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Prevented a risky surgery to remove the large polyp.

May 25, 2016

"I turned 65, got medicare, and thought getting a colonoscopy would be a good idea. I made a living doing carpentry at Lake Tahoe, and only knew the basics about colonoscopy. A screening procedure to search for polyps that could cause colon cancer. I did my first colonoscopy without any sedative or anesthesia and I was fully aware during the procedure. “Doctor S” found a large flat polyp. He biopsied the polyp about 8 times. Then he withdrew the scope. But before completely removing the scope, he decided to go back up and tattoo the polyp so he could find it next time. I didn’t realize at the time, but he had just made 2 mistakes that will make the removal of the polyp harder.  Biopsies and tattoos cause scarring.  Polyps are easier to remove if they have not been fiddled with. The type of polyp he found was the dangerous (prone to turn cancerous ) type and also tough to remove.   Our next meeting, Doctor S discussed the method of using a saline solution injected into the colon wall to lift the polyp off the colon wall so the polyp could be removed without perforating the colon wall. The abbreviation for this procedure is EMR. After the procedure Doctor S came out and said he got 90% of the polyp, and I should come back in a year to have the rest removed. I thought 90% was pretty good and 10% next year should be a piece of cake.  I got interested in the technique used to remove a polyp, and started googling about the procedure called EMR. Eventually I stumbled on an article called “How i do it”, in which 3 doctors discuss their way to remove these difficult polyps (Google: “remove sessile polyp how I do it”).   All 3 doctors said something similar to the following quote: “First and foremost, it is important to carefully assess the lesion to be removed. I will only attempt to resect a lesion endoscopically if I judge that it can be completely removed in a single procedure. Partial removal of a polyp is usually a disaster, leading to inevitable polyp regrowth over a “fixed” scar that may then prove impossible for resection at a later date. “  By incompletely resecting my polyp Doctor S sealed my fate and I may be left with no choice than to surgically remove 18” of colon.  The reason removal is now problematic is because scar tissue will prevent a saline solution from raising the polyp up off the colon wall. Some doctors suggest that a saline solution will still work for a period of 2 months after, because the scar tissue has not formed yet. Well, I’m way past the 2 month window. Why am I finding this out now? Online? Doctor S said come back in 1 year. Looks like 2 more mistakes. Really big mistakes. I read many articles on EMR. Everyone said it must be removed 100% or big problems. It’s like skydiving and pulling the ripcord 90% - a bad outcome. Doctor S had made my situation much worse. The polyp now had a much greater chance of turning cancerous and would be much more difficult to remove. I was regretting ever getting a colonoscopy. The next year ( per instructions) I went to see Doctor S to discuss removing the last 10%.  We talked about the surgery to be done and what if he could not remove the polyp. He said the surgery was “non invasive”, and it made me think of my eye cataract removal. It would be done in 1 day and I’d go home that night – or so I thought. His plan: Step 1: put scope in my colon , and look at the polyp, if he didn’t think he could remove it, then Step 2: I was going straight to surgery for the non invasive removal of the polyp. On the way out the door I asked him about possible scar tissue. “ I like scar tissue” was Doctor S’s response. So I went home and watched a youtube video of the non invasive surgery to remove the polyp. Wow, that was some video. Non invasive - B.S. Also, he forgot to mention 5 days in the hospital to recover. The next day I canceled the procedure with him. Doctor S had zero chance of removing a polyp that would be much harder on his second try. And the colon surgery done in such a rushed and unorganized manner did not appeal to me. If I got to do it, let's at least schedule the operation and let me find a home for my dog for 5 days. I started to call around to get another colon specialist to take a look. No luck. Maybe no one wanted to try to fix someone’s mistake? I started looking for doctors doing clinical tests in polyp removal. My search lead to the doctors at Interventional Endoscopy Services (IES) at CPMC.  One of the IES doctors, Dr Hamerski, responded to my email and said he might be able to remove the polyp. He was willing to try. A major breakthrough for me.   Dr. Hamerski  removed the polyp in one piece. A new technique? Certainly one I hadn’t read about. Called “underwater EMR”, it was pioneered by Dr Binmoeller, the Director of IES.  After the polyp removal Dr. Hamerski  presented me with a pamphlet containing a 6 page report on the procedure he had done 45 minutes earlier. The report included 4 pages of photos, and an explanation of what the photos showed. Also, an ultrasound view of the tissue below the polyp. Dr. Hamerski said the ultrasound did not show signs of cancer. Ultrasound - I never read about that in polyp analyzing . Great idea. The pride the IES Team takes in their work was very evident. They seem to look forward to challenging polyps. They are writing the book on new and better ways of polyp removal. Thanks IES and Sutter Health CPMC for your effort. You prevented a risky surgery to remove the polyp by removing a section of my colon then stapling my colon back together. You have a much better solution! No 5 days in the hospital! I wish Doctor S had referred me to IES in the first place. That should have been his first and only action once he saw the polyp. I don’t get it. How can a carpenter go online and discover Doctor S has violated the cardinal rule for this procedure. The Rule: If you are not sure or not committed to removing 100%, then do nothing. Just as puzzling , is the fact that neither Doctor S or my General Practitioner referred me to IES. Lake Tahoe is only 200 miles from San Francisco. I found IES by a spur of the moment email I sent.  The link to IES is: www.cpmc.org/ies."    

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