"I Decided I Can’t Live This Way" | Why should you have a colonoscopy?
"I Decided I Can’t Live This Way"
Dr. Adam Basler (left), St. James general surgeon, and Doug Hess, owner of Maple City Discount
Wine & Liquor, catch up six weeks after Doug’s successful laparoscopic colon surgery.
For Doug Hess, 57-year-old Hornell native and owner of Maple City Discount Wine & Liquor, diverticulitis had become a way of life. Diverticulitis is inflammation and infection of small pouches that develop along the walls of the intestines, which cause bloating, pain and overall discomfort.
“Twenty years ago Dr. Chaudhry, my PCP, diagnosed it and prescribed Cipro and Flagyl [antibiotics],” said Doug. This course of treatment often can help patients manage intestinal infection and inflammation brought on by diverticulitis. But for Doug it became a regular routine.
“I’d get a cramp on the right side, a light toothache type of pain,” he explained. “I’d try to stop it so it wouldn’t go any further…go on a liquid diet for three or four days, took Cipro and Flagyl. I had them on me all the time. Certain foods brought it on…if I ate a handful of popcorn, four days later I was in misery.”
The pattern of Doug’s episodes was unpredictable.
“I’d have about three bouts a year. But then sometimes I’d go six, eight months without a bout and suddenly I’d have two a month.”
The final episode that brought Doug to surgery was last November, when he and his wife Barb traveled from their Florida residence to spend Thanksgiving in Hornell.
“I was at the liquor store here,” he said. “It’s a busy holiday and we had about 600 cases come in Tuesday and I work right along with my people, so I was hauling booze all day long.”
Then he felt severe abdominal pain.
“I’d had a hernia operation about fifteen years ago,” he said, “and later that day I said to Barb, ‘I either have a real bad case of diverticulitis or I’ve ripped my hernia out.’”
Doug spent Thanksgiving with family and had planned to head back to Florida on Friday, but the pain intensified.
“I was getting worse and worse,” he said, “and at 2 a.m. the day after Thanksgiving and I had to go to the hospital. We got to St. James [emergency department] and I said just give me a pill and I’ll be fine. But the staff called Dr. Basler [St. James general surgeon], I had a CT scan, and they said it was bad…it was septic. They wanted to put me on antibiotics for 24 hours and admit me.”
Doug said Dr. Randhawa, St. James hospitalist, confirmed the seriousness of his condition.
“I asked Tariq, whom I’ve known for a long time, what do I do? He said, ‘Let’s see what tomorrow brings’ but he wouldn’t let me go home. They hooked me right up and I was out for about two days.”
On the second day Dr. Basler and Dr. Watkins [St. James general surgeon] and Dr. Randhawa visited Doug and said they thought he was out of the woods, so far…the antibiotics were doing what they’re supposed to do, but he would eventually need surgery.
Doug wasn’t convinced that surgery was necessary…after all, he’d been living with this condition for a long time.
“They left my room and I called Dr. Randhawa directly and he said, ‘These guys know what they’re doing, they have all the right equipment. With all the traveling you do back and forth, do what they say.’ I asked should I go to Rochester or Sayre or Cleveland Clinic and he said, ‘No, do it right here. I’ve got all the faith in them.’”
Although Doug was in serious condition, Drs. Basler and Watkins felt he could postpone the surgery for a later date, as long as his immediate symptoms improved.
“They wanted me to get mended up and stronger and have it electively done,” he said. “So Barb and I talked about it and set up a consult with Dr. Basler in January.”
At that appointment, Dr. Basler armed Doug with the information he needed to make an informed decision.
“The best part of my job is that I’m a guide, I’m not the driver,” said Dr. Basler. “I can help with decisions and keep my patients as informed as possible and let them know all the risks and all the benefits and what to expect. Doug presented with one of the most common reasons we do surgery…benign diverticulitis.”
Dr. Basler told Doug and Barb that surgery was probably the best long-term option.
“Doug unfortunately was dealing with it for over two decades and never got completely better,” he said. “The whole point of surgery is to take out the diseased segment and try to remove all the diverticuli or ‘out pouches’ of the colon, to prevent any chance of recurrence.”
Dr. Basler stressed that patients and their families ultimately are the decision makers.
“I sometimes have an opinion and will share my opinion if asked, but I want my patients to be the ones who are truly making the decision. What I think is, ‘If this was me what would I want to have done?’ I can tell you I don’t want to be on antibiotics the rest of my life and I don’t want to keep coming back to the hospital.
In many cases patients can think about it.
“If they’re not ready for surgery yet and they want to come back and talk to me later, or if they get admitted into the hospital for diverticulitis, we’ll have this conversation again,” said Dr. Basler. “This is always a patient-centered decision.”
Doug asked where he should have his surgery done.
“Dr. Basler said we’ve purchased new equipment [at St. James], and you’re not in any danger of needing an ICU, so you’re ok to do it here. And I said that’s good as it’s more convenient for my wife, so we scheduled it.”
This was to be one of the first laparoscopic colon surgeries done at St. James Hospital. Twenty years ago this wouldn’t have been available as the standard of care, said Dr. Basler.
“These days doing the minimally invasive approach – or at least attempting it – is the standard of care,” said Dr. Basler. “Some patients still need the open procedure because we cannot proceed safely laparoscopically, but most of the time this is done safely laparoscopically.”
He explained that surgery for diverticulitis is not what is once was.
“We’re not doing this through big, midline incisions. We make three to four small incisions, using small instruments and a camera. We inflate the abdomen with CO2 so that we can see everything in its entirety. Then we remove the portion of the colon that’s diseased and then use a special stapling device to attach the two healthy portions.”
The current standard of care also includes a thorough pre-op process.
“Before we even get to the OR we need to do a workup,” said Dr. Basler. “The patient is likely to have had a CT scan (imaging of the abdomen) to be sure it really is diverticulitis if there is a stricture. After that, we do a colonoscopy to be sure this is a benign condition, because certain cancers can behave like diverticulitis.
After all that is done, the procedure gets scheduled.
“We also want to be sure patients are eating appropriately before surgery so that their nourishment needs are met, especially protein,” said Dr. Basler.
Doug did the workup and reported for surgery on April 24. The whole procedure took about ninety minutes.
“We removed approximately 25cm [slightly less than 1 foot] of Doug’s colon,” said Dr. Basler. “His condition was fortunately confined to one place in the colon and there weren’t adhesions on other organs. Any kind of infection causes inflammatory response, which causes scar tissue, where organs can get ‘stuck’ to each other or the abdominal sidewall.” Dr. Basler also straightened a ‘kink’ in Doug’s colon.
That evening Doug was already up and about.
“By 10pm I was walking the halls,” he said. “The nurses said the more I walked the better I’d be. I had the surgery on Wednesday and I was out of the hospital on Friday at noon. I got home, and once the surgery pain wore off and everything got working again, each day I got better.”
The typical patient stays in the hospital three to five days, but Doug was able to go home in two days.
“That has nothing to do with how we do the surgery, but what we’ve learned about enhanced recovery,” said Dr. Basler. “For example, we let patients eat right away after surgery instead of ‘starving’ them until they move their bowels, like we did in the past.
With the minimally invasive procedure there usually is less of a need to use narcotics for pain control.
“This helps get everything working the way it’s supposed to much earlier,” said Dr. Basler, “as well as decreases medication side effects, and ultimately gets patients out of the hospital a lot sooner.”
Dr. Basler compared minimally invasive with traditional “open” procedures.
“With minimally invasive surgery, you’re not going to have the chronic abdominal pain,” he said. “You feel more like yourself if you don’t have to spend a week in the hospital. Midline [open] incisions hurt, and it takes a long time for that to get better, so the recovery time for laparoscopic is a lot faster. “
Even though it was major surgery, Doug had very little post-op discomfort.
“I quickly weaned myself off the pain pills,” he said. “They gave me about a week’s supply and I was on it a day and a half…and then was on ibuprofen for about two weeks and I was fine.”
Doug’s overall recovery progressed smoothly.
“I saw Dr. Basler the following Wednesday and we flew back to Florida that Friday. I stopped in to see him a month ago [May] and he said, ‘You’re fine…I’ll see you in a month.’
Rather than pain, Doug’s main complaint was post-op fatigue.
“The fatigue is caused by your body healing,” said Dr. Basler. “Although on the outside your small incisions look fine and are healed, inside your body is still healing, as that’s a lot of trauma to remove part of an organ. It takes time because it’s a big surgery. But recovery doesn’t have to be in a hospital…you can get your energy back at home.”
Dr. Basler said some patients take longer to recover.
“You have to take what you’re working with,” he said. “Patients who are older or have decreased functional status won’t bounce back as quickly as Doug did, but in general, doing it this way you’re going to bounce back a lot quicker with less complications…and get back to being yourself. “
Dr. Basler also explained how overall bowel function improves after surgery.
“The colon learns to adapt to the changes,” he said. “It can continue to function normally, which is mostly to reabsorb water. Most people feel better because they’ve had a stricture or chronic disease there and haven’t been able to move their bowels appropriately. Patients don’t even know this, because this is a smoldering process that’s happens over time, where things become more narrow.”
At the time of this interview, Doug was six weeks post-op and was feeling great.
“I had a bowl of popcorn two weeks ago and thought I had died and went to heaven! We went to the movies and ordered popcorn with double butter and felt like a kid in a candy store! You don’t realize what you adjust yourself to. I’m sure there plusses and minuses and people who have had problems [with the surgery], but mine, thank God, worked out perfect.”
Doug has nothing but praise for his St. James surgical team.
“It was a great experience,” he said. “Both Dr. Basler and Watkins came in, they both tag-teamed me, and one is as good as the other…but this Basler, he’s a peach…he’s a good guy. [Afterward] he knew I was going to be home and he stopped in to check on me, numerous emails back and forth…that was nice. Just a great guy…wonderful guy…I would recommend him to anybody.”
Doug has talked about his experience with others facing the same problem.
“I’d recommend it 100%...don’t wait. Matter of fact I’ve talked with three or four people at the store, and I’ve told them you’ve got to go see these people and have this done and don’t live with it any longer.”
He continued, “I probably wouldn’t have had it done, but you’ve got that security that this guy really knows what he’s doing and there was no second guessing. I did a little homework on him – both of them – and got nothing but great reviews all the way around. But up ‘til almost a year ago I probably wouldn’t have considered it. With that last bout I got scared, and I decided I can’t live this way.”
Dr. Basler recommends people take their condition seriously, but don’t assume that surgery is the only option.
“Diverticulitis is more common than people realize,” he said. “I think a lot of people are living with something like this and don’t even know it…they’re just used to ‘my left side hurts every so often and I just don’t feel good but then it goes away.’”
He said there are levels of diverticulitis, from just inflammation of the colon to having a large perforation that’s going to require emergent surgery.
“Some people have one or two bouts and it may never happen again…those people I don’t take to the operating room.”
Doug was happy with his whole experience.
“I have all the confidence in them and in the facility too. I can’t say enough about the facility…the nurses you have there and the staff, both in November and this last time…unbelievable. They’re good people. We’re so lucky in Hornell to have people like this…I hope we can keep the momentum up and great things will keep happening at the hospital.”
Dr. Basler or Dr. Watkins are available to talk with anyone suffering from chronic diverticulitis and similar conditions. Call (607) 385-3820 to schedule a consult.
Why should you have a colonoscopy? Tracey Ellis says, “Do it, because if there is something wrong it’s going to save your life.”
Tracey Ellis of Canisteo, NY is an active 51-year-old whose passion is her “second career” as a stay-at-home grandma.
“I’ve been taking care of my granddaughter Kaya almost four years now and I really love that,” she said. “It still means getting up at 5:00 every morning and getting everything going and running…it’s just like a regular job. I’m very active and very healthy…my granddaughter keeps me really busy!”
Upon turning 50, Tracey’s PCP recommended she get a screening colonoscopy. Given her busy schedule and anxiety with doctors, a colonoscopy wasn’t exactly on her bucket list.
“Well, I didn’t decide it…my doctor did when I turned that golden age of 50,” she said. “It’s just one of those health things you do to keep up with your body. It’s no different than a mammogram…keeping up with yourself and check-and-balance. After sitting with Dr. Ashdown and Marietta Goodliff [UR Primary Care Hornell], we came up with a referral and that’s how I got started.”
Tracey was sent to Dr. Adam Basler, general surgeon at St. James Hospital, and she was happy with her referral from the very start.
“I’m not good with doctors…I have white coat syndrome, so it took a lot to build myself up to get myself going to do it. When I went in [to Dr. Basler’s office] they explained everything to me…from what was going to happen, what to expect, how to cleanse myself, absolutely everything.”
Setting up a date for her procedure was quick and easy.
“They [Dr. Basler’s staff] were real quick about it…there was no lingering and I was glad for that,” said Tracey. “They then called in my prescription for the supplies and boom, boom, boom. It all happened real quick…they don’t let you sit around and think about it...for me it’s a really good thing.”
The pre-op nurse at St. James gave Tracey some tips on how to do the cleansing prep, which is generally the most unpleasant part of a colonoscopy.
“The nurse had ideas on how to get the drink down and that was so helpful,” said Tracey. “She suggested drinking it fast through a straw as I was walking around so I’m not getting filled up. I took half of it the night before and the other half five hours before the procedure...I got up at 2am to ‘dust it off’ and start over again, but it was fine. I was tired, but the whole cleansing was not bad at all…it really wasn’t.”
The day of Tracey’s procedure went extremely well and she was grateful for all of the extra TLC from the St. James staff.
“I was at the hospital by 7 a.m. When I came in everybody was so good to me. The lady at registration could tell I was nervous and she said, ‘It’s ok, I just had mine [colonoscopy] done and it was fine.’ The nurse brought me right in, took me into the cubicle and put my IV in…she got it first poke with absolutely nothing. Every few minutes I had someone coming in taking my blood pressure and checking on me. One of the nurses asked what I’d like to eat and drink after the procedure.”
Then her surgeon, Dr. Basler, came in.
“Dr. Basler is the greatest guy…I just love him. His bedside manner is great. He could tell I was really nervous, and he just kept smiling at me and said it’s ok. He went over everything he was going to do, what to expect, and just reassured me I was in good hands. He has this smile and charisma about him that just calms you.”
Tracey’s anesthesiologist was also very reassuring.
“She explained everything to me and said, ‘I’m going to be right beside you…my job is to watch over you, watch your breathing, blood pressure, everything. It’s going to be ok.’ [During the procedure] I was out but I not ‘out out’…I was just in a deep fog. The next think I know she’s waking me up and the girls were unhooking me and wheeling me back.”
While in the recovery area Tracey got her results. Dr. Basler found and removed one small benign polyp but otherwise everything was clear, and he said he’ll see her again in five years.
“What makes me feel so grateful for everyone is when I was done with my snack, the whole team that did the procedure with Dr. Basler came in. While he was telling me my results they all stood with him, and they all wished me well. It wasn’t just Dr. Basler, it was the whole team. That really, truly impressed me. Even my husband Mike, who has had two colonoscopies [elsewhere] said ‘I didn’t get that kind of treatment.’ They made my husband feel so comfortable and brought him coffee and everything.”
It was a quick transition from start to finish and Tracey was home by 9:30 a.m.
“I felt fantastic honestly! But I did come home and take a nap…they suggest you rest for a little while, take it easy and relax. The next day everything was pretty much back to normal.”
The follow up communication was thorough as well.
“Afterward I got two phone calls…one from the hospital to make sure I was ok and one from Dr. Basler’s office asking if I was ok, do I have any pains, the same questions plus more. They reassured me if I have any questions, nothing’s too small and don’t hesitate to call. From start to finish they don’t give up on you. They’re right there every step of the way.”
Tracey has important advice for anyone who’s been told they should have a colonoscopy or is considering it.
“Do it, because if there is something wrong it’s going to save your life. If they don’t find something, it’s peace of mind, knowing that that part of your body is as healthy as the rest of you. Having the experience that I did, with all the great people, that’s all I talk about now! I know that sounds silly, but I met so many great people and they truly care.”
Tracey is on a mission to be sure people get their colonoscopy to take care of any little problems before they become serious.
“It’s better off if they find a problem and take care of it, because for me, that little girl [Kaya] is my world. I want to see her graduate, I want to see her get married…and if you don’t do these things, you just never know. Some people say, ‘I don’t want to go through that’ and I keep telling them there’s nothing to it…it’s easy peasy and if I can do it, anybody can do it!”
For more info about colonoscopies or to schedule your appointment, call St. James Hospital’s surgical team at (607) 385-3820.