Kevin, M.D. - Medical Weblog

When you're treating a celebrity, you better not miss colon ca...lets do a colonsocopy...just to be safe...
 

Colonoscopies have a 10% false negative rate...if he was having recurrence or continued symptoms in our sue-crazy society, it's appropriate to repeat it.
 

I think either he or his doctor confused 40 with 50 as this quote
from the article shows:
"I've had two prior colonoscopies -- you should have these things fairly regularly after turning 40, and I'm 48".
So either his doctor recommended it or he decided it.
 

anon 6:20, I dont know about that. I've always heard screening colonoscopies start at age 50.

I had my first one at age 45 because I had some problems. MY GI spec. removed 3 tubular adenomas. Repeat at 5 years and he removed 3 more. I just had colonoscopy a few months ago (had been 3 years)and this time it was 3 more adenomas but with prominant mucosal lymphoid aggregate and architectural distortion.???

I don't even know for sure what that means and I don't want to know. I just listen to my Dr. and have the tests when he says I need too. He tells me, if he and I didn't practice preventative medicine, I would have colon cancer. I know what to look for but other than that I just show up on test day.
 

"I had my first one at age 45 because I had some problems"

People like you are making the GI's millionaires.

If I have a patient that complains of anything below the xiphoid process I refer to a GI for a colonoscopy and egd, you never know...the Gi loves it because he can retire early, and I love it because I am covered in the 0.0001% chance that there is gastric ca, colon ca, gastric ulcer, whatever...
 

"People like you are making the GI's millionaires."

Don't forget fever of unknown origin, unexplained shortness of breath, and unexplained "spot" on the lung. diarrhea, weight loss. All of the above symptoms earn Americans Colonoscopies and EGD's "just in case" in Sue-Happy America. Eventually you'll have your first screening colonsocopy as a requirement to start Kindergarten.
 

anon 7:06 and 7:10

Ok, so is this (what I described)defensive medicine or preventative medicine?
 

let's just say that because of the trial lawyers you were literally f*ed up the ass...
 

Thank-you, I appreciate your kindness. I should have known better than to expect a REAL answer!
 

Cathy: I'd say one colonoscopy for individuals above age 40 with risk factors (1st degree relative with Colon Ca, unexplained change in bowel habits) or any patient above age 50 is PREVENTATIve Medicine. I'd say an annual second, third and 4th colonsocopy in the same patient is DEFENSIVE medicine. (unless there was a finding)
 

So according to you, that would mean everyone over 40...let me guess, a gi?
 

The great thing about GI medicine is that the Physical Exam consists of doing endoscopy. If you don't look, you might as well guess.

That it is so handsomely rewarded is another issue. Perhaps the feds will catch up to the GI's the way they did with the ophthalmologists making a mint on cataracts. Nothing wroing with looking, but should they REALLY be making the kind of $$$$ they do??
 

One thing I am curious about is whether the incremental benefit of preventive colonoscopy (over other tests like FOBT) is higher than the risk of perforation (I know that it is 1 in 1000, but I am interested in the probability of individual benefit as well). I do understand that colonoscopy can find polyps where other tests can't. As far as I understand there is no data yet to show if it translates in significantly higher mortality reduction. Although since it prevents rather than detects cancer, I'd be curious to see how many people need to be screned for how many years to prevent one cancer and how much greater this number is than 1 in 1000. This is one thing I'll try to look at when I approach 50. Thankfully, I still have a few years, so I don't need to decide yet. Maybe they'll invent something better by them (unlikely, but a girl can dream)... Naturally, if I have change in habits, bleeding, whatever, I'll have it checked out.

I am always trying to look at the data and make my own decisions (this makes me responsible for the consequences, of course). For some tests I feel that the small probability of benefit is worth the risk for me, for other I feel it's not. It doesn't mean it is the same for other people which is why I like to decide myself.

As far as this famous guy in the article goes, judging from a posted quote from the article, he thinks 40 is the right age for everyone. Wonder where he got the idea.
 

anon 8:15,
Thank-you for your explanation.

Diora, a colonoscopy does detect cancer. When they remove those polyps, they are sent to the path labs. If you have any, you want them to come back hyperplastic.But if there is cancer there it will be detected. My Doc. says he does screening colonoscopies at age 50. If all clean then he waits 10 years for repeat exam. If you have adenomas then you get colonoscopies every few years.

I think if someone would get colon cancer that the cost of surgery and treatment would certainly be far more than the cost of preventative tests every few years, to get rid of the culprits.

**I think one of the hardest preventative tests to make some women and young girls appreciate is the PAP test. If they only looked at the figures of past cervical cancer and number of deaths caused by it they would not be so easily put off by this test. It is one of the greatest life savers of all times.

I'm all for preventative medicine but not defensive medicine.
 

Everyone on this blog should read "The House of God" by Samual Shem. So many things are still so true like the one axiom -- "There is a lot of money in shit" And he became a psychiatrist. Go figure.
 

Cathy, you misunderstood me. I know very well that colonoscopy can find polyps before they become cancerous. I know it can detect polyps other methods can't. I am pretty informed as far as screening goes, at least in my humble opinion.

My question is how many people have to be tested with colonoscopy in order to prevent 1 cancer that couldn't have been prevented by other screening methods. In other words, what is the chance for an individual that his cancer will be prevented in say next 10-15 years? Is it significantly greater than 1 in 1000 risk of perforation? Also, what is the chance that my life will be saved?

Here is what USPSTF has to say about it:
It is unclear whether the increased accuracy of colonoscopy compared with alternative screening methods (for example, the identification of lesions that FOBT and flexible sigmoidoscopy would not detect) offsets the procedure's additional complications, inconvenience, and costs
At any rate, unless I have symptoms I can safely postpone this decision until I am 50.

One other thing. Total number of deaths caused by a desease is not a measure of test effectiveness. All cause mortality is still 100%, btw. The test efficacy in reducing desease-specific mortality is important for those who set the guidelines. But IMHO for an individual, the probability that a test will save her life is more important. I have pap smears personally, but this is personal choice. If I decided against another recommended test, it is also personal choice made based on careful consideration of benefits/risks. I can change my mind at any time but only based on evidence.
I am not for- or against- screening. It benefits a few tremendously, it hurts a few, it has no effect for most. It is a personal choice.

I am definitely against defensive testing, but this is beside the point. Actually, I wasn't planning to go so much off topic, but I just wanted to answer.
 

Diora, Thanks for that link. It does give one some things to think about and consider. I have some very good Drs.,I feel it is wise not to p*** them off by always second guessing them. I have to trust what my Drs. tell me I need to have done. Defensive medicine is something I never knew about until reading here and I'm quite concerned about it.

I would have no idea how colonoscopies rank with detecting percentage of cancers found, based on total numbers of colonoscopies performed on the general public, as compared to percentage of complications created by the test itself. Or how many lives might be saved by screening colonoscopies.

I'am not in the medical field but I do have a brother that is an internist in N.J. and 2 uncles that are retired Physicians. They (2 uncles) are blown away by the things happening with the medical profession. My brother just informed me this past weekend that he practices the way we hear all the docs. on her practice. CYA all the way..I didn't know that before..He and I had quite a discussion about it. He is still for it I am still against it...

Now, I have went way off topic..Sorry!