Scientists of the world: Want a guaranteed Nobel Prize? Find an alternative to colonoscopies.
Seriously, you will have the world worshipping at your feet. There would be mass rallies of ecstatic oldies dancing in the streets, pouring jugs of GoLytely into sewer drains. For the uninitiated, GoLytely (and the newer Prepopik) are the citrus-flavored battery acids that patients are required to drink to cleanse their intestinal tract of anything they might have consumed in the last 15 years. There’s an historic French phrase that has nothing to do with colonoscopies but should be on the label of every bottle: "Après moi, le déluge.”
It is a rite of passage that on your 50th birthday, you open your mailbox to find an AARP card and an appointment for a screening colonoscopy. Congratulations! You’re old! And you may have cancer of the pooper!
By American standards, people over 50 are supposed to have a screening colonoscopy every 10 years. I say American standards because a good friend who lives in Sweden asked her physician about getting one. He laughed and said, “That’s only in America.”
We are so lucky! Is it too late for apply for Swedish citizenship? (Their colon cancer death rates are only marginally worse than ours.) I predict that I will get all manner of testimonials from people whose screening colonoscopy saved their lives. I get it. In fact, my husband Olof and I have each had cancer, he twice and I once, that we would probably be dead from were they not caught early. But in none of those cases did we have to have our colons blast-capped by electrolytic TNT to find out.
Colon cancer is the second most deadly cancer. I just wish the search for a less invasive way to diagnose it were the second leading objective of medical research. Forty million Americans over 50 would thank you.
As Olof and I know too well, these procedures have risks. You are, after all, dealing with an older population. Each of us has had one colonoscopy that went normally, which is to say, was merely abjectly miserable. But each of us has had one that went horribly wrong as well.
When you sign the consent form, you are usually on a gurney at the surgical center decked out in your backless hospital gown and hooked up to an IV, practically delirious from 24 hours of starvation and a 14-hour intestinal power wash. The Grand Slam breakfast at Denny’s, extra side of bacon, is only an hour away. So initialing all those little boxes about how there’s one chance in 1,000 of a perforated colon, massive hemorrhage, or stroke is no contest.
When I talked a reluctant Olof into a routine colonoscopy 16 years ago, he’d already had cancer once. So he did the procedure and left the next morning on his scheduled business trip to Dallas. Twenty-four hours later, he was in the intensive care unit at Baylor Medical Center where he spent five days. When I was persuaded to have a screening colonoscopy by my primary care doctor four years later, I debated going to Olof’s doctor. After all, if the odds are 1 in 1,000, Olof had used them up so unless this guy had done more than 999 colonoscopies in the interim, he was the safest choice in town. But ultimately I decided to try someone else and the procedure went miserably normally. As did Olof’s second screening colonoscopy five years ago with this same guy.
By almost-70, I should be doing my third screening colonoscopy according to American gastroenterology income requirements. Given that everyone in my family dies of cancer (although neither Olof nor I have a family history of colon cancer) I was persuaded to do an (overdue) second one. But unlike the first one, this one did not go well, not the least of which was that my blood pressure soared into stroke range.
The gastroenterologist summoned Olof back to where I was recovering, the Grand-Slam-breakfast-extra-bacon now a nauseating fantasy, and said, “I am recommending that your wife never have a colonoscopy again.” His report recommended “alternatives.” Wait! There were alternatives? Why was I hearing about this NOW?
Speaking with the doctor several days later, he clarified that those would be a CT scan, or hopefully, the perfecting of DNA testing of the stool, already available but not considered as reliable (or profitable?) a screening as a colonoscopy.
There are already “virtual” colonoscopies but they still require the euphemistic “bowel prep” (an experience which gives new meaning to the term “all-nighter.”) You just don’t have to be subjected to the other ultimate euphemism, the “digital optic instrument” (video cam in locations and directions never intended by nature).
If you’re considering cancelling your colonoscopy because of this column, don’t. We’ve already used up all the bad odds.
But seriously scientists: one day you will be over 50 if you’re not already. Forty million American’s colons are counting on you.
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