.  Then we see what we have when the pathologists have the entire mass to test.

All in all, so far this has been a pain in the a$$.  And, no – that’s literal – and pun fully intended.

Carry on, all.  I am, and so should you.  By the way – if you are 30 years and older – and have a familial (especially parental) history of colon cancer, you should talk to your Doctor about being screened.  If you are 40 or older, you should start having that discussion with your Doctor.  If your medical history doesn’t warrant a screening, your Doctor won’t likely have it done.  BUT, you should, should, should start raising the issue. If you are nearing 50, you should insist that your Doctor schedule a screening, regardless of your medical history.

I am going to be very, very frank – and I am going to post another article here relating to this very subject of screening: The cancer is MUCH worse than the screening.  In fact, the preparation FOR the screening is MUCH worse than the screening.  All of the prep you could possibly have to do is much less than what I’m going through right now.  And, I still feel VERY, VERY, VERY lucky that my Family Practice Doctor took my symptoms to heart and decided NOW was a good time to do a screening.  He probably saved my life.

Let me say this:  The prep sucks.  Seriously.  I’ve done it twice, I’m getting ready to do it again, so I think I’m becoming a pro at it.  You drink (literally – no joke) 2 liters of a purging mixture (read: heavy duty laxative) in about 1.5 hrs.  Then you purge.  A LOT.  Then, you wait about 6 hrs. and you do it again.  2 liters, 1.5 hrs. and purge.  Folks, they call this stuff ‘colon blow’ for a reason – and it’s obvious the first 2 liters why.

But, it’s necessary.  You need to have a clean colon for the Doctor to make it from the anus to the caecum (the caecum is the furthest most end of the large colon from the anus, just beyond where the small intestine and the colon join, and appendix is attached to this end of the colon).  If they cannot get all the way through, due to solid matter in the colon, you may have to endure a second colonoscopy with a more intense purge process (starting with a 10 oz. bottle of magnesium citrate drunk all at once.  Bottoms up!).  Really, you only WANT to do this once every 5 years or so.

But – the procedure itself is a breeze.  You are put into one of those ‘twilight’ sleep states where you are conscious enough to respond if the Doctor needs you to move or do something.  But, you won’t remember a thing about the procedure.  You remember the anesthesiologist beginning to ‘push’ the drug into your I.V., and then you wake up back in the recovery area.  Total time from “Hi.  you ready to do this?” in the colonoscopy room to the time you wake up – maybe 30 minutes.  Tops.  My second colonoscopy also involved an endoscopic ultrasound, and the Doctor was done with the colonoscopy and study of the known tumor via the ultrasound in 20 minutes.  I guess that’s why these guys and gals get the big bucks.

Ultimately, why am I telling you this?  Don’t IGNORE YOUR SYMPTOMS.  They are not going to go away and you might find yourself in my situation.  If something seems wrong, it probably is.  If you think you’re being a hypochondriac, let the Doctor determine that.  Colon cancer is a mostly silent killer.  It doesn’t hurt or present most of its symptoms until it’s too late.

Next post – we’re going to discuss (as delicately as possible) my symptoms, how long I’ve had them, what I should have done, and what I urge YOU to do if you are experiencing anything similar to my early symptoms.



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One Response to “The END (My End, rear end) is in sight?”

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Rick, it takes a lot of courage to document this journey the way you are documenting it, with truth and humor. I am thinking of you and sending you good thoughts on the eve of your operation. May all go exceedingly well and may you be back with us kicking the next resKit into optimum shape very soon. Blessings…Susan

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