Dear Doc: I’m a 50-year-old guy who needs a colonoscopy — at least that’s what my doctor and my wife say. I exercise, I eat right, I have no family history of colon cancer, and I hate the idea of drinking all that stuff. Any suggestions? — BC from Manitowoc
Dear BC: Yes, drinking all that stuff is a drag, but having colon cancer is a bigger drag, believe me. The present recommendation is to have this test every 10 years, but that might be too often. A landmark study showed that having a single negative screening colonoscopy was associated with a 9% reduced colorectal cancer incidence and mortality for up to 17 years.
Current guidelines recommend a 10-year interval between negative screening colonoscopies for average-risk adults. This recommendation is based on estimates of time between the development of a precancerous adenoma and cancer. This study looked was a biggie — it followed more than 165,000 patients over time.
Now if you don’t want a colonoscopy you can do a fecal immunochemical stool test, the FIT test. When done yearly it is nearly as good as a colonoscopy in normal-risk people. Then there is Exact Sciences’ Cologuard — it’s a DNA test done on your stool. The present recommendation is to do it every three years.
Now there is something on the horizon — a blood test called CellMax. Preliminary research shows that testing blood for three distinct cancer markers had a 90% sensitivity for picking up colon cancer. The test involves detecting gastrointestinal cancer cells that are circulating in the blood. Clearly this would be game changer.
My spin: There are many ways you can test for colon cancer — what’s important is to get off your butt and get it done.
Dear Doc: Six months ago I had deviated septum surgery. Since I have had the surgery, my nose feels plugged up. I go to blow it and I get air out but no snot. If I snort my nose I can hack it out. I do this all day spitting it out into Kleenex. My nose is dry and I have little taste or smell. I breathe through my mouth now, especially if I am doing any activity. I have gone back to the ear, nose and throat specialist. The first visit he said everything was fine and I couldn’t have those symptoms. The second visit he loaded me up with antibiotics, prednisone pack and nose spray. It was no better when I went back for third visit. He did a scan and said everything looks fine. This visit he adjusted my twice-a-day neti-pot rinse. It is still snort and hack all day. I have lost all quality of life and am physically worn out.
Do you have any suggestions or know of anything that will help me? Thank you so much. — CW from Spokane Valley, Washington
Dear CW: Whew. You are clearly suffering — and those extra visits to your doc didn’t seem to help at all. Looks to me like you had the whole nine yards — antibiotics, steroids, nasal sprays, scans and you’re still having problems.
Unfortunately this can be the case with nasal and sinus symptoms — where you’ve done everything but nothing seems to work. In these situations I ask myself, “What would I do if it were me or one of my family.”
I would get a second opinion. I would go to an academic institution where problems like this are vetted out. And you have that in Spokane — the Elson Floyd College of Medicine, which is part of the Washington State University. It’s a good place to start. Your problem is not a simple one: That’s where a tertiary institution comes into play.
This column provides general health information. Always consult your personal health care provider about concerns. No ongoing relationship of any sort is implied or offered by Dr. Paster to people submitting questions. Any opinions expressed by Dr. Paster in his columns are personal and are not meant to represent or reflect the views of SSM Health.