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Colorectal Cancer Screening

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1 September 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Colorectal Cancer Screening. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to discuss an important healthcare decision both males and females need to consider as we age:

Why You Should Have Colorectal Cancer Screening

Colorectal Cancer Screening

Colorectal cancer is a cancer that happens in the colon or rectum of our large bowels, and is called ‘Colon Cancer’ for short. On the inside of the colon or rectum where stool would normally pass through, abnormal growths can develop, what we refer to medically as ‘Polyps.’ Not ever polyp is cancer, however, some polyps may turn into cancer.

Why Colon Cancer Is Important

Colon cancer can affect both males and females across all racial demographics, and is most frequently found in individuals 50 years old or older.

You may ask yourself, doesn’t colon cancer affect primarily older individuals and should anyone younger be concerned? It is true that a greater amount of new cases are found in older individuals. However, colon cancer being diagnosed in young adults does occur.

It is the second leading cause of cancer-related deaths in the United States for men and women combined. In 2017 for the State of Michigan, there were 4,607 colon and rectum related cancer cases reported. A study in the Journal of the National Cancer Institute found that adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born in the 1950s.

Colorectal Cancer Screening

The American Cancer Society (ACS) recommends for individuals at average risk to begin colon cancer screening at age 45. 

Factors for individuals to be considered average risk include not having:

  • A personal history of colorectal cancer or certain types of polyps
  • A family history of colorectal cancer
  • A personal history of inflammatory bowel disease (eg- ulcerative colitis or Crohn’s disease)
  • A confirmed or known genetic colon cancer syndrome
  • A personal history of getting radiation to the belly to treat a previous cancer

It is mentionable that the United States Preventative Task Force (USPTF), another major panel that develops evidence-based recommendations for clinical preventive services, continues to recommend screening starting at age 50 years of age. 

Why the difference in Screening Recommendations? It comes back to the harms versus the benefits of screening. Ahh yes, too much of anything can sometimes be fraught with unintended consequences. However, If you’re reading this blog post, you have already accomplished the awareness for the need of screening. That’s a win, let’s leave it there for now.

Colorectal Cancer Screening Tests

Once the decision to be screened for colon cancer has started, people should talk with their doctor to determine which test is right for them, and how often to get tested. Several options for testing can be used to detect polyps or colon cancer beyond colonoscopies. Discussed is a sample of testing and how they work:

Colonoscopy

When most Americans hear “colon cancer screening” they think colonoscopy- that terrible elixir you have to drink to clean the bowels, the serpent-like scope, the shared ride home because you can drive. Alright, that is maybe how a doctor thinks of them. 

In reality, a doctor is able to look inside the rectum and colon when you are in twilight (sedation). They accomplish this by using a flexible, lighted tube that is inserted into the rectum and through the colon. It is the most popular method, and physicians who perform colonoscopies still regard the procedure as the “gold standard” since it has the highest detection rate of small growths and polyps. Added benefit: with colonoscopies polyps can be removed and suspicious tissues biopsied. The USPTF recommended frequency is every 10 years. 

Fecal Immunochemical Test (FIT), aka iFOBT

This test looks for tiny amounts of blood in the stool that may be displaced by a polyp. You get this test from your physician, take a stool sample at home, and then return the sample to the doctor or mailed directly to the laboratory. Only if you have a positive result would a colonoscopy be recommended. No colon cleanse or time off of work is needed. The USPTF recommended frequency is every year.

Cologuard, aka FIT-DNA

You have also seen those commercials with the talking box is it gets way too personable with the person in the bathroom. That is Cologuard, a test that looks for blood and DNA mutations in your stool that could indicate colorectal cancer. Comparatively, this test is a currently more expensive than the iFOBT, but does allow the same conveniences of having a stool sample at home collected without a colon cleanse or time off of work. The USPTF recommended frequency is every 3 years.

Which screening test should you choose?

Choose the one that fits your preferences, lifestyle, and resources available for testing and follow-up (ie. budget).

Why You Should Have Colorectal Cancer Screening

At Beyond Primary Care, we offer stool based testing from the comfort of your own home and work with gastroenterologists that perform colonoscopies. Create a relationship with a primary care physician. Learn about what you can do to decrease your risk and get screened to detect cancers at an earlier stage. If you have health insurance, a colonoscopy or any of the stool-based testing may be covered as a preventative screening test. If it is not covered, or if you do not have health insurance, we have negotiated competitive cash rate for our members. 

Please contact Dr. O’Boyle directly with any questions or to schedule an appointment to discuss further. I look forward to hearing from you!

Anxiety (in part) Explained

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22 February 2019

One of the most common medical conditions I treat as a family medicine doctor is anxiety. You most likely know what anxiety is, or personally know someone who suffers from anxiety. At my family medicine clinic, Beyond Primary Care, located in Ann Arbor Michigan, all appointments are a minimum 30 minutes, with opportunities to increase the appointment time. This length of time is an important for the treatment of any mental health concern.

What Is Anxiety?

Anxiety has many faces. Among others, it is that feeling of stress, apprehension, relentless worrying, tightness in your stomach or chest, racing thoughts, restlessness, rapid breathing, diarrhea, lack of concentration, and insomnia.

Does a person have to experience all those symptoms to have anxiety?

Absolutely not.

Does having even just one symptom mean you need medical treatment?

The best answer is that it depends on you and what the severity is.

Anxiety is a NORMAL Human Emotion

Dr. Jeff O’Boyle (who is writing this posts) experiences anxiety, you (who is reading this post) have experienced anxiety. Everyone has experienced anxiety. I feel a bit like Oprah when I just wrote that. Regardless, the truth is we all experience anxiety from the moment we are born.

Think about your own children, or other children you knew as newborns. The frequent cycles of crying and calmness. The newborn doesn’t know why they are wet, why they are hungry, why they feel cold, why they can’t sleep. So they cry. This is in part- anxiety. Eventually, after a few weeks (or months for some parents), the newborn stops crying. Overtime when there is a dirty diaper, or it learns that it will be feed every 3 hours, or the baby starts connecting it’s sleep cycles and starts doing it’s nights- much to the relief of the parents- the crying and fits decrease. The point is, we all have anxiety as newborns. We develop coping mechanisms though, inherent within our own emotional control centers to deal with this anxiety.

Treatment of Anxiety

Just as no two people are affected the exact same way by anxiety, there is no “one size fits all” treatment that cures this condition. What works for one person might not work for another. The best way to treat yourself is to become as informed as possible about the treatment options, and then tailor them to meet your needs.

In my professional opinion, becoming informed about anxiety does mean you have to be honest to yourself with how you feel. Extending that honesty to your family and friends you trust, and honest to your healthcare provider is crucial is knowing that your mental health is not something to deal with alone.

Patience with Treatment

It also takes time to find the right treatment. It might take some trial and error to find the treatment and support that works best for you. Understand how these treatments work and that they don’t work immediately. Anxiety cannot be treated like a case of bronchitis, where you get a course of antibiotics and poof- you are better in 10 days. In today’s society, I feel we are so focused on instant gratification and grossly appreciable results that we lose focus on the long-term control and relief.

Your emotional system only knows where it is at right now based upon where it just was. This is why in this work we are constantly reassessing our intervention afterwards. Where are you now? Now we do something. Where are you now? So we know if we are being effective or not. Do you want to waste your time doing stuff if you don’t know it’s working? I don’t. I want to do more of the stuff that is working and less of it that isn’t. As a doctor I’m constantly measuring.

But measuring anxiety, or any other component of mental health is not done over minutes to days, but weeks to months. Again, patience is key to treatment.