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Practice What You Preach – A Colorectal Surgeon Gets a Colonoscopy

Colonoscopy appointment date on calendar

As a colorectal surgeon, I have been telling my patients over the past 17 years to get their screening colonoscopy. Well, I just turned 50 and now it is my turn. Just like many of my patients, I had a million excuses not to get it done. Primarily, I was just too busy to take the bowel preparation the day before and too busy to miss work. This was not on the top of my “to do” list. But, I knew as a doctor, this was a must. I have seen too many patients delay getting a colonoscopy and develop colon cancer. Colon and rectal cancer are one of the few cancers that are preventable. Almost all colorectal cancers start out as small polyps that slowly grow and transform into cancer over several years. The idea in doing a colonoscopy is to detect polyps and then remove them. By removing the polyps, you can hopefully avoid developing cancer.

I was determined to practice what I preach and so I scheduled my colonoscopy. Here is how it went:

The day prior to my procedure I had a light breakfast and was only allowed to drink clear liquids the remainder of the day. I would start the actual bowel preparation later. I worked all day and had a business meeting afterwards. As soon as I came home, I drank my first glass of the preparation followed by 40 ounces of fluids. The preparation tasted like lime soda. Over the next hour I could feel rumblings in my stomach which gradually rose like a baby alien wanting to come out. Then I got the call and off to the bathroom I went. And I went…. And I went….. Within an hour and a half, I think my colon was empty. There was nothing but water. But, I knew I had to take a second glass of preparation later. My friend and colleague was performing my procedure and I wanted to be as cleaned out as possible. We don’t have many secrets in our house so I was the center of several of my children’s jokes the rest of the night. Again, since my procedure wasn’t until mid-day, I didn’t have to take the second glass until early the next morning. I went to bed and got up twice to go to the bathroom. I tossed and turned all night worried about the second glass of preparation. Will I get nauseated or vomit? Will I be cleaned out enough? Will I be able to drive to work and see patients in the morning without having an accident? Will I forget to wake up in time to take it? At 5AM, I drank the second glass and again another 40 ounces of clear liquids (Gatorade) and waited. Within an hour, the results started with a lot of watery bowel movements. I was done by 7AM and went to work.

Everyone in my office knew that I was getting a colonoscopy and cautiously asked me how I was doing. Several of my staff already had colonoscopies done by me and were familiar with “the drill”. I saw a few patients before my own scheduled appointment and only had to rush out of one my patient’s room to use the restroom.

I arrived at the surgical center at 11:30 AM. I was interviewed by the nurse and she started the IV. My friend and now doctor arrived and off to the procedure room we went. After several safety monitors were placed, I lay on my left side and went to sleep. The next thing I knew, I was waking up in the recovery room asking, like so many of my patients, when are we going to get started. Dr. Mari Madsen chuckled a little, said I was done, and showed me healthy pictures of my colon. No polyps and no cancer. Yeah!

After about 30 minutes, my family picked me up and we drove to Disneyland for my daughter’s birthday. It was the best present I could give her….my health. Surprisingly, the whole thing wasn’t that bad. Please put your colonoscopy on your “to do” list and then check it off.

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Cologuard vs Colonoscopy

3d rendered illustration of a polyp removal

Colorectal cancer is the third most common cancer in the United States among both men and women and is the second leading cause of cancer-related deaths. Colon cancer screening has been shown to significantly reduce the risk of colon cancer and death. Almost all cancers in the colon and rectum start as a small polyp or a growth in the lining of the colon. Over years, these polyps can slowly grow and transform into a cancer. Unfortunately, by the time a colon cancer is causing symptoms, such as bleeding or discomfort, it is usually large and already reached an advanced stage. This is why colon cancer screening is so important! The best time to treat a cancer is before it develops, not after…more on this later.

Colonoscopy is the gold standard for colon and rectal cancer screening and it is a quick, safe and painless procedure.   A bowel preparation is taken at home to clean out the colon the day before, which allows us to detect and remove any polyps that are present. Under sedation, a flexible lighted instrument is passed through the colon and rectum. The colon is carefully evaluated and if any polyps are seen they are removed. If a mass or lesion is too big, it is simply biopsied. The examination has an extremely small risk of complications (0.1% to 0.2% risk of bleeding or perforation). The goal is to prevent you from getting colon cancer by removing the polyps or precursors to colon and rectal cancer. Remember, when you have these polyps, you don’t know you have them because they are too small to cause problems. The secondary goal to screening would be early detection of cancer that can be curable if treated it is early stages. The recommendations by the American Cancer Society are to have a screening colonoscopy every 10 years (this timing is shortened if you have a history of colonic polyps, a family history of colorectal cancer or certain other risk factors).

Cologuard is a newer, non-invasive test for detecting colon cancer – perhaps you’ve seen television ads for it. Every day the lining of your colon sheds cells. These cells are expelled with your stool. Cologuard uses advanced stool DNA technology to find abnormal DNA and blood that may be associated with cancer or large precancerous lesions or polyps. If a Cologuard test is positive, you will need a colonoscopy for further evaluation.   In a 10,000 patient clinical study, Cologuard found 92% of colon cancers but only 69% of large polyps. It is not very good at findings small polyps. In contrast, colonoscopy can detect colon cancer over 95% of the time and miss rate of large polyps is only 6-12%.

Although the Cologuard test is a great advancement for the screening of colorectal cancer, in our view, it is not great for preventing colorectal cancer. The goal in screening for colorectal cancer is to REMOVE POLYPS BEFORE THEY EVER BECOME CANCER, not merely detecting a cancer once it has formed. As we mentioned earlier…it is always better to PREVENT CANCER than to treat it once it exists! Colonoscopy remains the best method allowing us to detect and remove polyps that may progress to cancer in the future. Currently stool tests aren’t sensitive enough for detecting small polyps and we reserve its use for people who cannot undergo a colonoscopy due to other medical conditions.

Colonoscopy remains THE GOLD STANDARD for colorectal cancer screening. It is a safe procedure with a proven track record and can, literally, save your life. The procedure itself is a non-event – you’ll be enjoying lunch within an hour after finishing and back to work the next day. Please don’t procrastinate and put yourself at risk — get your colonoscopy scheduled and get on with living a healthy, happy life.

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New Surgical Technique Targets the Source of Hemorrhoids and Yields Great Results

THD HemorrhoidsDo you suffer from hemorrhoids? Don’t worry. You are not alone. People are often embarrassed to talk about hemorrhoids. But everyone has hemorrhoids. Yes, you read that correctly. Everyone has hemorrhoidal tissue as part of his or her normal anatomy. Hemorrhoids are cushions of connective tissue with blood vessels. While there is no real scientific evidence as to the function of hemorrhoids, many physicians believe hemorrhoids help keep stool from leaking out of the anus.

Enlarged hemorrhoids, which can result in bleeding, pain, discomfort, and a prolapse or protruding hemorrhoid tissue, are caused when excess blood flows into the hemorrhoids causing the tissues to swell and stretch. This often occurs when the veins are under pressure from straining during a bowel movement, chronic diarrhea or constipation, obesity, pregnancy or even sitting for long periods of time on the toilet. When the veins around your rectum and anus stretch under pressure, hemorrhoids can bulge or become swollen either internally or externally.

It’s true that hemorrhoids are more likely to affect people as they age because the tissues that support the veins in your rectum and anus weaken as you get older, however, it’s important to note that hemorrhoids can affect anyone regardless of age. In fact, hemorrhoids affect 86% of Americans, and 50% of Americans will have suffered from hemorrhoids by the time they are 50 years old.

There are a number of treatment options for hemorrhoids. First and foremost is changing your diet. Physicians recommend eating a diet that is rich in high-fiber foods and low in processed foods, as well as increasing your fluid intake to six to eight eight-ounce glasses each day. In addition, topical creams and ointments such as hydrocortisone, warm sitz baths and Tylenol may help alleviate symptoms. Once you have enlarged hemorrhoids, however, they usually do not go away completely and you may need one of the following procedures to better manage the symptoms.

  • Injection sclerotherapy: This involves injecting the hemorrhoid with a solution that creates a scar and reduces the blood flow, however, it cannot be used for prolapsed or external hemorrhoids.
  • Photocoagulation: This uses an intense beam of infrared light. Heat created by the infrared light causes scar tissue, which cuts off the blood supply to the hemorrhoids. This procedure can only be used for small to mid-size internal hemorrhoids.
  • Rubber Band Ligation: This process ties off internal hemorrhoids at its base with rubber bands and cuts off the blood flow. It can require multiple procedures to fully remove all of the hemorrhoids.
  • Hemorrhoidectomy: This procedure involves making an incision, removing the external and internal hemorrhoidal tissue, and a recovery period of two to three weeks that is very painful.
  • Stapled hemorroidopexy (PPH): This minimally invasive technique uses a circular stapling device to remove the prolapse and secure the remaining hemorrhoidal tissue back in place with staples. It removes the rectal mucosal tissue, which is above the anus where the nerve endings are less sensitive, so the patient is not in as much pain during recovery as with a traditional hemorrhoidectomy. Usually patients can return to normal activities within four days.

 New hemorrhoid surgical procedure boasts great results 

All of the above treatments and procedures focus on fixing the symptoms of hemorrhoids not the source of hemorrhoid disease—excess blood flow. They remove the hemorrhoids or strive to alleviate pain, bleeding, and discomfort from enlarged or prolapsed hemorrhoids. Today, patients have access to a new, minimally invasive surgical technique that treats the source of hemorrhoid disease, offers a quick recovery, and has yielded great results for patients suffering from hemorrhoids. The procedure is called transanal hemorrhoidal dearterialization (THD). It targets the arterial blood flow that feeds the arterial plexus. The surgeon uses an anascope fitted with a light and a Doppler ultrasound probe.The procedure uses sound waves to locate hemorrhoidal arteries. Then the surgeon uses a ligation technique to tie off the blood flow.

THD Hemorrhoid 1

Next, the surgeon repairs the prolapse by lifting the tissue back into a more normal position.

THD Hemorrhoid 2

This hemorrhoidopexy procedure takes place in a part of the anal canal where nerve endings are less sensitive so it’s not as painful as traditional surgery. There is no excision of tissue and patients can resume normal activities within four days.

THD Hemorrhoid 3

THD received FDA approval in 2007 and has been gaining traction in the United States recently with more than 20,000 procedures performed annually. The benefits of THD to treat hemorrhoid disease include:

  • No removal of hemorrohoidal tissue
  • Reduced bleeding during the procedure
  • Less painful than traditional surgery
  • No anal stenosis, which is a narrowing of the anal canal that can make bowel movements painful. It can be a complication from traditional hemorrhoidectomy or PPH.
  • Low risk of complications and deformities
  • Quicker recovery

If you are suffering from hemorrhoid-like symptoms, you should go to the doctor and rule out any other causes of your symptoms such as colitis, Crohn’s disease, diverticulitis, or colorectal cancer. Then, if your hemorrhoids can’t be managed with the more conservative treatments, you should consider THD as a solution to rid yourself of painful hemorrhoids. Fortunately, most insurance and Medicaid plans to cover the THD procedure.

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The Role of Robotics in Colorectal Surgery

Robotic surgery offers a minimally invasive alternative to both open and laparoscopic colorectal surgery. When we are talking about robotic surgery systems, we are talking about a computer-controlled robot that physician’s use to assist them in surgical procedures. In other words, a physician moves the robotic arms and hands, makes clinical decisions, and performs the procedure. We are not talking about artificial intelligence. A physician is controlling the operation at all times.

Robotic surgical systems are a step up from both traditional open surgery and minimally invasive laparoscopic procedures because physicians benefit from:

  1. Better visualization. Robotic surgery provides physicians with a high-resolution three-dimensional screen that provides greater visualization and depth perception of the surgical field.
  2. Enhanced dexterity. The robotic arm can mimic the way a wrist would move. You can rotate it 360 degrees and bend it back or forward. This is an improvement over laparoscopic instruments, which are straight like chop sticks with no degree of movement.
  3. Improved precision. Physicians can also precisely move the robotic arm and hand, and the movement is scalable. For instance, the physician can move an inch outside the body and program that movement to be one-third of an inch inside the body.

There are still skeptics who question the benefits of robotic surgery and whether it is a financially appropriate system for healthcare. Yes, the initial outlay and training for a robotic surgery system is expensive. However, that cost is at the hospital or health system level. There is no difference in cost for patients receiving a laparoscopic or robotic procedure. The cost for patients is the same. In addition, the cost per use is not that expensive. Once you have purchased the technology, it makes more sense to use it rather than to leave it sitting in the corner.

While robotic surgery systems may be expensive, there are numerous benefits to patients including, smaller incision sites, reduced scarring, less blood loss, faster recovery time, reduced pain, and shorter hospital stays. In addition, many colorectal operations are performed near nerves that control the bladder and sexual function of patients. Because robotic surgery systems provide better visualization and dexterity, there is less chance of injuring those nerves. This means that robotic surgery can reduce complications, which reduces length of stay, which reduces cost per case.

The question that the health industry must answer now is which procedures benefit the most from robotic surgery? Even though you can perform a gall bladder surgery with the robot, doesn’t mean you should—especially if there are no added benefits to the patient. The types of colorectal procedures where the robot will make a big impact is in difficult operations in the deep pelvis such as rectal cancers and resections for anal cancer. This is because it is difficult for surgeons to access these areas to remove tumors without performing an open surgery that involves a large incision and long difficult recovery for patients. There are also certain patient populations, such as obese patients or those with a narrow pelvis, who would benefit from robotic surgery. For colorectal surgery, the industry is still defining which procedures and patients would benefit most from robotic surgery, because it is still a relatively new technology for this specialty.

In the future, there is no question that robotic surgery will play an even larger role in reducing surgical complications and improving patient safety. The robot is already equipped to inject a temporary dye into the blood stream of patients undergoing bowel surgery, which enables the surgeon to see the blood flow to the anastomosis. This can help the physician reduce the likelihood of future leaks from the procedure, which is one of the main complications of bowel surgery. Soon there may be other markers that can help reduce complications from other colorectal procedures and further improve patient safety.

 

 

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When Should You See a Doctor for Rectal Bleeding?

Everyone who has rectal bleeding should go to the doctor. There are numerous causes of rectal bleeding from something simple like hemorrhoids or irritation at the opening of the rectum to bleeding that is caused from something more serious like a cancer or diverticulosis. I would advise everyone to err on the side of caution and go to the doctor if you have rectal bleeding. Now, if you are 20 years old and have a hard bowel movement and you see a little blood and it goes away, I am not worried about that. If you are 20 years old and the bleeding persists, then you should be evaluated by a physician along with anyone over the age of 25 who has rectal bleeding.

The two most common misperceptions that colorectal surgeons hear from patients are the following:

  1. “It was bright red blood, so I thought that meant it wasn’t serious.”
  2. “I thought it was just a hemorrhoid that bled occasionally.”

There are many causes of rectal bleeding, including hemorrhoids, an anal fissure, infection, diverticulosis, an ulcer, inflammatory bowel disease, or cancer. The color of the blood may indicate the origination of the bleeding. For example, bright red blood may mean the source is low in the rectum or colon and dark red blood may indicate the bleeding is higher in the colon or small bowel. Regardless of the color of the blood, you should go to the doctor.

Most of the time the cause of rectal bleeding will be a minor issue, however, it can be something more serious. Colorectal surgeons often see patients who thought that they had a hemorrhoid problem and it turns out to be cancer. Our policy is that we want everyone—except for a very young person with a little smidge of blood that goes away—to be evaluated just to be safe.

I would also recommend being examined by a physician who is a colorectal specialist. Granted, I am a colorectal surgeon, so this may seem biased. However, the truth is that no one is really trained to evaluate the anal/rectal region of the body except a colorectal surgeon. Most general practitioners and general surgeons are not formally trained in this region of the body. This means that even physicians may mistakenly assume that the bleeding is from hemorrhoids. Yet half of the time, it’s not hemorrhoids. I had a woman in my office a few months ago, who complained to her gastroenterologist of rectal pain and bleeding for almost a year. The physician kept giving her suppositories and ointments. When I saw her in the office, her pain was so exquisite that I couldn’t examine her awake. I took her to the operating room to examine her and discovered that she had an anal cancer just inside the rectum.

 You don’t want to ignore rectal bleeding only to discover much later that you are in that 5% to 10% of patients with something more serious like anal or rectal cancer. The only way to determine if your rectal bleeding is a minor issue is to go to the doctor. A qualified physician can often determine the cause of rectal bleeding from the patient history and a small exam at the office. The exam is relatively simple and the physician will sedate the patient or use anesthesia if the patient is pain, so it will not hurt.  If the physician can identify the source of the bleeding, he or she will treat the source and reevaluate the patient in three to four weeks. If the bleeding goes away, then everything is fine. If the physician can’t identify the source of the bleeding or if the bleeding persists after treatment, then the patient will need further evaluation that may include a colonoscopy or a hospital stay.

People don’t like to talk about rectal bleeding or seek help because they are embarrassed are afraid of what the physician may find. My hope is that people will get past these fears and be evaluated when they have rectal bleeding. It may just save your life.

 

 

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Is a Colonoscopy Safe?

colonoscopy word display on tablet

The short answer is yes. A colonoscopy lets a physician closely examine the inside of the colon and rectum. The physician uses a thin, flexible tube with a small video camera on the end that is eased into the colon and can send pictures to a TV screen. The physician is looking for polyps, which are small growths that can become cancer. The majority of colorectal cancers start out as a small polyp, so the purpose of a screening colonoscopy is to prevent you from ever getting colon cancer or to detect a tumor early on.

Both men and women (at average risk of developing colorectal cancer) should start getting a screening colonoscopy at the age of 50, because that is when most people start developing polyps. However, African Americans should have screening colonoscopies starting at the age of 45 not 50, because of a higher incidence of colon cancer, as well as developing cancer at a younger age. Likewise, both men and women who have a family history of colorectal cancer should get an initial screening 10 years younger than the age any first-degree relatives were when they received a colorectal cancer diagnosis.

Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death. In 2012, 134,784 people in the United States were diagnosed with colorectal cancer and 51,516 people died from colorectal cancer, according to the Centers for Disease Control and Prevention. Colonoscopies are one of the few preventive tests that can actually increase cancer survival rates. If you are getting colonoscopies and having polyps removed then you will have less of a chance of getting colon cancer. That is why you should do it.

The two main risks of having a colonoscopy include a perforation, which is a tear in the colon or rectum wall, or bleeding from the site from where a tissue sample was taken or polyp was removed. When the physician removes a polyp, the colon wall can be weakened and the physician could tear the wall or you can develop a perforation a few days later. Similarly, bleeding can occur if the physician nicks a blood vessel or it can develop eight days after a polyp is removed when the scab falls off. If you do have a perforation, you will likely have to be admitted to the hospital and there is a 50% chance that you will need to go into the operating room to have it repaired. It is very rare, but can be a big deal if it happens. If a blood vessel starts bleeding during a colonoscopy, the physician can usually repair it right then or often the bleeding will stop on its own. In some cases the physician will have to perform another colonoscopy to repair the bleeding, or in extremely rare cases, you will have to go to the operating room to have it repaired.

However, the risks of any given colonoscopy are small with a complication rate of only 1% -3%. If you have a colonoscopy without removing any polyps, the complication rate is 1 in 3,000 cases, and if the physician removes polyps the complication rate increases up to about 1 in 1,000 cases. The reality is: it is very safe.

The three main reasons people avoid a colonoscopy are the following:

  1. They don’t want to do the bowel prep.
  2. They are embarrassed.
  3. They are afraid that something may be detected.

None of those reasons are worth the risk of avoiding a colonoscopy. First, the bowel prep that we use today is much better than it was seven or eight years ago. It consists of 5-8 ounces of fluid and medication to drink followed by an electrolyte of your choice. It is much easier and has less nausea. As for the procedure itself, we use light sedation so you don’t feel the procedure at all. It takes 30 minutes and afterwards you are back to normal within 30-40 minutes and you have no activity restrictions. Lastly, for people that are afraid of what the physician may find, it is better to find something today than three years down the road.

Colonoscopies are still the gold standard when it comes to identifying and removing polyps. It is a benign procedure that can save your life. So don’t avoid it.

 

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Is Robotic Surgery Safe for Rectal Cancer?

da-vinci-xi-surgical-arms-72dpi

When robotic surgery, through systems like the da Vinci® Surgical System, first emerged, I’ll admit that I was skeptical. I perform a lot of rectal cancer operations and I was not a believer in it. Before robotic surgery, there were two options for performing rectal cancer surgery:

  1. Open surgery. This is the traditional surgical procedure, which includes making a large up and down incision in the abdomen so the physician has adequate visibility and can use hand-held surgical instruments.  The incision site can be very painful and often there is a long recovery time. In addition, it can also be challenging for the physician to perform this type of surgery on someone who is obese or has a narrow pelvis.
  2. Laparoscopic surgery. This technique involves the surgeon making several small incisions instead of a single large incision. The surgeon uses a camera attached to a thin metal laparoscope to see a magnified view of the inside of the abdomen on operating room monitors.  The surgeon uses special instruments to perform the surgery, but these tools can only work a limited way, like chopsticks. The tools can’t bend and twist and turn to let the physician get into deeper areas of the pelvis, so this procedure can typically only be used on cancers in the upper region of the colon. The physician can also only do part of the stapling laparoscopically during a rectal cancer surgery and then he or she must make an incision to complete it, which means more pain and a longer recovery time for patients.

Two years ago, I went back and reevaluated robotic surgery and was amazed at how much the system has improved. With the robot, I am seeing anatomy in such detail that I have never seen before. And it is only going to get better, because the technology is continually improving.

Robotic surgery is a minimally invasive alternative to both open surgery and laparoscopic surgery. It has greater maneuverability with 7-degrees of motion, so physicians can reach areas of the pelvis that have tight angles. In addition, the robot has a special stapling devise so the physician can go to the very end of the rectum and staple across it with relative ease, which makes recovery easier because you are limiting the size of the incision. And finally, the visualization is incredible. This is extremely important because when you are removing cancer in the rectum, you have to work right next to nerves that control the bladder and sexual function. When you are removing cancer in the rectum with robotic surgery, physicians can see those areas much more clearly and can remove a tumor without injuring those nerves.

Whenever there is new technology, there are risks involved because you are dealing with a surgeon who is learning a new instrument. It is really important that the surgeon does their homework and makes sure he or she has done everything possible to perform the operation safely and effectively. For instance, I spent hours watching video and talking with surgeons. I observed surgeons. I did simulations on the computer and in labs. I did procedures on pigs. I did a tremendous amount of homework before ever touching a patient. I also had other surgeons familiar with robotic surgery in the operating room when I first started. When physicians are well trained, robotic surgery is a safe alternative to open or laparoscopic surgery and can greatly benefit patients. The benefits of robotic surgery for patients, include:

  • Reduced pain
  • Lower risk of infection or complications
  • Shorter hospital stays
  • Less scarring
  • Faster return to normal activities

Some newspapers have reported that robotic surgery has a high complication rate, but I would first say that this type of surgery, in general, has a high complication rate. Complication rates are a tough question to get a clear answer on. The reason is: I do a lot of difficult surgeries, which are more complicated than a surgeon who performs less challenging surgeries, so you can’t compare our complication rates effectively. You have to ask, what is your complication rate as opposed to someone who has comparable cases in your community. Physicians should keep track of their data, because we are all trying to continually improve patient outcomes, and be able to answer your question.

Patients should ask their surgeon the following questions when considering robotic surgery:

  1. What is your experience with robotic surgery?
  2. How many cases have you done?
  3. What is your complication rate compared to a physician with similar types of cases?

Robot-assisted colorectal surgery is still relatively new, however, there are reports emerging that show it is just as effective and safe as laparoscopic colorectal surgery, if not more so. For example, the World Journal of Surgical Oncology published a report in 2014, based on four randomized controlled trial studies, which concluded that robotic surgery is a safe alternative to laparoscopic surgery for colorectal operations. It also listed the advantages of robotic surgery as lower estimated blood loss and faster recovery time of bowel function. Currently, the biggest drawback for colorectal robotic surgery is the cost. However, patients do not have to pay more for robotic surgery because it is billed the same as laparoscopic surgery. Hospitals are the ones that are paying increased costs. There are no additional costs for patients.

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Can Women Get Colon Cancer?

So many of my female patients don’t think they need a screening colonoscopy because they think colon cancer occurs mostly in men. Colorectal cancer is the third most common cancer in women. The first most common cancer is breast, followed by lung cancer and then colorectal cancer. It occurs more often than ovarian and uterine cancer. Well known women such as Audrey Hepburn, Elizabeth Montgomery (Bewitched), Supreme Court Justice Ruth Bader Ginsberg and Queen Elizabeth have developed colorectal cancer.

Symptoms of colorectal cancer can vary significantly depending on the location and size of the cancer. Symptoms include:

  • No symptoms at all
  • Change in bowel habits
  • Bleeding
  • Diarrhea, constipation or sensation of incomplete evacuation
  • Narrow caliber stools
  • Abdominal pain
  • Anemia
  • Weight loss

All women with an average risk of colorectal cancer need to undergo a routine screening colonoscopy at the age of 50. African-American women face a slightly higher risk and need to be screened beginning at age 45. The purpose of a screening colonoscopy is to detect a tumor early or to prevent you from ever getting colon cancer. Almost all cancers in the colon and rectum start out as a small polyp or growth. Over time polyps may grow and transform into cancer. When you have polyps you typically don’t know you have them because they are too small to cause symptoms. When you have a cancer, it usually has to be big in order for symptoms to occur. During a colonoscopy, if polyps are detected, they are removed. By removing these precursors for cancer, hopefully, your risk of developing colon and rectal cancer will be reduced, if not eliminated. So ladies, it is not just the guys that get colon cancer. Colorectal cancer can occur in us too. Take charge of your health and get a colonoscopy.

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Smoking Significantly Raises Surgery Risks – Now Is the Best Time to Quit

Quit SmokingSmoking increases your risk of surgical complications. When scheduling a surgery procedure, it is best to quit smoking right away. Even though it’s easier said than done, quitting smoking can make a real difference in your surgical recovery and result in an improved outcome. The longer you abstain from smoking, the better your chances of a healthy recovery.

Smoking before surgery puts you at a higher risk for complications as well as postoperative heart attacks, blood clots, pneumonia and death. In a study done by the Cleveland Clinic, which compared 82,000 smokers with nonsmoking patients, the smokers were:

  • 57% more likely to have cardiac arrest
  • 80% increased chances to have a heart attack
  • 73% more likely to have a stroke
  • Twice as likely to have an pneumonia
  • 40% increased risk of death within 30 days of a wide variety of surgeries

Oxygen is what your body needs for your tissues to heal and recover. Smoking decreases by up to 40% the amount oxygen, blood and nutrients that go to your body’s surgical site.

Smoking interferes with all phases of wound healing and decreases the ability of cells to kill bacteria and fight infection. Patients with wound infections have an average length of stay in a hospital increased by 2-4 days. Patients also experience increased pain intensity, and higher amounts of narcotics needed for pain control.

Smoking causes complications with anesthesia. Anesthesiologists have to work harder to do to keep smokers breathing with lungs that have been compromised by cigarette smoke. Smoking also compromises normal heart function. This puts smokers at higher risk for heart problems during, and after surgery.

The silver lining here is there may never be a better day to quit than when you know you need to have surgery. The success rate for quitting is much greater when you quit before a surgery. There are many helpful resources available to help you quit which are proven to be effective. Discuss with your doctor the plan that’s best for you. Your quit smoking plan may include:

  • Smoking cessation planning with your doctor/surgical professional
  • Brief clinical counseling
  • Telephone counseling. Call: 1-800 QUIT NOW 
(1-800-784-8669). Help is free and confidential
  • Behavior therapy to cope when you want a smoke
  • Medications which may include: Nicotine replacement therapy, which can be purchased over the counter, or Varenicline (Chantix) and Bupropion SR (Zyban), which require a prescription and are started 1-2 weeks before quitting

For more helpful information please review this attachment:  Quit Smoking Before Your Operation

 

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Are Colon Cleanses Beneficial?

Enema Or Irritable Bowel Syndrome  Constipation Managed With Intestinal Cleansing

Doctors prescribe colon cleansing only to prepare for medical procedures and diagnostic tests such as colonoscopy; it is not something that is done in the name of detoxification. Your bowels and digestive system naturally eliminate all waste material from the body. The view of medical science is that you don’t need to perform special cleansing to accomplish this.

In contrast, online you will find many vocal advocates of colon cleansing for detoxification purposes. Their claim is that colon cleansing can be used to improve your health by eliminating toxins and help healthy bacteria to colonize your intestines. They believe that the gastrointestinal tract can be the source of a number of health problems such as asthma, arthritis, and even allergies. With the help of colon irrigation or cleansing, they believe that they can enhance the immune system and improve energy levels. Unfortunately, there isn’t much hard evidence to support the purported beneficial effects of colon cleansing.

Can colon cleansing be harmful?

The truth is that colon cleansing can actually sometimes be harmful. The procedure can cause some very uncomfortable side effects such as nausea, bloating, vomiting, and cramping. The problems are not restricted to these minor side effects alone. Colon cleansing enthusiasts may also have to contend with some other serious consequences, which may arise during or after undergoing the procedure.

  • Improperly performed colon cleansing can lead to perforation of bowels.
  • Colon cleansing can put you at risk for developing infections.
  • Increased risk of dehydration.
  • Imbalance in your electrolyte levels. This could be quite dangerous if you have certain pre-existing medical conditions such as kidney stones.

How can you perform colon cleansing safely?

If you really want to undergo colon cleansing, do so safely by taking the following precautions:

  • Check with your physician first about whether it is safe for you to undergo colon cleansing.
  • Discuss how your pre-existing medical conditions could be affected by the procedure.
  • Find out what herbal ingredients are going to be used for the procedure. Some herbs may cause health problems and also interact with the medications that you currently take.
  • It is important to stay hydrated during the procedure. Drink plenty of fluids during colon cleansing to prevent dehydration and related consequences.

Colon cleansing is not a procedure to be undertaken lightly. Be aware of the health risks that the procedure may pose before undergoing one.

 

 

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