PSA: for those over 45 years

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I didn't know that.
The problem is some do not track this information. We are supposed to track it for credentialing purposes. For example, I have a procedure I do. I have done it for 18 of 24 years. I have one complication in total, and I have done 5616 of the procedures. That is about 2 in 10K.

Ethically, I should and would tell you this information if you ask. For the non-emergent procedures, you have time to be choosey.
 
That is ok, but as a physician, I have to want folks to know that FIT and Cologuard do miss cancers. If you think they are perfect alternatives, you are fooling yourself. They miss a significant amount of colon cancer.

I had Cologuard and FIT for my first screening three years ago, Mine was normal. I have zero family members with a history of colon cancer, so I figured I am low risk so that I would go the easier and less invasive route. My Colo screening was not normal. I would not share that, but this is an opportune time to mention it. I do not have colon cancer, but I must get more regular screening because of the abnormalities.

Discuss it with a clinician and consider a Colonoscopy.

I bought off on the poop bucket screening (FIT or
The only thing I want to point out and anyone can correct me here is that many insurances would only pay for screening starting at age 50 when I retired two and a half years ago from practice. The AGA dropped the age for first screening to 45 and as a practitioner, I worried about this being covered though I agreed with the AGA's recommendation. If the surgeons or gastroenterologists see and remove polyps, the surveillance interval time needs to be shortened and the patient so advised.
I've had two and no big deal prep or otherwise. Back in the old days, it was a THREE day colon prep to have a colonoscopy!! Now, clear liquid diet, take pills and show up the next day for the procedure.
The G.I. docs had to come up with something better as people had a tough time with a three day colon prep. No one would likely consent to the procedure once word got out about the then 3 day prep. They then would have to roast their "snake scopes" to eat to survive. The one day prep is no big deal. Take off work, cruise the internet with a bathroom nearby. I had plenty of warning to get to the W.C. to get my business done. No explosive b.m.'s. Kurt
 
cancer should be 100 percent preventable if the insurance companies would pay for regular colonoscopies and everyone would have them done.
If a person could go to the doctor's office, lay on the table and the CT scan would make a quick pass over them, still most people would not want to do it. Even the 1 day prep and half a day in the clinic with anesthesia will knock out a lot more people.
 
He told me two things. One was that colon cancer should be 100 percent preventable if the insurance companies would pay for regular colonoscopies and ev

Not everyone has high risk to justify the expensive invasive procedure. But we should all get the easy cheap sample tests.

My point above, early in the thread. A couple other folks said they apparently are considered low risk, too.

The high risk folks, yeah, please go to the front of the line! You're worth it.

The procedure is lucrative for the gastroenterologists, preferred in US, but not other countries.
 
If a person could go to the doctor's office, lay on the table and the CT scan would make a quick pass over them, still most people would not want to do it. Even the 1 day prep and half a day in the clinic with anesthesia will knock out a lot more people.
That won't work for colon polyps "SAM". The gold standard is actually going through a visual colonoscopy which is not a big deal these days. C.T. will not pick up polyps. It will pick up the metastasis that are in the liver which by then is too late to save the patient.
The anesthesia is so good one won't have any discomfort with colonoscopy. I had one M.D. compatriot where they couldn't get an I.V. for anesthetic drugs but were already into the procedure. He said it wasn't that uncomfortable and told them to keep going. Told them where the endoscope was in his colon as they were doing it!! I was impressed. He was a tough doc and said it was no big deal to get a colonoscopy procedure without being sedated!!
Ahhhhhhh, most doctors offices don't have a C.T. scanner in them unless it's a radiologist group. I wouldn't want to be getting primary care medicine from a bunch of radiologists anyways. C.T. is not for primary diagnosis for colon polyps most of which are benign but if left in place but can turn malignant years down the road. One can't see polyps on C.T. Ask any radiologist about it and I'm sure I will be confirmed on that fact.
Kurt (used to M.D. but retired now)
 
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Not everyone has high risk to justify the expensive invasive procedure. But we should all get the easy cheap sample tests.

My point above, early in the thread. A couple other folks said they apparently are considered low risk, too.

The high risk folks, yeah, please go to the front of the line! You're worth it.

The procedure is lucrative for the gastroenterologists, preferred in US, but not other countries.
Ummmmm, surgeons are trained in the procedure of remedy and if they find a cancer they can actually jump in and help the patient. Yeah the G.I. guys refer on to surgery if the biopsy is positive and Depends on the "politics" in the area whether the surgeon or G.I. doc does the colonoscopy. The patient gets taken care of just the same. If a surgeon finds a suspicious lesion on colonoscopy, they can advise the patient as to what procedure will benefit them. No matter who does a colonoscopy, the verdict never is in until the pathologist calls the specimen cancer or benign. They don't just jump in and cut because of the looks of the lesion. Although, I've seen endoscopies where it was obvious it was a colon cancer. Patient will get scanned by various means to see if there are metastases as that will govern treatment.
If the person has widespread disease, no reason to cut on them unless a colon diverting procedure is needed for patient comfort.
If one has a malignant polyp on a routine exam, they'll get a metastatic workup and then a recommended segmental resection of their colon if no metastases. Perhaps radiation therapy will be recommended depending on what the surgical specimen shows. You can bet the surgeon will be feeling around in the patient's abdomen looking and feeling for metastatic lymph nodes and taking a good look at the liver. The liver is a prime spot. Scans can only show so much but being there inside a person is....................priceless!!
As far as saying that colonoscopy is priceless for G.I. Doctors I will pooh, pooh, the said respondent above. As the G.I. guys (there were no gals at the time I was in training) only had the patient's best interest in mind. A lot of Crohn's and Ulcerative colitis back then that the G.I. docs treated with the appropriate means/meds at the time. The surgeons loved they didn't have to cut on diseased colons and small intestines so much even back in the 80's due to the meds for UC and Crohn's disease from the G.I guys. Some of the UC patients didn't have to go to surgery early on but when they did, they got a total colectomy and did well afterwords with an ileostomy. Ileostomy is connecting up the small intestine to the abdominal wall to drain into an external collecting bag. Should be a PITA except I heard of the story below.
I remember a story a surgeon told of a poor 15 year old girl who suffered from horrendous ulcerative colitis. He did a total colectomy/ileostomy on her as it was warranted as the meds ran out of effectiveness but he felt bad about it. (It was in the 60's or early 70's when this happened.) Said she felt better afterwards and as the young woman thrived, gained weight, she didn't think having an ileostomy was a big deal. Had to wear a bag on the outside but suffering unreconciled pain and diarrhea before she had surgery, she was glad she had the ileostomy. Total colectomy was and still is a "cure" for UC back in the day and now, but I heard surgeons lamenting that doing a bowel resection on someone with Crohn's disease was something to be avoided. Was a "witch" to do and would only do if the patient was in dire trouble. Deal was with Crohn's is another segment of bowel could get involved with disease later on after a resection hence they always tried to avoid surgery. Back in the day, these folks got hammered with steroids and had to suffer the side effects but I think now they have gentler meds they can use. I never witnessed a bowel surgery with someone with documented Crohn's back in the day. I wouldn't have liked to take care of them in the ICU afterwards as it likely would have been tumultuous and traumatic for both of us! Kurt
 
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I didn't know that.
Yeah, but most of the G.I. and surgeon guys are pretty darned good at doing colonoscopies. I was a med student in the early days of flexible endoscopic scopes and they were good at it in the late 70's early 80's. I know as I was looking off the sidearm reflector back in the day while the attending was doing a procedure. If it was a difficult procedure, the attending apologized to me and took the sidearm off as it detracted from the light for him to see the biopsy site directly.
Now all the scopes use computerized video and the the G.I. or surgeon is looking at a high resolution video screen. Nobody is looking through an eyepiece anymore. It's much to the patient's advantage as the image is so much clearer now onscreen.
My younger mentally handicapped son needed a colonoscopy and my compatriot surgeon friend invited me into the room. I had seen so many of these procedures before, it was easy for me to tell where he was in my son's colon by looking at the video screen. Turns out the scoping was benign but we both saw some granola in the terminal ileum. My son apparently sneaked in unbeknownst to me the morning of or day before the procedure some cereal. We all had a laugh as I didn't know how he sneaked it in. His colon was clean otherwise. No pathology on random biopsies. Was having constipation as autistic spectrum/ADHD kids can have. Was pretty bad but have it sorted out now. Kurt
 
Not colonoscopy but:

People probably wondering whats with JB and all hes crazy posting. Well I have had some extra time on my hands. A week or so back I passed a kidney stone. That was fun. They tell me now I know how it feels to have a baby. Then I start seeing blood in my pee. Not a little. Call my Doc back ASAP. She immediately orders a CT, urine labs and blood labs. The CT comes back clean. No fragments nothing further up the track on its way. It looks clean. What happened was I either had a jagged stone or unusually large stone. Based on the pain, I would say so. Since the blood went away after 2 days and hasn’t happened since it should just heal on its own. No blood in the urine test. The blood lab was clean, nothing out of the ordinary. The urine, bacteria was off the charts and two other things way out of norm. She thinks the stone caused a urinary track infection which triggered a bladder infection. Basically I had toxins building up in my system making me a little loopy. She told me “men cand die from this”. I kinda laughed. She said, no, seriously. You could have died. So, I have been lying around on the couch taking my meds drinking LOTS of water and watching MST3K. When I get bored I go check out the forum. They also think I jarred the stone lose using my 2 stage snowblower. Isnt that crazy?
 
Not colonoscopy but:

People probably wondering whats with JB and all hes crazy posting. Well I have had some extra time on my hands. A week or so back I passed a kidney stone. That was fun. They tell me now I know how it feels to have a baby. Then I start seeing blood in my pee. Not a little. Call my Doc back ASAP. She immediately orders a CT, urine labs and blood labs. The CT comes back clean. No fragments nothing further up the track on its way. It looks clean. What happened was I either had a jagged stone or unusually large stone. Based on the pain, I would say so. Since the blood went away after 2 days and hasn’t happened since it should just heal on its own. No blood in the urine test. The blood lab was clean, nothing out of the ordinary. The urine, bacteria was off the charts and two other things way out of norm. She thinks the stone caused a urinary track infection which triggered a bladder infection. Basically I had toxins building up in my system making me a little loopy. She told me “men cand die from this”. I kinda laughed. She said, no, seriously. You could have died. So, I have been lying around on the couch taking my meds drinking LOTS of water and watching MST3K. When I get bored I go check out the forum. They also think I jarred the stone lose using my 2 stage snowblower. Isnt that crazy?
So you're saying that you're an infectious, stoned, blowhard? ;)

No, seriously, that is pain on a level all its own. I'm glad you're through the worst of it, glad you caught the infection in time, and I've been enjoying your posts. Blessings to you, get well!
 
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My experience with colonoscopies is that the gatekeepers for scheduling have far more authority than the physician that refers it.

I'm not talking about the age related stuff. I had to have one at age 45 for another issue, prior to a surgery. At 52, doc said I should get one done, and referred me to their office that would do that. I called for the appointment, and the receptionist said it hadn't been 10 years yet, so, sorry. She didn't care about the referral. I've missed my 50yo, and will apparently be held to age 55 if I go by the person who answers the phone (and allows/schedules the appointments).

If I was worried, I'd get into a pissing contest with the receptionist and/or my doctors help to actually schedule it. If they don't want me there, I have a real hard time trying to make them want me there.

A receptionist/bookkeeper that may remember me for causing trouble is a bad person to have as a problem in this environment. I'd generally not prefer to make waves.
 
My experience with colonoscopies is that the gatekeepers for scheduling have far more authority than the physician that refers it.

I'm not talking about the age related stuff. I had to have one at age 45 for another issue, prior to a surgery. At 52, doc said I should get one done, and referred me to their office that would do that. I called for the appointment, and the receptionist said it hadn't been 10 years yet, so, sorry. She didn't care about the referral. I've missed my 50yo, and will apparently be held to age 55 if I go by the person who answers the phone (and allows/schedules the appointments).

If I was worried, I'd get into a pissing contest with the receptionist and/or my doctors help to actually schedule it. If they don't want me there, I have a real hard time trying to make them want me there.

A receptionist/bookkeeper that may remember me for causing trouble is a bad person to have as a problem in this environment. I'd generally not prefer to make waves.
This is crazy.

I would have made waves:

Her: sorry, it hasn't been 10 years

Me: The doctor said I should have one now

Her: sorry, 10 years

Me: I'm documenting that you are personally overriding the doctor's directive, and sending a copy of it in writing to the head of the practice and to my insurance company. Unless, of course, you now see an opening for me...

Seriously! My wife had one yesterday, and due to prep not being perfect is going to go back one year from now. Can't schedule it until about five months out from the date, but no static about process.
 
So you're saying ygat you're an infectious, stoned, blowhard? ;)

No, seriously, that is pain on a level all its own. I'm glad you're through the worst of it, glad you caught the infection in time, and I've been enjoying your posts. Blessings to you, get well!
Thanks. Feeling MUCH better.
 
This is crazy.

I would have made waves:

Her: sorry, it hasn't been 10 years

Me: The doctor said I should have one now

Her: sorry, 10 years

Me: I'm documenting that you are personally overriding the doctor's directive, and sending a copy of it in writing to the head of the practice and to my insurance company. Unless, of course, you now see an opening for me...

Seriously! My wife had one yesterday, and due to prep not being perfect is going to go back one year from now. Can't schedule it until about five months out from the date, but no static about process.
Likely it was the insurance company, not the receptionist. You have to go back to your doctor, and he has to explain to the money source why they need to pay for another one so "soon". Like as if you're pestering your doctor... "Oh please, please, please can I get another colonoscopy?!" :rolleyes:
 
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