Last October Jay had his routine annual colonoscopy. The results of his colonoscopies are never fabulous, but reports of inflammation and irritation have become the norm. This time, however, the gastroenterologist removed a very large adenomatous polyp that was a bit concerning. The pathologist (who, thank God, goes to church with us and was willing to spend as long as necessary helping me understand what he saw) explained that the textbook answer to the polyp (which is pretty ordinary in a 50+-year-old patient but worrisome in a 36-year-old PSC patient) is to go ahead and remove the colon, but that we could certainly count on Jay's doctor to steer us in the right direction.
And he did. After consulting with Jay's hepatologist and another gastroenterologist at Vanderbilt, he decided that Jay would have a chromoendoscopy. Basically they shoot blue dye around while they're doing the colonoscopy to see if there's any dysplasia. That's what they did today. What they found was that Jay's Jackson gastroenterologist had, in fact, removed the whole polyp (the Vandy gastroenterologist was highly impressed with his work), and that there didn't seem to be any other dysplastic areas. The chromoendoscopy helps the doctor correctly identify dysplasia about 90% of the time, so while we won't exhale until the we see the pathology report on Monday, things are indeed looking good.
Jay will have another regular colonoscopy in six months and another chromoendoscopy in a year. The doctor was clear that if they ever do see dysplasia they will almost certainly remove his colon. The reason for this is that in 19-20% of colectomies due to dysplasia, they find cancer already present in the colon. Not a risk we're interested in taking.
And for those of you keeping up at home, somewhere around 80% of PSC patients also have ulcerative colitis or Crohn's Disease, and are at increased risk for colon cancer. It's all in the way the digestive system (of which the liver and colon are both part) works together.
On a lighter note, Jay got roped into participating in a clinical trial for ulcerative colitis, which really isn't a big deal except that I left him in the hands of a young, hot, smart clinical researcher when we parted this morning. That probably brightened his day a bit.
Oh, and there's methylene blue dye in some pretty interesting places.
As always, we are grateful for your prayers and well-wishes.