Fifty Is the New 40... Except for Cancer Screenings

My wife didn't want to get her first screening colonoscopy when she turned 50. Imagine that. In fact, it took me several years to convince her to take the plunge.  I kept telling her it's not as bad it it seems. I should know. At 50, I've already had four colonoscopies.

No, I'm not a masochist or some kind of pervert. I am one of those lucky guys who has a family history of colon cancer, which allowed me the privilege of starting my screenings at age 40. But I was even luckier than that! At 38 years of age, I was having some vague symptoms that required an extensive workup, beginning with a flexible sigmoidoscopy.

So here's my first life lesson that I want to share with you: If you're going to be proctally probed with a hose, I suggest you go all the way. You see, a flex sig (as we call it in "the business") invades only about 60 centimeters of your colon, while a colonoscopy penetrates all the way to your appendix, where your colon ends and your small intestine begins. Why suffer the indignity to have only a third of your colon explored, when for the same amount of indignity, you can have the whole darn thing look-see'd?

Another benefit of colonoscopy over flex sig: If your colonoscopy is "clean," you don't have to repeat it for 10 years. If you have a flex sig, on the other hand, and it is negative (no susupicious findings), you have to repeat it in five years.

Here's another important fact: It's not the colonoscopy, but the "prep" that is darn near unbearable. The "prep," or preparation, is a process designed by the Marquis de Sade. It requires that you drink a gallon of lemonade-flavored polyethelyne glycol (the main ingredient in antifreeze) the night before the Big Event.

About the time you get halfway through the jug of "prep," you'll discover what you are preparing. You are in fact going through a cleansing, to remove any material in your colon that might obstruct your physician's view through the scope of the surface of your colon. You might even be moved to file a truth-in-advertising complaint with the Federal Trade Commission against the manufacturer of the number-one selling prep, "Go-Litely." There ain't nothing "litely" about it. You go like a rocket-propelled grenade.

So, as I said above, I had the privilege of getting "scoped" for my first time at 38, and it was by my PCP, who performed a flex sig. I was surprised when he told me, contrary to what I had expected, that sedation is not necessary for a flex sig. And he was right: He didn't need any sedation to perform the procedure. But I sure as hell did. Instead I was completely awake and completely aware of every maneuver my doctor made... in particular the invasive maneuvers. I fully expected to watch the tip of that sigmoidoscope burst through my belly button like the baby extraterrestrial in the movie Aliens. Now I know how my bathroom sink feels when the plumber comes to snake the drain.

The doctor found three polyps. But because they were beyond the reach of the sigmoidoscope, he referred me to a gastroenterologist to perform a complete colonoscopy. The colonoscopy was much better than the flex sig, mostly because I was gorked out on morphine and fentanyl for the whole procedure. I woke up in the recovery room, not even realizing that the deed had been done. The rest of the day I was very happy, and telling everyone how much I loved them, beginning with my GI doc (who moved to Nashville immediately afterward), and the nurse who wheeled me out of the unit, and the cab driver who took me home. And the postman when he delivered the mail to my house.

The prep, however, was the same nasty thing. I'm trying to figure out how to invent a Go-Lite-tini (Grey-Goose, vermouth and magnesium sulfate, with a lemon peel) that will ameliorate the experience.

One of the polyps was pre-cancerous, so I was scheduled to repeat the procedure in three years. Two more polyps at 41, followed by another colonoscopy at 45 (three polyps) and a third colonoscopy at 49, which was finally "clean." I go back for my next colonoscopy at 54 (five-year interval).

You should be more fortunate than I. If you have no first-degree relatives with colon cancer, you should have your first colonoscopy at 45 if you are African-American, and at 50 if you are of any other ethnic background. If your first colonoscopy has negative findings, you won't have to repeat it for 10 years.

Colon cancer develops over five to ten years. The disease should be nearly 100 percent preventable, if people get screened and find pre-cancerous lesions before they develop into malignancies. But because only 63 percent of eligible adults get screened for colon cancer, nearly 143,000 people will be diagnosed with the disease this year, and more than 51,000 people will die from colon cancer.

It's not fun to get screened for colon cancer. But if you think colon screening is unpleasant, imagine how unpleasant colon cancer treatment must be. Not to mention dying of the disease.

For more information on colon cancer, its prevention and treatment, visit the American Cancer Society's web page at www.cancer.org. If you want to know how to get screened, e-mail me. I'll be happy to assist you.