Wanna Hear About My Colonoscopy?

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Probably not. If you’re reading this, you are either a) one of my very loyal readers, in which case I am most grateful for your perseverance; b) interested in all things medical, no matter how icky;  c) a catastrophizer like me, who always goes to the darkest possibility in terms of health; or d) just plain curious to find out what this strange woman is up to. 

Why do I want to tell you about my colonoscopy? March is Colorectal Cancer Awareness Month, so I figure if Katie Couric could have had a colonoscopy live on the Today Show in 2000 (after her husband died of colon cancer in 1998), it doesn’t take much courage to write this post for my blog. She also accompanied Jimmy Kimmel to his first colonoscopy, and you can find that amusing and instructive episode in this YouTube video. 

The purpose, of course, is to encourage screening among those who either don’t think about it or just can’t bring themselves to do it. Colonoscopy screening is one of the indisputable ways to save lives. But even if you have one regularly, I hope you’ll continue to read this because I’ve learned some important information that I don’t think is widely known, and perhaps you can spread the word to others. As Jane E. Brody, who writes the Personal Health column in The New York Times, stated:

“Although I usually refrain from columns linked to national health observances, I believe that Colorectal Cancer Awareness Month, in March, is too important to ignore. There are simply too many people who are still getting and dying from this preventable disease because they failed to get screening for it, including people with no excuse like ignorance, lack of health insurance, or poor access to medical services.”

I am close to two people who have lost loved ones to colon cancer in their early 50s. One was a beloved childhood friend; the other a treasured younger brother. Although any young death is a tragedy, both of these people were terrific, warm, loving individuals who left grieving spouses and children—and whose deaths were totally preventable. 

In addition, I think about the vibrant young woman, mother of two, whom I met when I took a mindfulness-based stress reduction course last year. She had had colon cancer once, had a recurrence, but was then doing well, she said. Her purpose in taking the course was to find a way to ease her anxiety while she awaited subsequent test results. She wept briefly as she described her circumstances, regained her composure, and for the rest of the eight-week course, was a delightful, wry person who dealt silently with what must have been a huge psychological burden. I think of her fondly, hoping her health is stable.

Here’s the important point that I’m not sure is well known: Last year, the American Cancer Society (ACS) lowered the proposed age for first screening (for people with no known risk factors or family history) from 50 to 45. That’s because so many younger people have been struck with the disease. 

And 45 probably isn’t low enough. In contrast to a drop in the overall death rate, attributable to greater detection and removal of precancerous polyps, an ACS study found that since the 1980s, colorectal cancer rates have increased by 1.0% to 2.4% each year in those aged 20-39, and since the 1990s, by 0.5% to 1.3% among those aged 40-55. Oncologists are seeing the disease even in adolescents. Those statistics should make us all sit up and take notice. 

It’s not clear why these rates are increasing, writes Patricio Polanco, MD, of the UTSouthwestern Medical Center. He and others say the factors considered include genetic mutations, low fiber diet, obesity, smoking, heavy drinking, and ulcerative colitis.

But conflicting conclusions emerge from other reputable sources. In a 2018 discussion among experts in an  OncLive Peer Exchange,  Michael Morse, MD, of Duke University Hospital said the data suggest neither obesity nor mutational differences are significant. He suggests “something environmental or habit-based…but until we can collect enough data from a large enough number of people, I just don’t see how we’re going to tease it out.” 

This is clearly a societal issue that requires greater awareness on the part of the public. Primary care physicians may need additional education as well, experts have suggested. As there’s no screening for those under age 45, younger people with questionable symptoms may have no time to waste, as noted below.

In my case, as an adherent patient and catastrophizer, there was no way I’d procrastinate in having the procedure right when I was told I should:  at age 50. That first one was fine, but the next one showed a few polyps, as did the following one. And since one polyp was precancerous, I was advised to have another colonoscopy after only three years. I’ve never had root canal, so I can’t use that comparison, but for the uninitiated, the experience is neither a walk in the park nor the worst thing imaginable.

The instructions are that three days before, one should eat only cooked fruits and vegetables. That eliminates about 2/3 of my diet, so right there, I’m at a disadvantage. No blueberries in my morning cereal; no huge salad with dinner, containing five or six of my favorite veggies; not even a small banana. For some reason, a line from Carl Reiner and Mel Brooks’ “2000-Year-Old Man” came to mind: “I’d rather eat a rotten nectarine than a fine plum.” I would have been happy with either—or both.

On the Day-Before-the-Day, I started the liquid diet. Fantastic options there: broth, apple juice, Jello (but nothing red, the only flavors I like), soda, coffee (neither of which I drink), sherbet (but not with milk and also not red, precluding my favorite raspberry). So using a wellspring of creativity, I came up with my day’s menu:

Breakfast: mug of chicken broth, glass of apple juice

Lunch: mug of chicken broth, glass of apple juice

Dinner: mug of chicken broth, glass of apple juice

Dinner was at 3 pm, because at 4 it was time to begin THE PREP.

As many of you may know from experience, the prep involves imbibing a truly noxious-tasting substance—a combo of ingredients designed to flush the system, in my case with a soupçon of lemon-lime flavoring to tickle the palate—all mixed with luke-warm water and then refrigerated, allegedly to make it more palatable.  

Suffice it to say, I got a lot of exercise over the next several hours running back and forth until my system was “clean as a whistle.” That’s all the scatology I’m going to inflict upon you.

On The Day, fortunately, my appointment was at 7:30 am. All the medical history review and pre-procedure steps went smoothly.

Then, with the anesthesia dripping into my vein and oxygen in my nose, I drifted off. What was probably 10 minutes later, I was awake. (The electronic schedule board in the waiting room had shown that my gastro had already done 4 of these before my arrival, and had 2 more in the works before he got to me.) I lay there for a few minutes, chose my post-procedure food and drink—cranberry juice and a blueberry muffin—finished them off in a nanosecond, and that was that.

The news was better than the last time: one small polyp, the gastro informed me—definitely not cancerous; he could tell that clearly. Tonight, just minutes before publishing this post, I got a call from the gastro telling me the biopsy report showed that the polyp wasn’t even precancerous. And because there was only one small one, I now have a five-year respite from this procedure, rather than only three years. So hooray for that!

I am telling you all this in the hope that it will be beneficial. In terms of cancer deaths in the US, colorectal cancers come in second; this year, according to Jane Brody, 51,000 people are expected to die of the disease. 

In addition to colonoscopy, there are less complex tests available; see Jane Brody’s column for a description of them. Colonoscopy, though, is considered the best test, as it can both detect cancer and remove polyps that may well develop into full-blown cancer in time.

The fact that an increasing number of those cancer deaths occur in people in their 20s, 30s, or 40s weighs heavily on me. Polanco, of UT Southwestern Medical Center, says it’s important for young people to be aware of the symptoms: abdominal pain, blood in the stool, constipation, diarrhea, decreased appetite, and weight loss, “and never assume they’re too young to get colorectal cancer.” 

Younger people tend to attribute their symptoms to something less serious, he writes, such as hemorrhoids or irritable bowel syndrome, and therefore don’t seek medical help until they have late-stage disease. Though I don’t want to generate panic on this issue, it is clear that changed circumstances require a new mindset to better protect younger adults. And the rest of us need to do the prudent thing to protect ourselves as well.

As always, I welcome your opinions, insights, stories, additional sources. And thank you for staying with me to the end of a post on a topic that I really didn’t want to write about at all, but felt compelled to do so.

Annie

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28 thoughts on “Wanna Hear About My Colonoscopy?

  1. You wrote that you’ve been uncertain if your posts are visible in WordPress emails and the like, and I said I would look for those kinds of emails that link to your blog. While I don’t think I’ve seen such an email as of yet, I saw this post in my reader tonight, and I thought I would visit and let you know if I have an answer.

    Liked by 1 person

  2. Great post Annie. I have family history of colon trouble. My father had colon cancer. My brother was diagnosed with colon cancer three years ago. Had three quarters of his colon removed and underwent three treatments of chemotherapy. He is doing well now. My sister had colitis for 20 years. She couldn’t stand the pain any longer and asked for her colon to be removed. I’ve had a colonoscopy for the last 20 years. Every 5 years at first and then because of the size and shape of the polyps found, every two years. So far so good. I’m keeping my fingers crossed. So there you have my complete family history on the subject.

    Liked by 1 person

    1. Thanks so much, Len. I appreciate your sharing your family history, which clearly implies a lot of physical pain and worries. Hope you all continue to fare well. Seems you’ll be ok, as any polyps will be removed pronto.

      Like

  3. A timely post on an important subject. I have done maybe 3 of them due to some family history. The prep is not pleasant but the actual day of becomes the most relaxing day of the year due to the cocktail of pharmaceuticals I am treated to. Altered conciousness with no residual painful recovery to go with it is always a winning combination!

    Liked by 2 people

    1. I agree about the altered consciousnesses. (JP: We have to stop agreeing like this!😊).

      In my case, the procedure is followed by a traditional visit to our local pancake house.

      Please help me spread the info about the need for vigilance among younger people.

      Thanks!

      Liked by 1 person

  4. Annie,

    Of course this is an important subject and it must have taken some guts? to include your personal experience,
    But I think most people are aware of this subject and put their head in the sand(thus leaving the relevant part exposed) about going ahead with the procedure. Afraid to do it: don’t think they could have a problem, don’t want to go thru the pre test stuff.
    I hope you’ll change some minds but I see a similarity with the anti-vaccination crew – minds already made up and logic won’t change their thinking,

    BTW- yummy pre day diet.
    Don

    Liked by 1 person

    1. Don, you may be right about the ostrich factor (and I appreciate your witty imagery), but do you think many people are aware of the growing incidence among younger adults?

      I’m hoping more people will hone in on that troubling trend—and perhaps in recognizing the potential harm to their younger children, friends, or colleagues, will realize it’s also time to take care of themselves.
      Annie

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  5. Don’t know how many are aware of the growing incidence among the younger folks, but I would hope their family or regular doctors are bringing it to their attention. The same way as the docs should do for their other patients.

    Liked by 1 person

  6. It is very ironic that as I was reading this an ad for Cologuard came on the TV. The ad states that this non invasive test is 92% effective and most importantly you don’t have to use the standard prep prior to the standard colonoscop. I think that for most people this is the reason many people haven’t gone through the process. I had the standard procedure three years ago and I plan to discuss the non invasive procedure when my time approaches.
    So far, I have been “clean” for all prior “visits.” Hopefully, all of your readers can say the same thing.

    Like

    1. Hi, Steve—
      When you said you were planning to visit my blog, I kinda thought you’d be drawn to the post on the Constitution and free speech, but this is important in its own way.

      I’m sure you’ll do your due diligence before it’s your exam time again, but if you click on the link to Jane Brody’s article that I’ve included, you’ll see that she says Cologuard misses about half of precancerous polyps.

      I’m asking all my readers to help me spread the word about the growing incidence of colorectal cancers in younger people. Until there’s greater understanding of the cause(s), knowledge of the puzzling trend, leading to earlier detection, is the best we can offer them.
      Annie

      Like

  7. Hi Annie,

    We all should know by now from personal experience or relations that the prep is not a comfort and the the procedure is not pleasurable.

    So everyone needs to get use to the facts and press on so they can have a healthier life and continue to provide financially and emotionally for their families.

    So here are my two stories of people I know and love.

    First is a family member who was age 86 at the time and who I love as if he was my father. He had his first colonoscopy and they found some flat polyps in a difficult bend in his lower intestine. As in usual diagnosis they were considered benign but still if left, considered pre-cancerous.

    Though he was healthy at the time and surgery was recommended as a follow up he and his wife of 55 years felt that due to his age, surgery was not going to be and no follow up was put in place.

    A few years later after his wife died and living alone on his own but otherwise still healthy enough to have a normal life, he had an extended time of constipation and told no family members.

    Once we found out, we had him go to emergency. The lack of bowel movement was due to the polyps had grown and caused a blockage. This was something we all knew could happen but he became afraid and mentioned it to no one.

    An emergency operation was performed to remove some of his lower intestine but due to the damage and now a more advanced age he now has an ileostomy bag and living in a nursing home as changing the ileostomy bag is difficult for him and due to his advanced age of 95 keeps him there though otherwise healthy with a full schedule.

    The second is about a close friend that had never had a colonoscopy and is age 75. A year ago after the findings from the procedure he to was diagnosed similarly to my family member referenced above.

    He thought that the polyps were not an issue though pre cancerous and he could out live it. I told him the story above, explained to him he could out live it because it would probably kill him or at best end up with an ileostomy bag and dependent on others and he would no longer be as active as he is and his every other day of running 5k was no longer going to be an easy life style.

    He had the operation, they cut out about 18-24” of damaged lower intestine, reconnected the healthy tissues and as of today he is back to his daily routines with no restrictions.

    He and his wife have been friends of mine for about 40 years. I have attended their children’s weddings, celebration of birthdays and can only imagine how sad it would be if when their grandchildren graduate schools and colleges he would not be able to attend or worse.

    Early detection due to an unpleasant 1-2 day procedure helped both live longer and better life. However, imagine if they both had no prior history due to no colonoscopy and the emergencies they would had faced was delayed, causes unknown and turned into sepsis or cancer.

    Moreover, anytime we can see a ticking time clock and know more of our selves, we can live a longer and fuller life by early detection and quality follow up. Before we can care for others, we need to care for ourselves so we can be their for them and they can have us in there lives.

    What better way to celebrate life than to live it.

    Everyone, get a colonoscopy and know who you are inside and out.

    And yes, I will have my 3rd colonoscopy next year at age 72. I look forward to a day of semi fasting, good results and continued good health.

    Annie thank you for this important posting.

    Liked by 2 people

    1. Hi, Charles—How good to hear from you from far away. Thanks so much for those excellent cautionary tales. I believe you have substantively helped me spread the message. Stay well!

      All good wishes,
      Annie

      Like

  8. Well, of course, I’ve learned here, as always. And as one catastrophizer to another, I am dutifully concerned for my loved ones. Especially the younger set, who think they are invincible and of course don’t particularly want to hear from their mother on these things. Now, they don’t have to hear me, because I’m sending them your column. Thanks, Annie. Keep on, keepin’ on .

    Liked by 1 person

    1. Hi, Denise–

      I hope my messianic zeal isn’t scaring people. My goal was to bring to light some worrisome statistics and to heighten awareness so people can make informed choices about their health. But as I say in the post, I don’t want to create panic.

      Gee: Younger set who think they’re invincible and don’t particularly want to hear about things from their mothers. Never heard that one before!

      Cheers!

      Like

  9. Okay tomorrow David and I are having our colonoscopies together we figured it would be easier that way to support each other and have one of our daughters drive us there so far it’s nowhere near as bad as I thought it was going to be I thought I’d be starving and never leave the toilet. I’m holding it together just fine honestly but of course the prep gives you a lot of toilet time we were told no blue colors as well as red so that also means purple I’ll post after I’m done with all the Japan pictures that we just got back on the trip from and thank you for posting this it was helpful to me

    Liked by 1 person

    1. I’m glad you found this helpful; I sometimes use my own experiences to encourage preventive care.
      His’n’Hers colonoscopies—what a novel approach, but clearly ideally suited to your new lives together.
      Good luck tomorrow. If you care to, please let me know how things went.

      Like

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