{"id":23217,"date":"2019-03-26T12:37:50","date_gmt":"2019-03-26T18:37:50","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=23217"},"modified":"2023-04-07T12:10:06","modified_gmt":"2023-04-07T18:10:06","slug":"one-tough-mother-back-on-the-road-after-colon-cancer-surgery","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/one-tough-mother-back-on-the-road-after-colon-cancer-surgery\/","title":{"rendered":"One tough mother back on the road after colon cancer surgery"},"content":{"rendered":"
<\/div>
\"The
The Fowler family, taken the week before Nicole started chemotherapy and had colon cancer surgery. Photo courtesy of Bridget Haber.<\/figcaption><\/figure>\n

Nicole Fowler didn\u2019t go through six rounds of chemotherapy, a complex six-hour HIPEC surgery involving a pelvis-to-stern incision and a painstaking abdominal cleanout, another six rounds of chemotherapy, and months of slow recovery to save your life.<\/p>\n

She did it so she can be there for her four kids \u2013 the oldest now 16, the youngest 12 \u2013 and her husband John. But perhaps her story,\u00a0can nudge you into saving your own life, for your own loved ones, at a far lower cost.<\/p>\n

Nickie, as her friends call her, was 44 years old and in phenomenal shape \u2013 she had run half-marathons in sub-8-minute splits and had recently finished a full marathon fast enough to qualify for Boston, a high bar. She was preparing for her first Ironman triathlon. Then, during a party at a neighbor\u2019s house during the 2016 Nebraska-Oregon football game, she got into bean dip for the first time in years. The nasty stomachache started dull but evolved into what she described as \u201clabor-like pain,\u201d which even the non-childbearing among us recognize as a synonym for \u201cexcruciating.\u201d<\/p>\n

She felt a bit better the next day, enough so that John joked, \u201cYou shouldn\u2019t have been eating bean dip. Leave that to the professionals.\u201d The day after that, Nickie seemingly on the mend, John was off to Montana on a business trip. But by Tuesday, the pain turned into a fever. Nickie ended up in an emergency room, and, soon, an operating room.<\/p>\n

It hadn\u2019t been the bean dip. Her appendix had ruptured.<\/p>\n

Why her appendix had ruptured would take more than a year to piece together. In September 2017, she noticed \u201csomething is growing in my abdomen, and I knew I wasn\u2019t pregnant.\u201d A surgery on Oct. 2 at a community hospital started under the assumption that they would remove a benign ovarian tumor; it ended with much more extensive excisions and a dire diagnosis: advanced abdominal cancer.<\/p>\n

\u2018Let\u2019s just get it done\u2019<\/strong><\/h2>\n

As best as doctors could tell, the ruptured appendix had happened because of cancer in the cecum \u2013 a cul-de-sac near the start of the colon. The appendix dangles off the outside of the cecum, and damage from the cancer probably triggered the appendicitis.<\/p>\n

John broke the news to his kids. Evan, the oldest, didn\u2019t say a word. Thomas asked if she was going to be OK. Sophie cried. William, who has autism, asked if she was going to die. No, John said. But it was going to be a battle.<\/p>\n

\"Nicole,
Nicole and John Fowler outside their home in Centennial in late February.<\/figcaption><\/figure>\n

The battle would be waged at UCHealth University of Colorado Hospital at the Anschutz Medical Campus (UCH). The first step was her file coming before a team of gastrointestinal oncologists, radiologists, radiation oncologists, pathologists and others participating in the hospital\u2019s Colorectal and HIPEC Multidisciplinary Clinic, where a diverse group of specialists establishes a care path for tough cases such as Nickie\u2019s. The team understood the cancer to be slow-growing and to not have spread beyond the abdominal cavity or to the liver or lymph nodes. HIPEC surgery \u2013 for hyperthermic intraperitoneal chemotherapy \u2013 would come into play. But the invasive, hours-long operation would have to wait.<\/p>\n

University of Colorado School of Medicine GI oncologist Dr. S. Lindsey Davis <\/a>and surgical oncologist Dr. Martin McCarter<\/a> met with the Fowlers to walk them through a plan for the weeks and months to come. Nickie would start with six rounds of FOLFOX<\/a> chemotherapy, after which McCarter would lead the HIPEC surgery. Once Nickie had recovered from the surgery, another six rounds of chemotherapy would follow. It was a lot to fathom, but Nickie was uncowed.<\/p>\n

\u201cI was heads-down, let\u2019s just get it done,\u201d she said.<\/p>\n

50 to 45<\/strong><\/h2>\n

Fowler was young for colon cancer \u2013 just 46. But cases of colon cancer among young people nationally have been on the rise<\/a>, and Davis and McCarter had recently been among several UCHealth physicians who had co-authored a paper<\/a> concluding that, while colon cancer rates in Colorado had fallen among those over 50, they had risen among those under 50.<\/p>\n

\"Nicole
Nicole Fowler during the 2016 Santa Rosa Marathon. Her time was fast enough to qualify for the Boston Marathon.<\/figcaption><\/figure>\n

What\u2019s causing that increase among younger people remains unknown, Davis said, though processed and fast foods have come under suspicion.<\/p>\n

\u201cStudies are really hard to do because there are so many different variables,\u201d she said.<\/p>\n

The trend has led the American Cancer Society to lower the age<\/a> it recommends for an initial colon cancer screening from 50 to 45 \u2013 though insurers may or may not cover until age 50, Davis said. (The U.S. Preventative Task Force guidelines, which are being updated, have so far stuck with the age-50 recommendation.)<\/p>\n

On Friday, Nov. 3, 2017, Nickie started chemotherapy via a port placed in her chest. Two of the drugs trickled in the outpatient infusion center at the UCHealth Cancer Care – Anschutz Medical Campus<\/a>; the third, fluorouracil (the second \u201cF\u201d in FOLFOX), would flow through a slow-drip pump over the weekend. John described the pump\u2019s fashionability in one of many CarePages posts<\/a>:<\/p>\n

\u201c\u2026she gets to carry [it] around in….wait for it…. A FANNY PACK. Yes…the fanny pack is back. Words fail me to describe how cool she looks. I’ve started scouring the internet for leg warmers, roller skates, and a Sony Walkman.\u201d<\/p>\n

Humor is only so effective a salve, alas. Chemotherapy took its toll. It whacked Nickie\u2019s white blood cell count, produced a nausea that took several tries with different drugs to quell, sapped her energy, ushered in neuropathy and, as winter set in, made her terribly sensitive to cold. The sixth chemotherapy round happened in mid-January. Scans afterward showed some reduction of tumor size, but she was far from clear. GI cancers such as hers don\u2019t respond much to standard chemotherapy, which was why HIPEC had been on the table from the moment she came to UCH.<\/p>\n

Serious colon cancer surgery<\/strong><\/h2>\n

HIPEC is, as McCarter described it, \u201ca very aggressive operation to try and treat a very difficult disease.\u201d Colorectal cancers and other abdominal cancers, most of which are adenocarcinomas<\/a>, often spread through the abdomen\u2019s peritoneum, a thin lining that covers and supports abdominal organs. There\u2019s not a lot of blood flow to that lining, which limits the effectiveness of standard intravenous chemotherapy. HIPEC involves the delivery of a hot liquid mitomycin-C chemotherapy \u2013 it\u2019s heated to nearly 108 degrees Fahrenheit \u2013 directly into the abdominal cavity. But first, the surgeon physically removes as much of the cancer as possible.<\/p>\n

More than 40 HIPEC procedures a year are done at UCH, by far the largest volume in the region. McCarter says the majority of them are done by Dr. Steven Ahrendt<\/a>, director of the CU School of Medicine\u2019s cytoreductive surgery\/HIPEC program. McCarter, also experienced with the procedure, performed it on Nickie on Feb. 21, 2018.<\/p>\n

HIPEC can routinely last 12 hours; Nickie\u2019s surgery took just half that long, a positive sign. McCarter removed hundreds of tumors and swaths of affected tissue, based both on what he saw and what he felt as he probed with gloved fingers for malignancies as small as a grain of sand. He then sutured Nickie closed so the team could circulate with a special pump the hot chemo fluid through her abdomen for 100 minutes, pressing and swirling her midsection with their hands to better the mixing. They drained the chemotherapy, McCarter tied up the loose ends, and they were done. Now it would be a matter of recovery, watching and waiting.<\/p>\n

So far, so good<\/strong><\/h2>\n

It was a tough recovery. The pain was severe, even from the perspective of a woman who took no pain meds after C-sections. Her digestive system took months to recover. The Fowlers were navigating rough seas; help from friends, family, their church, John\u2019s CrossFit gym and others kept the ship from foundering. Nickie recovered enough that, by April 20, she could start another six rounds of chemotherapy. It was just as hard as the first time around, although the weather was warmer, at least. Davis, her oncologist, felt for her.<\/p>\n

\u201cIt\u2019s hard to put someone through that difficult path, but it\u2019s the best chance we have,\u201d Davis said. \u201cThroughout, she was positive and upbeat.\u201d<\/p>\n

Scans in June came up clear, as they did in September and December 2018. Chances are, the cancer will return: Dr. Paul Sugarbaker, who pioneered the procedure decades ago, has put the odds of five-year survival for HIPEC patients at 33 percent, and the percentage of those cured at 25 percent. That\u2019s enough for Nickie, who\u2019s started running again and plans to be in the happy minority on both counts.<\/p>\n

\u201cLess than 5 percent of the population probably runs sub-eight half marathons,\u201d she said. \u201cAnd there\u2019s a mental component that\u2019s been pretty powerful.\u201d<\/p>\n

She and John described their care at UCHealth as \u201cawesome.\u201d But it\u2019s the sort of care they wouldn\u2019t wish upon anyone. Which brings us back to you.<\/p>\n

Are you pushing \u2013 or over \u2013 50?<\/p>\n

Have you had a colonoscopy or other colorectal cancer screening?<\/p>\n","protected":false},"excerpt":{"rendered":"

Nicole Fowler didn\u2019t go through six rounds of chemotherapy, a complex six-hour HIPEC surgery involving a pelvis-to-stern incision and a painstaking abdominal cleanout, another six rounds of chemotherapy, and months of slow recovery to save your life. She did it so she can be there for her four kids \u2013 the oldest now 16, the […]<\/p>\n","protected":false},"author":23,"featured_media":23218,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,890,263],"class_list":["post-23217","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-uchealth","tag-university-of-colorado-hospital"],"acf":[],"yoast_head":"\nColon cancer surgery: This mother is back on the road - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Nicole Fowler is an amazing woman and mother. 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