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Program: Colonoscopies - Dr. Allan Hill, General and Vascular Surgeon
Mark Olson came to the lectern to introduce our program speaker, Dr. Allan Hill. He graduated from UC Davis and has been practicing in town for twelve years. Dr. Hill does general and vascular surgeries as well as colonoscopies.
Mark asked him to speak to us because he has seen some of his patients who waited too long to get a colonoscopy and they found something they should have found earlier. Mark refers to it as a rite of passage for those at age 50. Mark emphasized how very important it is to get a colonoscopy if you haven't already.
Dr. Allan Hill thanked us for allowing him to speak to us. The purpose of a colonoscopy is to check to make sure everything looks healthy and normal within your colon. We all have colons and none of us want cancer, so it's vital that we are all proactive about our preventative health. If anything looks abnormal within the colon, it either has to be sampled or removed.
In this community, surgeons have been the ones to do colonoscopies because it is hard to get Gastroenterologists to come out here.
The good news is that people are living longer. The bad news is that the longer we live, the less other things we are going to die from, therefore we have a much greater risk of getting cancer. The estimated lifetime risk of getting colon cancer (for both males and females) is about 1 in 20. It is a real disease that touches a lot of people's lives. The great thing about colonoscopies is that having them done greatly reduces your risk of getting colon cancer. If someone gets a colonoscopy and a polyp is removed, their risk of getting colon cancer goes way down. So even though the odds of getting colon cancer are pretty high, it is possible to reduce your risk.
Dr. Hill added that in addition to getting a colonoscopy, there are other ways to reduce your risk of getting colon cancer such as through nutrition. Some risk factors of getting colon cancer include family history, a low fiber diet, a diet high in preservatives (especially nitrates and nitrites), heavy drinking and smoking, and a diet high in animal fat. Although these are some risk factors for getting colon cancer, as with all cancers sometimes you just get it anyways.
Just like our skin, the lining of our colon regenerates all the time. If one area of the colon starts regenerating too quickly, it starts to get raised up and if it gets large enough, it is called a polyp. The larger it gets, the greater chance there is that it has a malignant degeneration and that polyp can turn into colon cancer. Polyps are relatively common. About 35-40% of people have polyps in their colon,
but not all polyps turn into cancer. However we don't know which ones will, so we want to remove them all. Many people are of the mind set, "Why should I get a colonoscopy? I don't have any problems and it doesn't sound like a lot of fun." You don't want to wait until you have a problem because by then it is much more likely to be cancer. Dr. Hill compared it to your car. You don't drive your car until the "check engine" light comes on before you change your oil.
For those of us who haven't yet had a colonoscopy, it can be a mysterious thing, so Dr. Hill gave us a rundown of the procedure. The day before a colonoscopy, you have to cleanse the colon. Different doctors use a variety of different methods, but basically you have to be on an all liquid diet and take or drink something to make you excrete all the material in your colon the day before. The part that most people complain about isn't the actual colonoscopy, but the day before the exam. The day of the colonoscopy, you come in on an empty stomach. The nurses get you checked in, get you changed and start you on an IV. The IV is to sedate you. The colon does not like having things go up the wrong way, so the sedation is to offset the cramping that can happen and to make people less nervous. It is possible to do a colonoscopy without sedation and Dr. Hill has done it that way, but for most people it's uncomfortable. To get the colonoscope up the colon, they have to pump the colon up with air to open it up, which feels like having really bad gas. Once you are sedated, it takes about 20 minutes to get the colonoscope up the colon. As they pull the scope back out, they very carefully look around to see if there are any polyps, inflammation or other irregularities. If they see something, there are different tools they can put down the colonoscope to remove it. The colonoscope is about 5 feet long. It is very rare that there is something the doctor sees and is unable to remove. The chances of that are about one in every one to two thousand. It is rare to find something cancerous; usually the things that are removed are precancerous. The colonoscope also takes photos of the colon. Anything that is removed during the colonoscopy is sent to a lab to be reviewed. Since most of the polyps and samples are precancerous, it's not a very nerve-racking wait to hear back the results. The lab assesses the risk level of the polyp which tells them if they need to go back in and do another colonoscopy. Since polyps grow so slowly, if you have a colonoscopy and nothing is found, you don't have to get another colonoscopy for ten years. If there are polyps, patients usually come back again in another 3-5 years for another exam.
As with any medical procedure, there are some risks involved, but the chances of anything going wrong are about 1 in 20,000. Keep in mind that the risk of getting colon cancer is 1 in 20, so it's well worth the minimal risk to get the colonoscopy.
After the procedure, you wake up from the sedation. The nurses give you something to eat or drink. Your family or friends come and take you home. You are fine to do most things that day, but since it takes awhile for the sedation to get out of your system, certain things are not advised, such as using power tools, climbing on the roof or signing contracts. By the next day, you are back to normal, so the whole procedure only takes one productive day out of your life.
Most people wake up from the procedure and think, "Oh that was no big deal." The only challenging part is the prep the day before and the anticipation leading up to it. If you know someone who is thinking about getting a colonoscopy, encourage them to do so. Think about the trade off. You can give up one productive day of your life to get the colonoscopy or you can wait and later on in life possibly be on chemotherapy or have a colostomy bag. Colon cancer really is a preventable disease. When you get a colonoscopy, your chances of getting colon cancer drop from 1 in 20 down to infinitesimal.
As a population, the rate of colon cancer deaths is decreasing. That is probably a combined result of people eating better, smoking less and getting colonoscopies. Knowing about colonoscopies is good because hopefully if you didn't get one before because you were afraid or unsure about not knowing what to expect, now you know it's not that big of a deal.
Tess said that she hasn't had a colonoscopy, but she has had a blood stool test. Dr. Hill said that tests for polyps and colon cancer range in sensitivity. The blood stool test is very sensitive for any blood. The idea is that as a polyp gets larger, it
starts to bleed as material moves through the colon and scrapes against it. It is a good test because it's cheap,
sensitive, and has no risk. If there
is some blood in your stool, you and your doctor would talk about the next step, which might include x-rays, CT scans, and/or a colonoscopy. Dr. Hill thinks that it's better to detect and remove polyps before they start shedding blood and that is why he so strongly promotes colonoscopies.
Tess asked Dr. Hill to give his professional opinion on colonics. He said that you have to be careful where you spend your money. There is probably no harm in doing colonics, but he's not sure there is any benefit to doing colonics either. He said that he hasn't researched it very extensively though. He compared it to having a lot of junk in your garage. Once you clean it out you feel a lot better.
Most of the colon health products for sale are based on reasonable things such as getting enough fiber in your diet but they are way over priced for what you get.
Wayne Britton asked about endoscopies. Dr. Hill said that there is still prep needed the day before, as with colonoscopies. The endoscope is good for the small intestine which is about 15 feet long. It does work in the colon, but if something is found, you still have to go back and have a colonoscopy. Any preventative screening is good though in comparison to none.
Jim Glomb asked if colon cancer is more prevalent in men than women. Dr. Hill said that colon cancer is the second highest cause of death for both men and women (prostate being first for men and breast being first for women).
Dan Needham commented that when a polyp is removed, that causes a small wound within the colon which is a pretty high bacteria environment. He asked what the risk is of infection from that. Dr. Hill said that colon is amazing. If the body hadn't developed good defenses in the colon, humans would have died off a long time ago. The colon heals itself so fast that if you were to go back in with a colonoscope two days after a polyp was removed, it would be hard to find where the polyp previously was. The minute risk Dr. Hill previously mentioned was the possibility of perforation of the colon, which if left untreated could be serious.
Patty James asked if there has ever been a study of people who have had polyps removed and then changed their diet and lifestyle to promote colon health to see if they were indeed healthier within their colons years later versus those who didn't make the same lifestyle changes. Dr. Hill said that there has not been any such study because it is hard to have a controlled study where you encourage unhealthy behavior. However, it would make sense if a person changed their lifestyle in such ways that their colon would benefit from that and become healthier. Not all risk factors are environmental so it's hard to say for sure.
Julie Kidd asked Dr. Hill to address whether probiotics work to improve the environment of bacteria within your digestive system. He said that our colon is full of bacteria and that bacteria are important for our digestive health. The bacterial environment can be harmed from certain things such as taking antibiotics. Most products with probiotics have lactobacillus, which is one of the types of bacteria in our colon, but not the predominate one. The predominate bacteria in our colon is a kind we do not want going into our mouths. Dr. Hill commented that it does seem to work for some people, although it could be the placebo effect. To the best of his knowledge, if you put any live organism into a pH of 2 (our stomach acid) it dies, which is well before it gets to your colon. He suggests not spending a lot of money on probiotics, although they aren't bad for you either.
About ten years ago, Dewey had to lie and say that everyone he knew died of colon cancer in order to get his insurance company to cover the expense of getting a colonoscopy. He asked if Dr. Hill had noticed whether or not insurance companies are offering more coverage for colonoscopies. Dr. Hill said, "Yes and no." Insurance companies want to keep you healthy because in the long run it costs them less money, but they are also under the same financial pressures as everyone else, so they aren't really getting any more generous. There is legislation requiring all insurance companies to cover some sort of screening tests. But they have tricky ways of getting around it. A colonoscopy may start as a screening test, but then a polyp is found so then they say it wasn't really a screening test and charge you for it. It is important for all us to take charge of our health and you doctor will help be your advocate. If your insurance carrier doesn't want to cover a colonoscopy, there are most likely ways to get it covered such as saying you have symptoms or getting a blood stool test and tampering with it by getting a cut on your finger and sucking on it. He said, "I don't think they've gotten any better, but I encourage you to be creative." Dr. Hill thanked us for having him speak to us.
We gave Dr. Hill a round of applause and we made a donation to End Polio Now in his honor.
Joe led us in singing 'Happy Trails' to end the meeting.
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talked to kids from all walks of life. She asked each kid the same 25 questions about what they want and need to be healthier. Sonoma State University analyzed the data and gave Patty an 89 page report. Patty has her master's degree in nutrition. Back in 2008, she wrote and operated a pilot health program at Chops Teen Center. She took that program and made some adjustments based on the report from SSU and created Direction Five. Nancy is one of Direction Five's Board members. Clair is Direction Five's Student Advisory Member and was one of the first students Patty interviewed. There are five aspects of Direction five. The first direction is nutrition basics, which teaches about body systems and basics of culinary. The second direction is about the body-mind connection including stress and sleep. Direction three is about the body-earth connection including the food mile and the correlation between the earth's health and our own health. The fourth direction is fitness, which teaches kids not only that they need to exercise, but why they need to because of what it does for their body. The first four directions are taught while they kids learn how to cook. Of the kids Patty interviewed, 6.2% of them said they want to learn how to cook. They learn the information better while cooking because their main ingredient is fun! Currently, Direction Five is teaching at two schools in Santa Rosa and will soon be teaching at Boys and Girls clubs and holding summer camps. They are hoping to soon be working with kids at Brook Haven. Previously, the students had to use small, subpar knives in their classes, but with the Rotary grant money they recently bought all the proper knives they need. Patty thanked us and teared up in appreciation of our generosity. Patty added that they bought the knives from Sonoma Cutlery because they always try to buy locally and if not locally definitely from within the U.S.
really low and all the proceeds are going to help feed the hungry in West County. Even if you don't go to the event, you can still buy a ticket to support the cause. Tess announced that the menu for the event is chicken and sausage jambalaya, red beans and rice, Mardi Gras salad, a vegetarian pasta salad, cornbread, and Mardi Gras King Cake muffins for sale with babies hidden inside. If you get a baby, you get a prize. There will also be hurricanes, margaritas and oyster shooters. There will be special hurricane glasses for purchase too. Keep selling those tickets! Please keep track of the money and the numbers on the tickets you sell.
Dan asked us to remember how highly improbably our quality of life is, in comparison to the rest of the world. This year instead of ending the campaign on the 14th, it will end on the very special 5th Wednesday of the month. It gives you the opportunity to keep Valentine's Day in your heart a little longer. There will be a drawing of names of people to contributed at least $100 to their Paul Harris between February 1st and 29th. The prize will be a "Valentine's Day in Your Heart Every Day of the Year" package. Donations of at least $100 towards End Polio Now count as well.
