This is a "coumadin/colonoscopy" story and also a "pins and needles" story of living with a history of cancer. I've been cancer free for 2 1/.2 years, but the cloud never totally goes away.
Hopefully, this is just another "scare" that will renforce that life is precious and we need to live it to the fullest. (Like I really need the reminder.)
First a bit of history............ I've been getting annual full-body PET scans as follow up to 2002 Melanoma excision. The excision included a sentinal node biopsy (the nearest node is removed and disected). The SNB was normal. The Melanoma was very early stage.
PET scan Sep 2003 was normal.
Colonoscopy July 2004 was normal.
PET Oct 2004 showed some "activity" in intersection of the small and large intestine.
CT scan Oct 2004 scan showed it as well, but a small bowel series was normal. The oncologist thinks its an inflammation, but ordered a three month PET to track it.
Unfortunately the PET 2 weeks ago showed increased activity on that spot.
The good news is that Melanoma re-occuring in the colon is extremely rare. The bad news is that the recovery rate is very very very very poor (get my drift?). So last week I went back to the GE that did the colonoscpopy, and he refered me to a diagnostic GE specialist (a special specialist).
The GEspsp wanted to have me swallow a "capsule endoscopy", but after checking with St. Judes, decided against it. The capsulke is a camera that transmitts pictures to a computer for 24 hours. St Judes said there have never been tests on this camera/receiver apparatus with a St Jude valve, and so couldn't condone it. He would have liked to get picures of the entire digestive track.
He will do another colonscopy next Tuesday and go deeper than the last to see the spot and take a biopsy.
As an aside, the GEspsp's nurse used to be my Coiumadin nurse at the cardio's office. And since the GEspsp got tied up at the hospital for 3 hours, we had time to reminicse.
The GEspsp started to give me instructions for Lovenox bridge. I told him that I had experience in that. When he started giving me the number of days to hold Coumadin, I stopped him and told him that I home test and prefer to use 2.0 as the cutoff in both directions. He smiled and gave me a look of approval that he didn't expect me to know the details. It was a look of respect. He was not condescending or arrogant at all.
When he told the nurse to call in a prescription for 40 mg Lovenos, I told him my cardio prefers 100 mg. He says "that's way too high", that he does colonoscopies for valve patients all the time at 30-40 mg. He took off for another patient while I called the cardio's office on my cell phone and talked to the coumadin nurse. She freaked at 40 mg and double checked with the cardio. When the GEspsp came back in, I suggested the 2 docs talk to each other.............how about right now? In a flash the GEspsp nurse got the Coumadin nurse to run down the cardio again and handed my cell phone to the GEspsp. I can just imagine what the cardio told him. All I heard was, uh huh.....I see.....well if that's what you want, okay. No problem. After the docs hung up, the coumadin nurse hit #69 and called me back to be sure that it was settled and to determine who would call in the prescription. Gotta love her!
Then the GEspsp said to hold the Lovenox 24 hours prior to procedure and 24 hours after. He intends to be a bit aggressive with the biopsy. I told him I understood about the 24 hours after, but didn't like it. I surely didn't understand the 24 hours prior. He cut it to 12 hours prior, but held his ground on the 24 hours after. I agreed.
I don't want to leave the impression that the GEspsp is a jerk. He is sharp as a tack and was wonderful in the GE arena and attention to detail. I had a choice of going back to my other GE that did the previous colonoscopy, and chose to have the special specialist do it. I have great respect for him as a GE, but will always defer to my cardio in matters of Coumadin.
So I thanked God (again) for my friends in here that have raised this issue up and down the pole several times.
Oh, yes, one more thing. I asked the GEspsp about Virtual Colonoscopies. He said that they are worthless. They are not reliable and require prepping twice if something is found. I told him that we coumadin users are more sensitive about beeding and stroking than GI prepping, and find the idea of VC's atractive if/when they are reliable. He understood our perspective.
Hopefully, this is just another "scare" that will renforce that life is precious and we need to live it to the fullest. (Like I really need the reminder.)
First a bit of history............ I've been getting annual full-body PET scans as follow up to 2002 Melanoma excision. The excision included a sentinal node biopsy (the nearest node is removed and disected). The SNB was normal. The Melanoma was very early stage.
PET scan Sep 2003 was normal.
Colonoscopy July 2004 was normal.
PET Oct 2004 showed some "activity" in intersection of the small and large intestine.
CT scan Oct 2004 scan showed it as well, but a small bowel series was normal. The oncologist thinks its an inflammation, but ordered a three month PET to track it.
Unfortunately the PET 2 weeks ago showed increased activity on that spot.
The good news is that Melanoma re-occuring in the colon is extremely rare. The bad news is that the recovery rate is very very very very poor (get my drift?). So last week I went back to the GE that did the colonoscpopy, and he refered me to a diagnostic GE specialist (a special specialist).
The GEspsp wanted to have me swallow a "capsule endoscopy", but after checking with St. Judes, decided against it. The capsulke is a camera that transmitts pictures to a computer for 24 hours. St Judes said there have never been tests on this camera/receiver apparatus with a St Jude valve, and so couldn't condone it. He would have liked to get picures of the entire digestive track.
He will do another colonscopy next Tuesday and go deeper than the last to see the spot and take a biopsy.
As an aside, the GEspsp's nurse used to be my Coiumadin nurse at the cardio's office. And since the GEspsp got tied up at the hospital for 3 hours, we had time to reminicse.
The GEspsp started to give me instructions for Lovenox bridge. I told him that I had experience in that. When he started giving me the number of days to hold Coumadin, I stopped him and told him that I home test and prefer to use 2.0 as the cutoff in both directions. He smiled and gave me a look of approval that he didn't expect me to know the details. It was a look of respect. He was not condescending or arrogant at all.
When he told the nurse to call in a prescription for 40 mg Lovenos, I told him my cardio prefers 100 mg. He says "that's way too high", that he does colonoscopies for valve patients all the time at 30-40 mg. He took off for another patient while I called the cardio's office on my cell phone and talked to the coumadin nurse. She freaked at 40 mg and double checked with the cardio. When the GEspsp came back in, I suggested the 2 docs talk to each other.............how about right now? In a flash the GEspsp nurse got the Coumadin nurse to run down the cardio again and handed my cell phone to the GEspsp. I can just imagine what the cardio told him. All I heard was, uh huh.....I see.....well if that's what you want, okay. No problem. After the docs hung up, the coumadin nurse hit #69 and called me back to be sure that it was settled and to determine who would call in the prescription. Gotta love her!
Then the GEspsp said to hold the Lovenox 24 hours prior to procedure and 24 hours after. He intends to be a bit aggressive with the biopsy. I told him I understood about the 24 hours after, but didn't like it. I surely didn't understand the 24 hours prior. He cut it to 12 hours prior, but held his ground on the 24 hours after. I agreed.
I don't want to leave the impression that the GEspsp is a jerk. He is sharp as a tack and was wonderful in the GE arena and attention to detail. I had a choice of going back to my other GE that did the previous colonoscopy, and chose to have the special specialist do it. I have great respect for him as a GE, but will always defer to my cardio in matters of Coumadin.
So I thanked God (again) for my friends in here that have raised this issue up and down the pole several times.
Oh, yes, one more thing. I asked the GEspsp about Virtual Colonoscopies. He said that they are worthless. They are not reliable and require prepping twice if something is found. I told him that we coumadin users are more sensitive about beeding and stroking than GI prepping, and find the idea of VC's atractive if/when they are reliable. He understood our perspective.