“Did I talk to you while I was waking up? You look familiar.” Danica the post-procedure nurse smiled at me and said “Oh yes! It sounds like you had a great dream about Alice in Wonderland!”
“I’m reading the book to my daughter.” I gurgle, still shrugging off the last vapors of anesthesia.
“Did you understand what the doctor said to you a few minutes ago?”
“I don’t remember talking with the doctor.”
“Ok, I’ll ask her to stop back over in a few minutes.”
When the gastroenterologist reappeared, she stood beside the bed and told me very matter of factly that she found and removed two pre-cancerous polyps from my colon. “One was pretty big, considering your last colonoscopy was not even four years ago. Your best defense is to continue regular colonoscopies. I’m going to recommend continuing every three years. We’ll send the polyps to pathology. You should hear back in about a week.”
“That sounds like there’s a chance those are more than pre-cancer.”
“We send everything to pathology. You do not have colon cancer. Neither of these had penetrated the wall of your colon. But you have to be vigilant. This is the second time we’ve removed these types of polyps from your body. You’re young, but your mom’s history means you are going to be more likely to develop polyps, and unchecked polyps become cancer.”
My first colonoscopy was when I was 33. Years of mysterious GI symptoms had become unbearable. The pain and bloating were not enough to get me to go to the doctor, but I made an appointment when I realized to my horror that the coworkers at my new job knew I was ducking into the bathroom with alarming frequency. There were murmurs that I was pregnant. A tactless coworker straight up asked if I was having morning sickness. It was getting harder to hide the fact that something was very, very wrong.
I was in a new state for a new job with a relatively new husband. I didn’t have any friends in North Carolina, or a primary care doctor, let alone a gastroenterologist. One morning, after spending most of the previous night in agony, I walked into Melissa, my co-worker’s office and closed the door behind me. I asked if I could ask her for some help with a personal matter. She waved me in, I took a seat, and blurted out; “Do you like your doctor? I need to find a doctor. I need a referral for a gastroenterologist. I think something is really wrong with me. My mom died of colon cancer two years ago, and I am freaking out.”
Bless her, this near stranger confided that her mom had had colon cancer, too, but it was caught early and she was in recovery. Melissa had the gastroenterologist’s name and office number in her phone. She wrote it on a lime green post-it note and handed it to me across the desk. “He’s one of the best in the country. At Duke. He’ll take good care of you.”
At my initial appointment, I expected him to reassure me that I was too young for colon cancer, that my symptoms were certainly IBS or a food allergy. That he’d do all the necessary tests, of course, but not to worry. Instead he looked me in the eyes and said “These symptoms are symptoms of colon cancer. I have six colon cancer patients in their 30s. You must take this very seriously. We’ll do the colonoscopy, and act on what we learn.”
For the next two weeks while I waited for my procedure appointment, I pondered what I would do if I received a cancer diagnosis.
“I want to go to South Africa and take surfing lessons, and just stay there and keep surfing until I get eaten by a shark. Return to the food chain.” My husband of a year and a half was not amused. “You’ll fight it. We’ll fight it together. You’re not going to be eaten by a shark.”
“You know, MY MOM died of colon cancer but she wasn’t really, miserably, excruciatingly sick until she started treatment. She lived for less than two years after her diagnosis. The last year or so of that was in agony, the last 2 months were inhumane. I really, really want to just get eaten by a shark, ok?”
I thought about the kids I wouldn’t have and the life I wouldn’t live with Les. I wondered what he would do without me. Return to Illinois, presumably. He didn’t have a job yet in Raleigh. I thought about JAWS a lot and wondered if I would shriek out reflexively while being chewed in half, or feel satisfied that my plan had worked and my torture would be quick and organic rather than insufferable and chemical.
That first colonoscopy didn’t reveal any polyps, cancerous or otherwise. It did discover that my colon was kinked like a hose in two places, which would account for all the toilet troubles and general abdominal distress.
“Do yoga every day and try not to be so stressed. That’s the only way to prevent this from happening again. You literally tied yourself in knots. But given your symptoms and your family history, get another colonoscopy in three years, OK? Keep on top of this.”
The intestinal unkinking relieved a lot of my problems, but some persisted. I saw a doctor a few weeks later who suspected a gluten, dairy, or soy intolerance. Her suggestion jolted my memory back three years to the stark, unfussy acupuncture table in a dimly lit office above the Planned Parenthood in Edgewater. The locally famous (in certain “alternative medicine” circles) chiropractor insisted, as I lay with two dozen hair-thin needles sprouting from my skin, that I needed to cut out gluten to eliminate my chronic pain. “Your body can’t process it,” she said. “You have systemic, chronic inflammation. The acupuncture only alleviates some of the symptoms. You’ll need to change your life and diet to prevent inflammation.”
I had snorted at the impossibility of cutting bread or pasta from my diet. “You are helping me so much. Please just let’s keep doing what we’re doing” I pleaded as I imagined never eating a scone from Letizia’s Bakery again. At the time, I opted for chronic pain management over a scone-less life.
This time, I clutched the instructions for an elimination diet the physician’s assistant handed me on my way out the door, and drove immediately to Panera to cry into a cinnamon crunch bagel while making my bleak shopping list for the next two weeks. Most vegetables and some fruit were allowed, plus a very select few carbohydrates. No dairy, eggs, soy, nuts, or, in my case, a strict vegetarian at the time, any animal protein. I ate salads with vinaigrette and apples and plantain chips for two weeks, after which I was supposed to add each possible trigger food back in, one at a time.
When the hungry two weeks had elapsed, I tore into a chunk of baguette and prayed. I was still chewing it when my skin started to itch and my stomach churned. I threw the rest of the hunk of delicious gluten across the room and cried. That was it. I didn’t need to go on with the trial. Indeed, I felt no reaction to the dairy, eggs, soy, or nuts. Just the bread.
Within a week of my gluten free diet, the softly inflated dome of belly, which I had accepted as part of the newlywed “I’m like a baby, she’s like a cat, and when we are happy we both get fat” phase had flattened. I no longer bolted to the bathroom multiple times a day. My skin cleared up – both acne and eczema. The chronic nosebleeds I had dismissed as “some kind of weird seasonal allergy thing, probably” also stopped.
But the colonoscopies continued. I’ve had several now, and since that first unkinking procedure 11 years ago, each of my subsequent colonoscopies has removed precancerous polyps.
Food and I still regularly battle with clubs and sticks. Even some gluten free carbs seem to trigger IBS-like symptoms. I would feel better with less acid (coffee, wine, chocolate, tomato products). The omnivore/vegetarian/vegan/pescatarian/flexitarian choices paralyze me. The Ghost of Orthorexia Past haunts me.
The data on the causes of colon cancer are mixed, but some studies found that people who get less exercise and who eat higher-fat, lower-fiber diets are more likely to get colon cancer. And people who had an immediate family member diagnosed with colon cancer are also more likely to be diagnosed themselves. So if you are wondering if the pressure to try to “eat a low fat, high fiber diet and get enough exercise and also eat gluten free and (because of my personal, complicated feelings about eating animals) vegetarian and try not to let cancer sneak up and kill you” could lead to angst about food and general feelings of anxiety, the answer is yeeessssssss.
The morals of this story are these: Go to a gastroenterologist right away if you have symptoms of colon cancer. Get the stupid colonoscopy, either if you have symptoms or when you turn 45, whichever comes first. That birthday is coming up for a lot of you, my friends. And yes, the colonoscopy prep SUCKS, but you get to drink a gallon (accurate – not an exaggeration) of laxatives in the privacy of your own home, so it’s not like you’re going to be eaten by a shark. And yes, the day of the procedure is a time consuming hassle, and you may blabber incoherently about Alice in Wonderland when you emerge from anesthesia. But I am telling you, with all the sincerity and near-hypochondria of my heart, colonoscopies are better than cancer.