Long ago I learned that we medical doctors are cut from the same cloth as the rest of humanity. Some are overweight, don’t get enough sleep, eat junk food, and partake in the panoply of earthly sins. Although I’m aware that studies show that obesity is not simply a lifestyle choice, I still wonder how my overweight colleagues can counsel their patients on weight loss. I’m sure they must. Were I more sensitive, I might not imagine it as the elephant in the room.
So, both to serve as an example and avoid the taint of hypocrisy, I try to follow the health practices I recommend. I maintain a reasonable weight, exercise, drink alcohol in moderation (mostly) and try (sometimes not hard enough) to get the right amount of sleep. If I sound a bit boring, yours would not be a unique observation.
Time being relative, I soon learned the principle that time passes most slowly between paychecks and fastest between colonoscopies.
In line with the “follow my own advice” rule, I recently found myself in a colonoscopy suite. Colon cancer screening is one of the health maintenance issues “back burnered” by many during the pandemic. With survival at risk, we don’t think first of our colons. I had my first at age 50, as recommended at the time. Now, with the age of colon cancer diagnoses falling, we recommend starting at 45. My first revealed a tubular adenoma, a benign polyp. Such polyps confer higher cancer risk, so instead of ten years, I was told to have a colonoscopy every five. Time being relative, I soon learned the principle that time passes most slowly between paychecks and fastest between colonoscopies.
When I confessed to Dr. Ted Stein, my GI specialist, that I was some months overdue for my follow-up colonoscopy, he reminded me that as I’d had a normal interval colonoscopy, the current recommendation allowed for a seven-year interval. But, if I wanted to adhere to the old recommendation, that would be okay too.
A colonoscopy may not be the GI equivalent of a root canal, but I still don’t count off the days until my next, like I might for baseball’s opening day. Regardless, I opted to do it. Of course, there’s “the example thing.” For the next year, I can tell my reluctant patients, “I just had one myself. No big deal!” A bigger reason is fear of irony. Irony hunts down physicians. In my mind’s eye (which remarkably also functions as an ear) I could hear colleagues and patients, the ghosts of Hanukkah future, whispering, “So unfortunate about Dr. Stone and that colon thing. If only…”
It was not yet 7 a.m. when the bright and smiling Dr. Stein greeted me at the colonoscopy suite. Fortunately, I’ve known Ted for over 30 years. He’s just a friend who does this strange procedure. He introduced me to Dr. Lo, the anesthesiologist who administered propofol. She commented that it would sting a bit as it flowed into my intravenous line. After that momentary sensation I was off to dream land, to emerge when the procedure was over. Again, the smiling Dr. Stein was there to reassure me that we were done and all was fine. Dr. Lo had explained a bit about propofol. It wears off not by leaving the body but by redistribution. It starts in the brain, causing loss of consciousness, then re-distributes elsewhere allowing the return of consciousness when enough leaves the brain. If one pays attention, it leaves a “soft landing” that fades pleasantly through the rest of the day.
So, after my good experience, I’ll go back to being the pied piper of colonoscopy. (Though stool testing alone is a reasonable alternative for the procedure phobic.) Colon cancer remains the most common cause of death among non-smoking Americans. So, it’s a big potential target. Even before the age recommendation dropped to 45, fewer than half of Americans were current on screening. Some people reading these words would probably add years to their lives if they picked up the phone and scheduled their colonoscopy. Even without a friend of 30 years to do the procedure, everyone’s plan is likely to have a smiling GI doctor and an anesthesiologist to deftly manage propofol. Now wouldn’t it be ironic if you missed a timely reminder like this?
Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.
