Tuesday, March 12, 2013

Health Care and Colonoscopy

When your primary care doctor raises the topic about any invasive procedure, most of the time people cringe about the thought of any type of surgery or medical treatment involving going inside your body. For men especially, a colonoscopy is typically going to come up in conversation with your physician if you are close to the age of 50, or have any type of abnormal bleeding in your urine or other waste. A colonoscopy can be a “routine” way of finding out if there are any abnormalities in your colon. For any patient, though, there is nothing routine about this procedure.

Additionally, men over the age of 75 have a higher risk of additional health care problems. According to HealthLeaders Media, colonoscopies in seniors over age 75 should not be performed because risks of harm outweigh benefits; as many as 30% of these "potentially or probably inappropriate" procedures were still being performed, with huge pattern variation across the nation, especially in Texas.

For patients between 70 and 74, "procedures were repeated too soon after a negative exam," increasing the odds of avoidable harm, such as "perforations, major bleeding, diverticulitis, severe abdominal pain or cardiovascular events." The guidance, from the U.S. Preventive Services Task Force, which was released in 2008, also set a 10-year interval for routine colonoscopies for people between age 70 to 75 unless the patient develops certain symptoms.

"For example, in adults between the ages of 76 to 85, there are some considerations that would support the use of screening colonoscopy, such as a patient has a higher risk of developing an adenoma. But in general, screening guidelines indicate that should be exception, rather than the rule,” according to a study released in the Journal of American Medicine (JAMA). Much more detail about this particular focus for colonoscopies in seniors can be found at this website: http://www.healthleadersmedia.com/content/HEP-290006/Colonoscopy-Potentially-Inappropriate-for-30-of-Seniors## .

According to the American Cancer Society (ACS), a colonoscopy is an exam that lets a doctor closely look at the inside of the entire colon and rectum. The doctor is looking for polyps (pah-lips) or signs of cancer. Polyps are small growths that over time can become cancer. The doctor uses a thin (about the thickness of a finger), flexible, hollow, lighted tube that has a tiny video camera on the end. This tube is called a colonoscope. The colonoscope is gently eased inside the colon and sends pictures to a TV screen. Small amounts of air are puffed into the colon to keep it open and let the doctor see clearly.

The exam itself takes about 30 minutes. Patients are usually given medicine to help them relax and sleep while it’s done. Your doctor decides how often you need this test, usually once every 10 years, depending on your personal risk for colon cancer. It’s important for you to talk with your doctor to understand your risk for colon cancer, the guidelines you should follow for testing, and whether you need to start having the tests at age 50 or earlier.

Plus, these exams are usually not painful, according to the ACS. Patients are given medicine to make them sleep through a colonoscopy, so they don’t feel anything. During both of these tests, air is pumped into the cleaned-out colon to keep it open so that doctors can get the best pictures. The air pressure may cause some discomfort and cramping, but it should not hurt. As with most medical tests, complications are possible with both of these tests. Some can be serious — for instance, bleeding and puncture of the colon — but they are very uncommon. Make sure you understand how these tests work, how you can expect to feel during the test, and possible problems that may come up. Much more detail can be found at this website: http://www.cancer.org/healthy/findcancerearly/examandtestdescriptions/faq-colonoscopy-and-sigmoidoscopy .

Per the Cleveland Clinic, here is what you should expect after a colonoscopy:

• You may feel some cramping or a sensation of having gas, but this quickly passes.

• If a biopsy was taken or a polyp was removed, you may notice light rectal bleeding for one to two days after the procedure. If you have a large amount of rectal bleeding, high or persistent fevers, or severe abdominal pain within the next 2 weeks, please go to your local emergency room and call the doctor who performed your exam.

• If polyps were removed or a biopsy was taken, the doctor performing your colonoscopy will tell you when it is safe to resume taking your blood thinners. You will also be told if you need to stop taking medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen (Motrin®, Advil®) and naproxen (Aleve®).

Note: To follow are other important questions to ask your doctor. Keep in mind that each doctor and/or his or her health care facility has their own unique set of instructions for their patients. Most doctors/health care facilities are in general agreement with the following answers. However, ALWAYS ask your doctor for his/her specific instructions. Additional tips are as follows:

--Driving home. If sedation has been given, a responsible adult (a family member or friend) must drive you home.

--Being alone when home. For safety reasons, you probably shouldn’t be alone. Ask your doctor how long you should remain with family or friends.

--Returning to normal diet and activities. Unless otherwise instructed, most patients can return to their normal diet immediately following the colonoscopy. Other typical advice is to avoid alcohol, driving, regular activities, and operating machinery for 24 hours following the procedure.

More details can be found at this site: http://my.clevelandclinic.org/services/colonoscopy/hic_colonoscopy_procedure.aspx .

Also, another option is for a virtual colonoscopy. According to the Mayo Clinic, the virtual colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During virtual colonoscopy, an imaging technique known as computerized tomography (CT) is used to produce hundreds of cross-sectional images of the abdominal organs. The images are combined and digitally manipulated to provide a detailed view of the inside of the colon and rectum. Unlike traditional colonoscopy, virtual colonoscopy doesn't require sedation or the insertion of a scope into the colon. Virtual colonoscopy is one option used to screen for colon cancer. Discuss your colon cancer screening options with your doctor to determine whether virtual colonoscopy is the right option for you. The Mayo Clinic has a lot of material about this health care topic and more, beginning at this website: http://www.mayoclinic.com/health/colonoscopy/my00621 .

If you have any concerns about getting a colonoscopy, see your doctor or closest available health care provider. They are painless, and in the vast majority of cases have no lasting side effects. In most cases, your health insurance should cover most of the cost. Additionally, if any abnormalities are found during the procedure, they are addressed at the time and with any required follow up. Don’t be afraid to get one, especially if your physician recommends it. Although preparing for one and recovery can be a little uncomfortable, the results with a clear screening can be worth the aggravation, especially if you have positive results and are clear from any more medical issues. The old saying “An ounce of prevention is worth a pound of cure,” is particularly valid with a colonoscopy.

Until next time.

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