Friday, August 24, 2012

Post Treatment Colonoscopy: An Update

As reported in my previous entry, proton radiation permanently damaged a small segment of my colon. This diagnosis triggered an immediate research effort on my part. I am particularly interested in its long term implications. My research is incomplete and ongoing. In view of the potential interest to others, however, I feel compelled to file this interim report based exclusively on the opinions of Dr. A. N. Swer.
Dr. Swer is a practising physician with a Phd. in microbiology from Harvard University. His specialty is nuclear medicene. His interest in prostate cancer and proton therapy has been augmented by personal experience with both. Based on a photograph posted on the internet Dr. Swer's colon looks a lot like mine. In response to several of my concerns, Dr. Swer opined, in part, as follows:
"I would consider angiodysplasia to be the word for the tissue changes that are associated with radiation proctitis. Since the procedure that cured my bleeding, I have not worried about my angiodysplasia (which is likely worse than yours). My bleeding didn't start until many months after the treatment though I imagine that a great many men who have had photon or proton radiation for Pca have angiodysplasia of one degree or another and one pattern or another, with or without problems from it. I haven't seen a publication documenting this, however, I think it would be quite interesting ... I can't guarantee that you will never bleed, but also my guess is that area will never heal..."
"Radiation for Pca likely creates a small increase in the risk of cancer in tissues that it doesn't kill, including but not limited to the adjacent bowel. The overall increase is probably lower with proton than with photon therapy. That consideration goes in the plus column for choosing protons...
In short, I think your gastroenterologist is right on target, including scheduling you for follow-up colonoscopy; and my final word of advice, for what it's worth is: Don't worry."
Dr. Swer's expert opinion may not qualify as the clean"Bill of Health" I may have hoped for , but
it is not the proverbial "Kiss of Death" it could have been. More specifically my worst fears have been substantially amelioriated.In retrospect at this juncture the worst part of my colonoscopy mini-adventure is the complete absence of any expectation of permanent colon damage. None of my research before, during or after treatment prepared me for this outcome.

Saturday, August 11, 2012

Post Treatment Colonoscopy A Good Outcome With A Few "Inconvenient" Surprises

My colonoscopy uncovered a precancerous polyp which my physician removed as a matter of routine. This outcome was not unexpected, since I had similar results with my two previous colonoscopies five years and ten years hence. This was welcome news nonetheless because of the uncertainty introduced by the intervening proton radiation.

Thanks to my wife and her conscientous record keeping, I was able to compare the photographs of my current colonoscopy with those taken in 2006. What I saw caused concern. Comparatively the current photographs showed substantially larger and considerably redder blood vessels. In two of the five photographs, it appeared as if bleeding had occured. Accordingly I contacted by physician; the phone discussion developed as follows:

Comment: Please explain the differences between the current photographs and those taken in 2006.

Response: What you see is the result of radiation. Such damage to the colon is concommitant to all forms of radiation.

Question: Is there a difference between the effects of proton radiation and photon radiation?

Response: In my 30 years of practise you are my first patient to have undergone proton radiation. I would say that comparatively speaking you have a considerably milder version of what I typically see.

Comment: Two of the photographs were particularly red; please elaborate.

Response: Those particular areas appeared atypical and required a degree of probing and compression; consequential bleeding occured. No doubt these areas have completely healed by now and should not be a concern to either of us at this point.

Question: How much of my colon has been damaged?

Response: A very small segment in the area of the prostate.

Question: What kind of problems can I expect in the future?

Response: Inasmuch as you have experienced no problems in the past, e.g., spontaneous bleeding, it is unlikely you will experience any problems in the future.
Question: Is the damage to my colon temporary or permanent?

Response: I would be very surprised if it looked much different when we reexamine five years from now. I do not expect further deterioration nor do I expect much improvement.

In conclusion I would say (1) There has been permanent damage to a small portion of my colon that I did not expect based on my (limited) research to date and (2) It may be something or it may be nothing. Perhaps this entry will generate enlightened comment.