Tag Archive for: colon

Protect Your Colon Health: Do a Test

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Continuing with our examination of the study on invited colonoscopies versus usual care, what could the researchers have said to cause any controversy? Remember, the comparative rates of diagnosing colorectal cancer were slightly lower in the invited group. The controversy came when they stated that there was no difference in mortality over the course of 10 years. That suggests that it doesn’t matter whether you’re specifically asked to have a colonoscopy or get one as part of your usual care—your risk of dying from colorectal cancer, the second leading cause of cancer deaths in the U.S., is no different. As you might expect, nothing is quite as simple as it appears to be.

Invitations Don’t Mean You’ll Accept

The stunning part to me was that only 42% of the people in the invitation group accepted and had the colonoscopy. This is where going back to ask why the subjects did or did not have the colonoscopy is important. The people were not identified by name but by a randomly generated number. In order for the data to be meaningful, we need to know why the potential subjects chose not to participate.

What About Other Diagnostic Tests?

The most common test at this point is the fecal occult blood test (FOBT). This test looks at a sample of your stool to check for blood; the key is that it’s blood that’s not visible to the eye (that’s what occult means in this case). Blood in the stool can be a symptom of several conditions including anemia and colorectal cancer; the test can also be used to identify genetic risk factors for colorectal cancer.

What the test can’t do is identify those people who have adenomas, a precancerous growth. Not all adenomas become cancerous, but they can be removed during a colonoscopy and tested for cancer. The fecal occult blood test can’t detect adenomas that are not bleeding.

The Bottom Line

The thing to remember is that testing is important, whichever way you do it. Colonoscopies require the marvelous “colon cleansing preparation” that may be too hard on elderly people or those with poor health; it’s no walk in the park for anyone. The cost may also be prohibitive depending on the type of insurance coverage one has. Protecting your colon health calls for a serious discussion with your healthcare provider to find out what the best course of action is for you. Family and personal history both have a role to play and need to be considered.

The purpose of research such as this is to help you find what your path should be. But once you know it, follow it. Ignoring it may bring undesired outcomes—and the last time I checked, death is permanent.

What are you prepared to do today?

        Dr. Chet

Reference: New England Journal of Medicine. 2022. DOI: 10.1056/NEJMoa2208375

Research Update on Colon Health

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If I were to take a poll, I’d wager that most people would skip a colonoscopy if there were an alternative that provided the same information on the health of your colon. The key words are “same information”—not only that, but provided the same diagnostic outcomes. Will the alternative test tell you whether you have colorectal cancer? Will it give information on the health of your colon? A recent research paper called that into question. Let’s take a look at the study published in the New England Journal of Medicine.

Researchers from several European countries (Poland, Norway, Sweden, and the Netherlands) wanted to examine the difference in outcomes between two groups. The first were a group who were invited to have a colonoscopy. The second was a group that received usual care. Simply put, the second group relied on physicals and doctor discussions to decide whether to have a colonoscopy or not. They recruited over 28,000 people from 55 to 64 years old for the invited colonoscopy and compared them with over 56,000 people who received the usual care.

After following the subjects for 10 years, they found the risk of colorectal cancer diagnosis was 0.98% in the invited group versus 1.2% in the typical treatment group. That looked pretty good for colonoscopies. But it’s what the researchers suggested in the discussion portion of the article that raised questions. I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: New England Journal of Medicine. 2022. DOI: 10.1056/NEJMoa2208375

What It’s Like to Have a Colonoscopy

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A colonoscopy is a procedure designed to examine your colon, and for that to happen effectively, the colon must be clear of all food and waste material. Based on my personal experience as well as Paula’s, the preparation for the colonoscopy is infinitely worse than the actual colonoscopy. There are several medical websites that will give you details of the procedure complete with diagrams and video. That’s not my purpose in this Memo, so there will be none of that sh*t here (sorry, I couldn’t resist).

The Colonoscopy Preparation

Preparing for a colonoscopy requires that you consume no solid food for 24 to 36 hours before the procedure. What you consume are laxatives and fluids designed to completely empty your colon. The reason is simple: if there’s any waste material in the colon, the physician won’t be able to see the lining of this organ and thereby will be unable to examine its health.

The best way to describe the prep is to take the worst case of diarrhea you’ve had and multiply it times three. You won’t necessarily have the cramping that goes along with a bacterial or viral infection that causes diarrhea, but soon after you take the laxatives, you will have to visit the bathroom again and again and again—and then again. I’m going to predict that you won’t always make it in time, so be sure you don’t plan to be anywhere but at home close to the bathroom.

But here’s the upside: you can use it as a legitimate colon cleanse because that’s exactly what it is. If you want to reset your digestive system by emptying it completely, a colonoscopy will certainly do that.

The Colonoscopy Procedure

The medications they use today during the colonoscopy are far different from what they used to be. I fell asleep in about two seconds and remember nothing; Paula was semi-awake throughout so she remembers a little. The point of the procedure is to visually inspect the entire length of the colon for abnormalities. The equipment is a long tube with a camera and a secondary tube to add air to the colon to make it easier to inspect. The two most common concerns are polyps and diverticula.

Our Results

My colonoscopy was completely uneventful, but Paula had two columnar polyps that were completely removed to be tested. The lab technologist found no indication of abnormal cells, so she’s in the clear; there are many types of benign polyps, and hers seem to be the most common. What does it mean? It means she’s fine for now but has to do the colonoscopy (and its prep) all over again in five years instead of ten.

The Bottom Line

If you’re serious about taking charge of your health, you have to know its status. A colonoscopy is a part of that process as we get older or if we have genetic tendencies toward colon cancer. I understand the personal nature of the procedure. Really, no one wants to see a 15-foot hose and think, “You’re going to put that where?” But it’s another point of taking charge and aging with a vengeance.

If it’s time for you to get it done, don’t delay any further; call your primary care provider and get a referral. Ignorance is not bliss, and it has no place in Aging with a Vengeance.

What are you prepared to do today?

        Dr. Chet

Protecting Your Colon Health

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I’m sure you’ve heard the Benjamin Franklin quote “An ounce of prevention is worth a pound of cure.” That axiom is true about many things from fire prevention, as Franklin intended, to our cars and lawn mower. The same is true when it comes to our bodies. Paula just had a colonoscopy, so I thought it appropriate to talk about preventive colon health.

To set the stage, experts estimate a colon cancer growth rate of 2% to 3% per year globally. Early stage detection increases the survival rate, which is close to 100% at Stage 0 and goes below 5% at Stage IV.

One of the primary risk factors for colon problems such as colon cancer and diverticulitis is age. Therefore beginning about the age of 50, a baseline colonoscopy is recommended. Depending on the results, it’s repeated every ten years if your colon is clear or more often if growths called polyps are found.

In the future, we’ll also have our microbiome health examined as well. In a recently published study, researchers examined the microbiome of centenarians of Asian descent. There appears to be a similar pattern of microbes between people who live to 100 and longer in that culture. There’s a lot of research to go to establish both patterns and testing procedures. For now, we have to stick with what we know.

What’s a colonoscopy like? How did Paula fare? What can we do to improve our colon health? I’ll talk about all that in the next Memo.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. 2021. https://doi.org/10.1038/s41586-021-03832-5.