Sunday, June 16, 2013

A Little Reality Check

Author's Note: Today's entry doesn't deal with spanking on any level. It's a post about my health scare and the things that I'm going to do in the future to keep this from happening again. If you don't like this "reality check" then go find some fantasy stuff to read.

I remember the summer of 1988 distinctly. There are several reasons why I remember it so well (even better than summers that have happened more recently). One of the reasons was because I was 27 years old and I became distinctly aware of the fact that I was "pushing 30" as we used to say, and I wasn't married yet. I remember as a 14-year-old telling my mother that I had no plans to marry ever or have children. My mother and other female relatives would smile knowingly and say "Wait until you fall in love." It was one thing to say I never wanted to get married as a teenager and quite another to be passing marriageable age and say it. Believe it or not, even in the 80's 27 was considered old to get married. I also remember the summer of 1988 as one of the hottest on record. We had 90 straight days of 90+ degree weather. I was working as a hostess in a restaurant at that time and the uniform consisted of a wrap skirt and a blouse with a stand up collar. There was also a vest in the ensemble. I remember clearly having to powder my legs to get my hose on. I couldn't wait for the weather to break so I could get some relief. Last summer reminded me a lot of the Summer of 1988.

But the reason I remember it most is because that was the summer that my mother's cancer was diagnosed, opening the door for all of the miseries and sadness that followed. My mother had been losing weight for a few months and it was becoming noticeable. I asked her what was going on, but she just told me she didn't want to talk about it with me. This was back in the days when parents didn't discuss intimate topics with their kids. As upset as I was that she didn't want to talk about it, I had to respect that. Unfortunately, the onset of my mother's cancer symptoms coincided with the first appearance of dementia symptoms as well. She was only 53-years-old. The hospital where she worked sent her home, telling her to find out what was going on. I can't even imagine how scared she must have been. When she finally did go to the doctor, there wasn't a lot of options back then. They didn't have CTs and MRIs back then. I'm not even sure what tests she had because she was so secretive about it. I'm pretty sure she had a sygmoidoscopy (the precursor to the colonoscopy), which could only look at one side of the colon due to the fact that the scope was rigid. She probably also had blood work of some kind. But I remember when my father told us that she would be going in for "exploratory surgery" to see what the problem was. He never told us what the sygmoidoscopy showed but I suspect that a rather large tumor was blocking the way so the doctors couldn't see anything. I assumed that whatever they found would be removed and that would be that. That's how ignorant I was of cancer. I had no idea at that time what an evil, insidious disease it was. But I was about to find out. When the surgeon opened her up, he found a cancerous tumor the size of a grapefruit, necessitating an immediate colostomy (the removal of most of her large intestine and rectum). During the surgery, the remaining part of her colon was rerouted to a place in her abdomen, where waste would be collected in a bag attached to the abdomen. I assume (knowing what I know now about cancer) that all of the lymph nodes were also removed and checked for cancer cells. As soon as she healed from surgery, the horrible rounds of chemo and radiation started, her dementia getting worse as time went on. She was diagnosed with early onset Alzheimer's about the same time. My life was a nightmare at this time. There were nights where none of us got any sleep. Mom would be up crying and Dad would be trying to change her colostomy bag. This went on for four years, until she finally had a stroke and had to be put in a nursing home. We had to have her declared a ward of the court in order for her to be put on Medicaid (that's how it worked back then). It just angered me to think of my mother, a hard working married woman with a husband and a home having to be declared a ward of anything. Seven months later, the day after Valentine's Day, 1993, the hospital called to say that Mom had died, alone, in the pediatric ward of the hospital where she had once worked. I was the one who answered the phone and the news that my mother, a proud and beautiful woman, had died alone. I had to go wake up my father and tell him his wife of 38 years was gone. She was only 58 but she looked 30 years older. In an odd twist of fate, the same doctor who signed my mother's death certificate also signed Carol's when she died in 2010.

Flash forward 20 years. I'm now in my 50's and working full time and trying to have a life. An appendectomy at the first of the year put the wheels in motion for me to finally be under the care of a regular physician. The first time I met her, I liked her. She wasn't judgmental or scolding. She was just happy that I was finally going to get serious about my health. When she learned of my mother's colon cancer history and the fact that I'd never had a colonoscopy (people with a first degree relative with colon cancer are advised to have their first colonoscopy done a dozen years before they reach the age that their relative was at diagnosis) she said "Cheryl, you're going to give me a heart attack!" She put it on my To Do list and I dutifully scheduled it, knowing that it was months in the future. As the time approached, though I started to worry. What if they find something? Will I have to wear a bag like my mother had? I didn't let this fear stop me from going through with it. I went to the pharmacy and picked up the colon cleanse that had been prescribed for me. The PA that I saw in the doctor's office had told me that I could add Crystal Light to it to make it taste better (as long as it wasn't red or purple, those food dyes can stain the colon lining and look like blood to a doctor). I would have to drink an 8 ounce glass of this stuff every half hour until the 4-liter bottle was empty. I was told to start drinking the liquid at noon, but to start a liquid diet that day. All I could have was Jello, Popsicles, broth and Gatorade. There's no way to get around the fact that the doctor doing the colonoscopy needs a clean colon to work with. The colon cleanse contains salts that are not absorbed by the body, but go straight through, cleaning every nook and cranny. It also contains electrolytes to keep you from falling low on those essential salts the body needs. The laxative part of the cleanse hits like a ton of bricks and you're advised to be close to a toilet at all times throughout the day. The process of drinking my glass of liquid started off pretty well until I had to start going to the bathroom. Pretty soon, I would have only ten minutes to rest between drinking my next glass and then spending 20 minutes on the toilet. After awhile, I got pretty sore, too. I was told to use a little petroleum jelly to make me more comfortable. At 8 o'clock that night, I took my last glass of that stuff. While it wasn't pleasant tasting, it was far from as bad I'd heard it was. It tasted a lot like Alka Seltzer. Actually, I had a three-fold fear of this procedure. The first one was stomaching the colon cleanse. So, that hurdle cleared, I started to focus on the second part of my fear--that it would hurt and I would lie on the table screaming in agony, as I had heard others tell me had happened to them. I had a nightmare that night that the doctor did the procedure without any painkillers and I did indeed lie on the table and scream. That morning, my friend, Kathy, picked me up and drove me to the GI Lab where my procedure was being done. It was actually in the older part of a large hospital. I went in and got registered, where I showed them ID and my insurance card. The lady put a couple of bracelets on my wrist and sent me back to the waiting room to wait for them to call me. All of the people there having the procedure were women that day. When they called me, I went to the back where they would get me ready for surgery (yes, it's considered an outpatient surgical procedure). The first thing the nurse did was lead me to a bathroom, where she handed me a bag with two gowns and a pair of booties in it. I was to take off everything but my bra and put both gowns on, one open in the back and the top one open in the front. Then I was to slide the booties onto my feet and walk back to where the nurse was waiting. She had me sit down in a chair and she started an IV. She explained that the IV would keep my vein open (I assumed I would be getting saline or Ringer's or something of that nature since I hadn't had solid food in a day and a half) and also that the pain drugs would be administered through it. I wasn't a novice by any means and I kind of resented her treating me like this was my first trip to the surgery rodeo. She asked me if I had any last minute questions and I asked her what drugs I would be getting. She told me Demoral and Versed. I asked her if I would be awake during the colonoscopy and she said "Technically, yes, but a lot of people dose off in the middle. We'll keep you sleepy and comfortable. We don't allow patients to lie there in pain." That was a small consolation to me. After that, I spoke to one of the nurses who would be assisting in my procedure. She pretty much gave me the doctor's pedigree-- how long he'd been doing this procedure, etc. She also had the unenviable task of telling me all the things that could go wrong. She told me the most common complication is bleeding, which she assured me, could be easily controlled. Perforation of the colon was another possible complication. But the nurse made light of these possibilities. "These complications are uncommon. We've done thousands of these procedures and complications occur in about 1% of cases. It's very safe." I told her "I don't mean any disrespect. But the last time someone told me how 'safe' something was, I ended up in the ICU with an internal bleed. So I think my worries are valid." Both nurses spent a long time talking with me about how safe it was compared to conventional surgery. They also told me that, if anything was found, it would  be removed on the spot. Then they walked me into the procedure room. The doctor was already there. He extended his hand to me and shook it. He was a rather good looking Russian doctor. He explained the sensations I would experience and told me not to worry about any beeping or ringing sounds I heard. Those were no cause for concern and were normal. Then the nurse put me on a table and another one put a blood pressure cuff on my arm. One of them also put three telemetry stickers on me to monitor my heart and breathing. A pulseoximetry device was put on my index finger. One of the nurses put a nasal cannula under my nose. It smelled faintly chemical. Then they helped me roll on my left side. I started to feel sleepy so I could tell that the Demoral had already been started. I guess they all felt that I was either asleep or so out of it that explaining things to me at this point would be pointless. While I was sleepy and feeling pretty trippy, I was aware that the doctor had pulled my gown open and had inserted a finger into my rectum. I was told that a rectal exam was part of the procedure, in order to test the muscle tone of my sphincter. As someone who has participated in quite a bit of anal play over the years, this wasn't exactly shocking. I could see behind me a little and I could see the TV screen. It had my name on the screen and the beginning of my colon could be seen. But I was afraid and didn't want to look. With that, the third part of my tri-fold fear came into play-- the fear that they might find something. The scope didn't hurt a bit. I could feel it snaking its way through, but it didn't hurt. What DID hurt was the gas they were filling my colon with. The colon is full of wrinkles and creases and these folds can hide potential problems so the colon is filled with air to smooth it out so that it can be more easily viewed. I can remember wincing a bit as the gas filled me up. It felt like vaguely sharp pains. I don't remember very much else. Unlike the rectum, which is full of nerve endings, the inside of the colon has no nerve endings so you don't feel anything. I discovered later that the doctor had removed four polyps during my colonoscopy. All of them were large. One was 4 cm (called "giant" in medical terms).I was worried that the really big one was cancerous. Having been through my own cancer scare in 1993, when I was diagnosed with complex endometrial hyperplasia with atypia, which resulted in me having a hysterectomy at age 32. I also had been through my sister's breast cancer. So I certainly knew more about cancer than I had known in 1988 when my mother's had been diagnosed. I was taken back to recovery and given something to drink. Then the doctor came back and talked to me about what he had found. He didn't seem particularly worried. At the time, I didn't know this, but I later learned that doctors can tell a lot about the malignancy of a polyp just by looking at them. I was still a little out of it so a lot of what he said didn't register. But he didn't seem particularly concerned. My friend, Kathy, came back and sat with me for a little while while I shook off the cobwebs. The drugs wore off quickly, one of the main reasons that "conscious sedation" is favored over general anaesthesia. I was soon getting dressed. Unfortunately, I either wasn't given my discharge papers or I forgot them when I went to get dressed. At any rate, I now had the rough week of waiting for the results of my biopsies. I tried to be positive and not live in fear. That weekend was rough. I had to work both Saturday and Sunday. On Saturday night, I spent the night with my friend from work, Lisa. She had recently had her own cancer scare and I figured she would be much more comforting and understanding than my sister or her husband. I'm pretty sure that my sister thinks I'm a hypochondriac. She thinks that if you ignore something it either won't happen or it will go away by itself. Weird but true. She hadn't wanted me to go to the hospital when I'd had my appendix out. So she wasn't going to feel very sorry for me while I waited. I started to get online and look at colonoscopy procedures and saw that many large polyps are removed by cutting them with a wire and then cauterizing the area to keep it from bleeding. I was shocked to learn that this procedure is painless. I prayed a lot. I knew that, whatever the outcome, everything would be OK. On Monday morning, I called the GI lab and told the nurse that I had either forgotten or lost my discharge papers and that I needed to know who I call for my results. She  said "Oh we call you." She volunteered to pull up my chart, which she did. She said "Well, all of your polyps were pretty big. One was in the rectum. But everything looks fine, The doctor didn't put anything in his notes that any of your polyps were cancerous. But the pathology report is due sometime midweek. Just try and relax and take it easy." While this was reassuring, it didn't alleviate all of my fear. I prayed a lot during the next few days. I tried not to let this uncertainty make me any more scared than I already was. I went to work everyday and didn't let my co-workers know what I was going through. I was off work Thursday and I somehow knew that that was the day the report was going to come. I had been having frightening thoughts and had just about convinced myself that I had cancer. All of the literature I was looking at online said that roughly 30 to 50% of polyps larger than 3 cm turn cancerous. I was pretty resigned to it. On Thursday morning at about 10 o'clock, the phone rang. I was alone in the house so if the news was bad, I would have no one to console me. I checked the caller ID and, sure enough, it was someone from the pathology lab. I said a quick prayer and answered it. The lady was very nice. She said "Everything came back benign so the doctor doesn't want to see you for three years." It was the best news I could have hoped for. I was shocked because now I had to entertain the thought that I had gotten really lucky. I had watched a video of Dr. Oz's colonoscopy and on it, his doctor had found a pre-cancerous polyp. Dr. Oz had decided to have this colonoscopy and film it to show people that it's not as bad as they think and he knew that that polyp was found by accident. Here's a doctor who supposedly lives a healthy lifestyle, who is constantly talking to overweight people on his show about the dangers of eating a certain kind of diet and about getting their weight down, etc. and he gets a bad report. I've been overweight, smoked, exercised little, eaten red meat and had a family history and I got the best report possible, despite having four large polyps removed.

I was really lucky. Doctors say it takes ten to fifteen years for a little polyp to develop into cancer. If my doctor hadn't insisted that I have this done, I don't know how long I would have put it off before I finally got around to doing it. The main thing is that I had it done, got the problem spots dealt with and now it's up to me to make the necessary changes to make sure that in three years when I go back to have this done again, the news is good again. I'm cutting back on eating red meat (one of the things they tell you helps grow them), drinking more water and exercising more and getting my weight down further. The other factors-- being over 50, female, and my family history-- are things I can't do anything about. But my weight and diet I certainly can change and I intend to. This was a wake up call for me. I'm asking all of my friends who are over 50 or who have a family history or who are having rectal bleeding that they are shrugging off as hemorrhoids, to please get a colonoscopy. It takes less than an hour for a doctor to look at the entire colon. It's an hour that could save your life.