Baby Boomer Men and Cancer: An Uncomfortable Truth

This post is for Boomer men. Women may proceed, but this is going to be a large dose of guy talk.

For seven years, Mitch, my primary care physician, told me just to do it. For seven years I procrastinated, coming up with every possible excuse to avoid following my doctor’s advice.

This past year during my annual physical, Mitch frowned at me and said, “This is Dr. Gershten talking, not Mitch, do it before your next physical. No excuses.”

“It” is the infamous test haunting those over 50 called a colonoscopy: an uncomfortable truth about cancer screening for those who have crossed the half-century mark. This is not a test any John Wayne-swaggering, red meat-eating, football-addled man wants to endure.

But I really appreciate Mitch…er, Dr. Gershten, and prefer not to displease him. Good family doctors are hard to find.

So I made the momentous appointment with a gastroenterologist. I accepted that I would be sweating bullets for the next three weeks. I managed occasional hyperventilation attacks by imagining other unexpected people getting colonoscopies: Twiggy, The Rolling Stones (with Mick singing “I Can’t Get No Satisfaction”), the Rockettes (simultaneously), and Alan Greenspan. This helped me with perspective.

Then came the fateful day before the fateful day. After a light breakfast, I stopped off at the pharmacy where I picked up a prescription for HalfLytely with Flavor Packs. (Don’t you agree that this may be the Guinness World-Record winning euphemism for a laxative?)

A perky female pharmacist, about 25, tried to offer me advice about how to use the product, but recognizing her nubile, nymph-like lack of personal experience with what would be happening to me, I smiled gratuitously and backed away.

The bowel prep kit includes a tablet laxative, a two-liter jug filled with a clear medication and several packs of powdered flavoring weakly reminiscent of Kool-Aid. Instructions directed me to take the tablet first and later to consume the entire jug of liquid, a glassful at a time in 10-minute intervals until everything moved swiftly through me. And shift it did. The very good news is that I had my choice of flavor packs.

C-Day started with a cup of coffee and then no more liquids until the procedure. Around noon, I sat in the reception area still wearing sunglasses. I tried to convince myself that I wore them to shelter my eyes from bright light, but my true motivation was to avoid the possibility that anyone would recognize me at this compromising moment, especially Twiggy.

After fifteen minutes of mindless scanning of magazine ads, a nurse appeared and invited me to join her. A red-headed Irish woman with a thick brogue accent, she seemed antithetical to the solemn activities ahead. I’ll call her Nurse Bonny. She was an interesting combination of Mary Poppins and Maureen O’Hara, so I felt marginally safer.

Bonny led me into a preparation area, subdivided into cubicles by drapes, where she checked my blood pressure and asked basic questions about drug allergies and potential health risks. I mentioned my theoretical aversion to colonoscopies but received no deferment. I signed obligatory forms that would make a lawsuit fruitless.

She then exclaimed, “Now, are we ready for our happy drugs?” I could envision some uplifting possibilities in the forthcoming diagnostic procedure.

Nurse Bonny asked me to remove my clothes below the waist, slip into a hospital gown, and then sidle under a sheet covering the portable hospital bed. Then she left.

She appeared again momentarily, bright and enthusiastic, and covered me with another flannel sheet that had been warmed. My anxiety lifted with these day-spa touches. She inserted a small catheter into my right hand where happy drugs would be injected.

All preparations finished, Bonny rolled my bed into an operating room where the gastroenterologist appeared from nowhere. Dressed in business casual attire, Dr. Troillut is uncomplicated and laid back. He explained what was about to happen and asked if I had questions.

“Yes, two,” I replied. “Have you ever had done to you what you’re about to do to me?”

He nodded affirmatively, “Two times. Piece of cake.”

Observing flat screen monitors suspended over my head, I then asked,“Do I have to watch?” The doctor smiled and nodded at Bonny.

Bonny put a syringe into the catheter and began injecting the first drug.

Fentanyl is an opioid analygesic used for anesthesia. The product originates from poppies, those eye-catching orange flowers grown widely in Afghanistan, which our federal government has been unsuccessfully curtailing, years after a war on indigenous poppy growing. Derivatives of poppy plants also become either heroin or morphine, depending on who's cooking the brew, respectively drug dealers or pharmaceutical companies. More complex compounds originating from poppy opioids include Rush Limbaugh’s favorite pain-killing medication, OxyContin.

As the drug rushed into my bloodstream, I had a few introspective moments. Then I looked around this strange room full of strangers attending to various duties and I heard myself proclaiming, “I LOVE you people!”

Bonny inserted the second syringe into the catheter and began injecting another liquid. Versed reduces anxiety and creates sleepiness. The medical profession refers to the effect as twilight anesthesia, meaning that you will be semi-conscious but in a dreamlike state. You can respond to commands such as “Roll your butt over.”

This combination of drugs has another positive side effect: short-term amnesia…

Roughly twenty minutes after injection of the second drug, I found myself sitting up in the hospital bed in a recovery area chugging a glass of orange juice and babbling, “What a wonderful world it is!” I had zero recall of the colonoscopy.

While Nurse Bonny and I enjoyed this triumphant moment together, the doctor appeared with good news: a cancer free GI tract. My mental state had been perfectly attuned to hear such heavenly news.

Further, the doctor even gave me a thank-you gift: color photographs of my colon, including one handsome image of the intersection of my large and small intestines, near my appendix. It didn’t occur to me until later that the photograph serves as legal evidence that he did indeed guide the scope to the geographic location at which a successful procedure concludes.

So, here’s a debriefing on typical anxieties associated with colonoscopies:

1) The purge. Although the tablet laxative and liquid HalfLytely are not a cause for jubilation, the medications are not horrific. You spend a little more time in the john, but before you know it, your GI track is as clear as the day you were born, which, if you think about it, is a historic occasion.

2) Getting half naked around strangers. The people who do this for a living have found graceful compromise between total public humiliation and discreteness to the point of making the procedure impossible.

3) The drugs. Really groovy. The only requisite is that someone will need to drive you home since you’ll still be enjoying residual meanderings of psycho-pharmaceutical consumption for a few hours after your colonoscopy.

4) The colonoscope, a.k.a. “the tube.” It is the diameter of a pencil, not a fire hose, and you won’t remember it anyway. Those blessed drugs again.

5) Bad news. True, this is a possibility, but odds are extremely high for a negative test. Besides, successful treatment of precancerous conditions when found early rarely lead to worst-case scenarios. If your doctor discovers a polyp, he’ll remove it while you’re still commiserating with Timothy Leary. Early screening usually means never getting colorectal cancer. It’s much worse news to learn of colon cancer because you procrastinated, and I don’t even want to write about the procedures you’re then going to face.

Now for some sobering statistics for Boomer men, more than half of whom have passed the half-century milestone:

In 2000, only 42.5 percent of U.S. adults over 50 had undergone colon screening within the previous 10 years. That means 57.5 percent did not do what all doctors and wise peers advise: get colon screening, preferably a colonoscopy, when you turn 50.

Further, as many as 60 percent of deaths from colon cancer could have been prevented if everyone 50 and older would just submit to regular screening. For most healthy adults, beginning at age 50, this means once every ten years.

Colorectal cancer is one of the most commonly diagnosed cancers in the U.S, and the third most common form of cancer in men. The average age for those who develop the disease is 62, with two-thirds of the cases occurring after age 50. In 2004, the last year for which the Center for Disease Control provides statistics, 73,007 men were diagnosed with colorectal cancer; 26,881 men died of the disease or its complications.

Running the math, since 2004 I figure that about 64,500 red-blooded American males have died prematurely. They are dust in the wind when they could have been reading this blog instead, smugly self-satisfied over having submitted to the procedure. They have joined an unenviable list of luminaries succumbing to colon cancer such as Milton Berle, Jackie Gleason, Jack Lemmon, Vince Lombardi, Tip O’Neill, Charles Schulz, Joel Siegel, Walter Matthau, and Tony Snow, the Bush Administration press secretary and fellow Boomer.

Get the test, Boomer men. The truth is: It’s not that uncomfortable.

Comments

[Carlea Bauman]

Thanks for writing such a great piece on the importance (and ease!) of getting a colonoscopy.

I would like to add a comment about why so few men and women (as colorectal cancer does not discriminate based on gender) over the age of 50 actually get screened for colorectal cancer.

I am president of C3: Colorectal Cancer Coalition (C3) and we've been pushing for legislation in Congress that would guarantee access to colorectal cancer screenings.

In the past ten years, there has been a big increase in the awareness of the need to get screened for colorectal cancer, but if you're one of the 47 million under- or uninsured in our nation, knowing you need a colonoscopy doesn't do much if you can't afford one.

There are currently three bills in Congress that, if passed, would make colorectal cancer screening available to most Americans: the poor and uninsured, the elderly and those with private insurance (colorectal cancer screening is NOT a guaranteed right for any members of large private insurance plans).

C3 is urging folks to sign our petition to make colorectal cancer screening available to all. You can add your name to it here: http://advocacy.fightcrc.org/site/PageNavigator/CYBPetition

You can also join our fight by logging onto www.CoverYourButt.org and sending a message to your Members of Congress in support of these bills.

Thanks again for helping spread the word about colorectal cancer screening. If you can now help us get those bills passed, we'll be even farther along in our efforts to end death and suffering to colorectal cancer.

Sincerely,

Carlea Bauman, President
C3: Colorectal Cancer Coalition

[Brent Green]

Carlea,

You make an excellent point about the high cost of colonoscopies. I thought about this when I was writing the piece. If I had had to pay cash for the procedure, I'd probably still be thinking about it.

Nevertheless, too many men in my Boomer network who already have health insurance avoid the big "C" like the plague. My brother-in-law at 63, for example, just had his first colonoscopy, and only after plenty of teasing and cajoling from my sister and me.

Had someone laid out exactly what I could have expected (dealing with all my assorted anxieties), then I probably would not have procrastinated. I didn’t post the part where my doctor, Mitch, once boasted to me that not only did he have a colonoscopy, he did it without drugs. “I don’t mind if someone sticks a tube up my ass,” he proclaimed. That caused me to procrastinate another year.

Here’s a shift in consciousness: from an embarrassing / evasive medical probe to a rather pleasant drug experience. That will warm up many Boomer men debating the trade-offs.

I humbly hope I can help a few more macho guys get the screening test. Bill Clinton and George W. Bush have had theirs. So has Hillary.

Thanks,

Brent

[Cathy Warren]

Carlea,
I appreciate that the [C3}Colorectal Cancer Coalition has been pushing for legislation in Congress that would guarantee access to colorectal cancer screenings. My concern is that I am a 43 year women who was diagnosed with stage three colon cancer at age 41. My doctor did not push for colonoscopy because I did not fit the profile. Even though I have good insurance I was not age 50 which is the recommended age for screening. It took my doctor 8 months to discover the tumor. He treated me for IBS for 8 months. When I lost 25 pounds I finally had the colonoscopy. I can not help but think that had I been screened earlier maybe two of my lymph nodes would not have been affected and I could have avoided 6 months of chemotherapy. I feel there needs to be an awareness that people are getting these diseases earlier and that the screening ages should be lower for preventative care ,and mandate that insurance companies cover these preventative costs.

Sincerely,

Cathy Warren
Live Strong!

[Carlea Bauman]

Cathy,

Thanks for your comments.

We at C3 agree with you completely that people AND DOCTORS need to be aware of symptoms of colorectal cancer and the critical importance of having those symptoms evaluated with COLONOSCOPY.

These colonoscopies are NOT screening but diagnostic tests.

No one should accept excuses like “you’re too young” or “probably just hemorrhoids.” Don’t stop until you get a real evaluation that includes colonoscopy to rule out colon or rectal cancer!!

Symptoms of colorectal cancer include:

Changes in bowel habits that last more than two weeks: constipation, diarrhea, alternating constipation and diarrhea.

Rectal bleeding or blood in the stool.

Persistent abdominal pain, bloating, or gas.

A feeling that the bowel hasn’t emptied completely.

Weakness, fatigue, or unexplained anemia.

Unexplained weight loss.

Although there are many reasons for these symptoms that don’t include cancer, they still need a complete diagnostic workup. Besides colorectal cancer, they might point to other treatable conditions.

But . . anyone with any symptoms at any age needs a colonoscopy.

If your doctor doesn’t agree, find one who does. Your life may depend on a prompt diagnosis and treatment.

[Anne Holmes]

Thanks for the fantastic post!

I experienced my first colonoscopy a few years ago, and have the pictures to prove it! Thankfully everything looked good, and like you, it seemed like the build-up to the experience was much worse than the experience itself -- I'm sure it's the drugs.

Now if I could just get my husband to listen to HIS doc, the way you did to yours!

Thanks for being brave with the test, and bigger thanks for living to write about it!

Anne

[Brent Green]

Anne,

Thanks for adding your personal experiences and encouragement. Indeed, I am glad to be alive and writing.

Those in the colon screening business need a new marketing campaign, and, ultimately, that is the point of this blog: how we can constructively change and motivate Boomer social/consumer behavior through strategic marketing campaigns.

We can't change behavior without changing perceptions. We need a new male "collective mentality" around colonoscopies. This procedure remains shrouded in darkness and myths. Old behaviors (or non-behaviors) die hard, but getting the tube is much better than hearing somebody in a white jacket invite you to check into a hospice.

Perhaps your husband could benefit from more male peer pressure and a few other role models who submit to the procedure on live TV. John McCain and Barack Obama might be helpful here -- perhaps immediately following one of the debates. A further benefit would be unequivocal demonstration of bipartisanship at a time the country needs it.

Ask your husband to read this blog post, get the procedure and report back here. Maybe a little old-fashioned public accountability will drive him to the gastroenterologist.

[George Hollis]

A very good read,

I have just turned 59 and have never had a colonoscopy. Why? I am not sure. I have always been in good health, never really had any great family history, good bowel habits all my life, ect.

Even though we know the importance of it, sometimes the importance of it takes second or third place to every thing else.

I do appreciate the clarity of the procedure presented and indeed it does clear up some of the unknown. I have a regularly scheduled appointment soon so just may include discussion about 'the procedure'

George Hollis (Boomer)

[Erin]

Thanks for an interesting and enlightening article! I love men but sometimes I don't understand them. I want to help take care of the men in my life so this helps when I can show them a posting like yours. I also read two other related articles that you may find interesting...
Must-Have Medical Tests for Men -->
http://www.alternativehealthjournal.com/article/must_have_medical_tests_for_men/2159
and...
A Guy’s Top Fears of Going to the Doctor -->
http://www.alternativehealthjournal.com/article/_a_guy___s_top_fears_of_going_to_the_doctor/2165
Thanks again!

[Max]

Excellent post! I had been putting this off for years, I finally did it last October. Your post is a mirror image of my experience -- minus Nurse Bonny, mine was called Ellen. It was no where near as horrible as I had imagined. The drugs were good, but the news that there was no sign of cancer was great. Luckily this is not an annual procedure, but I think I can have it done once every 10 years. Thanks again for your post.

[George Hollis]

I wrote in Sept., 08 'I have just turned 59 and have never had a colonoscopy'. Well, now I have. It was as you said, not bad at all. I love to eat and that seemed to be the worst part, but it went quickly. By the way, every thing was fine.

George Hollis (Boomer)