Get with the program, Toe

I met with Dr. Oncologist on Friday to discuss the results of the colonoscopy.  She too was delighted that there was nothing to biopsy.  My elation faded, however, when she answered my question, "what happens if my colon is still glowing on the next PET scan?"  She said that that is when things get more complicated.  Either we continue to watch it, or if the region has increased in metabolic activity there might be some exploratory gut surgery in order.  Ugh!  I don't actually believe that this will be the outcome, but one never knows, does she?  So we'll just hope that the glowing colon will go the way of the glowing spine, lungs, and chest wall and stop glowing in time for the next PET scan.

My next PET scan is at the end of May.

In the meantime, a body part from the peanut gallery has decided to participate in the post-cancer fun times. I have been having an issue with the big toe on my left foot.  I wasn't even going to mention it in the blog, because I thought it wasn't cancer related, but the podiatrist has mentioned certain possibilities that close the gap between my big toe and cancer.  Gulp.

One day before we left for Santa Fe, I noticed that my big toe was hurting around the nail bed.  I thought nothing, literally nothing, of it.  It's a toe.  Also, sometimes things hurt periodically and then they stop hurting.  Right?  Surely you all have experienced some random pain somewhere in your body, and you don't know what caused it, and when you wake up the next morning it is better if not resolved entirely.  This was me and my toe.

Well, in Santa Fe it got worse:  redder, angrier, more painful.  ("More painful" is not a comment on the pain level itself, just a comment on an increase in pain.  I was not limping or anything).  So I soaked it in epsom salts and smeared neosporin on it.  No resolution.  As a side note, it is not an ingrown toenail because 1) I have good toe hygiene! and 2) the reddness is around the nail plate at the base of the nail, not the sides of the nail.  Also, there was no injury or incident that I remember between me and my toe.

Darn it if the thing hasn't been getting worse.  The pain has stayed at the same low level, but it is now a little bit black-and-blue under the nail bed while being red and inflamed on the nearby skin.  I took my audience with Dr. Oncologist on Friday as an opportunity to get her medical opinion on this 2-week-long toe issue, and she in turn sent me to Dr. Podiatrist.

Dr. Podiatrist has an excellent bedside manner, a soft spot for microbiology, and a gift for explaining the possible causes of and outcomes for my problem.  In short, I am a fan.  (Why couldn't HE have gone into gastroenterology?)  Unfortunately, my toe doesn't fit any textbook phenotypes, so he couldn't make a conclusion without a biopsy.  We agreed that it is a bit too soon to rush into a biopsy.  So I am on a course of antibiotics in case it is an infection, and I am to watch it for changes.

And here's where the connection is made to cancer:  his concern is that it could be a melanoma (skin cancer) that just happened to develop under my nail bed.  It happens, albeit rarely.  So if it suddenly becomes irregularly shaped or continues to increase in size, a biopsy of my toe and toe nail is in order.  I forgot to ask if this would have showed up on my PET scan a month ago.  Are my feet even scanned?  I have no idea.  

Also, who on earth has to worry about melanomas under their big toe nail?  Apparently the girl who had inflammatory breast cancer.

My preferred hypothesis is that it is an infection.  Cancer is still to blame for this possibility, I think, due to a continued weakened immune system.  Please join me in cheering on the powerful antibiotic cephalexin (I used this antibiotic to make discoveries in graduate school!) and hoping is makes it all the way down to the toe peanut gallery.  

What a ride

Before I forget, I have two more things to say about the colonoscopy prep.  1)  It dehydrates you.  This should be intuitive, since you are ingesting ungodly amounts of salts (laxative), but it's not because you are also consuming an ungodly amount of hydrating materials (liquid diet).  So try to drink EXTRA liquids despite the bloating and nausea and being just plain sick of liquids.  2)  Laxative-induced things do not stop coming out of your colon prior to the procedure.  I was feeling a bit embarrassed as I prepared to head to the clinic, stopping in the bathroom one last time at home in an attempt to evacuate things for the last time.  I wasted no time telling the nurse about this issue, in case the procedure would have to be rescheduled, but she said that this non-stoppage is the case with everyone.  The doctor will continue to suck out material during the procedure.

I would have been more comfortable, both physically and mentally, if I had known these two tidbits going in.  I hope they help you out someday.

On to the procedure itself.  The nurse insisted going in that I would be slightly awake but that I wouldn't remember anything.  Well, I have news for you, nurse:  if I'm awake, then I'm remembering.  Maybe not all of it, maybe not perfectly, but I'm remembering.  This is a well-trained steel trap up here (except when recalling movies--then it's an aluminum sieve).  And so it is with great delight that I report that I was awake during the whole procedure, and with a perfect view of the monitor!  I got to watch the camera go in, sucking up green slime along the way.  I got to feel the camera bending around the primary curves of my colon.  It tickled.  I heard the doctor ask about giving me more drugs (either percocet or fentanyl), but the nurse commented on my cooing, "Why?  It sounds like she's on a roller coaster!"  Dr. Gastroenterologist got the camera up to the proximal end of my colon very quickly, but he was slower on the way out.  There were several pauses to examine and photograph areas, followed by very swift movement to the next spot.  Then it was over, and without any pain or discomfort from the scope itself.  The nurse wheeled me to the recovery room and told me that I couldn't have anything to drink until I passed gas.  They pump a lot of air in there during the procedure so that things stay open.  So I rolled around until one enormous volume of air moved from within to without.  Then I got grape juice and hot tea.  My delightful mother-in-law helped me to get dressed while we waited for Dr. G.  In his street clothes, he came and gave us the report that there was absolutely nothing abnormal in my colon.  Huzzah!  I asked him whether there could be something abnormal on the outside of my colon that his examination would not have seen.  He said not likely.  Then I asked him what would happen if this same area shows increased metabolic activity on my next PET scan.  He said he wasn't sure, but I wouldn't be seeing him again.  He probably didn't use words quite so harsh, but this is the essence of what he said.  Then he backed out of the room as fast as he could.

Clearly he was banking on the fact that I wouldn't remember any of this.

Also, he gave me a sheet of paper containing 4 pictures of my colon.  Huzzah!  However, these were all stock positions of typical colon landmarks.  They were not photos of the region shown to be questionable on the PET scan.  What gives?  I could have told you that there was nothing wrong with my colon landmarks.  I want a picture of the questionable site.  Not seeing for myself the appearance of questionable sites is what got me into this mess in the first place (recall original ultrasounds of the left breast).

Needless to say, I was not very pleased with Dr. G.  But this shouldn't be surprising, because I'm rarely impressed with 1) procedural doctors (doctors who perform and bill by procedures), and 2) doctors I only meet once.

OH!  The nail in the coffin for Dr. G actually happened before any of these disappointments, right after I met him, right before he injected the drugs into my system.  I was lying on the procedure table, getting-to-know him, sharing the fact that I'm a microbiologist currently studying the microbiota of pigs.  I imagined talking a moment of shop with him, expressing our mutual affection for those amazing bacteria within.  Do you know what he said?  I was so upset that I don't remember it word for word, but here's the important part of the quote:  "...nematodes..."  NEMATODES!  Nematodes are WORMS, not bacteria!!!!  This calls for a survey of my non-scientist readers:  do you know that nematodes are not bacteria?  I don't care if you know nothing about either organism, but I'm pretty sure that you know that they are less related to each other than we are to primates.  Well, maybe you didn't know that analogy in particular, but now you do.

And finally, on to issues of recovery.  I am not feeling tip top today.  I worked almost a whole day, but came home early due to what I'm calling seasickness (nausea and dizziness) in addition to fatigue and tingly hands.  I called Dr. G's office but guess what?  Neither he nor his nurses work on Wed. afternoons, the day after their procedure day (shake head here).  I spoke with the gastroenterological nurse on call, and she told me to go to the ER because it sounded neurological.  Sigh.  So I hung up and called Dr. Oncologist.  She said to sleep on it and call her in the morning if it's not better.

In the interim I have come up with my own hypothesis:  low iron/malnourished.  This could lead to decreased hemoglobin in my blood, decreasing the oxygen to my brain and extremities (i.e. my phenotypes).  This would also make sense given the fact that I didn't eat for over 30 hours and my female parts are doing female things (i.e. my monthly bloodletting).  So I ate lots of green vegetables for dinner and I'll take my vitamin in the morning.  Maybe Dr. O will have other suggestions when I present this hypothesis.

Longest post EVER to say that my colon is FINE.  I will celebrate in due course, when I'm feeling better.  What an EXPERIENCE.

And while I was writing this, one of my favorite songs in the universe came on Pandora.  I hadn't heard it in ages.  So here it is for you.  "Into the mystic" by Van Morrison.  Turn up your bass.

                

Creating space within

I went to yoga last night, both to take my mind off of things such as colonoscopies and to get me out of the house during dinner (mmm...dinner).  As the class meditated, the instructor gave a little lecture on the space within our bodies.  Our bodies consist mostly of space, and it is important to nurture our internal spaces because that is where our pure potential lies.

If only she knew just how much space was being created in my body last night!

Whenever I ask seasoned people about the colonoscopy prep, they are quick to suggest tasty liquids or to reassure me that the procedure is no big deal.  However, they use hyperbole such as, "Get ready to be in the bathroom all night!" to explain what happens in between.  Naturally, the part that takes place in the bathroom is precisely what I am most concerned about.  Will drinking all of that liquid be uncomfortable?  Can I still read books to my kids, or will my Miralax-induced urges beckon me?  Will I literally be sitting on the toilet for hours?  Will I be able to sleep?

And so I have decided to make a Colonoscopy Prep Log (log!  ha!) to record the events, in case any of you are curious like me.  I'll try to keep this scientific and not gross.  All procedures are as prescribed by my as-yet-unmet gastroenterologist unless otherwise noted:

My assorted beverages and laxatives, posed with the colonoscopy brochure.

Eleanor investigated my pomegranate-ginger ale-laxative concoction, served up in a Capital brewery glass for moral support.

• 6:50  Took 2 stool softeners, 2 hours later than prescribed (hoped this wouldn't come back to bite me in the a$$) (ha!)
• 7:03  One hour later than prescribed (due to yoga).  Drank 2 capfuls of laxative (Miralax) mixed into ~8 ounces of pomegranate juice plus ~2 ounces of ginger ale.  Embarrassed to admit that it was delicious.  Felt optimistic for the next few hours.  Girls were very interested in what I was doing.
• 7:18  Drank the same concoction.  Discovered that it's easier to drink when it sits at room temperature (i.e. mix the next drink immediately after the previous drink, allowing it to sit on the counter during the interim).  Still optimistic.  Hungry enough that it seemed that 64 ounces would be no problem.  
• 7:43  Drank the same concoction.  Still optimistic.  A little burpy, presumably from the soda.  Started to feel a little full.  Pomegranate juice all gone, and tried to ignore the delicious pizza leftovers when opening the fridge to retrieve the next beverage.    
• 8:05  Drank 2 capfuls of laxative mixed into 8 ounces of apple juice plus 2 ounces of ginger ale.  Not as tasty as the pomegranate concoction, but still on the good side of tolerable.  Laxative intake 66% completed.  
• 8:23  Drank the same concoction.  Started to feel quite chilly.  Folded laundry to warm up.  Still a little burpy.
• 8:48  Drank the final juice/laxative concoction.  Body felt very, very cold.  Moved to the microfiber chair, with quilt and laptop warming my lap.  Thought about how easy it was to complete the beverage portion of the evening.  
• 9:24  Felt slightly nauseous.  Drank 2 cups of vegetable bouillon for a late "dinner" in an effort to settle the stomach.  Wished for a bowl of oatmeal.  
• 9:51  Bloated.  Sleepy.  Anxious to get this party started.
• 10:02  The party finally started.  
• In the bathroom at approximately 15-minute intervals for approximately 2 minutes at a time. 
• Persistent tummy rumbles a-la Harry in Dumb and Dumber. 
• Constant low-grade nausea, probably due to the hunger.
• Still cold
• 11:00 pm  Supposed to take two more stool softeners, but elected to skip it.  Nothing needs softening.  [Started to understand why my stepmom shrugged at some of the instructions:  how your own body responds to the treatment becomes clear (literally) as you work through the process.]
• 12:00 Lamented the wasted pomegranate juice.  At least it was on sale.
• Busy until my body allowed me to sleep at 1:00 am.  Hard to fall asleep out of fear of passing gas, which can no longer be trusted.  
• 6:50 am  Kiddos woke me up.  No longer bloated.  Still rumbly.
• 7:30 am  Drank 1/2 of a bottle of magnesium citrate (laxative #2, super gross).  Supposed to drink the whole thing at 5:30 am, but seriously, no more gut contents to shed.  [Plus, there is a little disclaimer on the instructions that if you have kidney disease, do not drink this stuff.  However, they offer no alternative procedure for the folks with kidney disease.  What gives?  Can this truly be required for someone who hasn't eaten in 24 hours, particularly knowing that there's a subpopulation with kidney disease who can skip it?]  
• 8:15 am  Drove kiddos to preschool.    

Rest of my morning:  Shower.  Knit through the tummy rumbles, nausea, and hunger.  Drink juice.  Think about attempting some science.  Walk to the clinic at noon.

My assessment of the prep is that it's annoying, but that's all.  The most annoying part is being in mental conflict with my bodily urges, primarily "Please please please, can't I eat just ONE cracker?"  But I'm on the home stretch.  Hopefully this truly is the worst of it, as people have counselled.

Prep for prep

Here we are at last, on the eve of Colonoscopy Eve.  Everyone tells me that the preparation for the procedure is worse than the procedure itself, so my efforts at mental fortitude are focused more on tomorrow than on Tuesday.  Then of course my efforts will shift to Friday, which is results day.

Tomorrow I am allowed to have a light breakfast, such as cereal or toast, and then I am to drink only clear liquids all day.  Jello and apple juice are allowed, but dairy and liquids with pulp are not allowed.  At the end of the day I drink 2 cups of laxative mixed with 64 ounces of a clear liquid of my choice.  This should effectively clear me out pretty rapidly.  But in case it doesn't, I am also to drink 10 ounces of bonus laxative in the morning.  Procedure doesn't start until 12:30.  Boo.

So what am I doing today, to prep for the prep?  Ian and I went out to brunch (thanks, dad and Barbara!) to the best restaurant in town.  I had quiche and fruit and salad and toast and potatoes.  And oh my goodness, it was the best brunch I've had since we moved from Madison (shout out to Cafe Continental, which sadly only exists in our memories).

Then we went to the store to buy the various laxatives and clear liquids.  We're not much of a juice family, as we prefer to eat our fruit rather than drink it, so we were truly in need of supplies.  When we got home, I decided to refrigerate some beverages but to keep some at room temperature.  I've been warned that drinking 64 ounces of laxative + cold liquids can make a person quite chilly, so I want to be sure that I have a range of temperature options.

With tomorrow's supplies ominously lined up on the kitchen counter, I decided to pre-medicate against tomorrow's liquid-diet weakness with a bike ride.  It is a glorious February day, with bright sunshine, sticky snow, and dry concrete.  I biked along the river, taking the same route that my family and I walked on New Year's Day.  I paused at a place where the river babbled over some rocks, listening to the crescendo of the wind as it gathered muster in the treetops.  This natural orchestra resonated with me as a metaphor for my first two months of 2012:  the constant bubbling of everyday life overlaid with occasional personal and professional uproars.  It was soothing and grounding--an empowering soundtrack that I will play in my head during the next week.