The guest author of this post is David Haas, a frequent contributor to the Mesothelioma Cancer Alliance, from Fairfax Virginia, who was kind enough to share his experience with cancer support groups.

The information he shares is universal.  When one is presented with a diagnosis of cancer, many emotions come to mind, as well as feelings of isolation.  There are people out there who have been through the same experience.  Many patients have found that support groups have been some of the most beneficial things to help them through a stressful time for advice or empathy.

Thanks David for wanting to share your advice!  Please check out his blogs.

http://haasblaag.blogspot.com/

http://www.mesothelioma.com/blog/

Work as a Team to Beat Cancer

There is an old saying: There is power in numbers. This is especially true for cancer patients. It is hard to
tackle a disease like cancer by yourself. That is why it is so important to get involved in a cancer support
group. In fact, almost any doctor will tell his or her patients that they need to get involved in a support
group. There are support groups for almost any type of cancer from the common and treatable diseases like
skin cancer to the rare diseases like mesothelioma.

They offer friendship

You may have your close friends and family already in your network, but you probably do not have
anybody who knows exactly what you are going through. In other words, you don’t really have someone
who can share your fears and anxiety and help lift you up.

You need friends that know what you are going through and can help you based on their own experiences.
Many patients who attend support groups are patients in remission. These people can tell you from first-
hand experience what things you can do to help the treatments and recovery process. They can also give
you words of encouragement, telling you that no matter what; you will recover in no time.

They offer knowledge

A cancer patient’s doctor may have all the facts and statistics, but he probably does not have the wisdom
to teach his patients how to cope with their condition. Even if he does, his tone may sound cold or
unsympathetic. Doctors must remain impartial to their patients; for many doctor’s it is their company’s
policy for liability purposes. However, your friends in a support group are genuine. They know how you
feel and can offer advice and tips based on those feelings.

They offer a positive environment

When you think of a support group, what do you see? Do you see sad or anxious people sitting in a circle?
Do you see them passing tissues and asking why them? You may be surprised to find out that there are a
lot of optimistic people in support groups. This is very important. Optimism helps the recovery process.
Beyond that, it is better to live a life with confidence and a positive sense of well-being.

Conclusion

If you have cancer, you must plug yourself into a support group. Though they may not seem like much
help, just talking or writing about your feelings is very therapeutic and can help your health. This article
also lists why support groups are important.

By: David Haas

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The proctologist

So whats the difference between being a proctologist vs a colorectal surgeon?  This topic is a bit of a pet peeve of most colorectal surgeons, myself included.  They are somewhat analogous terms, but then again, slightly different.  Often they are used interchangeably, but again if we are being specific on the semantics, they aren’t exactly the same term.  Proctology is also a bit of an antiquated term, akin to stewardess vs flight attendant.

To be specific, the prefix”procto-” refers to the anus or rectum.  So this pertains to anorectal conditions such as hemorrhoids, fissures, fistulas, condylomas or warts, etc.  The field of colorectal surgery includes anorectal, or protological conditions, as well as including the diseases and conditions involving the colon, rectum and small bowel, or the lower GI system.  (Upper GI is usually referring to the stomach, and esophagus.  There is also more specific hepato-pancreatcio-biliary systems to cover the entire GI system.)  The American Board of Colorectal Surgery actually did start out as the American Board of Proctology in 1934.  The term did change to its current name in 1961 to reflect the more encompassing nature of the specialty.  So yes, we are proctologists, but we think of ourselves as being more than just that as well.  There are actually colorectal surgeons who limit their practices to anorectal or proctological conditions and avoid any intra-abdominal conditions.

Where this comes up in our daily lives is when patients, or even referring physicians will mistake the two terms.  Often we will hear from patients that they weren’t sure if they found the right doctor for their condition because they couldn’t find a proctologist off their insurance website.  Places like Yelp perpetuate this in that we can only be categorized as “proctologists”, rather than colorectal surgeons.  Perhaps the most glaring example comes from one of my partners.  My partner had been seeing a patient for his anorectal conditions for years.  My partner had seen that the patient was in the hospital for a colon cancer surgery.  Out of concern, my partner had stopped in to say hello, and out of curiosity, asked why he didn’t come to him for the operation.  It turns out the patient’s primary care physician refers to a proctologist for anorectal conditions, but wasn’t aware that we operate on colorectal cancer, etc, and had thus sent the patient to a general surgeon to address the cancer.

Like I had mentioned, this is certainly a peeve of colorectal surgeons.  I just wanted to shed a bit of light on the topic.  I’m sure if you’re reading this, you’re probably not thinking that there is any difference between the two terms, but if we want to be accurate and current in our terminology, colorectal surgery and colorectal surgeon are the correct terms.  Thanks for reading.

Its always nice to get emails and cards from patients.  Nothing is a greater reward to surgeons than to know that you really made a difference in a patient’s life.  Everything from fixing their hemorrhoid problems to being able to tell a patient that they’re cancer free.

This patient had over the past few years, a progressively and relentless experience with Ulcerative Colitis.  Over the course of 1-2 years, he went from being perfectly healthy, to having up to 20 bloody bowel movements per day with pain, cramping, and weight loss.  Despite the most aggressive medications, his condition worsened.

He was going into his senior year in college, and he was elected to be the captain of his soccer team.  It was April and they had the tough decision on whether or not to pursue surgery (a total abdominal colectomy with a J-pouch).  His soccer season started in September with training camp starting October.  If the decision for surgery was made, it would have just been barely enough time for his recovery.  If all went well, he would be back on the soccer field.  We tried to present a realistic expectation that hey might not be at 100 percent.  It was truly wonderful to hear that he is back to enjoying what he loves and that his quality of life is much better for it.

Hello Dr. Yoo,

I hope you are doing well.  We thought you would enjoy seeing a photo of B in action posted on the HSU Athletic site.

B has progressed over the past few games to playing 65 and 90 minutes.  Team is struggling a bit, but it sure is great seeing B back on the field for his last season.  He struggled with a couple ankle injuries during training and the start of season.  Actually, I think that was a sign to prevent him from over extending himself and to take it easy as he works towards full strength.

To tell you the truth, I really don’t have any updates for you on his condition.  I guess that is a good sign.  Last I spoke with him, he had minimal butt burn and blood is very light unless he is very active.

From all of us, thank you for your contribution towards the great success B has realized.  At 16 weeks light conditioning with team and at 20 weeks 90 minutes of collegiate level playing time.  With everything that transpired, I don’t think we could ask for anything more.  This is a testimony to B’s determination and your great skills.

We will be in touch to schedule his next appointment soon.

Thank you,

D, S and B

The polyp-Before

All Gone!

I did a colonoscopy on a 99 (!) year old lady who was admitted to the hospital for a GI bleed.  She had black stools for a few days (a sign of bleeding).  Her last colonoscopy was 2 years ago in which they found a large tubulovillous adenoma, approximately 2-3 cm.  At that time it was completely removed in a piecemeal type fashion.

This time around, I saw the same polyp that was there from her last colonoscopy, just as big as before.  We removed the polyp with a hot-snare (using electrocautery and a wire loop) to excise the polyp.  It measured about 2cm and had no concerns for malignancy (by appearance and hardness).  Given her age, even if it did contain cancer, there would be little chance that we would put her through a big cancer bowel resection surgery.

For tougher polyps, you can utilize submucosal saline injections to “lift” the polyp from the deeper layers to remove things completely.  As long as you remove the polyp completely and as long as the final pathology report comes back having no cancer or high grade dysplasia, that is adequate treatment for the lesion.  Many times going into a bowel resection, we have no confirmed pathology of adenocarcinoma, but operate because there was a large adenomatous polyp that couldn’t be removed endoscopically.Size has a high correlation with chance of containing malignancy.  Larger polyps >1cm have a a 5%/22%/40% chance of having cancer within them for tubular/tubulovillous/villous adenomas.

Get your colonoscopy!

Thanks for reading.

-Dr. Yoo

I saw that someone had viewed my page after searching for the term “colorectal surgeon typical day”.

So what is the typical day?  The answer to that question varies tremendously depending on where one practices, such as in a large HMO (Kaiser), university teaching hospital, cancer center, or in private solo or group practice.  I describe my situation as a group private single specialty practice.  I’ve also had experience in my training of larger university settings and large HMO multi-specialty groups, so I can describe what my experience is in each of those settings.

Describing a typical week will give a more accurate answer. The short answer: Mornings consist of rounding on patients, attending conferences or grand rounds, being at the office to see patients, or being the hospital or surgical center for procedures.  For most afternoons, I’m in the office seeing patients.

If I’m lucky and not much is going on that morning, I’ll take my son to preschool.  Most of the time though, things get too busy for that to happen.  Each day, I usually start things by rounding on the patients that I have in the hospital.  This consists of patients that I’ve been consulted on, or post-operative patients.  By working at Cedars-Sinai and participating with the surgery residents and the colorectal fellow, they’ll give me updates on my patients.  I will also teach them about interesting findings and probe their knowledge about particular topics.  I’ll sign the charts and review the labs or studies and see my patients.  When meeting with patients, I’ll go over any questions or concerns and describe what to expect over the next few days to weeks.

If I have minor procedures that day, my day will consist of performing colonoscopies or anorectal procdures such as hemorrhoidectomies, hernias, condyloma fulgurations, fistula surgery, etc.  These will be performed at Cedars or at a surgical center that I operate out of.

I’ll try to grab a quick bite for lunch either at home or near the office.  Then my office starts up at usually 1:00.  When seeing patients, I’m following up on established patients, or meeting new patients.  We perform a few procedures in the office such as flexible sigmoidoscopies, rubber banding, hemorrhoid injections.  Even though each day is a routine, the variety of patients adds for a tremendous variety. You never know what the next patient will present with. Despite what you think your day will be like, there are always curveballs throughout the day.  There can be a patient that has to be squeezed in quickly because they’re in severe discomfort and need to be seen ASAP.  There can be urgent consultations in the hospital where everything has to be dropped in order to take that patient for life-saving surgery.  I try to leave each day caught up on all my charting and billing.  Things can add up in a hurry if you even skip one day.

Again, since participating as a teaching attending at Cedars, we’ll attend twice a week conferences in the evening at 5pm, or monthly Cancer Center tumor boards.  Sometimes consults at the hospital will come in through the day and make an effort to see them the same day.

On operating days, our group’s block time is on Friday’s, so those days usually start at 7:15 for the major bowel cases.  Some cases can take up to 6-8 hours, so grabbing a bite to eat and emptying your bladder is a priority.

Weekends are more relaxed, but again, hospital patients have to be seen.  If on call, there could be consults or emergency surgeries on the weekend.  Middle of the night emergencies do happen in colorectal surgery, but with much less frequency than other specialties such as trauma, vascular and general surgery.

Despite what sounds like a busy schedule, my home life is usually predictable.  I’m home for most dinners.  I’m able to give my son 99% of his baths, and I can plan on most weekends to go to the beach or Disneyland.  Its a great specialty for allowing me to be able to achieve a balance in life, as well as providing  interesting and stimulating challenges.

I get that question at least 4 times a day.

Usually, when people find out what I do, the polite ones will respond in a little bit of shock, but they will say “Ohhh, thats nice…”. The ones that are less inhibited will still have the same shock, but will ask, sometimes giggling, “Eww, why did you go into THAT?!”

I can certainly understand the sentiment behind the question.  There certainly isn’t much of a “sexiness quotient” to the field.  There can be endless jokes and puns made at our expenses.  There is no Nip-Tuck, Grey’s Anatomy, or Dr. 90210 about the colorectal surgeon.  Yes, our typical day is looking up close at many many butts, talking about bowel movements, constipation, fiber, hemorrhoids.

But(t) you know what?  I love the specialty and the profession.

I love the field because it allows me to master my craft by specializing in one area and not be spread too thin. Cancer and inflammatory bowel disease are extremely challenging adversaries. It can be an intense fight between that leaves me physically and emotionally exhausted. Nothing is more gratifying to be able to say to a patient, “your cancer is gone.” Most colorectal surgeons go into the field because they enjoy the oncology aspect, and that is certainly the case for me as well.

Even the anorectal stuff like the hemorrhoids and fissures can be extremely rewarding. You have a patient in your office who is in the most intense and humiliating misery that they have ever experienced. There is absolutely a sense of appreciation and relief from the patient when you can make them more comfortable.

Its a field that is still evolving with new techniques and technology always developing. I like the challenge of doing something better, or with less incisions, or less pain, or less time in the hospital. Laparoscopy has changed the way surgery has been approached, but there are still better ways of doing that.

In residency, I had a colorectal surgery attending who was always happy, always whistling, always practicing his golf swing. He would always tell me that colorectal surgery was the best specialty. Rather than vascular, trauma, neuro, or general surgeons, he would tell me that instead of 1-2 times per week that he would have to stay in the hospital late, or operating over night, colorectal surgeons may have those emergencies once a month. I soon saw that the other colorectal surgeons were the most down to earth, most approachable, and least disgruntled of my attendings. They all had outside interests, prioritized their family life, went on vacations. The theory is that colorectal surgeons can’t take themselves too seriously when they’re looking at rectum’s all day.

And you know what? Its catching on. When I was applying for fellowship, out of approximately 70 positions, there were 110 applicants, for a 30% unmatched rate. Now its even more selective with an approximately 50% unmatched rate, where the same 70 some spots now had 140-150 of the most talented general surgery residents applying. It is the 3rd most competitive surgical subspecialty out of general surgery, behind pediatric surgery and plastics. It is now much easier to be a cardiothoracic surgeon than a colorectal surgeon. That was definitely not the case 15 years ago. People are finally realizing the light.

Or in the case of our specialty, realizing the dark.

Colon vs Rectal cancer

Colorectal cancer staging

Surgery

Cancer statistics

Screening methods

Colon cancer and genetics

Polyps

Choosing a surgeon

Why does anyone go into colorectal surgery?

Colonoscopy

Go to a colorectal surgeon or a genearl surgeon?

“I regret to inform you, but the biopsies show that you have colon cancer.”

You just had a colonoscopy, and have just been given the news that you have colon cancer.  Now what?  This is the case for 150,000 in the US alone who get diagnosed with colorectal cancer.  Colon and rectal cancer also places itself #3 in both incidence and death with a lifetime incidence of 1 in 19.  Rates have slowly decreased over time, thought mainly to greater awareness and screening.  A recurring theme in this blog will be to encourage you get get screened-its one of the most preventable forms of cancer

There are many days of our lives that are just like any other.  Then there are those days when you’ve been told of a diagnosis that you have cancer.  Your life distinctly changes from that very instant.  The route that people arrive that diagnosis may have been told by your colorectal surgeon, gastroenterologist, or primary care physician.  Other ways people get at that diagnosis may be secondary to a hospital admission for abdominal pain, or GI bleeding.  There may be a CT scan as an incidental finding that is characteristic for colon cancer.  Most people do  have a confirmed tissue diagnosis, but occasionally, there may not be.

The next step in the management is to get at a best estimation of the clincal stage.  For now, we will be discussing primarly colon cancer, and not rectal cancer.  Though they are essentially similar diseases, there are some subtle and some distinct differences in management.  Mainly, answering the question of if it is Stage IV or not.  (We can get to the details of staging in another post, but for now, Stage IV is distant spread, or metastasis [mets]-usually to the liver.)  This distinction is important because the next step for stage IV cancer is to proceed in most cases to chemotherapy.  Stages I-III have surgery as their initial step.  In rectal cancer, a determination of stage I vs II/III vs IV is important to differentiate due the addition of radiation to the management.

Your doctor will most likely order a baseline set of labs, including a CBC (complete blood count), Electrolyte/metabolic panel, Liver function tests, CEA (Carcinoembryonic Antigen-a tumor marker), a coagulation profile, a type and screen or cross of your blood type.  Imaging workup consists of a CT/CAT scan of your abdomen and pelvis +/- your lungs.  Some physicians may choose to order a PET scan, which will pick up metabolic activity that correlates with cancer.  An ultrasound may be performed for evaluating rectal cancer.

Once the best clinical estimate of stage is done the next step is to get going on the treatment.  For most with colon cancer, this means surgery.  For rectal cancer, the treatment can begin with surgery, but more often consists of chemo and radiation first, then surgery.  We’ll save the actual treatment of the cancer for another post.  Thanks for reading.

-Dr. Yoo

Hello everyone.  My name is Dr. Stephen Yoo, and I am a colorectal surgeon in Beverly Hills California.  I am starting this blog to fill in an underdevelped niche in the internet and blogosphere about all things regarding colorectal surgery.  This includes topics such as colon and rectal cancer, inflammatory bowel disease such as Crohn’s disease and ulcerative collitis, and anorectal conditions such as fissures, hemorrhoids, fistulas and abscesses.  My goal is to have this a site where people can receive information, give opinions, share stories, ask questions, etc.  We’ll see how things develop based on what people are interested in reading about.

If there are any specific topics you would like me to address, please let me know by email or the comment section.  For now, welcome and thanks for reading.

-Dr. Yoo

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