Preventive Maintenance

[Ron T]

To continue safe enjoyable boating don't forget your colonoscopy! I waited 8 years, always something to do on the boat. Just got home from a week in Sloan Kettering where they remove ALL of a growth in my colon. I am very lucky. Another year and my time would have been short. Please take care of your self. Ron T

 

[DavidM]

I agree. Any man over 50 or woman over 60 (I think that is the recommendation) and particularly one with a family history of colon cancer should have a colonoscopy.

At the time of the procedure, if the GI guy finds suspicious polyps, he will snip them out. Removing developing polyps is an almost sure route to remaining cancer free. Sort of like removing basel cell skin cancers.

David

 

[cardude01]

I had a colonoscopy at 50 and I’m scheduled for another at 55. Colon cancer runs in the family so every 5 years they said. I was dreading the procedure but the worst part was actually the prep— the procedure was quick and painless.

 

[AusCan]

Good reminder, Ron.

In Australia everyone over 50 does a Hemoccult II FOBT (blood test on poo sample) instead of a colonoscopy. It is only slightly less effective (85%) as an early screening method, but much cheaper and simpler.

Everyone over 50 automatically receives a kit in the mail. That makes it more likely that most people will follow through. Your GP will also be aware of whether you've done your test. We just take a sample and send it back. Colonoscopy required only if the FOBT is positive.

A healthy diet helps too. Thats my preferred method of staying alive. I hate going to doctors.

 

[dhays]

I had a colonoscopy at 50 and I’m scheduled for another at 55. Colon cancer runs in the family so every 5 years they said. I was dreading the procedure but the worst part was actually the prep— the procedure was quick and painless.

Same story here. I have a Fm Hx of colon cancer and at 55 had a colonoscopy where they removed some polyps. The procedure wasn't bad, just an annoying disruption of a couple of days. I get to have it again next year at 60.

The other issue of course is prostate cancer screening. Should have your PSA checked yearly. I have prostate cancer now and am just waiting for a convenient time to have surgery. So far it is slow growing and not at risk of metastasizing but that can change.

 

[DavidM]

In Australia everyone over 50 does a Hemoccult II FOBT (blood test on poo sample) instead of a colonoscopy. It is only slightly less effective (85%) as an early screening method, but much cheaper and simpler.

The hemoccult test is a very good indication that something is very wrong, but it is often too late. My father had a positive hemoccult and a few months later was in the hospital for surgery. I had a colonoscopy more than 15 years ago and polyps were snipped out. With routine follow up colonoscopies, I don't ever expect to contract colon cancer. Katie Couric made that pitch some years ago on the Today Show (her husband had died of colon cancer).

So it is a question of more prevention costs (American colonoscopies) vs more surgery costs (Australia's approach) plus potential death.

I don't know where the optimum point is.

David

 

[angus99]

The hemoccult test is a very good indication that something is very wrong, but it is often too late.

I don't know where the optimum point is.

David

Me either, Dave. But I had a scope a week ago and am much happier knowing that the single “pre-cancerous” polyp they found is history. My understanding is that pre-cancerous is based on the statistical likelihood that a polyp of a certain size and shape will become cancerous at some point. The longer they remain, the greater the risk. I’m now on a 5-year schedule.

Colonoscopy pros:
- knowing that a trained specialist has inspected your plumbing and removed potential problems before they can become life-threatening
- kick-ass anesthesia

Colonoscopy cons:
- the fact that there always seems to be several lovely young women/nurses/trainees in the procedure room when I’m at my most vulnerable
- the god-awful prep brew!!!! (This has to be what Dumbledore went through in that cave.)

 

[sbu22]

Nothing to the procedure. Hell, you're unconscious. Prep bites - there has got to be a better way! Post-op - being coached by a pretty young thing to fart vigorously. Getting older ain't for wussies.

And, yes, you ought to do it as recommended. Stupid not to.

 

[DavidM]

The other issue of course is prostate cancer screening. Should have your PSA checked yearly. I have prostate cancer now and am just waiting for a convenient time to have surgery. So far it is slow growing and not at risk of metastasizing but that can change.

This is another tough call. Fifteen years ago I had prostate surgery after my PSA quickly rose from 1-2 to 5-7. I am totally cancer free but it did impact my sex life.

I have a couple of friends who engaged in "watchful waiting" as their PSA climbed past 10 and then had surgery. It saved them a few years. But the downside is both had metastasis and have to take drugs for the rest of their life to control the cancer. And sometimes the drugs don't work and you die.

But these three cases (me and my two friends) are purely anecdotal and the majority of men with elevated PSA values live a good life until something else does them in.

So again I don't know which approach is best. I am happy with what I did, but today's advice is don't do PSA tests. I think more men will die as a result or at the very least when the disease finally becomes symptomatic (severe difficulty in urination typically) it is often too late for surgery to be a complete success and at best you will have to take drugs for the rest of your life.

David

 

[BruceK]

Well caught Ron. I`m due, just had a reminder. Hate the prep, but the potential alternative is worse. Family hx, but not a polyp so far. Had a GP who put me on low dose aspirin as a preventative 30yrs ago. Does it help, maybe it reduces inflammation,who knows.
Had a colleague getting both gastroscopy and colonoscopy, the light hearted plan was for the 2 cameras to meet in the middle.

 

[MichaelB1969]

Shouldn't this be in the Maintenance and Systems forum! Ha ha, just kidding. I'm 48 and had one at 46. They were doing an endoscopy and figured they may as well check both the entrance and the exit as long as I was out!

 

[RT Firefly]

Greetings,
Hey c'mon guys. This thread is almost starting to overlap the "Leaking Drip less Seal" thread. TMI already.

 

[Lou_tribal]

I am totally cancer free but it did impact my sex life.

David

is that why yo became anal on diesel engine?

sorry just a bad joke, my apologizes

L

 

[Lou_tribal]

Had a colleague getting both gastroscopy and colonoscopy, the light hearted plan was for the 2 cameras to meet in the middle.

I am younger and still in my gastronomy and vinology phase and when both meet it is just good

L

 

[menzies]

Great thread.

I have a full annual physical every year, including full blood work. Most insurances will cover this in the US.

In fact I have a GI Scope scheduled for Dec 12.

I have a young female PA who does the physical - the prostate finger check and "cough" check are fun!

 

[BruceK]

Photos or It Didn`t Happen

I was given photos after one colonoscopy,presumably the Doc needed comparison pics for the next examination.
But just this once, let`s dispense with photos.

 

[Sabre602]

I generally follow the guidance of the US Preventive Services Task Force in teaching my patients (I'm a hospital nurse). They currently recommend colon cancer screening for all adults starting at age 50; there currently is no preference for selecting colonoscopy, sigmoidoscopy, or fecal occult blood screening. Australia really leads the US in their preventive approach...we do preventive care very poorly in this country.

Please be aware that colon cancer is strongly linked with heredity, so much so that all children of a person with diagnosed colon cancer should have immediate colonoscopic examination, no matter what their age.

As for prostate screening, it's a bit more complicated (and fraught). The USPSTF assigns prostate screening a grade of C, meaning that they recommend "selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small."

Rather than paraphrase it, I'll just cut-and-paste from the 2017 draft recommendation:

"The USPSTF recommends that clinicians inform men ages 55 to 69 years about the potential benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer.

The decision about whether to be screened for prostate cancer should be an individual one. Screening offers a small potential benefit of reducing the chance of dying of prostate cancer. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and impotence. The USPSTF recommends individualized decisionmaking about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision."

It should be emphasized that the old model of "watchful waiting" has been replaced here by "active surveillance," which may include a variety of monitoring modalities, including PSA trending, digital rectal exam and biopsy at intervals. It basically means studying the progression of the disease and only treating it when it's warranted. A study from Johns Hopkins found that fewer than 1% of men in an active surveillance program for diagnosed prostate cancer had meaningful progression of their disease 15 years later. That means that greater than 99% of those men were free from the complications and adverse effects of what would have turned out to be unnecessary treatment, including pain, incontinence, sexual dysfunction, and infection, not to mention expense. Yes, some prostate cancer is aggressive. Most, however, is fairly indolent, meaning that it smolders rather than bursting into flame; the man will die of other causes (or old age) before the cancer has a chance to advance that far.

Genetic and molecular biological testing has advanced tremendously; individuals should discuss risks and benefits with trusted practitioners and should not be afraid to seek expert consultation at a regional referral center.

 

[aboatman]

I have photos if anyone wants to see them.

My wife and I are on the schedule. I have them do the one that goes down the throat while I am out to check for esophagus and stomach problems. A friend of mine had stomach cancer discovered this way. He had surgery and is living but not the good life he enjoyed before the cancer.

 

[Steve]

I need to have anther one before too long. I'll bring along a gallon of Micron 66 and while they are in there get them to put a couple of coats of that on the inside. It works on barnacles maybe polyps too?

 

[Shrew]

I had a colonoscopy in my early 40's as a precaution. They found and removed 2 polyps. Now I'm on the 'every 5 yr. plan'.

 

[OldDan1943]

After my first one, I now tell doctors, "Not without dinner and a movie first."

 

[BandB]

Colonoscopy is the preferred approach by most doctors in the US. The reason for the intervals of five years is the normal growth pattern of polyp to cancer. In a typical person it's ten years, but with persons with a greater proclivity toward colon cancer it's more along the lines of 7 years. So, if they check today, remove any small polyps in the process, then 5 years from now they may find more pre-cancerous polyps. Now, like any procedure, it is not a risk free procedure. It's simply for most people the benefit far outweighs the risk.

Upper Endoscopies are also very important for many. The frequency of GERD and it's subsequent damage to the esophagus, the risk of Barrett's Syndrome as a pre-cursor to esophageal cancer, all point to it's value. Often it is done at the same time as a colonoscopy simply as a matter of convenience and to only require one sedation.

 

[aboatman]

............ Upper Endoscopies are also very important for many. The frequency of GERD and it's subsequent damage to the esophagus, the risk of Barrett's Syndrome as a pre-cursor to esophageal cancer, all point to it's value. Often it is done at the same time as a colonoscopy simply as a matter of convenience and to only require one sedation.

That's what I was talking about. I always ask the doctor to do this one first.

 

[cardude01]

That's what I was talking about. I always ask the doctor to do this one first.

[emoji15]

 

[dhays]

It should be emphasized that the old model of "watchful waiting" has been replaced here by "active surveillance," which may include a variety of monitoring modalities, including PSA trending, digital rectal exam and biopsy at intervals. It basically means studying the progression of the disease and only treating it when it's warranted. A study from Johns Hopkins found that fewer than 1% of men in an active surveillance program for diagnosed prostate cancer had meaningful progression of their disease 15 years later. That means that greater than 99% of those men were free from the complications and adverse effects of what would have turned out to be unnecessary treatment, including pain, incontinence, sexual dysfunction, and infection, not to mention expense. Yes, some prostate cancer is aggressive. Most, however, is fairly indolent, meaning that it smolders rather than bursting into flame; the man will die of other causes (or old age) before the cancer has a chance to advance that far.

Great information. I think that PSA testing is much like oil testing. A single test doesn't give nearly as much useful information as PSA readings over time. The PSA value can also vary from one test to another. My PSA has fluctuated from a low of 6.0 to a high of about 14 and then back to 7.2. However, I've had repeated biopsies that show very little/no progression of the cancer. The biopsies themselves are not risk free (nor terribly pleasant if truth be told) but at the relatively young age when I was diagnosed, keeping an eye on it is more important than if I was a couple decades older.

 

[BandB]

Great information. I think that PSA testing is much like oil testing. A single test doesn't give nearly as much useful information as PSA readings over time. The PSA value can also vary from one test to another. My PSA has fluctuated from a low of 6.0 to a high of about 14 and then back to 7.2. However, I've had repeated biopsies that show very little/no progression of the cancer. The biopsies themselves are not risk free (nor terribly pleasant if truth be told) but at the relatively young age when I was diagnosed, keeping an eye on it is more important than if I was a couple decades older.

I'm glad at least yours was discovered early so you could monitor it carefully. It seems like a condition that is very difficult to decide what to do. Seems also like the medical profession has gone back and forth and around in circles on the subject. Perhaps they're approaching a happy medium. Sounds like your approach is.

 

[Fletcher500]

Not a Doctor, but the comments regarding the stool test being a 85 percent less accurate than a scope are not entirely true. The testing accuracy at a lab is actually very high now. But agree, it appears the scope is still the most bullet proof method. Can't run from genetics.

 

[Gmarr]

I’ve had em all- ever since “one time” waking a little earlier than I would have preferred, I offer the anaesthesiologist a tip if I slumber until the recovery room! 30 years ago, my mother called it the “silver stallion” and there was NO knocking you out! Did that one too

 

[bgillroy]

Cologuard test Google it

 

[MichaelB1969]

When I got my first prostate exam my doctor said to just relax and he put one hand on my shoulder while doing the exam. He then said "If you feel both of my hands on your shoulders while I'm doing this that's when you should be concerned."

My doctor is bit of a wise guy.