Friday, February 26, 2021

A Recent Exchange of Emails Between a Fellow PCa Warrior and Yours Truly

  Don:

I keep up with your blogs.  I hope you are doing well and have completely healed from your injury.

Here is some information you may find interesting regarding UFPTI and proton radiation}

It will be 9 years in August since I had 39 radiation exposures.  My primary care physician decided I needed a colonoscopy.  I went last Thursday.  The physician was UNABLE to perform the exam.  It seems the radiation from the proton beam has caused adhesions in the sigmoid colon (either just past the rectal/sigmoid junction or near the descending colon).  The colonoscope was unable to bend its way through the colon since the radiation has made a section of the colon stiff.  The region cannot flex enough to allow the scope to pass through.  No amount of maneuvering would work to loosen the fold.  The physician could not attempt to force the scope through for fear of puncturing the colon.

I am having a barium enema (with air contrast) on March 8th in order to see if there are any polyps present.  I have had two polyps in the past 20 or so years.  Now, the real issue is just how on earth does a physician get INTO the colon to remove a polyp that shows up on the x-ray?  He certainly cannot enter through the rectum.  It looks like the only way to accomplish this feat is to drill a few holes in my abdomen, inflate the region, and then slice into the colon to allow a scope to snare and remove the polyp.  Of course the colon will have to be stitched, running the risk of a future blockage from scar tissue or suffering through an infection if the sutured area leaks.  

I have NEVER found any literature on this issue.  I know the institute never suggested this was possible.  Have you ever heard of it?

I am now 75.  My thought is this:  If by chance there are no polyps present I am not going to go through a barium enema experience for years.  Even if a polyp is found down the road, it will take 10 years for it to develop into cancer (if that ever occurs - a majority of polyps do not become cancerous).

If there is one or more large polyps found in the upcoming exam, I will have to decide if I want them out.  Keep your fingers crossed that none are found.

Take care. Les

Les

Always good to hear from you. I continue to make progress on my rehab., but never fast enough despite several months of physical therapy and daily home exercises. 
To date I have not heard of the colon problem you are experiencing. You seemed to be doing so well except for a chronic  (non-worrisome?) bleeding problem. I am surprised and concerned about  what you describe. It's your turn to keep me posted.
 Until recently I had been undergoing an annual colonoscopy. My proctologist usually detected a few benign polyps which he removed as a matter of routine. About two years ago he decided no further colonoscopy's would be necessary on the premise that at age 83 in all likelihood I would die of something other than colon cancer. I elected to rely on his judgement rather than seek a second opinion. Prior to this appointment I had begun to experience chronic constipation. Without indicating this was due to age, radiation or a combination thereof, he suggested I would need to control this as best I could with over the counter medications. I wish it were different, but so far so good.
 In retrospect it seems possible that the urologist who diagnosed my PCa knew a little something when he advised me that radiation is the treatment choice that keeps on giving.
 Here's wishing you the best. As indicated I would very much appreciate updates as you proceed.
Regards Don

Hey Don

I completed the barium enema with air contrast on March 8th.  It was a miserable experience.  Think of it as one round of proton radiation with the balloon, but it lasts 35 minutes.  At least for me it was extremely uncomfortable.  The good news is there are not any side effects to the exam, other than waiting for the colon and rectum to return to normal after a few days.

No additional polyps were found in the exam.  No news could be better than that.  I met with the physician assistant on Monday to discuss the findings and a future plan of action.  Since there was one polyp removed during the attempted colonoscopy, the physician and the PA want me back in 5 years for another exam.  The polyp that was removed was benign.  Both recommended another barium enema.  I asked the obvious question:  What happens if a polyp is located in the descending, transverse, ascending, or sigmoid colon that cannot be reached by the colonoscope?  The answer:  They call in a surgeon who bisects the colon and removes the polyp.  I explained to the PA that I will be 81 at the next go round.  I am not inclined to have my colon bisected and surgically repaired to remove a polyp.  Since I have had 2 polyps in 25 years located in the sigmoid/rectum area of the colon, and both were benign, I would prefer to only have a sigmoidoscopy when I am 81.  If there is a polyp present in an unreachable area, it is going to take it 10 to 15 years to be large enough to possibly become cancerous.  Since a majority of polyps are (1) located in the left portion of the colon which includes the sigmoid and rectum and (2) most polyps never become cancerous, I am willing to take my chances.  I can see much more potential harm coming to me by having to sever the colon and reattach it through a surgical procedure.  The PA agreed.  I will have a sigmoidoscopy in 2026.

Assuming you were in the same situation Don, what would you have opted to do?  I want to be sure my thinking has sound logic to it.  

Trust you are doing well.

Les:
"Return in five years" sounds like near perfection to me.
You appear to have analyzed your situation as well or better than any of us could.
Here is my advice, as if you needed it, return to your way of life and continue to make the best of it.
Stay in touch, take care and best wishes.
Don

Thanks Don.  You have sent reassuring words for almost 10 years now.

Take care and stay in touch too.

Les

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