good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne I'm your host Mark Evans, a very important subject tonight is Colon Cancer Awareness Month.

We're going to talk about colonoscopy and people I know watching going oh man oh boy.

>> But you know, they're very, very important and as time has gone on they have made it a lot easier and it's something that we're going to discuss tonight.

We're going to talk about the preparation for it.

We're going to talk about the procedure the more importantly the importance of it and how you can get some help if you actually need it.

So our special guest tonight is Dr. Jeremy Wilson.

>> He is a general surgeon.

He's been on the show before.

Nice to have you back.

Thanks for having me back.

>> And I hate to say it but last time I shouldn't hate to say it but it's truth.

But the last time you were on we had phone difficulties and it was no fun.

There was something in the area phone system was down or something but the phones aren't working tonight which is a very good thing.

You see that phone number on the bottom of the screen it's 866- (969) 27 two zero and we are taking your calls on this subject and typically we get several calls on this particular subject and it's good because it's a very candid show we're going to tell you just the way it is and this show is to inform you about very important things such as colonoscopies.

So Dr. Wilson, let's go ahead and get started.

Do you have any stats off the top of your head about colonoscopies and the prevention of colon cancer?

>> Well, you know, recently come out over the past several years that with the advent of widespread use of colonoscopy, incidence of colon cancer has gone down about one percent per year.

But what we're seeing and what's a little troublesome is that that risk reduction is more in the older population and actually in the younger folks we're seeing a one to two percent per year increase in colon cancers.

>> OK, it is something that you well let me let me phrase it this way how long have colon copies themselves been around or they've been around longer than probably you or I have been is that right?

>> But as far as a widespread use I'd say probably we started most in the 70s and 80s and then nowadays it's even more prevalent available and a lot of that has to do with some of those advances that have been made in preparation procedure sedation that we're going to talk about tonight.

>> OK, well let's go ahead and discuss that.

But my first question is now with the and again we're candid but people call it the in the box.

>> Yes.

And and also the the tests that you dip it into fecal matter.

>> Right.

What's that called fecal blood .

>> Oh OK. Yeah I mean there's the chemical test for it.

Well I think it's important to stress that those don't necessarily cover all the aspects of colonoscopy.

So the question is do I really need a colonoscopy when I take a stool test?

>> Why is it done?

Colonoscopy is considered the gold standard as far as polyp detection or removal and polyps are growth soft lining the colon certain types of polyps if left alone do have potential to turn into a cancer.

Those are called out anomalous polyps.

Those stool based tests that you describe I'll do a fair job as far as you know, detecting blood in the setting of the fit test or detecting blood and or when they're called methylated DNA cells for collagen or the in the box and test.

They don't pick up all polyps.

They only pick up what they're designed to to test for and then they don't have the availability to remove a polyp if it's seen right.

You know, with those tests that they do come back positive they have to be followed up with a colonoscopy.

>> Why would a physician recommend those type of tests over a colonoscopy convenience really?

>> I mean, you know, the not having to take time off of work, not having to do preparation as you would for a colonoscopy.

You know, it's one of those situations where if you can't do what's the best it's acceptable to do one of those isn't something as long as you're an appropriate candidate for those tests, there are some specific requirements that need to be met in order to have collagen.

>> Not everyone's a candidate for it.

OK, very good.

We have a call coming in and it looks like it's from Brian and Brian wants to be off the air.

By the way, if you don't want your voice on the air that's fine but we'd love to hear from you one way or the other.

But I'm going to read it off the teleprompter.

Brian is asking what are the risks of having colonoscopy?

In fact, it was one of the questions I was going to ask.

So that is I'll let you address that's a very important question.

I think that's one of the stumbling blocks that people have in regards to getting their colon could be done are the risks you know, colonoscopy complications happen one percent or less of the procedures.

The main ones that we discuss are sedation risks bleeding especially those effectively bleed.

There's always potential for a missed lesion and then the one everyone fears is perforation or puncture of the colon and those aren't very common punctures happen well less than one percent of the time the last statistic I saw was discussing all comers, not just people that have only a screening but folks that even have some more advanced colonoscopy procedures and those incidences are about one in 6000 procedures.

It doesn't stratify it down.

It's going to be much, much less than a screening colonoscopy and the punctures are mainly caused because of the weakness and maybe the the area or the intestine.

>> There are a few different ways that punctures could happen.

One is, you know, directly driving through the wall, the colon that's something that's not seen all that often anymore.

You know, it was a little more prevalent back in the olden days when back when back and back when you and I read OK, other things you know, removing polyp can weaken an area of a polyp is large enough it can make enough weakness that a perforation could happen just from blowing air into the colon which is something that is required to see during a colonoscopy.

There's also in the process of advancing the scope through the colon.

We see the end of the camera but back upstream from where the end of the camera is you can develop a twist or a loop in the colon and if you push through that, you know it can cause a little tear in the lining.

>> But the optics on them because they have cameras on.

Yes.

You mentioned those have gotten so much better over the significantly better you know, the advances that we're seeing with our home televisions with the four K in the high def and all these other things are in the medical field as well not just for colonoscopy but for laparoscope scopes and those things.

So we have, you know, super high def magnification views.

There are different lighting sources that we use during colonoscopy that could identify you know, is this a polyp?

Is this just a normal foaled?

So kind of helping those determination.

>> Well, I want to talk about the prep in the actual procedure, but here's a little question for you.

I remember when I had my colonoscopy it was a big deal because I was over the age of 50.

>> Yes, but now that is a younger set.

>> Right.

Right.

You know, as we had talked about before, we're seeing more and more polyps and even cancers in folks younger than the age of 50.

And so several years ago recommendations actually lower down to age 45 for average risk people to begin screening colonoscopy.

>> Well, and that's interesting too is it because as the age is getting younger, is that because of what we're eating maybe there's more alcoholic intake going on or all those true right diet you know, certainly high fat low fiber diet, alcohol, smoking those are all risk factors for developing polyps and colon cancer.

More people are doing those things.

>> Our diets have significantly changed even since Hamas won back some other very good but so forty five is a good time to get them started.

>> How often should one have you?

It depends it depends on what you found during your colonoscopy.

It depends on if you do have any of those risk factors.

You know if there's a family history of colon cancer in a first degree relative that's a significant increase in your colon cancer risk and so you're more likely to have colonoscopy sooner.

You know, if you don't have polyps on your initial most people would tell you five years for your next one if you do have polyps generally depends on how many polyps, how big they are.

There are certain different types of polyps as well.

Some carry a little higher risk than others.

And so I usually tell patients depending on the number type and size of polyp anywhere from a three to five year range if there are larger polyps that we have to take out in what's called a piecemeal resection, you take them out in pieces because you can't remove it all in one.

It's too big for the instrument.

No then those people actually sometimes have to come back three months, six months, even a year.

>> I see to make sure that the entire polyp was removed.

I got you.

>> All right.

And I want to go and remind our viewers tonight that we are live at this particular moment and we're talking to a physician who's a general surgeon, Dr. Jeremy Wilson.

And the subject of course is colonoscopy as it is Colonoscopy Awareness Month.

So please give us a call and I see a call coming in now and while they're taking that, let me get on to the next one.

>> Let's talk about preparation for a colonoscopy procedure.

>> Preparation I think is another probably the biggest stumbling block for people to get their colonoscopy done.

You do have to have your colon completely cleaned out.

I tell patients that the quality of the colonoscopy is directly proportional to the quality of the prep.

>> Most preparations involve what's called a low residue diet for a few days before the actual main preparation and you know, basically try to avoid fresh fruit and vegetables, whole grains things with a lot of roughage in them.

Then the day before the procedure most of the time it's clear liquids for the entire day beforehand doesn't have to be a colorless liquid.

Just has to be clear.

We tell people if you can hold it light and see through it, you can have it best to avoid certain colors such as red or purple because they can look like blood during a colonoscopy.

>> The evening then before the colonoscopy involves taking laxatives and there are very various different protocols for that.

It just depends on what you and your physician decide is going to be best for you based off of your other health issues.

>> OK, very good.

We have call coming in mind number five it looks like Rea he'd like to be offline.

I'm going to read that for him.

I'll take he says I take blood thinners.

How safe is it.

I'm sorry how safe is it to have a colonoscopy?

>> Are there any other higher risks?

Blood thinner is a special consideration when it comes to colonoscopy depends on the type of blood thinner certain ones we hold for two days beforehand.

Others need to be held for a week beforehand being on a blood thinner and having it still in your system during a colonoscopy would increase bleeding risk especially if biopsy or polyp ectomy is performed.

OK, so it just depends on the type of blood thinner typically we get with whoever is prescribing it for you and check with them and say you know we need to hold this medication for two days, you know, so resume it as soon as we can afterwards and I think that whatever medications you're on that the person doing that colonoscopy needs to know what you're on.

>> Absolutely.

There are some medications even excluding the blood thinners that should be held beforehand because the increased risk of injury to the kidney or electrolyte abnormalities other ones we definitely want you to take beforehand because they help protect the heart during the procedure.

So yeah, it's important to go over with the physician that's performing the scope what medicines you're on and make sure that you get in your preparation instructions the list of what you're supposed to take which is supposed to hold how long you're supposed to hold it and I take an aspirin a day and prescribed it so that would be something I probably wouldn't want to take the day of my colonoscopy.

>> Most endoscopy is OK with the low dose the eighty one milligram aspirin typically at the 375 the full strength aspirin has enough what's called antiplatelet effect that you'd probably want to hold that five to seven days beforehand.

>> Oh OK. >> Five to seven.

I don't think it was going to be that long but OK we're going to talk about what you can expect during the procedure.

>> We do have this call coming in from James Caan, a digital colonoscopy escapee replace a traditional colonoscopy and will the digital colonoscopy give you a better result with digital colonoscopy?

I'm assuming they're talking about the virtual colonoscopy or CT iconography.

>> It has similar drawbacks and features to what we were describing for the collagen right.

>> It does however still require the bowel before basically they run you through a CAT scanner and then they do computer remodeling to make it look like you're flying through the cold.

>> Oh, I see.

You know it does pick up polyps .

It can miss smaller polyps that may be caught on colonoscopy and then the biggest disadvantages that you can't remove a polyp with it.

>> Well, that's true.

That's true.

And yeah, that's the point with doing a colonoscopy is remove those polyps before they get a chance to turn into something else.

>> I don't know if we mentioned this or not because we talked before the show.

Sometimes I get talked about before the show and what we talk about on the show sometimes a little confused the instrument that you use we'll talk about well we'll talk about that procedure in a minute but it has a camera on it plus it has some surgical instruments that are attached to is there's what's called a working channel in the scope and we can pass different things through the the working channel.

There are biopsy forceps that you can, you know, take biopsies with or remove smaller polyps.

There are different size of what are called snares that we actually use.

It's almost like a lasso to snare a polyp off scene that's fascinating different different laser things to coagulate and things like that too if you need to if you have the capability at your facility, I bet that's a very expensive piece of machinery.

>> I imagine you're out of line six.

James, we did talk about that digital colonoscopy.

>> I didn't realize that there was such a thing.

It's a virtual colonoscopy pornography.

It's it is a legitimate strategy for colon cancer screening similar to the immunohistochemistry blood test or the collagen or the colonoscopy.

>> It's kind of an in between OK, but it still has that main drawback of inability to remove polyp if it's seen right.

>> OK, let's talk about what you can expect through the procedure now I know that I was sedated.

>> Yes.

And I guess that is the common way to go.

>> Very much so.

And is that conscious sedation?

It is technically called a conscious sedation before when we were doing these the majority of the time when we use a combination of two different medications, one kind the more sedative pain relief medication than the other one kind of sedation but it would also give you a little short term memory loss more and more nowadays we're having our anesthesia colleagues actually help us with colonoscopy.

They give a medication called Propofol.

It works very quickly but it also has the benefit of going way more quickly so you don't have as much of that hangover effect as we used to have back when we were using some of those older medications where people would say, you know, folks that I was awake and talking I had no idea what I said.

>> I don't remember anything until that next evening.

>> So now is the patient aware enough if you have questions or you want them to roll over or something, can I hear you?

>> Can they respond to usually not with the situations that we're using now.

You know the advantage though that medication does go away fairly quickly and so that if we need somebody to move on stage you can turn that medicine off and we can ask oh help us.

>> Then they turn it back on and that works.

Then again pretty quickly to get them back to sleep.

>> OK, got you.

Well, so the procedure itself you're going to have to get the sedation and I'm just kind of recalling from when I had my colonoscopy and you're chatting with the doctor next thing you know out like a light.

>> Yes.

And then it seems like I'm waking up in recovery so it just goes by so quickly.

>> What's happening that little dash there between the beginning and the end?

Sure.

Once patients are sedated we usually will do you know, start out with just the regular digital exam and also do an inspection to see if there's any sort of , you know, hemorrhoid or or you know, fistula abscess or other conditions.

You know, insert the scope you advance the scope around the entirety, the colon up into where the small intestine hooks in.

It's an area called the cecum.

That's one of the quality measures for checking to make sure adequate colonoscopies are being done.

You want to have greater than ninety five percent of the time where you reach the get all the way in around the bowel as we're going in we're inspecting the lining of the colon.

>> It's called the mucosa.

>> That's where these polyps start.

That's where most of the colon cancers are coming from.

Are those polyps any polyps we see on the way in will remove we also spend a more thorough time than inspecting the entirety of the circumference of the colon on withdrawal or removing of the scope.

That's another one of those quality measures that were going to say greater than eight minutes withdrawal time if you're withdrawing faster than that significant chance you're missing polyps.

>> OK, so after this is all over, when when does that patient get the results?

It depends.

>> You know, if for no polyps, no biopsies taken, we can tell them right away.

You know, we saw diverticular cyst which are little pockets that can develop in the colon.

We saw hemorrhoids.

We saw nothing if there are biopsies or polyps removed, those have to go to pathology and then we're kind of at the mercy of pathology to put them on slides, look at them underneath microscopes to generate reports but they're typically fairly good about that.

We get results usually within a few days some of the more complex polyps that are removed or if you biopsy something that you're fearful is a cancer quite often a pathologist will want one of their colleagues to look at it as well before they put out their report .

>> They say oh this is a cancer and so sometimes I can take a little bit longer than that.

We're checking the system.

OK, now let's talk about when the patient does get the results.

>> Of course a negative result means if there are no other risk factors then typically a recommendation is as long as you're not having any new problems repeat screening in ten years and ten years and the positive result you know, again, it depends on the number the type the size of the polyps but generally it's in a three to five year range.

>> OK, really so that's not too bad.

>> So I'm not going to be coming back next month.

No, no, no, no.

That would be a very, very unusual circumstance.

It does happen.

You know, some of these larger polyps that we can't remove with traditional endoscopic techniques there are special are called interventional gastroenterologists that can do a procedure called endoscopic mucosa resection.

They have really fancy endoscopes.

They can look underneath the lining and they have different techniques that they can remove very large polyps and even you know, early pre invasive type cancers.

>> Well, and I know that there's probably not a long line at the colonoscopy window for people to have the procedure.

>> You might be surprised really there are long, long lists of people that are waiting and just needing someone that can do that for them.

>> I see.

So do you.

I know I had to be referred from my family physician when I had my colonoscopy and it was just a routine test.

I didn't have anything going on.

We just wanted to you know, get in after I turned fifty and so sure.

>> But so do you have to be referred or is there another way around that you know, depending on what health care system you use, some health care systems have what's called a colon clinic or a number that you can call and they'll ask you several questions, you know, is their family history are you on blood thinners?

Do you have past history of polyps or cancer?

And depending on your answers to that, sometimes you can just schedule you for the colonoscopy without having to be seen in the office first.

>> And you know, I found to that most insurance companies health insurance companies say yeah, bring it on, get your colonoscopy, we're going to pay for it.

>> Yeah.

Screening tests are covered 100 percent by most insurance providers and you know from the insurance companies point of view, it's way cheaper to pay for a colonoscopy than it is to pay for a colon resection for colon cancer some it also is way, way better for the patient to have colonoscopy have a polyp removed rather than wait until we get symptoms.

Then we find it's a cancer.

>> Right.

Any complications after a colonoscopy that somebody could expect main ones you know that we discuss sedation and we have our anesthesia providers there.

People are hooked up to monitors EKG what's called a pulse oximeter monitor which monitors oxygen levels in the blood blood pressure monitors those sorts of things any sort of anesthesia issues, the seizure people are right there to deal with and they deal with it on the fly most of the time, you know, give this medication or that medication another main one would be bleeding.

>> You know, if a polyp is removed for biopsies performed potential for bleeding afterwards most of those post Paula back to me or biopsy bleeds quit without any sort of intervention.

It just may involve having to, you know, be observed in the hospital for a bit, make sure we're not losing significant blood if there is intervention required quite often it can be another colonoscopy and we, you know, put a clip on a spot that was bleeding or or inject or cauterize or whatever we need to do very, very rarely would surgery be required, you know, in the event of bleeding.

OK, you know and as we said before, the most dreaded complication that being perforation or puncture it depends on the degree of perforation you have what's called a microscopic perforation or small puncture where a little bit of air and other things escape outside the colon treated very similar to diverticulitis when those pockets can get infected antibiotics, bowel rest and those usually resolve major perforations still would require surgery.

>> OK, and we have about two and a half minutes left and we wanted to go over some of the most common fears or some of the what would you call myths?

>> Myths.

Yes.

So what are some of those you know, one of the main things we hear is is going to hurt and I think you hit it perfectly, you know any more nowadays with the sedation people wake up and say I didn't know you did anything.

>> Are you sure you did something?

So there's not pain.

>> You know, another thing we hear quite often I'm too old for a colonoscopy.

You know, there is some incidence of thinning to the wall of the colon, maybe slightly higher risk but it's not prohibitive when we're talking about colonoscopy, you know, for bleeding or for symptoms we're talking about for a screening colonoscopy.

Certain groups recommend stopping screening after age 75 unless you know, in speaking with your primary care, your family physician, it's thought ,you know, you've got a pretty long LIFE Ahead of you still.

>> So let's keep going with that screening.

>> There's no reason to not have one.

You know, if it's a situation where somebody is, you know, got a lot of other medical issues, they basically you know, this may not be the best for you right now.

It's an individualized thing after that point and yet people should definitely discuss it with their primary care provider.

>> OK, anything else as far as myths are concerned?

>> I think we've hit or we hit them all but not all of them but we hit on them quite a number of important I guess the biggest thing you know, the biggest point we want to get across is that colon cancer is out there.

>> It's real.

It can be prevented with colonoscopy, with removing a polyp rather than waiting until it becomes a cancer.

You know, incidences are going down especially for older folks because older folks are a little more compliant with the screening guidelines.

Younger folks are a little more resistant let's say.

>> Well, in your experience and we've got maybe thirty seconds left are people fairly relieved or are they happier once the procedure is done and especially when they find nothing?

>> What's the demeanor of that patient most by far the vast majority of patients are so happy when it's over and they say I was worried about this procedure.

Sure nothing is really turned out to be, you know, a minor inconvenience.

>> I'll tell you I fretted about it for weeks before I actually had mine and I thought that was just absolutely ridiculous.

You know, I was in good hands with a good physician test went fine.

>> They found nothing.

So fear of the unknown that that's exactly right.

>> Said it better myself.

Hopefully we dispelled a little bit of those myths and made a little bit more known what was unknown and that's what this show is all about.

>> Yes.

Well, some things Dr. Jeremy well some general surgeon for joining us tonight on HealthLine.

>> It's always a pleasure to have you and we thank you for watching.

Thank you for your questions and we'll see you next week on Tuesday for another HealthLine episode.

Until then, thanks for watching.

>> Good night and good