Unexpected consequences

Unexpected consequences can be rather scary. On the other hand, they can also be rather sweet. In case I haven't mentioned it before, leukemia was not my first cancer. In 1996, I was diagnosed with colon cancer. Unlike my journey through leukemia, the road back to robust health from colon cancer was a one and done. Fortunately, I had watched all the Public Service Announcements on TV as a kid, and when the telltale sign of CC (blood in the stool) reared its ugly head, I hied myself to the doctor very early. He ordered a sigmoidoscopy (a kind of junior colonoscopy that focuses on the sigmoid colon near the tail end of the colon). 

Being naturally curious and having a background in a health science, I asked to watch the monitor during the procedure. Eww, right? Well I have also watched my own knee surgery among other things, and somehow I am able to disconnect my mind from the fact that it is my body that is being invaded and view the proceedings like a medical student sitting in the gallery of a surgical theater. 

When I saw the cancerous lesion in my sigmoid colon, I knew precisely what it was...well, I had a good idea at least. My vision was good in those days, but not as good as that of a pathologist looking through a microscope. After the sigmoidoscopy, my PCP, who had performed the examination, hemmed and hawed trying to tell me but not wanting to say what he was pretty sure it was. Now, I had always thought that, if anyone ever told me I had cancer, I would just collapse. But as he struggled, I told the doctor that I was pretty sure I knew what he had seen, and I asked the logical question: "So, what are we going to do about it? "

I won't bore you with all of the details, but within about 10 days I had a colectomy, an operation that removed about eight inches of my colon. Several lymph nodes were also removed and after pathologic examination I was pronounced free of colon cancer. 

The legacy of that experience is that I have had colonoscopies regularly for the last 29 years, the most recent of which I endured today. A few years ago, I had some tummy complaints and called my favorite GI doctor, for an appointment. I was shocked and disappointed to learn that he was no longer working with Kaiser Permanente Northwest. Now, I have had very few untoward experiences at the hands of the Kaiser medical staff, but when you find a doctor who strikes you as a cut above his peers, well, you try to hang onto him/her. Dr Eickhoff is that kind of doctor. 

The Lord smiled on me (again!!), however, when I was given an appointment with Dr. Speer. I told him today that Dr. Eickhoff was almost as good as he is. He replied, "I'll bet you tell that to all the young gastroenterologists."

Based on my age and then current complaints, Dr. Speer planned to do not only a colonoscopy but an esophagogastroduodenoscopy as well. What the...?? It is essentially the same thing as a colonoscopy except starting at the other end; it is an inspection of the esophagus, stomach and upper end of the small intestine using an endoscope; essentially a flexible tube with a camera lens at the end for looking inside of things. 

Even gastroenterologists seem to refer to "esophagogastroduodenoscopy" as "an upper scope job" or something similar and easier to pronounce, let alone spell, than...well, that word. I coined a new term for it today. To wit: "upperoscopy." 

The first upperoscopy I had revealed a polyp in my small intestine near the common bile duct, which is the tube that delivers liver enzymes and pancreas enzymes into the intestine during digestion. Because of its location, Dr. Speer was hesitant to biopsy the polyp for fear of causing panceatitis, a dangerous and sometimes fatal malady of the pancreas. After a consultation with his colleagues, we decided not to treat that polyp. Instead, because that type of polyp is very slow growing, the plan was to repeat the upperoscopy in a couple of years to check for changes. 

That subsequent upperoscopy revealed no perceptible changes, so again the decision of the team was to let it ride. Today was round three in the upperoscopy series. And, lo and behold, that pesky polyp had disappeared.  I always like to chat with the medical personnel who care for me, and today was no exception. When Dr. Speer said the polyp was nowhere to be found, I told him that my rosacea (a persistent rash on my face) and the frequent styes on my eyelids (possibly a manifestation of rosacea) that have plagued me since my leukemia diagnosis have also disappeared since my bone marrow transplant. I also noticed that some inflammation that was present in my stomach lining in 2021 was also absent today. An appealing deduction would be that there may be a cause and effect relationship between my new immune system and the disappearance of preexisting inflammatory maladies. That would be a kind of sweet, unexpected consequence, don't you think?

Being a gastroenterologist, Dr. Speer began musing about whether it would be possible to treat chron's disease, a debilitating inflammatory disease of the intestines that has no known cure, by performing a bone marrow transplant. We agreed it would be interesting to do a retrospective study of patients who have suffered with chron's and discover whether any of them have subsequently had bone marrow transplant. If so, what, if anything, was the effect on the chron's? If I were a younger man, I might pursue a study of the medical literature along those lines. 

The outcome of today's procedures is that Dr. Speer gave me a clean bill of gastrointestinal health. He and I were both very pleased. The standard protocol in the face of such an outcome is to repeat these procedures in five years. Today, in our post operative consultation, Dr. Speer told me that in view of the findings, and since five years from today I will be well into my eighties, and because the accepted upper age limit protocol for colonoscopy is 80 years, I will no longer need to have routine exams. Only in the event of symptoms indicating intestinal disease would he recommend further colonoscopy or upperoscopy!! A clean bill of health is kind of a nice way to end a 29 year run of examinations, especially in view of my history of colon cancer. 

My insides are good. My immune system is good. My parents gave me genes of good longevity. And though we never know what tomorrow may bring, today the future is looking very bright from a medical perspective. 

The route of the Hebrew nation from the Land of Goshen in

Egypt to Marah (bitter water) and beyond. Source

In the book of Exodus, chapter 15, we can read the story of Moses leading the Hebrew people after they miraculously crossed the Red Sea. After a few days, they had found no water to drink, but at Marah they did find water. Unfortunately, the water was too bitter to drink. Moses prayed to the Lord, and the Lord showed Moses a log and told him to throw it in the water. 

"...and he threw it into the water, and the water became sweet. There the Lord made for them a statute and a rule, and there he tested them, ²⁶ saying, 'If you will diligently listen to the voice of the Lord your God, and do that which is right in his eyes, and give ear to his commandments and keep all his statutes, I will put none of the diseases on you that I put on the Egyptians, for I am the Lord, your healer.'” (Exodus 15:25-26)

May all of your unexpected consequences be sweet!