MYOPIA - i.e., nearsighted. Objects farther than 6 meters from the eye are blurred. This condition is corrected by wearing spectacles with concave lenses. In some cases gradually the power of the concave lense has to increase and there may be chance of vision loss due to retinal detachment. This condition may be hereditary. Medicines: NITRIC ACID, PHOSPHORUS, PHYSOSTIGMA and PULSATILLA - GrI.

HYPERMETROPIA - or hyperopia i.e.,farsighted. Objects closer than 6 meters from the eye appeared blurred. Normal vision can be restored by wearing spectacles with convex lenses. It is normally seen after the age of 40 yrs. Medicines: ARGENTUM NITRICUM, CALCAREA CARBONICA, SEPIA and SILICEA

Conjuctivitis: Aconite 30, Euphrasia 30, Gels 30

While it is always most accurate to be fully evaluated by a trained Ayurvedic practitioner filling out the following questionnaire can give you insight into the balances of energies unique to your body.


As you fill out the following questionnaire, give yourself two points if a statement is clearly true for you. Give yourself one point is it is somewhat true. Give yourself no points if it is clearly not true.


Add up the total number of points for Vata, Pitta, and Kapha. This will give you the relative dominance of each of the forces in your constitution. You may not necessarily be dominant in one type but may be a unique blend of the three.


Vata Questions


1. I am thin and my body build is "slight."

2. I have a difficult time gaining weight or I am like a yo-yo going up and down.

3. My skin tends to be dry.

4. I feel cold often compared to others and I do not sweat very easily.

5. My complexion is dull gray or dusty.

6. When my digestion is not normal I tend toward constipation.

7. The shape of my face and jaw line is long and narrow.

8. When I am healthy I have a lot of energy and enthusiasm but focusing can be difficult.

9. I am prone to feeling nervous or anxious.

10. I tend to be a light sleeper and often suffer from insomnia.



Pitta Questions


1. I am of moderate weight and my build is moderate with good muscle tone.

2. My weight is steady and fluctuations are small.

3. My skin tends to be oily.

4. I often feel warm and sweat easily.

5. My complexion is rosy.

6. My digestion is not normal I tend toward diarrhea or burning digestion.

7. The shape of my face and jaw like is angular.

8. When I am healthy I have a lot of energy and I am very focused.

9. I am prone to feeling irritated, angry and resentful.

10. I sleep well and wake up easily. I may be awoken by dreams.



Kapha Questions


1. I am of "stocky" body build and I often carry some extra weight.

2. It is difficult to lose weight.

3. My skin tends to be oily.

4. I often feel cold and sweat easily.

5. My complexion is pale.

6. My digestion is generally good though I may occasionally have some constipation.

7. The shape of my face is round.

8. When healthy I move slowly and have a lot of endurance.

9. I am prone to feeling lethargic and depressed.

10. I sleep deeply and sometimes have a difficult time waking up.

SURGERY FOR HEART FAILURE

Generally heart failure is considered as totally a medical problem as the risks with surgery are high. However in selected patients, who are resistant to medical therapy, cardiac surgery can make medical treatment easier, improving quality of life to the patient. And there are surgeries like heart transplantation which have been proven to increase the longevity of these patients. Basically surgeries in these patients are:

- Those that identify and remove the primary insult that resulted in heart failure
- those that try to surgically reverse remodel the ventricle,
- using assist devices
- heart transplantation and
- Sometimes combination of the procedures.
.

Surgeries for removing the primary insult:

These include operations for coronary artery disease and valve diseases that resulted in heart failure and significant left ventricular dysfunction.

Coronary artery bypass surgery: Myocardial ischemia is probably the most important cause of heart failure and is associated with a 30% - 50% annual mortality. However reduced ventricular function may be reversible with ischemia. Restoration of function with correction of ischemia may take some time, on occasion, months. Identifying the presence of such hibernation is probably best achieved with labelled (F18 deoxyglucose uptake) positron emission tomographic (PET) metabolic studies. If it shows viable myocardium >20% of left ventricular mass, evidence is stronger. Viable myocardium can also be demonstrated by dobuatmine stressed echo and its characteristic bi-phasic response to increasing levels of inotrope. There is an initial improvement in contractility followed by a fall off in function as dobutamine levels reach values of 25 – 40g/Kg/min. Magnetic Resonance imaging (MRI) is showing promise too by revealing scar or viable muscle. Sometimes even 2D echo may give some suggestion of viability through the thickness of myocardium and subendocardial thickening. However one has to consider the clinical condition, evidence for significant viable myocardium and the high risks involved in these patients before advising surgery. Sometimes bypass surgery may have to be combined with mitral valve repair surgery or with left ventricular remodelling surgery.

Valve surgery: In India rheumatic heart disease still contributes to significant proportion of heart diseases. Today advances in surgery allow most valve disease patients with left ventricular dysfunction to be operated successfully although prognosis is still reduced in such patients. However surgery is likely to reduce number of hospital admissions with heart failure and improve their quality of life. Aortic stenosis patients with low gradient and low ejection fraction without inotropic reserve and mitral incompetence patients with ejection fraction of <30% in whom mitral subvalvar apparatus cannot be preserved constitute the small group in whom valve replacement surgery should probably not be performed.


Surgical procedures to improve cardiac output by reducing left ventricular size (“La Place surgery”):

Many modalities are being tried in the world today that aims at reducing an enlarged ventricular volume and reversing the forces that are driving further ventricular remodelling. Some of these are
(i) The Myo-splint.
ii) The CorCap® or Acorn device
iii) Left ventricular aneurysmectomy.
(iv) Mitral valve repair for secondary regurgitation.

One of the more accepted modalities is left ventricular aneurysmectomy when there is a left ventricular aneurysm causing heart failure. Dyskinetic segment of ventricle is removed reducing ventricular diameter and so reducing ventricular wall tension. However the segment removed here is scar and not ventricular muscle. The aim is to restore a more “normal” ventricular geometry increasing the efficiency of ventricular contraction..




Surgical strategies to re-power the failing heart:
These include surgeries like implanting ventricular assist devices and heart transplantation.

Ventricular assist devices (VAD): The intention here is to off-load the failing heart. This is achieved by the unloading of blood from the ventricle and delivering into the arterial tree (pulmonary for right ventricular assist or RVAD and systemic for left or LVAD). Both ventricles may be supported simultaneously with BIVADs. Total excision of a failing heart is occasionally undertaken followed by replacement with an artificial heart (Cardiowest, Abiocor).
Generally a potential VAD candidate presents with severe, refractory heart failure with deterioration despite intensive medical therapy. A VAD is selected and may be temporary or long–term. Some are designed for per cutaneous insertion into the systemic arterial tree lying across the aortic valve (Impella). More usually VADs are inserted via a sternotomy. Patients are often mortally ill with multi-system dysfunction. Bleeding, control of vascular resistance and multi-organ failure are early problems soon replaced by risks of infection and thrombo-embolism. Mostly these are used as bridge to transplantation in individuals who are on inotropes with haemodynamic instability and waiting for a suitable heart donor.. Interestingly some patients (often those with a short but aggressive history of failure or myocarditis) recover so that the VAD can be removed and heart transplantation avoided.

Heart Transplantation: Despite many advances in the management of chronic heart failure, many patients continue to progress to advanced end-stage heart failure. For those that are suitable, heart transplantation is the only proven therapy to offer improved survival and quality of life. Current survival for heart transplantation approaches 80-90% survival and 50-60% at 10 years. In addition to improving the longevity of life, it is associated with a marked increase in quality of life despite the need to take life long immunosuppressive medication and follow-up. In India now there are centres working to develop this transplantation facility.

Anatomy and Physiology

Your colon, or large intestine, is a long muscular tube located in the last section of your intestines. After the stomach and small intestine digest food, the remaining material is passed through the colon, where water and electrolytes are absorbed. Formed stools are the end product of this process.

The colon is made up of: the cecum, the ascending colon, the transverse colon, the descending colon, the sigmoid colon, and the rectum.

Most of the conditions that are diagnosed or treated via colonoscopy affect the layer of cells that line the inside of the colon. A doctor can use the colonoscope to directly view this mucosal lining.

Reasons for Procedure

Conditions commonly diagnosed and/or treated with colonoscopy include: Colon cancer, colorectal polyps, colonic ulcers, colitis, or inflammation of the colon, diverticulosis.

Colorectal cancer, which initially occurs in the colon or rectum, is one of the most common types of cancer.

Essentially all colorectal cancers are believed to begin as polyps, which are abnormal growths of the mucosal lining. Detecting these polyps early is the key to preventing colorectal cancer.

In most cases, polyps cause no symptoms. colorectal cancer, however, can cause symptoms including: changes in bowel habits, blood in the stool, stools that are narrower than usual, abdominal discomfort, unexplained weight loss or fatigue.

Treatments

A colonoscopy is commonly used to screen for colorectal polyps. The purpose of a screening test is to detect a problem before it causes symptoms or serious harm. If left untreated, polyps may eventually develop into colorectal cancer. Colonoscopy is also used to treat polyps by completely removing them.

In a full colonoscopy, your doctor is able to see the entire colon, from the anus to the cecum, where it connects with the small intestine. In a sigmoidoscopy, your doctor is only able to see about half that distance, to the top of the descending colon. Either technique can be used to take a sample of tissue or remove a polyp.

Other screening tests for colorectal polyps or cancer include: fecal occult blood test, which is used to identify hidden blood in the stool; barium enema, which is a series of x–rays of the colon and rectum; digital rectal exam, which is a manual examination of the rectum; virtual colonoscopy, which uses a CT scan and computer to recreate a three–dimensional image of the colon lining.

The primary disadvantage of these tests is that they cannot be used to obtain a tissue sample or remove a polyp.

If you are diagnosed with colorectal cancer, your doctor will likely advise you to have other tests, such a CT scan of your abdomen.

Procedure

In the days leading up to your procedure: do not eat any solid food for 24 hours, or drink anything for 8–10 hours, before the procedure. Your doctor will recommend a preparation to clean the colon in order to make sure it is completely empty for the procedure. In addition to following a clear liquid diet, this may include taking laxatives, or performing an enema.

Also in the days leading up to your procedure: If you take medications, particularly nonsteroidal anti–inflammatory drugs such as aspirin, or blood thinners such as coumadin, ask your doctor if you need to temporarily discontinue them or change the doses. Do not start taking any new medications before consulting with your doctor. Be sure to arrange for a ride to and from the procedure.

A colonoscopy generally takes 15–60 minutes. Before the procedure, an intravenous line will be started, and you will be offered pain medication and a mild sedative to help you relax.

During the exam, you will lie on your left side with your knees bent. A colonoscopy is performed using an endoscope, which is a long, thin, flexible tube with a light and a tiny video camera attached to the end.

Your doctor will insert the endoscope into your rectum and slowly guide it to the point where your colon meets your small intestine. Your doctor will blow air through the endoscope into your colon to inflate it for better viewing.

The camera transmits an image to a TV monitor so your doctor can view the lining of your intestine.

If your doctor locates a polyp during the procedure, he or she may remove it using special instruments passed through the endoscope. The tissue obtained during this polypectomy is then sent to a laboratory for examination.

Risks and Benefits

Colonoscopy, with or without a polypectomy, is generally a very safe procedure. However, there is a chance you will experience some abdominal discomfort and/or distension. Other less common complications include: adverse reaction to medications, bleeding in the colon or rectum after a biopsy or polypectomy, a perforation, or tear, through the bowel wall, infection in the blood, heart and lung problems.

Benefits of a colonoscopy include: effective screening for colorectal cancer; both the diagnosis and treatment of colorectal polyps; diagnosis of other conditions such as colitis, or inflammation of the colorectal lining; diagnosis, and even treatment, of other causes of bleeding from the colon or rectum.

In a colonoscopy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate intervention for you.

After the Procedure

Colonoscopy is an outpatient procedure, so you will be able to go home after your sedative wears off, which generally takes 1–2 hours. You should receive your results over the phone, by mail, or at a follow–up appointment.

Air that is left in your intestines after the procedure may cause some persistent abdominal discomfort and bloating, which usually is resolved when the trapped air passes. If you had a polypectomy, you may feel some additional abdominal discomfort for up to five days after the procedure, but symptoms usually clear within 48 hours.

Be sure to contact your doctor if you experience: signs of infection, such as fever and chills, severe or worsening abdominal pain, rectal bleeding.

Colon and Rectal Cancer

Cancer affects our cells, the body's basic unit of life. To understand cancer, it is helpful to know what happens when normal cells become cancerous.

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as they are needed to keep the body healthy and functioning properly. Sometimes, however, the process goes astray -- cells keep dividing when new cells are not needed. The mass of extra cells forms a growth or tumor. Tumors can be either benign or malignant.

� Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.

� Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor. They may enter the bloodstream or lymphatic system (the tissues and organs that produce and store cells that fight infection and disease). This process, called metastasis, is how cancer spreads from the original (primary) tumor to form new (secondary) tumors in other parts of the body.

The Colon and Rectum

The colon and rectum are parts of the body's digestive system, which removes nutrients from food and stores waste until it passes out of the body. Together, the colon and rectum form a long, muscular tube called the large intestine (also called the large bowel). The colon is the first 6 feet of the large intestine, and the rectum is the last 8 to 10 inches.

Understanding Colorectal Cancer

Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancers affecting either of these organs may also be called colorectal cancer.

Colorectal Cancer: Who's at Risk?

The exact causes of colorectal cancer are not known. However, studies show that the following risk factors increase a person's chances of developing colorectal cancer:

� Age. Colorectal cancer is more likely to occur as people get older. This disease is more common in people over the age of 50. However, colorectal cancer can occur at younger ages, even, in rare cases, in the teens.

� Diet. Colorectal cancer seems to be associated with diets that are high in fat and calories and low in fiber. Researchers are exploring how these and other dietary factors play a role in the development of colorectal cancer.

� Polyps. Polyps are benign growths on the inner wall of the colon and rectum. They are fairly common in people over age 50. Some types of polyps increase a person's risk of developing colorectal cancer.

A rare, inherited condition, called familial polyposis, causes hundreds of polyps to form in the colon and rectum. Unless this condition is treated, familial polyposis is almost certain to lead to colorectal cancer.

� Personal medical history. Research shows that women with a history of cancer of the ovary, uterus, or breast have a somewhat increased chance of developing colorectal cancer. Also, a person who has already had colorectal cancer may develop this disease a second time.

� Family medical history. First-degree relatives (parents, siblings, children) of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves, especially if the relative had the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more.

� Ulcerative colitis. Ulcerative colitis is a condition in which the lining of the colon becomes inflamed. Having this condition increases a person's chance of developing colorectal cancer.

Risk Factors Associated with Colorectal Cancer

� Age

� Diet

� Polyps

� Personal History

� Family History

� Ulcerative Colitis

Having one or more of these risk factors does not guarantee that a person will develop colorectal cancer. It just increases the chances. People may want to talk with a doctor about these risk factors. The doctor may be able to suggest ways to reduce the chance of developing colorectal cancer and can plan an appropriate schedule for checkups.

Colorectal Cancer: Reducing the Risk

The National Cancer Institute supports and conducts research on the causes and prevention of colorectal cancer. Research shows that colorectal cancer develops gradually from benign polyps. Early detection and removal of polyps may help to prevent colorectal cancer. Studies are looking at smoking cessation, use of dietary supplements, use of aspirin or similar medicines, decreased alcohol consumption, and increased physical activity to see if these approaches can prevent colorectal cancer. Some studies suggest that a diet low in fat and calories and high in fiber can help prevent colorectal cancer.

Researchers have discovered that changes in certain genes (basic units of heredity) raise the risk of colorectal cancer. Individuals in families with several cases of colorectal cancer may find it helpful to talk with a genetic counselor. The genetic counselor can discuss the availability of a special blood test to check for a genetic change that may increase the chance of developing colorectal cancer. Although having such a genetic change does not mean that a person is sure to develop colorectal cancer, those who have the change may want to talk with their doctor about what can be done to prevent the disease or detect it early.

Detecting Cancer Early

People who have any of the risk factors described under "Colorectal Cancer: Who's at Risk?" should ask a doctor when to begin checking for colorectal cancer, what tests to have, and how often to have them. The doctor may suggest one or more of the tests listed below. These tests are used to detect polyps, cancer, or other abnormalities, even when a person does not have symptoms. Your health care provider can explain more about each test.

� A fecal occult blood test (FOBT) is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT is used to detect small amounts of bleeding.

� A sigmoidoscopy is an examination of the rectum and lower colon (sigmoid colon) using a lighted instrument called a sigmoidoscope.

� A colonoscopy is an examination of the rectum and entire colon using a lighted instrument called a colonoscope.

� A double contrast barium enema (DCBE) is a series of x-rays of the colon and rectum. The patient is given an enema with a solution that contains barium, which outlines the colon and rectum on the x-rays.

� A digital rectal exam (DRE) is an exam in which the doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas.

Recognizing Symptoms

� A change in bowel habits

� Diarrhea, constipation, or feeling that the bowel does not empty completely

� Blood (either bright red or very dark) in the stool

� Stools that are narrower than usual

� General abdominal discomfort (frequent gas pains, bloating, fullness, and/or cramps)

� Weight loss with no known reason

� Constant tiredness

� Vomiting

These symptoms may be caused by colorectal cancer or by other conditions. It is important to check with a doctor.

Diagnosing Colorectal Cancer

To help find the cause of symptoms, the doctor evaluates a person's medical history. The doctor also performs a physical exam and may order one or more diagnostic tests.

� X-rays of the large intestine, such as the DCBE, can reveal polyps or other changes.

� A sigmoidoscopy lets the doctor see inside the rectum and the lower colon and remove polyps or other abnormal tissue for examination under a microscope.

� A colonoscopy lets the doctor see inside the rectum and the entire colon and remove polyps or other abnormal tissue for examination under a microscope.

� A polypectomy is the removal of a polyp during a sigmoidoscopy or colonoscopy.

� A biopsy is the removal of a tissue sample for examination under a microscope by a pathologist to make a diagnosis.

Stages of Colorectal Cancer

If the diagnosis is cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the various stages of colorectal cancer.

� Stage 0. The cancer is very early. It is found only in the innermost lining of the colon or rectum.

� Stage I. The cancer involves more of the inner wall of the colon or rectum.

� Stage II. The cancer has spread outside the colon or rectum to nearby tissue, but not to the lymph nodes. (Lymph nodes are small, bean-shaped structures that are part of the body's immune system.)

� Stage III. The cancer has spread to nearby lymph nodes, but not to other parts of the body.

� Stage IV. The cancer has spread to other parts of the body. Colorectal cancer tends to spread to the liver and/or lungs.

� Recurrent. Recurrent cancer means the cancer has come back after treatment. The disease may recur in the colon or rectum or in another part of the body.

Treatment for Colorectal Cancer

Treatment depends mainly on the size, location, and extent of the tumor, and on the patient's general health. Patients are often treated by a team of specialists, which may include a gastroenterologist, surgeon, medical oncologist, and radiation oncologist. Several different types of treatment are used to treat colorectal cancer. Sometimes different treatments are combined.

� Surgery to remove the tumor is the most common treatment for colorectal cancer. Generally, the surgeon removes the tumor along with part of the healthy colon or rectum and nearby lymph nodes. In most cases, the doctor is able to reconnect the healthy portions of the colon or rectum. When the surgeon cannot reconnect the healthy portions, a temporary or permanent colostomy is necessary. Colostomy, a surgical opening (stoma) through the wall of the abdomen into the colon, provides a new path for waste material to leave the body. After a colostomy, the patient wears a special bag to collect body waste. Some patients need a temporary colostomy to allow the lower colon or rectum to heal after surgery. About 15 percent of colorectal cancer patients require a permanent colostomy.

� Chemotherapy is the use of anticancer drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control tumor growth, or to relieve symptoms of the disease. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel through the body. Most anticancer drugs are given by injection directly into a vein (IV) or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are given in the form of a pill.

� Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. Radiation therapy is a local therapy, meaning that it affects the cancer cells only in the treated area. Most often it is used in patients whose cancer is in the rectum. Doctors may use radiation therapy before surgery (to shrink a tumor so that it is easier to remove) or after surgery (to destroy any cancer cells that remain in the treated area). Radiation therapy is also used to relieve symptoms. The radiation may come from a machine (external radiation) or from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation). Some patients have both kinds of radiation therapy.

� Biological therapy, also called immunotherapy, uses the body's immune system to fight cancer. The immune system finds cancer cells in the body and works to destroy them. Biological therapies are used to repair, stimulate, or enhance the immune system's natural anticancer function. Biological therapy may be given after surgery, either alone or in combination with chemotherapy or radiation treatment. Most biological treatments are given by injection into a vein (IV).

� Clinical trials (research studies) to evaluate new ways to treat cancer are an appropriate option for many patients with colorectal cancer. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the promising new treatment to one group of patients and the usual (standard) therapy to another group.


Research has led to many advances in the treatment of colorectal cancer. Through research, doctors explore new ways to treat cancer that may be more effective than the standard therapy. The NCI publication Taking Part in Clinical Trials: What Cancer Patients Need To Know provides information about how these studies work. PDQ(r), NCI's cancer information database, contains detailed information about ongoing studies for colorectal cancer. NCI's Web site includes a section on clinical trials at http://cancer.gov/clinical_trials. This section provides both general information about clinical trials and detailed information about specific ongoing studies for colorectal cancer.

The NCI's Cancer.gov(tm) Web site provides information from numerous NCI sources, including PDQ(r), NCI's cancer information database. PDQ contains current information on cancer prevention, screening, diagnosis, treatment, genetics, supportive care, and ongoing clinical trials. Cancer.gov can be accessed at http://www.cancer.gov on the Internet.

Side Effects of Treatment

The side effects of cancer treatment depend on the type of treatment and may be different for each person. Most often the side effects are temporary. Doctors and nurses can explain the possible side effects of treatment. Patients should report severe side effects to their doctor. Doctors can suggest ways to help relieve symptoms that may occur during and after treatment.

� Surgery causes short-term pain and tenderness in the area of the operation. Surgery for colorectal cancer may also cause temporary constipation or diarrhea. Patients who have a colostomy may have irritation of the skin around the stoma. The doctor, nurse, or enterostomal therapist can teach the patient how to clean the area and prevent irritation and infection.

� Chemotherapy affects normal as well as cancer cells. Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, diarrhea, and fatigue. Less often, serious side effects may occur, such as infection or bleeding.

� Radiation therapy, like chemotherapy, affects normal as well as cancer cells. Side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Common side effects of radiation therapy are fatigue, skin changes at the site where the treatment is given, loss of appetite, nausea, and diarrhea. Sometimes, radiation therapy can cause bleeding through the rectum (bloody stools).

� Biological therapy may cause side effects that vary with the specific type of treatment. Often, treatments cause flu-like symptoms, such as chills, fever, weakness, and nausea.

Several useful NCI booklets, including Chemotherapy and You, Radiation Therapy and You, and Eating Hints for Cancer Patients, suggest ways for patients to cope with their side effects during cancer treatment.
The health care team can explain the possible side effects of treatment. Patients should report severe side effects. Doctors and nurses can suggest ways to help relieve symptoms that may occur during and after treatment.

The Importance of Followup Care

Followup care after treatment for colorectal cancer is important. Regular checkups ensure that changes in health are noticed. If the cancer returns or a new cancer develops, it can be treated as soon as possible. Checkups may include a physical exam, a fecal occult blood test, a colonoscopy, chest x-rays, and lab tests. Between scheduled checkups, a person who has had colorectal cancer should report any health problems to the doctor as soon as they appear.

Providing Emotional Support

Living with a serious disease, such as cancer, is challenging. Apart from having to cope with the physical and medical challenges, people with cancer face many worries, feelings, and concerns that can make life difficult. Some people find they need help coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional burden of having cancer is often a part of a patient's treatment plan. The support of the health care team (doctors, nurses, social workers, and others), support groups, and patient-to-patient networks can help people feel less alone and upset, and improve the quality of their lives. Cancer support groups provide a setting where cancer patients can talk about living with cancer with others who may be having similar experiences. Patients may want to speak to a member of their health care team about finding a support group. Many also find useful information in NCI fact sheets and booklets, including Taking Time and Facing Forward.

Questions for Your Doctor

This booklet is designed to help you get information you need from your doctor, so that you can make informed decisions about your health care. In addition, asking your doctor the following questions will help you understand your condition better. To help you remember what the doctor says, you may take notes or ask whether you may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

Diagnosis

� What tests can diagnose colorectal cancer? Are they painful?

� How soon after the tests will I learn the results?

� Are my children or other relatives at higher risk for colorectal cancer?

Treatment

� What is the stage of my cancer?

� What treatments are recommended for me?

� Should I see a surgeon? Medical oncologist? Radiation oncologist?

� What clinical trials might be appropriate?

� Will I need a colostomy? Will it be permanent?

� What will happen if I don't have the suggested treatment?

� Will I need to be in the hospital to receive my treatment? For how long?

� How might my normal activities change during my treatment?

� After treatment, how often do I need to be checked? What type of followup care should I have?

Side Effects

� What side effects should I expect? How long will they last?

� What side effects should I report? Whom should I call?

The Health Care Team

� Who will be involved with my treatment and rehabilitation? What role will each member of the health care team play in my care?

� What has been your experience in caring for patients with colorectal cancer?

Resources

� Are there support groups in the area with people I can talk to?

� Where can I get more information about colorectal cancer?

SOURCE: National Cancer Institute