Just Stick It!

While I am working on very serious FIRE close calls for upcoming columns, I have to beg your understanding as I also beg you to read this month's column, even though it is not about a fire, a crash or a rescue gone wrong. But this is all about saving a firefighter's life -- perhaps your own or that of a firefighter you work with or love. For so many firefighters, this month's column is about one of our most common close calls, but unfortunately for many others, a not-that-unusual death. And like so many close calls, the horrific results of this can be avo ed by taking action ahead of time -- by managing the risk.

This month's close call, while my personal story, is also written with the assistance of Firefighter-Flight Paramedic Mike Dubron of the Los Angeles County, CA, Fire Department and founder and president of the Firefighter Cancer Support Network. The Firefighter Cancer Support Network (www.FireFighterCancerSupport.org) is supported by both the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC). The network is a mutual effort to educate all firefighters about the preventable risks of cancer as well as to support all firefighters and their families who are battling cancer.

A few weeks ago, I finally did what should be considered the right thing for my family and me. I scheduled and went for a colonoscopy.

I don't care what age you are -- keep reading. Please.

At 53, I am a few years late (for the usual lame reasons), but figure that if I push this stuff about firefighter safety, health and survival, I ought to practice what I preach. Fortunately, no practice is required for a colonoscopy. And, actually, I felt nothing.

Essentially, the worries most of us have and the reasons we avoid getting a colonoscopy are because:

We don't want to drink that gross stuff the day before.
We don't want anyone going there.
We're worried about what the doctor may find.

So, for those of you still on the fence about going to get this done, here are my personal responses to these excuses:

There are different things you can drink. Some of you get some kind of prescription powder and have to mix it in a big jug and drink it. I was lucky -- my doctor doesn't use that. I simply picked up some over-the-counter stuff he told me to buy, poured it into 7-Up, drank one at 5 P.M. and one at 9 P.M., and that was it. I also couldn't eat anything solid that day, but could have things like Jello and chicken broth. I also kept within 50 feet of the can. You will too.
I went to the Colon Oscopy World place at 7 A.M. The staff had me put on a tissue-paper gown and lie down, and then they asked the usual questions (Why don't you trim your mustache? How do you eat with that? Aren't you too old to go to fires? Why do you think you're always right?). They took my vitals, and a few minutes later, they wheeled me into "The Procedure Room" (warm sounding, no?). I hung out there for a few minutes while listening to their stereo playing Jimmy Buffet music. While I was enjoying the tunes, they started an IV. Then, the doctor came in, and while we were talking, I asked how long it would take, and he said, "We're done." What?

Yeah, no kidding. The IV ran, my brain was put on "pause" because of the drug they used and I missed about 30 minutes or so of my life -- like the "hold" button on a remote. That was it. Done. Finished. I got up and walked out to my waiting daughter, who drove me home.
So what did they find? They found one small polyp that was removed 100% painlessly during the procedure. The polyp turned out to be non-cancerous and I have to go back for another routine colonoscopy in five years.

Why I am sharing these intimate details? Because, like a lot of other stuff we deal with as firefighters, colon cancer is one of the most common, yet preventable cancers. I have lost several very good friends to cancer over the last few years. Well-known fire service instructor Larry Davis recently passed away. Not so well known, but equally vitally important friends such as Chief Lee Strickland and Ex-Chief Lou Scida, both of the Manhasset-Lakeville Fire Department in New York, were young men who died of cancer. Odds are, you know a firefighter who has or has had cancer.

While many situations involving cancer may not be preventable, many are -- from wearing full personal protective equipment (PPE), never allowing any of that soot to get on you (absorption of carcinogens through your skin as well as through dirty hoods) and not breathing that junk to getting checked out. The "getting checked out part" is often the toughest for the reasons I mention on why we don't go.

If you are 50 or over, talk to your doctor and schedule your colonoscopy -- then actually go to the appointment. Colorectal cancer is one of several cancers associated with us as firefighters on varying levels of increased risk. More than 90% of people diagnosed with colon cancer are 50 or older. Research indicates that by age 50, one in four of us has polyps (colon cancer precursors), so getting screened is an excellent way to prevent colon cancer.

Why should you schedule and go for your colonoscopy? Look at the pictures on your desk, in your helmet, in your locker and in your wallet. Or, listen to the words of a firefighter who was not as luck as me.

The following comments are from Los Angeles County Firefighter-Paramedic Mike Dubron, a colorectal cancer survivor:

Still not sure? Approximately 145,000 Americans will be diagnosed with colorectal cancer and 54,000 will die from this disease each year. Colorectal cancer is the most curable of all cancers -- if detected early. Chief Goldfeder gave himself that chance and if a cancerous polyp had been found, he could have avoided the tragedy that my family and I faced.

I was 39 years old when I was diagnosed with stage-four colorectal cancer and given one to three years. Though I was extremely young for this, the bottom line is I had to pre-arrange my life to include possible end-of-life issues. I struggled with the thoughts of my two young daughters no longer having their father.

Fortunately for my family and me, I am now five years cancer free. It is now my passion to give back to the fire service and help educate you about what you will now see as one of the hottest topics in the fire service and country: cancer.

Reduce unnecessary exposures, take care of your personal protective equipment, participate in annual wellness exams and ask questions. Be honest about your family's history of cancer. For instance, my being diagnosed at age 39 means that my children will need to be aggressively checked for the disease beginning at age 29.

Do you have a family history of cancer? If so, chances are there are procedures that may need to be performed. If you do get cancer, early detection leads to cure and continued memories that could be missed because you didn't want to take a day out of your schedule.

Please become a member of the Firefighter Cancer Support Network (FCSN). The ability to reach out and educate or assist a fellow firefighter with the help that I once needed will be the most rewarding thing you will ever do.

I encourage all of you who are reading this column and are moved enough to actually act share your story on our website's guestbook. In fact, I dare you!

A final word from Chief Goldfeder:

In an attempt to get each of you to get checked, or to help those of you who know someone who should get checked, as a free public service here is a one-minute, 33-second video that will help you understand how easy the procedure is. Go ahead, watch it. Don't be nervous:

http://www.youtube.com/watch?v=QI1go72c5H8

Now Go Get Your Colonoscopy Scheduled!

Here are some related important links to further information:

http://www.firefightercancersupport.org/
http://www.cancer.gov/cancertopics/screening/colon-and-rectal
http://www.cdc.gov/cancer/colorectal/
http://www.cdc.gov/cancer/colorectal/basic_info/screening/

WILLIAM GOLDFEDER, EFO, a FirehouseÂ® contributing editor, is a 33-year veteran of the fire service. He is a deputy chief with the Loveland-Symmes Fire Department in Ohio, an ISO Class 2 and CAAS-accredited department. Goldfeder has been a chief officer since 1982, has served on numerous IAFC and NFPA committees, and is a past commissioner with the Commission on Fire Accreditation International. He is a graduate of the Executive Fire Officer Program at the National Fire Academy and is an active writer, speaker and instructor on fire service operational issues. Goldfeder and Gordon Graham host the free and noncommercial firefighter safety and survival website www.FirefighterCloseCalls.com. Goldfeder may be contacted at [email protected].

Firefighter Cancer Support Network Mission Statement

The mission of the Firefighter Cancer Support Network is to provide fire department members and their families an opportunity to receive assistance when dealing with cancer.

Together we can offer comfort, strength and hope through our own experiences in dealing with the devastating effects of cancer.
Together we can educate fire department members regarding the importance of cancer screenings and early detection.
Together we can provide an awareness that cancer does not have to be dealt with alone.
Together we can make a difference.

Scientists ID Genetic Contributor To Colorectal Cancer Risk

From the American Cancer Society (www.cancer.org):

Researchers at the Ohio State University Comprehensive Cancer Center and Northwestern University's Cancer Genetics Program have found a definitive link between an inherited genetic variation and colorectal cancer risk. The variation, which occurs on a gene known as TGFBR1, significantly increases a person's lifetime risk of getting the disease. ("Germline Allele-Specific Expression of TGFBR1 Confers an Increased Risk of Colorectal Cancer." Published online in Science, Aug. 14, 2008.)

"This is a very exciting study," said Durado Brooks, MD, American Cancer Society director of Prostate and Colorectal Cancer. "This represents a tremendous opportunity to intervene with intensive colorectal cancer screening and could also have near-term implications for developing new approaches to prevention and treatment."

The variation in question affects the receptor for TGF-beta, a protein that slows cell growth. The researchers found that this genetic variant makes the cell less sensitive to TGF-beta, so the cell doesn't get the signal to stop growth. If a person had colon cancer, those cells could proliferate more easily.

Researchers analyzed genetic samples and clinical data from 242 colorectal cancer patients (90 had a family history of the disease), and 195 cancer-free people who agreed to participate in the trial. All of the participants were white, and the average age fell in the mid-50s. Ten percent to 20% of cancer patients showed a decreased production of a receptor for TGF-beta. Only 1% to 3% of healthy participants showed lowered numbers. The lifetime colon cancer risk of the patients with the genetic variation could be as much as 9 times that of those without the variation.

"This probably accounts for more colorectal cancers than all other gene mutations discovered thus far," said Boris Pasche, MD, one of the study's authors and director of the Cancer Genetics Program at the Feinberg School and The Robert H. Lurie Comprehensive Cancer Center at Northwestern University.

While their findings still need to be tested in larger groups and in other racial and ethnic groups, the researchers hope to soon develop a clinical test that can be used to identify people who have the gene variant.

"We will be able to identify a large number of individuals that are at risk of colorectal cancer and in the long term, maybe decrease the cases of colorectal cancer and of people dying from it by being able to screen them more frequently," said Pasche.

While most colorectal cancer occurs in people who don't have a family member with the disease, up to 20% of people who get the disease have a family member who is affected. If you have a family history of colorectal cancer, you should talk to your doctor about colorectal screening before age 50, especially if you have a first-degree relative (parent, sibling, child) with the disease.

For more information about colorectal cancer and colorectal cancer screening, see Detailed Guide: Colon and Rectum Cancer and the American Cancer Society Guidelines for the Early Detection of Cancer.