The Colonoscopy

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The Colon: Everybody Has One

In a span of six months I saw two gastroenterologists (GE).  Nothing was wrong with me.  I had no symptoms.  It was just that my doctors kept referring me to other doctors and I did not argue because I’m retired.  I need to supplement my recreational activities with educational ones.

My oncologist (Onc) referred me to the first GE, whom I never met.  His registered nurse interviewed me and concluded that nothing should be done to me but her boss the GE always made the final decision on the matter.  Sure enough he said nothing should be done to me.  Onc was happy but my Primary Care Physician (PCP) was not. He referred me to the second GE and told me for the nth time me I should get a colonoscopy because of my cancer history.  I finally caved in and agreed.

So off to GE#2 I shuffled.  My insurance company gladly notified me of their approval of PCP’s request: a 30-minute face-to-face interview between GE#2 and me.

GE#2 is another one of those young, suntanned and handsome Southern Orange County physicians to whom I’ve grown accustomed.  He definitely descended from one of the failed Hollywood star wannabes of Bugsy’s era.

He had 30 minutes so he went straight to business and asked me what symptoms I had that brought me to him. I told the truth: no symptoms. He gave me two options. Option number 1 screening, which is usually given to people with no symptoms. It would require checking of the stool by PCP through lab test results. Option number 2 diagnostic colonoscopy entails him sending a camera through the rear-end orifice and analyzing every nook and cranny of my large intestine, also called the colon. A camera? I asked, with feigned terror in my eyes. How big is this camera you’re talking about? He chuckled and clarified: It’s tiny and you’ll be under anesthesia.  You will not know what’s happening and it will take only about 45 minutes. I’ll look for polyps or cancer signs. If I see polyps, I’ll remove them there and then. I said, I have no symptoms, I’ll take Option 1. What happens next? His response: Your PCP will just keep telling you to have Colonoscopy.

I decided to cut out the PCP agony and go for the colonoscopy experience or Option 2.

GE#2’s battery of assistants went to work.  The tech scheduled a date for my colonoscopy procedure to be performed as an outpatient in a facility where mostly elderly men and women allow the gastroenterologist surgeon  to insert this tiny camera in the rear end for a scenic tour of the large intestine.  It would be like a small train entering a dark tunnel that has 4 bends, each one almost 90 degrees, forming an open square. The camera takes photographs at points chosen by GE. But first, the patient’s large intestine must go through a thorough cleansing to get rid of any caca that might block the camera and a clear view of whatever adorns the innards.

The nurse gave me a page long of must-do things: buy 32-oz bottle of gatorade and a bottle of a laxative; mix the two fluids; take three laxative tablets two different times; drink the gatorade mixture along with a liquid diet at certain times all day before the day of the procedure and hours just before the actual colonoscopy.

All told, I dedicated 3 days of my leisurely life for the project.  Day 1 for shopping, Day 2 for cleansing, Day 3 for the colonoscopy.  Retirement is awesome.  It allows time for this kind of experience.  I was not even thinking of results, bad or good.

Day 2 was the toughest, definitely not a time to visit Disneyland. I had to stay home, prepared to plant myself on the commode at all times.  Laxative overload owned me!

Day 3 proved to be anti-climactic.  I was told to lie down sideways on the gurney and relax.  A nurse installed an Intra-Vein line in front of my elbow and inserted an oxygen thingy in my nose.  Next thing I knew I was waking up.  Okay!  Chop, chop.  I joyfully exclaimed.  Are we ever going to start the colonoscopy?  The head nurse responded, All done.  You’ve been asleep for 2-1/2 hours.  I was stunned.  I had no pain anywhere, no bleeding, no discomfort, nothing.  Whoa! I could have dropped dead and entered the pearly gates without any knowledge of colonoscopy.  I missed out on the event totally.

Everything went well, the handsome devil Dr GE#2 assured me and handed me a sheet of photographs of certain scenic spots inside my large intestine.  I studied each ghastly image with mixed disgust and curiosity.  They looked kind of gross, really, but the pictures of the inside of my colon brought good news: no polyps, no cancer signs.

The clinic’s post-colonoscopy written instructions were pretty serious: No walking home, no bus, no taxi.  Someone must drive the patient home and the driver must be physically presented during the check in otherwise the procedure will be cancelled.  Good for them but I had my own agenda.  I convinced a male friend to accompany me and pretend to be my driver.  I wanted to go home by myself.

After an hour of my coming to, the staff noticed that no one with car keys had arrived  for me.  They became suspicious.  They wheeled me to a corner of the recovery room and held me hostage.  No car, no release.   While buying time for the anesthesia to wear off,  I stared at the door and the exit sign.  They beckoned me.  But the nurses could read the glitter of excitement of escape in my eyes.  They took turns talking to me, still hoping someone would show up with car keys.  Finally, they gave up.  The head nurse instructed a young man to drive me home and walk me to the door of my manor.

Don’t we just love happy endings?  Happy dance, senior string-bikini babe!

 

 

 

 

 

 

 

Insurance Company Denies Payment

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Not a Pretty Picture!

 

My life is filled with conflict.  Fortunately, I dig conflict.  Being a self-proclaimed Drama Queen, I thrive on conflict.  Conflict becomes me.  Okay, you get the drift.

When it became almost clear that rociletinib, the CO-1686 trial drug aka poksceva, had started to differ with me as to its purpose in my well-being, my awesome Onc, Dr Brevity, decided to requisition the services of Guardant.  Guardant is the noted high-tech company that analyzes human blood to determine the types of mutated cells that are coursing through the veins of a cancer patient.  Dr Brevity said he wanted to know what happened to the cancer cell that was once identified as T795, a mutation developed out of my EGFR in exon 19 deletion to resist Tarceva.  Cancer cells do learn to outsmart cancer drugs!

I asked for the results of Guardant’s lab analysis as soon as it became available.  Like the Good Doctor, I wanted to know what new nasties were parading in my system.

I read the report with great interest.  The only problem was, I did not understand a thing about analysis of DNA, genes, and molecular pathology.  Well, what do I know about molecular pathology? I’m a civil engineer; I’m into sewers.  But I got the hang of what the report was saying: Those analysts did not know what to make of the results either because there was not enough material in my blood, consequently, they did not know what treatment to recommend.  So, now, a whole slew of us including Dr Brevity, the analysts, the CO-1686 trial sponsor, its employees and associates, and me, know more than what we did before Guardant came into my existence.  Zip, zero, nada.  And my insurance company put me and only me on notice that they will not pay for the lab’s analytical services.  In other words, you, Ms Senior String-Bikini Babe, shall pay.  The scenario reeks with conflict of interest!  The insurance company’s interest in my funds conflicts with my interest in not paying for anything whenever possible.

Well, I happen to be a veteran of conflicts.  In public events, when the emcee asks veterans in the audience to stand up and be recognized for their patriotic service to the country, I attempt to join those who rise, but a companion always pulls me down and puts me in my place.

I read the letter of the insurance company word for word and found I have 60 days to file an appeal.  I can name a relative, friend, attorney, doctor, or someone else to act as my representative.  The most logical representative is Dr Brevity because he was the reason for the payment denial, which, by the way, was given:  Medical records requested were not received.  In order to determine financial liability or medical necessity medical records are required to assist in a clinical determination. As these records have not been received, this claim is not payable by the insurance company.

It was my turn to put somebody else on notice.  And I did.  Voila!

(to be continued) 

I’d be glad to hear your experience if you have any on insurance payment denial of Guardant’s services.

 

Felt a Lump, Blamed Cancer

Cancer’s only redeeming value is that it comes in handy for blaming anything that goes haywire.  I have blamed cancer for everything from aging to zhingles.  I know, but shingles spelled correctly won’t cover the whole alphabet spectrum.

My most recent addition to the blame-cancer game is a lump on my left arm near the shoulder.  I noticed it one day while soaking in my five-minute vitamin D quota from the toasty Southern California sun while seating on the only patio chair in front of my privacy-walled minimalist manor.  At first I stared admiringly at the lump, delighted that I was getting some muscle definition.  But when I looked at the same area on my right arm and saw nothing there to balance it,  the lump raised my suspicion.  I didn’t think it suddenly appeared but I didn’t know how long the lump has been there.  I had been too busy taking selfies.

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At first sight of the lump, the author celebrated her new muscle definition, or so she thought!

I immediately blamed cancer, returned to my alma mater, Google University (GU) and revisited my mentor, the founder himself, Dr Google.  I asked about “lump in my left arm near the shoulder.” Sure enough, other alumni had already inquired about it.  How dare them debunk the myth that the Senior String-Bikini Babe is an original!

Dr Google had a few things to say about the lump. Its location, appearance and texture based on what I saw and felt, describe LIPOMA, a slow growing usually harmless, painless fatty lump that is most often situated between the skin and the muscle layer and located in the neck, shoulders, arms, and other areas that did not matter anymore after reading the shoulders and arms.  Any one can get Lipoma at any age.  It requires medical diagnosis because the lump may be LIPOSARCOMA, which looks similar but is bad news. I threw some more questions. Dr Google’s answer:  Enough already!  Stop self-diagnosis. See your doctor.

Grudgingly, I contacted my Primary Care Physician (PCP), a gerontologist who makes a living looking for as much wrong as he can find in me. Of course he has his RN for his first line of defense.  I described to her my GU findings.  She said she would ask PCP.  After conferring with him, she connected me with a surgeon, another young handsome Southern Orange County doctor.

Three days later,  I faced the good doctor, Dr Han Sahm.  The name sounds fictitious because it is, to protect his privacy.    Obviously he had already heard from RN everything about the lump.  He jabbed the lump with his forefinger, pushed it around and declared it 99.99999% not cancer. I said, So there is that 0.00001% it is cancer.  He said, I have operated on thousands of this over five years and the results have been 100%.  You have two options: (1) Remove it, or (2) Do nothing but watch it for some time and if it starts to bother you, we’ll remove it.  It will take only minutes.  My decision came swiftly: Let’s wait until it becomes the size of a cantaloupe then do the liposuction.  He laughed, We don’t want to wait that long. We want the procedure to last only minutes.

So there’s my lump story.

Tell me your own lump story, if you have any.