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.