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[Music]
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for Scientific American Science quickly
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I'm Rachel feltman few outpatient
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medical procedures Inspire as much
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negativity as the colonoscopy in honor
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of coloral cancer awareness month we've
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decided to bust up some of the myths
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that make people avoid this crucial
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procedure my guest today is John
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Nathanson he's a gastroenterologist at
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New York Presbyterian Columbia
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University City Irving Medical Center
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thanks so much for joining us today it's
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great being here thank you for having me
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so we are here to debunk some
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colonoscopy myths first things first you
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know why do you think colonoscopies are
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like so reviled by the general public I
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had one to check on some postco GI
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issues about a year ago and I was really
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surprised at how not awful it all was
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based on the general Vibe so yeah why do
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you think they sort of loom so large in
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people's minds well absolutely you know
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I think it's a sensitive topic people
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you know don't normally get these things
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checked out and don't normally talk
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about the things that we address in
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colonoscopy in a normal day-to-day
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conversation so I think for people
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there's this mystical nature about it
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where they kind of understand what we do
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but may not have a full understanding of
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everything and because it's such a
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sensitive area people tend to have some
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misconceptions about it yeah so what do
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colonoscopies do why are they important
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colonoscopy is a critical tool in our
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armamentarium as gastroenterologists
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number one colonoscopy can be used to
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diagnose common GI issues like
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constipation bleeding diarrhea without
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any other cause but more importantly and
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for the general public at large it can
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be used as a tool for screening for
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colon cancer so most people assume
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Colonoscopy prep is going to be really
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awful what does it actually involve and
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what is it like you know it's highly
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variable from Doctor to doctor everybody
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recommends their own way of doing things
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but for most people it generally
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involves a day before your colonoscopy
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modifying your diet and taking some sort
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of laxative to help cleanse the system
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prior to the procedure and why is
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getting a good prep in so important for
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the procedure getting a good prep is a
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critical part of this experience because
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the better the prep the more thorough
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our exam is so the cleaner the colon the
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more we are able to look for
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pre-cancerous lesions to make sure
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there's nothing else developing in the
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colon and to potentially diagnose some
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issues that brought people in in the
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first place yeah is there anything that
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people can do to make the prep process
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more easier I mean for example my doctor
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recommended you know slowly changing my
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diet in the days before which I found
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really helpful absolutely that's a great
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idea and you know we try and make very
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mild changes to people's routine so that
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this is not a disruptive experience
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rather this is just something that you
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get through very easily we generally
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recommend drinking the prep cold that
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can sometimes help number two is just
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changing your diet little by little
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prior to the colonoscopy mostly what we
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recommend is just the entire day before
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the colonoscopy be on a liquid diet but
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you can do things like drink broth
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Jell-O popsicles that type of stuff what
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are some of the sort of common mistakes
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people might make in their prep work
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that might impact the quality of the
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colonoscopy sure you know people these
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days love fiber and as a gastrologist we
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recommend that people increase fiber in
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their diet pretty much to everybody in
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the days leading up to colonoscopy
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however a high fiber diet may make it
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more difficult to prep completely for
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your colonoscopy so while fiber in
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general is excellent it's great for your
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health it's great for your digestion it
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may make the prep process a little bit
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more complicated and it may make it so
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that the prep is not as complete as we
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need it to be so generally we recommend
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a lower fiber diet in the days leading
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up to the colonoscopy that makes sense
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so moving from the prep into the
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procedure you know in the most not scary
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terms what happens during a colonoscopy
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sure while you come into our office you
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get an IV in your arm and you're being
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monitored by an anesthesiologist who is
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giving you medication to keep you
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comfortable and as a patient is asleep
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we put a camera in From Below to examine
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the lining of the colon while you're
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asleep we look for any signs of cancer
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or any signs of developing cancer and if
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we see anything regular or developing we
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biopsy it or take it out completely uh
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and do you have to be sedated to have a
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colonoscopy you don't we recommend it we
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find that when patients are more
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comfortable we do a more thorough and
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complete exam however there are patients
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that choose to forgo anesthesia
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altogether and do just fine yeah well
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and relatedly you know what about people
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who've heard that colonoscopies are
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really painful either during or even
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after due to bloating how bad is it
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usually the vast majority of our
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patients experience almost no discomfort
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at all during the procedure patients are
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incredibly comfortable and are being
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monitored by an anesthesiologist who can
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give them more medication if they
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experience any discomfort whatsoever and
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after the procedure any discomfort is is
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minimal as well patients usually pass
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gas very quickly don't feel any
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discomfort lasting after the procedure
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so now that we've demystified the
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procedure itself a little bit let's talk
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about deciding to get one so what would
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you say to people who assume they don't
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need colonoscopies because they're
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healthy they eat right they don't have
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any problems in the bathroom sure I I
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say to everybody
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if you are between 45 and 75 a
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colonoscopy is right for you for colon
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cancer screening this is something that
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everybody provided they are healthy
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enough to undergo anesthesia and healthy
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enough to undergo the procedure should
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be offered as a critical method to
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screen for and to prevent colon cancer
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so we've been seeing a lot of studies
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and stuff in the news about younger
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folks getting coloral cancer is there
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anything that people should take away
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from that in terms of when they should
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get screened
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or what symptoms they should be looking
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out for for sure and I think this is an
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important point to bring up we are
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seeing a slight increase in the absolute
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number of patients under the age of 45
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who are being diagnosed with colon
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cancer so colonoscopy is only one tool
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that we use to screen for colon cancer
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it's the tool that I generally recommend
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most often because colonoscopy has the
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added advantage of being able to detect
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but also prevent colon cancer I always
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say don't ignore symptoms if there are
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symptoms that are scary that are new
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speak with your doctor to figure out
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whether or not a colonoscopy is the
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right test to evaluate what's going on I
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will say starting at 45 is a great time
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to think about coloral cancer screening
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but if there is a family history if
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there is a high-risk genetic condition
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you may be a candidate to start
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screening earlier for example if a
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patient has a family history of colon
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cancer in a first-degree relative we
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generally recommend starting at 40 or 10
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years before the age of diagnosis
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whatever is earlier so I always say to
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talk with your doctor to figure out when
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you should start screening and start
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thinking about engaging in this process
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and if people have you know any GI
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concerns that make them feel like maybe
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they should be getting a colonoscopy
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what should their first steps be
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absolutely you know this is what we
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specialize in and if patients have any
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questions about GI symptoms I always
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recommend speaking with a
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gastroenterologist working with your
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doctor is an excellent way to figure out
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if a colonoscopy may be the right
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screening test for you and may be the
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right test to figure out what is going
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on and what is causing your symptoms
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I think a lot of people assume that all
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colonoscopy can do for you is tell you
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that you've got colon cancer what else
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can come out of these procedures yeah I
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think that's a dangerous misconception
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because colonoscopy is an excellent way
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to actually prevent colon cancer which
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is the reason why we push it so much or
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we we really talk with our patients more
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about getting colonoscopies because if
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we find precancerous pops we can remove
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them and prevent them from ever becoming
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an issue yeah that's a huge deal uh are
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there any other big misconceptions about
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colonoscopies that you want our
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listeners to know the truth about yeah
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that this is an unpleasant experience I
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find that most of our patients actually
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say well that was not much of a problem
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at all and if I had known it was so easy
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I would have come in sooner so this is a
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a straightforward test it's a safe test
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and it is a test that is not associated
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with significant discomfort awesome
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thanks so much for coming in and helping
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us dispel some of these myths absolutely
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thank you so much for having me
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that's all for today's episode we'll be
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back on Friday with a special look into
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the science of the hit TV series
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Severance featuring The Neurosurgeon who
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helped writers develop the show's
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titular
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procedure science quickly is produced by
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me Rachel Felman along with fondom wangi
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Kelo Harper Naima Marcy and Jeff dvicio
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Shaina poses and Aaron shadik fact check
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our show our theme music was composed by
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Dominic Smith subscribe to Scientific
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American for more upto-date and in-depth
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science news for Scientific American
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this is Rachel Felman see you next time
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