9.3 Colon comfort

Colon comfort

Eugene doctors hope to put people at ease about ‘the procedure’

By Randi Bjornstad

Published: February 18, 2013 12:00AM, Midnight, Feb. 18

It may be cheeky, but Dr. William Wu intends to deliver a serious message with the colonoscopy bracelets he designed.

The funny thing about a colonoscopy — and if you’ve had one with Dr. William Wu or his colleagues at the Oregon Endoscopy Center adjacent to Sacred Heart Medical Center at RiverBend, you know it doesn’t have to be a solemn event — is that it’s probably the health screening that people fear and loathe the most but the one that often gives them the best news.

“With colonoscopy, for most people it’s really prevention,” said Wu, who has done upwards of 1,000 colonoscopies per year in his nearly 20 years of practice. “If you start getting regular screenings at age 50 and you catch any polyps that are there before they go ‘bad,’ 90 percent of people will never develop colon cancer.”

Unfortunately, among those who should be getting screening, only about half actually do, he said.

For many, it may be financial. The outpatient procedure takes 30 to 45 minutes and averages about $2,500, definitely a chunk of change even with decent insurance coverage.

Then, there’s the “ick factor” of preparation the day before — drinking only clear liquids as well as a mandatory gallon of a mixture that tastes akin to non-fizzy Gatorade — not to mention the indignity of presenting one’s backside for medical scrutiny.

“No one likes the prep,” Wu said, “but you need a good, thorough prep to be sure you’re seeing everything.”

It’s worth the vexation. In my case, colonoscopy No. 1 revealed three tiny, pinpoint-sized polyps that Wu and his crew removed during the procedure. They were benign, although they were adenomas, meaning they would have been more likely than the other type of polyp — hyperplastic — to become cancerous eventually if not removed.

Because of that, and because there is some family history of polyps, Wu recommended that I have my next colonoscopy in seven years, as opposed to the 10 it would be with no evidence of polyps.

So, about 10 days ago, I drank the lemonade again — literally, because this time around the instructions gave the option of adding a sugar-free beverage mix to the pre-colonoscopy jug — and the next morning, innards scoured, went in for No. 2.

This time, Wu & Co. found one 4-millimeter polyp — mine was flat, but the little growths also can develop stems so they resemble tiny mushrooms — and took it off.

No problem, no cancer, come back in another seven years, Wu said.

The interval for rescreening depends on how many polyps are present, what type they are and how large, according to the American Society for Gastrointestinal Endoscopy.

Polyps that are larger, occur in greater numbers or appear to be developing abnormally mean coming back sooner for another colonoscopy, anywhere from a few months to several years. But, Wu pointed out, for most people, that means never having to hear, “You have colon cancer.”

On top of that, for those lucky enough to hit their mid- to late-60s before having a first colonoscopy — and whose procedure shows completely unproblematic results — one colonoscopy might suffice for a lifetime, he said.

“If you’ve gotten to that age and the colonoscopy shows you’ve never had any problems, you probably don’t have much risk for colon cancer,” he said. “It’s a slow-growing disease, and if it’s been clear that long, it’s probably not going to be a factor in life expectancy.”

Age 50 is the “break point” for colon cancer risk, except for African-Americans, who should begin regular screenings at 45 years, Wu said. “This is especially important, because there is even less screening done among the African-American population than Caucasians, and their risk is higher.”

Unfortunately, many people find it distasteful to talk about colonoscopy — much less schedule one — and that’s a taboo Wu and his colleagues are trying hard to eliminate, including through the use of humor.

“Nobody talked much about breast cancer or prostate cancer screening 50 years ago either, and now those are commonplace conversations,” he said. “That’s what we’re trying to do for colonoscopy.”

March has been designated National Colorectal Cancer Awareness Month, and Wu has done his part by designing a bracelet — the counterpart of pink for breast cancer, red for kidney cancer and lime green for Lyme disease, to name a few among many — to increase the chatter about colonoscopy.

“I’d like to see people give the bracelets to others who should get a colonoscopy, and when they do, I’d like to see them pass the bracelet along to someone else who needs one,” he said.

His bracelet is brown — no surprise there — and it unabashedly pokes fun at the area of the body that the colonoscopy scopes out.

“When I first designed it last year, I had it printed with ‘Up Yours!’” Wu said with a laugh. “But some of my co-workers said that was a little too crass, so this year it says, ‘What’s Up Yours?’”

It also says, “Colonoscopy can save your life.”

At 50, Wu has had his own first colonoscopy screening.

“I picked one of my partners to do it for me — a tough decision — and I did the whole process, the same as a regular patient, the exact same prep, everything. It was a great experience.”

Once the preparation is done, the colonoscopy is quite simple. Besides screening for cancer, it’s used to diagnose the cause of symptoms such as rectal bleeding, abdominal pain and changes in bowel habits.

The gastroenterologist uses a colonoscope, which is a long tubular instrument about ½-inch in diameter, inserting it in the rectum and guiding it by means of two dials that control vertical or horizontal movement. The scope sends back inch-by-inch photo images of the colon.

The tool first examines the sigmoid colon, which is just inside the anus, followed by the descending colon, transverse colon and ascending colon.

That may seem backward, but it’s not considering that the colon begins at the end of the small intestine — right near the appendix — on the lower right side of the abdomen and goes up, across and down from there.

The colon, otherwise known as the large intestine, is about 5 feet long in adults; its segments vary in diameter from about 2.5 inches to 3.5 inches.

Most colonoscopy procedures use sedatives rather than anaesthetics. With sedation, patients are not allowed to drive themselves home after the colonoscopy, but a normal diet can be resumed immediately unless there is some nausea.

A few patients choose to have no sedation at all.

“I had one guy who was an Oregon State trooper, and he wanted to get right back to work after his colonoscopy,” Wu recalled. “After it was done, he got on his motorcycle and took off.”

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