Cancer and Colostomy Bag

[al007]

I have today finished six weeks of Radiology and Chemotherapy, for Rectum and Prostate Cancer, at Chulalongkorn Hospital, BKK, incidentally I was impressed by the service, for both quality and technical expertise

 

I go home to KhonKaen to recuperate, before again being reassed by a team of three doctors, in early January, and there is a strong possibility I may have to have surgery and a colostomy bag fitted

 

The thought of this is to me awful, I will in the spring next year be 72, and am considering maybe not having surgery

 

I am gathering information so when I see doctors I can make a sensible and timely decision

 

I will need to know approximately how long I might live without surgery, and only the doctors can give guidance here

 

Also it would be helpful to hear from others who have gone through these experiences themselves or with close relatives

 

I am also looking for information on palliative care around KhonKaen, one thing that worries me is suffering pain, as I have heard hospitals are reluctant to prescribe pain killing drugs

 

I do not fear dying so long as I do not suffer pain

 

In parts of Europe Euthanasia is possible, can this be achieved anywhere in Asia, I do not wish to be a burden to my loved one

 

I am an optimist, but also need to face reality and gather information

[lopburi3]

Suspect have the cancer removed is your best choice in the pain department - there should not be any pain issues in hospital and if cancer removed that would be one less long term pain issue.  I have not had that surgery but have had portion of colon removed to use for bladder storage after bladder removal and there has not been any pain involved once out of hospital and very little in.  The stoma for me is just urine but believe colon will also be painless nipple on body.  As or age is similar you could well have many years so believe the short term pain of operation (almost none) to be preferred to fighting cancer as it progresses (or trying to battle with non invasive approach).  Believe you are far from needing the alternatives mentioned - but understand how down you can feel - especially with your recent experiences.  But at this point believe you can a positive factor in the crazy world and wish you the best and a longer and happy a life as you face what we will all fact at some point.    

[lostinisaan]

Your post really made me sad and I can feel your pain. Please keep in mind that positive thinking now is way better than most medication they'll give/offer you.

 

       Please do not worry about the pain now, they'll prescribe morphine sulfate should other drugs not help to take the pain away. It's not from hearsay, I receive quite a high dosage of both, morphine tabs a 30 mg, plus morphine sulfate syrup for my severe pain in my right leg.

 

      All government hospitals do have a pain relief department where you'll easily get enough to live without any pain.

 

       Your post shows a little part of pessimism, so please keep your last sentence up as the one you'll follow until the end. We all have to go one day. 

 

<snip>I go home to KhonKaen to recuperate, before again being reassed by a team of three doctors, in early January, and there is a strong possibility I may have to have surgery and a colostomy bag fitted < snip>

  

            If I were you I'd and see other specialist's opinion regarding the operation and then living with a colostomy bag for the rest of your life might not be the way other specialists would go. 

 

   You might be good to go for many more years without one and that's a huge part of life quality.

 

       I understand that it might be inconvenient to go to see other specialists, but please try to find other options. It's worth the time and hassle. 

 

    Please page me if you've got problems to receive the right pain killers that really enable you to do things without other peoples' help. 

 

        Positive thinking should be your main goal now. Cry when you're happy and smile when others cry.

 

       I know that I can't take your pain but would do so if iIcould. My sister back home had a cancer group for 25 years and I've experienced quite a lot of sad stories when I tried to help.

 

    Please smile when you've read my words and listen to the 3 hours of guitar music. Great for medication and good for your body to produce some Adrenaline...Best wishes from lower Isaan.

 

     

 

           

 

     

 

         

[Sheryl]

A colostomy can be permanent or temporary...big difference.

 

A temporary colostomy is unavoidable if they resect any portion of the intestine, because one cannot have a fresh suture line exposed to fecal matter, it will infect. So in that case, a colostomy is created temporarily until the internal incision line has fully healed, and then a second surgery is done to reconnect everything.

 

Assuming the surgery has a reasonable chance of effecting a full cure, it would be foolish to refuse this.

 

A permanent colostomy mainly is done when either (1) the tumor has invaded the anal sphincter to the point where there is no way to remove it without irreperable damage to the sphincter that cannot be repaired -- in that case, you would otherwise be completely incontinent so a colostomy is the lesser of the evils or (2) the tumor is so large that the amount of intestine that would have to removed is so long that it would not be possible to re-attach the remaining portions.

 

If permanent colostomy is advised, you need to consider not only how long  you are likely to live with and without the surgery, but also how much pain and suffering is likely to occur due to not having the surgery. Sometimes the surgery even when not curative is advisable on palliative grounds - -because the alternative may be having your bowel obstructed by a tumor, and a bowel obstruction is very, very unpleasant and painful: severe cramps, vomiting etc - a tumor cannot keep growing without affecting the patency of the bowel and there would be a period of time where you'd still be alive but your bowl partially or totally blocked off, at which point you'd be more than glad of a colostomy to relieve it (and one might yet have to be done on an emergency basis).

 

No legal euthanasia in Asia.

 

And yes, palliative care is not a strong point in Thailand, though it does vary with the doctor and the hospital, and there are some pain specialists to be found (though not many). Where it is especially weak is in provision of strong pain killers to out patients - no morphine drips in the home like in the west, have to be admitted to hospital for that. Which is a drawback for those who want to die in their own homes. Still, for a price, and provided you are willing to be admitted to hospital when it gets to the point that you can't take oral medication,  decent analgesia can be had in some private hospitals here. There are even some (few) with the patient-controlled analgesia devices. If going that route the key is to be admitted as a patient of a pain management specialist rather than an oncologist or surgeon...so that the Pain specialist has top billing, so to speak, regarding your care.

 

But let us hope none of this proves necessary in your case.

 

There are some Western GPs working in Bangkok and once you have gotten all the information and are thinking things through you might find it useful to go chat with one of them, both are very knowledgeable about Thai hospitals/health care. They are:

 

Dr. Nick Walters (American)  http://www.mission-hospital.org/en/component/k2/item/54-dr-nick-walters.html

 

Dr. Donna Robinson (British)  http://www.medconsultasia.com/

[lopburi3]

I also faced the operate or not and the added option to try and remove and kill remaining with chemo.  As you was not adverse to death as it is going to happen at some point so examined options with I hope an open mind.  My decision was even if limited there was enough to enjoy to make continued life the choice.  As it turns out there is very little limitation; although that can always change at some point life now is good. 

 

Original pathology was slow growing stage 2 (after operation and actual full pathology changed to fast) so doctor might have given me years and been very wrong.  As removal, in this and probably in your case, offers good chance of it being totally gone - and you have had pre-chemo which adds to the chance of success - believe it would be the best course to sail if doctors recommend.

 

Believe I had spinal epidural for long operation and was out immediately.  Was advised in ICU of button to push if felt pain but never needed and as I recall catheter was kept in place for several days and felt absolutely no pain at all until after it was removed and then pain was only enough to make sleep difficult so asked for pain med for a few nights to help that - but never needed during day.  So expect actual operation would not be that unpleasant.

 

If you need patch/bag you can get a good idea of process viewing YouTube videos.  I had a good idea before operation and did not believe it would be too bad and it has not been.  Do not know price of patch/bags in government hospitals but I only use two a week and many only have to change once a week from what doctor says (I use the adhesive designed for stool rather than urine as urine type does not seem to stick to my skin well so have damage to adhesive as urine gets to it but still can reliability go 4/3 day cycle).  You can still get out and do most things so life is not over.

 

Understand desire to have control and knowledge of how to depart if required and am sure you can find good information on internet.  But really believe you are most likely far from needing that option and probably will never reach it.  And suspect your loved one would much rather have you around.

[al007]

I would like to say the kindest and compassion being given on this thread helps me a lot, and is very valuable in forming an opinion on what to do

 

I also know generally the view and opinion of a group is more valuable than one's own view alone

 

I continue to learn what I did not know

 

I am not too depressed, I am a realist, and am optimistic, I consider I was lucky to discover my two different cancers when I did

 

I will be home wednesday and we have large gardens and I look forward to seeing all the bougainvilleas that are currently coming into flower, also our dogs one alsatian is about to have puppies, this all helps to keep ones mind off the negative stuff

[Oxx]

20 hours ago, Sheryl said:

No legal euthanasia in Asia.

 

Not quite.  It can be legal in Japan under specific circumstances.  E.g. 

 

- the patient suffers from intolerable pain
- death is inevitable and soon
- the patient consents
- the doctor must have exhausted all other pain relief measures.

 

That said, it would be very difficult for a foreigner to take advantage of the possibility.