BoomerGirl Diary

Dear Susan:

I am 51 and I think I should have a colonoscopy. I should have had one years ago but I keep putting it off. I even scheduled it once when I was 45 ago but then cancelled. My doctor recommended it but she is very busy, lost of patients, and isn’t pushy … So I let it slide.

I’m like this with a lot of medical things (I put off the dentist until I have a toothache). I just get anxious and phobic. But my aunt died of colon cancer, and my dad had something removed.

How do I get over the procrastination?

Phobic

Dear Phobic:

This isn’t like going to the dentist. The consequences here are far more serious. Like dying. Slowly and painfully. At a young age. Which is preventable if you catch colon cancer early.

Am I making my point?

Procrastination and phobia are quite different. The first is a tendency to avoid uncomfortable things, to push away what you don’t want to deal with. The latter is a breath-stopping anxiety-attack reaction that is physically and emotionally paralyzing.

You are not phobic, so you can manage this.

I just happen to have an article I wrote five years ago called “Susie Gets A Colonoscopy.” I was just like you … procrastinating! Lots of people get anxious about this valuable and life-saving procedure, when it is routine and painless. So, it helps to know what to expect, down the the itty-bitty details. So, read on, then pick up the phone and make the appointment!

Susie Gets A Colonoscopy

(or Colonoscopy for Dummies)

Colonoscopy. It’s one of those medical procedures that’s easy to put off. And off. And off.

I didn’t have any “serious” symptoms. No rectal bleeding or blood in my stool. But I did have chronic, unpredictable (and terrifically inconvenient) diarrhea, stool changes, plus excessive gas, bloating, cramping, fatigue. These symptoms are all consistent with IBS (Irritable Bowel Syndrome) but also consistent with early stages of colorectal cancer, ovarian cancer, and some other cancers and diseases. But, perhaps because they are “generic” symptoms (unlike a lump in one’s breast), they were easier to rationalize away. “I’m just stressed out,” I’d think. “I need to eat healthier, lower the stress.”

Now, I’m a reasonably intelligent 52 year old woman. And yet, despite all my smarts, I procrastinated, not weeks or months, but a few years before getting a referral to a gastroenterologist and scheduling a baseline, diagnostic colonoscopy.

A colonoscopy (in case you don’t know) is a procedure where a gastroenterologist uses a long, flexible, lighted tube to view the entire colon and rectum for polyps, signs of cancer, diverticulosis (diverticuli are pockets or projections extending from the colon.) The tube has a camera , which projects images on a screen. Polyps found can be removed for biopsy (which is very handy as many polyps eventually evolve into cancer.) It’s generally done under a light anesthesia. It’s an amazing diagnostic tool.

“I tend to recommend a baseline screening colonoscopy to be done sometime between 50-60 years of age. Since colon cancer is frequently asymptomatic, the best time to diagnose it is before it causes symptoms,” said gastroenterologist Dr. Teresa King. “Colorectal cancer is the third leading cause of cancer death. Over 67,000 women are diagnosed annually and more than 40% die from the disease. Early detection and treatment are key to survival.“

So why the resistance? Maybe it’s the thought of how the cute, little camera gets all the way up the colon. Maybe it’s the required preparation. Maybe it’s anxiety about the unknown. Maybe ....

It was, after all the angst, no big deal. The "prep" required a 24-hour clear liquid diet, but it allowed juices, broth, coffee, tea and pop. I had to take 3 tablespoons of Fleets Phospho-Soda in 4 oz. of water or juice the evening before and again the morning of the procedure (Not the greatest taste, but hold your nose and guzzle and it’s over in under six seconds) and drink four glasses of water or juice over the course of the evening. And I had to stay close to the bathroom. Very close.

The colonoscopy itself, at an outpatient facility, was smooth sailing. Within minutes I was checked in and escorted by my nurse down the hall to the procedure room. After the usual blood pressure checks, etc., an IV was started. I was completely draped, with warm blankets over my lower half (not that I’m particularly modest, but I’m not keen on drafts on my bottom.) I even kept my sweater on. My gastroenterologist, Dr. King, came in, and we chatted about any concerns. Then I was comfortably settled on my left side, and the drip started. The next thing I knew, I was in a cubicle in a recovery area, my husband was sitting next to me, and I felt sleepy, peaceful ... and wondering when the procedure was going to start (anesthesia can be so lovely). The colonoscopy took under 30 minutes, and the entire hospital stay was about two hours. It was totally painless. If I didn’t have the pictures (where one’s colon looks like the graphics of a video game), I’d swear it never happened.

The good news is that there was no sign of cancer or diverticulosis. And since I am an "average risk" individual, a repeat colonoscopy is not needed for 7-10 years (although an annual physical, with digital rectal exam, PAP and pelvic, and occult blood stool check, is important.)

So, now I can work with Dr. King to deal with the IBS by identifying dietary triggers, increasing exercise, lowering stress (yeah, right).

And I now recognize just how dumb it was to procrastinate.

How dumb would that be? Very, very, very dumb.

Symptoms of colorectal cancer:

• Rectal bleeding
• Blood in stool (bright red to very dark)
• Change in bowel movements, especially in stool shape (pencil thin)
• Cramping pain in lower abdomen
• Chronic gas pain
• Urge to move bowels when no need
• Fatigue

Risk factors for colorectal cancer:

• Average risk:
• Age 50 or older with no other risk factors.

• Increased risk:
• Family history of CRC or polyps
• Personal history of polyps
• Family history of multiple cancers involving breast, ovary, uterus, etc.
• History of inflammatory bowel disease such as Crohn’s Disease or ulcerative colitis
• Low fiber, high fat diet
• Sedentary lifestyle

Colonoscopy recommended when:

• Rectal bleeding or change in bowel habits
• Unexplained abdominal symptoms
• Examine patients who tested positive for blood in their stool
• Check for inflammatory bowel disease
• Age 50 or over