CHAPTER 1
Fit People Don't Get Cancer
How much happiness is gained, and how much misery escaped, by the frequent and violent agitation of the body.
Dr Samuel Johnson (1709-1784)
We stood together in the shade of the large plane trees – Richard, PK, Adrian and I – slowly munching on some cold and sweet-tasting watermelon. Little was said as we were all somewhat absorbed in our thoughts, contemplating what we had just completed. It was now about 9.30 am and the summer temperature was starting to rise significantly, signalling another hot day. We had been together since 6.30 that morning, running up and down some challenging hills in a national park a few kilometres from the city we live in. Our legs were aching and our bodies were tired after running this challenging 34-kilometre course for some 2 hours 45 minutes. However, despite the aches and pains we were all quietly pleased with our achievement and we all knew that we were now almost ready to run a marathon.
For the past three months we had gathered each Saturday morning to run together, progressively increasing the time and distance. Other runners occasionally joined our group and sometimes one or two mountain bike riders accompanied us. We all felt that this type of training was necessary to be able to run the 42.2 kilometres of the marathon and produce our best performance. The core group of four were a disparate group in ages, abilities and marathon experience: the youngest was 32 and I occupied the senior position being in my 64th year; two members were hoping to improve on their previous marathon performances; and I was training for my 21st marathon.
During these months of training together on this challenging course our friendships also deepened. While we bonded over our common running goal, we also bonded in other ways as we supported each other through the shared experience of pushing our bodies up and down long and steep hills, week after week. During that three-month period each of us had at least one bad day on this demanding course and were 'pulled along' by the support and encouragement of the others in the group. I am sure that similar experiences can occur through other activities, but it certainly takes place through running.
Marathon day came quickly after our last long run together, which we followed with a short tapering period to ensure that our legs would be fresh for the 42.2 kilometres that lay ahead. It was a cool autumn morning when we gathered waiting for the 7 am start. The last minute trips to the toilet were evidence of our pre-start jitters.
Following some last minute words of support and handshakes we lined up with the other runners. After a short wait the gun was fired and we were off on our 42.2-kilometre journey.
Some 3 hours and 20 minutes later I crossed the finish line, hurting and tired but very pleased I had completed my 21st marathon. I finished strongly, passing many runners in the last 10 kilometres, and my time for the event was faster than my time the previous year.
The group was finally all finished and as we hugged one another I felt tears run down my cheeks. Why was I crying and why did I feel so emotional about finishing this marathon? I remember finishing my first marathon and feeling very emotional. In fact I was on a high for over a week and all I could think about was the next one. Marathon running is, I suspect, like other endurance sports in that it takes you way out of your comfort zone and into an area that requires both physical and mental effort and training. I have run many half marathons and participated in lots of tough mountain and cross-country running events. They all required effort and training but the marathon is different. It takes you to another level where you can fail badly and hit the wall, or where you can achieve your goal and succeed physically and mentally. I recall after several attempts I achieved my goal of running a sub three-hour marathon and how emotional I felt and how that feeling lasted for a number of days. I knew what it was like to feel emotional after completing a marathon; why then was I crying uncontrollably?
The reason was that I had a secret that I had not as yet shared with my running mates. Ten days before the marathon I had been diagnosed with rectal cancer, which I had been told had been growing in my body for some time and I needed to have surgery to remove the cancer as soon as possible. I had made a decision to run the marathon and not to pass on the news of the diagnosis to my running mates until after the event. They didn't know it but they would become part of my journey with cancer.
Ten days before the marathon I had been to hospital for a colonoscopy, which I had assumed, given my excellent state of health and fitness, would reveal no abnormality. Even though I was 63 this was a new experience for me, as I had never had a colonoscopy. The process had involved a special diet two days before the procedure and fasting the day before, accompanied by the consumption of a salty and sickly liquid (designed to clean me out). For the colonoscopy an anaesthetic was administered via an intravenous cannula inserted in the back of the hand. This was followed by a couple of questions from the anaesthetist and from the gastroenterologist and then I remember being aware of the sound of people talking nearby. I had the feeling that I should be asleep waiting for the procedure to start and so I kept my eyes closed and tried to sleep. However the noise persisted and when I looked I was back in the recovery bed. I was soon offered refreshments, which arrived at about the same time as Penny (my wife), who had come to take me home. Penny sat by the bed and talked while I ate (hungry from no food the previous day). Before I had time to finish eating the gastroenterologist arrived and, looking rather formal, proceeded to pull the curtain around the bed. I immediately felt a little uneasy about this situation. He looked at both of us, paused, and then gave us the news that I had rectal cancer.
There was a period of silence, which seemed to last for ages but was in fact only a few seconds long. Penny and I looked at each other in disbelief. I seem to recall shaking my head, and feeling a sensation of numbness, which was I think my immediate way of handling the shock. I was thinking, 'how could someone who was so fit, who didn't smoke, who was extremely healthy, who ate all the right foods, have cancer?' I wanted to explain these facts to the gastroenterologist and get him to reconsider what he had just said. However, the reality of the situation kicked in and so I kept my thoughts to myself. (This kind of irrational thinking would reoccur from time to time.)
While I had never before had a colonoscopy, I had been involved several times in bowel cancer screening tests when I as in my forties. Apart from these tests I had regular health checks, involving an annual blood test and a physical examination by my GP (General Practitioner). During the previous three years I had also had several comprehensive health assessments done by a professional health assessment organisation. These assessments had involved a blood test, a comprehensive examination and a family history and lifestyle assessment. On each occasion I had achieved the best overall score of those in my work group.
It's clear that, despite being fit and having regular health assessments, my cancer could not be detected without having a more thorough testing process, such as a colonoscopy. I have of course asked myself the question many times why had I not had one previously. I believed that I was so fit and healthy that it didn't occur to me that I would ever have a need for further testing. Why then did I decide to have one now?
Following my last comprehensive health assessment I met with my GP and discussed the several pages of the report, a practice that I had developed in the previous two years. In the context of this discussion my doctor suggested that it might be timely for me to have a colonoscopy in order to complete the assessment picture. I was given a list of gastroenterologists but the decision to proceed with a consultation was left to me. Within two weeks I had arranged an appointment and was sitting in the consulting room with the doctor. The gastroenterologist took my history and then gave me a thorough physical examination. He concluded that I was clearly very fit and he could find no trace or indication of a problem. His concluding advice was that the only way to be sure was to have a colonoscopy.
I had never been in hospital, had not required any medical intervention, had not been sick (even with a cold) for the previous 30 years, and so this procedure seemed to me to be a little unnecessary and somewhat invasive. However the gastroenterologist explained that although it would involve inserting a small camera into my large bowel via the rectum, I would be unaware what was occurring, as an anaesthetic would be administered. He also explained that there were risks but that they were very small risks. The risks included perforation of the bowel wall. He also indicated that sometimes polyps are found during a colonoscopy, which are usually a benign growth in the lining of the bowel. They are sometimes attached to the lining by a stalk and can almost always be removed without surgery during a colonoscopy. The reason for removing them is that they can sometimes develop into a cancer. As well as being advised about the restricted diet and fasting in the lead up to the procedure, I was also advised that I would need to prepare by eating and drinking only certain foods two days prior to the procedure and then fasting the day before. I was told that I'd be given a kit containing sachets of powder that I should dissolve in water and drink at particular intervals during the day. This was to ensure that the bowel was as clean as possible for the camera to have the best possible view.
I agreed to proceed with the colonoscopy. In retrospect had I not done so you would probably not be reading this book.
It's interesting that I had none of the usual symptoms of rectal cancer even though the cancer had been present for some time (possibly years). Apparently in the early stages there are usually no symptoms, but then, as the disease progresses – which can take years – symptoms, such as constipation or diarrhoea, weight loss, abdominal pain or tenderness, cramping and fatigue, start to appear. I had none of these symptoms. Even during a thorough physical examination I had no signs of tenderness. I certainly wasn't suffering fatigue as I had just completed three months of hard marathon preparation, and although this rendered me tired at times, I was not fatigued.
The gastroenterologist advised me that the prognosis was good and that I should recover fully after the removal of the cancer. He probably said other things about the possible treatment but I don't remember much about that conversation, as I was preoccupied with the news that I had rectal cancer. I do remember him saying that I may need radiotherapy to shrink the cancer prior to surgery and that he had made an appointment for me to see a surgeon. I left the hospital with many questions buzzing around in my head. What would radiotherapy be like? What would the surgery involve? Would I recover fully? Would I have any permanent difficulties or problems as a result of the treatment?
Colorectal (colon and rectal) cancer, or bowel cancer, is one of the most common cancers. According to Bowel Cancer Australia there are around 15,000 cases diagnosed in Australia each year, but fewer than 40 per cent of these are detected at the early stages of the cancer. Chances of survival are good if the cancer is identified prior to spreading beyond the bowel, but having been advised that my rectal cancer had been there for some time I was wondering if it might have spread. However I would have to wait a little longer to have this and other questions answered.
We left the hospital and the gastroenterologist clutching a discharge paper with notes on next steps, a referral to a surgeon, a blood test form and forms to have an MRI (magnetic resonance imaging) scan and a CT (computerised tomography) scan. I also had a nice rather graphic colour photograph to take with me of my cancer taken during the colonoscopy.
It's interesting that one of my recurring thoughts about this diagnosis and the possible consequences was to contemplate what this might mean for my running. Would I still be able to run? Could I still run marathons? Would I still be as competitive in my age group? For the non-runner these thoughts might appear a little bizarre, but running was a significant part of my life, and had been for over 30 years. Every morning my first priority was to go for my daily run. It didn't matter if I was away from home I would still get up early enough to fit a run in to the schedule for the day. I travelled to many places as part of my work and as a result I have run around the streets in many towns and cities including in a number of overseas cities (a great way to see new sights). If I missed my run I felt cheated, particularly from the clarity of mind that came to me through running. I always felt that I didn't perform as well at my job if I missed a morning run. And hence my fears were real.
While I also thought about some of the other possible consequences of having cancer, the potential impact on my running was ever present. I have been told more than once that I must be mad, that my body would disintegrate, that it was unnatural (we weren't meant to run) and that running is selfish. My experience is, in fact, contrary to all these claims.
My running is very good for my mental health, my body has not disintegrated, it feels natural to me to run (we run as kids and only stop because adults tell us to slow down and walk) and I have made many wonderful friends through running. I have never regretted going for a run, even on those mornings when I was feeling tired, it was minus 3 degrees Celsius outside and it was nice and warm in bed. I would soon warm up and get into a rhythm. The water on my body during a shower always felt better after a run. Soon after I started running regularly I noticed changes to my body – both physically and mentally. When I ran I felt calmer, I could concentrate more easily and for longer periods, I felt more in control of my life and I was much more confident in my ability to cope with whatever I encountered in my job and in my life more broadly. It's interesting to observe the increasing number of studies that are showing the mental health benefits that are derived from running and how it is being recommended for people with significant anxiety, depression and other mental health problems. And because of my running I was lean and healthy looking. Running had become a way of life for me. How would I cope if I couldn't run?
Penny was also in shock following my diagnosis and, like me, she had many questions. The night of the diagnosis we decided to go to a restaurant for dinner. It was a belated wedding anniversary celebration and quickly became a celebration of life. We both decided that this cancer would only present a temporary setback, that I would recover fully, that we would only need to postpone our travel plans and that I would certainly be back to running again after my treatment. We were to have many such discussions over the ensuing months.
That night I had difficulty sleeping, which was unusual for me. I awoke the next morning still in shock, with a sense of disbelief that I had rectal cancer and still not fully believing that this was actually happening to me. I now needed to prepare for some tests and a meeting with a surgeon the following week.
CHAPTER 2
What Now?
Positive thinkers think about what's possible. In concentrating on the possibilities, they make things happen.
Follow Your Heart. Andrew Matthews
In preparation for my meeting with the surgeon I was required to have a blood test, an MRI scan (magnetic resonance imaging) and a CT scan (computerised tomography – also known as a CAT scan). I quickly had the blood test but had to wait a few days to secure an appointment for the MRI and CT scans. The MRI scan was long and noisy. The scanners are gigantic humming electro magnets that spin and excite all the hydrogen nuclei in our bodies. Then it lets them relax and turns this into pictures. Unlike the CT scan and X-ray there is no radiation exposure with the MRI. The CT scan, in comparison to the MRI, was relatively quick and involved an intravenous injection containing ionising radiation. At that time I was not aware that I would have many blood tests and CT scans as part of my treatment and the subsequent follow-up process.
Following the scans I returned to work and during the day I had a phone call from a close radiologist friend, Malcolm, who had access to my scans. He had some good news. The scans indicated that it appeared that the cancer was located in the muscle tissue of the rectum wall and had not escaped through the rectum wall. If this were the case it would simplify treatment. The news about the location of the cancer was good and increased my optimism that I would be fine and that I would return to work after a short period of convalescence.
