(Warning: This post contains graphic, unpleasant descriptions and explicit anatomical references, all of which do lead to an important conclusion.)
Men can also sail Denial River, sometimes with dramatically tragic outcomes.
I remember this 45-50 year-old businessman from way back to my student days at the Medical College of Wisconsin. On call at the VA Hospital during my 3rd year general surgery rotation, I picked the patient up after his initial triage in the ED. The chief complaint line on the ED chart simply stated "Smells Bad."
His employer had forced him to seek medical attention. "Man, you stink, and you have been stinking for too long. I can't have you around our customers when you stink. So either go to the hospital and find out what's wrong, or you're fired."
In spite of having showered that day, he absolutely reeked, like an obnoxious combination of feces and rotting flesh. We wondered how he could even stand to be around himself, let alone foist his malodorous presence onto others. He'd been that way for weeks if not months, yet had somehow managed to deny to himself and his family that anything was wrong...until threatened with financial ruin.
The symptoms of his underlying disease began about six months previously, with a change in his bowel habits and persistent abdominal bloating. He had sometimes noticed blood in his stools, but figured he must just have hemorrhoids. Finally he had only liquid stools, nothing solid, and a chronic sensation of incomplete evacuation. And, yes he had lost weight, but couldn't say how much. Plus he admitted to progressive fatigue. And he didn't sit much, because it hurt his buttocks to do so.
When examined, he was running a fever and looked ill. His abdomen was mildly distended, diffusely tender and tight, with rare high pitched, rushing bowel sounds. The cause of his vile odor resided in his perineum and peri-rectal area, where a raging infection had invaded the soft tissue spaces around his rectum and genitalia, enlarging his scrotum to the size of a softball.
The cause? Some time previously, a fungating invasive cancer had perforated his rectal wall and allowed the bacteria-laden fecal stream to gain access to the highly vulnerable soft tissues on the other side of that wall. For months these voracious microbes, who do not require oxygen to live, had feasted at will on his flesh, creating new pus-laden cavities where only virtual spaces normally exist. Had he not been forced to seek medical attention, these insensate microscopic space invaders would eventually consume the life of their most accomodating host.
The treatment turned out to be more gross than the disease. The surgical team labored for hours, with oil of wintergreen stuffed up their noses to fight off the stifling stench, methodically filleting wide open all the involved tissue to get rid of the bacteria, then packing the exposed flesh (testes included) with gauze to encourage healthy remaining tissue to overgrow that which had been destroyed by the microbial invaders. The cancerous tumor, meanwhile, had to be left alone for the nonce. It would continue to grow in place because we had to control the infection first before the surgeons dared to resect the tumor.
I rotated from that surgical service while this unfortunate man was still in the hospital, but I believe he survived this tragic event. His open wounds were gradually healing, and the surgeons talked of taking him back to the OR to get rid of the cancerous mass. That would take extensive resection and an even longer recovery, and would leave him with a permanent colostomy. But he would live.
A prominent colo-rectal surgeon once stated that the most efficient, effective, and cheapest diagnostic tool for early detection of rectal cancer is a digital rectal examination...an admittedly uncomfortable and sometimes embarrassing procedure for the patient. In truth, most rectal cancers can be felt by the examining finger way before they can take down a grown man like this one.
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