BowelPrepGuide https://bowelprepguide.com Your guide to excellent bowel prep Sun, 17 Jun 2018 03:49:46 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.6 92279279 You have anemia. Why you should see a gastroenterologist https://bowelprepguide.com/have-anemia/ https://bowelprepguide.com/have-anemia/#respond Sun, 17 Jun 2018 03:38:02 +0000 https://bowelprepguide.com/?p=7567 Anemia affects a lot of people. One-quarter of the world’s population have anemia. More than 3 million Americans have anemia. The most common form of anemia is iron deficiency anemia. This is anemia caused by lack of enough iron. Iron deficiency anemia is bad. It can reduce your quality of life and cause premature death. […]

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You have anemia

Anemia affects a lot of people. One-quarter of the world’s population have anemia. More than 3 million Americans have anemia. The most common form of anemia is iron deficiency anemia. This is anemia caused by lack of enough iron.

Iron deficiency anemia is bad. It can reduce your quality of life and cause premature death.

What is anemia?

The World Health Organization defines anemia as hemoglobin below 13.0 g/dL in male adults, below 12.0 g/dL in non-pregnant female adults, and below 11.0 g/dL in pregnant women.

What is iron deficiency anemia?

Iron deficiency is suggested by low mean corpuscular volume (MCV), wide red cell distribution width (RDW), transferrin saturation less than 20% or a ferritin level lower than 30 ng/mL.

What causes iron deficiency anemia?

Iron deficiency anemia can be due to poor iron intake, poor absorption of iron, increased demand for iron, gastrointestinal loss, gynecologic loss and others.

Lack of iron consumption
  • Vegetarian diet. Click HERE for foods high in iron.
Poor iron absorption
  • Celiac disease.
  • Surgery such as gastric resection, gastric bypass, and duodenal resection.
  • Autoimmune gastritis.
  • Helicobacter pylori gastritis.
  • Crohn’s disease affecting the small intestine.
Not enough iron due to increased need
  • Pregnancy.
  • Lactation.
  • Use of erythropoiesis stimulating agents.
Gastrointestinal Loss
  • Malignancy like stomach cancer, colon cancer.
  • Peptic ulcer disease like gastric ulcer and duodenal ulcer.
  • Variceal bleeding.
  • Esophagitis.
  • Mallory-Weiss tear.
  • Angiodysplasia and vascular ectasia.
  • Dieulafoy lesions.
  • Cameron lesions.
  • Meckel diverticulum.
  • Infectious colitis.
  • Inflammatory bowel disease (ulcerative colitis and crohn’s disease).
  • Diverticular disease like diverticular bleeding and diverticulitis.
  • Anal fissure.
  • Rectal ulcers.
  • Hemorrhoids.

 

Gynecologic Loss
  • Menorrhagia (heavy menses).
  • Uterine cancer.

 

Other causes
  • Blood loss from trauma, surgery, childbirth.
  • Blood donation.
  • Medications such as non-steroidal anti inflammatory drugs.
  • Parasites such as hookworm and tapeworm.
  •  Idiopathic pulmonary hemosiderosis.
  • Hereditary hemorrhagic telangiectasia.

 

Why you should see a gastroenterologist for iron deficiency anemia

  • If you are older than 50 years or a post-menopausal woman, iron deficiency anemia is often due to gastrointestinal loss.
  • Gastroenterologists are trained to perform various endoscopic procedures.  They can identify bleeding lesions within the gastrointestinal tract and control them. A gastroenterologist is also trained to take endoscopic biopsies if necessary and remove lesions within the gastrointestinal tract.
  • If you see a gastroenterologist, you are likely to get an upper endoscopy and a colonoscopy. An upper endoscopy is also called esophagogastroduodenoscopy (EGD). If EGD and colonoscopy are negative, you may also get a capsule endoscopy. Also, you may need a push enteroscopy or balloon enteroscopy.  There are other tests that may be necessary for iron deficiency anemia such as nuclear bleeding scan, arteriography, or meckel’s scan. If no bleeding source is found, you may need a bone marrow biopsy.

Treatment for iron deficiency anemia 

  • Blood transfusion if necessary.
  • Iron supplementation (oral or intravenous).
  • Identify the cause of iron deficiency anemia.
  • Stop further loss of blood.

 

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When your patient has colon cancer https://bowelprepguide.com/colon-cancer/ https://bowelprepguide.com/colon-cancer/#respond Mon, 11 Jun 2018 00:10:44 +0000 https://bowelprepguide.com/?p=7564 Jane (not true name) was referred to me for iron deficiency anemia. This is anemia due to lack of enough iron. She was 62 years old and attained menopause at age 55 after removing her uterus due to fibroid. Jane was divorced yet she enjoyed life and liked to socialize. Bring up the possibility even […]

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when your patient has colon cancer

Jane (not true name) was referred to me for iron deficiency anemia. This is anemia due to lack of enough iron. She was 62 years old and attained menopause at age 55 after removing her uterus due to fibroid. Jane was divorced yet she enjoyed life and liked to socialize.

Bring up the possibility even before the diagnosis

We discussed her blood count and the evidence that supports iron deficiency. Her anemia was not severe enough to require blood transfusion.  I asked her if she saw blood in her stool or have black stool and she said no. We discussed all the possible reasons she may have iron deficiency anemia including cancer.

All patients referred to me for unexplained iron deficiency anemia gets an upper endoscopy and colonoscopy unless information points to a specific location as the source of blood loss.

Tell them what you see looks like cancer but confirmation needed

Jane’s upper endoscopy was normal. There was no evidence of celiac disease. Her colonoscopy however showed a large mass in the colon. The mass occupied about 50% of the lumen of the colon. Biopsies were obtained from the mass and submitted to the pathologist for analysis.

After the procedure, Jane was taken to the recovery room. Patients often come for procedures accompanied by a family member or friend. Mary (not true name) accompanied Jane. I asked Jane some questions to ascertain her level of alertness. She said it was okay to discuss her health in the presence of her friend. I described what I found. Furthermore, I was direct in telling them that I think the mass was colon cancer and the reason she has iron deficiency anemia. Confirmation of the diagnosis is needed from the pathologist, I told them. I ordered a tumor marker called Carcinoembryonic Antigen (CEA test). And, I ordered a CT scan.  In addition, I called the pathology department to put a rush on the request.

Over the phone or in-person 

Two days later, I received a call from the pathologist. It was poorly differentiated adenocarcinoma of the colon. I asked my medical assistant to make an appointment for Jane to see me. She was told to bring a a family member.

Again, Jane came with Mary. I told her she has colon cancer. Also, her CEA level was high but the CT scan did not show any spread of cancer anywhere else. I waited for her to digest the news. I waited for a response. She expressed understanding of the result.

Where do we go from here 

Because the cancer is limited to the colon, there is a chance for cure. I went over treatment options. I asked her what she wanted to do. She chose to pursue treatment and fight. A referral was sent to a medical oncologist and a colorectal surgeon.

Last week, I saw Jane for her 1 year surveillance colonoscopy. She had surgery and chemotherapy. Her colonoscopy did not show any polyp or mass. She had beaten colon cancer.

How to tell patients they have colon cancer

  • Know your patient. A knowledge of your patient’s clinical, psychological, social, and economic background will help you take care of the whole person.
  • Have someone else with the patient when you break the news. If possible, tell patients of their diagnosis in the presence of a family member or close friend. Often, patients don’t hear any other word after the word cancer has been mentioned.
  • If possible, tell the patient in-person. There are times when a phone call will suffice. Usually, there are follow up questions by the patient or a family member. Having the patient in front of you allows you to connect with the patient at their most vulnerable point.
  • Be direct. Be frank and honest with your patient regarding the diagnosis and prognosis.
  • Stay. Be with the patient has they journey through treatment. Assist in any way possible.
  • Recognize your limitation. Despite your best efforts, communication may go wrong or treatment may fail.

 

Suggested Reading

 

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My colonoscopy bill: The true cost of colonoscopy. https://bowelprepguide.com/colonoscopy-bill/ https://bowelprepguide.com/colonoscopy-bill/#respond Wed, 06 Jun 2018 03:15:32 +0000 https://bowelprepguide.com/?p=7537 Colonoscopy is a life-saving procedure but it comes with a bill. There are so many factors that influence the cost of colonoscopy. The cost of colonoscopy varies from region to region, facility to facility and provider to provider. Components of a colonoscopy bill Doctor’s visit. Bowel cleansing agent. Cost of missing a day’s work. Facility […]

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colonoscopy bill

Colonoscopy is a life-saving procedure but it comes with a bill. There are so many factors that influence the cost of colonoscopy. The cost of colonoscopy varies from region to region, facility to facility and provider to provider.

Components of a colonoscopy bill

  1. Doctor’s visit.
  2. Bowel cleansing agent.
  3. Cost of missing a day’s work.
  4. Facility fee. The fee charged by the facility where the procedure is performed.  This fee covers the use of the facility, equipment, and staff.
  5. Professional fee. This includes professional fee for the physician (gastroenterologist), the anesthesiologist (if one is used), and the pathologist (if one is used).

 

Why colonoscopy bill may be different

  1. Type of colonoscopy.  There are 3 types of colonoscopies. Screening colonoscopy, diagnostic colonoscopy and therapeutic colonoscopy. Screening colonoscopy is covered for free under the Affordable Care Act. However, if a polyp is removed, it changes to a therapeutic colonoscopy and you may have a co-pay. Therapeutic colonoscopy costs more than screening or diagnostic colonoscopy.
  2. Type of facility.  There are four different facilities where a colonoscopy can be done. Hospital, hospital out-patient department (HOPD), ambulatory surgery center (ASC), and physician office. Colonoscopy is more expensive in hospital and HOPD.
  3. Type of sedation.  Colonoscopy can be done without sedation but most people prefer sedation. If sedation is used, it can be minimal, moderate, deep or general anesthesia. Minimal and moderate sedation can be achieved using intravenous medications like fentanyl and midazolam (versed). Sometimes diphenhydramine (benadryl) is also used. Minimal and moderate sedation can be given by the same physician performing the colonoscopy. Deep sedation can be achieved with propofol. If deep sedation or general anesthesia is required, a separate provider (an anesthesiologist or nurse anesthetist) is usually involved. This provider charges an anesthesia fee that increases the cost of the colonoscopy.
  4. Type and number of specimen (biopsies).  Any biopsy or tissue (polyp, growth, cancer) removed during colonoscopy is sent to the pathologist for analysis. The more the bottles of specimen submitted for analysis, the more expensive the procedure.

 

Fees and Charges associated with colonoscopy bill

  • Technical fee. The fee charged by the facility where the colonoscopy is performed.
  • Professional fee. The fee charged by the physician (gastroenterologist, anesthesiologist, pathologist).
  • Co-Pay. This is a fixed amount you pay for health-care services. Under the Affordable Care Act, co-pays and deductibles are waived for preventive services like screening colonoscopy.
  • Deductible. This is the amount you have to pay for health-care services before your insurance company begins to pay.
  • Co-Insurance. This is your share (in percentage) of the cost of health-care services. If you have co-insurance, you usually pay this after paying your deductible.
  • Billed charge. The amount the provider charges the insurance company.
  • Reimbursement (Allowed) amount. The amount actually paid by your insurance company.
  • In-Network. This means your physician or procedure facility already has an agreement with the insurance company to provide services for you. In-Network providers cost less than Out-Network providers.

Find out the cost of colonoscopy in your area

For the cost of colonoscopy in your area, click HERE.

 

Suggested Reading

The 3 P’s of colonoscopy: Factors that determine the outcome of colonoscopy.

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How to use Plenvu for colonoscopy bowel preparation https://bowelprepguide.com/how-to-use-plenvu/ https://bowelprepguide.com/how-to-use-plenvu/#respond Fri, 01 Jun 2018 05:06:51 +0000 https://bowelprepguide.com/?p=7531   Plenvu is the first 1 liter PEG-based bowel cleansing agent. Plenvu can be used alone or in conjunction with over the counter laxatives like bisacodyl or magnesium citrate. If an over the counter laxative is also recommended by your physician, it is usually used about 1 hour before the bowel cleansing agent. There are […]

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how to use plenvu

 

Plenvu is the first 1 liter PEG-based bowel cleansing agent. Plenvu can be used alone or in conjunction with over the counter laxatives like bisacodyl or magnesium citrate. If an over the counter laxative is also recommended by your physician, it is usually used about 1 hour before the bowel cleansing agent. There are 2 main ways to take your bowel cleansing agent: the day before regimen or the split dose regimen.

Day-Before Bowel Preparation For Colonoscopy Using PLENVU

What do I do a day before the colonoscopy?

  • Have a clear liquid diet throughout the day. Clear liquid diet excludes red and purple colored substances. No solid foods, milk products, fruits, seeds & nuts.
  • Be sure to keep hydrated by drinking 8oz of clear liquid every hour.
  • If you have diabetes mellitus, you may need to take half the dose of your medication while on clear liquid diet. Please, talk to your provider about this.
  • Open the carton and remove the dose 1 sachet.
  • Pour the contents of dose 1 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 1 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes. This should be done in the afternoon or early evening before the colonoscopy (e.g., 4:00 to 6:00 PM).
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.
  • If severe bloating, distention, or abdominal pain occurs, following the first dose, delay the second dose until the symptoms resolve.
  • Dose 2 – Approximately 6 hours later in the evening the night before the colonoscopy (e.g., 10:00 PM to 12:00 AM):Take the second dose of Plenvu.
  • Pour the contents of dose 2 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 2 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes.
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.

What do I do on the day of the colonoscopy?

  • You may take your morning medications as usual unless as directed by your doctor.
  • Avoid further fluid intake 2 hrs before your scheduled colonoscopy.
  • If you are diabetic, do not take oral diabetic medications or short-acting insulin on the day of your colonoscopy. Talk to your provider about this.

 

Split-Dose Bowel Preparation For Colonoscopy Using PLENVU

What do I do a day before the colonoscopy?

  • Have a clear liquid diet throughout the day. Clear liquid diet excludes red and purple colored substances. No solid foods, milk products, fruits, seeds & nuts.
  • Be sure to keep hydrated by drinking 8oz of clear liquid every hour.
  • If you have diabetes mellitus, you may need to take half the dose of your medication while on clear liquid diet. Please, talk to your provider about this.
  • Take the first dose of Plenvu during the evening before the colonoscopy (e.g., 5:00 to 9:00 PM).
  • Open the carton and remove the dose 1 sachet.
  • Pour the contents of dose 1 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 1 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes.
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.
  • If severe bloating, distention, or abdominal pain occurs, following the first dose, delay the second dose until the symptoms resolve.

What do I do on the day of the colonoscopy?

  • Take the second dose of Plenvu 4-5 hours before your scheduled colonoscopy.
  • Pour the contents of dose 2 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 2 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes.
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.
  •  Avoid further fluid intake 2 hours before your scheduled colonoscopy.
  • If you are diabetic, do not take oral diabetic medications or short-acting insulin on the day of your colonoscopy. Talk to your provider about this.

 

Day-Before Bowel Preparation For Colonoscopy Using PLENVU and Bisacodyl (Dulcolax)

What do I do a day before the colonoscopy?

  • Have a clear liquid diet throughout the day. Clear liquid diet excludes red and purple colored substances. No solid foods, milk products, fruits, seeds & nuts.
  • Be sure to keep hydrated by drinking 8oz of clear liquid every hour.
  • If you have diabetes mellitus, you may need to take half the dose of your medication while on clear liquid diet. Please, talk to your provider about this.
  • Take 4 tablets of bisacodyl (Dulcolax) around 3:00-4:00 PM.
  • Open the carton and remove the dose 1 sachet.
  • Pour the contents of dose 1 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 1 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes. This should be done in the afternoon or early evening before the colonoscopy (e.g., 4:00 to 6:00 PM).
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.
  • If severe bloating, distention, or abdominal pain occurs, following the first dose, delay the second dose until the symptoms resolve.
  • Dose 2 – Approximately 6 hours later in the evening the night before the colonoscopy (e.g., 10:00 PM to 12:00 AM):Take the second dose of Plenvu.
  • Pour the contents of dose 2 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 2 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes.
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.

What do I do on the day of the colonoscopy?

  • You may take your morning medications as usual unless as directed by your doctor.
  • Avoid further fluid intake 2 hrs before your scheduled colonoscopy.
  • If you are diabetic, do not take oral diabetic medications or short-acting insulin on the day of your colonoscopy. Talk to your provider about this.

 

Split-Dose Bowel Preparation For Colonoscopy Using PLENVU and Bisacodyl (Dulcolax)

What do I do a day before the colonoscopy?

  • Have a clear liquid diet throughout the day. Clear liquid diet excludes red and purple colored substances. No solid foods, milk products, fruits, seeds & nuts.
  • Be sure to keep hydrated by drinking 8oz of clear liquid every hour.
  • If you have diabetes mellitus, you may need to take half the dose of your medication while on clear liquid diet. Please, talk to your provider about this.
  • Take 4 tablets of bisacodyl (Dulcolax) around 3:00-4:00 PM.
  • Take the first dose of Plenvu during the evening before the colonoscopy (e.g., 5:00 to 9:00 PM).
  • Open the carton and remove the dose 1 sachet.
  • Pour the contents of dose 1 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 1 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes.
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.
  • If severe bloating, distention, or abdominal pain occurs, following the first dose, delay the second dose until the symptoms resolve.

What do I do on the day of the colonoscopy?

  • Take the second dose of Plenvu 4-5 hours before your scheduled colonoscopy.
  • Pour the contents of dose 2 into a measuring container that can hold 500 ml of fluid.
  • Add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes.
  • Drink the 500 ml Plenvu dose 2 solution over 30 minutes by drinking 1 glassful every 10 to 15 minutes.
  • Following the Plenvu dose, drink a further 500 ml of clear fluid over a further 30 minutes.
  •  Avoid further fluid intake 2 hours before your scheduled colonoscopy.
  • If you are diabetic, do not take oral diabetic medications or short-acting insulin on the day of your colonoscopy. Talk to your provider about this.

 

Click HERE for video on how to use your bowel cleansing agent. 

Click HERE for full prescribing information.

 

 

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Why do I have blood in my stool? https://bowelprepguide.com/blood-in-stool/ https://bowelprepguide.com/blood-in-stool/#respond Sat, 26 May 2018 23:40:06 +0000 https://bowelprepguide.com/?p=7297 Blood in stool can be a sign of a life threatening disease like cancer or a vexing but benign condition like hemorrhoid. Blood in the stool can be visible or invisible. When it is visible, it can be black and tarry (melena), burgundy (maroon) or bright red. When it is invisible, it can only be detected […]

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blood in stool

Blood in stool can be a sign of a life threatening disease like cancer or a vexing but benign condition like hemorrhoid. Blood in the stool can be visible or invisible. When it is visible, it can be black and tarry (melena), burgundy (maroon) or bright red. When it is invisible, it can only be detected by a stool test. Stool-based tests for colon cancer are designed to detect blood in the stool.

Why do I have blood in stool?

Hemorrhoids

Hemorrhoids are swollen veins around the anus or lower part of the rectum. They are common affecting more than 50% of people over the age of 50. Sometimes they bother people and sometimes they don’t. They may cause painless rectal bleeding or what is called “bright red blood per rectum.” They can be inside or outside. They do not lead to cancer. For more information on hemorrhoids, click HERE.

Colitis

Colitis is inflammation of the colon. This can be acute or chronic. Colitis can be due to infection, ischemia, or inflammatory. Infection or ischemia (when blood supply is blocked) can lead to acute colitis. Chronic inflammation is usually due to inflammatory bowel disease. There are 2 types of inflammatory bowel disease-ulcerative colitis and crohn’s disease.

Diverticular disease

The presence of a diverticulum or diverticula in the colon is called diverticulosis. A diverticulum is a pouch within the wall of the colon. Inflammation of the pouch is called diverticulitis. Diverticula can bleed without inflammation or infection. Diverticulitis can also lead to blood in the stool.

Angiodysplasia

Angiodysplasia is also called angioectasia or arteriovenous malformation (AVM). These are abnormal blood vessels on the wall of the colon. They can also be present in any part of the gastrointestinal tract. They may bleed on and off.

Solitary rectal ulcer syndrome 

This is a rare condition that is associated with constipation. Solitary rectal ulcer syndrome causes rectal bleeding, straining during defecation and a sense of incomplete evacuation.

Colorectal cancer 

By far the most worrisome reason why you may have blood in the stool is colorectal cancer. It is a leading cause of cancer deaths in the U.S. If you have blood in the stool and have not recently had a colonoscopy, you probably need one. If your stool test is positive for blood, you need a colonoscopy. Read Colorectal Cancer in 2018: The Good, the Bad and the Ugly.

Others

There are many other reasons why you may have blood in the stool. The blood may be coming from your upper gastrointestinal tract (esophagus, stomach and small intestine). An ulcer or cancer in the esophagus, stomach or small intestine can also make you have blood in the stool. Blood in stool may be due to a bleeding or clotting disorder. Certain medications like blood thinners may make bleeding worse.

You should see a physician if you have blood in your stool.

 

 

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Founder and Editor, Adewale Ajumobi, MD, MBA, FACP https://bowelprepguide.com/adewale-ajumobi-md-mba-facp/ https://bowelprepguide.com/adewale-ajumobi-md-mba-facp/#respond Sun, 22 Apr 2018 05:32:03 +0000 https://bowelprepguide.com/?p=7500 Adewale Ajumobi, MD, MBA, FACP is a board-certified gastroenterologist with expertise in colorectal cancer prevention and screening. He founded BowelPrepGuide in 2014 when he could not find a website he can direct patients to for information on bowel preparation for colonoscopy. BowelPrepGuide (www.bowelprepguide.com) provides bowel preparation resources to patients and providers. He received the SCOPY awards three years […]

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Adewale Ajumobi, MD, MBA, FACP

Adewale Ajumobi, MD, MBA, FACP is a board-certified gastroenterologist with expertise in colorectal cancer prevention and screening. He founded BowelPrepGuide in 2014 when he could not find a website he can direct patients to for information on bowel preparation for colonoscopy. BowelPrepGuide (www.bowelprepguide.com) provides bowel preparation resources to patients and providers. He received the SCOPY awards three years in a row in 2015, 2016, 2017.

Background

Wale Ajumobi received his MBA from the University of La Verne, California. He completed his internship and residency training at Loma Linda University, California. After residency training, he worked as a staff physician with Loma Linda VA Healthcare System and as Assistant Professor of Medicine at Loma Linda University from 2008-2012. He then completed a gastroenterology and hepatology fellowship at University of Texas Health Science Center, San Antonio. Dr. Ajumobi completed a certificate course in clinical safety and effectiveness at the University of Texas. He is the president of Coachella Valley Digestive Health and an Assistant Professor of Medicine at University of California, Riverside. Wale practices gastroenterology at Eisenhower Health. He is a fellow of the American College of Physicians.

 

 

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How to choose a screening test for colorectal cancer https://bowelprepguide.com/how-to-choose-a-screening-test/ https://bowelprepguide.com/how-to-choose-a-screening-test/#respond Mon, 16 Apr 2018 00:55:28 +0000 https://bowelprepguide.com/?p=7444 Colorectal cancer is a leading cause of cancer death in the United States. There are many tests available to screen for colorectal cancer. How do you choose the right screening test for colorectal cancer? Some tests can detect both colorectal cancer and colorectal polyps. Others detect only colorectal cancer. Some tests are invasive while others […]

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how to choose a screening test for colorectal cancer

Colorectal cancer is a leading cause of cancer death in the United States. There are many tests available to screen for colorectal cancer. How do you choose the right screening test for colorectal cancer? Some tests can detect both colorectal cancer and colorectal polyps. Others detect only colorectal cancer. Some tests are invasive while others are non-invasive.

Colonoscopy

Advantages:

  • The only test that can see the entire colon.
  • It can be used to remove polyps.
  • It can be used to remove early stage cancer.

Disadvantages:

  • Requires bowel preparation.
  • Often requires sedation (anesthesia).
  • Invasive.
  • It can lead to certain complications such as bleeding or perforation (tear in the colon).

How often: 

  • Colonoscopy is recommended every 10 years for people at average risk as long as their test results are negative.

Choose screening test:

  • If you have high risk for colorectal polyps or cancer. These include people with family history of colorectal cancer, personal history of colon polyps or cancer, Lynch syndrome or polyposis syndrome. Also, choose if you have inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
  • If you want only one test done since all other tests lead to colonoscopy if they are positive.

Flexible Sigmoidoscopy

Advantages:

  • It can be used to find and remove polyps in the lower part of the colon (the rectum and sigmoid colon).
  • Often does not require sedation (anesthesia).
  • Unlike colonoscopy, it does not require intense bowel cleansing prior to the test. In most cases, all you need is an enema before the procedure.

Disadvantages:

  • It does not look at the entire colon therefore can miss polyp or cancer in the upper part of the colon.
  • Invasive.
  • It can lead to certain complications such as bleeding or perforation (tear in the colon).
  • You still need a colonoscopy if positive.

How often:

  • Every 5 years.

Choose screening test: 

  • If you don’t have access to a colonoscopy.
  • If you have average risk for colorectal polyp or cancer.

Double-contrast Barium Enema (DCBE)

Advantages:

  • Non-invasive.
  • No need for sedation (anesthesia).

Disadvantages:

  • Requires bowel preparation.
  • Exposure to radiation.
  • May miss small or flat colon polyps.
  • The barium used for the test may change your stool color and cause constipation.
  • You still need a colonoscopy if positive.
  • This test is rarely used now in the U.S.

How often:

  • Every 5 years.

Choose screening test: 

  • If a colonoscopy could not be completed in you.
  • If you are mainly interested in knowing if you have a big mass or cancer in the colon.

Computed tomography colonography (CT colonography)

Advantages:

  • Non-invasive.
  • No need for sedation (anesthesia).

Disadvantages:

  • Requires bowel preparation.
  • Exposure to radiation.
  • Looks like the entire abdomen and pelvis thereby picking other findings unrelated to colon polyps or cancer. These findings may lead to unnecessary tests and procedures.
  • May miss small or flat colon polyps.
  • You still need a colonoscopy if positive.

How often:

  • Every 5 years.

Choose screening test: 

  • If a colonoscopy could not be completed in you.
  • If you are mainly interested in knowing if you have a big mass or cancer in the colon.

FOBT (fecal occult blood test)

Advantages:

  • Non-invasive.
  • No need for sedation (anesthesia).
  • No need for bowel preparation.
  • Done at home.

Disadvantages:

  • It cannot differentiate between blood coming from the colon or other parts of the GI tract. It can be positive due to stomach ulcer, colitis, diverticulosis, hemorrhoids.
  • Some foods and medications can affect the result. You need to stop non-steroidal anti-inflammatory agents like ibuprofen 7 days before the test, Vitamin c 3 days before the test and red meat 3 days before the test.
  • You still need a colonoscopy if positive.

How often: 

  • Every year.

Choose screening test: 

  • If you don’t have access to colonoscopy.
  • If you are not a high risk person for colorectal cancer.

FIT (fecal immunochemical test)

Advantages:

  • Non-invasive.
  • No need for sedation (anesthesia).
  • No need for bowel preparation.
  • Done at home.
  • Unlike the FOBT, you do not need to stop certain foods or medications before the test.

Disadvantages:

  • It can be falsely positive.
  • It cannot detect certain polyps (sessile serrated polyps).
  • You still need a colonoscopy if positive.

How often:

  • Every year.

Choose screening test: 

  • If you don’t have access to colonoscopy.
  • If you are not a high risk person for colorectal cancer.

Stool DNA test (Cologuard)

Advantages:

  • Non-invasive.
  • Does not require bowel preparation prior to the test.
  • No need for sedation (anesthesia).
  • Done at home.

Disadvantages:

  • It has a lot of false positives (positive even though there is no polyp or cancer).
  • It is not meant for patients with high risk for colorectal cancer.
  • You still need a colonoscopy if positive.

How often: 

  • Every 3 years.

Choose screening test:

  • If you don’t have access to colonoscopy.
  • If you are not a high risk person for colorectal cancer.

 

The best colorectal cancer screening test is the one that gets done.”

 

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How to get a clean colon like Jimmy Kimmel https://bowelprepguide.com/how-to-get-a-clean-colon/ https://bowelprepguide.com/how-to-get-a-clean-colon/#respond Thu, 29 Mar 2018 04:04:21 +0000 https://bowelprepguide.com/?p=7467   Recently, Jimmy Kimmel turned 50. To celebrate this milestone, he had a colonoscopy. He had a clean colon. Average risk  persons should be screened for colorectal cancer starting at the age of 50. There are several ways to screen for colorectal cancer but colonoscopy remains the Gold Standard. It is the only test that […]

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clean colon like Jimmy Kimmel

 

Recently, Jimmy Kimmel turned 50. To celebrate this milestone, he had a colonoscopy. He had a clean colon. Average risk  persons should be screened for colorectal cancer starting at the age of 50. There are several ways to screen for colorectal cancer but colonoscopy remains the Gold Standard. It is the only test that allows the physician to remove colon polyp or early stage cancer at the same time as the test.

 

 

In the video, Jimmy Kimmel colonoscopy revealed a clean colon (bowel prep). A clean colon allows the physician to see the inner lining of the colon. The adequacy of bowel cleansing is scored during colonoscopy using several bowel preparation scales. Adequate bowel prep is one that can detect polyps 5 mm in size or more. Inadequate bowel prep is associated with a reduced chance of detecting pre-cancerous polyps. It leads to longer procedure time and aborted procedure. Ultimately, it leads to higher healthcare cost.

How to get a clean colon like Jimmy Kimmel

  • Adjust your medications.  About 1 week before your colonoscopy, stop taking fiber supplements such as Metamucil, Citrucel, Benefiber. Also, stop taking iron tablets or products that contain iron. Avoid medications used to stop diarrhea such as Imodium, Lomotil and Pepto-Bismol. Stop taking fish oil about 2 days before colonoscopy.
  • Change your diet.  Start eating low fiber foods 3 days before your colonoscopy. Most physicians also recommend a clear liquid diet 1 day before your colonoscopy.
  • Split your bowel cleansing agent.  There are many medications approved by the Food and Drug Administration for bowel cleansing. These include Colyte®, GoLYTELY®, NuLYTELY®, TriLyte®, HalfLytely®, MoviPrep®, SUPREP®, OsmoPrep®, Prepopik®, and CLENPIQ®. Regardless of the bowel cleansing agent used, the split dose regimen has been proven in multiple studies to be the most effective way to use the medication. In the split dose regimen, half of the bowel cleansing agent is taken the evening before the colonoscopy. The 2nd half is taken 4 to 5 hours before the scheduled colonoscopy.
  • Keep hydrated.  Drinking plenty of fluids prevents dehydration and improves the cleanliness of your colon. In most cases, you can drink clear liquid fluids up to 2 hours before your scheduled colonoscopy.
  • Finish your bowel cleansing agent.  You may be tempted to not finish your bowel cleansing agent because you think you may be clean. Please, don’t. Finish all your bowel cleansing agent. Read how to tell if your bowel is clean prior to colonoscopy. 

 

How to prevent colorectal cancer 

  • Know your family history.
  • Get screened.
  • Avoid tobacco.
  • Drink alcohol in moderation.
  • Consume less red meat and processed meat.
  • Eat more fiber.
  • Lose weight.
  • Be physically active.
  • For more information, read 3 ways to prevent colorectal cancer.

 

Suggested Reading 

 

 

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How to use your bowel cleansing agents [Video] https://bowelprepguide.com/how-to-use-your-bowel-cleansing-agents-video/ https://bowelprepguide.com/how-to-use-your-bowel-cleansing-agents-video/#respond Wed, 28 Mar 2018 04:25:13 +0000 https://bowelprepguide.com/?p=7448 English Version   Spanish Version      

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English Version

 

Spanish Version

 

 

 

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How to use your bowel cleansing agents for colonoscopy https://bowelprepguide.com/how-to-use-your-bowel-cleansing-agents/ https://bowelprepguide.com/how-to-use-your-bowel-cleansing-agents/#respond Mon, 19 Mar 2018 17:40:21 +0000 https://bowelprepguide.com/?p=7172 Bowel cleansing agents are used to clean out the colon before colonoscopy. A clean colon allows the physician to find polyps and remove them. GoLYTELY, MoviPrep, SUPREP, OsmoPrep, Prepopik are examples of bowel cleansing agents. Bowel cleansing agents can be used alone or in conjunction with over the counter laxatives like bisacodyl or magnesium citrate. […]

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bowel cleansing agents

Bowel cleansing agents are used to clean out the colon before colonoscopy.

A clean colon allows the physician to find polyps and remove them.

GoLYTELY, MoviPrep, SUPREP, OsmoPrep, Prepopik are examples of bowel cleansing agents.

Bowel cleansing agents can be used alone or in conjunction with over the counter laxatives like bisacodyl or magnesium citrate.

There are 3 ways to take your bowel cleansing agent: the day-before regimen, the split-dose regimen, and the same-day regimen.

In the day before regimen, the entire bowel cleansing agent is used the evening before the colonoscopy.

In the split-dose regimen, half the total dose of the bowel cleansing agent is used the evening before your colonoscopy and the 2nd half is used 4 hours before your colonoscopy. Split dosing leads to better colon cleansing and improved detection of polyps.

In the same-day regimen, the bowel cleansing agent is used in the morning of the colonoscopy. This can only be used for patients scheduled for afternoon colonoscopy.

Follow the advice of your physician regarding how you should use your bowel cleansing agents.

For more information, visit www.bowelprepguide.com.

English Version Video 

Spanish Version Video

Additional Information

How to Use Suprep for Colonoscopy Bowel Preparation

How to Use Golytely for Colonoscopy Bowel Preparation

How to Use Prepopik for Colonoscopy Bowel Preparation

How to Use Moviprep for Colonoscopy Bowel Preparation

How to Use Miralax and Gatorade for Colonoscopy Bowel Preparation

How to Use OsmoPrep for Colonoscopy Bowel Preparation

How to do the 2 Day Bowel Prep for Colonoscopy

How to Use CLENPIQ for Colonoscopy Bowel Preparation

 

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