This is an inspiring story of an 85-year old man who was an epitome of courage. He was borderline diabetic and had borderline hypertension. He had cardiac and kidney problems too to compound things. Yet he put up a brave face as he was vomiting profusely and showed signs of dehydration when he came visiting me.
He was indeed a regular patient and I knew his complete medical history. I remember him having prostate surgery when he had a prostate condition. I also took his record and remembered that at last visit he had a higher creatinine level as shown in his diagnostic reports. This time around when he visited me, he complained of chronic constipation accompanied by vomiting. He had a visible distention in his abdomen. He was dehydrated and I began talking to him to understand the symptoms he was presenting from his own words. He was then asked to be admitted at the hospital. After his admission he was rehydrated and administered a conservative treatment for 24 hours. There was no visible improvement, the distention did not resolve and this may very well be due to the age factor.
A limited CT abdomen was done because of his kidney problem. The scan did show signs of obstruction in the sigmoid level. This was probably cancerous growth because at this age usually any growth is cancer in nature. CT Scan report revealed that it was nearly 25cm above anus and I should say that the growth was complete and was indeed an obstruction. I was clear that at least the obstruction needs to be relieved even if not giving a complete curative treatment for the tumor. A colonoscopy could not be done because of his age. It was almost an emergency situation and hence I recommended surgery despite the fact that he was pretty old.
The patient’s nephew was also a surgeon in the US and he had called me and recommended that I do not do the surgery due to the age factor. He asked me if a colonoscopy can be done instead of a full blown surgery. I ruled out the same due to the age factor.
As the patient was suffering, he was pretty aware of the risk factors clearly. Though aware of the reservations of his nephew he was pretty clear and minced no words when he said that he was ready for the surgery. As a matter of fact, he encouraged me to do the surgery on him.
We did an open sigmoidectomy surgery and we observed that the growth was indeed there but had not spread luckily. The colon was filled with motion which we cleared. We proceeded to do a colostomy and had to divert the colon to reduce the pressure on the suture point. We planned to keep the colostomy on till the healing was complete. We did send the tissue samples for a comprehensive biopsy report. The medical oncology reports (PET) did not find any remnant growth and hence it was decided that the resection was complete. Chemotherapy was hence not carried out and because of the same the colostomy will be closed once he shows full recovery. What an inspiration indeed from the senior citizen!
