What’s your next surgery?

My next surgery is a Lower Anterior Resection (LAR), scheduled for Tuesday, July 28th. 

It’s perhaps the biggest piece of the puzzle. And the thing I’m afraid of most. 

In LAR surgery they don’t just remove the tumor, they remove an entire section of your rectum and many surrounding lymph nodes. Then, the surgeon reconnects the colon to the remaining lower rectum or anus.

So, pretty major surgery in a difficult-to-access, highly sensitive area of your body.

The good news is that my tumor is in the middle of my rectum, making preservation of the sphincter muscle—and avoiding a permanent colostomy bag—likely.

The bad news is that because it’s in the middle, my surgeon will have to remove most of my rectum. That means a temporary ostomy is possible, and LARS (more on that below) is very likely.

More good news (trying to find it where I can…): my surgeon will use the da Vinci Surgical System—a robot!—to do the surgery, which should make recovery easier and reduce the risk of complications. I should walk away with one 2” incision and a bunch of smaller ones in my abdomen rather than having my abdomen slit open.

I believe the surgery takes about four hours and I’ve been told I’ll stay in the hospital for about two days—though now knowing how my body responds to intestinal disruption and anesthesia my guess is it’ll be closer to four days. Fun fact: I’ve never been hospitalized before. Both of my previous surgeries were outpatient. (Yes, even the mastectomy.)

I’ll have to do a bowel prep the day before, will be on a liquid diet for a bit, then will graduate up to my favorite—the low-residue diet—for a couple weeks before being permitted to add foods back in very slowly under the guidance of the dietician I see at the cancer center.

I’ve been told I’ll be sore for two weeks and tired for about six. The long-term side-effects are many and their duration is pretty unknown. More on that in the LARS section below.

After surgery, the tumor will be sent to pathology and my oncologist will make the decision on what my next course of treatment looks like—which is likely six more rounds of chemo, maybe removing Oxaliplatin (the chemo that can cause neuropathy) for part of it. This will start no sooner than four weeks after surgery—another mini recovery window. Knowing my colorectal oncologist, that next round of chemo will start exactly four weeks after surgery if it looks like I’m healing even remotely well.

Wait, what’s LARS?

LARS stands for Lower Anterior Resection Syndrome, a collection of long-term bowel and digestive symptoms that can happen to those who have LAR surgery. LARS is extremely common. The extent of what my LARS will be is unknown, as the surgery affects everyone differently.

LARS happens because your rectum is removed and the rectum is the storage chamber for stool once it moves through the colon and before it exits through the anus. Also, like with all surgeries, you’re causing major muscle and nerve disruption to the entire surrounding area.

LARS symptoms typically include:

• Urgency
• Clustering (having multiple, frequent bowel movements in a short period of time)
• Incontinence
• Incomplete bowel movements
• Altered consistency (constipation, diarrhea)

Temporary LARS is pretty much guaranteed. Which symptoms I’ll have… well, we won’t know until it happens.

LARS can be life-long for many people, but symptoms can improve a good bit in the first six months to two years.

It can be managed by:

• Dietary changes 
• Medication intervention
• Pelvic floor therapy
• Sacral nerve stimulation

How are you feeling about it?

I’m scared and I’m anxious. Or, since anxiety is just fear in different clothes, I guess I’m just really scared.

I think I’m less scared of the surgery itself (I trust my surgeon, I’m at a great facility, I love this robot idea—knock on all the wood) and more scared of LARS. I’m also a little scared of staying in the hospital but mostly because that’s just a new thing for me and I know I’ll be in pain and unable to get good sleep which usually makes my mental health tank pretty quickly.

My oncologist was surprised when I told him I was scared of the surgery. He suggested that maybe I might feel relieved. I love this idea and I would love to get there in my brain.

It took me a day or two after hearing that to think, “oh yeah, they are literally cutting cancer out of my body (save for any rogue cells).” That’s something I can get behind.

But the long-term lifestyle changes that are completely unknown? That’s what I’m having a hard time with. I like to travel. I like to hike. I like to be on water. Also, I just did this—and am in the process of processing this—with my mastectomy. I’m learning how to be in a new body and how it impacts my quality of life. And now I have to do it with another part of my body too? And the unknowns on this one are very overwhelming to me. With the mastectomy we pretty much knew what I was getting into and what I’d walk away with, for the most part. This is like, “well… we’ll see!”

How are you coping?

Um.

Well…

About ten days ago I was not but I’m trying to work on some things—mostly mentally—before the 28th.

Here’s what I’m finding interesting with this one: the balance between preparation and surrender.

My usual MO is to do all the research and all the preparation possible. I did this with chemo, remember? I had a plan for every possible side effect. My house still has Pepcid, Immodium, Tums, ginger chews, peppermints, ginger and peppermint tea, bland foods, barf cans by my bed, serums and wide-toothed combs for hair loss, etc etc. Mastectomy, I had button down shirts, cushions to help me sleep upright, loads of OTC pain pills, special pillows, etc.

For this… I’ve got nothing. I have a pre-op with my surgeon six days before the surgery so maybe she’ll give me a list of things but after scouring the internet I can’t find anything. Probably because… you won’t know what’s happening until it happens. I mean, I guess I have a shower stool and a bidet so…? Win? Adult diapers? Loose fitting clothes? Who the fuck knows.

My Unlikely Friend and I butt heads about this a little bit the other week. It seems he can’t accept my answer of “there is nothing I can do to prepare.” It makes sense. He’s wired toward preparation. Toward action. Toward mitigating risk. I guess this is a dude thing, a special ops thing, an EOD thing. It makes sense. I’d want to know all possible outcomes and precautionary measures before I’d diffuse a bomb too.

However, maybe I need to remind him of something he said to me over a year ago. And that’s this:

“You can have all the training, all the experience, and all the intuition in the world and sometimes, the bomb gets the vote.”

We’ve talked about this a lot throughout the course of this living nightmare of mine. On paper, before this, I was living a life that was the “training, experience, intuition” that should have kept me from getting cancer. But I got two. I thought I was doing everything right in my marriage. I still got left.

Here’s the real scary thing about life: it is, actually, out of your control. 

Feel free to argue that all you want.

But I’m going to bring you back to something that’s discussed a lot in the 12-step rooms. There is a difference between being powerless and being helpless. 

I am completely powerless over much of what is happening to me.

But I am not completely helpless.

So what can I do?

Ironically, I can actively lean into powerlessness. I can say, I’ve gathered the best team I can, researched enough to know what I can expect, I can “stay active and eat a lot of protein” per my surgeon’s suggestion, rest, enjoy these couple weeks when I can eat and do many things I like, and then… I have to turn it over. 

The moment I’m wheeled into the OR, everything is out of my control. The entire process—-and how it will affect the outcomes—is in the hands of something greater than me: my surgeon, God, Universe, Higher Power, whatever you want to call it.

So, to decrease my pain and suffering and fear, I have to practice surrender—-not resisting. Suffering is in the resistance.

The only thing I can do is meet each pain, each emotion, each symptom, as it arises, one at a time. 

For someone with decades of clinical anxiety this seems like a monumental undertaking.

And, to My Unlikely Friend, this time I think the action is in the surrender.

 

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