Chadwick Boseman, Rest In Power. Also, I need you to lie for me.


Good afternoon, beloved readers. First, I want to tell you some things. Then I am going to ask you to lie for me, and to get every adult under age 50 you care about to lie their asses off for you, too.

My heart is heavy today. I awoke to news of the death of actor Chadwick Boseman, at age 43, from colon cancer.

FORTY THREE.

Chadwick BosemanChadwick Aaron Boseman
November 29, 1976 – August 28, 2020
__________

Whether or not you’re a fan of Black Panther and the Marvel Universe movies, or of Boseman’s portrayals of iconic Black historical figures like Jackie Robinson, Thurgood Marshall and James Brown, this man – by all accounts a kind person and talented beyond measure – has left our world too soon. And he is gone because of a preventable disease.

And as you might imagine, beyond my sadness at this tragic loss lies a fair amount of…well, RAGE. If you or people you love happen to live in the U.S. today, you are living in a country where this is true:

There’s nothing to stop insurers from covering the tests starting at age 45, and some are likely to do so, but at this time insurers are not required to (and some might not) cover the cost of colorectal cancer screening before age 50.

Needless to say, a first colonoscopy* at age 45 would not have saved Chadwick Boseman. But what if he got one at 30? In fact, the youngest victim of colorectal cancer I know of (via a Nurse Practitioner on my surgeon’s team) is a young woman who died at age 29.

Chadwick BosemanYou see, our wise and benevolent for-profit health insurers know that it’s simply not profitable to pay for colon cancer screenings at an earlier age. Insurance companies don’t rack up record profits by screening people in their 20s, 30s or 40s to detect polyps before they turn cancerous. That would just be silly! Instead, they insist that statistical outliers who get colon cancer young – like me, and Chadwick Boseman – suffer and die needlessly.

Makes perfect $en$e.

cartoon man pointing right "You there: Fuck off. And when you get there fuck off from there too. Then fuck off some more. Keep fucking off until you get back here. Then fuck off again.So. I want you – yes YOU, the person reading this right now – to get a motherfucking colonoscopy, no matter your age. Unless you are a Trump voter or any other species of Republican. In that case, you can fuck right off.

And then, I want you to convince every single adult you care about to also get a motherfucking colonoscopy, no matter their age. And there is only one way I know of to get around the age restriction and not become another (highly profitable) statistic:

LIE.

If you have health insurance.

Familiarize yourself with symptoms and risk factors for colon cancer, and pick a few you think you can sell to a doctor. If your (very, very profitable) insurance company requires referrals, the type of doctor you want to see is a gastroenterologist.

Symptoms of colon cancer include: a persistent change in your bowel habits including diarrhea or constipation; rectal bleeding or blood in your stool; persistent abdominal discomfort, e.g. cramps, gas or pain; the feeling that your bowel doesn’t empty completely (btw, this is called “tenesmus,” and you DO NOT want it. Ask me how I know.); weakness or fatigue; and unexplained weight loss.

Risk factors besides being over age 50 🙄 include: African-American ethnicity; chronic inflammatory diseases of the colon (e.g. ulcerative colitis, Crohn’s etc.); family history of colorectal cancers; low-fiber high-fat diet; sedentary lifestyle; diabetes; obesity; smoking; heavy alcohol use; and abdominal radiation therapy for other cancers.

Iris Vander Pluym head shot from 2016, one year before colon cancer diagnosis.

White Person Iris Vander Pluym in 2016, one year before cancer diagnosis.

Obviously, some of these are easier than others to lie about to a doctor. (Oh hey, doc! I’m, uh, African-American! And I’m also very overweight!) I included these here in case they are true for you – then by all means, pile those on too!

NOTE: I have given this very same advice to friends and family previously. At least two of them took it, and succeeded in getting “under age” (non-profitable!) colonoscopies. IIRC, they used a fake “family history” and “rectal bleeding or blood in stool” to accomplish this mission. One of them found polyps early enough to make a difference (i.e. before they turned cancerous), and the other came back perfectly clean. Either one of these outcomes is a WIN.

Here is a fun exercise. After you pick out your preferred lies, memorize them in the form of something like the following, and practice it out loud in front of a mirror:

“Doc, I keep having diarrhea, it’s been over a month now, and there’s been blood in it. Also, my aunt Trudy died young from colon cancer – I think she was in her early forties? My mom’s sister. And I know my mom’s had a lot of polyps over the years. Can I get a colonoscopy?”

If you do not have health insurance

There are low-cost/sliding-scale fee clinics that perform colonoscopies. Same lies apply.

(I have no idea what the requirements are for colorectal cancer screenings in the many decent and humane countries with single payer healthcare. If need be, feel free to adapt your lies accordingly.)

Do it for me. Do it for yourself. Do it for those who love you, care about you and depend on you. Or do it to make for-profit health insurance companies juuuuust a little less profitable next quarter.

BE A LIAR 4 IRIS!

💙

________
*Yeah, about those colonoscopies. I am a pro at this by now, but I get it. Exceedingly few people would actually want a colonoscopy, not that there is anything wrong with that. But I can tell you, as several people told me beforehand, that it is nowhere near as dreadful as you are probably imagining. And no I didn’t believe them either, but it turns out they are right about this.

The worst part is the bowel prep the day before, but even that is over with mercifully swiftly. The procedure is not painful, and if they green light the Good Drugs™ you will be knocked out and neither feel nor remember anything at all. I’ll tell you something else, too, and this is important. A colonoscopy is nothing – and I mean nothing – compared to the many other horrific procedures, disfiguring surgeries, multiple indignities and hellish treatments you will be facing if you ignore my advice and it turns out you waited too long to get one.

So go get one.

Comments

  1. kestrel says

    Excellent advice. The Partner and I are due and just today talked about scheduling them.

    My aunt (no blood relation) died of colon cancer. She would not go in and get checked, despite rectal bleeding. She didn’t want to have to wear a colostomy bag, so she thought if she just ignored all symptoms, she wouldn’t have to wear one. Well, she was right. When they finally examined her it was WAY too late for any sort of treatment at all. She basically had to go home and suffer to death. Um, yay because no colostomy bag? But I think her children (my cousins) would have really preferred to have her just go in and get the screening and still be alive. My friend’s mother died of colon cancer as well and I know for a fact _she_ would have preferred to have her mother get the screening and still be alive.

  2. secmilchap says

    Our Mom died at 41 – a dreadful, painful, lingering illness. My MedDoc started monitoring me in my 30s, and there have been 4-5 instances of polyp removal. At age 73 a pre-cancerous polyp was removed. The only way to do it was to remove the Ileo-cecal valve where it resided. I miss the valve, but I’m more than twice the age that Mom was when she died. Early exams save lives. With DEA now interfering in medical treatment, you really don’t want to be experiencing a slow death.

  3. says

    My understanding is that 50 is more or less the age where the benefits of the colonoscopy start to outweigh the risks (and that a colonoscopy is not risk-free). However, I’m not a doctor. I would suggest checking with a couple of oncologists before advising early colonoscopies.

  4. says

    kestrel @1 – I am sorry to hear about your aunt’s fateful decision. I don’t know how long ago this occurred, but the standard of care now (for stage 3) is to put in place a temporary ileostomy for a few months, while the surgically reconnected colon heals (after excision of the section containing tumor + margin). I have had two ileostomies, and to be honest they are probably worse than anything your aunt even imagined. A colostomy, on the other hand, is by all accounts much easier to live with than an ileostomy. However, they don’t do colostomies at the treatment stage because it destroys another segment of healthy colon they may increase infection risk and/or interfere with recovering bowel function after ostomy reversal. In my case, which is rare, that tissue was needed for a second resection surgery after the first one failed.

    If you think you and your partner are due, I think you are waaaay past due. ;) Please don’t delay.

    secmilchap @2:

    you really don’t want to be experiencing a slow death

    …or any kind of death, really. Seems like it could potentially ruin all my fun.

    Seriously though, I am truly sorry to hear about your mom. That is really, really awful. But I am glad that 30-40 years ago, a doctor recognized your increased risk and began monitoring early. It sounds to me like that decision saved your life, and I am sure you and your loved ones are grateful for that. FWIW, I am grateful for your presence in this thread and in the world too. Keep up the good work! :D

    One Brow @3: Okay. *takes deep breaths* I am having ambivalent reactions to your comment.*

    😇ANGEL IRIS SEZ: You are correct: a colonoscopy is not risk-free. And, there are alternatives: a sigmoid scope of the lower colon and rectum is in my opinion more unpleasant than a colonoscopy, but it is less risky. There is also a non-invasive test; commonly known as the “poop test,” it involves collecting stool samples and sending them to a lab for analysis. It can be done at home. Although these are not as reliable as a colonoscopy, they are certainly better than nothing. (I don’t know about the cost; the poop test is advertised direct-to-consumer and requires lab handling, which suggests to me it’s not cheap. I can look up what my surgeon charged for my last sigmoid scope if anyone is interested.)

    I acknowledge that I cannot be objective about this issue, as I lie here in bed, physically weakened and in considerable pain, with a poor quality of life. All of this is (hopefully…) only temporary as I slowly heal – IF I heal – from my most recent surgeries over the next year or so, said healing being affected by “chronic, severe” radiation damage.

    That said, anyone receiving a colonoscopy must first sign off that they have been informed of all risks, and consent to the procedure. From my point of view – and I suspect Chadwick Boseman and secmilchap’s mother would likely have agreed with me – that risk is well worth taking. First, because serious adverse events are rare, and that rate increases with age. And second, because weighing on the other side of that risk scale is an unimaginably devastating, often deadly disease, that is increasingly appearing and in more aggressive forms at younger and younger ages for reasons currently unknown. And it’s preventable.

    So the million dollar question is: who should be weighing those risks and making that decision? My answer is that YOU should. EVERYONE should. I should have, but with no family history of the disease, it was never even on my radar. I am trying to put it on YOUR radar, so that you can. Regardless, I hope we can at least agree that such a risk determination should never, ever be made by for-profit health insurance company executives.

    👿DEVIL IRIS SEZ: FUCK YOU. Go tell it to Chad Boseman, or secmilchap’s mother, or the rapidly increasing number of younger adults being diagnosed too late. But don’t you fucking DARE tell it to me. I am far from out of the woods yet, and I am struggling in misery every. single. day. Whether I survive 5 years or not, it is simply a fact that a colonoscopy at age 30 would have prevented or significantly minimized the sheer hell I have been living for the past three years. It would have likely saved Chad Boseman, and countless others. WE are, were and will be those pesky statistical outliers, comprising “only” the 10-12% of cases diagnosed under age 50. And WE are telling you, with our words or with excruciating silence, THAT THE RISK IS FUCKING WORTH IT. Especially if you are young.

    If YOU don’t think the risk of a colonoscopy is worth risk of trading places with me or with Chadwick Boseman? Fine. No one is going to force you. Just FYI, tho:

    In 2020, there will be an estimated 49 new cases of colorectal cancer in people under 50 diagnosed a day, or 18,000 for the year.

    Fuck these people, amirite?! It simply wasn’t worth the (very small) risk of a colonoscopy to screen them young! Tens of thousands of people should just suffer needlessly and/or die from a preventable disease.

    STFU + GTFO.
    __________
    *Angel Iris sincerely apologizes for Devil Iris’s crude language, rudeness and hostility. Devil Iris makes no apologies whatsoever, and reminds Angel Iris (yet again!🙄) that one cannot legitimately apologize on behalf of someone else.

  5. says

    I have no objections to anything Devil Iris said, much less Angel Iris. I get colonoscopies s they are recommended by my physician, and I’m lucky in that they have been negative. I know you’ve been through hell (I’m a regular reader), and I’m sorry that I phrased it so insensitively.

  6. jenorafeuer says

    I’ve been getting regular colonoscopies for a while. Then again, I was also diagnosed with Crohn’s disease before I hit 30, so… I don’t have to lie to say I have a risk factor. I’m also in Canada, so the economics are different.

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