Search for tag: "colorectal"

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Scot: Troy, are you ready to talk about colonoscopies?

Troy: I'm ready.

Scot: All right. Who's had one, by the way? Have you had one, Troy?

Troy: I have.

Scot: Oh, you have? I didn't think you had yet.

Troy: Yeah, I have had a colonoscopy. I went to my primary care provider last March and he said, "The recommendations have changed. You are due for a colonoscopy." And I said, "That's not the news I wanted to hear." I signed up for it and did it. I got in the first opening they had. They had a cancellation. I got in for it two weeks after that appointment. I'm like, "I'm just getting this thing done." And I did it.

Scot: Getting it out of the way. Mitch, you haven't had yours yet. You're not old enough for it, right?

Mitch: No, I'm still under 40. Is 40 the new 50? Is that the slogan?

Troy: Forty-five is the new 50.

Mitch: Forty-five is the new 50. Yeah, I got a decade.

Scot: All right. Well . . .

Troy: You're good.

Scot: Colonoscopies are one of those things that men just kind of don't want to get and don't want to talk about. We just want to ignore it, pretend it doesn't exist. But as I was thinking about this topic . . . And I have had my colonoscopy. I guess in my mind, it's two choices, right? It's possibly get the second most deadly cancer men get and have your life disrupted for who knows how long, or get a colonoscopy every 10 years, right? I don't know.

So today, we're going to talk about the reasons men don't get colonoscopies. Troy and I are going to talk about our experiences to find out if maybe some of the perceptions out there that people have about them are true or not.

Welcome to a Men's Health Essentials episode of "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. I bring the BS.

And the part of the colonoscopy I didn't like was the prep. I don't know about you, Troy. Troy is the MD to my BS. What didn't you like about your colonoscopy?

Troy: I agree. The prep. And that's what I'd heard, too, going into it. The prep is the bad part. The colonoscopy is easy. That was basically my experience.

Scot: Yeah. Mitch Sears is on the show, and he's a ways away from his colonoscopy, but I guess you can't wait, right? You're pretty excited about it apparently.

Mitch: I wouldn't say excited. We're back to that area. I don't love these episodes, but it's something I want to be prepared for. So I'm ready to learn.

Scot: And I don't know his colonoscopy status, because we just met. We've got Nathaniel Ferre on the podcast. He's a community health educator at Huntsman Cancer Institute, and he works with the public to help them understand the importance of cancer screenings, including colonoscopies. Welcome to the show, Nathaniel. Have you had yours?

Nathaniel: Thanks, Scot. Great to be here. I, like Mitch, have not gotten mine yet. I'm not of the age quite. So we'll get there eventually, but . . .

Scot: All right. So, on the podcast, I guess we have Team Scoped, which is Troy and me.

Troy: Team Scoped. We've been there, done that. Speaking from experience.

Scot: And we have Team Unscoped, Mitch and Nathaniel.

So I want to start with actually both of you guys. Like Team Unscoped, what is your perception of what a colonoscopy is like? Mitch, what do you think?

Mitch: Oh, I've heard . . . No one talks about what actually happens, but it's like, "Here's this miserable prep step," and then the process itself sounds pretty uncomfortable. None of it sounds good. None of it sounds positive, but it's something you've got to do if you're not going to die from cancer. That's my perspective.

Scot: Nathaniel, you have a different perspective, obviously, since you help people understand the value of colonoscopies, and probably deal with a lot of these barriers that we're going to talk about today. What would you like to say about your perception or the perception of colonoscopies in general?

Nathaniel: Yeah, absolutely. Well, even though I haven't had it yet, I have heard it's a nice nap, right? You get a nice, solid sleep there in the middle of the day. And so that is an advantage, I guess, if you're looking for a good rest, but . . .

Scot: That's so funny because I had a friend that got it that said the same thing, that when they came out of the whatever it is that they put them under, it was like, "Can you please put me back under? I was having a great dream."

Mitch: Wow.

Nathaniel: "This is a great break right here."

Troy: That's so funny. My first thought when I woke up was, "I need to give patients more propofol," because that's the medication they gave. I was like, "That was so nice. I slept so well. I had no idea what was going on." That was my first thought when I woke up. So it was a nice nap.

Nathaniel: Yeah. Other than that though, obviously I think we've all heard about the prep. Like Troy said, it is a rough part maybe of it. But again, I think you think about the pros and the cons, and you think about what you're getting accomplished there. That few days of hard prep can really pay off with a great nap. And then, of course, the cancer screening to go on top of it.

Scot: That's right. And colon cancer, tell me . . . When we talk about cancers a lot of time, we talk about survival rates, right? We talk about dying. That's obviously the worst thing that can happen. But cancer can also cause really a lot of disruption in your life.

First of all, I did say it's the second deadliest cancer for men. How important is finding it early? How important is the colonoscopy in this step to survival or minimizing the impact on your life?

Nathaniel: Well, for colorectal cancer, extremely important. As we look at the five-year survival rates, which we normally do for cancer, if we find it early, we have over a 90% chance of five-year survival. It's really treatable. We've gone a long way to be able to treat this disease.

Where it really gets tricky and why that mortality rate is so high is the late stage. If we don't get screened, if we find it late, that mortality rate just skyrockets and the survival rate dips all the way down to 14%, which is really sad and very disruptive.

And so that just stresses the importance of screening and finding this early in order to be able to treat it much better.

Scot: And I understand about less than half of colon cancers are discovered at an early enough stage to make a difference.

Nathaniel: Yeah. Luckily, we're getting better with that as we continue to make strides in screening, but as we see some of these trends going on where people are maybe getting it younger or not paying attention to some of the prevention things that we can do, it is difficult to find it. But if we do get screened, then we can find it. It's just a matter of taking that action.

Troy: That kind of speaks to the age change too. Like I said, I went to my primary care provider. I think the recommendation just recently had changed. I was surprised to hear it had changed to 45 from 50.

I will say I had not looked forward to the colonoscopy, but I thought, "I'm good until 50, and maybe by then there will be another screening technique." And there wasn't, so I had the colonoscopy. But why has that recommendation changed, and why are we now getting it at 45?

Nathaniel: Yeah, that's a great question, and it really speaks to some of the trends that we're seeing as we see younger and younger people get affected by this disease.

Actually, certain groups, too, historically have been affected worse. The screening recommendation has been 45 for a long time for African-American males and females, as it's really affected this group much more hard than other groups in comparison.

And so lowering that to 45 is really an indication of we're seeing it younger. We're seeing increased risk due to diabetes, due to some other gastrointestinal diseases. And so, in order to reduce that, we see there's not a huge risk with a colonoscopy. We're looking at what's the pro, the con, the risk versus the reward, and the risk is quite low for a very high reward of finding those cancers early and really being able to address them.

Scot: I think most men and most people know that colonoscopy is something that is beneficial for them. But I mean, let's face it, there are a lot of reasons to put that thing off, right? It's like one of those things that's really easy to postpone time and time and time again because there's kind of a lot of stuff involved that it's easy to postpone.

Troy, was there anything that made you want to put it off? I mean, you jumped right on it, but what might make you . . .

Troy: I jumped on it.

Scot: Yeah. What might make you put it off? Well, first of all, why did you jump right on it? I'm curious about . . .

Troy: I'll tell you. That's exactly why I jumped on it, because I knew of every reason I wanted to put it off. And I knew the longer I put it off, I was just going to dread it.

Here I am, a healthcare professional, trying to talk myself out of doing it. I was literally just talking to myself saying, "I don't really need this. I'm low-risk. I don't have a family history. I don't see why the age dropped to 45. Why can't I just wait a few years?" All of these things. And so that's when I finally said, "I'm getting in as soon as I possibly can," because the next appointment wasn't until August. And so I got this done in early April.

And so, yeah, the big reasons I didn't want to do it were just the embarrassment of having to go in there and having a whole lot of people around me and having a probe inserted in my rectum and going up there and looking for polyps. Just that piece of it. It's just the fact that you have to be exposed like that. So I wasn't thrilled about that.

The prep, I had heard, was miserable. I just heard it was awful, that you're just sitting on the toilet and you can't get off it, and you're going in your pants, and things like that just sounded horrible.

And I didn't know I was going to be completely sedated either. I thought it was going to be a light sedation and I would be aware of what's going on during it. I thought, "This is really going to be uncomfortable and it might hurt." So that was a fear I had as well.

So those were all things going through my mind, and those were all the reasons I said, "I've just got to get this done so I'm not thinking about it." So that's why.

Scot: How about you, Mitch? Is there anything that would make you put it off? Or does something scare you about it, or something that concern you about it?

Mitch: So I don't mess around with cancer. I don't know. If there is the tiniest bump, I go in. And so I know that whatever the recommendations are, I'm going to do it because the alternatives scare me a bajillion times more than the actual thing.

I was in the same boat. I just barely found out five minutes ago that you're put under. I assumed you had to be up and maybe people . . . I think I was thinking of a colon cleanse rather than a colonoscopy, right? Where I assumed that I was awake for the whole thing. No. If I'm out, I know it'll suck and there are a lot of terrible things, but no, I'm not . . . Check it. Make sure I'm not dying.

Scot: Right? It's like, "What am I going to talk about while they're doing this?" I don't know.

Mitch: Right.

Troy: Yeah. It's like being at the dentist. I'm trying to have this awkward conversation.

Nathaniel: That's exactly what I was thinking.

Scot: So another concern, and this is . . . well, this whole episode is TMI, right? Too much information, quite frankly, but . . .

Mitch: Or the perfect amount.

Scot: Well, yes. I mean, we're trying to normalize talking about this.

Mitch: And nailing it.

Scot: This is a dumb thing, but I think it's something that would keep somebody from getting it. How my butt would feel after. Would I be able to tell that there'd been a scope up there, right? Is this going to be a residual feeling I'm going to have for the next two days? Who's laughing at me?

Nathaniel: Well, you got Mitch there.

Troy: I think it's Mitch.

Scot: By the way, the answer was no. I wouldn't have known that anything happened.

Troy: Yeah, I'll second that. I will second that.

Mitch: We are so concerned that it's going to feel . . . All right. Cancer. You guys, cancer. Okay. I'm sorry. I shouldn't laugh at your concerns. My butt might feel weird, but it's also cancer, you guys.

Scot: Nathaniel, what are some of the reasons that you hear when you go out into the community that people put it off for? What are some of the perceptions out there that make people not want to get one?

Nathaniel: Yeah, a lot of the reasons that we've already talked about, right? That it's going to hurt, or the prep is terrible, or we're looking at, "Well, I know I should do it, but I just don't have the time to do it. My life is busy. I have things to do and it requires a couple of days of prep, and maybe I have to take work off." These things are pretty common that come up really, and it's great to address them.

Scot: Yeah. I mean, I'm really quite privileged and lucky, because first of all, I have good insurance that paid for the whole thing. Second of all, I have good sick leave, so I could take that day off. I had to have somebody else take the day off to drive me in and then drive me home, and then be with me for that day, right? So there's another potential.

But not everybody has that advantage. How do you make the case to somebody that taking time off is just really hard from a financial standpoint, let alone a couple of people, in addition to the other things we've talked about?

Nathaniel: I mean, it's hard. It's hard to be able to put yourself in every situation possible, but really, I think it goes back to that same mentality of the risk versus the reward and kind of the payoff, as we think about, "What are some things that I can do that really impact my health in the future?" And this, I think, certainly is one of those things, especially as we think about, "Hey, if you do a good prep and a good clean, and they go in and there's nothing in there, you're off the hook for 10 years."

Mitch: Ten years?

Nathaniel: It's not something that . . . Yeah, that's the recommendation, right? If everything is clean, we don't find any polyps, and you did a great prep, and you followed all the doctor's instructions, if you will, yeah, your next scope is going to be in 10 years.

And so it's not like going to the dentist. You think, "Oh, I've got to go to the dentist twice a year. Wow, I've just got to schedule around that." Not to go back on the dentist thing, but . . .

Scot: Yeah, we're going to get some . . . "Thanks, guys. Appreciate that."

And I guess something else maybe to consider, I don't know, but this is so hard when you're in that situation where money is tight anyway to take that time off, but if you end up getting colon cancer, that's a lot more expensive and going to take you out of work and out of your family, out of your life for a lot longer. I mean, what's it like when somebody gets colon cancer? What's that experience like that you've seen?

Nathaniel: Yeah, it's really tough. I think it's one of the cancers that you can definitely see on the outside, especially when you think of oftentimes if it's a late stage. Our surgeons are going in and actually removing large sections of your colon, which really interrupts your life as we talk about needing the use for ostomy bags and other things to help you move forward.

And luckily, we do have those advances. We do have ways to address it in the later stage, but it's just a lot more difficult, to your point, right? It requires a lot more effort, a lot more time away. And if we can find it early, we don't need to do those things.

And one of the great things about a colonoscopy is actually it's one of the only cancer screenings where we can actually do something about it during the same screen, right? During the colonoscopy, we can remove those polyps in that same procedure.

Troy: I think that's one of the coolest things about colonoscopies, is not only does it detect early cancer, it prevents cancer. If you find a pre-cancerous polyp and they remove it, it's great. That risk is gone. That polyp is out of the way. It's not going to develop into cancer. So I think that's a really cool thing about it.

Nathaniel: Yeah, you're really getting kind of that two-for-one there. You don't have to go back for an additional procedure or what have you to remove that polyp. They just do it right then and there.

Scot: For somebody who doesn't necessarily have the best insurance and there's going to be some out-of-pocket expenses, are there other resources that could help that those individuals get their colonoscopy? Or are there some alternatives that might not be quite so expensive that can help prevent colon cancer?

Nathaniel: Yeah. We definitely can look at . . . There are a lot of great free clinic resources and federally qualified health centers, which is what we call them, throughout the Valley. And they have some good resources to help with this. And there are a lot of voucher systems or being able to pay out of pocket at a reduced cost.

But you bring up a good discussion that we can have. There are other ways and other modalities for people to get screened for colorectal cancer if it is hard to go in and get the colonoscopy due to cost, or maybe even you live far away from somewhere where you can get a colorectal cancer screening test.

Scot: And what are those that are recommended?

Nathaniel: Yeah, maybe some people have seen on TV Cologuard. It's in kind of that white box, and that is one. We call that a DNA FIT kit, or alternatively, just a normal FIT kit. And FIT stands for fecal immunochemical test. Sometimes it's referred to as a fecal occult blood test.

And really what it is, is it's almost like a pre-screen to a colonoscopy. And so these tests, you can do at home. They're very inexpensive. Even if you're paying out of pocket, we're looking at like $20. And what they're testing for is just elevated or abnormal levels of blood in your stool, and that can be a marker that there might be something wrong in your colon. There might be a polyp that's bleeding or something else.

And so you can do one of these tests at home, and if this test comes back negative, then you're good. You repeat the test in a year. If it comes back positive, then you know for sure you need to go and get a colonoscopy and make that effort. If it's coming back positive, there is something we need to get a better look at.

Scot: I will say my doctor gave me that option, right? My doctor kind of laid out the FIT test or the colonoscopy. Here's what made my decision. The FIT test, you have to do your own stool sample and send it in. Am I correct?

Nathaniel: This is true.

Scot: Yeah, and you have to do that every year.

Nathaniel: Exactly. I mean, colonoscopy continues to be the gold standard. And like I said, even if you do a FIT kit, these tests do not diagnose colorectal cancer per se. They just say, "Hey, there's something going on. We need to get a colonoscopy for sure or not."

And so it's really a great resource again, like I said, for if you're unable to really foot the expense, or you really don't have the time, or maybe if you live somewhere that's hours away from a place that has an endoscopy suite. Those are the instances in which they really make a great impact and we can make sure we need a colonoscopy before going in and doing it.

Scot: And I'm going to say, risk versus reward, right? I've had to take a fecal sample before, and it sounds worse than it is. At least in my experience it was. I mean, if it's between getting colon cancer and doing that, I'll tell you what I'll do every single time.

Mitch: Right?

Nathaniel: Exactly.

Mitch: Everyone is just talking about all the potential . . . For me, it's just like, "Or you could have cancer," right? That's just me.

Scot: Isn't it funny? We're supposed to be men and we're supposed to be so brave, but this is such a thing for us, right? Isn't it bizarre?

Troy: And I will tell you in hindsight, no pun intended, that I'm glad I had the colonoscopy.

Mitch: It was intended.

Troy: It wasn't until I said it, and then I thought, "Okay."

Anyway, I'm glad I had the colonoscopy, and it was the prevention piece of it that really makes me glad I had it. I had two polyps removed. Neither of them was cancerous, but because of that, I am now recommended to go back in five years to get another colonoscopy.

If I hadn't had a colonoscopy, if I just had the FIT test, if those were not bleeding, which probably they wouldn't have been, there was no blood they saw in the colonoscopy, those would not have been detected. They wouldn't have been removed.

So the fact that they did see those, they did remove them, I'm glad I had the colonoscopy to make sure that was done, and I'm glad I know that I need to go back in five years. So I think for me it was beneficial.

Nathaniel: Yeah. And that brings up a good point. That is something, again, that's very unique to a colonoscopy as we compare it to maybe other different cancer screenings. Colonoscopy, we really can do a lot. If we're looking at getting the biggest bang for our buck, a colonoscopy, we're going to remove those polyps, we're going to take care of it, and send it for biopsy all right there.

Troy: Yeah, and that was great. Like you said, it was all one and done. It's not like I had to come back for a second procedure. They did the procedure, I was out for I think 20, 30 minutes, whatever it was, and then got the report a couple weeks later that reported what they found with the pathology results and they said, "No cancer, but recommended just getting it again in five years."

So it was nice just to get everything done at the same time and also have that prevention piece of it as well.

Nathaniel: And that's maybe another thing. I mean, Mitch, did you realize the colonoscopy really only lasts 20 or 30 minutes? It's a pretty quick thing.

Mitch: No. Everyone makes it sound like it's this whole ordeal. You go in and you are put under for 20 to 30 minutes?

Troy: You're under for 20 to 30 minutes, but yeah, it's . . .

Scot: Let me go through my experience just to give you an idea. Again, we're talking about risk/reward, but I think this is one of the reasons why this is easy to put off, right? The prep isn't fun. I mean, I'm not going to lie. I don't like the feeling of diarrhea. I just hate it.

Mitch: No one does.

Troy: I'm going to correct you, Scot. It was not a feeling of diarrhea. It was a feeling like there was a river running through my body.

Scot: Yes. Right?

Troy: It was different than diarrhea. It was so weird.

Scot: I will say after the first couple times, I got used to it. It's not that big of a deal.

Troy: Yeah, exactly.

Scot: The prep wasn't as bad as I thought it would be. It's not terrible, but it was a little bit more of a disruption in my life. Three days before, you can't eat any nuts, popcorn, granola, uncooked veggies or fruit, whole grain bread, anything with bran. I mean, I eat fairly healthy, so that was a little bit of an imposition, right? I had to completely change how I ate three days before.

Troy: Yeah, me too. That was a big change.

Scot: Yep. The day before, you have to start a clear liquid diet. No solid food at all. And dealing with the hunger, that wasn't as big of a deal as I thought it would be.

And then as far as the prep, that started for me in my instance at 4:00 that night. So I was able to work that whole day, if we're talking about time being a consideration, but that night was done because you start taking the prep and then around 7 or 8 is when the cleansing, let's say, began. I did sleep through the night. Did you, Troy, or did you have to get up a lot?

Troy: I had to get up quite a bit. Yeah. I was up every couple hours just because that stuff was flowing through my system. See, the difference between me and you, though, probably is that I had to start my prep at 7:00 a.m. the day before. I also worked an ER shift that day while I was on a clear liquid diet, which I would not do again because I was just chugging Gatorade and I was so hungry. It was just not a good thing. And then I started the prep at like 5:00, so that night, it was definitely like every two hours.

Scot: Got it. I was able to sleep through the night, and then I had to get up really early because I think my procedure was at 8:00 and you have to get up and do more prep like four hours before the procedure.

And I was really stressed that it wasn't going to be clean enough. But I'll tell you what, literally 10 minutes before, that very last time at the doctor's office before I went in, it was like, "Well, we're there." That was a little bit of a stressful situation, like, "I don't want to have gone through all of this to not be able to do it."

So then they took me into this room, like the prep room, right? And this kind of East-Coast-sounding accent nurse named Tony told me that I was the kind of guy who doesn't like to be not in control. He was funny. I actually liked Tony a lot. Tony was great. Made me laugh, made me feel pretty comfortable in the situation.

They take you into the room. The gastroenterologist introduced himself. You've got everybody else standing around. I don't know if that's when they administered the stuff that makes me take the nap, but it was almost instantly I was asleep. And then I woke up back in the prep room and went out for a burger. I mean, I was hungry and I felt good. I took the rest of the day off, and it was fine.

Just like you, Troy, they found a few polyps, they removed them, they were non-cancerous, and now I have to go back in 5 years rather than 10.

Troy: There you go.

Scot: As Mitch would say, "But, guys, cancer."

Mitch: It's cancer.

Troy: Come on, guys. Quit complaining. Cancer.

Scot: I suppose I shouldn't complain about that.

Nathaniel, is there anything that we missed that you really feel like we should get in here? You deal with individuals . . . You have the hardest job in the world, I think. You could have found an easier gig than convincing people that colonoscopies are a good idea, but maybe not. Maybe it's a super easy sell. Is there anything else that we should really talk about here before we wrap up?

Nathaniel: I think the only other thing that really applies to cancer broadly, and colorectal cancer for sure, is just knowing your family history, right? This can be another big reason why, "Hey, I should get a colonoscopy if somebody in my family's had colorectal cancer," or even a different kind of cancer.

The more and more we learn about these genetic risk factors, the more and more we find the importance of just, if you can, knowing what kind of health issues run in your family and addressing those in a timely manner.

Troy: So I guess that brings up the question then, if you do have a family member who had colon cancer in their 30s or early 40s, should you be getting screened then?

Nathaniel: Well, you should definitely be talking to your primary care provider about that. Oftentimes, yes, we do scope people younger than 45, particularly if they have extensive history of early or numerous cancers, particularly colorectal cancer.

There is something called lynch syndrome, which is a genetic syndrome that you can be diagnosed with where you have many people in your family back first-, second-, third-, even fourth-degree relatives that have had colorectal cancer.

Scot: Does your risk go up if you have relatives that just have had other types of cancer? Or are we looking specifically at colorectal cancer for an increased risk?

Nathaniel: It depends. You want to know all cancers that are coming up, and there are some cancers that share common genetic risk factors, and there are common genes that might contribute to multiple types of cancer. So it's good to know all cancers that have run in your family, and then talk those through with your primary care provider.

You might get referred to somebody called a genetic counselor. That's just a trained medical specialty that can talk you through, "Hey, these different cancers that run in your family might put you in an increased risk for this. Let's think about genetic testing and see if you have these genetic predispositions as well."

Scot: Any additional risk factors that would make you want to have that conversation with your primary care provider getting tested earlier than the 45, other than genetics?

Nathaniel: Other than genetics, we do look at diverticulitis, if we've been diagnosed with that, or inflammatory bowel disease. Some of these other gastrointestinal diseases can lead to an increased risk of colorectal cancer.

I really like to put it this way. Anything that's making your gut work harder than it should, whether that's a disease or the types of food you're eating, that's generally just not a good thing, right? And so if your gut has to work harder than it should, it is just increasing that risk a little bit.

Scot: And what is your 60-second message as we wrap this up to men about colonoscopy or colon cancer screening? What would you say if you only had the elevator pitch?

Nathaniel: Well, I think as we've heard today, it's a great opportunity to get a great nap. And as a side benefit there, we can prevent cancer. I think that's the biggest thing that I say. Colorectal cancer is something that we have a great resource for.

And as you meet these patients and their stories, and you see especially the great stories of patients who haven't ever gotten a colonoscopy and were able to get it through a program or a pilot program that we have, and we find some polyps, we remove them, that makes a huge difference on a lot of people.

And not just that person, right? I think it's important to remember that. Our health is not just our health, right? I mean, we have friends. We've got family. These people we have to also care about, and this is one of those diseases that we can address.

Troy: Nathaniel, I'll say, too, if my primary care provider contacted me today and said, "Hey, you need to get another colonoscopy in the next month," I'd be like, "Okay, no big deal." I've gone from someone who really quite honestly dreaded it to having been through the process. It wasn't a big deal, and I would not hesitate to get it done again.

Scot: Well, it's been a fun conversation. I think it's been an informative conversation, and I think the takeaway is this is not one of the easiest screenings to get, and there are a lot of kind of unknowns about it. People are kind of afraid of it. We all kind of have our own things. Some people feel like it's a threat to their masculinity, I've read. There are just a lot of reasons you might say, "Eh, I'm not going to do it." But it's just, as we learned, super important.

And it does take a little planning. I had to get the calendar out. I had to work with somebody who's going to take me there. I had to make sure I was trying to get it around a time where I could take minimal time off. So it does take a little effort, which, of course, as we all know, makes people less likely to do something. But the upside is so, so huge to get your colonoscopy.

Nathaniel, thank you for being on the show today. We do appreciate it. And thank you for caring about men's health.
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Interviewer: Were you aware that lack of knowledge about colorectal cancer causes a significant percentage of adult deaths from colon cancer every single year? So that means just by listening to this podcast today you are going to reduce your risk of colorectal cancer.

Dr. Priyanka Kanth is from Huntsman Cancer Institute and here are the bullet points that we're going to talk about today to help inform you so you are less likely to get colorectal cancer.

So, first of all, it's one of the most common cancers, and it causes a significant percentage of adult cancer deaths. Colorectal cancer impacts men and women equally. You need to have screening even if you don't have a family history and by the time you have symptoms it can often be too late, that's why screening is so important. So let's start with the first one Dr. Kanth, colorectal cancer I didn't realize this, one of the most common cancers and causes a lot of deaths.

Dr. Kanth: That's correct. So colon cancer is the third most common cancer in the U.S. And so number one being lungs and number two being breast and prostate in the respective gender. And then third is colon cancer, and that's pretty high. And it is also the second most common cancer to cause death in the U.S. So the first is lung cancer, leading the highest deaths from a cancer, and the second is colon cancer. So it is surely that the burden of disease is very high.

Interviewer: Yeah. I think that surprises a lot of people. A lot of people don't realize that and, as a result, maybe don't take screening as seriously. Another misperception is that men . . . It's a man's disease, but it actually impacts men and women equally. Tell me more about that.

Dr. Kanth: Absolutely. So there is no separate recommendation for men and women. Both genders can get this cancer, and both genders should start at the same age. So there is no difference in recommendation. It is a disease for anyone. So anyone should get screened and now at age 45, yes.

Interviewer: And another perception is, well, my family, nobody in my family had colorectal cancer. So I'm probably going to be okay. Maybe I don't need to get screened at 45, which is the new recommendation. Maybe I can wait till I'm 60. But that's false too.

Dr. Kanth: Absolutely, you're very correct about it. A lot of time we don't think that it is a problem for us because we don't have anyone in our family, but that's not correct. It can happen to anyone. In fact, 70% of all colorectal cancer patients don't have a family history. So that's a big number. And that's why it's so important to have this screened because screening is the best prevention.

Interviewer: I also understand that there's a misperception that colorectal cancer just happens to older people, like in their 60s, 70s, and 80s, so I can put off my screening.

Dr. Kanth: Again, a very, very good point. It can happen to anyone. So age is a number. It surely can happen more in older age, but even young people can get it. And we have seen a rise in incidents in less than age 50. So it is not a disease of only old age. It is a disease for anyone to be worried about.

Interviewer: And then the other misperception that I've heard is, oh, I'll go in and get my screening when I start to show symptoms. But that's very dangerous and inaccurate.

Dr. Kanth: It is. It is very dangerous because colon cancer, especially early stages will not have any symptoms. Even sometimes late stages you'll have symptoms, very minimal symptoms. This is a disease where you don't produce symptoms, you don't think about it and it is inside you. So you have to be very, very aware of this. That don't wait for symptoms. Go ahead and get your screening.

Interviewer: And how difficult is it for treatment if a patient comes to you is at the point where they have symptoms?

Dr. Kanth: Absolutely. So if the symptoms are already there, we are worried it is a late-stage disease. And treating a late-stage disease when it has spread beyond colon is much more difficult compared to treating a stage one or two disease, when it is just in the colon. If it's just in the colon, we take your colon out. We all can live without our colon believe it or not. We can have some change in quality of life, but we can have same life expectancy. So treating an early-stage colon cancer is way easier compared to treating a stage four, late-stage colorectal cancer, yes.

Interviewer: And the two options you've got the stool test, or you've got a colonoscopy. Tell me the advantages and disadvantages of each one of those, because, you know, we know that 45 is the number we should be screened at, but some of us don't necessarily want to take, you know, the day off before and after to get a colonoscopy, so talk me through that.

Dr. Kanth: That's correct. So colonoscopy is gold standard. The reason we call it gold standard is this is the only preventive tool where we can go in, we can see a precancerous lesion, which is a polyp, and we can take it out.

Interviewer: And so it's a diagnostic tool.

Dr. Kanth: It's a diagnostic.

Interviewer: In addition too, if there's a problem at the same time, you can take care of it.

Dr. Kanth: You've taken care of it. It will never turn into cancer. Stool test are very, very, very good tests to detect colon cancer. They may not detect polyps, but they will detect colon cancer at a very high sensitivity. So it is a very good option for patients who are worried about colonoscopy. Now, colonoscopies are not without risk. It's an invasive procedure. We give you sedation. You have to go through a prep as well. You have to take time off, like you mentioned, and yes, some risks associated with the procedure itself, like bleeding or perforation. Those risks are very small, very, very small, but can happen. Stool tests on the other hand, are very safe, can detect colon cancer readily, may not be polyps, but it's a very good tool, once we find that you have blood in stool. Now remember this, if your stool test is positive, you have to get a colonoscopy. That is the next step. So just to keep in mind, any screening test result like we said, best screening test is the one that gets done. So we should consider screening whatever option works for you.

Interviewer: And the advantage of a colonoscopy too, is once you have that done, if no polyps are discovered, you're good for another 10 years.

Dr. Kanth: Absolutely. If your prep was good, if you did a good exam and no polyps were found, you have no family history, you don't have to repeat it for 10 years. So even with small polyps now we don't have to repeat it for 7 to 10 years. So the recent recommendation has changed and become more relaxed for even if you had one or two small polyps, you're okay.

Interviewer: And the stool test is yearly.

Dr. Kanth: So stool test, there're a couple of stool tests. One stool test, where you have to do pretty much yearly is called fecal immunochemical testing. The other stool test is called FIT-DNA, which is commercially called Cologuard which you may consider doing it every three years. But it is surely more frequent to do it than getting a colonoscopy done.

Interviewer: And let's talk briefly about barriers that keep people from getting either one of the two screenings. So maybe we can help talk them through and encourage them, you know, if they have average risk to get screened at 45, because that is really the best way of preventing death from colorectal cancer. So what are some of the barriers and how can people overcome those?

Dr. Kanth: Absolutely. So the biggest barrier, I think, is the knowledge. They should know that they have to get screened. So there is a provider and patient education involved either away. So if no one told them, or if they did not hear it on the radio, say they don't know. So that's the biggest barrier. So education is very important from both aspects. The other barriers are, I would say another very big barrier is, of course, insurance coverage, if you don't have insurance. But there are other tools, there are other ways, like I said, stool tests, they are very cheap. So things can still be done even if you don't have insurance. Apart from that, other barriers are just being worried about getting a procedure. A lot of people think colonoscopy is painful. I have to go through this. It's not true. Colonoscopy is a very smooth, painless procedure, honestly. So those kinds of things that this is going to hurt me, that's not correct. So those are the main things. I would say if I have to pick any, I would say education. If you're aware you're going to do it, you will do it.

Interviewer: And sometimes it's just getting it on the calendar, right?

Dr. Kanth: Absolutely.

Interviewer: Whether it's the colonoscopy or whether it's the stool test, just talk to your primary care provider. Have that discussion find out where it works out for you.

Dr. Kanth: Absolutely. Yes. And that's for average risk screening, you can choose anything, colonoscopy or stool test. There are other tests, other modalities too, but these two are the most common. If you've family history, we recommend colonoscopy, that's the usual tool is recommended. So the best way is to contact your primary care provider, talk to them what's best for you.

Interviewer: Colonoscopy has reduced deaths from colorectal cancer up to 70% but yet some people still don't have them done. Can they help you overcome some of the common barriers that people face to getting a colonoscopy next on The Scope.

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Interviewer: Dr. Kathleen Boynton is a gastroenterologist at University of Utah Health and colonoscopy is one of these instances where it's a really good tool for prevention but a lot of people still choose not to use it. What are the reasons and how can we overcome some of those barriers? Dr. Boynton, I guess there's five of them so let's just start with number one.

Dr. Boynton: I think it's probably fair to say that perhaps what we need to be doing as a medical establishment is doing a better job of informing patients about why we emphasize colonoscopy screening. We know that colonoscopy, as you mentioned, is effective at cancer prevention in up to 70%. In other words, your reduction and the likelihood of getting colon cancer is decreased by 70%.

Interviewer: Yeah, it's one of the most deadly cancers but yet, one of the most preventable but only if you get the colonoscopy.

Dr. Boynton: Right, right. And it's a tricky thing because most people assume that cancer causes symptoms but not necessarily and that's why we do screening. We recognize that for both breast and colon cancer for instance, you don't have symptoms. When you get symptoms is generally when the disease is advanced and your window for cure is gone. So when studies are done to look at how is colon cancer affected by getting a colonoscopy, we see that the decrease and likelihood is substantial.

Interviewer: So sometimes it can be a little overwhelming. As a patient, it feels like there's all these screenings and tests we have to take which is not necessarily always the case. However, colonoscopy is one of those that really we know is really effective at preventing a disease. So that's the first thing is a lot of people don't realize the importance. Number two, this is a common one I hear, the preparation is tough. You have to drink all sorts of stuff and it takes a day of preparation. Explain that a little bit.

Dr. Boynton: Yeah, well, I do not mean to sound as though I'm making the experience a trite one. I think it is a very difficult prep but in my mind, it's worth the investment. As difficult as it is, I think it's worth it to go through that experience for that reduction and risk. And keep in mind, the risk reduction, let's say it's 70% risk reduction, if I tell you you don't have to come back for 10 years, I'm telling you you have a 70% decline in your likelihood of colon cancer for the next 10 years. That's pretty profound.

Interviewer: Yeah, for a 12-hour, 24-hour investment of your time. Who wouldn't do that, right? The return on investment on that is really good. So the preparation can be tough for some people but the return on investment is really, really high and it's probably not as bad as a lot of people . . .

Dr. Boynton: Yeah, we get the gamut of experiences but I think it's fair to say we generally have a couple of patients everyday who say it's not nearly as bad as I thought it was going to be.

Interviewer: All right, number three, one of the barriers to people choosing to get a colonoscopy is just the fear of the unknown, like there's a lot of scary things involved with this, least of which is, "If I have cancer, I don't know that I want to know that I have it." So what about pain? I would imagine a lot of people fear that they don't know if it's painful or not.

Dr. Boynton: Yes, yes. My answer if patients ask me about the likelihood of pain, I generally say, "The possibility that's going to happen is very low that you're going to experience any discomfort at all." In very unusual circumstances if somebody has a complication related to the pain medication, we may back off, but that's decidedly an exception to the rule. Generally, it's painless to go through this.

Interviewer: And back to the main point. One of the biggest fears is, you know, that diagnosis can be kind of scary. Maybe I'd rather not know. Do you run in to that a lot?

Dr. Boynton: Yeah, and I can sympathize with that. I don't want to go to the dentist because I'm afraid I'm going to have something wrong.

Interviewer: Yeah, like a cavity which . . .

Dr. Boynton: Yes.

Interviewer: This is something quite a bit, a lot worse, right?

Dr. Boynton: Much. Very much so. But in this case, again, I get back to the idea of why we do this exam. Generally, when I find it on a scope, it's a curable lesion and many times, we can remove it at that time.

Interviewer: Don't even have to come back.

Dr. Boynton: Right. Even if it's an early cancer, we can take it out.

Interviewer: Reason number four, it can be a bit of an invasive experience and some people are afraid of that.

Dr. Boynton: Yes, yes.

Interviewer: What do you say to that?

Dr. Boynton: I think that is also in a sense related to that whole fear of the unknown. We've taken in breast cancer and colon cancer, we're kind of screening in very personal areas of the body and I think for a lot of patients, just this idea, this concept in their mind of what we're about to do, much less with people you've never met before, is pretty daunting. At the same time, I can say with great assurance that, at least here, we are very aware of how complicated this is and very sympathetic with how invasive this seems. We're investigating a very private area of the body, how is this going to happen in a way that's not awkward or embarrassing? So the link that we've provided on our website is actually a reenactment of going through the prep and the colonoscopy, and hopefully it serves to reassure people that we are very aware of the hesitations people have about this.

Interviewer: And then finally, the cost. There can be some confusion sometimes as to what the insurance might cover, what it might not cover for those without insurance, how they pay for it so . . .

Dr. Boynton: Right. So the university will investigate this issue on their own as well as you can call your insurance company and find out what your limitations are. We are very happy to work with people that have certain limitations provided by their insurance. Generally, screening is covered on insurance.

Interviewer: And they're getting . . . even if you might have to pay a little bit more, as far as all the tests that are out there in the world, this is really one that could make a difference in the quality of your life, not only just the longevity but the quality of it.

Dr. Boynton: Yes. The co-pay for a colonoscopy is much less than the co-pay for colon cancer.

Interviewer: Right, right. So we covered, I think, a lot of barriers and of course, if people have any other personal barriers, what should they do at that point?

Dr. Boynton: When we call to schedule patients, we have a dedicated call team that schedules only these. They can leave a message with the call center that's scheduling individuals and let them know what their concerns are and we do get that message and we're very happy to work with anyone if it makes their experience easier.

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Interviewer: Figuring out the best colorectal cancer treatment option for you. That's next on The Scope.

Announcer: Medical news and research from University of Utah Physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Courtney Scaife is a surgeon that specializes in gastrointestinal oncology and is also an expert in colorectal cancer treatments at Huntsman Cancer Institute. I was doing a little bit of research on colorectal cancer treatment options and I've got to tell you, Dr. Scaife, it's overwhelming. There are a lot of different options. I can't even imagine somebody's who has just been diagnosed that's trying to parse through all these different options on their own what they're facing. Help me make sense of that.

Dr. Scaife: There's no question that the information available on the Internet, on public institutional venues and so on is overwhelming. Doing research, investigating your diagnosis before you see your doctor is useful, but if you haven't had your diagnosis narrowed down exactly what is your diagnosis and what is your stage, that information can be very, very overwhelming. To some extent, knowledge is power, but when it becomes overwhelming, it's helpful to wait until you meet with your physicians and get your diagnosis and your staging narrowed. But that information can be whittled down into a package that's more tolerable.

Interviewer: Yeah, I think I scrolled through six, seven pages of a bunch of words that made no sense to me. After you get your diagnosis you said the two key things are your stage . . .

Dr. Scaife: Correct.

Interviewer: . . . and what's the other one?

Dr. Scaife: Your stage and your diagnosis. Colorectal cancer is a term that we group together. Colorectal cancer, it is one disease, but the distinction is the anatomy or where the tumor is located in the body. Because of the anatomy of the rectum, which is the farthest down or the lowest part of your colon, the anatomy of that is a little bit different than the colon so we treat rectal cancer, which is a sub-type of colon cancer, just a little bit differently.

The first thing we decide is does someone have rectal cancer or do they have colon cancer. Then, we decide what stage is it or what is the preliminary staging that helps us look at the treatment plan from there.

Interviewer: Help me walk through some of this process when you do have a patient in your office. They would go through some tests. You would determine the stages. You would determine the type of cancer. What do you do at that point to determine the treatment option that's best for them?

Dr. Scaife: Well, the most common scenario is that someone's had a colonoscopy. Either they had symptoms or they're in their routine surveillance, which should be everyone at the age of 50 and then every five to 10 years after that. If something was found, a concerning polyp, a precancerous high-grade dysplastic polyp is what it's called, or a cancer, then the next thing we do is stage that.

We do the staging by getting a CT scan of the chest, the abdomen and the lower abdomen that we call the pelvis. If we are sure that there is no evidence that, that cancer in the colon has tried to spread to other organs, specifically the lungs and the liver, the most common, that would make it a stage IV if it has spread to other organs. If it has not it's a stage I, II, or III.

That stage is determined by are any of the lymph nodes involved, which would be a stage III, or how thick has the tumor tried to go through the wall of the colon, which would distinguish a stage I, II or an advanced stage III. Those things we often don't know until after a surgery.

If you have rectal cancer, we do further studies to try to help to find those stages first. If you have colon cancer, surgery is the first treatment and that stage is determined at surgery. Already, you can see that the distinction between colon cancer and rectal cancer starts making those decision trees very different. Interviewer: What are some common questions that patients ask in that consultation with you after you've determined the type of cancer and the stage?

Dr. Scaife: The most common question is, "When can we get this taken care of?" Obviously, as soon as possible. We'll do everything we can to do that as soon as possible. The next most common question is, "Will I need chemotherapy?" We don't know the answer to that until after we've decided if it's rectal cancer, most commonly. We often do use chemotherapy. If it's advanced stage II or stage III colon cancer, then it will get chemotherapy after surgery, but surgery would be first.

The third most common question is, "Will I need a colostomy? Will I need a bag to poop in?" Unless it's a low rectal cancer or a really worrisome, very, very large left-sided or more distal in the colon, colon cancer, it's really uncommon to need to have a colostomy bag.

Interviewer: Are there often, after that point, different ways that you can approach the treatment that the patient might have to make the decision, "I would rather do treatment A or treatment B?"

Dr. Scaife: Yes and no. Most commonly, that comes if we have a clinical trial. An important point is that a clinical trial is only ever available if we think that the investigative arm is most likely to be a better option than the standard of care.

Some patients are very scared of trials, but we can't write a trial and IRB wouldn't approve a trial if we didn't that the trial arm is probably actually better than what is the standard of care. If a clinical trial is available, then we give patients the option do they want to be involved in the trial or not.

Otherwise, for colon cancer, really surgery is the first option. Then decisions of do they want chemotherapy after the surgery if they're a stage II or a stage III. In rectal cancer, decisions about do you want only chemotherapy before surgery. We do chemotherapy and radiation often before surgery in rectal cancer. Do they want chemotherapy only? Do they want chemotherapy and radiation before surgery? Do they want a short course of radiation or a longer course of radiation? All of those decisions are decisions that patients participate in but based on the advice of the medical oncologist, radiation oncologist, and surgical oncologist.

Interviewer: What tends to be done most often, it sounds like, is surgery.

Dr. Scaife: Correct. Again, for rectal cancer, it's very common to get chemotherapy and radiation before surgery, but the treatment for either colon or rectal cancer is surgery.

Interviewer: What are some of the other considerations that a patient should keep in mind as they're going through this conversation, as they're sorting through what options they might have? What would you want them to keep in mind?

Dr. Scaife: Definitely the most important thing to do in getting ready for a treatment for colon cancer surgery and possibly chemotherapy is really to just be healthy. There's a big push across the country. The University of Utah and Huntsman Cancer Institute have a huge push right now to really emphasize pretreatment health.

Minimize or stop, ideally, your smoking. Control your diabetes really well. Control your other medical problems, your high blood pressure. Try to exercise three or four times a week at least 30 minutes those three or four days a week. Try to eat a well-rounded, healthy diet. There's no special diet that can prevent or cure rectal or colon cancer, but just a well-rounded, healthy diet really strengthens a patient to get through surgery and other treatments that are necessary.

Interviewer: That's kind of nice. Somebody could take control of those things right away before they know anything else about their cancer.

Dr. Scaife: That's exactly right. There's actually data now that shows that people that exercise before and after colon cancer surgery decrease their risk of recurrence.

Interviewer: Do people that tend to have colorectal cancer have time to get in shape before the surgery? Are we talking about they would have three or four weeks that they could stop their smoking? Is it a slow-moving cancer that they're allowed that luxury?

Dr. Scaife: Yes and no. The answer is yes, there usually are two to three weeks. It is a very slow moving cancer. Two to three weeks, five to six weeks won't make a difference in the outcome of the cancer. Sometimes even longer.

But the other side to the answer of your question is that even just two days is beneficial. For a smoker, just not smoking for two days before an operation makes a really, really big difference. For a person who's relatively sedentary to just go out for a 30-minute walk three days a week for just the two days before your operation can already make a difference.

Interviewer: It sounds like wait until you find out the type of cancer and the stage before you start freaking yourself out with all the options. Let your physician or your cancer team help narrow those down for you. It sounds like surgery is going to be kind of the first thing and then some other decisions will have to be made after that point and get out and exercise right now in preparation for any treatment that you might get. Is there anything else that you would tell a patient at this point as they're leaving your office because I imagine it's an emotional scary time for them?

Dr. Scaife: After the diagnosis has been made and you're leaving your doctor's office, as you said, this information is overwhelming from the beginning. But now that you know is it colon or rectal cancer and you know what stage it is, I, II, III or IV, now you can start to find out specific information.

Asking your doctor what questions to ask, where to get the information. One of the most valuable resources is the Cancer Learning Center at Huntsman Cancer Institute. It's one of the biggest, I think it is the biggest, patient cancer centered library in the country. They have librarians trained to teach people how to get the resources in their diagnosis, in their family situation and in their social network and their questions that they have. The librarians can help them get educational materials appropriate for their diagnosis.

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Interviewer: Carri is a marathon runner, a long-distance cyclist, a wife, a mother, an author of "Along Came Hope," it's a book about the death of her baby, clashing twice with cancer, and adopting her daughter. Carri, today we want you to share your story as a way of learning more about colorectal cancer and to give somebody that's in a similar situation a better idea of the journey ahead, from diagnosis to treatment and how you got through it. First of all, my first question is you're under 50. You're pretty young.

Carri: Yes, I'm only 41.

Interviewer: When people start getting their first colonoscopy, they're 50.

Carri: Yes.

Interviewer: So how did you even find out? Take me to that moment when you found out that you had a colorectal cancer diagnosis.

Carri: In 2009, I was diagnosed with endometrial cancer, cancer of the uterus. And through genetic testing and genetic counselors where I was treated, they said, "With your cancer right now, endometrial cancer, there are similarities between that and someone that might be diagnosed with colon cancer. From here on out, we want you to be tested, have a colonoscopy yearly because we just want to be cautious." I was like, "That's not going to happen to me. I'm 34, but whatever, I'll do the colonoscopies.

So I recovered from my endometrial cancer and then, a year later, they said, "Just to be careful, we're going to do mammograms as well." So I'm 34. A year later, I'm going to do the mammogram, I'm going to do the colonoscopy. There were a lot of things that were going on our lives. So by the time the third one was going to come up, I was like, "No. I'm not doing it." And so I just kept putting it off and putting it off.

So I put it off 2 1/2 years later. So in that 2 1/2 year mark, that's when I went in and I was like, "I better get it done. Fine. Okay." So I go in and I do it and, Okay. We found a polyp." Okay. That's fine. And I've had the same line of doctors and they knew my previous history and so I was at home with my two-year-old and she had the constant cough and we were getting ready to go the doctor. And she's running around and I'm like, "Let's go see [Dr. I]. Let's go see. He wants to hear your cough. Blah, blah, let's go." My phone rings and it's my doctor. My doctor and it's the surgeon. And surgeons never call you.

Interviewer: Yeah, I've heard when the nurse calls, probably okay. When the doctor calls, there's probably a problem.

Carri: Right. And then you answer the phone and he's like, "Hi, this is Dr. so and so." And I'm like, "Ugh." So in the meantime, I'm trying to get my two-year-old dressed, who's like wrestling an alligator and trying to get out the door to go see her doctor for a cough. And he's like, "The test results came from the polyp we removed and there are cancer cells, blah, blah, blah."

I say, "Blah, blah, blah," like I don't want to talk about it, but what really happens is when you hear those words, "These cancer cells turned into cancer. It's positive," it's like tunnel vision. Everything just kind of goes silent. But when you have a two-year-old, you don't have time to kind of let it sink in. I'm like, "We've got to go."

Interviewer: Yeah. It was just such a clash of two different things.

Carri: Yeah. And our daughter was very new to us as well. She was adopted and she had not even been home with us for a year. It was just a lot of different things going on within that moment. And I'm at her doctor's and I'm just sitting there like, "Ugh, I've got to through this again." It was stage one, which is very good. That means it didn't spread but they test lymph nodes and that is very common with all cancers and the lymph nodes were like glands. And I'm not a doctor at all so I'm like, "What are lymph nodes again? What did they do?"

Interviewer: That health class in grade school is a long time ago. Remind me.

Carri: So I'm giggling. I'm like, "What do lymph nodes do again?" Basically, that if the cancer cells or the cancer goes into those lymph nodes, that's bad. We don't want that to go in there, but they can't test the lymph nodes until they do surgery, until they remove the cancer in the area that it surrounds. And that's very typical of cancers. Basically, I wasn't like, "Well, let's just do another biopsy." It was kind of like, "Let's be preventative and let's talk about your options."

So the options are, "Let's remove your whole colon, let's look at your quality of life, or let's remove the part of the colon that we found the cancer so your quality of life can somewhat remain the same. But we won't know until we do the surgery and then when we do the surgery, we'll test the lymph nodes and that's we'll find out if it's spread."

Interviewer: So the decision of just trying to get the part where they believe the cancer is, the risk of that is that they might not get all cancer, is that right?

Carri: Right. So that's the . . .

Interviewer: That's the downside, but the upside is if they do get all the cancer, much better quality of life. They remove the whole colon, then you like to do a lot of endurance stuff, cycling, running, long hikes you wouldn't be able to do that because you have to go to the bathroom a lot.

Carri: Exactly and so . . .

Interviewer: Or the bag?

Carri: Sometimes what they do is when you go in for that surgery to remove the whole colon, they'll go ahead and they'll remove it and then they attach it to . . . this is very wrong, probably, but they kind of attach it to the rectum area. But they can't do it in one surgery so they do the surgery where they remove all of it and they gave you a bag and then they like you heal and then, once everything is good and it looks like it's going to repair, then they're going to go ahead and do another surgery where they're going to basically tie up where that colon was left off to basically your rectum and put it together.

So I would have a bag, but only temporarily. Some people, there could be an issue with the surgery and sometimes people end up with a bag for life because the surgery didn't go well. And it's really hard to determine what's going to happen.

Interviewer: How did you make that decision? How did you decide, "Let's just do part of it"?

Carri: Because I'm young and my quality of life my husband and I are very active and it's like, "What do you want to do?" But it's funny because right now, here today, I had my colonoscopy done last week and they found another polyp.

Interviewer: They did?

Carri: So basically, that's what they said what's going to happen. It's common for you to get polyps. And I'm still waiting for that polyp result to come back. Is it cancer, is it not? And I don't know.

Interviewer: How do you get through it?

Carri: I wrote a book. The book is called, "Along Came Hope," and in that dedication I put, "All it takes is just getting up and putting one foot in front of the other." And you can mean the smallest sense or you can put that in the largest sense. And sometimes, putting one foot in front of the other is just getting out of bed and putting your foot down on the floor and just saying, "Game on. Let's start the day." Your day could be like, "It's so hard and all I need to do is go to work today," and that could be your game on. I mean, sometimes, yeah, you want to go to sleep. When we lost our baby halfway into our pregnancy, it was either . . . I wanted to hibernate. I understood suicide. I really understood it, but that was my thing. Go to work.

Interviewer: That was your "do something" at least.

Carri: Yeah. Do something or just show up and game on because the opposite of that is go to sleep. And either go to sleep forever or go to sleep for three weeks or whatever. And I just couldn't do that. I had a husband and I couldn't let my family down. I couldn't let my mom down, my siblings down and my dad down. I couldn't do it and that just kind of kept me going.

Interviewer: In terms of support, you have done a lot of this on your own, but you've also had some great support. What did you need in terms of support and did you have to ask for that or were people pretty intuitive to give that to you?

Carri: Well, because I've been through my own challenges through various things, obviously, but losing the baby and then endometrial cancer and then having colon cancer, so my support system has always been my family, my husband, my dear friends, everyone has. But at first, when I was first diagnosed with this in 2009, I was like, "Facebook." I'm just reaching out because I can't hold things in. I know a lot of people just want to isolate themselves and not do that, but that's not me

But now, here I am today, waiting for a possible third cancer diagnosis. I just don't want to . . . here I am on the radio and I'm saying I don't want to to tell anybody about it, but I just want to keep it in and I think that people have to understand what it is, how they need help and own it. And just say, "I'm owning it and I need to isolate myself and I'll be fine. If you give me that, I'll show up in a week." Or, "I need to remove myself from social media," and just saying, "I'm not checking social media. I just need to be by myself." Or just saying, "I do need to talk about this and let me talk. I don't want to hear you talk. I'm going to talk about this."

Interviewer: So that would be a big piece for somebody else that's struggling, "Oh, what do I say?? Maybe just don't say, "How are you?"

Carri: Just ask them in a curious way. Not like in a judgmental way, but in a curious way. So how does that feel? What are your next steps? So tell me about lymph nodes. I don't even know what they are." So people that are listening and have a friend, a family member that are going through it, ask them in a curious sense and let them talk about it and just say, "How are you dealing with it? Are you okay with it? What can I do?" Meaning that in a very honest, genuine sense and acknowledging their grief, whatever it is.

Interviewer: Did you find any tools or resources that were useful that you would recommend to somebody else who's going through the same journey?

Carri: Like I said before when I said to stay off of social media and the Internet and don't self-diagnose yourself, that was me. For me, what was helpful was feeling it emotionally. Some people are logical and they want that information.

Interviewer: I think I would want to learn as much as I could about it.

Carri: They want to do that. And so if you're a technical person, you're a logical person and you want that, go online. Read all about it, but read scientific things. Don't read the, "This is what happened to me," because it may not happen to you. You might come through with flying colors and someone's story might be so dramatic that . . . for me now, being on this cancer journey for the past number of years, I can't read anymore because I feel like I heard so many stories, read so many different things that it drains me. And I can't allow myself to be drained because I know how negative I'll feel and I just can't afford that because that means I'll just fall into a cave.

Interviewer: How has this experience changed the way you view things, life?

Carri: It's allowed me to challenge my limits. It's allowed me to say, "I'm going to do this," and it allows me to when I say something and I'm going to tell someone, I'm going to do something, that means I'm going to do it because I don't want to not follow through with something. And that's challenged my belief system. It's challenged me to understand that I'm not in control of my life. I don't know what is in control of my life. It's challenged me to look inward and develop my own faith. And when I say, "my own faith," I don't mean religion, but it means for me to find my own God.

Interviewer: Any final thoughts?

Carri: Don't get colon cancer.

Interviewer: If there's anything you can do to prevent it. And get that colonoscopy right? You put it off for two and a half years.

Carri: I know.

Interviewer: And it's probably fortunate that it didn't get any longer than that.

Carri: So get the colonoscopy because I know the prep sucks and it's awful, but get the colonoscopy because no one wants that. Believe me, no one wants it.

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Dr. Miller: You have rectal cancer and you're concerned that you might need a colostomy bag. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller here for Scope Radio, and I'm here with Dr. Molly Gross. She's a colorectal surgeon and an Assistant Professor in the Department of Surgery here at the University of Utah.

Molly, you get referrals, I'm sure frequently, with patients who have colorectal cancer, and one of the concerns and most frightening things that a patient would probably wonder about when they're visiting you is when you do the surgery, if you need to do surgery, will they need to wear a colostomy bag. How do you address that problem and what do you say to the patients in terms of what the likelihood of that need might be?

Dr. Gross: Everyone wants to poop the normal way. No one wants to poop in a bag. Our goal is always to help people poop the normal way even if they have rectal cancer. Sometimes that means they need a temporary bag while a new connection heals, an ileostomy that's called, but we always try to reconnect people, reconnect their colon back to their rectum, as long as the muscles of control, the sphincter muscles, aren't involved with tumor.

Dr. Miller: Now, would it be fair to say that the majority of surgeries that you do result in the patient pooping the normal way?

Dr. Gross: Unfortunately, once people's rectums are removed they never really poop completely normally. I like to say the rectum is the smartest organ in the body. It knows the difference between solid, liquid and gas, so without the rectum, if we have to remove it for cancer, it's difficult sometimes to hold onto poop. People have urgency, meaning they have to get to the bathroom quickly, but they usually have control. They just might need to know where the bathrooms are.

Dr. Miller: And certainly that would seem to be a better option than having a bag.

Dr. Gross: For some people it is. Everybody's different. Some people would rather poop in a bag because they want to fish, and it's really hard from your boat to go have a bowel movement.

Dr. Miller: Do some people find that if they have a colostomy that it's psychologically damaging?

Dr. Gross: It can be for a lot of people initially, but with time they learn to live with it. We also have other resources in the form of patients that have bags who are willing to talk to other patients who are just about to get a new bag. It takes some adjustments and it can be hard, but sometimes people live even fuller lives with a bag than they did when they were having 20 bowel movements a day.

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Dr. Miller: Rectal bleeding. Could that be a hemorrhoid or what is that? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller for Scope Radio, and I'm here with Dr. Molly Gross. She's an Assistant Professor in the Department of Surgery, and she's also a colorectal specialist.

Tell me a little bit about rectal bleeding. If someone comes in and says, "Look, I had some blood that I saw on my stool or in the toilet bowl." Is that usually due to a hemorrhoid, or what should they think?

Dr. Gross: Everyone has hemorrhoids, and often it could be due to hemorrhoidal disease, bleeding from internal hemorrhoids. However, there are other things that can cause bleeding such as a fissure which is a skin tear in the skin by the anus.

Dr. Miller: Is that painful?

Dr. Gross: Yeah. That kind of bleeding usually is associated with pain with the bowel movement. People describe pooping a knife out sideways.

Dr. Miller: Now sometimes hemorrhoids can be painful and sometimes not. What's the difference there? Is there a problem with recognizing what's painful and what isn't in terms of hemorrhoids?

Dr. Gross: Internal hemorrhoids which are up inside usually aren't painful, and they just bleed. External hemorrhoids which is on the outside of the anus, those hurt when they have problems and when the blood vessels inside clot off or thrombose.

Dr. Miller: Is there a simple way to take care of those hemorrhoids, or does one always need to see a surgeon about that?

Dr. Gross: Rectal bleeding can also be concerning because it could represent cancer or a polyp which should be seen by a professional. Hemorrhoids, if you know that you don't have a cancer, and you just have hemorrhoids, the patient can first start to do some things at home to help with those.

Dr. Miller: And what might those things be?

Dr. Gross: The important thing is to have good formed bowel movements. I say have a bowel movement looking like a greased banana. So how do you get that greased banana? Fiber, fiber and fiber.

Dr. Miller: And so what is the best source of fiber? Should people purchase fiber at the store like Metamucil, or do they just up their diet in terms of vegetables and fruits?

Dr. Gross: It's really hard for the average person to eat enough fiber in the day. You'd be having to eat lettuce all day long to get 30 grams of fiber. So I recommend starting Metamucil, Citrucel, or the generic, Fibercon, Konsyl, any of these options. Start with one tablespoon once a day.

Dr. Miller: And then move up to maybe twice or three times a day depending on how it goes?

Dr. Gross: Correct.

Dr. Miller: Okay.

Dr. Gross: Also, the other thing is to not strain on the toilet. Don't bring your phone.

Dr. Miller: Don't sit and read the newspaper, if people are still reading newspapers.

Dr. Gross: Or your phone.

Dr. Miller: Or your iPad.

Dr. Gross: Yeah.

Dr. Miller: And then the other thing about that is what about over-the-counter remedies, Preparation H? Do those things actually work?

Dr. Gross: They can't hurt, but really what needs to happen is to have a better bowel movement and not strain. As long as you're having those troubles, you will continue to have some bleeding. But I also want to stress the importance of being seen by a health care professional to rule out other causes of bleeding like rectal cancer.

Dr. Miller: And so how would one determine if they had those more rare and serious causes of bleeding?

Dr. Gross: A colonoscopy is the best way to rule out other causes of bleeding.

Dr. Miller: So one must not necessarily assume that it's just due to a hemorrhoid. They actually need to see a physician or a health care provide that could actually send you to have a colonoscopy or a sigmoidoscopy to sort out the cause of the bleeding. Now, does everyone that has rectal bleeding need a colonoscopy to rule out the serious nature of bleeding?

Dr. Gross: Not everyone. However, if the bleeding continues despite treatment of the hemorrhoids, or the patient has a family history of colon and rectal cancer, or if they're above 50, they definitely need a colonoscopy.

Dr. Miller: What else would you say for patients that have painful hemorrhoids? Should they use a donut that you can purchase at the pharmacy? Does that work? Does that make any sense?

Dr. Gross: No, donuts really don't work. People who have painful hemorrhoids, like external thrombosed hemorrhoids, if they have a blood clot in them sometimes they get better just from lancing it in the first 24 to 72 hours after the clot has formed. Otherwise, we often recommend sitz baths, so that's filling your bathtub with a little bit of warm water and sitting in it.

Dr. Miller: That sounds like a home remedy. Does that really work?

Dr. Gross: It does work.

Dr. Miller: And if they do that what, once, twice, three times a day?

Dr. Gross: Once or twice a day and after bowel movements.

Dr. Miller: Now, there's something that I understand is called laparoscopic banding. Do you do that?

Dr. Gross: Rubber band ligation is a management, an office procedure to treat internal hemorrhoids that are bleeding. That is simple and easy to do in the office at the time of our initial consultation if we see large hemorrhoids that are causing some problems. Those are for internal hemorrhoids only.

Dr. Miller: Now, if I remember what you said, internal hemorrhoids are not necessarily painful, so banding them would not be painful either.

Dr. Gross: Correct. Banding shouldn't be painful. If it is painful, that can be concerning. Usually patients say it feels like they're sitting on a cue ball for a couple days. There's some pressure but no pain.

Dr. Miller: So the bottom line is if you have rectal bleeding it could be due to a hemorrhoid, but you have to assume that there are other things and perhaps some rare things that are very serious, and you need to have that checked out by a health professional, and certainly bleeding that's persistent needs to be looked at.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 7, 2019
originally published: January 6, 2016

Dr. Miller: Fecal incontinence, oops, that happened again. We're going to talk about how to treat that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: Hi I'm here with Dr. Bartley Pickron, and he's a surgeon here at the University of Utah and specializes in colorectal surgery. Bartley, tell us a little bit about how you fix fecal incontinence, and for the audience fecal incontinence is leakage of stool.

Dr. Pickron: Well it ultimately depends on what the cause is. I mean most of the time we see patients with either weak or damaged anal sphincter muscles, and we have to go about and try to restore that normal anatomy.

Dr. Miller: Fecal incontinence usually occurs in people who are a bit older.

Dr. Pickron: Usually, but we're also starting to see it in some of the younger patients as well, as it gets a little bit more . . . a little bit less public taboo.

Dr. Miller: Right, well it's obviously an embarrassing subject for people who have it. They're going to feel guilty but if they make their way to your office, what kinds of treatments do you offer to them?

Dr. Pickron: Well it depends on the underlying problem. I mean, what we would like to do if at all possible is if the muscle is torn and damaged then there is surgery to repair that. There are also other options if it's just some weakness problems, for example, we can put in a device called a Sacral Nerve Stimulator.

Dr. Miller: And that is a device that uses electric current to tighten muscle. Is that what that does?

Dr. Pickron: Yeah it's pretty similar to . . . it kind of works along the same principles a pace maker does for the heart. This is a little device, it's implanted in a little tissue pocket on the buttock, and it has a lead that goes through one of the holes in the tail bone, and it just adds an extra stimulus to the nerves that go to the pelvic muscles to add some extra tone and strength.

Dr. Miller: In 2015 these are new treatments? I mean is the field advanced since the middle of the last decade?

Dr. Pickron: The Sacral Nerve Stimulator is certainly a new treatment for fecal incontinence. The urologist have been using it for urinary incontinence for some time, and one of the side benefits they saw when they first started using it was an improvement in bowel function, so then is subsequently got approved for the treatment of fecal incontinence too.

Dr. Miller: Do you use and sling procedure like the gynecologists use for urinary incontinence sometimes?

Dr. Pickron: Not currently. There's a couple of those coming down the pipeline through still in the experimental phase, but hopefully in the next couple of years we'll have an answer on that.

Dr. Miller: Now once you're working with people with fecal incontinence, how well do these treatments work? I mean can they expect to be incontinence free, or can they expect to have no leakage after these surgeries or treatments?

Dr. Pickron: You know, making a bad muscle perfect is a big challenge.

Dr. Miller: But you can definitely make it a little better with some.

Dr. Pickron: We can definitely make it a lot better.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Miller: I'm here today with Dr. Bartley Pickron and he is a surgeon in the department of surgery. He is also a specialist in colorectal surgery. It's good to see you. I have patients that come to me and they ask, "I've got this pain in my bottom/rectum," and they say, "I think I have a hemorrhoid." How often is it a hemorrhoid or is it something else?

Dr. Pickron: Most of the patients we see for anorectal pain don't have hemorrhoids, but everybody has hemorrhoids to some degree.

Dr. Miller: Most don't.

Dr. Pickron: Most don't, but the real causes of pain are more things like fissures, an abscess, and other things that aren't hemorrhoids.

Dr. Miller: Fissures can be incredibly painful.

Dr. Pickron: They're horrible.

Dr. Miller: What causes a fissure?

Dr. Pickron: Usually it's a tear and it happens directly in the front or directly in the back. Most of the time these things heal up just fine, but if they don't and they get deep enough to where the anal sphincter gets irritated . . .

Dr. Miller: Ouch.

Dr. Pickron: . . . then you get a spasm of that muscle and that prevents the tear from healing and then you just enter this vicious cycle that just won't quit.

Dr. Miller: So you use different therapies to try to repair that.

Dr. Pickron: Yeah, generally we focus not so much on the tear but on the muscle itself because if we could make the muscle relax and stop the spasm then the tear generally heals just fine on its own.

Dr. Miller: While hemorrhoids aren't the usual cause, as you pointed out, they're both internal and external hemorrhoids, my understanding is that the external hemorrhoids can be painful.

Dr. Pickron: They certainly can. The most common thing we see when they are painful is a thrombosis, where you get a big blood clot with the pain and swelling.

Dr. Miller: Ouch. How do you treat that?

Dr. Pickron: Most of the time, we let them these reabsorb on their own. If patients come in within the first two or three days after the event happens, then there is some benefit to removing it surgically because they'll get better faster, but usually once they're kind of over the pain curve and their symptoms are getting better, then the pain and swelling will generally just take care of itself.

Dr. Miller: After you do the treatment, is there any kind of change in diet that they might need to make? My understanding is that constipation, straining, those things can contribute to external hemorrhoids. What's your thought on that?

Dr. Pickron: Absolutely. Constipation and particularly straining or sitting on the toilet for a long time during bowel movements reading the magazine, for example, all tend to predispose people to hemorrhoids. We recommend a change in bowel habits, usually by the addition of fiber or stool softeners and staying hydrated.

Dr. Miller: When do you treat a fissure or hemorrhoids with a procedure?

Dr. Pickron: I'll talk about the fissures first and probably maybe 10 or 20% of those are actually treated surgically. We have creams that we can use that generally take care of things. If that doesn't work, Botox injection is an option. If those don't work, then the last resort is certainly surgery.

Dr. Miller: So that's treatment for fissures, how do you treat hemorrhoids?

Dr. Pickron: Again, most of these are treated non-operatively. There are procedures in the office we do. The most common thing we do is a procedure called rubber band ligation, where we put rubber bands around the hemorrhoids on the inside. That sounds pretty painful, but truthfully the internal hemorrhoids really have no sensation, so it's a very easy procedure to do and very well tolerated. It's usually just some mild pressure for about 24 hours and that's it. The ones that do need to be treated surgically, like I said, are typically the external ones and those are, fortunately for patients, fairly rare.

Dr. Miller: It would seem to me to be rare, but are there times that the pain could be induced by something like a cancer?

Dr. Pickron: It is. That's certainly one reason that these symptoms need to be evaluated very thoroughly.

Dr. Miller: So if they're going on for weeks, that's something that probably ought to be looked at?

Dr. Pickron: Right. So any combination of pain and bleeding and particularly if there is a little mass or something that just doesn't feel right, then that absolutely needs to be checked out.

Dr. Miller: Any other causes of rectal pain? I know that there's one that is a spasm that occurs from time to time in some people.

Dr. Pickron: Some people get this kind of vague rectal pain, which as you mentioned is just kind of a spasm, it's fairly poorly understood. There are some options for it such as physical therapy, biofeedback, but these can be challenging things to treat.

Dr. Miller: It comes on suddenly and then goes away over seconds to minutes, I think, sometimes.

Dr. Pickron: Yeah, usually happens in the middle of the night. People kind of wake up and they feel this intense pressure almost like a Charley horse in their rectum, which not a pleasant sensation.

Dr. Miller: Any other causes of pain?

Dr. Pickron: Those are primarily the big ones, infections, abscesses are fairly common and those are typically treated with surgical drainage.

updated: November 25, 2020
originally published: September 22, 2015