Any afib risk in doing a colonoscopy

My insurance company (Blue Cross Blue Shield of NC) sent me a letter today saying I need to schedule a colonoscopy....I'm 58.......not one colon cancer in my family tree.......anyway 2 questions 1) can they require it? 2) any afib risk? drinking barium and screwing up my electrolytes? getting put under etc

Tom

You might want to see if they'll accept a barium enema in lieu of the colonoscopy, that's what I did. It is very uncomfortable, but much safer - no danger of perforations, no drugs. Only a few percentage points different in outcome success in catching a precancerous growth - but if a polyp is found that needs removal, you'll need the colonoscopy anyway. The insurance co just looks at stats.

Why the enema, you ask?

I've personally known only 5 people who had colonoscopies, two died, one almost died ( all from perforation of the intestine) two were OK. That was enough for me....

Rock on, medical world, if you were a car dealership you'd be out of business.

thanks Tom, I'm not doing it

Wow, Tom B - that's a very skewed sample - kind of like the number of people I've known who have died while scuba diving, so I don't do that.

At any rate - I personally know at least 100 people who have had uneventful colonoscopies, including me. Worried about afib, I did research here and asked my gastroenterologist what I could do to prepare and save my electrolytes. I used "MoviePrep"(SP?) and it worked fine, I went through the procedure without any discomfort, and ate a huge lunch afterward. Plus the prep wasn't too disgusting. Just another perspective...

Good luck either way. I am suspicious of screening for no reason, and so probably wouldn't have done the colonoscopy but GI bleeding was suspected for unexplained anemia.

Cindy O

I've already had 5 colonoscopies my boss co-workers, mom, brothers etc all have...... no one dies from this simple lifesaving preventative measure. People die from the embarrassment of of not being screened. I know some who died of colon cancer because they never got screened or wear colostomy bags which is not pleasant after major surgery. Perforations are rare with an experienced GI. Just bad advice to avoid them which is a major cause of preventable colorectal death.
Never went into afib during preps either.

I well know that the sample I use for this discussion is skewed....but unfortunately it is true. I've read the outcome stats and I have no doubt my perspective is unusual. A customer of mine died during the procedure...bled out, my uncle was in critical care for weeks after his procedure, a teacher who had just retired (worked with my wife) died about a month ago, same story. On the plus side both my wife and another uncle had no problem.

McHale, to say no one dies from this simple procedure is completely false. Saying it is not likely to be fatal would be more accurate. The people I've described who died were all in their 70's or 80's and likely should not have been screened to begin with...

In any event, one should look to his own risk factors for colon cancer and make an educated choice IMO. I have personally never known anyone who died of colon cancer - so I don't see it as issue others may do - but I did get that barium enema....close enough for me after what I've witnessed.

Two months ago I had a colonoscopy and an endoscopy on the same day, with no problems at all. What they found where two very small polyps in my colon, which where removed. I personally don't know anyone who has experienced anything life threatening while having a colonoscopy. I think the benefits of having a colonoscopy far out way any risks. I would also think the chance of dying while having this procedure would be quite remote. I know a number of good friends and family members who are alive today thanks to having a colonoscopy performed.

Tom P. I had the same concerns that you do with regards to the bowel cleansing method, with regards to electrolyte loss etc. but I had no problems. I don't know what the numbers would be but would imagine there are thousands of these procedures done every day in Canada and the U.S. I would call them very routine.

Lou

I have done it without any ptoblem or afib. If it is indicated you will get peace of mind after the procedure.The risks are minimal.2 per thousand get perforation.
Plz read:
[jnci.oxfordjournals.org]

Tom - just be sure that you use the electrolyte-sparing bowel prep or you may have AF as a result.
Because I had some polyps that were removed, I had annual colonoscopies for about 7 years. I learned the hard way not to do any other prep than the Colyte or GoLitely.

Jackie

My mother nearly died because her colon was punctured during the procedure. She was rushed to the hospital a day after the procedure. The paramedics told us they almost lost her.

Debbie

As with all medical procedures, there is risk. One has to do research to find the "best" doctors, whether its an ablation or colonoscopy. My wife was the director of the gastroenterology department of the largest hospital in Dallas, and is/was quite familiar with the risk/benefits of the treatment.

I have had three and my wife has had two, and both had polyps removed. When you measure the risks against colon cancer, only a fool would not elect to have a colonoscopy. The actual procedure is a "non-event". You don't remember anything with "conscious sedation". The prep is not so much fun, but it just means you spend several hours at home next to the toilet. You can drink all the electrolytes you like if it is in a clear solution. I didn't add electrolytes, but the prep never caused afib either (two before my ablation and one after).

Two recommendations - have it scheduled in the morning (you get hungry of you wait until the afternoon). Start the prep earlier than they suggest. You don't want to go to bed before your bowels are clear (midnight surprise).

A recent study says a colonoscopy IS riskier for afibbers and the elderly...supporting the thought that the people I know who died from the procedure should not have been screened in the first place.

[health.usnews.com]

Here are some stats from a study done in the early 2000's for gen population:

•Perforation occurred in about 1/3,450 to 1/139 colonoscopies. (nothing like a wide variation, eh?)
•Heavy bleeding occurred in about 1/500 to 1/37 colonoscopies.
•Death occurred in about 1/30,000 to 1/3,000 colonoscopies.

I wonder why some of the population has such high colon cancer risk? I honestly don't know anyone who has had colon cancer - but I've had two friends die from pancreatic cancer, two aunts and a cousin die from breast cancer, a cousin died from ovarian cancer, I one guy I know has brain cancer... Some people I know have prostate cancer... but no colon cancer anywhere to be found amongst those I have known and know.

Is the procedure a good money-maker for the city folk? LOL.... just kidding....kinda.....

I woke up from my first colonoscopy to find out that I had gone into afib, I had never even heard of afib prior to that procedure. That was the beginning of my afib adventure. I realize now that my high Sodium diet and then the prep for the procedure and perhaps the anasthetic all worked together to put me in afib.

Commenting on the prevalence of colon cancer - Over the years in my practice of clinical dental hygiene and reviewing patient health histories, I've known a dozen or so patients out of 3-4,000 over a 25-year span and have had two friends develop it, caught early and 'cured'... All of the patients and friends were those who never were exposed to much sunshine. There is considerable reporting about vitamin D deficiency and cancer in general, but my two friends who specifically avoided getting sun exposure developed the colon cancer. One, ended up with a permanent colostomy; the other just had a small resection. And, incidentally, neither had the requisite colonoscopy at around age 50 as a preventive screening.

Just FYI.

Above all else, just as you would with an EP, select a highly-skilled practitioner who does colonoscopies for a living to help avoid the calamity of a perforation.

Jackie

Here's a question I will ask my wife. Since the Dr. can see everything they are doing inside the colon during a colonoscopy, how does one rupture the colon without knowing it?

Snipping off a polyp could cause bleeding, so it would be VERY important to be sure you are not on blood thinners. This could be an issue for afibbers on meds, but you would likely have to stop the blood thinners well before the colonoscopy.

Ken - that's very important advice about the anticoag if going for colonoscopy. Many years ago with my first scan, I was taking aspirin daily for muscle pain. No one told me to stop at least a week or more prior to the scan. As it turned out there were two polyps removed. That night, I had accumulated a lot of blood leaking from the excisions which was expelled into the toilet. Imaging my surprise and alarm! It was a holiday weekend so I called the ER to ask what to do. They said stay home as I'd be better off there than in the ER. I ws fine but it certainly was unsettling.

In all my years of followup scans, I was never warned about bleeding interferences and when I presented for the procedure, no one double checked my meds or asked about anticoagulants.

This may be a flaw in our local system, but it certainly deserves to be discussed...so thanks for the reminder. I had forgotten about that trauma.

Jackie

Bozo's work in the medical field too....a lot of them. I think that is the essence of problems ocurring with high volume in-and-out procedures - they may be trained for their specific duties but lack any kind of general perspective regarding health matters. I'll be up front with my position here, I think most doctors are worthless. I never used to feel that way, but time and time again they have done more harm than good to myself and those I care about. I feel that colon cancer risk is over-hyped, apologies to Katie Curic and the media onslaught that followed.

It really ticked me off when the local hospital killed my customer and friend, Bob Davis. He had just turned 80 years old, had parkinsons disease but really enjoyed "flying" his computer flight simulator long distances, lol, - he was a retired airline flight instructor. (At that time I was a computer guy and set the advanced system up for him).

About a week after my last visit to him, I was scanning the obits and saw his name...I couldn't believe it. I later talked to his widow, and asked what had happened. Well, some white-coated idiot decided to check him for polyps...(I know dang well it was a money thing all the way) and that bulky piece of wrapped metal and plastic rammed through his aged and very thin intestinal wall---- have any of you aging people looked at your skin thickness? I have to wear gloves to do an kind of mechanical work or blood is everywhere. Well, virtually every bit of our body has lost flexibility and tissue depth too -

The problem is that the intestine is not a straight tunnel - no matter who is at the controls there will be contact, friction, and some tissue damage (bruising) - if the intestinal walls are thin, you can have perforations - this isn't rocket science. So those who would decide to use this procedure on 80 year olds are, in my opinion, nth degree (fill in very derogatory term here).

For those who think these procedures are no-brainers - well, that might describe some who perform them, as well as the medical structure that allows persons at that advanced age to be subject to such nonsense.
There are other ways to explore if there is reason to suspect cancer (not in either cited case here) such as barium enema or the new virtual colonoscopy.
Even if he had early stage cancer, it would not have mattered, he was not in good health and was not likely to live many more years.

My uncle Art was also in his eighties and nearly died of blood loss during the procedure. Luckily, (sarcasm) the procedure was done in the local hospital and he was close to the surgical area where they opened him up to try to fix the tear. Eh, after a few weeks of recovery he was able to go home and live a normal life.

Whew....what a rant, but I can't help but think that our society is greatly over-dependent on the machine that is modern medicine - testing and all. Most of us would be far better off tending to ourselves with good diet and exercise and an open dialogue to explore alternatives, such as is often presented in this great forum.



Edited 1 time(s). Last edit at 05/02/2012 02:06PM by Tom B.

Paranoia isn't good advice.

I talked to my wife, who was the director of Gastroenterology at a major hospital about colonoscopy dangers. She said that perforating the bowel with the scope while "driving through tunnel" is a rare occurrence, but it's always good to have an experienced driver.

She said that when perforations do occur, it's usually when a polyp has been snipped and too much of the colon wall is taken. If it does happen, they generally know it since they can see what they have done and are also taking photos of the polyp before and after the removal. Again, experience counts. So the greatest risk is when polyps are found and removed, so if you choose a less invasive procedure (all requiring similar preps to clean the bowel) to see if there are polyps and some are found, then you will still have a colonoscopy. I would prefer to have it all knocked out at one time. Also, the less invasive procedures are less effective at finding polyps.

Regarding the blood thinner risk and preparations, I speculate that the proper information is probably provided, but a few will not hear or may misunderstand, or may not read all of the information. And in some cases, it may be neglected all together. I can't speak for all Gastroenterology departments, but the big ones tend to be assembly lines and move people through in a very efficient manner. You will likely see the Dr. for a minute or two just before the procedure and a minute or two after. However, you will never remember the after conversation. You are also required to have someone there with you to take you home, so you do have another set of ears to listen to the Dr. after the procedure. You will feel perfectly fine, but your brain will still be in a fog, you just won't know it. However, I do remember all the checks and balances prior to the procedure that were checked and double checked to help guarantee the best outcome.

Imagine a life after colon cancer, assuming you survive and no longer have a bowel or rectum. Don't be afraid to get checked.

As long as everyone is weighing in here on colonoscopies.......
I would not even think about missing a regular colonoscopy here. I have had too many friends and family die of colon cancer which is totally preventable by this simple and safe procedure. As to age.... my father, who is 92, had one not too long ago and had polops removed.

Of the friends and family that have not had the procedure and whom HAVE been stricken with colon cancer, I can assure you of two things. First, it is a nasty, nasty way to go. Nasty. And secondly, if they were able to go back in time and rethink their decisions or ignorance of the situation, each and every one of them would opt for the colonoscopy. I say this freely and without a moment of hesitation.

We also have one friend who is a survivor of colon cancer. No colonoscopy. Her life leaves much to be desired and is not very nice. But she is a survivor and makes the very best of the poor situation.

There is now a virtual colonoscopy done with CT scan and contrast; computerized. They say it is pretty much as accurate and efficient as the colonoscopy without the discomfort although the prep is the same. The risk factors are apparently not very different either. The reason it is not mainstream is simple that should a polop be found they would have to reschedule you for a colonoscopy and surgery anyway - best have it done in one shot.

That is my feeling today, in any event. I do whatever I am able to, weighing the odds, to avoid an untimely demise. At least I do my best to.

Frankly, I would opt for a regular colonoscopy unless there are other mitigating circumstances.

As to electrolytes I cannot comment except to say that you will certainly be squeaky clean and in need of some hydration for sure.... but keep in mind that the cleansing process includes intake of large quantities of liquid(s) to start with and that (I think) for the most part, your supplements and meds have been processed by the time they reach your colon (?). It was not an issue for me in any event.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Ken Wrote:
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> Paranoia isn't good advice.
>
Nice one, Ken. I guess if it's not your point of view, it's just not tenable, LOL....

Tom,

I just believe in painting a clear, balanced and rational picture for those trying to decide on what to do regarding a colonoscopy. Your views are relevant, but at the same time pretty volatile. It's only fair to present "the other side" of the issue.

Murry's comment regarding the discomfort of a colonoscopy I guess depends on the type of sedation given and who is giving it. My and my wife's experience is that there is no recollection of the event what so ever after having "conscious sedation". It's the easiest medical treatment I have ever had, with the exception of the prep.

All of this just suggests that doing one's homework about any treatment is important. That's pretty much why this forum is here, to learn.

Ken,
I agree with what you are saying regarding a balanced and rational viewpoint. My perspective is different - for obvious reasons - pesonally knowing of two deaths and a near-death occurrence tend to taint my viewpoint regarding this procedure, especially for the older among us. I absolutely agree that those who have a family history of colon cancer, or who may have other indicators that point to a greater probability of getting cancer should be screened. It is all about probability vs risk - citing to everyone the horror of getting cancer as a means to get screened is a tactic that exploits the innate fear that exists to some degree in all of us - but does not constitute rational discourse as I view it.

Another issue is that of medical cost and the practical application of medical services in general. If one were to take the advice of every medical advocacy group and be screened for every type of cancer, visit the doctor every time a common-to-many-issue symptom pops up, etc. the cost of insuring would go well beyond what the system could bear. As it stands now the system is on the brink of chaos, with medicare's ability to function nearing a crisis stage depending on the supreme court decisions that are pending. Beyond that decision, medicare is projected toward financial failure due to the massive influx of baby-boomers.

So, should people who do not have any indication of higher risk (including diet and lifestyle) be screened for colon cancer? Should those who are older and at greater risk for bleeding or perforation yet have no elevated risk factors for cancer be screened? My postition is no. I believe that is a rational conclusion -

Many doctors say if you have atrial fibrillation you need to be on aspirin or blood thinners, including LAF'rs. Many here, including myself, have looked at studies and have concluded (based on our own personal assessment of risk) that such treatment will do more harm than good. I see the promotion of the universal use of colonoscopy by the medical system as being similar in key ways to that promotion of blood thinners. Both are issues that really need to be assessed based on individual circumstance.

Tom I like you buddy but you are doling out bad advice here. 1 in 20 get colon cancer so if you think this is no big deal then to each his own. 1 in 20 think about that for a minute....I'm sure many of those had no risk factors but got it anyway.
I've already had 5 precancerous polyps removed. No one is talking about giving 80 year old's their 1rst colonscopy without proper screening and I'm sure many would have lived into their 80's with proper screening that have died from colon cancer. My mom is 7 years out from colon cancer because she never got screened but survived and approaching 84 yo. And the reason she survived is the incredible treatment she got at Sloan-Kettering specifically Dr. Martin Weiser who did a laproscopic minimally invasive procedure incredible surgeon...or Dr Blue Eyes as my mother warmly calls him in her broken english.
Peace out!

[www.huffingtonpost.com]



Edited 2 time(s). Last edit at 05/03/2012 11:46PM by McHale.

BTW the drugs are great especially the Demerol drip that puts you into a twilight sedation.

McHale Wrote:
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> Tom I like you buddy but you are doling out bad
> advice here. 1 in 20 get colon cancer


The cancer rate for men in the US is closer to 3.4 per 10,000 [appliedresearch.cancer.gov]

McHale, I don't give out advice, just my own perspective. What anybody else does is their business, not mine.

But, the fact that you thought that 1 in 20 get colon cancer tells me there is a lot of misinformation out there - kinda like the afterlife and the true believer, as I see it - LOL... but that's OK, it's just human nature to cover our arses (pun intended).

The reference study is for yearly incidents - notice some poor countries have lower rates, likely due to a lower fat higher fiber diet.

If one looks for a lifetime rate, then incidence per age group must be factored, I would imagine, like most cancers, the incidence per age group increases with age.

The rate of incidence in the study is a composite of all persons, so the rate does not represent those with no family history of colon cancer, or whose diet is anti-cancer, i.e, lots of fiber and reduced saturated fats. The rates for those groups would be much less. Ethnicity is a factor also.

To put this into a common perspective; you are more likely to be killed on the highway than to die of colon cancer. 1 death per 10000 persons colon cancer/yr (USA), vs 1.2 deaths per 10,000 persons auto accident/yr (USA).

[en.wikipedia.org]

What's that? You're going to sell your cars? How many trips did you take to the doctor this year? (Just kidding)


I think I've beat this subject to death....



Tom



Edited 3 time(s). Last edit at 05/04/2012 11:49AM by Tom B.

One in 20 Americans will develop colorectal cancer. About 140,000 cases are diagnosed in the United States each year, resulting in about 49,000 deaths, according to the National Cancer Institute. It is the third most common cancer worldwide.

[www.huffingtonpost.com]

Yep misinformation somewhere? Statistics based on yearly cancer rates per 10,000?
I would go with statistics in ones lifetime which is 1 in 20 not good odds don't ya think?
Unless you don't expect to live past 50 yo then you're safe from colon cancer
Anyway nitrates/nitrites preservatives in food is the culprit in developed countries besides the other usual suspects you mentioned.
Yep I think we all need go make our own decisions!



Edited 1 time(s). Last edit at 05/04/2012 07:41PM by McHale.

FWIW, I just had a routine colonoscopy done at age 59 by my gastroenterologist, one polyp removed. The prep was fine, no problems whatsoever with AF. Suprep worked fine and within just a few minutes of the first 16 oz mix, had first BM. Started the prep at 6pm and was back to normal by 8:30-9:00pm. Took my second prep dose at 5am on day of exam and same thing. Got to hospital at 8:30am and was IV'd and wheeled into the exam room. I was given IV propofal and fentanyl (felt great by the way) and procedure began immediately. I was done and wheeled into recovery by 10:30am and fully awake but a little foggy. Out the door and home by 11am. Felt great from the fentanyl for a few more hours then back to normal by late afternoon. All in all, it was a non event but the doc did remove a polyp for which I am very greatful. Need to go back in 2 yrs for follow-up procedure. The worst thing was not being able to eat any solid food on the day before the procedure. Just clear liquids and some jello allowed and all the Waller Water I could drink. No med's or supplements on exam day until I got home from the procedure. I hope this short blog helps someone make the right choice on having the procedure done.

Cheers,
Ralph