I am a bad, foolish person, and now I’m feeling guilty. A few years ago, I made an appointment for a colonoscopy, and then what happened? Work happened, and I had to cancel my appointment. The prep work for the scan is unpleasant, and I knew it was going to mess up at least a day, and I couldn’t afford the time just then.
Worse, after canceling, I didn’t make another appointment. I’m just letting it slide. You know, that’s stupid. Especially after opening the latest issue of JAMA this morning and reading an editorial, Using Outreach to Improve Colorectal Cancer Screening. Early diagnosis of colon cancer makes a huge difference in prognosis, so you’d have to be an idiot to put it off.
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, with more than 50 000 deaths expected in 2017. Screening can reduce CRC mortality, and several methods of screening are available and recommended for average-risk adults aged 50 years to 75 years. Modeling studies suggest that several different methods of screening produce relatively similar levels of mortality reduction if there is good adherence to the underlying screening program.
Despite strong evidence of effectiveness, more than a third of age-eligible US adults are not up-to-date with CRC screening, with important disparities by ethnicity, income, education, and availability of a regular source of care. Currently, most CRC screening in the United States is achieved by colonoscopy. Studies of audiotaped encounters suggest that few clinicians and patients are having high-quality, shared discussions about screening options.
Increasing screening levels to greater than 80% has the potential to prevent an estimated 200 000 deaths in the United States in less than 20 years.
At least I’m not alone in my stupidity — a third of people in my cohort have been blowing it off. That’s no excuse, of course. Knowing that there are tens of millions of people in my situation does not make it less derpy.
So…I’m going to call in and make an appointment today. There’s a long wait time around here, so I probably won’t get in until Decemberish, which is all the more reason to call now.
Much of the editorial is about how health care providers can better inform and encourage people to get screened, and assessments of the effectiveness of various methods. I’m not a doctor, so I’ll just mention that I think outreach like Crispian Jago’s cancer diary helps me realize how important this is — and although it would be convenient to complain that my local hospital should have followed up with me after my canceled appointment, the truth is it’s all on me. And on you. If you’re over 50, contact your physician and make arrangements, if you haven’t already.
It’ll be fun! Weird liquid diets and spending a day purging your bowels so they can slide a camera up your butt? How can it not be exciting?
Prep for my last one was remarkably easy compared to the previous two. Just a couple days on clear liquids (non-red gatorade, black tea, water, etc), and a laxative. And I was out cold for the procedure. Piece o’ cake compared to the cystoscopy and the prostate biopsy. Ain’t aging grand?
I’ve had 5 colonoscopies so far. (I have to have one every 3 years because I have Crohn’s disease, an autoimmune disease that affects absorption in the colon.) So you could say I’m an old hand at this–I know the drill. It isn’t as awful as everyone thinks. Sure you have to limit your diet for a few days and limit your meds. And you have to drink this prep the night before that makes you have diarrhea for a few hours. It tastes like lemonade–really!. The thing that irritates me the most, however, is having to get up early to go to the surgery center. You will be completely unconscious when the doctor does the procedure. You may have to work with your doctor if the anaesthetic disagrees with you–my doc has written in my chart which anaesthetic is best for me and which ones he shouldn’t use, based on my experience (.I react badly to a lot of meds). And you may be a bit groggy later in the day if the doc uses the wrong anaesthetic. But it really isn’t that bad. Don’t believe all the horror stories you hear.
One thing that doctors don’t tell people about, because it’s not as good a test and it’s cheap and easy is fecal occult blood test. You can request the test and you get a little tube and a qtip and you get to send in a sample of your poo and they check for blood and metabolites that might indicate colorectal cancer. It’s not as accurate as having a camera stuffed up your butt, but if you’re busy or don’t want to star in “Deep Inside PZ Myers” it’s an alternative.
Based on my preferences and family history, I am most likely to get alzheimers or a heart attack, so I have been just doing an annual occult blood check (I like saying “occult blood” ok?) and have passed up on the buttcam. I did it once, and apparently when the drugs started hitting me and they were doing their thing I said “NO waiter! I ordered a Bud Light!” and the doctor’s apprentice laughed so hard she had to sit down for a few minutes. Apparently. By the way, it really complicates flirting with the cute doctor when you’re getting the butt cam; saying “now that we know eachother so well, how about catching a movie and some dinner?” does not work, for sample size N=1.
What anxionnet said. Oh, and if you can get them to give you propofol to knock you out, do it. Blam, you’re unconscious. Blam, you’re awake. No wandering around in a fog afterwards. I skipped the knockout once, because I couldn’t afford to be woozy the rest of the day. I got through it, but it’s pretty painful. Much better to use the meds, even if they won’t let you drive yourself home afterwards.
Finally went for a colonoscopy last year only about 5 years late.
Only needed to be on a clear liquids diet for 24 hours.
A few tips:
If they prescribe SUPREP (R) ask if there is another option, it is so salty and odd tasting it was by far the most unpleasant part of the procedure.
Be aware that with most private insurance policies do not cover the procedure if they remove one or more polyps. This makes it a subject to deductible procedure that can cost you up to $1000.00US.
Do not panic if after the procedure you are told they removed polyps or a small tumor and you’ll have to wait for the biopsy results to know for sure. The odds are very good the results will come back as benign. (I was told they removed multiple polyps and a tumor they were very confident was malignant. Two days later the lab results came back benign. The 3 month later follow up colonoscopy confirmed there is no problem.)
I’ve had two and the only thing bad about the experience was that they would not let me drive myself home or take a taxi(?) because I had been on an anesthetic. (I never could figure the taxi part.)
But even if the procedure were really unpleasant, consider this: I had a very dear friend – a very smart, generous woman (her husband and I were coworkers a long time ago, still one of my best friends) — who skipped colonoscopies. And one day she had such severe abdominal pain that their daughter (a physician) took her to the hospital. It was colon cancer that had spread into her liver. The doctors dealt with the colon cancer but nothing worked on the liver cancer. She lived about two years – with her husband often driving her to various facilities in the hope that something would deal with the liver cancer – and the chemotherapy and other treatments finally became too much. She went into hospice. I was trying to set up a trip to see her one last time, but she went very fast.
So get a colonoscopy. I’ve seen the results of not stopping colon cancer before it’s too late. It’s ugly. Not getting one cost the life of one very special woman, one who should be enjoying retirement with her loving husband, 3 fine children and, soon, grandchildren. And FYI – she was just one month younger than me. She, her husband and I celebrated our 50th birthday with a party. We were talking about a joint 60th birthday party. She didn’t make it. Get a colonoscopy.
I put mine off, too. By the time I got around to it, I had Stage IV cancer…
So, HEED PZ!
keithb@#7:
I put mine off, too. By the time I got around to it, I had Stage IV cancer…
Ouch, sorry to hear it. Hope it works out as well as it can.
My sister had a colonoscopy done and they found some stuff that looked bad and it turned out to be lung tissue. And that’s just a bad diagnosis, that’s what that is.
I just had my first scoping last month after pooping a brick (felt like it at least) and having some bleeding. Worst part of the whole experience was definitely the SUPREP(R). It may be the nastiest tasting concoction I’ve ever consumed! There is some kind of fruity flavor to it but the salt/chemical taste hit me like a hammer. I’m definitely asking for another prep option next time.
I came out of it with a couple small polyps removed, which showed no problems upon examination. I’m thankful. My mother had colon cancer several years ago and lost a large segment of her bowel to it.
My favorite doctor was a crusty old man. On my first visit with him as we reviewed history he asked if I had ever had a colonoscopy. I answered no. With a complete straight face and without missing a beat he said “Do you want one?”
Okay, you had to be there but it was hilarious at the time.
@Marcus Ranum: Up here in Socialist Paradise (my part of it anyway), the government sends a fecal occult blood test to all residents aged 50 and over every two years. You just mail it back in, postage paid. I love being a Canadian collectivist parasite!
@wsierichs: My stepmother dies from metastasized colon cancer at 49. It was hellish for everyone concerned, and just about finished off my poor father. Just go and get tested, people!
Ugh, I had my first one this year and… the procedure itself was just fine and the nurses were cheerful, even if the surgeon himself was dour and silent for the most of it. Maybe because unlike the nurses he actually has to deal with assholes all day?
The cleanout beforehand, though, left me with the *worst* piles for days afterward. I’ve never had them so bad. It took a month for them to clear up, and I don’t get piles. Gnarly as heck, and I’m a recreational sodomite!
Over the sea in the not-very-socialist-anymore paradise they send you fecal occult blood tests once you are over 60. That said I’ve had to have a colonoscopy and rather enjoyed it, I wasn’t knocked out, but had gas and air, for the first two bits you can see the what the specialist sees as they are doing it which is interesting. It isn’t comfortable when they go round the bends in the colon, but I wouldn’t describe it as painful either, though as I have a chronic pain problem YMMV. I didn’t find the prep a problem either, not much fun, but certainly no raging diarrhoea, biggest problem was not being able to eat fruit or veg and having to only eat pale food which I found surprisingly hard. All in all far more pleasant than a gastroscopy
I have had three colonoscopies. The last prep was not so bad, I forgot what the solution was, but it did not come with a gallon jug. Even though I was sedated I got to see my innards on the monitor.
I do love the heated blanket.
@Marcus Ranum:
My sister had a colonoscopy done and they found some stuff that looked bad and it turned out to be lung tissue. And that’s just a bad diagnosis, that’s what that is.
Er, just how far up did they go?
Yeah… I’ve known several people, including family members, who did not get a colonoscopy and died early. :-( Really, it’s not that bad to do the prep, and the procedure itself is no big deal.
We have some amazing medical technologies these days, and some amazing treatments. You may as well take advantage of living in the 21st century.
@Marcus
Thanks.
I had good care, with Radiation and Chemo – which did not affect me very much – and I am almost 5 years clean. I need to schedule another colonoscopy 8^).
It must be tough to work in a colonoscopy office. You deal with sore assholes all day. Tired, grouchy people, too.
I had to have one early @44 because of some bleeding. No issues beyond a couple polyps and an annoyed hemorrhoid.
But, the prep has to have been the foulest thing I have ever had to ingest. I don’t remember what the name was, but from earlier replies, I’m assuming it was suprep because it was like drinking a half-gallon of lemon-flavored salt water.
I didn’t know there were other prep options. If they try to give me that crap for my next one I’m going to see if I can do something else. It was all I could do to keep it from coming out BOTH ends.
I’ve had 3 colonoscopies (so far). The prep is not necessarily a single-day event.
See https://gasstationwithoutpumps.wordpress.com/2010/09/03/colonoscopy/
and https://gasstationwithoutpumps.wordpress.com/2015/08/31/eighth-weight-progress-report-and-colonoscopy/
(The 2015 report is from my own protocol for the colonoscopy, since the doctor-ordered ones had been “inadequate” twice.)
Laxatives (ducolax) and magnesium citrate are much easier than the gallon jug thing. The one issue is that the laxatives continue to work even after you’re done and start eating again. By biggest complaint is they wouldn’t give me a copy of the video for youtube.
I am one of those men who is on the 3-5 year plan of getting colonoscopies. I don’t enjoy them but I would enjoy colorectal cancer even less. I don’t want to experience it or visit that experience on my family. The prevention is better. If PZ gets even one more person to get a colonoscopy (in consultation with their regular doctor) it will be a good thing. Yes, he is talking to YOU. Take care of this for yourself and your family.
You should consider no sedation for your colonoscopy.The discomfort is minimal and the benefits are great. No drugs mean you are up and can get on with you day. You aren’t in a stupor for a couple hours after the procedure. I’ve had it done both ways and prefer being able to talk to the doctor and nurses the whole time and then being able to leave ASAP afterwards.
I had one a year late. First time I ever received general anesthesia. The prep was largely unflavored, so it tasted salty and horrible. My doctor suggested I flavor it with Crystal Light or Gatorade powder. I choose Crystal Light and that helped, slightly. I was out for the procedure. Five micro polyps removed, that tested benign. I am good for 10 years.
@wsierichs
I always figured the taxi part was because the taxi driver wouldn’t want to deal with you having complications. Not as well as the person you have to have take you home.
The test is even available as a slide you can do at home — no need to send anything in. It is actually a very sensitive test for hemoglobin, so it detects blood pretty much directly. It’s useless if you have hemorrhoids, though, because it always comes up positive.
+1, although I’m told the amount of discomfort varies widely from person to person. For me, it felt like being quite bloated, nothing worse (and the prep was tolerable and lasted less than 24 hours).
I am alive now because I had a colonoscopy.
I had a different type of prep last year, where they basiclly wash out your colon. Still have to have a restrictive diet for a couple of days.
I agree with Rick Thomas. I’ve found recovery from the sedative much worse than the procedure itself. I’ve had two without sedatives and am scheduled for another in a couple weeks. Without sedation you can talk to the doctor during and after — and remember the conversation. You can drive yourself home and you can actually accomplish something the rest of the day.
My maternal grandfather died of colon cancer. My mother had pre-cancerous polyps removed at age 40 and has to go in every couple years. I had my first one at 33. The prep wasn’t bad… gatorade for a couple days and lots of miralax the day before and morning-of. I also did it without sedation because I tend to be either super sensitive to such drugs… or I become aggressive on them. Not much middle ground.
I guess I have a high pain tolerance because it was on par with my lower level period cramps, and even then only for the minute or so it took to get ’round the bend.
To: 12. elfsternberg
RE: “the surgeon himself was dour and silent for the most of it. Maybe because unlike the nurses he actually has to deal with assholes all day?”
He should be happy. Business is looking up.
For medical reasons I am required to have an annual colonoscopy, usually but not always combined with a gastroscopy. Either way, the anaesthetic is so light that I am able to understand clearly the words “no sign of cancer” and smile and say “thank you” to the man who helps keep me alive and to the woman who makes sure I feel no pain or discomfort. I am 76 and have had multiple gut problems for thirty years or more. The peace of mind this procedure gives me and my family is way more than worth the relatively insignificant discomfort of taking the preparations. I am surprised to read the complaints about icky taste or whatever of the oral preparations required to clear the bowel and colon. Take them and take them according to the directions if you want to ensure that Dr Gastro gets a good look at one of the most vulnerable organs of your body.
PZ wrote: “The prep work for the scan is unpleasant,”
Indeed it is. I had a colonoscopy some years ago. The prep work consisted of spending the prior day fasting and taking a powerful laxative. I mean, a seriously powerful laxative. I mean, you have NEVER had diarrhea until you have had medically-induced diarrhea. It was astonishing. It was hilarious. It was an order of magnitude more than I had even thought possible. Remember that scene from Dumb and Dumber? Multiply that by 10.
But the actual procedure was no big deal.
Get it done. The pre procedure purge is humiliating, the procedure itself uncomfortable and a bit humiliating (though at least I know what my own arsehole looks like now), but the knowledge that you’re clear, or that you’re in time to do something about a problem, is priceless. In my own case I had symptoms that worried both me and the doc. It turned out to be clear of cancer, but I have rampant diverticulosis. It’s not often that you see someone to be so happy to be told that they’ve got a sometimes debilitating, sometimes humiliating condition, but I’d much rather control my diet than undergo chemotherapy.
I have ulcerative colitis I have had three colonoscopies’ so far. Do not screw up the prep like I did I ended up going three days on a liquid diet, not fun. Get it done it is not the end of the world.
I don’t love colonoscopies, mostly because the only time I had to have one my shitty employer provided health insurance covered, like, $5 of it and it ended up costing me over $3000.