Friday, November 14, 2008

Necessary unpleasantness

kw: medical tests

More than 50,000 people died of colon cancer in 2007. Most of these were in their 60s or older. But a 60-year-old who is found to have a bowel cancer could have been spared if that bowel had been checked ten years earlier.

Are you fifty or older? If not, is someone you love over fifty, and never has had the colon checked? Please read this, or have that person read it. I'll tell you about my own experiences with the unique test that can prevent colon cancer.

There is only one: Colonoscopy. That means full-length viewing of the colon with a flexible fiber scope. Only full-length colonoscopy can find every pre-cancerous polyp ("polyp" means "tumor", whether cancerous or not). I have had five colonoscopies, beginning with the one that saved my life.

I was unlucky, in a way. I was found to have a large colon cancer at the age of 53, much younger than usual. To keep it short, let's just say I began to have abdominal pain in mid-2000, and after a few false leads, went for a colonoscopy in November. A few days later a tumor the size of my fist was removed, along with half my colon. I had six months of chemotherapy to begin 2001. What made this tumor particularly dangerous was that it was in the cecum, the large pouch (with appendix attached) that begins the colon, low on the right side. There is a lot of room there for a cancer to grow without causing any symptoms, not even "occult" bleeding.

Because of my responsible position at work, I had had yearly tests for "fecal occult blood" since the age of forty. None ever showed any blood. Only during the last month before my surgery was there any blood in my stool.

I was told by one doctor that this cancer was ten to fifteen years old. Had I been tested by colonoscopy at age fifty, a much smaller cancer or polyp would have been found, removable by colonoscope without the large abdominal operation (five hours) that I underwent.

I was like a lot of people: In denial, and "putting it off" after I passed my fiftieth birthday. I need not have worried. Let me walk you through a typical procedure. It really isn't that bad. Do you know what is the worst part? Getting the intravenous (IV) put in! Really.

Eight years ago, the worst part was the "prep". I was given a prescription for a gallon of Colyte, which I had to drink within about four hours. It tastes vile. Luckily, things have changed. Here is a time line:

Prep Day, 24-36 hours before the procedure

The "prep" is now pills, either Senna (OTC) or a prescription substance in pill form. On this day, eat no solid foods: just clear liquids and lime, lemon or orange Jell-O. About midday take half the prep with a couple glasses of water. Within 2-4 hours you'll want to stay close to the bathroom!

About the time your bowel quiets down, say 9:00 PM (your doctor's instructions will have an exact time, depending on which prep is used), take the other half of the prep with a couple glasses of water…or maybe three or four. You'll be cleaned out by midnight.

Midnight at the end of Prep Day

Nothing more to eat or drink until the procedure is over. Go to sleep.

Procedure Day

Arrive at the clinic, probably an ambulatory surgery center, and sign in. I've had early morning procedures and mid-afternoon ones. The earlier your schedule, the more likely it is to be on time. The actual procedure takes 15-30 minutes, unless the doctor finds a polyp large enough to make him slow down and remove it carefully. This can add a half hour to things. Guess what; the patient just before you will take an extra hour.

You have to have someone with you to take you home. The anesthesia they usually use is just a little Pentothal and Demeral, or something equivalent. No gases. But they don't want you driving yourself home. Some people can't think clearly for half a day or more afterwards.

Soon you'll be taken into a room to undress and put on a robe. The anesthesiologist will come to put in the IV. Did I mention this is the worst part? Tell him or her if you are so scared of needles that you want benzocaine rubbed on the skin first so you won't feel the catheter being put in. I've never done that, but they will if you ask.

So, the IV goes in, a slow saline drip is started, and soon the nurse comes to walk you to the procedure room (it is NOT an operating room).

In the Procedure Room

There are at least three people with you: the doctor, the anesthesiologist, and one or more nurses. There is also a "tower" with the equipment, which includes a TV monitor and the fiberscope itself. You can ask for an explanation if you like. Whatever the fiberscope sees is shown on the monitor.

The anesthesiologist attaches a syringe to the IV and squirts something in. In five seconds you're out. With no transition, you open your eyes and greet the nurse and the person who came with you. At least for me, Demerol prevents memory formation, so from the time it hits until it wears off (about half an hour) is like it never happened.

In the Recovery Room

After waking, it takes a few minutes before you can sit up or get off the gurney. As soon as you can, the nurse helps you to a comfortable chair and brings you some apple juice or soda. Your first calories in hours and hours! Lovely.

At home

If there were no delays, within about two hours after arriving at the clinic you are on your way home. Did I mention that someone else is driving?

You are to take it easy the rest of the day, but you can probably eat normally. Don't dive into a giant meal, but start with a small meal or snack, then more a couple hours later. There are lingering effects of the Pentothal that help me get a very good sleep. By morning, I am ready to return to work, if I haven't scheduled the procedure for a Friday. You'll feel pretty good, too.

The exception was my first colonoscopy. I awoke to be told I had a large cancer, and was taken in for a CT scan about an hour later. That showed several enlarged lymph nodes nearby. I was admitted for surgery a few days later. Let's hope in your case, you'll have a clean colon and be told, "Return in five years."

I have had five colonoscopies in eight years, because I am now at higher risk, and indeed, two of those times, new polyps were removed. This time, just last week, it had been three years since the prior one. I had a polyp that was getting pretty big (close to an inch). I expect I'll be on a 2-year schedule from now on.

The upside is, I've had eight years of life that I might have lost, and I could live another thirty years. I am grateful.

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