Colorectal Cancer Awareness Month; Tinnitus

The following information reflects highlights of Let's Talk Medical with Doctor Gigi as it broadcasted live on Friday March 9, 2012.


Colorectal Cancer

March is Colorectal Cancer Awareness month.  Colorectal cancer is cancer which affects the colon or the rectum.  The colon is your "large bowel" whereas the rectum is the pouch at the end of the colon where you store your poop (or stool) until it passes.  Though they are slightly different cancers, they are similar enough to lump together.  Though colorectal cancer is common & potentially deadly, the reason we harp on routine screening for it is that it is usually very slow-growing.  Thus, screening will often find it in a pre-cancerous form (which is treated during colonoscopy as opposed to major surgery) or at an early stage when surgery itself is curative.  When it is diagnosed later, treatment will likely also involve chemotherapy, & a "cure" is not as easy to achieve.  Obviously, if you get colorectal cancer, you hope to find it early, so let's talk about that. 

Usually we begin screening with stool cards which look for "occult" blood... which is blood that is in the poop, but which you cannot see with the naked eye.  You take these cards home & follow the instructions to collect the samples.  The usual cards test for any blood, so you must follow a diet which eliminates other sources of blood such as red meat, especially if not fully cooked.  These cards usually require 3 different stool samples.  There is another occult blood test which tests for blood which has human DNA, so this is a more specific test, & you need not worry about red meat or your diet.  Usually these cards require 2 stool samples, so in general they are better & easier to collect, but more expensive.  Most people should begin doing ANNUAL stool cards at 40-45 years of age, though if colorectal cancer runs in your family, you might begin as early as 35.  If your stool cards are positive, this means that you have blood in your stool, but it does not mean that you have colorectal cancer... it means you need further studies, such as a colonoscopy, to look for a source of the blood, as hemorrhoids & anal fissures, as well as many other things can cause bleeding in the GI tract!  If your stool cards are negative, it does not mean you do not have colorectal cancer, but in the absence of other signs or symptoms, it is likely that you do not.

So let's say you've done your cards as recommended & they have been negative, but now you turn 50 years old or perhaps a family member develops colorectal cancer.  Well, now you need to proceed with the more definitive test for colorectal cancer... a colonoscopy!  This is a procedure usually performed by a Gastroenterologist (or occasionally a Surgeon or even a Family Practitioner) which involves pushing a scope with a camera on the end through the anus & into the rectum, then through the entire large bowel.  As it literally goes from your rectum, up the left side of your colon, across your belly & down the right colon to your appendix area, it requires that you be under sedation.  Thus, a colonoscopy should not be painful, as the doctor will give you anesthesia.  This is different from a flexible sigmoidoscopy which uses a shorter scope & thus does not evaluate the right colon, nor does it necessitate the use of anesthesia.  I almost never request a patient undergo a flex sig as they are potentially painful & not as complete as a colonoscopy.  Either procedure will require the patient have a bowel prep the day before... this is to empty the bowel of stool so the doctor can see the bowel wall fully.  The bowel prep is actually the worse part of the colonoscopy, as it sometimes makes you nauseated, & almost always makes your anal area sore.  I recommend you ask for a prep called "Movie Prep" as it requires you drink 8 ounces of the prep every 15 minutes for 1 hour, then you rest for about 4 hours & repeat the process once.  Thus the prep involves a total of 64 ounces of fluid, which is less than in some preps.  Also, your anal area will thank you if you rub Vaseline around it before the prep starts & after each loose bowel movement!

There is a thing called a "virtual colonoscopy" which is a CT scan of the bowel.  It eliminates the need for anesthesia yet still looks at the entire bowel.  Sounds great, but it has limitations!  As it is only an x-ray study, it can only show an abnormality or not.  If there is an abnormality such as a mass in the bowel, you will still need a colonoscopy so the doctor can actually see the mass AND so he can biopsy or remove it.  Remember, you will need a bowel prep for the virtual colonoscopy, & if you have an abnormality, you will need a real colonoscopy... and that likely means a second bowel prep!

The above information refers to things we do to screen for & to diagnose colorectal cancer, but what should you look for as warning signs or risks for this type of cancer.  Obviously, physicians recommend screening for everyone, but we worry even more about people who have one or more of the following:
     1)  bowel changes - such as diarrhea or constipation or just something different from your usual,
     2)  thin or flat stools - which can be due to pressure on the stool as it passes a mass or stricture,
     3)  blood in the stool - though this can be from a benign cause so don't freak out, just get further studies to determine the cause,
     4)  unexpected weight loss - which to a doctor is worrisome for a cancer of any type, not just colorectal cancer,
     5)  anemia - which means you are bleeding or not producing enough blood cells, so again it does not mean you have cancer, but it is a clue that something is wrong & needs further study such as a colonoscopy,
     6)  abdominal or pelvic pain, &
     7)  risks, which include:
               a)  family history of colorectal cancer,
               b)  previous glandular cancer, such as breast cancer or prostate cancer,
               c)  a diet high in fats,
               d)  being overweight, &
               e)  smoking - which is associated with lung cancer & bladder cancer, as well as  heart attacks & strokes!


As a final helpful hint, when you attempt to collect your stool sample for the occult blood cards, I recommend you start by turning the water off at the toilet.  Then you flush the toilet to empty it.  After you poop, you can easily collect the sample for the card, then turn the water back on & flush!  This is easier & less messy than using the paper supplied with the kit!


I have one last point to make.  If you have a normal colonoscopy, you likely do not need another one for 10 years... UNLESS something changes, such as new symptoms, a family member being diagnosed with colon cancer, or stool cards which are positive.  So you still need to check the occult blood stool cards YEARLY!  If you have benign polyps or tumors, you probably won't need a repeat colonoscopy for 3-5 years.  And if you have pre-cancerous or cancerous polyps you will likely need a repeat colonoscopy in 1 year. 


Tinnitus

Tinnitus is a ringing or other noise in the ear.  It is very common & many times it has no specific cause... which unfortunately means there is often no great treatment.  It can be due to:  wax in your ears, pressure in your ears (such as with Eustachian tube dysfunction), or Menierre's syndrome, or other hearing problems.  Aspirin in high doses can cause tinnitus, so be sure to cut back on aspirin use if you have this problem!  Though a cause is often not found, you should see an Otolaryngologist (Ear, Nose, & Throat doctor) for an evaluation, as some of these things are easily treated.  If no treatable problem is found, the only recommendation which I have is to never be in quiet places!  You need to find a way to always have "white noise" in the background, such as that created by a sound machine like the one sold at Brookstone's.  This creates sounds which will make you unaware of the ringing in your ears without engaging your brain.   So listen to the sound of waves or sounds of a thunderstorm, & you will be less likely to notice the ringing.  Note that music is not white noise if it engages your brain, so music is OK only if it is instrumental & you don't know or want to sing the words.


By the way, there is an app for that!  The iPhone,  iPad, & iPod have an app called White Noise Lite which is free.  It plays white noise such as thunderstorms, waves, an oscillating fan, chimes, & true white noise.  You can set the timer so you can try to fall asleep with it on.  They also have an upgraded app which costs a little, & I am certain the other Androids, etc. have a similar app!



Hopefully this helps you or someone you love!  If you find the information useful, please become a "follower" of my blog, & please share with your Facebook & Twitter friends, as well as with your family!  Remember to always discuss with your own physician, as this blog is meant to educate you & prepare you better for those doctor visits!  And until next week, here's to our health!

Doctor Gigi

PS  Remember to listen live to the radio show on Fridays at 1:00PM Eastern time on WTAN 1340-AM in the Tampa/St. Petersburg, Florida area.  If you are not local, you can listen live or to the podcasts via the computer at:  www.SkipShow.com.  If you want to speak with me about a medical question, please call during the live show via:  (727)-441-3000 or toll-free at (866)-TAN-1340.  And if you are too shy to talk to me, you can e-mail your questions to me at:  DoctorGigi@SkipShow.com.