COLONOSCOPY – POLYP GARDEN

Fresh from the colonoscopy 2 weeks ago, I received results: two polyps… 

Benign adenomas, precancerous, come back in a year… *Sigh*…

It was disappointing learning of the polyps since it has been only one year since the last colonoscopy and my results were clean then, so I was hoping for a repeat of that. But instead two tiny polyps still sounded alright, I could live with that. They would be biopsied and results would arrive in a few days. So my results today showed the polyps were “benign adenomas”, or precancerous polyps. That is not good, and what the heck does “precancerous polyp” mean anyway?

Polyp Phases

Phases of a polyp

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I’m guessing mine was at “severe dysplasia” stage, as it was benign, yet still precancerous.

 

 

 

 

 

 

Everything I’ve read about adenomas is that it will take between 2-10 years for one to develop into cancer. For a polyp to form and become precancerous within one year tells me that my polyps were under unusual conditions to become precancerous so early. This year has been unusually stressful, and unfortunately I have an unusually poor way of handling stress, ie. I hold it in. I convince myself it could be worse, I can handle it. This explains my “polyp garden” colon and why my resistance to growing these little guys is so low. This also explains why for survivors of colon cancer we have to stay on top of our maintenance exams (scans, colonoscopies, blood tests). I need to stay on top of my tests, I need to manage stress better. I’ve been doing the former exceedingly well, yet there’s more progress to be done on the latter.

In May 2016 my oncologist noted on my CT scan results a spot in my liver that he wanted to watch, and told me to have another scan done in three months. No worries, I thought, it’s too soon after chemo treatments, it must be something else. I did not worry. During the summer we started a new business, had Matt’s daughter and her fiancé move in with us, we had a series of financial difficulties and some personal issues come up all at once. I began losing sleep and obsessing over order in my house, an effort to keep some sort of control over a huge period of change. I (all of us) began feeling overwhelmed and out of control. We all worked from the moment we woke to bedtime every day for months straight with no breaks just to keep ahead of bills. I was on top of everything, I felt I was handling it, but was exhausted all the time. It was a miserable, stressful time for me and my family, and I began to worry about my health. I’d had a tickle in my chest for months. Thinking back about what my oncologist said about the spot in my liver, I could not let go of the fear that cancer had come back and settled in my lungs and my liver. I had no money to get the follow-up scan, and decided it would not hurt to put it off for a month or two until we could figure out our finances.

The fear overwhelmed me and I believed I was sick again. I worried for Matt, my parents, my friends, I dreaded telling them I was going to die. I worried about going through all of the diagnosis, treatments, months of uncertainty and sickness again. If this disease could come back so quickly twice, it must want me; I must be doomed. Things got extremely desperate and I could not shake the fear of not knowing. So I scheduled the scan and results came back clear.

I celebrated the good news, as did everyone around me. I had not made my concerns public, but my family knew. And yet the fear came back. The tickle in my lungs was still there, and I began to wonder how much of my chest the CT scan covered? I had not had a blood test in a while, and realized it was time. I was only a week or so off my schedule, so I scheduled the blood test and met with my oncologist. The blood test came back clear, the oncologist hypothesized that the tickle was coming from a new allergy. Again I felt better, but there was still an insecurity in my mind. No spots in my liver, no sign of disease in my blood,… the colonoscopy should turn out healthy too, right? With all the stress over the summer, what would it take for the cancer to come back? Where would it? After the first occurrence of cancer in 2012, it was only 2 1/2 years until the second occurrence in 2014. It has been about that long again, and I was inconsolably worried.

The colon prep this time around was miserable because I had a cold, too. Ugh… no fun. Coming off of the anesthetic the first thing the GI said to me was he found two small polyps. He did not think they would be problematic, but they would be biopsied all the same. The fact that the results came back precancerous is a red flag that I am not doing enough to manage stress.

The moral of the story is, I’m glad that I am being so closely monitored, that I have great health insurance (thank you Obamacare), I’m glad that at this stage the polyps could be removed with no incident. I am safe again, for now, thank goodness. I will continue practicing stress management, continue getting enough rest, exercise, good nutrition, laughter, and

I will continue with my maintenance exams.

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How polyps are removed, a retractable wire loop severs the neck of the polyp.

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Little bastard

ARTICLE – Colorectal Cancer and Younger Adults

Colorectal cancer is getting more attention from the science community

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The medical community is shining more light on the causes behind the spike in colorectal cancer diagnoses in younger adults. This article was sent to me by family friend and local surgeon, Dr. Earl Schuman. Because cancer is now a part of my life, as with some of my peers and my generation of family, it’s worth sharing:

Colorectal cancer incidence rising sharply among younger adults

By: SUSAN LONDON, Frontline Medical Communications

SAN FRANCISCO – The incidence of colorectal cancer is rising sharply among younger adults in the United States, a study showed.

Researchers analyzed Surveillance, Epidemiology, and End Results (SEER) data for 383,241 patients in whom colorectal cancer was diagnosed between 1975 and 2010.

The results showed that the age-adjusted incidence rate of colorectal cancer fell steadily among patients aged 50 years and older at diagnosis, lead author Dr. Christina E. Bailey, a surgical oncology fellow at the M.D. Anderson Cancer Center in Houston, reported in a poster session at the annual Gastrointestinal Cancers Symposium. But the rate rose among younger patients.

The annual percentage change in the age-adjusted incidence rate of colorectal cancer during the 35-year period was a significant –0.92 in the cohort overall. In stratified analyses, the annual percentage change fell significantly among patients aged 50-74 at diagnosis (–0.97), and aged 75 years and older at diagnosis (–1.15). But it rose among patients aged 35-49 at diagnosis (0.41) and especially among patients aged 20-34 at diagnosis (1.99).

The findings were similar for colon cancer separately (with strongest results seen for disease that was distant at diagnosis) and for rectal/rectosigmoid cancer separately.

A predictive model suggested that if the observed trends persist between 2010 and 2030, the incidences of colon cancer and of rectal/rectosigmoid cancer will rise by 90% and 124%, respectively, among 20- to 34-year-olds, and by 28% and 46%, respectively, among 35- to 49-year-olds.

Much of the decreasing incidence among older adults “can be attributed to the fact that screening is recommended beginning at the age of 50,” Dr. Bailey commented in an interview.

“We saw dramatic rises in the predicted incidences of both colon and rectal cancer in our younger cohort that point out that further studies need to be done to determine why this is happening and what can we do now to prevent this trajectory from occurring in the future,” she said at the symposium, sponsored by the American Society of Clinical Oncology.

Likely explanations for this sharp uptick, she suggested, include increasing population levels of obesity and physical inactivity, and consumption of a diet high in fat and red meat – factors implicated as risks for colorectal cancer.

Another possibility is that primary care physicians are now more alert for this cancer in young patients with symptoms such as rectal bleeding, which previously may have been attributed to conditions such as hemorrhoids, delaying diagnosis until an older age.

Recommendations still call for routine colorectal cancer screening only in those patients younger than age 50 who have risk factors such as familial adenomatous polyposis and Lynch syndrome, Dr. Bailey noted. And even though the incidence is rising in the younger age groups, it is still considerably lower than it is among people aged 50 years and older.

Dr. Bailey said she had no relevant financial disclosures.

seer-logo

COLLABORATION: To Blog or Not To Blog

To Blog or Not To Blog

A collaboration with Tammy Schuman of Scooter Saga

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Scooter Saga – by Tammy Schuman

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Cancer4Me – by Michelle Dennis Lattanzi

I’ve reblogged posts from Tammy Schuman before, and I have followed Tammy’s Scooter Saga for a long time. She blogs from the perspective of someone living with Spinocerebellar Ataxia (SCA), and she does a marvelous job of bringing her readers into her world of ups and downs living with ataxia, and the day-to-day challenges she faces as her disease progresses. Tammy and I have become friends through our blogs, reading about our own life journeys.

Recently Tammy approached me to do a collaborative post about two bloggers’ perspectives on what blogging is and what it does for us. Each of us wrote our own essays on the topic, and Tammy brought them together. Below is an excerpt:

To Blog or Not To Blog

TAMMY – I enjoy blogging, but never appreciated the varied ways it could be used. As I mentioned earlier, I started journaling on my sister–in–law’s recommendation and my musings morphed into a blog* (web log). Getting Skeeter changed my perspective and provided all sorts of laughable moments. It was a compatible context for serendipity, my smart mouth, and learning to deal with a disability… Read more.

MICHELLE – Since I was very young, I enjoyed writing. I have always found it a comfortable and easy way to express my thoughts. I’ve journaled off and on for most of my life, with no other goal than to think on paper. Writing is a great way to work out problems. By writing down my stream of consciousness, I can order my thoughts and analyze them, then sometimes a solution will miraculously appear!.. Read more.

It was incredibly fun, and a first attempt at a collaboration for both Tammy and me. Enjoy, and please let us know what you think.

MAINTENANCE

maintenance-cancer“Your annual exam sounds like taking the car in for maintenance.  They “flush the lines” and “blow the pipes”, then do some diagnostics.  The mechanic then tells you that your car may have a few dings and scars on the outside but still looks pretty darn good.  The engine is running well after their “tune-up”.  It may backfire once in a while and is a little slower going up a long hill, but it gets there.”

– Dr. Earl Schuman

I love this analogy because:

the human body = mechanics = plumbing = gardening, etc…

All systems are like, and can be used to explain each other. By making analogies like this, our great fears, such as mortality or failure, can be put into a familiar framework and therefore seem less scary.

I’ve mentioned Dr. Earl Schuman in previous posts. He is the family friend who has coached me through major life medical decisions, physical and emotional changes, throughout my 2012 colorectal cancer episode. He has regularly kept up with my writings and offered encouragement and advice, even with a busy work and home life.

Since I have earned good health marks and moved on to a more routine existence, I mistakenly assume that I must be far from Dr. Earl Schuman’s mind. Our original connection is through my dad’s cousin Bonnie’s college roommate and lifelong friend, Tammy, who married Earl (what, do you want a diagram?). Aunt Bonnie lives in California, and when I was diagnosed, word traveled to Bonnie who referred us to Tammy, a retired nurse, and Earl, a general surgeon in Portland, to advise me on how I should proceed. He did not have to help. But I came with no expectations and no clue! That’s where Earl shined!

I don’t know where to begin to thank Earl. Over the course of my treatments, Matt and I called in panic once or twice, plus a few times to run our research past him to see if we were on track making decisions about my treatment. I would email him updates. And then at times he would just check in. It was truly like having a guardian angel sitting by somewhere in the ethosphere.

Since achieving wellness, and even before, I have followed Tammy Schuman’s blog, Scooter Saga. She writes about life with Spinocerebellar Ataxia (SCA), from which she began suffering in her 40’s and which forced her to retire early from her nursing career because of loss of muscle control, balance, fine motor coordination. Tammy’s blog is a portal into a world where adapting to every-day surroundings with an ever-changing muscle control is the new normal. And then to do it with grace, gratitude and laughter makes it a true inspiration. Tammy makes her experience so easy to digest, everyone should read along with Scooter Saga! I’ve been able to connect with Tammy through her blog, and feel that I’ve become friends not only with Earl, but also with Tammy.

Daily, and in their own way, the two are making the world a better place, and reminding the rest of us to keep the scary stuff in perspective!

BALANCING THE BOWELS

The next chapter in colorectal cancer recovery is: Balancing the Bowels.

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Not OK on low residue diet

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OK on the low residue diet

I wish I could say recovery has gone well, but it has been quite bumpy. I’m frankly getting worn down to the wick and frustrated. The biggest problem is that I’m too healthy! Yeah! My bowels aren’t tolerating my healthy diet!

At first it helped. High fiber foods, basically what Matt & I keep in the kitchen, are whole grains, fresh vegetables, etc. These were helping my system loosen up, but now it’s a curse and I need more refined foods,  like white bread, white rice, bakery foods, etc. All stuff we stay away from as a rule. On top of the diet is the medication – antibiotics, pain relievers and supplements, which all throw a monkey wrench into the machinery.

And I still need more rest. I am trying to take on some simple chores, such as grocery shopping, but afterward I am punished with debilitating cramping and fatigue.

This is a phase that I ‘just have to get through’; part of the healing. Matt is trying to adapt to my ever-changing needs, and is an amazingly compassionate and attentive partner, but at some point the caretaker, as the patient, gets worn down. Matt & I are looking forward to moving on to the ‘next phase’ of our lives, and to our trip north.

Currently, I have a couple of great books, and plenty of time to sit still and read them – such a rarity for a ‘well person’!

When the bowels are balanced, we will be enjoying friends again. Until then, it’s rest and relaxation!

DAY 5 POST OP – RELIEF!

Happy as a hog in mud!

For now, at least. I had my first full plate of eggs and toast! I showered for the first time in a week, got fresh bedding and gown, went for a walk, sat in the sun… I’m fed, ‘drained’, cleaned and feeling blissful!

Again, last night was rough. Beginning yesterday afternoon, the flow of fluids through the stoma slowed then halted. *Oh no*, because this means accumulation and explosion of intestinal fluids, like a grape getting ready to burst. It would be a matter of hours before the excess fluid would be jolted up through my mouth. So, preemptively, I began walking and moving around hoping the stoma would relax and start moving things through again, all the while feeling miserably uncomfortable. NOTHING!!! Stubborn stoma…

About 8:00pm, I’d had enough and gagged myself. That was disappointing because hardly anything came up. Ugh! What do I have to do to get some relief???

Matt was beside himself. Now, a partner who has to stand by and watch his partner go through horrendous pain and discomfort with no resources at his hands can get very stressed, like a caged animal. So he sent the nurse to call my surgeon and ask what can be done for me. The nurse came back with little helpful news. So Matt told her to get the surgeon on the phone he wanted to talk to her right now. She did, and Matt and Dr. Childs had a discussion that imparted how very concerned Matt was about me, I hadn’t eaten, was miserable, etc, and Dr. Childs insisted that this is still normal for me to be feeling this way, that she would come by in the morning to try a different approach to getting my flow going again.

So, many hours of discomfort, fatigue, ache, etc, etc…

In the morning, the usual hubbub began with a vitals check, toridol injection, protonics injection, changing of IV bag, so on, and so on. Then Matt leaves to get his coffee from the cafeteria, and I get up to look out the window. Just then, my surgeon walks in (halleluja!), and I describe yesterday and last night to her. She pokes around my bag a bit, goes over a couple of options, then proceeds to use a clear tube stint to drain the contents of my abdomen into a bucket where she could measure exactly how much had come out of there. More, and more, and more, and more. And that’s when Matt walked in. He jumped in to assist as the doctor’s right hand man. He loved to be involved!

Dr. Childs, like Matt, is animated when she talks. Picture me lying in bed, Matt wearing surgical gloves that are way too small for his hulking hands, standing next to the doctor who is draining my innards. She is talking and gesturing with her gloved hands like she is at a party, bile is flinging and flying in spatters all over me, Matt, my bed, the floor. She did mention that anything in the small intestines is sterile, thank God. And I’m amused by this whole scene because I’m feeling RELIEF!

It takes a while for a tiny tube to drain the fluids out, and in the end, there are 1750 CC’s (that’s quite a lot to be sitting in my bod). We discuss next steps, food intake, and how to keep me comfortable for the rest of my time here. She ordered me scrambled eggs, and a high-protein, soft food diet, then was on her way.

And it was like heaven. Six days of not eating, I think I mentioned before, is frustrating, especially when I’m so close to being ready. I had my first shower, all bedding replaced, my breakfast…

…And I literally felt like rolling in mud! Oink!

PARENTS’ VISIT: SYMPATHY SYMPTOMS?

Parents caught an intestinal bug; were these sympathy symptoms?

Matt & I just saw my parents off after spending the week here in our humble settings. It started off like a normal vacation: parents rolled in on a lovely afternoon, moved into their accommodations, and sat down to have hors d’ oeuvres and drinks out on the deck with Matt & I. This is the first time I have seen my parents since the diagnosis of colorectal cancer nearly 2 months ago! So it would make sense that they would show some sympathy, right? Well, I didn’t know that would mean sharing symptoms!

The next morning we all went to the Ventura Harbor fish market, had brunch in town and spent the afternoon exploring Ventura. It was a hot day, and spending the day near the ocean meant we would miss the heat of the day up on Matt’s hill where it is nearly 10 degrees warmer. Then on to our friend Darrel’s to celebrate the UFC mixed martial arts fights, and mingle with Darrel and friends at his Tiki paradise (think Gilligan’s Island meets Swiss Family Robinson. This place is thoroughly A-mazing).

Sunday and Monday were about meeting the neighbors, photography for my dad, socializing with the hummingbirds and the sunshine for my mom.

Then…

Tuesday I had scheduled a follow-up appointment with my radiation oncologist, Dr. Chaiken. As we rushed to leave for the appointment, I learned my dad had been awake much of the night with diarrhea. Not wanting to draw attention away from the meeting at hand, plus a tendency for him to be stoic about such personal things, my dad showed he was alright. We didn’t feel worried, and proceeded into my appointment. It turns out, a rather serious case of the runs was keeping my dad in constant need of a nearby toilet. Believe me, considering my last several months of my own intestinal discomfort, I could relate, and really felt for him!

While in the exam room Matt and my parents sat quietly while I answered questions from my friendly nurse Janet and when Dr. Chaiken entered, I introduced her and we proceeded. By that time my dad calmly excused himself to leave the exam room. Nothing seemed out of the ordinary, he just got up and left.

Moments later, Dr. Chaiken wrapped up the meeting, and we all lined up at the door. When the door opened, there was a machine on wheels in front of us, two nurses leaning over my seated, perspiring father, looking concerned. They were monitoring his blood pressure and giving him water.

Holy cow! What happened to my dad!

Well, thank goodness we were already at a hospital, and the emergency unit was right upstairs, where they could easily run some tests to make sure he was ok. We had taken separate cars, so three hours later, I was driving my parents to the pharmacy and then home to meet Matt, who was busily cooking a lamb roast for dinner.

What a day! Dad was feeling normal, outside of the uncomfortable intestinal difficulties, no definitive results turned up, and it turned out an intestinal infection and severe dehydration was changing the whole course of my parents’ vacation. That would have been the only blip in the agenda, but then my mom came down with a similar condition the next night!

Sympathy Symptoms

Unable to positively identify the cause of the bug, we theorized that it could have been some infected party foods that everyone was sharing. But what if they just secretly wanted to experience the same thing I was going through?

We took a break from activities, restricted diet to simple foods, and made use of some new medications and supplements. That kept the world goin’ round and the whole trip was not a loss. We could still get out to see things and do things. My parents wanted to be able to meet our neighbors and friends, do some tourist activities, practice some photography, to catch up and have some laughs, and to see that their daughter is doing OK!

By the time my parents left they were starting to feel ok and appreciated the time spent getting to know Matt better and being part of our eclectic existence here in Southern California.

Well, I guess I’m not too proud to give up the spotlight on my cancer diagnosis for my parents’ sympathy symptoms. We are family, after all.

Weight: 148 (I gained another 4 lbs!)
“Sun” burn fading, still itchy
Normal diet of whatever I want to eat and drink

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