Transcription:

Scott Webb (Host): Colonoscopies are the gold standard when it comes to diagnosing and treating colon cancer. And I'm joined today by Dr. Andrea Fribush. She's a Gastroenterologist with Emerson's Concord Gastroenterology Associates. And she's here today to take us through the entire colon screening process from prep to results. This is the Health Works Here podcast from Emerson Hospital. I'm Scott Webb. So, Doctor it's so great to have your time. We're going to talk about colonoscopies today, but before we get rolling, let's just answer the question that probably a lot of folks have about going to the hospital. And I know I sort of had these concerns myself during COVID when I needed my colonoscopy.

So as we get rolling here, maybe you can just answer this sort of million dollar question, if you will. Is it safe to come to the hospital?

Andrea Fribush, MD (Guest): Yes. It is safe to come to the hospital. We follow all local and national safety and disinfection regulations. What is unsafe is to postpone your routine health care, which includes screening for colon cancer and polyps. When doctors recommend colonoscopy for their patients, we want them to keep in mind that at colonoscopy, we can remove precancerous polyps, which will decrease a person's risk of future colon cancer. So, it's not only a test to screen for colon cancer, it actually helps to prevent colon cancer.

Host: Yeah, it definitely does. And I know that the, some of the guidelines have changed and maybe folks got a little confused is it at 45, is at 50. So it's great to have an expert on. At what age should we start our colonoscopies?

Dr. Fribush: The American Cancer Society has recently updated their guidelines. It used to be that the age of first colonoscopy was 50, but it's recently been lowered to 45 because statistics have shown an increase in colon cancer being diagnosed in people before age 50. So, now the current recommendation is have your first colonoscopy at age 45 if you have no family history of colon cancer or polyps, but you should have it at age 40, if you have a family history of colon cancer or polyps, or often have other cancers that your doctor may tell you would increase your risk for colon cancer.

Host: Yeah, that sounds just right. And that was the case for me. It's like if your normal risk then, you know, follow these guidelines, which if, if you have a family history, which of course we cannot outrun our family history, then you move it on down possibly as early as 40. So let's talk about the prep a little bit.

I was dreading the prep. And it really wasn't so bad and all the horror stories, nightmares that I'd heard over the years. It really wasn't so bad. It seems like things have gotten a little better, a little easier for folks, but maybe you can take us through this. What is the prep really like?

Dr. Fribush: I agree with you. The prep has come a long way. It's not the full gallon that we used to do 10 years ago, we have what's called a split preparation, which means you drink part of the preparation the night before your test. And then the second half of the preparation about five hours before you arrive at your endoscopy center.

It is a lot of liquid. People do need to be near a bathroom since the preparation is a laxative. So you will be having cramps and diarrhea, and we tell people during the time they're doing the preparation, they should not plan on caring for family members alone. If they have small children or elderly people whom they normally take care of, they should get some help with that because the person who's drinking the preparation will be running to the bathroom a lot.

And we also tell people that if you know, you're a person who tends toward having nausea, call your gastroenterologist's office ahead of time and ask for an anti-nausea medicine, we can give you a prescription for a low dose anti-nausea medicine to make the preparation easier.

Host: Yeah, that's great advice. I was going to ask you about caring for the family. Cause I know in my case, in particular, you don't wanna speak for everybody, but I was fairly indisposed and it was probably better if everybody could take care of themselves or my wife could help out. So, great advice. And, my experience when I went from mine was that I didn't meet the respective gastroenterologist, anesthesiologist until right before my colonoscopy. So wanted to ask you, is that kind of standard? Do we kind of meet those folks, you know, as we're kind of coming through the door and also, why do we need an anesthesiologist for this procedure?

Dr. Fribush: The first person you meet will be your nurse, who's very knowledgeable and supportive who will get you ready and explain everything. Then you'll meet your gastroenterologist and your anesthesiologist and they will explain again, have you sign some permission forms. The reason we have an anesthesiologist come is that they are specially trained to give deep sedation with close monitoring and they focus entirely on your comfort and safety. Everyone benefits from having an anesthesiologist. That includes people who are healthy and on no medicines or people coming in for a colonoscopy who have other chronic medical conditions and who are on a lot of other medicines.

Host: Yeah, that sounds good. And I certainly felt better that there was an anesthesiologist nearby. So, comfort, safety, care, all good things. And I know we're not supposed to drive ourselves. But generally speaking, how do folks feel afterwards? You know, obviously don't drive yourself home, make sure you get a ride that day, but generally speaking do most folks feel pretty good afterwards?

Dr. Fribush: Usually people feel alert but tired. And when they go home, we give them a lot of written instructions so they know what to expect. We recommend people drink extra fluids at home. You can eat normally. You may need a nap. And we tell people they shouldn't plan on driving. They shouldn't plan on caring for other people or going back to work that day. And then the next day, most people are able to go about all their normal activities.

Host: Yeah. And boy, I enjoyed that nap. That was one of the best naps I've ever had when I got home. That was a pretty awesome nap. So, how long does it take to get the results?

Dr. Fribush: Your doctor will talk to you after the test and tell you what they saw. And if polyps are removed or any kind of samples are taken, most doctors will send you a letter within two weeks because we wait for the lab results to come back first. And in the rare event that we see something and it turns out to be a cancer or any other significant biopsy results, your doctor would normally call you within a week and your primary care doctor will receive a copy of everything.

Host: And what if a woman has their period or they're considering pregnancy, are those any concerns related to a colonoscopy?

Dr. Fribush: Yeah, a woman can have a colonoscopy when she's having her period. We don't want people to worry about that. If it's their usual habit to wear a tampon, they can do that. If they don't want to wear a tampon, that's fine. The nurses are used to cleaning up everybody, men and women of all ages. So, we don't want them to worry about that.

If you are considering becoming pregnant, and your doctor has said, you're due for a colonoscopy, we recommend that you have your colonoscopy before you become pregnant, because we really don't like to do colonoscopy or any other procedures on women who are pregnant, unless it's an urgent issue or a medical emergency.

Host: Yeah, that makes sense. And what if somebody is considering a hip or knee surgery, any kind of major surgery like that. Is that something we need to sort of plan ahead and consider into our colonoscopy plans?

Dr. Fribush: Yeah, planning ahead is always the best thing. If you're due for a colonoscopy and you are planning some kind of surgery, such as a knee or hip replacement, a hysterectomy or a weight reduction surgery, talk it over with your doctor, but usually we recommend having your colonoscopy first and getting it out of the way before those operations.

On the other hand, if you're being evaluated by a cardiologist for a possible heart problem, or seeing a lung specialist for a significant breathing issue, you need to complete those evaluations and treatments before your colonoscopy, because we want your heart and lungs to be in the best possible condition before you have your colonoscopy.

Host: Yeah, definitely. And this has been really educational today, you know your stuff, and you're so efficient and Doctor, as we wrap up here, the final takeaways, just about colonoscopies screening or just maybe cancer in general?

Dr. Fribush: Well, two things. One is read your preparation instructions. Once you sign up for your colonoscopy, your gastroenterologist's office will send you preparation instructions, open it and read it right away. Don't wait until the night before the colonoscopy, because if you have questions, we want to get your questions answered ahead of time. Because if you have a problem with the preparation, then the doctor's not going to be able to see as well. And we want your colon to be really clean. And the other reminder is don't put off your routine screening. Remember colonoscopy is for prevention and early detection and prevention is the part where we remove the pre-cancerous polyps. If a colon cancer is found at an early stage, which is one of the other benefits of colonoscopy then that will increase the probability that you can have a complete cure of colon cancer.

Host: Yeah, which is definitely the goal. So, Doctor again, very educational, thanks for your expertise and advice today. And you stay well.

Dr. Fribush: You too. Thank you.

Host: And visit Emersongi.org for more information, or to make an appointment. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb and make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple, Google, Spotify, or wherever podcasts can be heard.