Prior Foreshadowing Being Realized

In my final blog entry of 2007, just after finishing chemotherapy I mentioned the transition that I am now experiencing in going from treating cancer back to treating Crohn’s disease. This was relevant because my medications may have contributed or even caused my lymphoma, especially the immunomodulators. It has now been approximately 15 months after chemotherapy, and my Crohn’s disease has progressed to the point where the standard anti-inflammatory drugs are losing the battle. I am still within that two year window where a recurrence of Hodgkin’s Lymphoma is most likely, and if there are a few remaining cancer cells that have survived, going back on the immunomodulators could weaken my immune system enough to allow the cancer to spread once again. The immunomodulator Remicade was the only drug that I have taken during the eleven years since my Crohn’s diagnosis that has effectively controlled and prevented symptoms. My recent colonoscopy revealed that the inflammation in my terminal ileum has progressed to the point where the scope could not even safely navigate through to inspect the extent of the disease. I am at risk of a blockage induced by long fibrous foods becoming trapped through the bottleneck into my colon. Now I have to make a difficult decision. My gastroenterologist feels the best option is to have an intestinal resection surgery to remove the affected portion of my terminal ileum. I have agreed. Because my doctor was unable to physically see the entire affected portion during my colonoscopy, I had a small bowel follow-through procedure. This procedure is a fairly simple radiological procedure. I drank a barium solution and then waited for it to travel through my small intestine. After a startling short twenty minutes, the barium solution had traversed the entire 30 feet and I was ready for the radiologist to start filming. He took several pictures of my innards while I watched him prod me with a device that was invisible to the X-ray. He told me that it appeared that the affected portion was approximately 7-10 inches traveling upstream of the terminal ileum from the connection point of the colon. He said otherwise he could not see any fistulae or other affected portions.

My next step is yet to be determined. I am awaiting an appointment with my gastroenterologist who will refer me to a surgeon. I will then learn exactly what to expect from my upcoming surgery. I know that these procedures are very routine and typically are performed by general surgeons as apposed to a specialized gastrointestinal surgeon. They are commonly performed laproscopically followed by a 4-5 day stay in a hospital. I don’t know if there is an extended bed rest period following the hospitalization or how many days I will be required to use a colostomy bag. There are a million questions running through my brain and I cannot wait until my pre-surgical meeting with my surgeon, whomever that will be. In the mean time I have been ordered by my doctor to go on a low residue/low fiber diet. That means I am not allowed to eat raw fruits and vegetables or whole grains. Imagine a doctor telling you to go on a “all hostess product diet” and that is my reality! I am at risk of a blockage every day until my surgery so I have to be careful. I am preparing to fly to Buenos Aires for a 10 day vacation next week, and I am a little worried about the possibility of incurring a blockage and needing emergency surgery while I am in Argentina. Hopefully, that fear will not ruin the trip. I have been put on a large dose of Prednisone to bring down the inflammation, which hopefully will keep me out of the hospital until my scheduled surgery.

And so the struggle continues of controlling my Crohn’s disease while still not inducing a recurrence of Hodgkin’s Lymphoma or another cancer caused by immunomodulators. Fun stuff!