So What's in Your Colon?
As homeschooling dads, moms, and grandparents, we have a great incentive to take care of ourselves so we can be our best for our families. In this article, I outline some simple steps you can take to stay healthy and detect dangers to health early on.
One of my patients (we’ll call him Mr. McDonald) was complaining of his stomach grumbling at night, with lots of gas. “Do you think it could be ’cause of my canolopies?” he asked.
Silently I mused, What in the world is a canolopie? “Your canolopies?” I asked out loud, hoping for a clue.
“Yeah, ever since I had my canolopies I’ve had this problem.”
Okay, I seemed to be narrowing it down. A canolopie never seemed to exist singularly, only with other canolopies. And a canolopie was not something he had at birth, but something that he had only recently encountered. Further, it was not likely a food, or he would have said “ever since I ate my canolopies,” not “ever since I had my canolopies.” Mr. McDonald is not lacking in intelligence; his tongue just lacks the ability to wrap itself around common medical lingo. Astutely discerning my baffled expression, he went on: “I asked Dr. Hull, and he didn’t really think so.”
Now I was beginning to make sense of it all. I knew Dr. Hull to be the surgeon to whom I had referred him recently for routine bowel screening. I asked, “Do you mean to say colonoscopy?”
“Yeah, canolopies,” he replied.
I bit the inside of my cheek and stared at the computer screen in front of me. Outwardly I attempted to maintain a look of professional concern, but inwardly I was teetering on the brink of hysterics. I took a few deep breaths, waiting for the urge to pass.
Then, as if he knew of my inward struggle, and felt badly about my pent-up giggles, he delivered the coup de grace. “So
” he asked, “how’s my prospate?”
I could contain myself no longer
I erupted in laughter. Fortunately we go way back, and his sense of humor is as weird as mine. We shared the levity of the moment as I coached him in the proper pronunciations and then answered his questions.
Mr. McDonald, following the standard advice given to those in the over-the-age-
of-50 category, had chosen to have a colonoscopy to screen for bowel disorders, such as polyps and tumors. We had also checked some routine blood work, including a
prostate-specific antigen (PSA) test, to look for evidence of prostate cancer. But is preventative care really needed? Is there science to back up the recommendations, or do doctors push for health maintenance measures merely for financial gain?
Even without studying the medical literature, one can postulate an answer to this question by a look at the business world. There was a time when insurance companies would balk at covering a screening study such as a colonoscopy. But now many of these same companies are sending notices to their clients, asking them to remember to schedule their preventative care. Since these businesses are mainly concerned with the bottom line, it should come as no surprise that the evidence shows that screening for certain health problems saves money in the end. This cost savings is the direct result of a healthier clientele.
Health maintenance for adults can be roughly broken down into FOUR MAIN CATEGORIES: (1) cancer screening, (2) cardiovascular screening, (3) metabolic screening—for conditions such as diabetes, and (4) infectious disease prevention. The remainder of this article will focus on the first of these categories: cancer screening.
Category 1: Cancer Screening
Those organ systems commonly affected by cancer and for which we have evidence that routine screening may be beneficial include the colon, breast, cervix, and prostate.
Colon screening is best accomplished by a colonoscopy, done initially at age 50, then repeated every 10 years if the initial study is negative. A colonoscopy is a procedure done with a flexible scope that is about four feet in length. With the patient in a sedated state, the scope is passed into the lower bowel. The entire large intestine (a.k.a., colon) is viewed for evidence of polyps, inflammatory conditions, or tumors. If there is a strong family history of colon cancer, it may be wise to initiate screening at a younger age, with the procedure done on a more frequent basis. Screening the stool for blood is another method for detecting bowel disorders, but it is not as sensitive as a colonoscopy for lower bowel cancers and most physicians do not rely just on stool studies to screen for colon cancer.
Breast cancer is very common, afflicting approximately one in every 11 women. Screening is done by way of monthly self-exams, a yearly physician exam, and regular mammograms (a special x-ray of the breast). While some controversy exists regarding the schedule for mammograms, the most commonly accepted routine is for an initial mammogram to be done between the ages of 35 and 40, repeated every other year from 40 to 50, then yearly after the age of 50. I suspect that many of you mothers are biting your lip at this point, having put off that initial mammogram. For you ladies with a family history of breast cancer involving your mother or sister, screening is all the more urgent, with regular screening possibly beginning at an even earlier age.
Most women of childbearing age have either heard of or had the privilege of experiencing a Pap smear. This is the standard screening test for cervical cancer. It is recommended that women have Pap screening every third year during their reproductive years and until age 64, assuming all Pap smears have been normal. An abnormal result will require more frequent testing or referral for additional studies. No further testing is needed after age 65. (Now that is something worth looking forward to!)
Screening for prostate cancer is more controversial. I generally recommend an examination of the prostate at age 50, and yearly thereafter to the age of 75. Controversy exists because early detection of prostate cancer has never been shown to improve the rate of mortality in those individuals with positive findings. Two good studies are underway to help settle the question, but the results will not be available until 2009.
This discussion of cancer screening in adults is by no means exhaustive, but it provides a foundation for decision-making as you strive to take good care of your body. In the next issue of the Court Report, we will discuss the remaining categories of adult preventative health care.
|About the author
Rodger Sayre, MD, FAAFP, has been an HSLDA board member since 1997. He and his wife, Mary, homeschool their 11 children. Dr. Sayre received his medical degree from Thomas Jefferson University, is a Diplomat of the American Board of Family Medicine, and is a Geisinger Medical Group associate with a busy practice in Tunkhannock, Pennsylvania.