May 2011

Sponsored by Sanofi Anevtis

Lamont’s Colondar Bio

Lamont Holm had been ignoring the blood in his stool for nearly two years. One day, it was so profuse that he drove himself to the ER, where the doctor told him to get a colonoscopy. A week later, Lamont was diagnosed with stage III rectal cancer.

He and his wife were counseled on family planning and discussed the possibility of children in their future. They still wanted to have that choice, so in addition to tests and doctors visits, Lamont began banking sperm.

Lamont is grateful that his doctors discussed the effects of chemotherapy and radiation on his fertility. He hopes that other young patients will research their options and raise the subject with their doctors before they begin treatment.

Lamont’s story

My name is Lamont Holm and I’m originally from Dewitt, Michigan. During my high school years I lived a healthy and active life. I participated in track and field, played on the JV football team, and the varsity cross-country team. After high school, I moved away from the small town I was raised in to the San Francisco Bay Area.

It was here in late 1996 that I met my wife Katie.  After a brief romance, we were married in late 1997.  Most of the next ten years was dedicated to college while working full time. We eventually received B.S. degrees, mine in Information Technology, which provided an avenue for me to transition from an accounting job into a career as an I.T. professional.  My wife has worked her way up at a mid-size pharmaceutical company.  With our careers established, and ten years behind us, we knew 2008 was the year to change our lives.  At the end of 2007 we talked about everything we wanted to do in 2008:  travel, develop a better work/life balance, and start a family. We had a feeling 2008 was going to be a pinnacle year for us…we just didn’t expect it to include cancer.  In April of 2008, I was diagnosed with stage III rectal cancer (adenocarcinoma).

To tell the story of my “cancer journey” correctly, I’ll need to flashback a few years to 2006.  It was in 2006 that I first started to see the signs that something was wrong.  I started seeing blood in my stool.  It was a little at first.  It came and went. I ignored it out of the fear of embarrassment in discussing it with my doctor.  How would I explain this to my doctor? Out of naiveté for the significance of this sign, I didn’t do anything.  Fortunately, my wife found out, and she made an appointment with a doctor for me. When the doctor visit concluded, he told me that he wasn’t concerned due to my age, my vegetarian diet, and no family history of cancer. He told me that the blood was due to internal hemorrhoids. I went home happy to have an answer that explained the blood. I continued seeing the bloody stools and I continued to ignore it until April 2008. I was desperately hoping it was hemorrhoids and everything would be okay.  But I had a feeling deep down that it was more than that.  I just didn’t know what it could be. So I ignored it…for almost 2 years!

It was a Sunday, and I was at work getting caught up on some projects when I started to have uncontrollable bleeding out of my rectum.  I was freaking out.  After I ran to the bathroom, I began trying to calm myself down.  I realized I was all alone and that I’d have to figure how to get to the ER by myself.  I also knew that I could have prevented this if I hadn’t ignored the signs for so long.  When I was able to control the bloody bowel movements to the point that I could venture out of the bathroom, I thought of calling an ambulance.  But I didn’t want to make such a grand entry into the hospital.  That wasn’t my style.  So I looked for the directions to the local hospital on the internet.  My next obstacle was finding towels to lay on the driver’s seat of my car.  I didn’t want to get blood on the seats! Complicating the whole situation was the need for me to continually run to the bathroom.  The blood was still pooling in my rectum.

Once I was at the emergency room, it seemed like forever for the nurse to admit me.  It seemed like a slow day for them with no one in the waiting room. I had the feeling that they didn’t take my situation that seriously. Once I was admitted to the room, the nurse put a hood on the toilet to capture the bloody stool. Finally I was waiting for the doctor to see me.  I remember feeling cold and bewildered but finally able to close my eyes and rest. I didn’t know what was wrong.  I wished that Katie was there next to me.  Unfortunately, she was out of town on a work trip in Chicago, and she wasn’t going to be home for a couple of days.  As I relaxed, the doctor on duty that night entered the room. He started to ask questions and talked about hemorrhoids or colitis and other ailments but nothing about cancer.  I told him about the pre-diagnosis of hemorrhoids, and then I asked him to check the sample in the bathroom.  Once the doctor saw the volume of blood, I felt a shift in the way they were treating my case.  They started to take me seriously. After he estimated how much blood I lost, he ordered fluids to replenish what I lost. I didn’t realize how much I lost, but once the IV started, I could feel the difference in my head. After a couple of hours, the bleeding subsided, and I was released from the ER with a 9 a.m. appointment to see a gastroenterologist the next day.

I left the ER room and the subsequent GI appointments feeling scared.  Katie was in Chicago, and I didn’t know what was wrong.  I was healthy and young. I have never even broken a bone!  My only sicknesses had been common colds. I had never been in a situation like this before, and I didn’t know what to do.  Even through the ER and doctor visits, the word ‘cancer’ was never mentioned to me.  After a few days (with Katie by my side), I went in for a colonoscopy.  While I was still coming out of the sedation, we were told the colonoscopy found a cancerous tumor in my sigmoid colon. A week later, the pathology report confirmed it.  I had a malignant tumor (adenocarcinoma) located in my sigmoid colon.

The next couple of weeks were a whirlwind of activity. I needed CT -scans and PET scans, various blood tests, and an anal ultrasound. I don’t remember much about this time. It was a crazy blur for me.  I was still mourning my own situation.  I was looking at my own mortality, and questioning why this was happening to me.  I was afraid of the possibility that this is how I was going to die.  I kept thinking “I’m going to die at 32 from colon cancer.” While I was processing the recent events, I relied on my wife to make the doctor appointments and talk to the doctors.  At the first news of my cancer, she jumped in and was ready to fight for me.  I was still processing the shock that I had cancer, and she was taking the lead with the logistics and planning so I wouldn’t have to.

We were referred to the University of California San Francisco (UCSF) by our primary care physician, Dr. Kealey.  I was so excited to have Dr. Garcia-Aguilar as my surgeon.  I remember being at work when his office called me to tell me they would accept me as a patient. I started to cry while I was on that call.  Dr. Garcia-Aguilar referred me to Dr. Korn for oOncology. They are wonderful doctors, and UCSF is a great hospital.  I want to take this opportunity to thank them both for their help.

As we were figuring out our treatment options, we were counseled to think about family planning.  I had some intimate discussions with my wife regarding our future family plans and what we should do.  We made the decision that we should plan for a family of our own and we started looking into sperm banks.  In addition to all the doctor visits, I had to fit in making deposits at the sperm bank.  Talk about getting kicked when you are down!  But I laugh about it now.  I remember telling people “I’m running some errands for lunch- I’ll be gone a little longer than an hour.”  Oh, if they only knew what I was doing during lunch.

My treatment plan was different from most patients.  I decided to enroll in a clinical study which was in the second round. The study was analyzing the effects of the timing of surgery after radiation. When I enrolled in the study, Katie and I got to know the study coordinator, Karen.  She asked if she could shadow me while I was at my appointments. Her goal was to have a better understanding of what a patient goes through.  This would enable her to better help other patients she works with.  I agreed to her request.  I learned to put my emotions and personal embarrassment aside. I wanted the medical community to learn from my case.  I wanted others to know about the symptoms I had ignored.  I enrolled in the study and I started documenting my treatments and my thoughts at www.colontales.blogspot.com. After the treatments, I started to realize that this partnership with Karen was beneficial to me. She was instrumental in helping us plan appointments, and she provided a single point of contact when we had questions and concerns.  Through Karen, I developed a sense of ease while I was participating in the study. She provided a familiar face at most of my appointments, albeit even though she was another person (and a female) in the room when I was getting poked and prodded in areas that I didn’t want to have many witnesses.

My treatment started with chemo-radiation (radiation every Monday- Friday and a 5-FU chemo pump that I wore 24/7) for six weeks.  Once this was completed I had a two week break.  Normally, this is when a patient would have surgery. However, since I was on the study, I was given an additional month to wait before surgery.  During this time I received two rounds of Folfox (5-FU, Leucovorian, and Oxaliplatin) prior to surgery. The goal of the study is to determine if it is more effective to delay surgery after chemo-radiation to give it more time to work.

I tolerated the chemo-radiation well. During this six week period I continued to work and my life went back to a daily routine.  After a few weeks of the 5-FU I started to get tired and cranky, but before I knew it I was finished and was going to start the Folfox treatments.  I was planning to work through all of the chemo treatments.  I wanted to keep my mind on something other than my cancer. As the day for Folfox grew near I realized that I needed to make myself the priority, and in an attempt to reduce stress I elected to go out on disability. The first two rounds of Folfox were my worst. The nausea was prevalent, and I didn’t handle it well.  I had one anti-nausea drug to start with and after the first round I was given an additional anti-nausea drug.  The second round was worse than the first, but I started to recognize the signs of nausea, and I learned how to manage them. Once I was prescribed the third anti-nausea drug, I finally had the right treatment combination to offset the nausea, but it was time to stop the Folfox and prepare for surgery.

I had surgery on August 21, 2008, the day before my 33rd birthday.  When I awoke from the surgery I thought, “I am now a man without a rectum,” and I quickly examined my abdomen.  Getting my mind around the ostomy was the hardest part.  I was afraid of wearing the appliance. How would I look wearing it? How would it affect my life? Now I look back at my time with the ileostomy, and I have a feeling of respect and appreciation for the device.  I was able to live my life for 9 months with it.  I wasn’t home bound, because the bag allowed me to function normally.

A week after surgery I got the pathology report.  The report stated that the pathologist did not find any cancer cells in the colon tissue and or the 30 removed lymph nodes! Katie and I were ecstatic at this news.  This was the beginning of a mental change for me. The doom and gloom that I was feeling was gone.  I had the paper that told me so. I read and re-read the pathology report, and I felt for the first time that I’ll be okay.  I would make it through this.

After I healed from surgery my doctor and I decided to continue the treatments based on my original stage III diagnosis.  I received an additional 6 rounds of Folfox. However, unlike the first time with Folfox, I was prepared for the nausea, because I had the anti-nausea cocktail of the three drugs.  I knew what to expect and how to read the signs.  Just to be cautious, we had Katie’s mom, Ellie, come and keep me company at our home during the weeks I was going through chemotherapy.  Katie was able to work, and her mind was at ease knowing that her mom was staying with me just in case anything came up.

I received my last chemotherapy treatment on January 5, 2009. During the last rounds of chemotherapy I started to have some of the side affects from Folfox.  When the neuropathy started in my fingertips, my doctor scaled back the dosage. I also had a few rounds of Folfox pushed out a week due to low blood cell counts, and they gave me Neupogen shots to counteract this.  In February, 2009 I had my ileostomy reversed. I was back to working full time in April of 2009- one year since after I was diagnosed with rectal cancer.

It may sound strange to say this, but having cancer changed my life in a good way. It has given me a new perspective on my life that I wouldn’t have without this experience.  Some days I think it was all a dream, but then I look at my ileostomy scar, and it is the evidence that my memories are real.  My scar symbolizes what I went through in 2008. I know that cancer will always be a part of my life, but not because I had it.  Cancer will be a part of my life because of the role it played in shaping the person I was meant to become.