Sunday, August 28, 2011

Drinking, Drugs, and Colonoscopies

In 2001 when the doctor said to come back in 2011 it seemed so far out in the future.  But starting yesterday I was on my two day liquids diet in prep for cleaning out my system so he can send his instruments in to check me for polyps.

Is this something we need to do?  My doctor - I have a good one I trust - suggested yes.

What are the odds of colon cancer?  From the National Cancer Institute: 

Incidence Rates by Race
All Races55.0 per 100,000 men    41.0 per 100,000 women
White54.4 per 100,000 men    40.2 per 100,000 women
Black67.7 per 100,000 men    51.2 per 100,000 women
Asian/Pacific Islander 45.4 per 100,000 men    34.6 per 100,000 women
American Indian/Alaska Native a42.7 per 100,000 men    40.0 per 100,000 women
Hispanic b39.9 per 100,000 men    28.4 per 100,000 women

That's five white males out of 10,000; 1/2 a person out of 1000;  1/20 a person out of 100.  I'm not even sure how to write the percentage.  .005%?  That seems like a pretty low risk.  But further down on that page it says:
Based on rates from 2005-2007, 5.12% of men and women born today will be diagnosed with cancer of the colon and rectum at some time during their lifetime. This number can also be expressed as 1 in 20 men and women will be diagnosed with cancer of the colon and rectum during their lifetime. These statistics are called the lifetime risk of developing cancer. Sometimes it is more useful to look at the probability of developing cancer of the colon and rectum between two age groups. For example, 2.04% of men will develop cancer of the colon and rectum between their 50th and 70th birthdays compared to 1.53% for women.
That looks riskier, but still. . . the only risk factor I have for colorectal cancer is age.  

So what is colon cancer?  Here's an explanation from the Mayo Clinic website:
Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they're often referred to as colorectal cancers.

Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers.
Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer.
Poster in Dr's Office - Click to Enlarge

The Mayo Clinic site explains colonoscopy this way:

Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view your entire colon and rectum. If any suspicious areas are found, your doctor can pass surgical tools through the tube to take tissue samples (biopsies) for analysis.

I'm guessing this is one of those examples of how health care coverage skews how health care money is spent.  The money spent on people over 50 with insurance for  colonoscopies,  would have a much bigger positive impact on American health if it were spent on preventive care for pregnant women and children without health coverage.

The Drinking

So, in preparation for Monday, I've had to be on liquid diet Saturday, today, and Monday.  The instructions say:
Stay on a FULL LIQUID DIET the entire TWO days (anything that is liquid or melts into a liquid;  no solids).  Acceptable items include cream of wheat (not oatmeal), Jell-O, puddings, ice cream, yogurt (the type without the fruit), Ensure, chicken broth and tomato soup (no crackers), etc.
The Drugs Part 1

Then Sunday night I start taking the purging medicine and move to clear liquids only.

Naturopaths tell us that cleansing the bowels is a good thing.
In fact, nothing has changed since the great natural healer Dr. John Harvey Kellogg, founder of the Battle Creek Sanitarium in Michigan, declared nearly a century ago that “90% of the diseases of civilization are due to improper functioning of the colon.” (from curezone)
WebMD says cleansing routines are worthless:
But the science behind the detox theory is deeply flawed, says Peter Pressman, MD, an internal medicine specialist at Cedars-Sinai Medical Center in Los Angeles. The body already has multiple systems in place -- including the liver, kidneys, and gastrointestinal tract -- that do a perfectly good job of eliminating toxins from the body within hours of consumption.
"There's no evidence at all that any of these approaches augment the body's own mechanisms," Pressman tells WebMD.

So I figured this was a chance for a lot of smoothies this weekend.  Except when I got the ingredients into the blender, it made a lot of noise, but the blades didn't go around.

If I screwed it on loosely, the blades went round, but it also leaked all over.  We ended up buying another Osterizer - $29 didn't seem too bad.

When we got it home, I saw the rubber seal was thicker than the old one.  Even though ours is at least 20 years old, the seal from the new one fit nicely on the old one.  And when I turned on the blender, it worked fine.  Who would have thought such a tiny difference in thickness would shut down the machine?

New one on the right
So, J went back to the store and bought two new rubber rings and returned the new blender.  But think about it.  The new machine cost $29.  Two rubber rings cost $4.99.  What's wrong with that?  In the end we were $25 ahead by one way of thinking, but I was in a rubber factory in India where they made things like these rubber rings for a fraction of a cent each.  (I've posted about this cost disparity elsewhere.)

I also took shameless advantage of the situation to buy some things I'm allowed to consume this weekend.

So, there's lots of drinking going on.  Made some mushroom soup last night and more smoothies this morning.

The Drugs Part 2

And tomorrow there will an anesthetic that leads to these instructions:
Make arrangements for a ride home and a caregiver following the procedure, you should not drive for 12 hours after the exam as you will have been given an IV medication during the procedure that will reduce your reaction time.
 I do remember the last time.  The time allotted for the procedure is an hour.  I remember  it seemed like it was over in 5 minutes.  So the drugs do work in interesting ways.  But we live a five minute walk from the office.  The person at the desk said they would not let me walk home. I know, I'm being a guy about this.   We'll see how I feel.   J will be there.  With a car.

And they didn't think I should go to the book club meeting tomorrow night.  I understand that the medication is powerful, but it works differently on different people.  But I won't drive - I would ride my bike normally anyway.  We'll see how I feel.  J has volunteered to take me to the meeting and pick me up.  They say that people have reported going out for dinner after the procedure and not remembering anything.  I'll take notes as I do things.  We'll see.

The National Cancer Institute says:
On January 1, 2008, in the United States there were approximately 1,110,077 men and women alive who had a history of cancer of the colon and rectum -- 542,127 men and 567,950 women. This includes any person alive on January 1, 2008 who had been diagnosed with cancer of the colon and rectum at any point prior to January 1, 2008 and includes persons with active disease and those who are cured of their disease.
Most people with colon or rectal cancer are over 50.  (In 2000 there were about 77 million people over 50 in the US.)   The doctor said the rates of colorectal cancer have dropped significantly, mainly because it is one of the few cancers where they can take easy preventative measures before cancer forms - by cutting out the polyps before they become cancerous.   

I have no idea how much this procedure costs.  Most of it will be covered by insurances.  But I still think the money would be better spent on pregnant women and children health care and health education. 

Trivia note:  I think this is the second time I've had a post with 'colon' in the title, and the first one was only two weeks ago.



    Specialists create demand. "No one knows exactly how big a business colonoscopy screening has become. Some 37 million Americans over the age of 50 have had one. And yet the first good study of its effectiveness only came out last year. A large study out of Ontario. It found that colonoscopy did not do better than that older, cheaper test, the sigmoidoscopy, to reduce cancer deaths in the more hard-to-reach half of the colon. In other words, if looking at part of the colon is good, looking at the whole colon may not be any better."

  2. Good luck with that.

    I don't mean to scare you, but I had a colonoscopy February 8th this year, and everything was A-OK in my colon...but 4 days later I became very short of breath and could barely walk from one room to another.

    I was so weak I was admitted for a CT scan instead of having it as an outpatient, and it turned out I would have been admitted anyway -- I had multiple (LOTS of) pulmonary emboli, none large enough to kill me, but they sure impeded my ability to breathe. I was in the hospital for a week while they shot me full of holes dissolving the worst of the clots. It took me several months to feel healthy.

    No telling if the two events were related, but be sure to monitor your vital signs (or have someone observe) for several days after your procedure.

  3. Regarding your blender, yes a gasket can make quite a difference: remember the shuttle explosion in 1986? -- o-ring failure. Regarding your colonoscopy, I feel it's more about how we die, not so much when. Bowel cancers are a painful mess. And that will scare most of us into testing -- but only as long as our insurance covers it.

    So how do different levels of insurance coverages increase overall costs of health care? 'Moral hazard' in this situation is quite large. I'm sure the companies have it figured out for colonoscopies by now. It may all be a shell game for our fears and perhaps, misdirecting financial resources.

    But haven't many of us heard the life policy salesperson say, "But I know a fellow who didn't buy our XYZ policy and he died the next week. Left his family in quite a state." Or "If you don't do it for yourself, why not for those you love?"

    Getting to the point and more importantly, is there a history of colorectal cancer in your family? We're back to the determinant of genetics. In my family, the answer is yes, an aunt on both sides. I have NHS here in London. I'll retake the procedure in three more years. Prenatal and post-natal care is covered for all.

    Here's to jello and smoothies!

  4. Iaato, I was getting the sense this might be the case. Maybe in ten years it will be very clear that I don't really need another one.

    KaJo, that wasn't one of the possible side effects my doctor mentioned. But I'll pay close attention.

    Jay, I skipped the Jell-O.

  5. Just an aside... When I had my last colonoscopy, I told the doctor that if possible, I wanted to "be there" rather than be out during the procedure. I did the entire procedure without any drugs. There was a bit of discomfort, but no pain to speak of. And, best of all, I was there watching the monitor and getting the play by play of the doc through the whole thing. That was MUCH better than the small printed photos and post procedure descriptions that I'd gotten with previous colonoscopies.

    The staff had plumbed me for drugs if they were needed, but because they weren't, when the procedure was done, I got dressed and drove myself home with no "recovery" time.

    I strongly recommend doing your colonoscopy without drugs if you can talk the doc into it.

  6. Anon, I appreciate your comments. I asked to do it without the anesthetic and they offered no resistance. However, about five minutes into the procedure I began feeling it in my stomach and after trying to you the old Lamaze techniques decided to let them add the drip. I'm home now, tired, and we did walk home, but I'm clearly thinking slowly, talking slowly, and walked slowly. But I'm looking forward to eating and taking a nap.


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