WA5IYX

1986 Medical Update
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A barium enema was done Oct 19, 1981, with normal results.

In December, due to a very low platelet count (some suspected it was a lab
error) the chemotherapy was delayed a week.

Chemotherapy was discontinued in January 1982 (a little more than half of the
regimen).  The side effects were just getting a little bit worse and lasting
a little bit longer each time.

This combination (3 drugs) chemotherapy was only experimental for those with
a colon Dukes B or C classifcation.  It was being evaluated as a surgical
adjuvant.

A colonoscopy done June 1, 1982 was normal.

A liver-spleen scan (Aug 3) and full bone (Sep 23) were nominal.  There was
a slight enlargement of one of the liver lobes and some of the blood liver
enzymes were elevated.  One doctor said from that he suspected that I might
have had a case of hepatitis.  (If I had, it was subclinical, i.e., no
symptoms.  Maybe all the blood transfusions - but they are supposed to be
checked for that.)

Some higher enzyme levels could also indicate liver damage caused by tumor
spread to it.  However, other enzyme levels were normal.  Considering later
blood tests, it would seem that these higher levels are "normal" for me (as
they haven't risen).

April 1983 brought a blitz of tests: liver-spleen scan, bone scan, and
colonoscopy.  All of which turned out to be normal.

There have been suggestions that I take a barium enema instead of the
colonoscopies.  Some doctors consider the tests complimentary (i.e., each can
find things the other doesn't).

However, I have several reasons for opting for the colonoscopy.  I'd had a
diagnostic BE in Feb 1981 which only showed that "enlarged ileocecal valve"
which later had to be pinned down as a tumor with the colonoscope.  However,
the major factor is discomfort - there is absolutely no sedation for the
barium enema (feeling like you have a doorknob to pass for the 20-30 minutes
the exam takes).  I figured with half of my colon gone the BE would be a much
shorter examination - it didn't seem a bit!  My hemorrhoidal condition doesn't
make this any better.

Also, if anything abnormal was detected by the BE, they would still have to
do the colonoscopy to get a more detailed view of the situation.

This was still the proceedure of my choice even though it called for about
a 2-day clear-liquid diet preparation and an overnight stay in the hospital
(for laxatives and enemas).  (While the barium enema was done on an outpatient
basis with only a one day use of laxatives at home.)

The April 1983 colonoscopy, instead of using saline enemas, used the oral
ingestion of it.  Rather than be intubated with an NG (nasogastric) tube, I
tried again to do this by mouth.  And as in 1981, I couldn't keep up a fast
enough pace.  So after about 3-liters of it, they put the lubricated tube in
(which has to be experienced, not described!).  In this case I think they
actually used a large and rather stiff suction tube (like I had post op. in
1981) rather than the smaller and more pliable tube used for feeding.

Of course once it's in, it's a fast and very effective way to clean out your
system (running in and out virtually simultaneously).  This 0.9% saline is
what is known as isotonic (i.e., same salinity as the blood plasma).  In that
way it is not absorbed thru the stomach or the intestines but simply flushes
out the digestive tract.  (If it were too high a salinity it would draw water
from the plasma and lead to dehydration.  If it were too low, the blood would
absorb it only to be dumped out by the kidneys as excess urine.  Either way
the desired "flushing" action would not be achieved.)  All told, about 3 hours
to get things done (vs. all night in 1982 with the enemas).

This is much more complete a cleansing than the enema approach, since in that
method there is always new material "dribbling" in from the unaffected small
intestine.

The colonoscope does have irrigation and suction channels in it as well as
the illuminating and return fiber optic bundles and a biopsy channel - a lot
in a tube about the size of a finger!  No wonder the instrument costs about
$20,000.

My next scheduled colonoscopy would have been Feb 21, 1985.  However, I came
down with the flu (with temp. to 102) and that had to be cancelled.

Due to the federal limits put on funding diagnostic routines, the colonoscopy
is now done on an outpatient basis.  The same 2-day liquid diet restriction
with the laxatives and enemas administered at home before you arrive for the
examination.

With only half a colon, the colonoscopy is a much quicker exam (maybe 15-20
minutes; being partially sedated, it's hard to tell) without the difficult
hepatic flexure to negotiate (i.e., where the transverese - horizontal portion
- becomes the descending - cecum - on the right side.

The latest colonoscopy was done on Jan 6, 1986.  This was done on an
outpatient basis, with the nominal appointment for 7 am.  Things finally got
around being done near noon.  It actually took longer to find a suitable vein
on my arm for the I.V. catheter insertion than the exam!

The 10 mg Valium (injected into an I.V. port) was effective (I wondered why I
was smelling an acetone-like odor -- it was what I was exhaling from the
injection!).  I was given a brief view thru the colonoscope again (just the
pinkish mucosa this time).

The exam was thus nominal (i.e., no abnormal findings).
