How Old Is Too Old for Colorectal Cancer Surgery?
When a reasonably healthy octogenarian gets a diagnosis of colon cancer, the issue of age is bound to come up. How old is too old for colon cancer surgery? What are the risks? What kind of recovery and quality of life can the very elderly expect afterward? Is it worth it? Johns Hopkins explores these questions and others in this Special Report.
Few studies have looked at how the elderly fare after colorectal cancer treatment and pursued these hard-to-ask questions. But in the ones that have, the short answer is that octogenarians and even nonagenarians can fare as well as younger seniors, if they are in otherwise good health.
It is true that the risks of colorectal cancer surgery are higher for some older people. An analysis of 28 studies found lower survival rates among the elderly who have coexisting health conditions, are diagnosed at an advanced cancer stage, and have to undergo emergency procedures. Another study found that octogenarians with early stage cancer survived 10 or more years after colorectal cancer surgery if they had no chronic illnesses.
It appears that quality of life after colorectal cancer treatment can be as good for octogenarians as it is for younger seniors -- even in the face of coexisting illness, according to a Canadian study that compared the outcomes of people over age 80 with those in their 60s. The average age of the older group was 83 years at the time of colorectal cancer surgery, while the "youngsters" ranged in age from 65-69. People in both groups underwent comparable surgical procedures and had similar coexisting health problems (such as hypertension and diabetes), although the older group had somewhat less advanced (lower-stage) cancers.
The responses to a survey on quality of life and functioning before and after colorectal cancer surgery were remarkably similar in both groups. Before surgery, both worried about pain, becoming a burden, and death. After colorectal cancer surgery, there were no major changes or differences between the groups in terms of their ability to perform daily functions or their overall health, sexual function, or quality of life.
Too Early To Draw Firm Conclusions?
The Canadian researchers emphasize that their study findings are preliminary, and some results may be biased. While the results are preliminary, the study provides further ammunition for the argument that determining which patients are candidates for colorectal cancer surgery shouldn’t be made solely on the basis of chronological age. High-functioning elderly people who undergo colorectal cancer surgery appear able to retain their ability to function and maintain a good quality of life.
Experts note that regardless of age the outcome of colorectal cancer surgery is likely to be better under these conditions:
* The cancer is at an early stage. Most people in the study had stage 0, I, or II cancer; none had stage III or IV.
* The person about to have treatment is functioning at a high level before surgery and in good general health, without multiple serious chronic diseases. People who have three or more chronic diseases -- such as diabetes, rheumatoid arthritis, or heart disease -- tend to have poorer outcomes.
* The surgery is seen as a positive action, and the person with cancer is aware of the procedures to be performed and the potential outcomes. Other issues that could affect outcomes at any age include a family history of longevity and a good support system of family and friends.
Posted in Colon Cancer on July 15, 2008
Saturday, July 19, 2008
Thursday, July 17, 2008
My Colon Cancer Abdominal Resection
My Colon Cancer Abdominal Resection
November 2003
My first surgery was for tonsils. Maybe I was seven. I remember wanting popcorn after surgery but my mom brought ice cream. I think I stayed overnight in the hospital.
In my thirties I had two hernia repair surgeries. I had to rest a few days. No big deal. In your thirties you still think you can live forever. Hernia repair was just a speed bump in my race through life. I had stitches in my crotch so it was hard to sit up and it hurt to laugh. I did not want my friends with a sense of humor to come see me in the hospital. One friend brought me lilies and made me watch the Night of the Living Dead.
In my forties I had three nasal polyp surgeries. These were outpatient and easy because I had no real fear of dying. Surgery was quick and recovery was a short duration. I had support at home and was surrounded by friends.
Preparing for colon cancer surgery was scary. My cancer diagnosis felt like the kiss of death. I carried the intense fear of dying on the operating table during my abdominal resection. I did not know if they would be able to remove all the cancer from my body. Maybe the cancer was spreading. Maybe I would die slowly wasting away as cancer spread through my body.
After my diagnosis I got a second opinion from another doctor. He confirmed I had colon cancer. Next step was to find a surgeon to do the procedure. Carrie and I met with the doctor. I asked questions and Carrie wrote down answers. I was still overwhelmed about my cancer diagnosis. The doctor who did my colonoscopy called me on my personal cell phone to make sure I got my abdominal resection surgery scheduled as soon as possible.
I made sure my health insurance would cover my procedures. The night before my surgery I had to empty out my lower intestine and colon. No food or water after midnight.
Early in the morning, Carrie, my brother, and Carrie’s parents brought me to Sutter Hospital in Sacramento. An armband was placed on my left arm. When you enter a medical center for surgery, you submit to the surgical procedures. I took off my street clothes, glasses, watch, and changed into a blue and white hospital gown. I was just another medical patient now. I gave my medical files, my wallet and car keys to Carrie. I call this my surrender to surgery.
I laid down on a gurney. I tried to relax. I was really cold. The nurse covered my legs with a warm blue blanket. Then another nurse brought elastic stockings. These were to be worn to prevent blood clots. Then my legs were surrounded with a device that massaged my legs.
Next step to prepare me for surgery was for a nurse to start an IV. Unfortunately for me a young nurse in training was assigned to me to find a vein. After several failed attempts I asked for a more experienced nurse. I noticed Carrie was getting squeamish. Carrie had fainted during one of my earlier surgeries. I suggested she find my brother David to keep me company. An experienced nurse arrived to start my IV. She found a vein immediately. She connected the needle in my arm to clear tubing and a bag of glucose.
I tried to relax. My brother and I were surrounded with a curtain. This was supposed to provide privacy in a crowded surgical waiting room. I looked into my brother’s blue eyes to draw upon his strength. We were both scared. We both were trying to be brave.
My surgeon opened my private curtain and said “Good Morning.” He looked at my medical chart. A surgical mask hung around his neck. I was probably ab resection number two on his list. For him this was just another medical procedure.
“Do you have any questions, Mr. Beckstein?” he asked.
“No.” I replied.
Another nurse appeared through the curtain to position adhesive strips on my body. These were for the EKG machine and other electronic devices. She disappeared.
My anesthesiologist arrived. He looked at my chart.
Is he old enough to practice medicine? I thought to myself. He looks so young! Hope he knows what he is doing I thought.
“I am Doctor Saunders. We spoke on the phone last night. I will start a drug to help you to relax and then when we are in the operating room you will go to sleep. “Do you have any questions, Mr. Beckstein?” he asked.
“No.” I replied. I am ready for my surgery Doctor.
I was glad my brother David was by my side. We listened to the noises coming through my privacy curtain. The anti-anxiety medicine was starting to smooth the edges of my experience.
One month before my surgery a friend recommended “Successful Surgery.” A compact disk by Belleruth Naparstek. This guided imagery and affirmations helped me prepare for this day. I played the CD at home several times to help me relax and to prepare for this stressful surgery. The day of the procedure, I forgot to bring the CD into the operating room but I could recall Belleruth’s voice.
“You will see a shimmering….” I could hear her voice telling me to relax. Her entire message was there in my brain ready to recall before my procedure.
My body began to relax as the IV medication helped me feel warm and safe. I felt like I was in a movie. My brother disappeared from view like a ship floating out to sea. My gurney rolled through big stainless steel doors and I entered the operating room. The room was very bright. I saw my surgeon and my anesthesiologist looking at me as the nurse hooked up my electrodes to the EKG.
“Ready Mr. Beckstein?”
Yes.
Fade to black.
Notes from my medical record…
A small bowel resection was performed while the patient was under general anesthesia. A nine inch incision was made in the abdomen. The diseased part of the colon was removed and the two healthy ends were sewn back together. The abdominal incision was closed. The Abdominal Resection was successful. Twenty-five lymph nodes were removed for testing.
Post-OP
“Can you hear me Mr. Beckstein?”
The recovery room nurse’s voice was far away. Maybe I could understand every other word. Like a spotty cellphone connection. I was surrounded by muffled voices drifting into my field of hearing.
A machine was inflating and deflating the blood pressure cuff squeezing my right bi-cep. It recorded a reading of 130 over 79. Pulse 60.
“Can you open your eyes Mr. Beckstein?”
“I rather not Nurse, I thought to myself. Leave me alone. I do not want to wake up. Let me sleep a little longer.”
Out of focus lights appeared through the fog covering my body.
“If you can hear my voice blink your eyes Mr. Beckstein.”
I blinked.
I was officially awake following my abdominal resection. My body felt heavy. I considered trying to move my arms but I felt like a lead blanket was covering my chest and arms like a dentist office x-ray procedure.
Nurses and doctors were walking back and forth around my gurney. Other patients were wrapped in white sheets like Egyptian mummies. No dead people here. Think I am in the recovery room. No privacy curtain here. Big wide open room where the nurses watch patients like bees buzzing in a field of flowers.
I was bored looking at the ceiling tiles, I had a wild idea. Maybe I could move the fingers of my left hand! I wiggled a few fingers. Hey they moved. Next I tried to bend my elbow and move my fingers. Success. Do I dare explore my belly to feel the incision? I was curious and scared at the same time. Conflict. What to do? I pushed away the hospital blanket to bravely explore my midsection only to be stopped with bandages and gauze and wide strips of adhesive tape. Better not to proceed to the incision just yet. Maybe too much information.
Beep. Beep, beep.
The EKG recorded my heart beat with the latest digital display for the nurse.
I was breathing.
My heart was beating.
I was alive.
I was done with surgery.
I did not die on the operating table.
Do I still have cancer in my body?
Did they dig it all out?
“You are doing very well Mr. Beckstein” my surgeon and my primary physician were looking at me. They both had a big smile. Both in surgical scrubs.
“In a few minutes they will move you to your hospital room. You get some rest. We will talk to your family now. Do you have any questions?”
“Did you remove all the cancer during this surgery, doctor?”
“Yes.”
I thanked them and drifted off to sleep. I felt no pain. Morphine floated into my bloodstream and I was grateful. I was grateful to be alive.
Someone pushed my gurney into a huge elevator. A few moments later my body was transferred from gurney to my hospital bed.
I was alone.
November 2003
My first surgery was for tonsils. Maybe I was seven. I remember wanting popcorn after surgery but my mom brought ice cream. I think I stayed overnight in the hospital.
In my thirties I had two hernia repair surgeries. I had to rest a few days. No big deal. In your thirties you still think you can live forever. Hernia repair was just a speed bump in my race through life. I had stitches in my crotch so it was hard to sit up and it hurt to laugh. I did not want my friends with a sense of humor to come see me in the hospital. One friend brought me lilies and made me watch the Night of the Living Dead.
In my forties I had three nasal polyp surgeries. These were outpatient and easy because I had no real fear of dying. Surgery was quick and recovery was a short duration. I had support at home and was surrounded by friends.
Preparing for colon cancer surgery was scary. My cancer diagnosis felt like the kiss of death. I carried the intense fear of dying on the operating table during my abdominal resection. I did not know if they would be able to remove all the cancer from my body. Maybe the cancer was spreading. Maybe I would die slowly wasting away as cancer spread through my body.
After my diagnosis I got a second opinion from another doctor. He confirmed I had colon cancer. Next step was to find a surgeon to do the procedure. Carrie and I met with the doctor. I asked questions and Carrie wrote down answers. I was still overwhelmed about my cancer diagnosis. The doctor who did my colonoscopy called me on my personal cell phone to make sure I got my abdominal resection surgery scheduled as soon as possible.
I made sure my health insurance would cover my procedures. The night before my surgery I had to empty out my lower intestine and colon. No food or water after midnight.
Early in the morning, Carrie, my brother, and Carrie’s parents brought me to Sutter Hospital in Sacramento. An armband was placed on my left arm. When you enter a medical center for surgery, you submit to the surgical procedures. I took off my street clothes, glasses, watch, and changed into a blue and white hospital gown. I was just another medical patient now. I gave my medical files, my wallet and car keys to Carrie. I call this my surrender to surgery.
I laid down on a gurney. I tried to relax. I was really cold. The nurse covered my legs with a warm blue blanket. Then another nurse brought elastic stockings. These were to be worn to prevent blood clots. Then my legs were surrounded with a device that massaged my legs.
Next step to prepare me for surgery was for a nurse to start an IV. Unfortunately for me a young nurse in training was assigned to me to find a vein. After several failed attempts I asked for a more experienced nurse. I noticed Carrie was getting squeamish. Carrie had fainted during one of my earlier surgeries. I suggested she find my brother David to keep me company. An experienced nurse arrived to start my IV. She found a vein immediately. She connected the needle in my arm to clear tubing and a bag of glucose.
I tried to relax. My brother and I were surrounded with a curtain. This was supposed to provide privacy in a crowded surgical waiting room. I looked into my brother’s blue eyes to draw upon his strength. We were both scared. We both were trying to be brave.
My surgeon opened my private curtain and said “Good Morning.” He looked at my medical chart. A surgical mask hung around his neck. I was probably ab resection number two on his list. For him this was just another medical procedure.
“Do you have any questions, Mr. Beckstein?” he asked.
“No.” I replied.
Another nurse appeared through the curtain to position adhesive strips on my body. These were for the EKG machine and other electronic devices. She disappeared.
My anesthesiologist arrived. He looked at my chart.
Is he old enough to practice medicine? I thought to myself. He looks so young! Hope he knows what he is doing I thought.
“I am Doctor Saunders. We spoke on the phone last night. I will start a drug to help you to relax and then when we are in the operating room you will go to sleep. “Do you have any questions, Mr. Beckstein?” he asked.
“No.” I replied. I am ready for my surgery Doctor.
I was glad my brother David was by my side. We listened to the noises coming through my privacy curtain. The anti-anxiety medicine was starting to smooth the edges of my experience.
One month before my surgery a friend recommended “Successful Surgery.” A compact disk by Belleruth Naparstek. This guided imagery and affirmations helped me prepare for this day. I played the CD at home several times to help me relax and to prepare for this stressful surgery. The day of the procedure, I forgot to bring the CD into the operating room but I could recall Belleruth’s voice.
“You will see a shimmering….” I could hear her voice telling me to relax. Her entire message was there in my brain ready to recall before my procedure.
My body began to relax as the IV medication helped me feel warm and safe. I felt like I was in a movie. My brother disappeared from view like a ship floating out to sea. My gurney rolled through big stainless steel doors and I entered the operating room. The room was very bright. I saw my surgeon and my anesthesiologist looking at me as the nurse hooked up my electrodes to the EKG.
“Ready Mr. Beckstein?”
Yes.
Fade to black.
Notes from my medical record…
A small bowel resection was performed while the patient was under general anesthesia. A nine inch incision was made in the abdomen. The diseased part of the colon was removed and the two healthy ends were sewn back together. The abdominal incision was closed. The Abdominal Resection was successful. Twenty-five lymph nodes were removed for testing.
Post-OP
“Can you hear me Mr. Beckstein?”
The recovery room nurse’s voice was far away. Maybe I could understand every other word. Like a spotty cellphone connection. I was surrounded by muffled voices drifting into my field of hearing.
A machine was inflating and deflating the blood pressure cuff squeezing my right bi-cep. It recorded a reading of 130 over 79. Pulse 60.
“Can you open your eyes Mr. Beckstein?”
“I rather not Nurse, I thought to myself. Leave me alone. I do not want to wake up. Let me sleep a little longer.”
Out of focus lights appeared through the fog covering my body.
“If you can hear my voice blink your eyes Mr. Beckstein.”
I blinked.
I was officially awake following my abdominal resection. My body felt heavy. I considered trying to move my arms but I felt like a lead blanket was covering my chest and arms like a dentist office x-ray procedure.
Nurses and doctors were walking back and forth around my gurney. Other patients were wrapped in white sheets like Egyptian mummies. No dead people here. Think I am in the recovery room. No privacy curtain here. Big wide open room where the nurses watch patients like bees buzzing in a field of flowers.
I was bored looking at the ceiling tiles, I had a wild idea. Maybe I could move the fingers of my left hand! I wiggled a few fingers. Hey they moved. Next I tried to bend my elbow and move my fingers. Success. Do I dare explore my belly to feel the incision? I was curious and scared at the same time. Conflict. What to do? I pushed away the hospital blanket to bravely explore my midsection only to be stopped with bandages and gauze and wide strips of adhesive tape. Better not to proceed to the incision just yet. Maybe too much information.
Beep. Beep, beep.
The EKG recorded my heart beat with the latest digital display for the nurse.
I was breathing.
My heart was beating.
I was alive.
I was done with surgery.
I did not die on the operating table.
Do I still have cancer in my body?
Did they dig it all out?
“You are doing very well Mr. Beckstein” my surgeon and my primary physician were looking at me. They both had a big smile. Both in surgical scrubs.
“In a few minutes they will move you to your hospital room. You get some rest. We will talk to your family now. Do you have any questions?”
“Did you remove all the cancer during this surgery, doctor?”
“Yes.”
I thanked them and drifted off to sleep. I felt no pain. Morphine floated into my bloodstream and I was grateful. I was grateful to be alive.
Someone pushed my gurney into a huge elevator. A few moments later my body was transferred from gurney to my hospital bed.
I was alone.
Wednesday, July 9, 2008
Fitting Exercise into Your Life
Being physically active has so many health benefits. So if you are thinking you can't possible fit 30 minutes or more of exercise into your daily routine, these tips from Johns Hopkins can help.
If finding enough time to exercise seems too much to contemplate, remember that any exercise is better than no exercise and small steps are the key to eventually making larger changes in your habits. What this means is that you shouldn’t forgo exercise altogether just because you can’t find the time or energy to exercise for 60 minutes a day -- even 30 minutes of exercise on most days of the week offers significant health benefits. Here are some strategies you can try to increase your amount of physical activity
Replace sedentary activities with more active ones.
For example, instead of watching television while sitting on the couch, take a walk while listening to a book on tape or talking on your cell phone. Or at least try doing some calisthenics while watching your favorite show.
Look for stolen moments throughout your day to add activity.
Climb the stairs instead of taking the escalator, walk instead of taking your car or public transportation, do a lap around the mall before you start shopping, and return your cart all the way back to the supermarket instead of leaving it in the nearby cart bay.
Buy a pedometer.
This step counter will help you assess how many steps you’re taking per day. We and other experts recommend 10,000 steps a day (equivalent to about 5 miles), although most people walk much less than that. Start off by tracking the number of steps you take on a typical day. Then, try to increase your step count by 500–1,000 steps every 2–3 weeks. Keep a record of your step counts and reward yourself (not with food, of course) when you reach your goal.
Plan for exercise every day.
Mark out 30 minutes or more a day for physical activity and stick to it as if it’s an important meeting or appointment. Individuals who become habitual exercisers are those who make physical activity a priority.
Calories Burned During Moderate vs. Vigorous Activities
Calories Burned Per Hour for a 154-lb Person
Hiking 370
Light gardening/yard work 330
Dancing 330
Golf (walking and carrying clubs) 330
Bicycling (less than 10 mph) 290
Walking (3.5 mph) 280
Weight lifting (general light workout) 220
Stretching 180
Running/jogging (5 mph) 590
Bicycling (more than 10 mph) 590
Swimming (slow freestyle laps) 510
Aerobics Walking (4.5 mph) 460
Heavy yard work (chopping wood) 440
Weight lifting (vigorous effort) 440
Basketball (vigorous) 440
*People who weigh more than 154 lbs. will burn more calories per hour and people who weigh less than 154 lbs. will burn fewer calories per hour when engaged in the activities listed here. Source: Dietary Guidelines for Americans, 2005.
Posted in Nutrition and Weight Control on July 9, 2008
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