Archive for category: History

Recovering from Surgery

10 Aug 2012
August 10, 2012

I’m starting this blog on my first day of chemotherapy treatment, but in the interests of chronicling my whole experience, I’m writing a few posts that go “back in time”.  I’ll try to present things as clearly as I can remember them.  Given that this has all happened over the last few months, that shouldn’t be too hard. Also, I’m writing about colon cancer, which means that from time to time, I’ll be referencing things that I otherwise wouldn’t talk about in polite company (stool samples, bowel function, etc.). Fair warning…

After I was finally released from the hospital, things were actually pretty easy at home. It’s amazing how comfortable your own bed and couch feel after being in a hospital bed for five days. Add to that the fact that you don’t have an IV needle in your arm (or hand), and it’s bliss.

I had planned to be off from work for three weeks after my surgery to recover, and when I was planning to be out I couldn’t really envision being at home and not in contact with work at all for that amount of time. I’d probably want to check email every once in a while and make sure that everything was okay, right? Nope. I truly stayed unplugged, and I think that was a good thing.

The first week that I was home, I was tired and moving around very slowly. I was comfortable when I was lying down or standing up, but the transitions between the two were awkward and a little uncomfortable – not shooting pain or anything, but enough twinges of pain that I was careful when I was getting up or lying down. I spent a lot of time lying down, and dozed off into naps from time to time, partly due to pain meds that I was still taking. This then really messed with my sleep schedule, so I often found myself up until 2 or 3 AM, and then sleeping until 10 or 11 AM… or, let’s be honest, 12 or 1 PM. I didn’t have to go to work the next day, so it wasn’t a problem, but after a week or two, it was a little strange how off my hours were.

Towards the end of the first week/beginning of the second week, I didn’t need to take any prescription pain meds any more (percocet, which is basically oxycodone and tylenol), and was just taking tylenol periodically if I needed it, which was mostly later in the day, especially if I’d been moving around a lot.

They (the doctors, nurses, etc.) want you moving around as much as you can. Like my pacing the hallway in the hospital, this started with me just getting off the couch several times a day and walking around my house – doing laps from my kitchen to the living room and back again, pausing to pet the cat as I walked by her favorite spot to perch, from which she was watching me closely. Under normal circumstances if I was on the couch she’d be in my lap, so she’d had to make some adjustments while I (or, at least, my lap) recovered.

When you’re sent home from the hospital, you get a packet of discharge instructions, and it covers a lot of detail, but the one thing that is left incredibly vague is diet. I was told that I didn’t have any dietary restrictions, but that I’d want to “take it slow” with eating normal food: eat smaller meals and milder foods to start with, and work my way back up to complex/spicy/interesting food.

This sounds fine in theory, but it leads to a guessing game and we really wished that there’d been some food guide that got handed to us instead: something that laid out a suggested diet plan for the first week or two. That would have been incredibly helpful. While I didn’t have any bad reactions to food, every time I added something back into my diet I was wondering whether I would have a bad reaction to it.

For the first few days, I did keep it simple: scrambled eggs and toast, plain pasta… things like that. After three or four days I had some plain chicken and rice, a tuna fish sandwich, and started moving onward from there. Most resources we found online suggested not overdoing it on the amount of fiber, so I actually had white bread for the first time in years. I’d forgotten how amazing white bread is. It’s like the best thing since… well, you know.

The thing that I was warned about before the surgery was that it might take a while (weeks to a couple of months) before my bowel function was back to normal. My surgeon told me that this could mean anything from having looser stools for a while, having to go to the bathroom more frequently, having to go to the bathroom less frequently, or something else completely. It’s one of those places where all they can say is that it’s different for everyone.

Before the surgery, this part of the recovery had me pretty worried. I think that most of us take going to the bathroom “normally” pretty much for granted, and I wasn’t looking forward to several weeks to two months of it being “off” in some way. Thankfully, I was pretty lucky and things started working and feeling “normal” pretty much after the first week or two home.

Prior to my surgery I was connected to a friend of a friend who’d been through the same surgery about five years ago and got a chance to ask him for any advice/thoughts based on his experience. He told me that your body pretty much tells you what it’s ready for, and as long as you don’t push to hard and overdo it, the recovery is pretty smooth. He was right. As the days went by I started to feel a little better, and I’d do a little more: go for walks, drive to the grocery store, go into the grocery store, wear something other than pajamas (a prerequisite for me before going to the grocery store, despite what I see some other people wear there), go out to dinner, etc.

For me, three weeks at home was enough time to feel good enough to go back to work. And so I did.

 

A Partial Left Colectomy

31 Jul 2012
July 31, 2012

I’m starting this blog on my first day of chemotherapy treatment, but in the interests of chronicling my whole experience, I’m writing a few posts that go “back in time”.  I’ll try to present things as clearly as I can remember them.  Given that this has all happened over the last few months, that shouldn’t be too hard. Also, I’m writing about colon cancer, which means that from time to time, I’ll be referencing things that I otherwise wouldn’t talk about in polite company (stool samples, bowel function, etc.). Fair warning…

The symptoms that led to my diagnosis started in late April/early May. I saw my primary care doctor at the beginning of June, and by the end of June I’d had tests run, been referred to a gastroenterologist, had a colonoscopy, and been delivered a confirmed diagnosis of a malignant tumor in my descending colon. I do feel lucky that this all happened so quickly. I’ve heard way to many stories about people being misdiagnosed for months/years, and in my case, what started as some pretty vague symptoms were definitively diagnosed in just a few weeks.

I met with a colorectal surgeon in Boston at the very beginning of July to discuss what the next steps were. The next steps were to remove the section in the middle of my colon that the tumor was growing in (along with a little extra on each side) and then stitch the two ends back together. Allow a little time for me to recover and I’d be all set. Official name of the procedure: a partial left colectomy.

This is one of those times when a doctor is telling you something that sounds like a big deal, and they refer to it as routine. I think that’s supposed to make you feel better, and on some level I suppose it’s comforting to know that you’re not dealing with some once-in-a-lifetime event, but it’s not all that comforting.

I’d been referred to the surgeon that I met with by a friend who works for a gastroenterologist (not the same one that did my colonoscopy). That plus going to one of the major hospitals in Boston definitely made me feel like I was getting the best care I could.

The initial consultation was pretty straightforward. The doctor described the basics of the procedure, and confirmed that they’d do it laparascopically, which meant that my incisions would be smaller and recovery would be faster. The highlights of what I was told:

  • The surgery itself would take 2-3 hours
  • I’d probably be in the hospital for 2-3 days. They’d basically let me go home once I was able to get up, walk around, and go to the bathroom.
  • I should plan on taking 2-3 weeks off of work after the surgery to recover
  • Recovery wouldn’t be bad. I’d have some pain and sensitivity at my incision sites, would have to ease back into eating and would probably have some decrease in my appetite, and would be tired and need to rest. The doctor actually said that the biggest thing that recovering patients report/complain about is fatigue.
  • It would also could be as much as two months before my bowels might get back to normal. While it adjusted to a section of it being removed, I might have to go to the bathroom more often, etc.

With the surgery, they would remove not only a section of my colon, but also some of the surrounding tissue, including lymph nodes. Once everything was taken out of me, they’d be able to do some additional pathology testing, basically to see whether there was any evidence of spread of cancer to the lymph nodes, and to see how deeply it had penetrated into the wall of the colon. This is how they assign the cancer a “stage” (there’s some great info on the differences between colon cancer stages here). It’d take about a week for the results of that testing to come back, and they would determine if I’d need any additional treatment. Basically, if the results said that things were Stage 2 (meaning that there was no spread to the lymph nodes), then the surgery would be all I’d need. If it was Stage 3, then they’d recommend a course of chemotherapy.

Once I’d recovered, I’d need to come in for office visits 3-4 times a year and have some blood drawn; I’d have a CT scan once a year; and I’d need a colonoscopy ever 2-3 years. They’d monitor me for 5 years, and if there wasn’t a recurrence, I’d be in the clear.

There was one moment during the meeting that totally took me off guard:

Doctor: “We could do the surgery soon, if you wanted.”

Me: “When’s soon?”

Doctor: “Thursday.”

Me: “…”

What felt like a minute, but was probably just a few seconds went by.

Me: “Do we need to do the surgery that soon?”

Doctor: “No, this isn’t an emergency situation, we’ll just need to wait a few weeks if we don’t do it this week.”

I opted to wait, as I definitely needed some time to prepare for being out of work for 2-3 weeks. My surgery was scheduled for July 26th.

The next few weeks was the time when the name for this blog was born. Many well-meaning people in my life told me that it sounded like I was really lucky that I “only” had to go through this surgery and then it’d probably all be okay. I know they meant well, but after a while, that really got to me. This wasn’t a flu shot. It wasn’t a quick outpatient trip to the hospital. It could have been a lot worse, but it was a BIG FUCKING DEAL, and I got very tired of people talking like it wasn’t (despite their best intentions to try and spin things positively).

Waiting also got hard the closer the day of my surgery got. I was definitely nervous, mostly because I wasn’t sure exactly what to expect. I wasn’t so nervous about the procedure itself; I didn’t think that I was going to die on the operating table or anything, but I just didn’t know how I was going to feel afterward, and how long it’d take me to get back to feeling “normal”.

Remember how everyone warns you that the worst part of a colonscopy is the prep? Well, that’s not true for surgery, unfortunately, though there’s also a prep to go through. This time, the stuff I had to drink was different: magnesium citrate. It’s not pleasant, but I was able to get it down. It’s a clear liquid, but it’s a little thick and bitter. However, I only had to drink 10 ounces of it at a time, so it wasn’t so bad.

The day of surgery was actually pretty uneventful for me, since I was asleep for all the real action. We got to the hospital and I was brought up to the surgical waiting area, changed into a hospital johnny, and laid down on a gurney to wait. Over the course of the next hour or so, I spoke with nurses, an anesthesiologist, my surgeon, and a surgical resident. Several people went over my medical history and the details of the surgery. I found out that not only was the surgery being done laparascopically, but also robotically. I’m not gonna lie to you, Marge… I thought that was pretty cool. At the time, I posted the following to Facebook:

Found out that there’s a robot involved in my surgery. We live in the future, people.

I remember being wheeled into the operating room, moving from the gurney onto the operating table… and that’s it. Next thing I knew, I was waking up in recovery. After a little while there, I was wheeled up to my room.

For the first couple of days I was hooked up to a pump that would deliver pain medication (morphine, I think) whenever I pressed a button, as often as every six minutes. This worked very well while I was awake. The first night, I fell asleep for several hours straight, and when I woke up, I was hurting, and was hammering the button pretty hard. After 15 (well, probably 18) minutes or so, I was okay.

It’s hard to rest in the hospital, even when you’re tired after surgery. There’s a lot of noise, even when everyone’s trying to be quiet at night; a nurse comes in every four hours to take your vital signs (blood pressure, temp, and blood oxygen levels); and you’re uncomfortable because there’s an IV needle sticking into you. I ended up sleeping for an hour or two here or there.

Getting out of bed for the first time was strange. I had no idea how to move my body. Getting back in was even weirder, and one of the nurses had to help me swing my legs back onto the bed. They want you up and moving around as much as possible, though. Surgery shocks your system and walking around helps wake everything back up.

For the first 24 hours I was very sore and in noticeable pain. In general, things got better each day. At the end of day 2 they took me off the IV morphine and I was able to drink some water, and then they started giving me pain meds orally. Late on day 2/early on day 3 the catheter got removed (that was one of the weirder experiences in my life) and it was easier to get up and move around.

The big “event” that they’re waiting for after surgery is for you to pass gas. That shows that your digestive system has woken up and is moving again. Unfortunately for me, this didn’t happen very quickly. The original “2-3 days in the hospital” estimate ended up being almost 5 full days. I’ve never had so many people ask me about whether or not I’d farted…

Not only wouldn’t they let me leave until I’d passed some gas, but they also wouldn’t let me eat solid food. So, for four days, I only had liquids: beef or chicken broth, Jello, and a frozen flavored ice of some kind. I came out of the hospital close to fifteen pounds lighter than when I went in.

I was really down on my fourth day there. In retrospect, I feel bad for both my wife and the nurse that was on duty that day… I was pretty inconsolable. By that time, I just wanted to go home, I hadn’t slept at all the night before, it was my wife’s birthday and I felt bad about still being in the hospital, and I was just wanted my body to get with the program.

The next morning, I farted. Never in my life was I so happy to do so. You’d better believe that I reported it to the nurses and the doctors that came by on rounds in the morning. A little later that day, I was allowed to have some solid food. Scrambled eggs and toast never tasted so good.

Once I ate and held down the food without any problems, I was cleared to go home, around 6pm on day 5. The nurses had all been fabulous, my roommate had been a very nice guy, and the eggs were delicious, but I was so happy to get out of there and get back to my own bed.

 

Diagnosis

27 Jun 2012
June 27, 2012

I’m starting this blog on my first day of chemotherapy treatment, but in the interests of chronicling my whole experience, I’m writing a few posts that go “back in time”.  I’ll try to present things as clearly as I can remember them.  Given that this has all happened over the last few months, that shouldn’t be too hard. Also, I’m writing about colon cancer, which means that from time to time, I’ll be referencing things that I otherwise wouldn’t talk about in polite company (stool samples, bowel function, etc.). Fair warning…

Sometime in May 2012 I started having some pain in my abdomen. At first it was just a couple of times a day, but after a couple of weeks it was bad enough that I called my doctor for an appointment. By this time, I was feeling some level of discomfort or outright pain throughout the day, and there were times when it was acute enough that I needed to stop whatever I was doing and take a few deep breaths while the pain passed.

I’d tried to pay attention to my own body and habits a lot. Was it worse when I ate certain foods? When I didn’t get enough sleep? At home? At work? Nothing seemed to jump out at me, and nothing big had changed recently in terms of habits (good or bad). So, when I went into my doctor’s office, I felt like I was able to answer his questions well, but everything I had to say was a little non-specific. I had pain, but I couldn’t tie it to any specific events, foods, activities, etc.

My doctor is pretty conservative, and tends to treat the symptoms you have without going overboard. He’s not the kind of guy that hands out a super-strong antibiotic for every cold or immediately sends you for a bunch of unneeded scans or tests. Overall, I think this is a good thing, but it also meant that I was prepared for the conversation we had after I described my symptoms:

“So… what’s new in your life?” he asked.

“What do you mean?”

“Well, you’re describing symptoms of Irritable Bowel Syndrome, or IBS, which can often be caused or made much worse by stress. So, what’s new at home, at your job… in your life?”

We talked for a little bit, with me telling him that I’d been trying to look at those sorts of questions/factors as objectively as possible, but that I didn’t see anything relevant. Work was busy, but no busier than usual, and there’d actually been a few things that had happened in the last couple of months that were making things a little less crazy than usual. My diet hadn’t really changed. I was generally feeling okay otherwise… We also discussed possible food and environment factors that could be at play: lactose intolerance, gluten allergies, things like that.

Ultimately, I said something like “all I know is that this has been bad enough for long enough that I know I can’t have it continue like this. I need to do something.”

So, he ordered a few tests and sent me next door to the hospital.

There’s a lot of shorthand that happens when you go from one doctor to another or from one doctor to a lab. I encourage everyone to ask a lot of “so, explain to me what’s going to happen next” questions, because otherwise, things can get a little confusing. To wit…

I go next door to the hospital lab and they draw a few vials of blood. Then, the nurse asks “did you already schedule your lactose test?” “Huh?” I say intelligently, since I have no idea what she means. Apparently, the lactose test is done over two and a half hours, and is normally done first thing in the morning, since you have to fast for it. No problem, I say, even though it’s ten o’clock, I haven’t eaten yet today, so let’s do it now.

The lactose test consists of you drinking a gritty mixture that contains roughly the amount of lactose in a single meal, and then they draw blood every 30 minutes for two and a half hours. It was a heck of a morning.

My doctor also requested that I bring back a stool sample to the lab, and had the lab give me three “cards” for a fecal occult blood test (this has nothing to do with witchcraft, by the way). The cards each come with a flat wooden stick. You’re supposed to open each one up and use the stick to smear a small amount of your feces onto two boxes. Then you fold them up and bring them back to the lab. So, this is gross. Collecting ones own stool sample is also gross, and a bit complicated. Best left there.

A few days after I brought the stool sample back to the lab, I got a call from my doctor’s office. They found blood in my stool, and so they wanted to have me see a Gastroenterologist. They referred me to someone nearby who luckily had an opening just a few days away, so I didn’t have to wait long.

The consultation with the gastroenterologist was a relatively short appointment, during which I was told that I needed a colonoscopy. The blood in my stool was indicative of a variety of possible problems, and ultimately, there wasn’t any way to be sure exactly what was going on without one. I scheduled it for the following week.

If you ask anyone who’s had a colonoscopy about it, you’ll probably hear the same phrase repeated (I certainly did): the prep is the worst part.

So, let me tell you a secret about colonoscopies: the prep is the worst part. The prep basically involves drinking some amount of stuff that doesn’t taste great, and that makes you go to the bathroom. A lot. I do remember ingesting all of this stuff and then sitting there for a couple of hours thinking “nothing is happening… what happens if nothing happens…?” And then, it all kicked in, and I was running to the bathroom every 20-30 minutes, eventually wondering how there was anything left inside me.

Actually having the colonoscopy was uneventful. I showed up at the office, changed into a gown and had my info reviewed by a nurse, and then was wheeled into the procedure room. You’re given drugs to sedate you so that you’re not really aware of what’s going on, and I don’t remember anything about the procedure. Ultimately, I woke up in the recovery area feeling fine.

Once I was awake, the doctor came and reviewed the results with me. They’d found one polyp that they’d removed, and a tumor in my descending colon that they’d taken biopsies of. The doctor confirmed that this tumor was likely the cause of my abdominal pain, and that even if it was benign, it should be removed. Then, he dropped the bomb: “Based on its size, I’d be surprised if it weren’t cancer.”

It would be dramatic to say that “everything stopped” at this point, but it didn’t. I went into “one step at a time” mode instead. I asked a handful of additional questions and said thank you. The doctor said that he’d be following up with me in a few days when the biopsy results were back. While the word “cancer” definitely had me freaking out a little, there didn’t seem to be any point in worrying much until the test results came back.

Three days later, the doctor called me and told me that the biopsies had come back positive. Adenocarcinoma was the official medical term in the report, and it meant that the tumor was malignant and definitely needed to be removed.

At this point, I was more upset and worried, but was still mentally taking it one step at a time. From everything the doctor said, it was likely that I’d just need surgery to remove the tumor, and then that’d be it. A surgeon would be able to give me more details. So, the next step was meeting with a surgeon and scheduling the surgery…

 

Photo Credit

Photo by Alex Proimos and used in accordance with the Creative Commons Attribution license.

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