Tempus Fugit Iterum or Time Flies When You’re Having Fun, Part 2

Who would have thought there was so much information to share about colonoscopies? And who thought it would actually be interesting? Not me. But acting like a grown up and taking care of my health is both informative (We all know I research everything. It seems to be a compulsion.) and interesting. One site brings me to another.

colonoscopySince last week, I’ve gotten a few questions about the topic. One is how often should this be done? As we learned last week, most people – those without any risk factors – start at the age of 50. I started a bit later than that and had normal results, so was told I wouldn’t need one for another ten years. Yay!

That’s when things changed: sometime during the second decade after the first colonoscopy. This was almost five years ago.  The change was that several colon polyps were removed this time; some because they were bleeding, some because they were the larger kind that could become cancerous (adenoma).

Apparently, bleeding colon polyps are troublesome because they can be the source of your fatigue if you already have low levels of iron as most CKDers do. At least, that’s what my former nephrologist said. Although they were bleeding, removing them did not stop the fatigue.  Maybe it was the sleep apnea…or maybe it was just plain being a Chronic Kidney Disease patient.Bleeding

Now, about that adenoma. AboutHealth at http://coloncancer.about.com/od/glossary/g/Adenoma.htm defines an adenoma in the following way.

An adenoma is a pre-cancerous (benign) growth that may occur in the colon. Adenomas arise from or resemble glands and can lead to colon cancer. This means that if left untreated, some adenomas eventually will develop into colon cancer. If an adenoma becomes cancerous, it is called an adenocarcinoma. Fortunately, adenomas typically are easy to find and to remove before they become cancerous, during routine colon cancer screening tests, such as adenomaa colonoscopy or a flexible sigmoidoscopy.

The American Cancer Society at http://www.cancer.org/cancer/news/specialcoverage/7thingstoknow has an easily understood, easy to read explanation of the whole process of colonoscopy and explains more than I have here.

While it sounds like an awful procedure, more often than not, you’re anesthetized first, both to make sure you don’t move (which might cause a perforation) and for your own comfort.

You are a medically comprised patient.  I’ll repeat that – you are a medically comprised patient.  As such, you need to be treated differently as far as anesthesia. Two things are very clear about anesthesia for us.

  1. The dosage of the anesthesia may have to be modified and
  2. You must let your doctor know on your first visit that you have Chronic Kidney Disease.

I was both disgusted and fascinated by the photos my gastroenterologist sent me after the procedure.  I saw the colon polyps.  I saw the inside of my colon. I simultaneously wanted to get as far away from those revolting pictures as I could AND examine them carefully to see just what was going on inside me.

I keep using the term colon polyp, but haven’t explained it yet. MedicineNet at http://www.medicinenet.com/colon_polyps/article.htm#what_are_colon_polyps will help us out here.

Colon polyps are growths that occur on the inner lining of the large intestine (colon) and usually protrude into the colon. Polyps form when the genetic material within the cells lining the colon changes and becomes abnormal (mutates). Normally, the immature cells lining the colon are programmed to divide (multiply), mature, and then die in a very consistent and timely fashion. However, the genetic changes that occur in the lining cells prevents (sic) the cells from maturing, and the cells do not die. This leads to an accumulation of immature, genetically abnormal cells, which eventually results in the formation of polyps. The mutations may occur as a sporadic event after birth or they may be present from before birth.

I’ve got to be honest. I don’t care how I got mine. I.simply.want.them.gone. It’s come home to me lately that I am closer to 70 than 60. It’s also come home to me lately that I love my life and want to keep it as long as I can.IMG_2867

Last week, I touched on the prep having to be tailored for your CKD, too. Here’s a warning from The National Kidney Foundation at https://www.kidney.org/atoz/content/oralsodium

Patients with chronic kidney disease (CKD) who use bowel cleansing products should be aware of a recent warning issued by the FDA for a type of sudden loss of kidney function or acute kidney injury, as well as, blood mineral disturbances. Phosphate crystal deposition in the kidneys causes the loss of kidney function, which can lead to kidney failure. The medical term for this condition is acute phosphate nephropathy.

The warning relates to the use of bowel cleansing agents, called sodium phosphate (OSP) products as laxatives or in preparation for colonoscopy. OSPs are available both with and without a prescription and are taken by mouth. These products can cause phosphate nephropathy.

On the other hand, The National Institutes of Health at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678056/  has suggestions, although the parentheses are mine.Miralax

For early chronic kidney disease, PEG (4 L polyethylene glycol) or SPMC (2 L sodium picosulphate plus magnesium citrate) are acceptable. Cases with late chronic kidney disease without dialysis should be prescribed with PEG or PEGA (2 L PEG plus ascorbic acid). SPMC have a risk of hypermagnesemia in patients with kidney disease without dialysis.

Obviously, that’s something to discuss with your nephrologist. By the way, one polyethylene glycol product is Miralax, an over the counter medication. The picture above does not indicate an endorsement of the product.

What is itHere I am in NYC, not spending all that much time thinking about CKD except for the sleep, diet, exercise, and lack of stress (nothing else, though) and having a grand old time with my daughter. In other words, I haven’t paid any attention to the GiveAway for What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. That’s the book Geo was reading in last week’s blog. Do let me know if you’re one of the winners so we can celebrate you.

Oh, and don’t forget about that book’s twin younger siblings.IMG_1398

Until next week,

Keep living your life!

Time Flies When You’re Having Fun

IMG_1625Last week, Bear and I were in Las Vegas for a mini-family reunion. It was my mother’s nephew’s… let’s just say it was a combination of blood relatives and those we consider relatives without the blood connection.

What with the complimentary hotel room at the absolutely gorgeous SLS (which we understand was formerly the Sahara) and the gift of tickets to the outrageous show ‘Diva’ (male impersonators of female celebrities), an edifying tour of The Neon Boneyard, a family Las Vegas style buffet at Red Rock Casino, and a leisurely stroll down the overly-stimulating Fremont Street, we had a wonderful time.

I even got in my usual 20 minutes of gambling. I don’t really have tolerance or a liking for it, but it seemed the right thing to do since that was why the hotel gave us the two nights gratis. I won.IMG_1638

But in another way, I lost. My cousin Amy wasn’t there. She was part of this family. Her husband was there. Her uncle was there. Her mother and brothers were, but she wasn’t.  Three years ago she died of cancer.

She died within one week of my dearest, closest buddy on earth who also died of cancer. My buddy died of colorectal cancer. She’d refused any contact with the medical community for the last decade of her life and she paid the ultimate price for it.  A colonoscopy could have saved her life.

Almost five years ago, I had a colonoscopy… and now it’s time to have one again.  While this is not my favorite activity, I am willing to do so since cancer runs in my family and I’ve already had a bleeding polyp. These are not issues I usually share and, yes, it’s a bit awkward for me but if I can convince even one person who’s presently nauseated just thinking about colonoscopy to have one, it’s worth my personal discomfort.

While the term is becoming common, not everyone knows what a colonoscopy is. WebMd at http://www.webmd.com/colorectal-cancer/colonoscopy-16695 explains.

colonoscopy Colonoscopy is a test that allows your doctor to look at the inner lining of yoularge intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcerscolon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected (biopsy) and abnormal growths can be taken out. Colonoscopy can also be used as a screening test to check for cancer or precancerous growths in the colon or rectum (polyps).

The colonoscope is a thin, flexible tube that ranges from 48 in. (122 cm) to 72 in. (183 cm) long. A small video camera is attached to the colonoscope so that your doctor can take pictures or video of the large intestine (colon). The colonoscope can be used to look at the whole colon and the lower part of the small intestine. A test called sigmoidoscopy shows only the rectum and the lower part of the colon.

Before this test, you will need to clean out your colon (colon prep). Colon prep takes 1 to 2 days, depending on which type of prep your doctor recommends. Some preps may be taken the evening before the test. For many people, the prep for a colonoscopy is more trying than the actual test. Plan to stay home during your prep time since you will need to use the bathroom often. The colon prep causes loose, frequent stools and diarrhea so that your colon will be empty for the test. The colon Normalprep may be uncomfortable and you may feel hungry on the clear liquid diet. If you need to drink a special solution as part of your prep, be sure to have clear fruit juices or soft drinks to drink after the prep because the solution tastes salty.

You have CKD; this is not the prep you will be using.

The National Institute of Health at https://www.nlm.nih.gov/medlineplus/colonoscopy.html suggests you have a colonoscopy for the following reasons.

  • To look for early signs of cancer in the colon and rectum. It may be part of a routine screening, which usually starts at age 50.
  • To look for causes of unexplained changes in bowel habits
  • To evaluate symptoms like abdominal pain, rectal bleeding, and weight loss

Let’s talk about prep a bit more. You cannot take the usually prescribed Fleet enemas or anything with oral sodium phosphate. Get it?  Sodium?  Phosphate?  Both bad news for CKDers.  One possible alternative is a polyethylene glycol (PEG) solution such as Miralax.  As usual, check with your nephrologist.

DucolaxDucolax is also often prescribed as prep for the procedure, but everydayhealth.com at http://www.everydayhealth.com/drugs/dulcolax-laxative makes clear it’s not automatically safe for CKD patients. (Bisacodyl is the compound name; Ducolax is the brand name.)  Take note of the first item on the list.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use bisacodyl:

  • kidney disease;
  • trouble swallowing;
  • a history of bowel obstruction, diverticulitis, ulcerative colitis, or other intestinal disorder; or
  • if you are taking a diuretic (“water pill”).

This is decidedly turning into a two part blog.  More on the curiously challenging concept of colonoscopy next week.

We’re not the only ones who took a vacation. Here’s a picture of the man behind the title of Loyal Reader, Geo De Angelo, on his vacation:

003

Meanwhile, back at the ranch (better known as my office), I wonder if you’re one of the winners in the GiveAway for What Is It and How Did I Get It? Early Stage Chronic Kidney DiseaseWhat is it. You know, the GiveAway in which I paid for ten of each eighth book bought. If you are, please announce yourself either here in the comments section, on the Facebook page – https://www.facebook.com/WhatHowearlyCKD – or on Twitter @SlowItDownCKD so we can publicly congratulate you. If you haven’t seen the GiveAway yet, you can at http://www.amazon.com/What-How-Did-Get-Chronic/dp/1457502143/ref=sr_1_1?ie=UTF8&qid=1445197041&sr=8-1&keywords=What+Is+It+and+How+Did+i+gET+IT%3F+Early+stage+chronic+kidney+disease.

If you missed it, no worries.  I’m presently working on a different sort of GiveAway with a certain Facebook Kidney Disease Support Group.  More on that next week when I have all the details. Oh, and let’s not forget about the twins (presently being indexed) …IMG_1398

Until next week,

Keep living your life!

This One’s For Cheryl… And Amy… And…

It’s true, the world is a sadder place these days.  Two dynamic women have lost their lives to cancer this week, and both of them touched me.  One fought valiantly until there was nothing more to fight with. One didn’t. The end result is they’re both gone.  The cause of their deaths? Cancer.

I simply accepted that Cheryl Cook Vincent and I would grow to be outrageous old ladies together.  Now my partner in crime is no more and I am so sad. I cannot think of a single purpose her death served.

Or maybe I can. Let’s take a little detour from the usual ckd related material and talk about cancer.  It’s my way of honoring both Cheryl and my cousin, Amy Bernard-Herman.

Cancer is defined by the World English Dictionary as, “any type of malignant growth or tumour, caused by abnormal and uncontrolled cell division: it may spread through the lymphatic system or blood stream to other parts of the body.”

One of these women went to her doctors regularly; the other hadn’t been in decades. Had she gone, she would have been told pretty much the same as the one who did.  Cancer is treatable in the early stages, sometimes even curable as with skin cancer, the most common form of cancer.  Sometimes, it is not as with some breast cancer which is the second leading cause of cancer deaths in women. For men, the second leading cause of cancer is prostate cancer.

It seems that cancer really covers over one hundred different diseases rather than just being a disease all by itself according to medterms (http://www.medterms.com/script/main/art.asp?articlekey=2580). Even though it may appear in different parts of the body once it’s metastasized (spread), it’s referred to by the site where the tumors first appeared.  For example, back in 1988, my father died of pancreatic cancer.  The cancer had metastasized throughout his body by the time he died, but it was still referred to as pancreatic cancer.

Being an English teacher and a writer, I wanted to know why it’s called cancer. I found the most informative answer to my question at: http://wiki.answers.com/Q/Why_is_the_disease_cancer_called_cancer. Basically, the tumors themselves have a crab like appearance.  In the zodiac, the crab is called cancer. I enjoyed the etymology more than I should have, but that’s my ‘thing’ so I won’t bore you with it here.

Colon cancer caused Cheryl’s death, directly or not. How could she have known she had this disease? According to the Mayo Clinic, these are the symptoms (although the disease may be asymptomatic in the early stages in which case a colonoscopy would have detected it):

  • A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
  • Unexplained weight loss
  • Rectal bleeding or blood in your stool
  • Persistent abdominal discomfort, such as cramps, gas or pain
  • A feeling that your bowel doesn’t empty completely
  • Weakness or fatigue

Their address for more colon cancer information is: http://www.mayoclinic.com/health/colon-cancer/DS00035.

You may need a reminder as to just what these parts of the body are.  According to WebMD, who also provided the picture, the colon is the last part of the digestive system.  This is where fluid, salt, and some nutrients are removed from your body’s wastes as the digestive process occurs.  Peristalsis, or the movement of the muscles lining the colon, helps with this.  You can read more about this at: http://www.webmd.com/colorectal-cancer/default.htm.  The rectum is the last four inches of the colon, ending with the anus.

Cancer has stages just as CKD does. MedicineNet has a better explanation of just what this is and why it’s done than I could have come up with: “The stage of a cancer is a measure of the extent to which a cancer has spread in the body. Staging involves evaluation of a cancer’s size and its penetration into surrounding tissue as well as the presence or absence of metastases in the lymph nodes or other organs. Staging is important for determining how a particular cancer should be treated… cancer therapies are geared toward specific stages. Staging of a cancer also is critical in estimating the prognosis of a given patient, with higher-stage cancers generally having a worse prognosis than lower-stage cancers.”  They are on the internet at: www.MedicineNet.com.  You’d have to know which type of cancer you are dealing with since there is no general cancer site at this address.

Cheryl told me she could never do what I did.  She was talking about researching my diagnosis, writing a book about it, and urging all others with chronic kidney disease to pay attention to their condition.

After having to research each sentence of this blog, I see what she meant. It was heart wrenching.

And I never got to tell my most excellent buddy that I was able to raise my eGFR from 50 to 60 in just three months. She would get so excited about good medical news for me whether she understood it or not.

Rest in peace Cheryl… and Amy… and every other person who has died of cancer.

To those of you who remain behind, I offer you every bit of good energy I can find. After all, if we’re not here to help each other, why are we here?

No book news today, folks.

Until next week,

Keep living your life – for yourself and those around you.

Published in: on October 15, 2012 at 11:13 am  Comments (5)  
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The Thing You Don’t Want to Talk About

It’s sure not the screening of “The Final Contract!”  That was last Wednesday night. You’ve probably seen it on What Is It And How Did I Get It? Early Stage Chronic Kidney Disease’s Facebook page, but do you know it won a Gold REMI Award? If you get to see it, I play Anne Howard – a supporting role in this independent Christian film.  I’m Jewish, but have no problem with the film’s message of hope, family and freedom of speech.  These Five Talent Films are my payback for all the good fortune I’ve had since moving to Arizona (yes, I do remember I have CKD, but that is not my whole life).

According to Wikipedia, The Remi Award is inspired by the creative genius of the western artist Frederic Remington, famous for his paintings and sculptures of cowboy life in Texas and The West. [Well, that’s appropriate since the movie was filmed in Arizona.] The Grand Remi Statuette is presented for the top award in each major category. The Special Jury Awards are Grand Remi Nominees, they are the highest awards for creative excellence in each major category. Then the Platinum, Gold, Silver and Bronze Remi Awards are 1st, 2nd, 3rd and 4th place in each sub-category. There are ten major competition categories that can win the Remi Award; Shorts, Features, TV Productions, Student Productions, TV Commercials, Experimental, New Media (including Interactive and Websites), Music Videos, Unproduced Screenplays and Film & Video Production (which includes Documentaries of various genres). WorldFest receives a total of more than 4,500 category entries in all ten categories.

Thank you for being my cheering squad Kelly, Bear, Amy, an acting friend –Nancy Panossa, Michelle & Ed Davis, and Carleta and Gilbert who are so newly married that I don’t know their last name yet. Notice the cast of characters here is entirely different (except for Bear, but he’s my person) than that for the premiere. My person took a picture of me all gussied up – something I rarely am in our hot state. In the picture, I’m showing off my nails which were done to match my dress.  What fun!  (Can I remove the nail polish yet?  This is not in character for me!)

But enough about me, as an unnamed celebrity often says.  So, what is it you never want to talk about?  Your colonoscopy, of course. This is something readers have asked about and it’s time to deal with it, unsavory thought or not. If this is a new word for you, once you read WebMD’s description, you will realize why no one ever wants to talk about this:

Colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected (biopsy) and abnormal growths can be taken out. Colonoscopy can also be used as a screening test to check for cancer or precancerous growths in the colon or rectum (polyps).

The colonoscope is a thin, flexible tube that ranges from 48 in. (122 cm) to 72 in. (183 cm) long. A small video camera is attached to the colonoscope so that your doctor can take pictures or video of the large intestine (colon). The colonoscope can be used to look at the whole colon and the lower part of the small intestine. A test called sigmoidoscopy shows only the rectum and the lower part of the colon.

Before this test, you will need to clean out your colon (colon prep). Colon prep takes 1 to 2 days, depending on which type of prep your doctor recommends. Some preps may be taken the evening before the test. For many people, the prep for a colonoscopy is more trying than the actual test. Plan to stay home during your prep time since you will need to use the bathroom often. The colon prep causes loose, frequent stools and diarrhea so that your colon will be empty for the test. [Delightful prospect isn’t it.] The colon prep may be uncomfortable and you may feel hungry on the clear liquid diet. If you need to drink a special solution as part of your prep, be sure to have clear fruit juices or soft drinks to drink after the prep because the solution tastes salty. [You have CKD; this is not the prep you will be using.]

The National Digestive Diseases Information Clearinghouse (NDDIC) at The National Institutes of Health (NIH) says this about when to start being tested:

Routine colonoscopy to look for early signs of cancer should begin at age 50 for most people— [Don’t you just love these gifts that come with getting older?] earlier if there is a family history of colorectal cancer, a personal history of inflammatory bowel disease, or other risk factors. The doctor can advise patients about how often to get a colonoscopy.

Their material about colonoscopy is well worth looking at, but you need to remember you have CKD and so, cannot take certain substances in preparation for your colonoscopy. You cannot take the usually prescribed Fleet enemas or anything with oral sodium phosphate. Get it?  Sodium?  Phosphate?  Both bad news for CKDers.  One possible alternative is a polyethylene glycol (PEG) solution such as Miralax and (I think) Ducolax.  As usual, check with your nephrologist.

This is the link to NIH’s information on this subject: http://digestive.niddk.nih.gov/ddiseases/pubs/colonoscopy/

During my own colonoscopy last year [yay!  I’m home free for nine more years since it’s suggested the test be performed every ten years], several polyps were removed; some because they were bleeding, some because they were the larger kind that could become cancerous (adenoma). Apparently, bleeding polyps are troublesome because they can be the source of your fatigue if you already have low levels of iron as most CKDers do. At least, that’s what my nephrologist said, but I’m still tired (sleep study coming up next month).

More often than not, you are anesthetized before the procedure, both to insure you do not move which might cause a perforation and for your own comfort.  You are a medically comprised patient.  I’ll repeat that – you are a medically comprised patient.  As such, you need to be treated differently as far as anesthesia. I have to admit that the research I found was far too medical for me.  BUT two things were very clear: 1.The dosage of the anesthesia may have to be changed and 2. You must let your doctor know on your first visit that you have Chronic Kidney Disease.

I was both disgusted and fascinated by the photos my gastroenterologist sent me after the procedure.  I saw the polyps.  I saw the inside of my colon.  And I was aghast to realize it looks just like a winding slide at a water park.  Once I stopped laughing, I was able to really take a look.

That’s the end (couldn’t resist that pun) of this column.

Until next week,

Keep living your life!