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Cancer Colon cancer. More generally referred to in the medical community as colorectal cancer. It is a topic that until recently, I have had little experience with. In my personal life, colorectal cancer was the death sentence given to my grandfather when my mother was just 16 years old. His neglected, nonspecific abdominal pain slowly ravaged his body until the pain was severe enough to get help. His death left a gaping whole in my mother's teenage years. Colon cancer was the enemy, and there was no defense system. The Young and the Innocent Fast forward to 2022 when a 37-year-old mother of 2 sat helpless on the floor in her office as pain riddled her ability to get help. Until this day, her pain had been nonspecific, mimicking a lot of other pain one may feel occasionally, or even cyclically but had no identifiable alarming cause. After emergency help arrived and imaging had been completed, the cause was undeniable. Tumor with colon rupture. metastasis. Stage 4. Jump again to September, 2023. A close friend. 39-year-old mother of 3. Intermittent nonspecific abdominal pain over the course of 3 months. The list of differentials is endless. Gallbladder. Constipation. Ovaries. Irritable bowel. After the pain was severe enough one day, she popped in to the urgent care before the weekend hit. The CT was undeniable. Tumor. Metastasis. Stage 4 colon cancer. She had a chemo port even before the biopsy results were in. Now It's Personal Halfway through writing this article I was stopped by another wrench in this colorectal saga. October, 2023, just one month after my friends diagnosis, I found myself in a position I never imagined. I sat in the chair beside my husband's hospital bed after his first colonoscopy (he's 46). "We found a tumor.” "You mean a polyp?” "Tumor". "A large polyp?” "A very large mass. We've sent biopsies. It looks to be cancer". “…………” Three months prior it was discovered, through routine yearly blood work, that he had lower than normal hemoglobin. Additional iron studies confirmed iron deficiency anemia. When his colonoscopy was scheduled 3 months later, my best guess for the cause was an absorption problem. Celiac at the extreme. To say that nothing can prepare you for those words is an understatement. My mind was racing and I had absolutely no idea how to fix this one. No idea what the future held—for him, for me, for my 4 young kids. Our story turned out better than the other two. The MRI showed the spots on his liver were non-cancerous. The MRI of his lungs showed nothing unusual. He was a perfect candidate for tumor removal through surgery. Removal Within 4 weeks of diagnosis, he had undergone a robotic assisted hemicolectomy. The right side of his colon from the small intestine up to the liver was removed, along with the baseball size tumor through a 4-inch incision in the wall of his abdomen. Seventeen lymph nodes were also removed and biopsied. The small intestine was joined to the remaining section of colon that was left and he escaped this nightmare without a colostomy. The surgeon said the tumor had most likely been growing for 8 years. The relief I felt when I could tell my kids that all seventeen lymph nodes came back with no cancer cells was overwhelmingly bitter sweet. I felt elated that our story's ending seemed to be a happy one. But extreme confusion, sorrow, and unbelief that that other women's outlooks were far more complicated and uncertain. We know a parallel path in the cancer world does not exist, but our paths diverted in an extreme way that day. And the guilt of it hit me hard. Cancer Community According to the American Cancer Society, colorectal cancer related deaths have seen a steady decline in the older adult populations since the 1980s. This is largely due to the increase in screening with the use of colonoscopy. However, since the mid-1990s, that trend has seen an increase of 1-2% EACH YEAR in adults under the age of 55. In 2024 alone, colorectal cancer is expected to claim the lives of 53,010 people. (2) The cancer community is a tricky one. It is one word that describes over 100 types of cancer. It is one word that will affect 1 in 4 people in their lifetime. It is one word that will claim over 600,000 lives this year. (1) Yet, the differentiation is expansive. The treatment options are endless, and the outcomes are variable. In the same way the one word "cancer" can unite those who experience it, it can also leave devastation as one person becomes another one of the 600,000, and one does not. What Can Health Professionals Do? · Encourage preventative care. Make sure your patients are getting yearly exams that include bloodwork. · Encourage body awareness. This teaching should include paying attention to elimination patterns, pain and fatigue. · Encourage conversation. The cancer community needs to be able to talk about what they are dealing with, without feeling labeled by it. Neither avoiding the subject or dwelling on the subject is helpful. Find a balance between acknowledging this part of their life without defining them by it. Sensitivity is key. · Encourage support. Survival guilt is real. Those who have an optimal prognosis are often interacting with those that do not. The person and families of cancer survivors can be tempted to minimize their traumatic experiences for the sake of those in their community that did not or will not survive. Talk about that too. They need to process the guilt of mixing the "why me" in getting cancer with the "why me" of surviving cancer. · Smile as often as it is appropriate. It makes people feel seen and brings hope in dark places. You are the front line in vulnerable places, and your face really can set the tone of the interaction. Cancer affects us in our professional AND personal world. It is essential that we approach it with openness and sensitivity. Allow it to become the enemy against which we unite. Let us work together to support each other 1) through it 2) as we fight against it and as we 3) recover from it. 1. https://my.clevelandclinic.org/health/diseases/12194-cancer 2. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html

Jennifer, thank you for your comment, and your perspective. Unforeseen hiccups, even minor issues can quickly become much larger inconveniences without some of these preps.

International Travel is Growing Again For some, this is a long-awaited relief! They have been waiting to hop on a plane to wherever, whenever! For some, it is the chance to finally see that family member again. Maybe for some, it is a dreaded necessity for their company that they were happy to have gotten relief from when all business meetings were conducted via virtual platforms. Whether it is the families finally taking that dream trip, seeing that long-distance family member, business meetings, sightseeing with a tour group, or sailing the seas on a cruise ship, traveling poses health risks to everyone. Here are some things to review with your patients, friends and family members before they travel. Before You Travel 1- Check your vaccination record The risk of contracting some viruses increases with travel. For example, Hepatitis A, a virus that is spread through the handling and consumption of food infected with it, has a two-part vaccination that effectively prevents illness. The vaccine did not become a part of pediatric vaccinations until 2007. Subsequently, many adults have never received this vaccine. Other countries recommend or require updated vaccines like yellow fever, MMR and Polio because of the higher risk in the area. The CDC, as well as travel health clinics, can supply country-specific data on these vaccine-preventable illnesses. 2- Protect your skin Illness as a result of sun exposure and insect bites put a real wrench in travel experiences. Educating your patients on the importance of keeping their skin covered to prevent insect bites and sunburns can make a big impact. Sunscreen with a 30 SPF will block 97% of UVB rays and should be applied before insect repellant. Having the right insect repellent to apply to exposed areas is also essential. Repellents with 30% DEET are effective against most insects. Encourage your patients to invest in 2-3 outfits that are of a light weight, but protective material that can be mixed and matched throughout the trip. Materials geared toward travel are often protective yet still breathable, even in hot climates. Outfits should include tall socks, long pants, long sleeves, and protective footwear. Additionally, clothing can be sprayed with permethrin and allowed to air dry a few days before packing. This provides an additional layer of insect repellent. 3- Drink from a bottle ... or any other sealed beverage Bottled water should be the only water consumed when traveling abroad. Encourage your patients to put tape over the faucets in their accommodations to remind themselves not to use tap water, even when brushing their teeth. Other beverages that are carbonated are also a good choice because they ensure a proper seal has been in place. Additionally, ice should be avoided, as it is typically made from tap water. 4- Take your medications with you Key medications can be very helpful when traveling. Pepto Bismol can be taken for mild traveler's diarrhea. It has formulations suitable for air travel and can be very effective in saving multiple trips to the bathroom. Caution, though, it can only be taken by those who are able to take aspirin-containing products. Also, many providers will write a prescription for a 3-day course of antibiotics in the case of severe traveler's diarrhea. Those traveling to higher altitudes should also consult their primary care provider or travel health clinician about the use of acetazolamide (Diamox) to prevent altitude sickness. All other regularly prescribed medications should be kept in their labeled containers for ease of travel through security checkpoints. Patients should also have a detailed medication list kept in an area that is easy to locate quickly. 5- Consider travel health insurance Emergencies out of network and especially out of the country can be financially devastating. Reputable travel health insurance companies offer affordable policies for the trip duration. They also provide resources for locating accredited emergency facilities, should the need arise during their travels. 6- Finally, pack a first aid kit Depending on the place of travel, basic first aid may be hard to come by. A first aid kit should contain the following: alcohol swabs an assortment of bandages pain relief medications oral and topical antihistamine medications for allergic reactions and insect bites extra contacts or eye glasses hand sanitizer a face shield small scissors A few brief moments educating your patients on basic safety considerations while traveling can have a huge impact on their experiences. It will give greater peace of mind and allow for much more enjoyable travels. References/Resources Travelers' Health: CDC