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Some Answers to Questions About Flexible Sigmoidoscopy
SOME ANSWERS TO QUESTIONS ABOUT FLEXIBLE SIGMOIDOSCOPY
This test has been booked for at to be done in my office.
If you fail to keep this appointment, then we reserve the right to bill you for not showing up.
How to prepare for Flexible Sigmoidoscopy?
1. Stay on clear fluids after lunch the day before the procedure.
2. The evening before the test, take one bottle of Magnesium Citrate at 8:00p.m. One or two hours before coming to my office, use one FLEET ENEMA rectally.
3. No Aspirin or Aspirin containing pills for 7 days and no blood thinners like Coumadin for 3 days before the procedure. Consult your family doctor.
4. Stay on clear fluids the day of the procedure.
5. Take Midazolam 7.5 mg orally with water ½ hour before the procedure. You cannot drive that day.
What is Flexible Sigmoidoscopy?
A Flexible Sigmoidoscope is a short flexible tube that is about the thickness of a finger. It is inserted through the rectum into the large intestine (colon) and allows the physician to carefully examine the lining of the left colon. Abnormalities which are too small to be seen on x-ray may also be identified.
If the doctor sees a suspicious area, he can pass an instrument through the scope and take a small piece of tissue (a biopsy) for examination in the laboratory.
What is Polypectomy?
During the course of the examination, a polyp may be found. Polyps are abnormal growths of tissue which vary in size from a tiny dot to several inches. Polyps are usually removed because they can cause rectal bleeding or contain cancer. Although majority of polyps are benign (noncancerous), a small percentage may contain an area of cancer in them or may develop into cancer. Removal of colon polyps, therefore, is an important means of prevention and cure of colon cancer, which is a leading form of cancer in Canada.
What should you expect during the procedure?
Usually, no medication is required for this procedure. While you are lying in a comfortable position, the scope is inserted into the rectum and gradually advanced through the colon while the lining is examined thoroughly. The scope is then slowly withdrawn while the intestine is again carefully examined.
The procedure is usually well tolerated and rarely causes pain. There may be some discomfort during the test but it is usually mild. A limited examination may be sufficient if the area of suspected abnormality was well visualized. Rarely, the examination may be unsuccessful due to technical reasons.
What happens after flexible sigmoidoscopy?
You may feel bloated for a few minutes right after the procedure because of the air that was introduced while examining the colon. You will be able to resume your diet after the test unless you are instructed otherwise.
Are there any complications from flexible sigmoidoscopy and polypectomy?
Flexible sigmoidoscopy and polypectomy are safe and are associated with very low risk when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. One possible complication is perforation in which a tear through the wall of the bowel may allow leakage of intestinal fluids. This complication usually requires surgery, but may be managed with antibiotics and intravenous fluids in selected cases.
Bleeding may occur from the site of the biopsy or polyp removal. It is usually minor and stops on its own or can be controlled by cauterization (application of electrical current) through the scope. Rarely, transfusions or surgery may be required.
Why is Flexible Sigmoidoscopy necessary?
Flexible sigmoidoscopy is a valuable tool for the diagnosis and treatment of many diseases of the large intestine. Abnormalities suspected by x-ray can be confirmed and studied in detail. Even when x-rays are negative, the cause of symptoms such as rectal bleeding or change in bowel habits may be found. It is useful for the diagnosis and follow-up of patients with inflammatory bowel disease as well.
The greatest impact is probably in its contribution to the control of colon cancer by polyp removal. Before, major abdominal surgery was the only way to remove colon polyps to determine if they were benign or malignant. Now, most polyps can be removed easily and safely without surgery.
Periodic scoping is a valuable tool for follow-up of patients with previous polyps, colon cancer, or a family history of colon cancer.
Flexible sigmoidoscopy is a safe and extremely worthwhile procedure which is very well tolerated. If you have any questions about your need for this test, do not hesitate to speak to me, and I will be happy to discuss it with you. We share a common goal – your good health – and it can only be achieved through mutual trust, respect and understanding.
Additional Instructions: If due to unavoidable circumstances, you cannot keep your appointment, please let us know well in advance for us to call another patient waiting for this test.
Revised: July 7, 2003
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Christmas and New Year – The Price of Overindulgence!
Parents are happy that the Christmas concerts are over.
Students are happy that schools are closed for holidays.
Businesses are happy that there will be a last minute rush to buy Christmas presents.
Mothers and may be some dads will be busy (and perhaps happy) doing their last minute baking and cooking.
Although there will be no peace on earth, there will be joy and happiness in many homes.
On the other hand, there are some families who find this time of the year very stressful and difficult.
Some families cannot afford the extravaganza of the Christmas festivities the tradition of exchanging gifts, lavish feasting and partying.
Some cannot partake in the Christmas celebrations because they are sick, they are in pain, or are on the verge of dieing.
There are some who are lonely and sad because they have lost their loved ones since last Christmas.
But one thing good about our society is that there are so many voluntary organizations that take care of people for whom life has been unfair or difficult.
The generosity of the people who contribute to these organizations in cash and kind speaks volumes to our humanistic society. A society where so many are willing to give rather than complain about not having enough.
Just before Christmas almost everything in the city grinds down to a slow pace.
The hospital will be empty accept for the very sick. Most doctors (except those who are on-call) will get some time to spend with their families.
But the Christmas lull is be broken by the arrival of Boxing Day.
Emergency department gets busy – thanks to too much food and alcohol.
There will be patients with tummy ache, diarrhea, and vomiting – probably due to food poisoning. Some will have bowel blockage, some will have stomach and intestinal bleeding, some will have gall stone attacks, and some will have pancreatitis (due to gall stones or alcohol abuse).
Some will come with chest pain and heart attack. Some will be in heart failure. Some may get asthmatic attacks, some may get migraine.
Some will get involved in motor vehicle accidents, and some will get involved in fights.
Those who survive all this will soon recover to get ready for the New Years Eve bash. There will be more food and more alcohol. And then there will be a hangover and 2003 will be history!
The New Year will arrive with mail box full of bills instead of Christmas cards. And businesses will tempt you to buy more when everything goes on sale.
Isnt this all wonderful? We go through the same cycle every year! And although people complain about it, there is no way anybody can change it. It is part of our life just like day and night.
Am I being cynical about Christmas and New Years celebrations?
May be so. But as a physician I feel I should warn you (not that you didnt already know about it) that there is a price to pay for over indulgence especially when it comes to shopping, eating and drinking alcohol.
Believe me, I have seen it all.
Before I slowed down in my practice, for almost 10 years, during the Christmas week, I had volunteered to be the general surgeon on-call at Medicine Hat Regional Hospital (the old Medicine Hat General Hospital). It used to be a very busy round the clock seven days. What I write here is what I have seen.
So, enjoy the Christmas and the New Years Eve bash but do it in moderation. Know your limit and you wont regret it.
Merry Christmas and Happy New Year! Dont drink and drive. This column will be back in January, 2004- hopefully without a hangover!
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Religion and Health
Somehow, every December, I start thinking about religion and its role in our life.
As a physician, I am always looking for ways to inform my patients that certain type of life style is good for them. But I never talk about religion. I believe it is a personal and private matter. But I have written on this subject in the past. These columns can be read on my website nbharwani.com.
What is interesting is that a Newsweek poll shows 72 percent of Americans would welcome a conversation with their physician about faith. The same number say they believe that praying to God can cure someone, even if science says the person doesnt stand a chance.
My question is: Do we need religion to stay healthy and happy? Does religion make us a good person?
Let us look at the second question first. Peter Alliss, TV commentator, author and golfer says in a Golf Digest interview:
I am a humanist. I am not an agnostic or an atheist, really, though I dont believe there is a higher power in the form of an old man with a white beard, controlling events from the heavens. I believe you go through life learning by observing good and bad in other people, and putting those lessons into practice. I believe you do unto others as you would have them do unto you, and it doesnt take a Bible to convince me of that.
Alliss is not the only one who believes that being religious is not always synonymous with being a good person. One can be a good spiritual person without being a religious person.
Although religion is a strong positive factor for many people, others find that it puts constraint on their freedom to be a broad minded good individual. Then there are those who use religion in a very negative way. Perhaps more than anything negative application of religion gives it a bad name.
For most people religion is a very personal and private thing. We cannot impose our beliefs on others. If people want to change then they have to search for the truth and pursue it. That desire has to come from within. It cannot be imposed from outside.
As we renew our resolutions for the New Year, our desire to change ourselves has to come from within us. Most of us have a desire to be a better, kinder, gentler person who can make a difference in the world we live. Whether religion can help fulfill our desire to be a good person depends on ones belief and how it is applied in life.
Does religion make us healthy and happy? Should religion be part of our health care system?
The Newsweek poll says that 84 percent of Americans think that praying for the sick improves their chances of recovery; 28 percent think religion and medicine should be separate.
What does science say?
Again there are differing opinions. The difficulty is – how do you measure the power of prayer? It would be impossible to do a double blind prospective trial on the power of prayer.
The Newsweek article says that Dr. Lynda H. Powell, an epidemiologist at Rush University Medical Center in Chicago, reviewed about 150 papers on this subject. Her findings? While faith provides comfort in times of illness, it does not significantly slow cancer growth or improve recovery from acute illness.
There was one positive finding. People who regularly attend church have a 25 percent reduction in mortality. They live longer than people who are not church goers.
The Newsweek poll also shows that 84 percent of Americans said praying for others can have a positive effect on their recovery, and 74 percent said that would be true even if they didnt know the patient. But this is not confirmed by scientific studies.
But whatever science says, every individual has his or her spiritual relationship with God. How we use that relationship to stay healthy depends on us. If we believe in something then it usually works.
I feel December is good time of the year to reflect on such matters. And remember, do unto others as you would have them do unto you! It does not matter whether you are agnostic, atheist or religious.
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