Archive | October 29, 2013

Why I Can’t Wait for My Colonoscopy

Photo Credit: abcnews.go.com

Photo Credit: abcnews.go.com

You’re probably wondering what’s wrong with me.  Why would anyone in their right mind look forward to a colonoscopy?

It’s simple.  I can’t wait for the “prep” to be over.  But it may not be for the reason you are thinking…

Of course the prep itself is rotten.  It has been three days since a morsel of food has crossed my lips.  And drinking this God-awful stuff that wrenches your insides and makes you feel as though you are tethered to toilet is no picnic.  And because Palliative Care (see Palliative Care at 30-Something: What Does it Mean? Part I and Part II) has me on around-the-clock opiates, I was required to do the “Extended Preparation” which includes “extra” days of not eating and of a clear liquid diet, a few different types of unpleasant liquid solutions that make you “go” with extreme urgency, pills that also make you “go,” and enemas.  Did I mention I’ve gone 3 days without eating any food and have been consuming only clear liquids?**  Can you tell this one is getting to me

Photo Credit:  pregnancy.lovetoknow.com

Photo Credit: pregnancy.lovetoknow.com

Right now I’m trying to drink the last 4 liters of yucky stuff from the pharmacy in the prescribed 3 hours, but I can’t keep it down.  I have been vomiting so much that I’m not sure there is anymore liquid to throw up — until I throw up again.  I stop drinking entirely this afternoon.  And then I have to give myself 2 enemas in the 2 hours before the procedure, holding the contents of the enema bottles “in” for 15 minutes per bottle before I can go to the bathroom.

If you’ve ever had a colonoscopy, you are probably nodding your head now.  You know how rotten the prequel to this procedure can be.  Or maybe you’ve blocked it out of your mind and forgotten?  If so, I’m sorry for reminding you.

I must admit that I had forgotten.  Tucked the memories of my last “clean out” neatly away in my brain.

Okay, really what happened was that they were replaced by much more traumatic scenes. The last time I did this it wasn’t for a colonoscopy — I honestly can’t recall my last one, let alone the prep.  I just remember waking up shocked that I was dressed and asking who had put my underwear back on.  The answer was “me,” but I was so out of it from the anesthesia that I had no recollection of the day’s events.  Sounds like spring break gone bad!

No the last “prep” of this kind that I am talking about was for my hysterectomy and salpingo-oopherectomy last year.

It’s no wonder the prep is not what I recall about the events leading up to this surgery.  I had complex pelvic masses.  One was so large that you could feel it when you touched my belly.

I needed to have my right ovary removed the day after Halloween two years ago thanks to the side effects of Tamoxifen* [see below].   The ovary was filled with a crap-ton (urbandictionary.com defines a crap-ton as “4 shit loads”) of septated cysts.

And here I was facing the prospect of losing my remaining ovary and my uterus.  At the age of 35.

A part of me wanted to be sure of what they were seeing before I went under the knife again.  This was the part that didn’t want to have to go through another major surgery and recovery.  And this was the part that was still holding on to the hope of giving birth to a little girl, the daughter I had dreamed of having from the time I was a little girl myself.  It was also the part that wanted to be absolutely sure of what they were seeing before I let them cut into me again.  And this was the part of me that was just tired of all of the cancer crap.

And then there was the part of me that wanted to shake some sense into the aforementioned part.  This was the part of me that, after each scan or exam, grew more and more fearful that what I might be dealing with was ovarian cancer [breast cancer increases this risk], or ovarian mets (metastasis) from the breast cancer to the ovaries.  I was also dealing with the concern that I could have a new primary cancer in my uterus.  I say a new primary rather than a metastasis in this case because Tamoxifen upped my risk of developing uterine cancer.  “Tamoxifen acts as an anti-estrogen in breast tissue, but it acts like an estrogen in the uterus. It can cause the uterine lining to grow, which increases the risk of endometrial cancer.” [Source: cancer.org]

In a short period of time I had multiple gyn exams, transvaginal and abdominal ultrasounds, an MRI, and a CAT scan.  Each of these tests confirmed the presence of these complex masses.  And they were growing.

At my last ultrasound appointment, the technician asked me to stay on the exam table while she went for the doctor.  When they came into the room together, my doctor told me that I needed to go to the hospital immediately, and she sent me to the emergency room.  I remember scrambling because it was a Tuesday afternoon and I didn’t know how long I would be in the hospital, but I knew it would be long enough that I would need to find somebody to pick my boys up from elementary school.

Another CAT scan was performed in the Emergency Room.  It didn’t look good.  The thought that these masses could be ovarian mets or ovarian cancer scared the hell out of me.  And there wasn’t really a decision to be made.

After meeting with the leading GYN oncologist in our area, my surgery was scheduled for the next week.

But a part of me wondered if there was any way out of this.

And then I began hemorrhaging just before my surgery.  There was so much blood.  I remember trying to get into the shower before an appointment.  It was just a few steps from where I disrobed to the shower, and just with those few steps, I managed to cover the floor with a large pool of blood.  I was as pale as a ghost.  And I felt like I was a stone’s throw from becoming one.

When I went in to see my regular gyn, she was clearly concerned that this was further evidence that I might have uterine cancer.  She did a biopsy that day and prescribed drugs that would help to lessen the bleeding until my surgery.  They didn’t really help, so I was almost “thankful” that my hysterectomy was just around the corner.

My gyn oncologist removed everything that was left of my female parts, with the exception of the one that starts with a “V,” but even “it” did not come out unscathed.   Since he took my cervix, the surgeon had to use the top of the vagina to create what’s known as a “vaginal cuff.”

Though I had signed all of the consents prior to my surgery, including the special one you have to sign when you are of childbearing age (indicating that you understand that you are undergoing surgical sterilization), I was still shocked to wake up to find that everything was gone.  Everything.

I spent 4 days in the hospital after the surgery.  It was a difficult 4 days, emotionally and physically.  I required blood.  I needed enemas and catheterization.

I could barely get out of the hospital bed, let alone make it down the hall — for days.  {The blood transfusions helped with this, thankfully.}

And I had a massive migraine.  As a chronic migraine sufferer, I am no stranger to headaches.  But this was worse than any headache I had ever experienced.  The consensus was that the cause was linked to the fact that my estrogen levels had soared in the year before my surgery, and then, suddenly, plummeted as a result of the surgery.  And nothing would alleviate the pain.  Not the morphine drip, not the oxicodone or the oxycontin, not the dilaudid.  Nothing.  I needed my hormones back.

A normally positive person who tries to see the good in everything, I lay in that bed, broken and empty, as I awaited the pathology report.  I felt as though I was a shadow of my pre-cancer self.  I pictured Hansel and Gretel walking on that path through they woods, leaving bits of bread behind so they could find their way back home.  I had been leaving bits and pieces of myself behind on the long and winding road since my diagnosis.  But I knew I would never find my way back home.

So doing this “colon prep” has been especially difficult.  Not just because it’s physically rough, but because it has made the memories of my hysterectomy flood back through gates I had sealed shut soon after the surgery.  As the old saying goes, “Denial (The Nile) ain’t just a river in Egypt.”

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There is more to this story.  But I will have to save the remainder until I am feeling better.  Thank you for reading…

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*Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its activemetabolite, hydroxytamoxifen. In other tissues such as the endometrium, it behaves as anagonist, and thus may be characterized as a mixed agonist/antagonist. Tamoxifen is the usual endocrine (anti-estrogen) therapy for hormone receptor-positive breast cancer in pre-menopausal women, and is also a standard in post-menopausal women althougharomatase inhibitors are also frequently used in that setting.[1]

Some breast cancer cells require estrogen to grow. Estrogen binds to and activates the estrogen receptor in these cells. Tamoxifen is metabolized into compounds that also bind to the estrogen receptor but do not activate it. Because of this competitive antagonism, tamoxifen acts like a key broken off in the lock that prevents any other key from being inserted, preventing estrogen from binding to its receptor.

[Thank you, Wikipedia, for this Tamoxifen info!]

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**In case you are interested, here’s the list of approved clear liquids:  water, Sprite, apple or white cranberry juice, clear or yellow Gatorade/Powerade, chicken broth (nothing in it — NO beef broth), black coffee/tea (no milk or cream), Jell-O (yellow, orange, green only), or popsicles (not red or purple).

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P.S.  As much as I’ve struggled with the prep, I know it’s worth it.  IWith symptoms like pain and rectal bleeding (and with my cancer history), I know it’s better to do this than risk the alternative.  Please don’t let my post deter you from having a colonoscopy.  The “extended prep” is usually not necessary, and the procedure and the prep are over before you know it (and I think my reaction to it is rare?).  They are also far easier than dealing with cancer would be.  So please follow the recommended screening guidelines and do this important test (generally beginning at age 50).  In some cases (like mine), a colonoscopy may be necessary before you turn 50 (or in between the recommended 10 year gap from screening to screening).  If you have a family history of colon cancer or if, like me, you are experiencing issues (i.e. rectal bleeding or a change in bowel habits), please consult your doctor to see if you are in need of a colonoscopy.

“Almost all colorectal cancers begin as a small polyp. If a polyp is found during colonoscopy, it will be removed and this prevents the polyp from every turning into cancer. But if you don’t have your colonoscopy in the first place, then you are throwing away the chance to detect polyps when they are easily treated.” [http://www.columbiasurgery.net/five-reasons-not-to-get-colonoscopy]

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