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Wednesday, November 28, 2007

Off Kilter

I woke up early this morning feeling off kilter. In case you're wondering, my greenhouse isn't actually sliding down a slope. When I snapped the photograph, I was trying to get the rose at the angle I wanted and didn't think about what that would do to the background. Since I am feeling off kilter, I thought this was an appropriate photograph. I got my first colonoscopy done yesterday. It went well. I had three polyps removed and sent off to a pathology lab but the doctor said they looked like they were benign and that at most one might be pre-cancerous. That didn't bother me since the whole purpose of a screening colonoscopy is to remove polyps before they become cancerous. I won't get the results for 7 to 10 days but I'm not expecting any problems.What has thrown me off kilter was the doctor's attitude. I am trying not to read too much into it and as it turns out I don't think it will affect my getting adequate testing. When we were discussing my history prior to the test, I wanted to make sure that he knew that I was a stage III melanoma survivor. He said, aren't you here for a routine screening. I said yes. He said, I'm not looking for anything like that (referring to melanoma). I felt like saying, well I hope if you see it, you don't look the other way and what's the point of making me feel like a dodo bird when I'm trying to give you information for valid reasons. The reason I wanted him to know about my melanoma history is because colon polyps can be metastatic melanoma, although that is rare. From what I've read colon polyps which are melanaoma tend to be amelanotic meaning they are colorless and can masquerade as benign polyps. I want to say right off the bat, I do not think I have metastatic melanoma in my colon. That's not the problem.I've read that it is important for doctors who do a regular colonoscopy screenings to know about a history of melanoma; so they will be sure to biopsy all polyps because sometimes patients will be asymptomatic, and the melanoma will not look like a cancerous polyp. I have also read that melanoma metastasis to the colon, may not be as rare as was previously thought because often it is not found until autopsy. The reason being that the patient is asymptomatic for the colon issues and the polyps didn't show up on scans. Even so it is relatively rare and the risk benefit ratio would not call for all melanoma patients, regardless of age and symptoms to receive a colonoscopy. I was not getting one because I was a melanoma patient. I got it because I was 50 and my gynecologist said I should get one for routine screening, when I had my physical this year. However, since I was getting one, it was valid for me to want the doctor doing the test to know about my history.
Even though there was a complete history in my file, I could tell by our question answer session that he hadn't looked at my file. I get that. I understand these doctors doing God knows how many of these screenings per day don't sit down and read a thick file cover to cover. However, I would feel better at one level if I thought that it was on his radar, with someone like me, that polyps should be removed and biopsied, keeping in mind the off chance of melanoma. The only question mark in my mind is if the lab would automatically use the stains which would show metastatic melanoma, even if they don't know the patient has a history of melanoma. I don't have a clue about that. What pisses me off is that I end up needlessly worrying when I'm actually not worried at one level. At the risk of being repetitious, I do not think these polyps are metastatic melanoma. All I want to know is that the laboratory doing the pathology will know to do the kind of microscopic examination with the appropriate stains to rule out metastatic melanoma, then I wouldn't worry at all.For all I know the lab would automatically do those tests. The article I read wasn't discussing the lab so much as they were discussing the need for the doctor performing the colonoscopy to be aware that ordinary benign looking polyps should be sent to the lab, keeping in mind the off chance of melanoma, if the patient has a history of melanoma. My polyps were removed and sent of to a lab. I don't think they are anything but what the doctor said they were. All I need to stop worrying is to be assured the pathologist will run the necessary tests and for all I know they will. I do resent being brushed off during the question answer session with the doctor. I didn't tell him about anything I've read. I didn't spend a lot of his time. All I said was, I have a history of node positive melanoma and he said, I'm not going to be looking for anything like that. This is a routine age screening for the big 50, isn't it? Well screw you. No I didn't say well screw you. I didn't say much of anything because shortly after that I was unconscious.When he came back to talk to me in post op, I was way too off kilter to say much of anything. I was relieved to hear that all he found were 3 benign looking polyps with at most one being pre-cancerous. I was also relieved that all three were going to be reviewed at a pathology lab. It wasn't until much later that I started letting my brain go in circles about whether they would do the tests which would rule out melanoma. That's all I need to know to put it straight out of my head. There's nothing I can do about the GI doctor's people skills. I don't even care about that since people skills aren't necessary when I'm only seeing someone pre-op and post-op for a screening test. The first part of my concerns has been taken care of. He did remove the polyps he found and sent them off to a lab. Hopefully, the lab will run all the tests which should be run. I've thought a lot about something a wise blogger said in a comment on my blog. She said that anxiety can replace intuition. That has helped me more than I can say. I'm not aware of being anxious at one level but I do have a little voice that won't shut up and I'm starting to see that little voice as being anxiety as much as it is intuition. I find that reassuring in an odd way. In some ways I'm less anxious at my age than I was when I was younger. However, I do think that the chronic conditions I have had since my lymph node dissection have thrown my intuition out of whack. I can not go by how I feel so it does make me extra sensitive and yes anxious to be sure that the objective tools are adequately utilized. Lord knows I have enough doctors. I could do with a few less doctors. I think my doctors are all competent professionals and do their best. Even the hurried GI one, who wasn't interested in my history, was no doubt competent and doing his best. Oh well, as usual it's a waiting game.

15 comments:

Kat said...

I love the "off kilter" pic! The roses are beautiful even with the frost on them. Not sure if you'd be interested so I tagged you for a meme. Check it out here http://katskrackerbox.wordpress.com/2007/11/28/7-random-things-about-me-meme/

Kat said...

I love the "off kilter" pic! The roses are beautiful even with the frost on them. Glad your colonoscopy went well!! Not sure if you'd be interested so I tagged you for a meme. Check it out here http://katskrackerbox.wordpress.com/2007/11/28/7-random-things-about-me-meme/

Mar said...

Sorry about the waiting game...but you know everything will be fine. Doctors are only human but that's not an excuse for not working professionally. And they'd better do a good job or change professions...

Your roses are beautiful!

jmb said...

Well Carver, you did all that you could do. Now it's up to them. I hope everything is fine and they let you know soon so you can stop feeling off kilter.

Carver said...

Hi Kat,

Thanks for stopping by and I'll try to do the tag soon.

Hi Mar,

I appreciate your thoughtful comment and I had to laugh at the " they'd better do a good job or change their professions". It helps me to think about saying that, as in, you better do your job buster, not that I'd actually say it like that. It's better than me thinking about cursing them out when I'm annoyed.

Hi JMB,

Thanks so much for your thoughts and I appreciate what you said about how I did all I could. I hadn't really thought about that but in a way it's a release to realize that I did my part and now it's up to them. I'm sure it won't take too long and in all likelihood will be good news.

Gledwood said...

The leaves are beautiful and so is life. Keep being a survivor!

Carver said...

Thanks Gledwood I appreciate that.

Theresa said...

I know from my sister-in-laws experience you have to be your own advocate with some of the doctors- she had a lot of great doctors, but she had some not so great ones too.

I am glad to hear everything came back benign.

Maybe we are all looking at the picture the wrong way, the rose is beautiful, it is the outside world that is off kilter!

thess said...

Bless you for your strength.

and for your eyes, you really have eyes for beauty

Carver said...

Hi Theresa, I'm glad your sister in law has had great doctors and I'm sorry she had to deal with the not so great ones. I think most people that have any condition which requires a lot of different specialists, plus the routine screenings, ends up dealing with a few in the not so great category. I feel better about it this morning. I'm assuming the lab work will come back benign or at most pre-cancerous based on what he saw with the naked eye. The crazy part is I've had so many pathology reports since they automatically give them to me whenever I have a biopsy with my surgical oncologist, that I will be able to request a report and look at it to verify if they used the stains which would rule out melanoma. I've learned about things I never thought I would.

Hi Thess, Thank you so much for your kind words.

SabineM said...

I love the off Kilter Picture too! And The rest are soo nice. LOVE THIS TIME OF YEAR!
The waiting game is difficult I know. And After what you have gone through in the past I can see why you are a bit anxious!
I think you were right to tell the doctor about your past history and to put it on HIS radar!!
If you are still not happy with him, you could always go to another doctor, or have someone else look at the results. I also understand what you are going through in your head, and if that voice inside your head doesn't quiet down, put your worries to bed by having someone else look over the results!
Either way, I AM SURE all is going to be fine.

Carver said...

Thanks Sabine, I think the idea of having someone else look at the results is a good one, if I'm still concerned.

GBex said...

very beautiful pics.....

have a nice day to you!

understatementman said...

you really have a talent for seeing the broad textural aspects of nature; the carpets of leaves, interwoven branches, muted layers of trees- i love them purely as abstract images.

Carver said...

Thanks so much U.M. (P), I appreciate that a great deal. I wish I had your talent to paint and draw.