Good morning, everybody! It’s colonoscopy prep day, and I am so excited!
For you young’uns out there, this is a rite of passage you get to enjoy once you turn 50, or maybe earlier if you have risk factors. This is a process where a doctor invasively scrutinizes every inch of your colon to screen for cancer, and you get to do it every 5 years (or in my case, every 3 years because last time they found a few harmless polyps). So today is the day I get ready for an outpatient trip to the local hospital.
Everyone will tell you the prep is worse than the procedure, and it is. You have to completely empty your bowels so the doctor’s view isn’t impeded by, umm, shall we call them Deplorables? Today I’m purging the Deplorables.
First thing, I’m fasting. No solid foods at all today. I made some pineapple jello yesterday, and I get to have clear broth, but otherwise, it’s all drinking down fluids and nothing else. I do get to drink all the coffee I want, so I will.
I have to take 4 Dulcolax pills this morning, a stool softener.
At 3pm this afternoon, I get to fill up this jug with four liters of water, and start drinking it. I’m supposed to finish all four liters by 6pm. Chug, chug, chug!
It says “lemon flavor”. This is only sort of true, if your lemonade tastes more like watery mucus. I will cope. This is really the worst part of the worst day. Well, maybe the worst part — I do get to spend the rest of the evening expelling Deplorables.
Then, as of midnight, I go dry. No water, nothing, shall pass these lips, and prep day will have passed.
Tomorrow I go into the hospital at 8:15. I get to strip naked and put on one of those chic hospital gowns that opens at the back, and the nurse will stick a needle in my arm, and Dr Sam will walk in and tell me to lie on my side and bring my knees up to my chest, and then deliver the magic drugs and a veil of darkness will fall over the unspeakable events that ensue. He’s going to stick a tube up my butt with a small flashlight and a camera at the end, and also little snippy scissors so he can chop out anything he wants to take a closer look at.
By 10am I’ll be groggily putting my clothes back on and my wife will drive me home, where I’m told I’m supposed to be lazy all day. I can do that! I might also be hungry.
Why am I doing all this? Consider the payoff matrix. It’s the only rational thing to do.
| I get a colonoscopy | I don’t get a colonoscopy | |
| I have cancer | I catch it early! I have to get cancer treatments, but I have a better chance of not dying, and the treatments won’t be as debilitating as if I let the cancer grow. | I have cancer, but I don’t know it. It grows until the unpleasant symptoms become noticeable and require more serious intervention. Or I die. |
| I don’t have cancer | Yay! And I know it! Relax, resume my decadent lifestyle until the next colonoscopy. | I’m OK! But do I know for sure? I do not. I might have to hold some reservations, rather than plunging into my life of careless hedonism. |
As you can easily see, all the possible outcomes from the decision to get a colonoscopy are positive, while all the outcomes from shirking my responsibilities range from negligible concerns to dire, horrible consequences.
We even have graphic examples right here on Freethoughtblogs!
The Fight, ©Caine, all right reserved
Caine died of this terrible disease in 2018, after a long struggle.
Iris discovers a serious problem.
Fortunately, Iris is surviving, but read her account of her travails: no one wants to go through that. I don’t want to experience that.
So, yeah, get your butt checked regularly. It inconveniently wrecks a day, but that’s better than wrecking your life.
Did it for the first time a couple of years ago. It’s not a pleasant experience and I’m glad I’m only asked to do it every five years. But as you say, the positive outcomes in all possible scenarios far outweigh the unpleasantness for a day!
Like your good self ,I have to have one every three years .Due early next year, because they found some polyps .
You wimps get to be sparko ,all we get is gas and air .But we get to see the inside of our colons ,plus a sort of satnav
showing where the camera is .At one point i felt like asking him to check on my Tonsils .
All this because I was on the toilet and the bowl was full of blood Oh my I thought ,colon cancer ,turns out to be a bad case
of the Farmer Giles .
Anyway ,thoughts and prayers for tomorrow .
I’ve had a couple of these myself and didn’t think it was that bad, especially considering the possible outcome of not getting one. Some good advice I got from a surgeon colleague who has also had a couple; mix the big bottle of PEG solution with really hot water the day before and it will dissolve completely and avoid that gritty texture some people find objectionable. Then chill it thoroughly as cold as possible so it won’t have as much taste.
I’ll drink to that!
My first colonoscopy may have saved my life. Turns out I had stage 3 colon cancer. I’m three years on now after surgery and chemo; so far, so good. I never know how to describe my situation. I’m not sure if I’m in remission, cured, etc. but each follow up oncology appointment is usually good. I’ll feel a little better once I hit the five year mark,
I’m aware of two people on the fringes of my social circles who died from this and were younger than me, as well as Chadwick Boseman. I feel like the guidelines should push the minimum age to 40 instead of 50. I sometimes wonder if we could save even more people that way.
Anyways, get the procedure as soon as you can, if you can.
As a 62 year old who has been on the “every three year” colonoscopy plan for about 20 years, I noticed that you missed an important option in your payoff matrix. It the “I have precancerous polyps that can be removed now in order to stop them from advancing” option.
As someone who’s 52 year old brother died of colon cancer earlier this year, I want to reinforce the importance of colonoscopies.
Well, if it’s any consolation, it isn’t to avoid deplorables, it’s to avoid methane gas pockets. Patients, before the purging era, had literal methane gas explosions inside of their colon when a sample was taken and the wound cauterized.
Yeah, I’m serious. The case records are available to the masochistic reviewer of Google Scholar.
Although, after chugging my own gallon of dogshit flavored PEG, then the fucking car broke down (cracked engine block) and billed for the missed appointment, it’ll be a while before I try another gallon of dogshit.
Although, I’m sure there’ll be a new flavor available by then. Horseshit.
When it’s offered in apeshit flavor, I’ll decline over cannibalistic reasons.
Your payoff matrix is incomplete. There are two more options:
1. You have cancer and get a false negative.
2. You don’t have cancer and get a false positive.
I’m not trying to discourage anyone from screening for bowel cancer as it is one of the programs for which there is good evidence of benefit, but there are downsides to colonoscopy: they are very expensive, especially in the US where the price can be an eye-watering US$4-7,000 (cf. Australia where it’s around AUD$6-700)…and about 1 in 2000 result in an accidental bowel perforation (and that’s with an experienced proceduralist), which usually means urgent transfer to a surgical theater for full anaesthetic, surgical repair, and broad-spectrum antibiotics IV.
In almost every developed country, the baseline screening test for bowel cancer is the fecal occult blood test (FOBT) because it is cheap and non-invasive. The main limitation with FOBT is that there are non-cancer causes of bleeding (false positives) and also the cancer might not have bled on the days tested (false negative). But there is no bowel prep and no perforation risk.
People with very high risk such as those with a young first-degree relative with bowel cancer are advised to go straight to colonoscopy and bypass the FOBT altogether, but for the majority of people the risk-benefit analysis favours FOBT as first line.
The US is generally more aggressive in its screening recommendations than other countries. There are two reasons for this. Firstly, litigation risk pushes doctors to be more interventionist, and secondly the recommendations in the US nearly always align with the monetary interests of the specialists involved (even within the US there is variation, and the guidelines that recommend earliest mammography come unsurprisingly from the College of Radiologists, not the public-health focussed USPSTF).
Anyway, if you are high familial risk or have a positive FOBT, yes you should get a colonoscopy. But it shouldn’t be the first line screening test for most people.
Unfortunately, the argument you’ve put up there is the medical equivalent of Pascal’s Wager (in that it drops out very important qualifying information, not in the sense that it’s the wrong conclusion for you). And it’s not just the small but important risk of perforation, because colonoscopy also has a significant false negative rate (3.5% in this 2015 UK audit), so your green box isn’t quite right.
There’s also spontaneous regression of cancer, as in this remarkable case where a patient’s large colorectal tumour completely disappeared between colonoscopy and surgical excision, but the chance of remission is so small (less than 1 per 100,000) that it’s fair to ignore it. So that black box outcome is not completely accurate, but true enough for all practical purposes.
Finally, it should be noted that colon cancer is only associated with some hedonistic activities. As a vegetarian you are already protecting yourself from the worst modifiable risk factor, red meat consumption. There’s no reason to abandon all debauchery!
@ Matt G, # 4: Bottoms up!
Last time I had to chug those four liters, I did it but threw up the last half liter or so. Still, I will likely be doing it again in the next year or so. I keep hoping the prep will get less unpleasant.
My problem is that I’m an old fart who lives alone, and there’s nobody who can drive me to and from the procedure (or sympathize and hold my hand during the prep).
I did do one of those tests where you mail a stool sample to a lab. It came up negative, so there’s that at least.
I had one earlier to screen for various conditions that could account for my irritated bowels.
They found nothing. Zilch. No pathology of any type.
It was months before my bowels got back to their normal state, and even now they’re still a bit out of sorts. Given their normal state was bad, it’s been a big improvement!
(This story brought to you by the department of N of 1.)
@9 Wrote ,
“They are very expensive, especially in the US where the price can be an eye-watering US$4-7,000 (cf. Australia where it’s around AUD$6-700)
Compare that to good old GB where there are no up front costs .Dog bless the NHS ,but those bastard tories are just itching to introduce an American style Health service ,yet the dimwits who rely on the NHS continue to vote for the bastard tories .
Don’t forget there is also the fecal blood test. It’s not as thorough as a colonoscopy but its a lot easier. I do it every year. You just make a sample and mail it off.
@15 Ah ,the good old poo on a stick .
good old peg! i use a straw and hold it as far back in my mouth as possible so as not to engage very many tastebuds. then i pop a hard candy (not red) to kill any lingering flavor.
good luck!
My theory about those 4 liters of vile PEG solution: I believe they count on most people NOT finishing the full amount, so they build in an extra buffer.
That is my theory, and that which it is too…and it’s mine. [Anne Elk]
@14 davidc1 I agree that colonoscopies are too expensive in the US. I had my first one 2 years ago. I live alone like @12 billseymour and don’t like to tie up a friend all day to accompany me to the surgery center. I also work in cancer clinical trial research. So I did mine awake. I got to see the video and talk to the doc during the procedure! I’m such a nerd I wouldn’t pass up the opportunity to see that. It also reduces the fee for the procedure significantly without the anesthesia charges. I’m in Kentucky and believe it or not we have state legislation that makes colonoscopies a no out-of-pocket procedure. Of course we also have some the highest rates of colorectal cancer in the nation.
There are lower-volume prep solutions out there, and the clinic where I go has used them for many years. For whatever reason, polyethylene glycol is becoming popular, and I was given that once. I’ve never tasted anything so bad. Not the liquid itself, but it leaves a horrible aftertaste. You are also required to drink a gallon of it within an hour.
The stuff I’m normally given is done in two one-liter doses twelve hours apart, each consumed over an hour and then chased with half a liter of water. Tastes like salty water, not pleasant but not ghastly, either, and can be improved with lemonade-flavored Crystal Light. If the clinic is concerned that complete cleanout might not be achieved (for example, if it didn’t happen during your last one), they’ll ask you to take a dose of magnesium citrate the day before. Last time, the GI group wanted to give me the glycol ghastliness, I said wait, we’ve done several of these with the old preparation and that’s better, so they gave me a prescription for that instead.
It’s always a good idea to challenge the GI docs a bit on the prep if it’s really, really difficult, because they have other chemicals in their toolbox.
@19 Wrote .
“A no out-of-pocket procedure.” Sorry for appearing thicker than the offspring of donald and boris johnson supporters ,but
what does that mean?
chrislawson@9: There is also the FIT or FIT-DNA, both of which are noninvasive and have a better sensitivity and specificity than stool guiac. That being said, they don’t detect polyps and polyp removal is probably what’s responsible for a drop in the colon cancer rate (and colon cancer death rate) in the US.
TMI alert: I’m on the “colonoscopy not alternative” list because I’m the only one in my nuclear family that (so far) hasn’t had an adenoma removed, making me high risk. Even better, due to unrelated colon issues, I have to do a two day prep with twice the golytely. It’s a true joy.
Here in the Netherlands everybody between 55 and 75 gets an invitation every two years for the free bowel cancer screening program. This starts with the stool sample test. If blood is found in that, a colonoscopy can be done. It is all done voluntarily, and about 70% of the invited people participate.
Some interesting statistics from a report about the screening program here in NL. In 2019, 1.568.511 people participated in the initial screening, 67.391 were redirected for a colonoscopy. As a result, 3.086 colon cancers were found and 18.054 advanced adenomas. About 0.5% of the colonoscopies resulted in complications that required hospitalization.
The sensitivity of the screening program was 82%, and the specificity 94%.
chrislawson@9: very glad we start with the FOBT first.
I’ve had 3 and I’m clean. (Referring to the prognosis, not the … um … prep process.)
I had a dear friend whom I wish had had a colonoscopy when she reached the right age. She kept putting it off. And so, one day, she, her husband and their three children were celebrating a holiday when she suddenly had severe abdominal pain. Her daughter, a doctor, finally persuaded her to go to the hospital. She had surgery to remove a good bit of her cancer-ridden colon. Sadly, it turned out the cancer had spread to her liver. For more than two years, her husband drove her all over the South to specialist clinics for treatments that might have saved her life. But the cancer was too aggressive. It could be suppressed temporarily, but never to a point that it could be cut out of her liver.. Finally, she could not stand all the side effects of the treatments and the pain from the cancer, so she went into hospice. Her husband called me soon after she died and I have never heard him so broken. She was one of those special people whom you would love to know.
So anyone reading this, please get a bleeping colonoscopy when you’re advised to, and keep getting it every time your doctor tells you to. That’s my sermon for today.
I’ve known two people who died of it. It’s a miserable way to go. Colonoscopies aren’t so bad, considering.
@21 davidc1
I don’t know if your don’t live in the US, or are uninsured, or have simply had little interaction with the health care industry in the US, but it’s unfortunately a common term here. Assuming I’ve chosen a health care provider that is covered by my insurance company, my bills are paid by my insurance, and I’m billed based on the terms of my insurance. Some things are fully covered, but those are rare. Otherwise, I have to pay a certain portion of the bill, up to a limit. The first limit is the deductible. For anything other than routine visits, you typically pay the full amount negotiated by your insurance company up to the deductible limit. Beyond the deductible, you still pay something called co-pays up until you meet the insurance company’s “maximum out of pocket limit”. My deductible is something like $3500 and my max out of pocket is something like $7500. When I had a basal cell carcinoma removed, I maxed out my deductible immediately, but I still had to pay about $500 in co-pays for all the subsequent follow up visits. If the law requires that something is covered with no out of pocket expense, it means that it is completely paid for by insurance regardless of the deductible or co-pay. What insurance companies are legally required to cover, what is covered by the deductible, and what is subject to co-pays was somewhat standardized by the ACA (Obamacare), but still varies quite a bit from state to state. So, I basically never know how much anything will cost, only that it won’t exceed $7500 in a calendar year. If that sounds crazy, it is. Welcome to America.
I had my first ‘scope last year for ongoing and at the time, worsening, bowel issues.
It was an expensive confirmation that I do, in fact, have a raging case of IBS. (But it’s not cancer!)
I am going for my third colonoscopy soon. I’m on the 5 year plan as the first one found a polyp. I am probably an outlier as I found drinking all the prep poly fluid was OK. Maybe because compared to drinking any American beer like Schlitz Budweiser or forgive me Rainier, it was OK. I drink the solution and nature takes it course. On the insurance angle, I am an outlier. Between Medicare and Tricare I should pay nothing. All should have this.
I’ve been out of the loop a bit, I didn’t know Caine got cancer, that fucking sucks :(
PLease do get all the cancer screenings available to you. Because right now I’m crying again, because my best friend in this world just died from undetected cancer.
+++
The American medical obsession with making patients feel humiliated and vulnerable is fascinating. I know, American doctors will give you all kinds of reasons why this is totally necessary, while here doctors will do about everything short of actual surgery while you’re at least in the comfort of your own clothing.
@26 Hi ,I live in the so Called United Kingdom .
Had my 9th colonoscopy last year; I’m on the yearly plan. My first (the 50th birthday present) revealed a very large mass that everyone was surprised was not malignant, yet. I had four colonoscopies as a result (the first at a clinic, which also removed a few small polyps, two more in the hospital to remove the large mass, and one final one to check the area after healing). Since then, once a year – and they remove small polyps every time.
The prep is a pain, but I do it happily in the knowledge that I dodged a major bullet.
Thank goodness for Canadian health care – I only have to pay for parking at the hospital.
I’ve had 3 so far, but it is more than a day of inconvenience for me as I have a long “transit time” and found that I had to start the prep a few days ahead of the doctor’s default schedule. I prefer the 4-liter prep to the 2-liter prep.
https://gasstationwithoutpumps.wordpress.com/2015/08/31/eighth-weight-progress-report-and-colonoscopy/
describes the prep I designed for myself (which worked, unlike the the one the doctor originally prescribed).
My last colonoscopy was in 2015, so I’m overdue (I didn’t want to do one during COVID, so I may still wait a bit).
I do see it as fairly important, as my sister’s boyfriend died this year of metastatic colon cancer (or complications from the surgery to remove the tumor that completely blocked his colon or of the chemotherapy to treat the metastases—at some point it is hard to determine which of many causes is the main one).