For colorectal surgeons, one question tends to come with the territory: Why would you ever choose this specialty?
The three physicians featured in this edition have many reasons, all of which fuel their drive to make a difference in the lives of their patients. Their field is high-tech, complex, challenging and constantly evolving. They also often have the satisfaction of curing people of life-threatening, debilitating and embarrassing conditions.
The colon is an intricate organ, with its coiled, densely muscular tubes that wind through much of the abdomen. Totaling roughly five feet in length, three inches in diameter and four pounds in weight in the average adult, it can develop a wide variety of problems, including cancer, ulcerative colitis, diverticulitis, fecal incontinence, rectal prolapse, severe constipation, anal fissures and hemorrhoids.
Such issues have plagued humans throughout history. In the Second Chronicles of the Bible, King Jehoram of Judah apparently suffered from severe rectal prolapse, or perhaps rectal cancer. As the King James edition reads, “The Lord smote him in his bowels with an incurable disease. And it came to pass, that in the process of time, after the end of two years, his bowels fell out by reason of his sickness: so he died of sore diseases.”
Ancient Egyptian papyrus papers mention anorectal diseases. Anoscopes were among the surgical instruments discovered in the ruins of Pompeii in Rome. All the way back in the 5th century BC, the Chinese recommended acupuncture as a treatment for hemorrhoids.
None of that is surprising, given that colorectal disorders are quite common – far more common than the patients who feel so isolated and self-conscious about them realize.
Hemorrhoids affect about 1 in 20 Americans, for instance, including about half of adults older than 50, according to the National Institutes of Health. Of the 1.6 million Americans with inflammatory bowel disease, roughly 900,000 have ulcerative colitis, which in turn increases their risk of colon cancer.
Colorectal cancer is the third most common non-skin cancer diagnosis in the United States, striking an estimated one in 21 people during their lifetimes. In cancers that affect both men and women, it is the second leading cause of death, trailing only lung cancer. Southeastern Virginia is a national trouble spot, too, with a colon cancer death rate 9 percent higher than the national average.
At the same time, many disorders are also highly treatable. Even colorectal cancer is both preventable and curable with regular screenings, prompt removal of precancerous polyps and early diagnosis of cancerous growths. The five-year survival rate for patients with stage I cancer is about 92 percent, according to the American Cancer Society; that drops to 11 percent for stage IV disease.
So Drs. Lisa A. Coleman, Eric C. Feliberti and Ray T. Ramirez are passionate about educating Hampton Roads residents and community physicians on the importance of colonoscopies, as well as about fighting the shame and silence that still surround colorectal disorders. Too often, they say, patients suffer for months, years or decades – and in some cases, forever – without asking for help.
Happily, patients who do speak up can benefit from multiple advances in the field, particularly laparoscopic procedures that reduce pain, recovery time and complications that require a permanent colostomy bag. Newer treatments even can extend to complex cancers, such as a combination of surgery and liquid chemotherapy used to attack tumors that have spread within the abdominal cavity.
As for all those “why” questions – and more than a few “rear-end” jokes – the colorectal surgeons profiled here aren’t offended by them. On the contrary, they tend to be a down-to-Earth bunch – skilled professionals who realize that a welcoming, occasionally light-hearted bedside manner helps patients more openly discuss problems that, if resolved, can no longer devastate their quality of life.
