Questions

• When is colon surgery necessary?
• I have a brother who drinks far too much. In fact, every time I see him he is drunk. I have repeatedly brought up the issue, but he either flatly denies it and gets angry, saying he does not have a problem, or pushes me away by saying, “I’m stopping tomorrow.” I am worried, because my uncle was alcoholic and he was eventually killed in an alcohol-related accident. Is there any hope for my brother? What should I do?
• I have recently been diagnosed with Type 2 diabetes. What complications might
  I expect and how can I manage those complications?

As long as your colon is doing what it’s supposed to do, you probably don’t think much about it. But people can have serious problems with their colon, especially as they age. The most significant problems are:

• Polyps: Growths on the colon wall that can become cancerous. Many times, polyps don’t cause any symptoms, but they can bleed or cause cramps or constipation.
• Diverticula: Pockets that usually develop in weak areas next to the colon’s blood vessels. Stool can get trapped in one of these pockets and cause infection and inflammation. Called diverticulitis, the condition is characterized by periodic pain as well as constipation and sometimes fever.
• Tumors: An abnormal growth of normal cells in the lining of the colon. These growths are usually cancerous.

Colon surgery is recommended to remove tumors, large or hard-to-reach polyps, or diverticula that cause severe symptoms. In some cases, surgery is necessary to determine if a growth is cancerous. The procedure is called a colon resection, and its goal is to remove the section of the affected colon.

After making an incision in the abdomen, usually down the middle, the surgeon will cut out the diseased portion of the colon. The portion of the colon above the area that is resected is then reattached to the portion just past the resected area. Called an anastomosis, the re-attachment is done using a suture or with a stapling device. The procedure usually lasts from two to four hours or more depending on the amount of colon that is removed, the amount of previous scarring and the technique used.

Sometimes, but only when absolutely necessary, a colostomy will be constructed during colon surgery. This will allow the colon to heal before it is rejoined a few months later.

According to a recently published study in the New England Journal of Medicine, researchers have found that less-invasive laparoscopic surgery is just as effective as traditional surgery for treating early-stage colon cancer and may be a reasonable treatment option for some patients.

Because laparoscopic surgery uses smaller incisions, patients typically recover from the operation sooner. It should not, however, be used for patients whose cancer requires extensive surgery to other organs besides the colon.

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Alcohol use disorders are common conditions that affect about 13 percent of the population (10 percent men and 3 percent women) at some point in their lives. There is a clear genetic predisposition, but many children of alcoholic parents never develop this disease. Alcohol intoxication is implicated in many accidental deaths, especially from motor vehicle accidents, and accounts for 38 percent of the traffic fatalities in our state.

Families often feel frustrated and hopeless when the alcoholic minimizes or denies his or her condition. It is vital not to lose hope, however. Alcoholism is best defined as a chronic condition such as diabetes, and often requires significant lifestyle changes. But it is also treatable, and does not prevent the person from having a rewarding and productive life if it is well managed.

Alcoholics often become more aware of their illness and less resistant to treatment in gradual steps. Early on, they can be defensive, irritated and in denial, or at least ambivalent about whether to seek treatment. This should not be taken to mean that there is no hope. Open criticism and confrontation often have little or no effect in these early stages and result in further alienation. A nonjudgmental approach that focuses simply on reviewing the negative impact that drinking has had on the person’s life and reinforces the idea that treatment is available is likely to be more effective. Al Anon participation can provide great relief for families of alcoholics.

Efforts should be made to seek professional help as soon as the person agrees to it; this can accelerate motivation and treatment. Of course, if the person is out of control or dangerous to himself or other people, the family should not hesitate to call the authorities.

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High blood sugar levels are toxic to the blood vessels and cause them to narrow. Both large
and microscopic vessels are affected, compromising the blood supply to vital organs of the body.

Some of the complications of diabetes are angina, heart disease, mini-stroke or stroke, kidney failure and poor circulation in the extremities. Poor circulation can lead to gangrene or the necessity for amputations, and damage to the retinal vessels can even cause blindness.

Another possible complication with diabetes is neuropathy, which can lead to foot ulcers due to reduced sensations in the legs and cause a burning sensation, pain, paralysis of the eye muscle, or muscle atrophy and weakness. Other aspects of neuropathy include delayed gastric emptying, inability to empty the bladder and erectile dysfunction. People with diabetes are also very prone to infections, especially yeast infections.

If you have diabetes, it’s important that you understand your risks and take steps to prevent them. You can lower your risk by monitoring your blood sugars regularly and keeping your blood sugar, cholesterol and blood pressure levels under good control. Making wise food choices and getting rid of any excess weight also play important roles in preventing complications of diabetes. Most importantly, stay active and remember to see your health care provider on a regular basis so that any developing complications can be picked up early and treated. Regular eye exams are also a must.

You are the key to preventing the complications of diabetes. Educate yourself about the disease as much as you can. Finally, strive for these levels: a fasting blood glucose level of 110 or less, two-hour post meal blood glucose of 140 or less, HbA1c of 6.5 or less, low-density cholesterol below 100 and a blood pressure of 120 by 80.

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