Archive for December, 2014

Finally got the colonoscopy after delaying it five years. It is not worth fretting over.

December 20, 2014

I got a colonoscopy on Thursday, Dec. 18th. I was 55 when I finally got it done, after putting it off for five years.

My reasoning was that I had an elderly colleague that was one of the extremely rare cases where something goes wrong. She reportedly died from the infection caused by a perforated colon. On the other hand, she had a compromised immune system as a kidney transplant recipient. So, it was an unusual case all around. I admit it represented the triumph of anecdote over evidence, but welcome to the real-world of how human beings operate. Something isn’t rare if it happens to you or someone you know.

Two factors finally got me to get it over with. First, a couple of years ago I got to see my mother-in-law’s final days of death by colon cancer. So far as I know, she never got a colonoscopy after turning 50. The cancer was the size of a baseball when finally detected by one. What got the colonoscopy scheduled was a mass so large a doctor felt it when pressing down on her abdomen during an exam.

She had passed fecal occult blood tests — which indicates how unreliable they are as a screening tool. Major surgery followed, followed by chemotherapy, but the cancer came back and she later died from it.

Then I got a stage IIB melanoma diagnosis this year (it was an itchy mole) and had to go through a neck surgery and two lymph nodes removed for testing (no spread detected) and all the cancer follow-ups.

It seemed rather silly to risk what could be far worse interventions over another type of cancer that was mostly preventable. The gold standard screening tool for colon cancer is the colonoscopy. It was also something I could do for very minimal cost under my insurance.

Now that it is over, I have concluded the actual event doesn’t live up the anxiety or squeamishness hype. The prep was not bad. Just use a double dose of Orange Crystal Light and ice to cover the taste of the Miralax. The four Dulcolax pills had no taste.

I experienced no discomfort from the prep. Starting about 2 ½ hours after the first glass of liquid prep I had to go to the bathroom. This was repeated through-out the night until pretty late. Other than meaning no evening plans, it was pretty easy.

The procedure itself consists of being asked to take four deep breaths while a nurse anesthetist injects propofol into an IV. Once it hits your brain (less than 10 seconds), you get a second or two of blurring vision and wake up in recovery not long afterward. Within ten minutes you can be dressed and going home. There are no memories at all of the actual procedure.

No nausea, little or no hangover, your can eat immediately afterward (nice after all that fasting), and it wears off ultra-fast so you can be clear-headed within minutes. I did some work from home later that same day.

I had no discomfort at all from the procedure itself. The only thing that was sore was where a nurse kind of blew out a vein starting an IV.

Downside is they snagged a polyp (benign) and found some diverticulosis. So, have to load up lots of fiber in the diet. Learning about the diverticulosis was a benefit, since it responds to diet as a treatment. Hopefully I can keep it from ever becoming an issue.

The lack of anything serious means I don’t have to repeat the colonoscopy for ten years. So, it is something to put on the to do list at age 65.

Anyhow, it is something to look forward to if you actually make 50. But, having done it once, I would have no problem doing it again (so long as propofol sedation is employed).

If it is something that you or family member is procrastinating on getting done, hopefully relating my non-event experience helps get it scheduled.

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What is wrong with the US health car system in a single SNAFU: Lack of communication

December 6, 2014

I was overdue to have a screening procedure (colonoscopy) done that involves anesthesia and use of a specialist. I dutifully sought out a primary care physician referral, made an appointment with the specialist, and then scheduled the procedure with  full month’s lead time.

This procedure involves multiple days of dietary prep, to include fasting on the day beforehand and consuming laxatives the night before it occurs. Late in the afternoon before I was scheduled to show up I got a frantic call from the specialist’s office. It seems that the whole thing was in doubt due to not having the primary care referral on file. Indeed, the procedure was ultimately cancelled when it became clear the referral wouldn’t be in place in time.

I then had to spend most of a day getting it rescheduled for two weeks later. I couldn’t get anybody to call me back at the specialist’s office and finally went there in person and camped out in their lobby.

I had arranged time off from work, my wife had moved another medical appointment (she was my ride to and back) and I had not eaten in nearly 24 hours by the time I was told to forget about it. Fortunately I had not started chugging laxatives yet, but was within a few minutes of when that stage of the prep was scheduled to start.

Needless to say, I was not a happy camper. Somehow the office staffs of two physicians couldn’t get it together to get a simple referral filed with a month’s notice. The specialist’s office called me the afternoon before the procedure asking for the name of the primary care doctor and her number. Please note this is information contained in all those forms I had filled out for them. The primary care insisted they had faxed over a form, but it turned out to be a patient progress report.

Worse, now I am getting erroneously overbilled by the specialist because my insurer is showing them as not having the proper referral in place.

This is a comedy of errors that highlights a medical system where fragmentation and lack of communication is the norm. In my case the only issue was inconvenience and lost time. For others, it can lead to worsened outcomes.

UPDATE: I got the procedure reschedule. Then, the day before the procedure I got a call asking if I could move it to later the same morning. OK, I agreed. Then their phone-based appointment reminder system called me near close-of-business asking me to confirm a completely different appointment time. Had I followed what it told me, I would have missed the procedure time. C’mon folks, this is Marx Brothers stuff. No other industry would tolerate this much pure sloppiness when dealing with customers.

Deus Ex: Human Revolution rocks, but pacifist mode is broken

December 6, 2014

I love the original Deus Ex and at one point worked in the same building as Ion Storm Austin. The development team picture in the end credits was the plaza of the place. I hoped Deus Ex: Human Revolution would live up to the first game’s greatness after the disappointing Deus Ex: Invisible War.

For the most part, the new game rocks. It gets the feel of Deus Ex right. I love it!

However, there is one flaw that I think cries out for a patch. Sadly, the pacifist mode is broken. I keep trying to do a non-violent play-through, but keep discovering enemies that show up as dead after using stun guns, tranquilizer rifles, or non-lethal takedowns. What is worse is that the initial takedown may show up as non-lethal, but then you come back several saves later to discover them dead.

This is unfair to the player and ruins any chance at the pacifist perk. The game needs to be patched so that if the initial takedown is non-lethal, the enemies cannot be counted as killed.

UPDATE: I am sad to post that the pacifist perk is still broken in the Director’s Cut version of the game. Darn…