There is truth to this. I’ve heard patients ask specialists questions that anyone with a medical degree should be able to answer, yet they refer the patient to their internal med doctor.
Well, at almost 70 I am quite healthy (knock on wood) and I don’t have any chronic conditions to worry about, thank goodness. I hope I don’t when I’m 75 or 80, either. But that prep was quite exhaustive and definitely not for the faint of heart or faint of body.
Also, assuming I don’t have anything show up at the next exam, it will have been over twenty years since the first colonsocopy and over twenty years since the polyps were found, and which were never seen again. We’ll see what the advice is by then. Also, we’ll see who my GI doc is at that time, since today’s doc – who’s been my GI doc since I started all this – is 67 and acknowledges he doesn’t know how long he’s going to keep doing this. Chance are that in five years, I won’t be seen by him.
It’s a very litigious society so doctors refer out so they don’t get sued.
My 89 y/omother just had an endoscopy today and found a polyp. If cancerous she will have an colonoscopy to remove more. She is healthy, pretty much, living alone with my sisters close and drives. Old age actually is on both sides of mine and my wife’s family. I think you have to evaluate how healthy you currently are and not to do a colonoscopy to prevent something later on is silly. Dying a painful death from cancer is not the answer to not drinking the crappy solution.
Fair point, @Knowsstuff. I’m just tired from my last two days. In five and ten more years, I’ll go through this again, I know.
Cancer treatment can be quite painful and carries significant risk as well (my DH had stage 3 colon cancer, and his treatment year was pure hell). It’s up to the patient to decide whether or not he or she would want to go through treatment at an advanced age. Some put a good amount of thought into this question and decide to decline to continue colonoscopy screenings, and their views are valid. I’ve never seen a physician refuse to do colonoscopies on any patient who can be expected to tolerate the procedure well simply because the patient is elderly; it’s always the patient who makes that decision (in my experience).
@Nrdsb4: I"m sorry about your dad’s stroke. Was this recent?
Those who do not have much remaining life expectancy may want to forego screenings for cancers which would not shorten remaining life expectancy if they occurred. Remaining life expectancy by age can be found at https://www.ssa.gov/OACT/STATS/table4c6.html . Someone who is 100 years old and therefore has a remaining life expectancy of a little more than two years may not be worried about finding a polyp that may become a metastatic cancer in five or ten years.
I guarantee you that if I’m still alive at age 100, I will not be having a colonoscopy. Guaranteed. I’ll put money on it.
Anyone want to bet me? If I’m wrong, you can collect in only 30 years and three months!
I should have added that he was 46 when diagnosed and perfectly healthy otherwise (took no medicines whatsoever), and this treatment was a brutal beating. I can totally understand why someone in their 80s or 90s would decline to screen for colon cancer.
“And, they now say that you shouldn’t stop when you’re 75, because people live so much longer these days.”
“Dying a painful death from cancer is not the answer to not drinking the crappy solution.”
Sure. But it isn’t really about drinking the yucky solution.
The real question is at what point do you stop testing and treating things. Because treating certain conditions today changes your odds of what you are going to get later on. So everyone has to eventually decide when the lines cross on quantity vs. quality of life.
Personally, I’m with Dr. Zeke. No tests or surgeries for me after 75. If cancer gets me at 76, that won’t be great. But at least I won’t have to worry about getting Alzheimers later.
https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/
Ruth Bader Ginsburg is 85 years old. In recent interviews she has suggested she might consider retiring at age 90, the age Justice John Paul Stevens was at retirement. RBG had colon cancer at age 66; and pancreatic cancer at age 76. One reason she survived pancreatic cancer is that it was found and treated early, because she kept right on with the testing and treatment thing.
Yes, there is a point at which it makes sense to stop, but 75 is a rather low cutoff.
And, as has been pointed out above, there certainly are less invasive options for colon screening than colonoscopy.
Articles about Ginsburg indicate that her pancreatic cancer was found accidentally during an operation to remove something found by CT scan (the articles did not indicate why the CT scan was done, as it is not a regularly recommended screening, and has medical risks relating to the radiation exposure). This was very fortunate for her, since there are no good screening methods for pancreatic cancer.
Yes, using non-invasive stool tests annually as the primary screening method means that the expected number of invasive colonoscopies (and hence their costs and medical risk) is lower. However, colonoscopy is still indicated if the stool test finds blood in the stool. Basically, the other methods like the stool tests are ways to try to reserve the use of colonoscopy for situations more likely to find cancer.
It does mean that if you are not willing to do colonoscopy at all (due to low remaining life expectancy or medical conditions that make it inadvisable), it may not be worth it to do the other types of screening that need to be backed up with colonoscopy if indicated.
Another reason for the recommendation to not routinely screen for colon cancer at older ages is that the risk of complication with colonoscopy (perforation and other undesired outcomes) increases with age, so the risk/benefit ratio weakens. Yes a person could choose a noninvasive test, but if results are positive it would lead to colonoscopy.
Yes, but the risk benefit equation might be different if the colonoscopy is only considered after an indication from a FIT test.
Are my gastroenterology doctors sadists? Is this about control, or is Golytely really so much better than anything else?
I asked if I could use Clenpiq or at least Prepopik, based on what I read here. The consulting doctor said, “No, Golytely”. I had that last time, it is disgusting and makes you sick (even though I went through all sorts of gyrations to drink it). He said that I could try different things to make it taste better (I tried about ten different flavors last time), and that they could give me something for nausea (ain’t gonna help it go down). The doctor said I wasn’t as clean as they liked last time, and they didn’t want me to do a low volume prep.
I sucked down every drop of that crap last time, and probably wasn’t too clean because I eat an ultra high fiber diet. Most everything I eat is on the list of “don’t eat this for a low residue diet”, which I didn’t do last time.
They hadn’t even heard of Clenpiq, and said I could use it, however if I wasn’t as clean as they wanted, they wouldn’t do the procedure but I would have to pay for it. I said that I wasn’t going to do the colonoscopy if they required the Golytely, to which the assistant gave me the second answer (apparently they anticipated this). Okay, you can have the Prepopik if you drink massive volumes of fluid.
So now I’m going to try this low residue diet and see how that works, though I don’t know how long I should do it for. I’m just trying to hang on and not cancel and reschedule this!
I’m willing to bet this isn’t about control as much as it is about the above statement. Some people have slower motility than others, even when following instructions to a T. Golytely is usually the prep that has the least incidents of not getting completely cleaned out, and once a patient has had a bad result, there is no reason to think a prepopik will be an improvement, because the results of prepopik have not been as good as that of Golytely.
If I were you, I would do at least 2 days of a low residue diet. White bread, white rice, mashed potatoes without the skin, mac and cheese, eggs, chicken, fish, things of that nature. You won’t go hungry, you just are eating some of the stuff (highly refined carbs) we have been trained to avoid, which I got a kick out of if I’m being honest. Then the day before the procedure, you stick to clear liquids even if it says you can have solid food for breakfast. Then follow to the letter the instructions regarding drinking fluids with your prep. The fluids are so important, not just for helping with hydration, but for enhancing the effects of the prep laxative.
I did prepopik for my first prep, but my doc also had me do the low residue diet AND take a dulcolax tablet on day two of the low residue. This last time I did Suprep, and it was much harder to get down. So I don’t blame you for your feelings about Golytely, since it has even more volume than suprep.
Good luck!
Thanks, @Nrdsb4! That’s great information. I was thinking that perhaps my problem was having large amounts of fiber the week prior, and the five chocolate chip cookies I ate for breakfast the day prior 
(okay that was dumb, I was thinking it was all getting washed out anyways). I think if I do this and still have a problem, then it’s perhaps the slower motility that you mentioned.
I just asked them about doing the low residue diet (they didn’t even recommend it, I suggested it). The nurse told me seven days. That seems kind of excessive to me, though I could eat nothing but mac and cheese for the rest of my life…
@busdriver11 happy to email you my directions. I’m up Aug. 20 for my first. I was rescheduled and really trying not to chicken out. My extensive instructions start low res diet five days out I think.
I am currently preparing for my colonoscopy on Monday. My directions also said to eat low residue for five days. I went ahead and started two days early. As someone that normally eats lots of fruits and vegetables along with some amounts of whole grains, I have to say the lack of fiber is making me physically uncomfortable. (Sorry if TMI.)
I took a dulcolax/miralax prep last time, but am also prescribed golytely this time. I am dreading it. I guess she wants me thoroughly cleaned out since she found polyps last time.
If I recall that correctly, I switched to zero plant and fruit three days before my prep. Chicken broth with a slice of white bread and a hard boiled egg - that was my meal stuff. I ditched the bread and the egg and just drank salty clear broth for two days prior. The nasty prep fluid was just ugh. But I am making my own next time based on the recipe on the can! No. Yucky. Sweetener. I can do salt and sour, but that artificial sweetener was jus bleh.