what it feels like: colon, rectum, prostate and bladder removed to fight colorectal cancer
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dr. tim sproule was diagnosed with colorectal cancer, the second leading cause of death from cancer in men. supplied
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dr. timothy sproule had just taken his first vacation in years when he noticed what he thought was a hemorrhoid. a few doctor visits later, sproule received a horrifying diagnosis: colorectal cancer.
colorectal cancer develops in the lining of the colon or rectum and generally has few to no symptoms until it has progressed to an advanced stage. in men, it is the second leading cause of death from cancer and the third leading cause in women, according to the canadian cancer society. approximately 1 in 14 men and 1 in 18 women will develop colorectal cancer at some point in their life.
sproule and his treatment team decided on an aggressive approach to this already-spreading cancer, using both radiation and chemo therapy to give him them best possible chance of a cure. sproule also underwent a pelvic exenteration, a major surgery that resulted in the removal of his descending colon, rectum, prostate and bladder. after severe complications from this surgery, sproule — an expert in wound healing from his work as a reconstructive surgery — found himself exploring innovative treatment methods and now uses his experience from the other side of the gurney to develop better therapies for patients.
what led to your colorectal cancer diagnosis?
i was diagnosed around the last week of october/early november 2015.
the way it happened was a little bit disconcerting; i had been on a holiday for the first time in many years. i noticed what i thought was a hemorrhoid and eventually got around to getting it investigated. but i really had no inkling, no concerns, that i could have had something more serious. cancer didn’t run in my family and i was, i thought, quite healthy in terms of my lifestyle and all that stuff. but i had a colonoscopy done and i had this diagnosis hit me like a bombshell.
so, after that the journey started and it felt a little bit like a black diamond ski slope for a while.
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you were a plastic surgeon when you got your cancer diagnosis — coming from a medical background, what was that like?
well, plastic surgeons look after a lot of cancer. i’m more oriented toward reconstructive surgery — i do some cosmetic surgery, but a lot of people have an idea that plastic surgeons are just cosmetic surgeons. i had a practice where i did burn care and wound care and reconstructive surgery for difficult cancers, complex breast reconstruction on people who had had mastectomies for breast cancer. and so i did have, i would say, a fairly significant insight — i’m not an oncologist, but i certainly knew a lot about it.
i went online, and i probably downloaded 1000 articles about all sorts of different things and i went through the elisabeth kübler-ross thing where she talks about the five stages of grief. i went through all that. part of it was going through an aggressive learning curve about what was available in terms of treatment options. i had a forlorn hope that maybe there’s some magic treatment, because we’re in an exciting time right now in terms of cancer care. maybe i [could] travel to some exotic place and get some kind of magic treatment that will allow me to be cured. at the end of the day, i settled on pretty much the standard, conventional and pretty aggressive treatment. [i think] i made the right choice, but i certainly went through a lot of issues with that.
what was your treatment?
i had, initially, a more aggressive and broader rang of radiotherapy plus what’s called adjuvant chemotherapy at the same time, over a course of a few months around christmas 2015 into 2016. and the reason that i had a stronger radiation and so on was i had probable evidence [that the cancer was spreading], so they had to radiate more.
one of the things that’s an issue is that while radiation is more precise now than it used to be, it is something that basically just tries to kill the cancer cells a little faster than your own cells. and so you get a lot of secondary damage.
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i had this radiation and it was, like, amazing. i had a really a profound improvement in my cancer. the classifications system that’s used is called the tnm classification. t stands for tumour, n stands for nodes and m stands for metastases. so you can determine very grossly how bad your cancer is by putting it into that category. and mine was a t four, n one, m one cancer — that’s pretty bad. the m means metastasis, which means spread beyond the local bed. it had not spread to my liver or my lungs, which is a much more serious thing. but it had spread locally and so i knew i was in bad shape. after the radiation, you couldn’t even see my tumour except for a little tiny nub on my rectum on the inside.
i actually had an argument with my radiation oncologist and said, look, can i maybe just wait and see how it goes? [but] because we used high fraction radiotherapy, [it was] all going to fall apart. you can’t just [leave it].
so i went ahead and had the surgery in march 2016, and the operation i had done was called a pelvic exenteration. that’s the biggest operation, pretty much, that general surgeons do. they took out my rectum, my descending colon, my bladder, my prostate. and then i had to make holes for various stuff to still come out, so i had a colostomy put in which is permanent, which i still have, and also an operation reconstruction called an ileal conduit. it’s a very exotic thing where, because they removed the bladder entirely, the ureters that come out of the kidneys have to be put into a situation where they can drain out to the outside. so you still have a bowel that works and then you’ve got two holes coming out — two stoma, they’re called — coming out of the abdominal wall, one makes pee and the other makes poo. i went through a lot of issues related to that from a psychological perspective.
dr. tim sproule at rouge valley hyperbaric medical centre. supplied
what was this major surgery like?
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i had a 14-hour-long operation. i had really never experienced surgery as a patient before of any significant degree and so it was a real eye opener. a few things were really very positive initially. i had an epidural put in for the week i was in hospital — what’s used in baby [delivery] to reduce the pain — and it is amazing. for the week i was in the hospital i didn’t take a single narcotic painkiller, it was so astounding even though i had this huge operation. i went home and [was] really feeling pretty good about stuff at that point. but then, a couple of weeks after i got home, i had a bunch of wound complications. i developed a condition called peritonitis, which is an infection in the peritoneal cavity. i got catastrophically sick and had to be readmitted to hospital for about a month. it was really horrific. i didn’t have any pain initially, but i sure as heck had pain afterwards. and it was just awful, the pain was so severe that there was basically nothing that he could give me that would take away the pain.
after a number of weeks i finally healed up, although there were still various problems with the wounds. some of that’s related to the fact that i had radiation — that makes healing a little bit less reliable. and then i had to start on chemotherapy. it was a horrific experience. ([thankfully] it has improved, i think, over the years.)
i had a special port that was implanted into my chest and i had a routine for four months where i would go in on a monday, get blood work taken, go in on a tuesday and see my oncologist, go in on a wednesday and then have a whole bunch of poisons run into my vein and then recover over the next two days. i was able to go home, but with each passing week it became more and more intense and more difficult. and so that delayed some of the healing of my wounds that had been healing up reasonably well up until that point.
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you went through hyperbaric treatment to help treat the wound that were having trouble healing — what is that?
it works is by flooding the body with more oxygenation at a higher pressure than you could possibly get in nature. that helps to eradicate or to improve processes within the body: excessive bleeding or excessive infection, or impaired blood supply and things like that. and the way it works in most centres, and certainly in the one that i’m affiliated with now, is they’ve got specially designed chambers that look sort of like big acrylic torpedo tubes. so the actual thing you go into is a little disconcerting if you’ve got claustrophobia, but it’s like very much like a torpedo tube. so you get slid in, they clang the door shut and lock it closed, and then they pressurize the chamber and give you 100 per cent oxygen.
you can get problems with your ears popping, just keep going up and down in a plane. and i had that happen to me a little. and you also get pressure put on your cornea so that your vision can change a little bit if you have a lot of treatments. my vision improved for close vision, which is good for me as a plastic surgeon. it’s slightly decreased for distance vision, which isn’t as big a problem and i just ended up that after waiting several months for it to recover after my treatment. i just changed the prescription of my glasses and i can see better now than i did before my injury.
does it feel weird in this or is it just more or less like, you’re going up in a plane, you feel a little bit of pressure?
you don’t feel anything special. occasionally you get a bit of sinus headache because of the pressure change. you just lie there. the issue is, once you’re under full pressure, they can’t take you out. they can’t just pop the door and slide you out — that’s a bit disconcerting. it’s hard not to feel just a tad claustrophobic when you’re in that position. but i find it very relaxing. i had the entire original macgyver series, so i just watched a video every day when i went in.
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what was it like adjusting to living with stoma?
one of the things that was a problem, and one of the reasons why i got into doing a bit of advocacy for other people who’ve gone through cancer treatment that includes ostomies is, in the run up to having my surgery, i had decided i’m gonna have to get myself in the best possible shape i can so i can cope with this. and one of my exercise passions is swimming.
so, i got home from the hospital and a homecare nurse and ostomy nurse came to my home to check things out. at that time, i didn’t have a clue as to how to change these things and it’s a lot more of a challenge than you think — there actually is not very good information on how to do it properly. so i asked this ostomy nurse when can i start swimming again, and she said, oh, you’ll never be able to swim again. i was a little bit crestfallen about that.
when i then went through a discovery of what exactly i could do, and frankly, i did it more from just going on blogs and websites from other passionate people who had ostomies, to learn from them what the truth was. and the thing is, there’s so much nuance to it. there’s different kinds of ostomy sizes, there’s different kinds of ostomy companies, there’s different adhesions, there’s different bags you use, there’s all sorts of nuances to how to do this. and i had to learn it, basically, on my own, even though i’m a medical professional who’s got lots of contacts and ties with the medical profession. i was really shocked at how poorly it was taught.
one thing i used to do before i got sick was a lot of volunteer work. i’ve been to a bunch of different countries around the world as a surgical volunteer, mostly doing things like cleft lips and burns and microsurgery and things. and i actually have been on a trip since my big issues — in 2018, i went on a trip to india. i had significant anxiety but when i got there i was able to do pretty much everything that i wanted to do. in some ways i was even better than i did because i had a different kind of level of compassion and insight into pain and suffering than i’d had before. and i am hoping now that covid is finally lifting then i’ll be able to do that kind of stuff again because it was important to me. so i really believe that you can cope with whatever, you just have to go through a systematic process of solving one problem at a time. and that’s sort of where i am now.
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are you swimming now?
oh, yeah. i swim almost every day.
mentally, how did you cope with all of the changes needed to stay healthy after this surgery?
well, i still have some trouble with it all, frankly, all things considered. but i would say i was already a little bit of a disciplined person, that’s sort of why i ended up getting into medicine. but i have been [interested in] stoic philosophy. it’s mostly taking the attitude that you’re not going to get too emotional about stuff and you’re just going to cope with things as best you can. i’ve been doing a little bit of that and mostly that works out. i’m pretty good with it. i’ve had some ups and downs emotionally, but overall, i’m pretty grateful for my lot in life. i’m pain free. i’m able to swim and ride a bike and run. i’m able to practice my beloved specialty once again, i’ve got myself involved in new friendships and new relationships, both professionally and personally. so i’m doing really well.
you also experienced neuropathy in your hands — what was that like as a surgeon?
that was pretty devastating for sure. that was probably the worst time. the chemotherapy drugs are well recognized at causing this problem and i knew this was a risk, so i took some medication and some supplements and things ahead of time to reduce my risks of having problems with neuropathy. through my entire chemo course, actually, i didn’t have anything but then about a week after i stopped it happened. i woke up one morning with a sensation that i was wearing gloves and socks on my feet and hands. i couldn’t feel what was in my pockets. i couldn’t handle instruments like knives and forks. it was really difficult and i really was devastated. because, yeah, as a plastic surgeon my manual dexterity is key. it’s what i have to have.
[now] it’s resolved completely. i think that’s been because of a lot of different interventions, but one of them is just the passage of time — things just regenerate. and so i’m pretty grateful for my situation. i’m pretty excited about these recent stories about new immune therapies that may significantly reduce the risk of having to have that kind of toxic treatment in the future.
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how was getting back into your surgery practice?
it did take a while. in fact, i think the biggest problem was kind of a shakiness in my confidence, frankly. i eventually just started doing things again. covid made it a little difficult because no one was doing any surgery for a while, so there was that to deal with. but i’m now back doing fairly big, complicated cosmetic surgeries like doing facelifts and body contouring surgeries and all sorts of things like that. i’ve decided that i need to step aside and let younger physicians do more of the reconstructive surgery; i’m just trying to mentor them a little bit. i’m not doing an aggressive active practice where i’m taking calls and looking after mangled hands and emergencies and things like that.
i think i’m a better cosmetic surgeon than i was because i have an appreciation of the magnitude of the issues that people deal with that you maybe don’t think of when you’re a treating physician. i’ve got an insight into that from being on the other side of the gurney.
and you also work at the hyperbaric treatment centre as well as your plastic surgery practice?
yeah, they were real good to me. they saw i was a little bit forlorn, i think initially, looking around to [re-]start my practice. they suggested that i do this because i had an expertise in wounds [as a plastic surgeon] and that allowed me to maybe contribute something that was useful for them. it really worked out for me, i’m grateful for the opportunity to be part of the team that the hyperbaric centre gave me and the nurses are just great.
everyone, every one of us is on a journey. all of us have got a pretty hard light one way or the other and i think all of us can aspire to make a little bit of a difference. the thing i feel really more than anything right now is gratitude that i’ve been given a further opportunity to make a difference. i am pretty satisfied with my lot. it’s not like i wouldn’t trade my pelvic exenteration for having a relatively normal physical appearance, but the fact is i’m good with what’s happened.
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dr. timothy sproule is the interim chief of plastic surgery, scarborough health network and is on staff at the rouge valley hyperbaric medical centre.
there is no shame in talking about our bodies — speak to your doctor to determine if you should be screened for colorectal cancer. readers interested in learning more can visit colorectal cancer canada and the canadian cancer society.
emma jones is a multimedia editor with healthing. you can reach her at emjones@postmedia.com or on instagram and twitter @jonesyjourn.
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