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Old 01-28-2008, 12:30 AM   #21
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Stop dithering. The risk of perforation is directly related to the number of biopsies. Having had two friends die of colon cancer that originated in the right colon area, I am a strong advocate for getting the full monty. I think having to do home stool occult blood tests is just impractical and not reliable.

It sounds like you are looking for an excuse. I consider my colonoscopy the best medical insurance I have. Now I know what I have and don't have.
To take a different view of this, let me tell you that the Colonoscopy was recommended by my Dr. when I turned 50 during my annual physical. It is TOTALLY paid for by my insurance. This leads me to believe (because the black hearted, non-caring) insurance company actually pays for this as preventative health care, that it is cheaper to find the cancer early then to try and treat it after it has spread. It must actually work. The insurance companies are in the business of insurance, not keeping you alive.
GET THE COLONOSCOPY! Tell the doc you want it and you want it NOW.

to quote a 60's (drunk driving?, no smoking?, or Smoky The Bear?) ad ' remember the life you save could be your own '.
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Old 01-28-2008, 01:01 AM   #22
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Maybe this will help: Sigmoidoscopy Screening Misses Cancer More Often - National Cancer Institute

"People aged 50 and older commonly develop small growths on the inner wall of their colon or rectum that may or may not turn into cancer."

"Colonoscopy is the most effective screening tool but it is also the most invasive and expensive"

"Less effective but also cheaper and safer is flexible sigmoidoscopy, which also inserts a lighted tube into the colon but less than half as far, leaving the upper (proximal) part of the colon unexamined. Both methods risk puncturing the colon, but the risk is somewhat greater for colonoscopy."

Results of the study:

"Advanced neoplasia were detected in 72 (4.9 percent) of the 1,463 women. Of these, researchers determined that only 25 (1.7 percent, an absolute difference of 3.2 percent) would have been diagnosed as having advanced neoplasia if they had been screened with sigmoidoscopy alone.
In other words, 47 of the 72 women (64.8 percent, or two-thirds) who actually had advanced colorectal neoplasia would have been told there was nothing to worry about if examined by sigmoidoscopy alone. The comparable percentage of men who would have been falsely diagnosed from VA Cooperative Study 380 was 33.7 percent – half that of the women. Researchers didn’t know what accounted for the gender difference."

So, there you have it, perforation issues exist with both, but are lower with a sigmoid. I'm sure there's also some risk with sedation involved with the colonoscopy. However, the risk of perforation according to these people: eMedicine - Colonoscopy : Article by Jennifer Lynn Bonheur, MD

"The risk of perforation of the colon is 0.2-0.4% after diagnostic colonoscopy and 0.3-1.0% with polypectomy. A higher rate (4.6%) is associated with hydrostatic balloon dilatation of colonic strictures. Perforation is more common (1) in patients who are oversedated or under general anesthesia, (2) in the presence of poor bowel preparation, or (3) with acute bleeding, and generally results from mechanical or pneumatic pressure or from biopsy techniques."

So, compare a 0.2%-1% risk of perforation against the fact that, in men in an at-risk group, the sigmoid caught the cancer 33% less. That's quite a gamble, especially when it's your life.
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Old 01-28-2008, 01:39 AM   #23
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I think having to do home stool occult blood tests is just impractical and not reliable.
.
Impractical or not, I collect the samples and return them to the doctor who has the lab test them. They get done.

And where is the demonstrated stats that those who get full colos have less eventual deaths due to cancer than those who get sigmoidos along with the blood tests? If there is no better outcome from colo, isn't that a reason to question going that route?
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Old 01-28-2008, 01:43 AM   #24
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Thanks for the references. This is the type of data I was looking for. Of course, now I get to choose whether to believe the other reputable article I read, or the above article with differing conclusions.
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Old 01-28-2008, 02:04 AM   #25
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After reading these posts and my own experience, now I'm wondering whether a sigmoid is a "poor man's" colonoscopy, based on the level of one's health insurance?
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Old 01-28-2008, 02:53 AM   #26
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I think the worst part of my sig was watching it with the doc. I felt sorta invaded.
I dunno, I guess I've had it done too often - I'm starting to like it.
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Old 01-28-2008, 07:34 AM   #27
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Thanks for the references. This is the type of data I was looking for. Of course, now I get to choose whether to believe the other reputable article I read, or the above article with differing conclusions.
fwiw, my doctor talked to me and showed me severa studies that indicated he and others were more inclined to use sigmoids for initial screenings.

In my case, when I need to start screening, I think I'll go with the colonoscopy because I have a family history of colon cancer. If I didn't have that history, I would be inclined to go with a sigmoid either initially or for subsequent screenings.

The sigmoid is a fun ride (ok, no, no it's not, but it is memorable). Prep for it is way worse than a colonoscopy, though.
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Old 01-28-2008, 08:37 AM   #28
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I also have had both, was interesting that the Sigy was done by my general practitioner in his office. I agree with all the comparisons of the two.

Anyway the real reason I'm adding to this pleasant thread is the prep. I have a bad gag reflex and after the Sigy I knew I was going to have problems. With a little research I discovered there is an easier way than drinking a gallon or so of evil tasting fluid. Try to get your doctor to prescribe Visicol pills. They are big and you have to take a total off 40 but they work and you can take them with your choice of clear liquid. My doctor said no, turns out he had never used them and had all kinds off inaccurate reasons why I couldn't use them. I told him I would not be able to get the liquid down and he would have to come up with something else or I would go to a different doctor. He went off and studied what Visicol was for 10 minutes (probably Googled it), turned out it was similar to the liquid but in pill form and he agreed none of what he warned me about was true. He agreed to try it with the warning that if it didn't work we would have to do it over. They worked fine and a lot easier. My wife has used them twice, once just the pills and once the pills and a small bottle of the liquid which she could manage, worked fine for her to. I don't remember the exact way you took them but it was something like 4 at a time with 12oz of liquid every 15 minutes till you have used the first 20, then a waiting period then another series of 4 at a time till the second 20 was finished. So you end up with lots of liquid but it is good tasting liquid.

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Old 01-28-2008, 09:21 AM   #29
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The sigmoid is a fun ride (ok, no, no it's not, but it is memorable). Prep for it is way worse than a colonoscopy, though.
Marquette, how do the preps differ? I would have thought they would be essentially the same.

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Old 01-28-2008, 10:01 AM   #30
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Marquette, how do the preps differ? I would have thought they would be essentially the same.

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Fun information to follow.

First, it could simply be a fact that my wife and I went to two different clinics for two different reasons (she was being tested for wheat allergy while they were trying to track down some mysterious bleeding in my case).

For my wife's colonoscopy, she had to drink two bottles of magnesium citrate (as an aside, do not drink this with your favorite juice, you will never touch that juice again after the procedure) followed by Fleet Phospho-Soda.

I also had to do the magnesium citrate. However, I got to follow that lovely procedure with an enema and two suppositories.

So, in my case, I had to clean my colon out, then wash it out with saltwater, then I got to follow it up by shoving a horse pill up there, twice. Honestly, I was on the floor in the bathroom in the fetal position wimpering as I tried to go through with it... not one of my stronger moments.

edit: Another possibility is that my doctor hates me. Also, make sure you find out how to stay hydrated with either procedure. My wife, who normally can get an IV right away, had veins so shrunk that they had to try both hands for a spot.
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Old 01-28-2008, 02:18 PM   #31
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Thanks for all the info, experiences, and *encouragement*?

Now anyone wonder why I originally titled this thread "virtual colonoscopy", and was looking into (hoping for) some magic, easy, effortless alternative?

Anyway, I have just one more stool sample to collect to send back to doc. If it shows blood---or has a false positive, maybe cause I ate the wrong thing---I get the full colo. Otherwise I get another sigmoido in about three weeks.

Then I'll be good for five years with only more stools to collect samples from every year.

I may go for the full colo five years from now.

I am apparently considered "average" risk since no history of colon cancer in sibling, parents, or either set of grandparents. Plus I had a "very clean" sigmoido result last time (so said the butt doctor), and no blood in any of the stool tests since then.

Isn't ER great? Time to study all this cr*p?
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Old 01-28-2008, 04:13 PM   #32
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I have a bad gag reflex and after the Sigy I knew I was going to have problems.
Not to trouble you too much, but I think your doc pushed the camera in too far. Or, went in the wrong way. You may want to try a different doctor in the future
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Old 01-28-2008, 11:28 PM   #33
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FYI: Screening info and guidelines from American Cancer Society (ACS :: Error) for colorectal cancer----


American Cancer Society Colorectal Cancer Screening Guidelines
Beginning at age 50, men and women who are at average risk for developing colorectal cancer should have 1 of the 5 screening options below:
  • a fecal occult blood test (FOBT)* or fecal immunochemical test (FIT)* every year**, OR
  • flexible sigmoidoscopy every 5 years, OR
  • an FOBT* or FIT* every year plus flexible sigmoidoscopy every 5 years**, OR
    (Of these first 3 options, the combination of FOBT or FIT every year plus flexible sigmoidoscopy every 5 years is preferable.)
  • double-contrast barium enema every 5 years**, OR
  • colonoscopy every 10 years
*For FOBT or FIT, the take-home multiple sample method should be used.
**Colonoscopy should be done if the FOBT or FIT shows blood in the stool, if sigmoidoscopy results show a plyp, or if double-contrast barium enema studies show anything abnormal. If possible, polyps should be removed during the colonoscopy.
In a digital rectal exam (DRE), a doctor examines your rectum with the gloved end of his/her finger. Although a DRE is often included as part of a routine physical exam, it is not recommended as a stand-alone test for colorectal cancer. However, your doctor should do a DRE before inserting the sigmoidoscope or colonoscope. This simple test, which is not usually painful, can detect masses in the anal canal or lower rectum. By itself, however, it is not a very sensitive test for detecting colorectal cancer due to its limited reach. Doctors often find a small amount of stool when performing a DRE. However, simply checking stool obtained in this fashion for evidence of bleeding with an FOBT or FIT (iFOBT) is not an acceptable method of screening for colorectal cancer. Research has shown that this type of stool exam will miss more than 90% of colon abnormalities, including cancers.
  • If you are at an increased risk, or higher than average risk, of colorectal cancer, you should begin colorectal cancer screening earlier and/or be screened more often. The following conditions place you at higher than average risk
  • a personal history of colorectal cancer or adenomatous polyps
  • a personal history of chronic inflammatory bowel disease
  • a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60, or in 2 first-degree relatives of any age)
  • a known family history of hereditary colorectal cancer syndromes (familial adenomatous polyposis or hereditary nonpolyposis colon cancer)
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Old 01-29-2008, 01:25 AM   #34
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Thanks for all the info, experiences, and *encouragement*?

Now anyone wonder why I originally titled this thread "virtual colonoscopy", and was looking into (hoping for) some magic, easy, effortless alternative?

Anyway, I have just one more stool sample to collect to send back to doc. If it shows blood---or has a false positive, maybe cause I ate the wrong thing---I get the full colo. Otherwise I get another sigmoido in about three weeks.

Then I'll be good for five years with only more stools to collect samples from every year.

I may go for the full colo five years from now.

I am apparently considered "average" risk since no history of colon cancer in sibling, parents, or either set of grandparents. Plus I had a "very clean" sigmoido result last time (so said the butt doctor), and no blood in any of the stool tests since then.

Isn't ER great? Time to study all this cr*p?
yeah, it's not a good idea to have a rare steak before you submit your sample. ... by the way, the reason I had my 1st colonoscopy at 50 was that my (very thorough) Dr. suggested it as a baseline for me. If it showed nothing then I was good for 10 years. It turned out I had a couple of non-cancerous polyps, which they removed. I am now on the '5 year' plan. The last one I had showed no polyps ... The 'butt Dr.' (love that term) will be seeing me (literally) in 5 years. My DW who had the test at the same time was clean (no comment) ... and is on the 10 year plan. If you have to do the prep, I think I would have the whole monty so you have a baseline. ... but that's me.
Good luck on your tests whichever you choose.
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Old 02-15-2008, 12:03 AM   #35
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Got a clean (ie, no blood) fecal occult blood test sample result after my physical. Had my flexy sigmoido done, and no polyps or bad things found. The sigmoido doc siad I am good for another five years.

The first time I had a sigmoido, that doc made me come back a second time a week later and I had to fast and reclean colon all over again (even though I followed the prep instructions to a letter the first time). Then it took him about 20-30 minutes to do the sigmoido screening, and much of that time was the "going in" time.

This time this doc was able to go right in (no sending me home to reclean my colon with another fast), and he was out and done in maybe 10 mintues total, and most of that was the coming out time. Very efficient, yet thorough. Makes me wonder now about the first guy all these years later.

Anway, now I just done annual blood stool tests till five years. Then I decide if I go the full colo route next time. OR see if they have refined some new blood testing techniques by then to help zero in on colon cancers. I understand some tests along this line are on the horizon, and only if positive blood tests from these bio-markers would they then do colonoscopies.
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Old 02-15-2008, 12:38 AM   #36
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. . . OR see if they have refined some new blood testing techniques by then to help zero in on colon cancers. I understand some tests along this line are on the horizon, and only if positive blood tests from these bio-markers would they then do colonoscopies.
There is some very encouraging research along that line, a blood test that came back positive for 100% of colon cancers; the problem with the test as it stood last summer was it also came back with false positives 18% of the time when all the patient had was common, benign polyps. So the concept needs to be refined so it cuts the false positive rate down to the point where there's at least a 50-50 or better chance that the patient returning a positive test has pathology that needs attention, otherwise you spend a heck of a lot of money and worry a heck of a lot of people over diagnosing a common, benign condition of aging.
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Old 03-23-2008, 11:43 AM   #37
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When did knocking you out become routine for a colonscopy? I had one in my mid-40's and I was awake the entire time. The Dr. even showed me how much of that microscope line he had up me (gosh, looked like 4 feet!). Didn't hurt at all. The prep was far worse than the test was.
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Old 03-23-2008, 11:57 AM   #38
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When did knocking you out become routine for a colonscopy? I had one in my mid-40's and I was awake the entire time. The Dr. even showed me how much of that microscope line he had up me (gosh, looked like 4 feet!). Didn't hurt at all. The prep was far worse than the test was.
I was awake during mine 12 or 13 years ago. I am about to schedule my next one so will be interested to see if I am concious or not. I'm expecting not as DW and a friend who I picked up from after he had his were both unconscious.
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Old 03-23-2008, 01:40 PM   #39
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The Dr. even showed me how much of that microscope line he had up me (gosh, looked like 4 feet!). Didn't hurt at all.
I think men usually are not fond of big things being shoved up their butts. We are prejudiced against it.

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Old 03-23-2008, 01:57 PM   #40
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i'm a few few months short of 49. Not at all looking forward to this. I guess the alterrnative is worse...
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