Health
#colonoscopy recap
Submitted by Aldon Hynes on Sat, 05/19/2012 - 08:39At quarter of ten on a sunny Friday morning in May, I arrived at the gastrointestinal center in the neighboring town for a colonoscopy. I looked around the room. Except for my wife, and some nervous looking woman sitting alone, I was the youngest person in the room. All of a sudden, I felt old; old enough for an AARP card, old enough to get a colorectal cancer screening.
I've done a lot of reading about colonoscopies, polyps, stages of colon cancer. I had a pretty good idea at the odds. Yes, my odds were perhaps a little higher, due to family history. The occasional aches in the gut, were probably stress, gas, or from pants that were too tight, and not something I normally worried about. I hadn't notice changes in stool size or color, but I must admit, I don't normally look closely at my stools.
The procedures seemed very efficient. 10:02, I was in the first room, where I put on a hospital gown, signed some forms and got hooked up to different machines. Blood pressure was fine. They triple checked the medications I was on, as well as any food allergies that I have. I've heard that a shellfish allergy, like I have, rules out certain medications that somehow have shellfish related to their preparations. I later found out that the anesthesia that I would be having is sometimes prepared with soybean oil and egg emulsifier.
They put in an IV, another first for me, and I admired the curved steel sculpture holding up the the bag of saline solution. 10:14, I signed more forms and waited for the anesthesiologist. 10:22, the anesthesiologist arrived, described the sedative they would use, its effects and warnings. Then, it was time wait to go into the room where they would do the actual colonoscopy. The background music was "Girls just want to have fun".
At around 10:40, I was walked into the colonoscopy room. I laid down on the hospital bed and got my wires reconnected. They hooked up oxygen, another first for me. It had a sweet but metallic smell. My blood pressure was still fine. I rolled over on to my left side, moved my left leg forward, had the blankets arrange and the railings adjusted and it was just about time to start. My blood pressure climbed a little at this point.
There was a safety check to make sure everyone was on the same page, and that I was the patient they though I was. The anesthesiologist injected what looked like a think white syrup into my IV. The propofol, or "milk of amnesia" took effect almost immediately.
I was groggy as I emerged from the propofol fog. I was in a different room and my wife was sitting next to me. She told me the time, and let me know that it was the third or fourth time that I had asked that. We talked a little bit and the doctor came in with the results.
I had one polyp, which they removed. It was around 5 mm. Such polyps are not unusual and are rarely cancerous. I was not surprised to find that I had a polyp, but relieved to hear that it was small. They are doing a biopsy to be sure that it wasn't cancerous. I also have diverticulosis. While I wasn't expecting to hear that, it wasn't surprising. Diverticulosis runs in the family, and is a good explanation of abdominal pains I sometimes experience.
The one unexpected result was erosion of the terminal ileum. That is where the small interesting joins the large intestine. It may well have been caused by the baby aspirin regimen that I've been on for years, and the doctor told me not to resume the baby aspirin for another two weeks. Another possibility is Crohn's disease, which does run in my family, but is fairly unlikely. Again, a biopsy was taken and I'll learn more later.
After I was given the details, along with some patient education materials about diverticulosis, I headed on my way. Kim and I went to a small local restaurant for brunch. I had a turkey burger that tasted really good, and Kim and a mushroom omelette.
So, I've cross the threshold for people over fifty by complete the colonoscopy rite of passage. If there were properly gamified personal health record systems, I could add the IV badge, the anesthesia badge, the colonoscopy badge and the polypectomy badge.
Perhaps, more importantly is returning to Joseph Campbell's monomyth. As I return from my adventure, I need to tell others. So, if you are over fifty and/or have a family history of polyps or colon cancer, go out and get the screening done. The prep work the day before the colonoscopy isn't fun, nor is having the tape that removed the IV, but they are all minor compared to knowing what is going on in your digestive track.
Intestinal Fracking
Submitted by Aldon Hynes on Fri, 05/18/2012 - 06:09I pour clear fluid from the small brown bottle into the large white cup. I add water, and pause for a moment to look at it. My mind wanders. Here is the poison. In this case, it will kill off ecosystems, entire macrobiotic worlds as it clears my intestines for my colonoscopy. I think for a moment of people on chemotherapy, pumping poisons into their veins to kill the cancer. I put a positive spin on the comparison. This poison will help the doctors detect if I have precancerous polyps and potentially prevent the onset of cancer.
The first gulp of the grape flavored brine goes down easily. The second is a little harder. Soon, I find each gulp getting smaller, drinking half the remaining fluid each time. I know that at this rate, I'll never finish the whole cup, so with one final gulps I swallow the last of the fluid.
My stomach rumbles as it starts to take effect. Soon, I will be expelling gases and fluids, not unlike the rocks of Pennsylvania after they receive their fracking fluids; intestinal fracking.
For the next hour or two, I will sit in my makeshift office, my laptop sitting on the sink as the solution takes effect. I'll pour fluids in one end, as they rush out the other. A few hours later, I will be sedated as a medical team explores my insides.
Thoughts before a Colonoscopy
Submitted by Aldon Hynes on Wed, 05/16/2012 - 20:10On Friday, I am scheduled to have a colonoscopy. I'm at an age with a family history where this is recommended. Since I work for a health care organization, I figure this is a good experience for me and I've spent more time than most researching colonoscopies.
I've looked at the relative prices of different facilities; searching information from my insurance provider as well as from online sites. I've read up on the procedure and possible outcomes.
According to the American Cancer Society, "Overall, the lifetime risk of developing colorectal cancer is about 1 in 20 (5.1%)". The survival rate for colon cancer depends on the stage it is detected. For Stage I, it is 74%, for Stage IV it is 6%. The numbers are pretty compelling. One in five chance of sometime developing colorectal cancer, but if it is detected early, you have over twelve times the chance of survival.
I've read all the details about the preparations for the test, and am not especially excited about the preparations, but I'll be fine. I've picked up little tidbits here and there. For example, my primary care doctor had suggested I take daily aspirin years ago. However, aspirin can increase the chance of bleeding, so I was told to stop taking aspirin at least a week before the procedure.
Another person I know, passed out after he began his preparations. In his case, it was dehydration. The instructions talked about drinking a lot of fluids. That's why. In my case, I've also been on a diuretic, which I've been told to stop taking shortly before the procedure. Yet I can and should keep taking a different blood pressure medicine.
I've read about the different types of anesthesia and the pros and cons of each. I'm not positive which anesthesia they will use, but have been told it won't be one that I had expressed concern about.
As to what is likely to happen, the University of Iowa reports 30% of people over 50 have polyps. So, I would not be surprised to have a polyp. The odds are much less that there will be anything cancerous, but if it wasn't a possibility, I wouldn't be having this test.
Hopefully, I'll write a blog post about the experience at the end of the week, and be done with it for several years.
Judicial Good Behavior
Submitted by Aldon Hynes on Sun, 05/06/2012 - 14:54Today, I read the latest court order in Planned Parenthood of Hidalgo County Texas v. Suehs about whether the State of Texas can cut off funding to the organization that provides basic preventive health care to nearly half of the participants in the states Women’s Health Program.
This is just the latest in the ongoing court battles about health care in America. Opponents of the Affordable Care Act, and especially, opponents of abortion are seeking to block health care reform through State Legislatures and the judicial system. In the Planned Parenthood case in Texas, a District Judge order a stay of implementation of a new Texas law that would defund Planned Parenthood. A judge on the Fifth Circuit, overrode that stay, allowing the law to go into effect. Then, a three judge panel, including that judge, overrode the judge's override.
So, who is this judge? Fifth Circuit Judge Jerry Smith. Does the name sound familiar? Perhaps it should. Judge Smith was appointed to the Fifth Circuit in 1987 by President Ronald Reagan. He attended Yale for both his undergraduate and his law degrees. In 1996, he wrote the majority opinion in a case in which the Fifth Circuit struck down the use of affirmative action in admissions to the University of Texas Law School. This decision was later overturned by the Supreme Court.
Yet recently, he has been making more news. Last month, he was the judge that ordered the Obama Administration to explain its position on judicial activism. It appears as if Judge Smith is in favor of judicial activism when it comes to overturning liberal laws, but in favor of judicial restraint when it comes to defending conservative laws. That is, he does not seem to possess a fair and even handed judicial temperament.
There is a long tradition of not criticizing judges, but with the Citizens' United decision by the Supreme Court, that has all changed. The Pew Research Center recently issued a report, Supreme Court Favorability Reaches New Low. The report notes that:
The court receives relatively low favorable ratings from Republicans, Democrats and independents alike.
While there have always been bad apples wherever you look, the U.S. Supreme Court has usually stayed above reproach. Yes, there was the Dred Scott decision a century and a half ago, but that is often viewed as an exception.
After the Citizens' United decision, Keith Olbermann compared Dred Scott to Citizens' United, and by extension, Chief Justice John Roberts to Chief Justice Roger Taney. We shall yet see if Citizens' United will be a greater threat to the United States as we know it than the Civil War was, or if Chief Justice Roberts shall suffer a similar fate as Chief Justice Taney. However, the current trends do not look good for Citizens' United or the esteem that our courts are held in.
Judges like Fifth Circuit Judge Jerry Smith only compound the problem of Americans' faith in the judicial system and endanger their own legacy. Wikipedia, as well as NNDB do not list Judge Smith as having been a judge, either at the district level, nor on a state court prior to becoming an Appellate Judge. No, Judge Smith's qualifications appear to come from having served on executive committee of the Texas Republican Party for over a decade.
NNDB lists his wife as Mary Jane Blackburn and Fundrace lists Mary Jane B. Smith of Houston Texas as having contributed $866 to Ted Cruz's U.S. Senate campaign back in 2009. Cruz has been endorsed by the Club for Growth, the Tea Party Express and lists repealing 'Obamacare' as one of his top priorities.
The Constitution says that judges "shall hold their Offices during good Behavior". Traditionally, "good behavior" has been determined by Congress for Federal Judges. However, given the low esteem that both Congress and the Supreme Court are held in, is it time to reconsider what "good behavior" is?
In The News
Submitted by Aldon Hynes on Wed, 04/04/2012 - 19:06When I started this blog, many years ago, it was intended to serve as a place where I could gather my writing from other places. Over the years, I've found more of my writing specifically for the blog. When I started at the Community Health Center, I didn't have as much time and energy for personal writing and so the tenor of the blog changed. Likewise, as the audience changes, so does my writing.
I have not been cross-posting blog posts I write for the Community Health Center here, for a large variety of reasons. However, I there have been some blog posts there that I've felt were particularly important. Today, I posted one of them. Psychiatric Telemedicine for Uninsured Patients without Stable Housing. It has a wonky title, but I hope you will stop by and read it. As an aside, SB 13, AN ACT CONCERNING A STUDY OF TELEMEDICINE SERVICES passed the Insurance committee with all 18 members at the committee meeting voting in favor of it. Unfortunately, it was tabled for the calendar.
Another topic I've been following is a very lively discussion on SpinSucks, PR Crisis for Skittles In Wake of Controversial Teen Shooting. How should Wrigley's respond to the increase in sales and people suggesting Wrigley's should donate the money "to the family or causes that would help with racial reconciliation or underprivileged communities".
With around 150 comments there, mine might get lost, so I figured I'd share them here:
John F. Kennedy once said, "When written in Chinese the word crisis is composed of two characters.One represents danger, and the other represents opportunity". It seems as if there is too little focus on the danger, and not enough on the opportunity.
Like many corporations, Wrigley's has a commitment to social responsibility.http://www.wrigley.com/global/principles-in-action/people.aspx
"We aim to make a difference by respecting diversity and encouraging inclusion, consistently improving our health and safety practices, providing volunteer opportunities for our associates and through philanthropy with real impact."Wrigley should focus on this and highlight efforts to help make communities safer. "Any kid should be able to walk safely to a neighborhood store."
Use the opportunity to build the brand's Social Responsibility cred.
In a follow up I was asked how I would advise them to do it while staying out of the politics. I responded:
I believe that focusing on neighborhood safety can be presented as a neutral issue. Everyone wants safer neighborhoods, whether they be members of Neighborhood Watch, or parents of black youth. It is a common ground, and by focusing on the common ground, they aren't giving into the activists, they are staying neutral to the politics, and are probably least likely to end up in legal problems.If I were there, I would probably look at putting money into grants to neighborhood organizations that are working towards this. I'd probably try to do a little branding with this, something like the "Safer Rainbow Initiative".
I'd probably do it as part of the Wrigley Company Foundation as part of their "sustainable local initiatives... to improve communities around the world"
http://www.wrigley.com/global/principles-in-action/foundation.aspx
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