July, 2007

Friday, July 27 - Thyroid

I had my one-year post chemo CT scan and a thyroid module was identified. As a result, I went to see an endocrinologist last Monday. Thyroid modules are quite common and usually benign. The general population has a .01% chance of having thyroid cancer, but I have a genetic mutation for colon cancer, which also means my chances are higher - 1% to 2%. Driving to the endocrinologist, I got quite scared and was sure I was going to get bad news. She said CT scans did not really provide a good picture of the thyroid and I am scheduled to have an ultrasound next week. She did a physical exam and said it was probably just a common, benign nodule. If that is so, then she indicated she would want me to be reviewed on a regular, yearly basis. I had been feeling doctored out, but perhaps the energy required by it all exhausted me. I seem to feel comfortable about accepting that more regular doctor visits are just part of what happens.

Friday, July 20 - Emotional Exploration

A fellow survivor wrote a good synopsis of what happens when you get cancer and why we often become activists in the arena: "I think it is important ... to keep integrating new experiences ... ; that way (you) get to control them, as opposed to the other way around. I think adulthood is defined by experiences which separate people into those who have had that experience and those who have not. Marriage, Divorce, widowhood, and cancer are clear examples of that. I think, with cancer, confronting not only mortality, but the possibility of living a life plagued by disabilities is life altering at it most extreme. "

Sponsored by Swedish Medical in Seattle, The 5th Annual PsychoOncology Symposium: Unspeakable Emotions: Love, Hate, Anger and Seduction in the Clinical Encounter was held earlier this year. The recorded lectures are now available online http://videomedia.swedish.org/Mediasite/Viewer/?cid=8b059584-adba-4209-b79a-04a60fb374f5


Monday, July 16 - Oncology Visit

Good news, neutral news. They say the more you go to doctors, the more you find out that you need to go. That's how it was today.

- Polyps. Good news. The five polyps from the colonoscopy are not an unusual occurrence. When they are very small, they take a while for them to become visible. The oncologist agreed with the GI doctor that I could wait 2 years for another colonoscopy, but will probably do it in a year and half to coincide with another upper endoscopy.
- CT scan-thyroid. The good news from the CT scan was "negative for locally recurrent disease or metastatic disease." However, the indeterministic news was a "stable, small thyroid nodule". Just to be cautious, I've been recommended to go to an endocrinologist. According to one web reference (www.endocrineweb.com/nodule.html), "Occasionally a thyroid nodule is found because the patient is undergoing a CT scan ... of the neck for some other reason ... Thyroid nodules found this way (by accident) are cancerous far less than 1% of the time." So I'm probably fine, but just one more thing to get checked out.
- CT scan-contrast. The other item from the CT scan was there was a small concentration of the contrast in a pocket in the stomach. Since I had an upper endoscopy (looking into the stomach) less than a year ago, it's probably nothing. The oncologist has emailed the GI doctor who did the procedure to make sure he agrees that this can wait until next year, when the next routine endoscopy is scheduled.

I appreciate the thoroughness of the oncologist and do know it's the right thing to always follow-up, but I just feel doctored out.

Thursday, July 12 - "Hoof" and mouth

My right thumb (which stopped working and I had surgery on in April) has almost full movement now. I still need to build strength and I cannot totally flex it up, but it's basically fine. I can write, play piano, etc. The loss of total flexing may be a result of the nerve virus that they think caused the original problem and total recovery could take up to two years. I saw the surgeon yesterday and he gave me my "release" papers. He said I could do whatever I wanted to with the hand (no 10 lb only lifting limitation) and I didn't need to go to physical therapy any longer.

I had the same reaction, but to a less intense extent, as I did when I finished chemo. I was elated that the chapter was over and my hand was better, but there's a let-down as your life is no longer organized around it. The waiting room has a jigsaw puzzle that people can work on and I stayed about an hour after the appointment, working on it and finishing it. It felt like I needed some closure.

I also have been feeling good enough lately to not be using food to deal with emotions. I've been back to eating nutritiously for over a week now and decided to reflect this commitment of taking care of myself to someone else, by agreeing to a monthly check-in with a primary care doctor. I feel like the effects of the chemo - both physically and mentally - are finally wearing off.

The biopsy report on the polyps removed came back and they polyps were benign - another hooray!!!

Saturday, July 7 - Post Colonoscopy

The results of my colonoscopy pretty much follow the lines of currently "no evidence of cancer" - o.k. for now, but wait and see. I had 5 small polyps removed, which for one year makes me feel scared that as I get older the growth will increase. Also, with the genetic mutation I have, you never know how really fast they can grow and one could become cancer sooner. I have to wait for the biopsy reports to make sure the ones removed are non-cancerous. I feel like I've gotten a stay of execution, so to speak, but next year might be different.

I noticed my anxiety over this in a few ways. The first is that I am posting more. It's a way for me to vent my emotions. Second, I was pretty calm about the colonoscopy, but right before I was put under I started crying and said I didn't want to have cancer. The third, was the follow-up phone call the clinic always does. I had forgotten they do this and when I heard it was the clinic, I thought the biopsy report must have come back and they had called to give me bad news, as they always call immediately when it is. The biopsy results take a few days, so it was just them checking up.

I was prescribed a different prep from previous times - Moviprep - and got quite sick from it. I was nauseous twice, even though they gave me meds. I was still "clean" enough, though, and the nurse said that each person is different in how much it takes. Someone commented that they initially thought it was "Movieprep" and the GI doctor was recommending movies to watch. I thought the movie Sideways for the position was appropriate, as was Cable Guy for the doctor.

Wednesday, July 4, 2007 - Western Diet

SOURCE: Abstract #4019 ASCO 2007 Gastrointestinal (Colorectal) Cancer Poster Display/Discussion Session - Stage III colon cancer patients who followed a "Western diet" with emphasis on red meat, fat, refined grains, and dessert were significantly more likely to have their cancer return that those who reported they ate a "prudent diet" with emphasis on higher intakes of fruit and vegetables, poultry, and fish. Patients whose diet most closely resembled the Western pattern and fell into the fifth quintile were nearly four times more likely to have their cancer return or die within 3 years that those in the first quintile who ate the most prudent pattern foods. Risk of dying or having cancer return was 3.91 times higher for Western pattern eaters. Recurrence risk was 3.14 times higher.

My weight remained the same during the first four months of chemo and then I put on about 20 lbs. This, I attributed to, a change in metabolism, but it has been about a year since completing and I've put on another 15 pounds. I know I am eating badly - the Western diet - that is described here - so not only am I heavier and have all those "body image" issues to deal with, but now am increasing my risk for a recurrence. I do all these things - surgery, chemo, tests - to reduce the risk, so why not have a better diet?

Wednesday, July 4 - Resources on-line

http://healthlibrary.stanford.edu/ - This is the home page to the Stanford University health library. There is an ebook link that has 1,000s of books on-line and a Medline link is to recent research, among other things.

http://www.mskcc.org/mskcc/html/11570.cfm - alternative medicine at Sloan Kettering

My yearly colonoscopy is tomorrow. I'm handling the anxiety by focusing on prep tonight.