How do you deal with the pressure from the mass in the rectum?
The mass makes it hard to do BMs and it's getting increasingly harder to pass gas or even water from laxatives. There is some pressure on the urinary tract as well. I have four days until treatment starts and I often feel like I'm not going to make it to treatment - and then I really want the treatment to shrink the tumor as fast as possible so that I can pass things out.
How bad did it get for you and what did you do to deal with it? I asked the surgeon if they could cut part of it out and I've worried that I'll wind up in an ER with a lot of pain. I've read a few notes here and there but I'd like to know how you deal with it.
Comments
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Mine was already too big
That it was already blocking my large intestine (I think) or colon or whatever so that my wastes can't come out. It has been 3 days since my last BM and then the pain was already too much so I checked into the ER. They conducted a CT scan and advised for an emergency operation to remove the mass. I suggest you bring the matter up to your doctors, I mean, you shouldn't suffer in agony because you're still undergoing treatments. Why don't they remove the mass first then just do the mop-up chemo? Just my non-expert advice. I believe you tell your doctors about it, air your concerns because first and foremost, you are the one who knows your body. They might know everything by the book, but they're not the one being bugged by the agony day and night.
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...
I know it takes time, getting appointments and all, but I would seriously think about a second or third opinion. I was definitely at your stage, when first diagnosed; and surgery was the only thing that gave me relief. I didn't have a bm for upward of two weeks, so you can imagine the kind of pain I was in.
Tru
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I didn't have your issue, but
I didn't have your issue, but I remember the pressure from pain killer induced constipation, and that alone was miserable. I'm sorry you have to suffer that misery, but it sounds like the mass has to be dealt with.................................Dave
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For those that had emergency surgery
did you continue with your treatments afterwards or did you have to wait to recover and then continue with your treatments? I did bring up the issue with the doctors but they just offered stool softeners. I get the feeling that the doctors and nurses don't understand what I'm going through. The oncologist made a side comment to his nurse that I might be in the ER over last weekend for emergency surgery but I was able to poop on Saturday and Wednesday but I was very worried about making it to treatment. I really wanted to start this week but was disappointed and worry that it will start next week. The question: can I make it? I don't have any pressure or pain right now. I probably have two days of stuff in me and I'd need another day or two before there's pressure to go on the rectum. I took a Miralax and some of the liquid came out and I'm considering a bottle of magnesium citrate to get more out. I'm also really hungry as the natural reaction is to cut back on eating food with this kind of problem. So I'm not really at the ER stage - moreso worried about it and maybe close to it.
So a few more details would be helpful. You went to the ER, told them your problem, they took a scan or felt around and decided to do surgery. How long did it take to recover and did you just keep going to treatments or did you have to stop them to recover and then start them back up. I'm sure that the mass will just start growing again after any surgery so I need the treatments to shrink it and don't want to wait or wait too long afterwards.
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Constipation and Obstructive Mass
NHMike:
I have learned to deal with opiod induced constipation. Those small pills can quickly turn feces into concrete! While I was doing so I had no idea that I also had an obstructive (cancerous) mass in my rectum. Consequently, it was doubly challenging to evacuate my bowels.
This is the solution that I finally discovered (works for me anyway). Each morning I would mix some Miralax into a glass of juice. Then when it was time for my daily BM, I would simply irrigate my rectum and lower colon with warm water. Little did I know that the miralax solved the constipation issue, but it would not move due to the obstructive mass. The water enema provided sufficient liquid to allow it to slide around the mass.
I wrote that paragraph in past tense. My situation has changed now that I am taking Xeloda and radiation. I no longer have any need for the Miralax, but I still must irrigate. My mass is shrinking and even "sloughing off" so hopefully soon I will no longer need to irrigate. However, all of that may change after my surgery and become a thing of the past if I need to have an ostomy.
Crisis management, pain management, financial management, material management and even feces management. Who would have thought...?
Jim
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How did you do the irrigation?airborne72 said:Constipation and Obstructive Mass
NHMike:
I have learned to deal with opiod induced constipation. Those small pills can quickly turn feces into concrete! While I was doing so I had no idea that I also had an obstructive (cancerous) mass in my rectum. Consequently, it was doubly challenging to evacuate my bowels.
This is the solution that I finally discovered (works for me anyway). Each morning I would mix some Miralax into a glass of juice. Then when it was time for my daily BM, I would simply irrigate my rectum and lower colon with warm water. Little did I know that the miralax solved the constipation issue, but it would not move due to the obstructive mass. The water enema provided sufficient liquid to allow it to slide around the mass.
I wrote that paragraph in past tense. My situation has changed now that I am taking Xeloda and radiation. I no longer have any need for the Miralax, but I still must irrigate. My mass is shrinking and even "sloughing off" so hopefully soon I will no longer need to irrigate. However, all of that may change after my surgery and become a thing of the past if I need to have an ostomy.
Crisis management, pain management, financial management, material management and even feces management. Who would have thought...?
Jim
Hello Jim,
I have a box of Miralax packages and I guess I'll try them one a day (I have been using them here and there since I bought more than I needed for the Colonoscopy prep). I also have a bottle of Magnesium Citrate that I was considering using though that's more like using a hammer. And the nurse talked about Colace and something else - maybe Senokot. Those appear to be stool softeners.
When you say irrigate, I assume that you're talking about using enema equipment. Do you know how much water you typically used and did you mix anything in with it? That's something that I could try to keep things manageable until the tumor starts to shrink. Also, how many days on Xeloda and radiation did it take before you determined that the tumor is shrinking? Thank you for your reply above.
This cancer stuff is really heavy and hits like a ton of bricks in all the ways you talked about. The biggest problem that I have these days is worry - there are problems but the worries make it a lot worse.
mike
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My case
Everything happened so fast. Stomach pain, ER, then emergency operation. I had no clue I had cancer in me until that emergency operation. And I thought the mass was just a mass until the biopsy came. Stage 3B. Dang. I was advised to do chemo after a month of recovery. However, I was delayed for chemo for another month because at first I didn't want to do chemo. I sought alternative medicine, drank herbs and all that. Eventually I gave in to chemo because I was afraid the cancer cells continued to spread without me doing anything.
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Constipation and Irrigation
Mike:
I just noticed your question to me reference bowel irrigation. An explanation about that follows, but first I want to share some other thoughts and feelings.
My attention to this list, and your question, was diverted temporarily because I was trying to be "normal" for a day or two and turned my back on rectal cancer. My treatments are suspended during the weekends and those two days have taken on a new meaning for me. It gives a body a chance to briefly recover and regroup before the next five days of burning and poisoning recommence.
During my twenty years in the Army I learned many things about life, people, and myself. Interestingly, the most valued "thing" for me and others was not what you would think. Time. Just a moment to be alone. Just a moment to rest. Minutes mattered. It was surprizing what could be accomplished in hours. Days off seemed like forever. So whenever a soldier must choose between anything and time off, the choice will always be time off. "Beer, beer, beer said the private; I want a 3-day pass said the corporal." That is what I have experienced during my recent weekends this summer. It's only 48 hours, but it sure does make a difference mentally. And now, within a short 10 hours, it will begin again.
Back to your question. I irrigate only with warm water. What I use is a store bought enema device of some type that initally contained a solution. I believe it was designed for one use, or limited use, but I have gotten some mileage out of it. This came about in early 2015 when my dosage of opiod med's were increased and I suffered immediate blockage. After literally begging a practitioner for an emergency colonic (on two occasions) and paying $150 cash for each, I swore that I would get ahead and stay ahead of this issue.
My regimen evolved into miralax from one end and warm water from the other on a daily basis. I never understood, until after diagnosis and scans/MRI's, but the slight pain and obstruction I encountered inserting the enema hose was my cancerous rectal tumor.
To address another question you posted separately - my tumor is shrinking rapidly. I say this because almost daily I am passing tissue and even chunks of tissue during a bowel movement. My intestines are shedding from the inside. In theory and faith, the combination of targeted radiation and specifically designed chemicals (Xeloda) are making it happen! I have completed 14 out of 25 treatments. My stools are now much looser because of the radiation so I no longer take Miralax, but I still irrigate because my rectal mass continues to obstruct the natural movement.
Cancer may have my **** but it doesn't have my heart, my head or my soul!
Jim
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Thanks for your reply Jim.airborne72 said:Constipation and Irrigation
Mike:
I just noticed your question to me reference bowel irrigation. An explanation about that follows, but first I want to share some other thoughts and feelings.
My attention to this list, and your question, was diverted temporarily because I was trying to be "normal" for a day or two and turned my back on rectal cancer. My treatments are suspended during the weekends and those two days have taken on a new meaning for me. It gives a body a chance to briefly recover and regroup before the next five days of burning and poisoning recommence.
During my twenty years in the Army I learned many things about life, people, and myself. Interestingly, the most valued "thing" for me and others was not what you would think. Time. Just a moment to be alone. Just a moment to rest. Minutes mattered. It was surprizing what could be accomplished in hours. Days off seemed like forever. So whenever a soldier must choose between anything and time off, the choice will always be time off. "Beer, beer, beer said the private; I want a 3-day pass said the corporal." That is what I have experienced during my recent weekends this summer. It's only 48 hours, but it sure does make a difference mentally. And now, within a short 10 hours, it will begin again.
Back to your question. I irrigate only with warm water. What I use is a store bought enema device of some type that initally contained a solution. I believe it was designed for one use, or limited use, but I have gotten some mileage out of it. This came about in early 2015 when my dosage of opiod med's were increased and I suffered immediate blockage. After literally begging a practitioner for an emergency colonic (on two occasions) and paying $150 cash for each, I swore that I would get ahead and stay ahead of this issue.
My regimen evolved into miralax from one end and warm water from the other on a daily basis. I never understood, until after diagnosis and scans/MRI's, but the slight pain and obstruction I encountered inserting the enema hose was my cancerous rectal tumor.
To address another question you posted separately - my tumor is shrinking rapidly. I say this because almost daily I am passing tissue and even chunks of tissue during a bowel movement. My intestines are shedding from the inside. In theory and faith, the combination of targeted radiation and specifically designed chemicals (Xeloda) are making it happen! I have completed 14 out of 25 treatments. My stools are now much looser because of the radiation so I no longer take Miralax, but I still irrigate because my rectal mass continues to obstruct the natural movement.
Cancer may have my **** but it doesn't have my heart, my head or my soul!
Jim
Thanks for your reply Jim.
I never have expectations on message boards that people will respond quickly to questions as that's often the case. I'm glad that you're able to spend some time getting away from the idea of cancer. For me, getting away from cancer was going into the office last night and working for a few hours and taking some walks with my wife over the weekend. I'm greatly appreciative of your experiences here along with the wisdom of a military guy.
michael
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Mass
Mine was in the rectum also, but I'd been having loose stools for a long time so constipation or passing wasn't an issue, but the pain was bad, most of my pain came from sitting. My radiologist was able to shrink my tumor extensively, however they had to take the whole rectum out. They gave me a temporary ileostomy and then a reversal later. I've always felt it better that they take the whole section out but my rectum needed to come out due to it's location. They actually made a new rectum from the descending colon and then reversed the ileostomy. My new rectum certainly doesn't compare to the old one, but it did allow me to get rid of the ostomy (bag). Make sure you ask the doctor if they think you need an ostomy because my initial doctor never told me that and that made me upset learning that was what they were going to do. Ask if you can get some protafoam (I'm not really remembering the name because it's been so long), but it's steroid that numbs the tumor. Hope you can get some good answers from your doctor.
Kim
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AnnabelleAnnabelle41415 said:Mass
Mine was in the rectum also, but I'd been having loose stools for a long time so constipation or passing wasn't an issue, but the pain was bad, most of my pain came from sitting. My radiologist was able to shrink my tumor extensively, however they had to take the whole rectum out. They gave me a temporary ileostomy and then a reversal later. I've always felt it better that they take the whole section out but my rectum needed to come out due to it's location. They actually made a new rectum from the descending colon and then reversed the ileostomy. My new rectum certainly doesn't compare to the old one, but it did allow me to get rid of the ostomy (bag). Make sure you ask the doctor if they think you need an ostomy because my initial doctor never told me that and that made me upset learning that was what they were going to do. Ask if you can get some protafoam (I'm not really remembering the name because it's been so long), but it's steroid that numbs the tumor. Hope you can get some good answers from your doctor.
Kim
My surgeon told me that she would tell me whether it was definitely a bag for the rest of my life from the MRI after the chemorad. If it's not definite, then she would make the determination while she was in there doing the surgery. Obviously I would not have a choice in the matter. She drew a diagram for me and showed me the conditions for a permanent bag vs a temporary bag. This was in my rounds for second opinions at Dana Farber Cancer Institute and Brigham and Womens Hospital. My local oncologist was somewhat vague on what I'd wind up with - I think that the surgeon is the best person to discuss this with (in my case, she brought it up).
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"If dreams were thunder and lightning was desire...."
Hey Mike:
At face value that is a simple question and it should have a simple answer. However, I'll give you the loooooong answer.
When I was in my prime I was an avid runner (10K; 15 K; marathons). To improve my stamina and even speed I would lift, but not a gut-wrenching, moaning, drop the bar on the floor type of lifting. Somewhere between light weights and heavy weights. That all came to an end when my lumbar spine gave out and I submitted to a two level fusion in 2011. The outcome of that procedure left me in more pain and with less stability, so we revised it in 2013 and I ended up with the same outcome.
Due to the two rods and six screws in my lumbar spine my mobility quickly lessened and even walking short distances (500 yards) became a challenge. That messed with me mentally and physically. I tried all modalities of therapy and non surgical intervention seeking relief, but I finally succumbed to pain management in 2014 after three years of deferring that course of action. That is when I began my journey with opioid induced constipation which could have been a trigger for rectal cancer (who knows?).
Currently (with the exception of this tour of duty with Xeloda and gamma rays), my exercise regimen is limited to pushing a lawn mower and working in the garden. If I don't keep moving I will slowly and gradually loose my flexibility and strength, but my movement now no longer includes running or lifting. Life provides us the opportunity to adapt; if we don't then we will be left behind or even left out of life. With sadness and lots of humility, I hung up my running shoes and cancelled my membership at the local exercise facility and accepted the title of "retired runner."
On a related topic, I have very strong opinions about the recent national opioid epidemic. My condition and pain level is chronic and I am dependent upon opioid medication to manage that pain to improve the quality of my life. I am not addicted to opioid medication, I am dependent upon them. There is a difference and that distinction is lost in the current uproar about opioid meds. I, as well as thousands of others in similar physical distress, are facing increasing difficulty in getting prescriptions filled. For the record, I would give nearly anything I own to be able to swap the opioids for the opportunity to exercise, break a sweat, and then enjoy the relaxing feeling provided by natural endorphins.
And that leads to the subject of my response. That phrase is a snipet from the lyrics of a John Prine song (Angel from Montgomery). Taken out of text, it describes how I feel about the lost ability to run and the life altering effects of chronic spinal pain. Now, with the addition of rectal cancer to my medical resume, I long even more for the old Jim - that younger, healthier person who used to run and lift weights.
The simple answer to your question - no, I do not lift weights. I barely have the energy to pick tomatoes in the garden. But this too shall pass.
Jim
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Hello Jim,airborne72 said:"If dreams were thunder and lightning was desire...."
Hey Mike:
At face value that is a simple question and it should have a simple answer. However, I'll give you the loooooong answer.
When I was in my prime I was an avid runner (10K; 15 K; marathons). To improve my stamina and even speed I would lift, but not a gut-wrenching, moaning, drop the bar on the floor type of lifting. Somewhere between light weights and heavy weights. That all came to an end when my lumbar spine gave out and I submitted to a two level fusion in 2011. The outcome of that procedure left me in more pain and with less stability, so we revised it in 2013 and I ended up with the same outcome.
Due to the two rods and six screws in my lumbar spine my mobility quickly lessened and even walking short distances (500 yards) became a challenge. That messed with me mentally and physically. I tried all modalities of therapy and non surgical intervention seeking relief, but I finally succumbed to pain management in 2014 after three years of deferring that course of action. That is when I began my journey with opioid induced constipation which could have been a trigger for rectal cancer (who knows?).
Currently (with the exception of this tour of duty with Xeloda and gamma rays), my exercise regimen is limited to pushing a lawn mower and working in the garden. If I don't keep moving I will slowly and gradually loose my flexibility and strength, but my movement now no longer includes running or lifting. Life provides us the opportunity to adapt; if we don't then we will be left behind or even left out of life. With sadness and lots of humility, I hung up my running shoes and cancelled my membership at the local exercise facility and accepted the title of "retired runner."
On a related topic, I have very strong opinions about the recent national opioid epidemic. My condition and pain level is chronic and I am dependent upon opioid medication to manage that pain to improve the quality of my life. I am not addicted to opioid medication, I am dependent upon them. There is a difference and that distinction is lost in the current uproar about opioid meds. I, as well as thousands of others in similar physical distress, are facing increasing difficulty in getting prescriptions filled. For the record, I would give nearly anything I own to be able to swap the opioids for the opportunity to exercise, break a sweat, and then enjoy the relaxing feeling provided by natural endorphins.
And that leads to the subject of my response. That phrase is a snipet from the lyrics of a John Prine song (Angel from Montgomery). Taken out of text, it describes how I feel about the lost ability to run and the life altering effects of chronic spinal pain. Now, with the addition of rectal cancer to my medical resume, I long even more for the old Jim - that younger, healthier person who used to run and lift weights.
The simple answer to your question - no, I do not lift weights. I barely have the energy to pick tomatoes in the garden. But this too shall pass.
Jim
Hello Jim,
I've always been active and not being able to run, lift, and play tennis would be very tough to get through. I have had to stop in the past for injuries but it was okay because I knew that I'd be back at it when the injury healed. So I can imagine the stress in having to give up a lot of the things that you had to give up.
My mother had curvature of the spine back in the 1990s and she had an early procedure at New England Baptist to have a rod put in her back and that stopped the progression of the curvature. She has trouble walking and doing things that she took for granted when she was younger but she adapted. This getting old stuff stinks and I don't consider myself that old. I'd guess that you don't consider yourself that old either.
I am planning on hitting tennis balls this week and would like to take video of it just to show that you can do a few things while on chemo and radiation treatments. I don't know if I'll do the video as it's a headache to set up but I do want to hit just to see whether or not I can.
The opiod problems are severe in my state. I think that it's one of the worst states in the country on a per capita basis in deaths. There's all sorts of crazy crime associated with it (a coworker was hit by a vehicle trying to evade the police), and the number of people that get arrested for drug crimes is crazy (there's a list of people and pictures every Friday in the local paper). My son knows someone from his driving class that lives a quarter mile away with several arrests for posession and dealing. So the situation out there is tragic. That said, the surgeon said that she'd give my oxycodone for pain after the surgery. I'm actually quite scared to take it because of the potential for addiction. Same goes for anything else that's potentially addictive. But maybe I won't have a choice because they put it into an IV or because I can't take the pain. I won't know until I get there.
I understand the issue of dependency. I have a friend with lung cancer. A miracle-drug has shrunk his tumor quite a bit but it has stopped shrinking and he's basically on maintenace mode now. He has to take the drug for the rest of his life or until another drug comes along that can kill the tumor. I think that he's somewhat comforted that we are making a lot of progress in cancer.
One of my tennis partners damaged his shoulder many years ago in a fall. He was never able to get tennis functionality fully back into that arm. So he developed left-handed strokes. It took him ten years to build up decent strokes but he wanted to be able to play that badly that he worked on them. Yeah, to be able to run, lift, and feel the exhilaration of a workout.
I'm very sorry that you've lost that.
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A note on the pressure
After two days on Xeloda along with radiation treatment, I'm rather pleased at some amount of progress. Basically the ability to pass gas without having to go to the bathroom. It might not seem like much but it actually is as it reduces trips and reduces pressure on my stomach. I'd guess that the shrinkage wouldn't have to be much to allow that: maybe 5% or so but it represents progress and I now don't worry anywhere near as much about blockage issues. I haven't taken Miralax for a few days now and am undecided as to whether or not to take it regularly now. I guess it will depend on how things go in the next few days.
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For some reason I can't start
For some reason I can't start new threads so I dug up an old one and will reply to it.
I got the results from the post-chemorad MRI and the tumor has gone from 100+ cm^3 to less than 10 cm^3 or shrinkage of over 90%. The three enlarged lymph nodes decreased from 40% to 76%. So the chemo+radiation worked quite well in my case.
I was wrong with the number of weeks. I checked my calendar and surgery is 7 weeks out. I told the doctor that I was done on Sep 1 but my calendar indicates that I was done on Sep 8.
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A happy reportNHMike said:For some reason I can't start
For some reason I can't start new threads so I dug up an old one and will reply to it.
I got the results from the post-chemorad MRI and the tumor has gone from 100+ cm^3 to less than 10 cm^3 or shrinkage of over 90%. The three enlarged lymph nodes decreased from 40% to 76%. So the chemo+radiation worked quite well in my case.
I was wrong with the number of weeks. I checked my calendar and surgery is 7 weeks out. I told the doctor that I was done on Sep 1 but my calendar indicates that I was done on Sep 8.
That is impressive shrinkage. I am so happy to hear it.
I've got Darcher's surgery date on my calendar, so now I'm ready to add yours.
As I said above, I had to have my tumour out immedietely, and I was glad of it; but getting your tumour shrunk down, will make it all the more easier/better to excise it with clear margins and no leakage of Cancer cells.
Happy day!
Tru
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WowNHMike said:For some reason I can't start
For some reason I can't start new threads so I dug up an old one and will reply to it.
I got the results from the post-chemorad MRI and the tumor has gone from 100+ cm^3 to less than 10 cm^3 or shrinkage of over 90%. The three enlarged lymph nodes decreased from 40% to 76%. So the chemo+radiation worked quite well in my case.
I was wrong with the number of weeks. I checked my calendar and surgery is 7 weeks out. I told the doctor that I was done on Sep 1 but my calendar indicates that I was done on Sep 8.
That is good reaction to treatment. You are very fortunate that it has taken that good. Radiation and chemo work about 6-8 weeks out from ending so that is a good thing that you are waiting as it reduces further even though you are not actively taking treatment. So good to hear of your positive response.
Kim
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I just had a PET scan done
I just had a PET scan done yesterday and I was able to see the results. Although it doesn't show size it does show metabolism which reflects viability. Mine was dark, ie, dead. I'm still somewhat plugged up and it seems the tumor is breaking up bit by bit so that's good news. I also found out the size isn't that of a chicken egg. It took a little thought and speculation that it's the glow of it that I was looking at and not the actual size when I saw it at the surgeons office. I asked the Pet scan techs about that and they said yes, exactly, the size of the image isn't indicitive of the tumor size. I just wish they'd tell a person these things so they don't freak out like I did. When I saw it at the surgeons office I assumed it was the x-ray. Turns out it was the first Pet scan done back in July.
Surgery is on Nov 3 and prepop on Oct 20, next Friday. I have to write these things down and keep them posted on the wall otherwise there is a good chance I'll loose track of it. Pet scans along with any other screening test isn't perfect and there is a good chance there could be some small colonies just waiting for their chance to grow so the surgery is stilll on along with the chemo afterwards.
Another thing we're told about is how atitude plays a big part. What they need to do is break it down and explain why. Stress causes cancer to grow and form mets. Like anything else when a person is told not to worry it often gets pushed aside as just casual good advice. With this, it can mean the difference between living and not. It needs a lot more attention and instruction.
I hope all are well or getting better. So far so good in my camp.
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Attitude & stressdarcher said:I just had a PET scan done
I just had a PET scan done yesterday and I was able to see the results. Although it doesn't show size it does show metabolism which reflects viability. Mine was dark, ie, dead. I'm still somewhat plugged up and it seems the tumor is breaking up bit by bit so that's good news. I also found out the size isn't that of a chicken egg. It took a little thought and speculation that it's the glow of it that I was looking at and not the actual size when I saw it at the surgeons office. I asked the Pet scan techs about that and they said yes, exactly, the size of the image isn't indicitive of the tumor size. I just wish they'd tell a person these things so they don't freak out like I did. When I saw it at the surgeons office I assumed it was the x-ray. Turns out it was the first Pet scan done back in July.
Surgery is on Nov 3 and prepop on Oct 20, next Friday. I have to write these things down and keep them posted on the wall otherwise there is a good chance I'll loose track of it. Pet scans along with any other screening test isn't perfect and there is a good chance there could be some small colonies just waiting for their chance to grow so the surgery is stilll on along with the chemo afterwards.
Another thing we're told about is how atitude plays a big part. What they need to do is break it down and explain why. Stress causes cancer to grow and form mets. Like anything else when a person is told not to worry it often gets pushed aside as just casual good advice. With this, it can mean the difference between living and not. It needs a lot more attention and instruction.
I hope all are well or getting better. So far so good in my camp.
I have had major family stress post-surgery. Trying to maintain mental peace and positivity can be so difficult. I appreciate the reminder of how important this is to our healing.
Wishing you well during your countdown to surgery. May your pain management be a breeze.
0
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