Don't Ship Your Pants

There has been a fine line these last few weeks since finding out that my sigmoid colon is nearly obstructed. From the initial colonoscopy report, they were unable to pass either the pediatric scope or the endoscope, leaving only an 8 mm lumen for things to pass down and out: solid, liquid, or gas...

Hilariously, I hadn't really been having issues. I wasn't feeling like I was struggling in the month before my "hernia pain." My family will tell you that I think quite a few of us are chronically constipated, so it's not exactly a prospect I ignore. In fact, we regularly have a two-quart pitcher of Magic Juice on hand in the fridge, with Crystal Light and two caps of MiraLax pre-dosed for anyone.

Regardless, I started MiraLax the evening I heard it was colon cancer, trying to get a head start on the bowel prep I knew was coming.

Morning and evening cup of coffee/ tea dosed! Sometimes add a midday round as well...

I hadn't really thought through the mechanism of MiraLax. Knowing that it's pretty benign and completely palatable, I was comfortable being somewhat aggressive with my dosing, keeping everything flowing. The trouble is that it works by drawing liquid into the bowel, effectively dehydrating you as it goes. That first weekend, combined with lovely bouts of tears and no real appetite, I became quite fluid imbalanced before coming back into town. Gratefully, our ED ushered me straight into a room and gave me a few extra liters of saline to balance the system back out.

Since then, I've become somewhat hypervigilant about my hydration and nutrition status. Before all this, I had been intentionally cutting calories, specifically carbs and alcohol, while increasing protein and vegetables as part of my training and running. Conversely, now I need to add back some of the "happy fat" weight I had lost, and I'm finding it surprisingly challenging to do on a limited diet.

One of the first meet-and-greet consults we had was with a colleague of mine, a sort of "Welcome to GI Cancer" visit. The key takeaway from our banter:

"Do not let a spare sprig of broccoli send you for an emergency ostomy."

I was dismayed to learn that the opening in the colon was so slight that any excess fiber, think seeds, hulls, husks, let alone leaves and branches from some of my favorite cruciferous veggies, could ultimately cork that space and force me into an unwanted surgery.

And should we get to a bowel obstruction, here's the lesson: they do not touch the cancer. They simply divert the colon to the outside, above the blockage, and continue you on your regular treatment plan of chemo and everything else.

We can certainly say I was fairly warned, and I'm working hard to avoid most foods that threaten to plug things up.

Oh how I miss brussel sprouts and broccoli, salads and green beans 😩

The oncology dietitian was helpful in different ways. He gave specific guidance on things to avoid and, obviously, listed a number of options. Not exactly the type of grocery shopping I usually do, he suggested regular visits to the baby food aisle.

This is not to say I'm on a strictly liquid or baby-food diet. However, everything has to be pre-digested in a way, or completely digestible on its way through. No insoluble fibers. No stringy fats. No tough meats.

Flaky fish and white rice are okay. White pasta and bread, not so much. Flaky pastry, okay. Pancakes, maybe not so much.

Scrambled eggs, yogurt, cottage cheese, soups with no residue, and of course the all-time favorite recommendation: calorie and protein supplement drinks!

Mashed foods are tolerable when well cooked

To go from avoiding carbs and sugars to immediately needing them as a mainstay of my diet has thrown me for a loop. In a very "unfuck my brain" sort of way, we're trying to override the very little appetite that grief and cancer treatment allow and push through enough fluids, calories, carbs, and bowel meds to keep the system running efficiently and safely.

Getting creative lately, making dirty sodas with Boost, flavored seltzer, and topping with extra cal whipped cream...

Adding chemo to the mix will soon create a separate layer of challenges. Nausea, vomiting, and diarrhea are lovely side effects, as are mouth sores and mucositis, all of which make eating and drinking both imperative and difficult.

I've lost twenty pounds or more, at least half intentionally, obviously, and I need to hold here for now and eventually regain. Should that prove increasingly difficult, the dietitian was wonderfully frank that nasogastric feeding tubes are friends. They can come into play anytime I can't maintain above the minimum threshold, helping meet nutritional needs and perhaps sparing me from the well-meaning family and friends who would otherwise harp on me about intake.

For the time being, I have enough friends in my new port, chemo regimen, daily bowel meds, and very high-calorie Boost to keep me company.

I'm happy to know the resources exist, and I'm doing the work to be consistent every day in treating myself like a baby: eat and drink, sleep, poop, get some activity in, and do it all over again...

Oh yeah, and don't ship my pants.