Surviving Colorectal Cancer, Part 34
At first, I didn’t understand the impact of removing my Sigmoid colon during my surgery for advanced colorectal cancer in late January 2023.
Yes, my oncology surgeon told me right after the surgery that diverticulitis had damaged my Sigmoid colon so much that he removed all of it to minimize the risk of cancer recurrence. He showed me a digital photo of what he removed, pinpointing the tumor that five months of chemo and radiation shrank from 10cm to 5cm. His digital photo is too ugly to share, so I’m sharing a visual from the National Cancer Institute.
Later, I found that the Journal of the National Cancer Institute has a scientific paper that documents a 33 percent increase in colorectal cancer among patients who have diverticulitis. Here’s a relevant quote:
Patients with diverticular disease who have colorectal histopathology have an increased risk of overall incident cancer. The increase in colorectal cancer risk was primarily restricted to the first year of follow-up and especially early cancer stages.
Aha! As I near my second-year follow-up after my successful cancer surgery, I am thankful that my oncology team decided to remove my damaged Sigmoid colon to minimize the risk of recurrence. Very thankful.
However, at first, I didn’t understand the function of the Sigmoid colon.
For readers who may not remember one of my earlier chapters, the National Library of Medicine has a detailed explanation. A key quote about the Sigmoid colon caught my attention:
“Its primary purpose is to remove the final components such as water, vitamins, and minerals from the gut contents through reabsorption to make the stool solid enough to be stored in the rectum.” (I bolded that last part for emphasis.)
Does that mean my poop might be less solid, my rectum might not store it completely, and I might have bowel movements more frequently? You bet it does. The upside is that I’m never constipated.
It also took me more than a year to figure out why I was experiencing “clustering,” the medical term for frequent small bowel movements within a few hours. A helpful discussion is on the website of the Colorectal Cancer Alliance. The discussion offers 20 suggestions for managing the problem.
Over the past year, I’ve tried almost all the suggestions. Some work better than others for me. More exercise, the number 13 suggestion on the CRC list, seems to help. My daily routine includes several exercises to stretch and strengthen muscles, especially my quadriceps, and I try to walk a total of two miles a day.
I’ve found that changing my daily diet also helps. That’s covered in suggestions 4 through 10. I track everything I eat and log it in the MyFitnessPal application on my iPhone. The nutritionist at the medical center wants me to have 90g of protein every day to avoid losing too much weight.
Eating less helps me reduce the amount of food to digest. Consuming fewer calories, carbohydrates, and fats also seems to help minimize clustering for me.
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Over the past year, I’ve reduced my overall daily calorie consumption to 1,200 calories by eliminating desserts and added sugars. At that level, I’m able to maintain my weight of 175 pounds and that makes my nutritionist happy.
I quit eating processed meats in late 2022 when I learned that the World Health Organization decreed in 2015 that they are a carcinogen in Group 1 just like tobacco and asbestos. At the same time, the WHO stated that red meat is a likely carcinogen in Group 2, especially if it is grilled or seared at high temperatures.
After the WHO recommendations, I also quit eating red meat, which was always hard for me to chew and digest. Now, I eat “fork food” that I can cut with a fork. I don’t want to abuse my remaining colon and risk cancer recurrence.
I mostly eat eggs and chicken and fish and shrimp for protein, supplemented with an organic protein powder if necessary. For added fiber, I eat boiled vegetables. No raw vegetables that are hard to chew and digest.
It’s hard for me to consume fewer than 100g of carbs daily because I eat a banana and a cup of papaya or cantaloupe with a teaspoon of Greek yogurt. And I sometimes have a small serving of pasta.
Limiting overall fat and saturated fat on a daily basis is another goal. The Mayo Clinic has guidelines for the recommended daily allowance of both. Putting half an avocado in my daily romaine lettuce salad adds 11g of fat, but I’m usually able to stay below my goal of 36g of overall fat.
Limiting saturated fat is perhaps more important for me. The same guidelines state that the recommended daily allowance for saturated fat is no more than 10 percent of daily calories. That’s 12g of saturated fat for my 1,200-calorie daily diet. I’m usually slightly below that amount but not always.
Even with exercise and these dietary changes, and embracing several other CRC suggestions, I still have some clustering almost every day. But I can manage it.
Not having a Sigmoid colon and changing my daily habits is a small price to pay for reducing the risk of colorectal cancer recurrence.
(Original published on Substack at https://mikelkmiller.substack.com/p/ive-learned-how-to-live-without-a)
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About me: In June of 2022, at age 78, I was diagnosed with Stage IIIc colorectal cancer. After five months of aggressive chemotherapy and radiation, I had successful surgery in January of 2023 to remove the tumor followed by successful surgery in May to reverse my colostomy.
Surviving advanced-stage colorectal cancer was like starting a new life. My oncologist and my wife both urged me to write about my experience as a catharsis and to encourage people to have colon cancer screenings. I began journaling every day, and to celebrate my 80th birthday in October of 2023 I began posting articles almost every week on Medium.
I hope my articles will motivate people to have thorough colon cancer screening starting in their 40s and continuing past 75 and also help other colorectal cancer patients deal with everyday life while trying to survive five years or more.
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