DEAR READER: This is a simple same-day procedure, meaning that you will enter the hospital in the morning, have the procedure performed, and be discharged a short time after the sedative wears off.

Colonoscopy is preceded by a preparation that will be explained by someone from your doctor’s office. You will be given a solution to drink that will remove all solids from your digestive tract. Following that, you will be restricted to drinking liquids such as clear soup broth, fruit juice, ginger ale or tea the day before. You can work or function as you would ordinarily but will find yourself spending a fair amount of time in the bathroom.

After you check in at the hospital, you will receive a sedative through an IV tube to help you relax. Once in the operating room, your doctor will insert a flexible tube with a camera known as a colonoscope into your rectum. Air will inflate the colon as the colonoscope advances. Images from the camera will be sent to a computer monitor that he or she watches throughout the procedure. If polyps or unusual tissue are noted, small tools can pass through the scope to remove the questionable material so the tissue can be biopsied. The whole process usually takes an hour or less. You will then be taken to the recovery room, and once the sedative wears off, will likely be free to go home. Because of the sedative, it will be necessary to have a ride home. Some patients experience temporary gas and bloating following colonoscopy because of the air introduced into the rectum, but this is normal. Your physician will advise you to report to him or her if pain, bleeding, fever or other symptoms occur.

At your next appointment or through a telephone conversation from your physician, you will be advised of the results. If all is well, you will likely be cleared from further testing for five to 10 years. Colonoscopy can be a lifesaver. It can detect cancer in its early stages, and any lesions can be removed early. Because of your age, your physician is timely with his recommendation. While the procedure may be mentally daunting, it can save years of treatment when cancer is detected early.

To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Let’s first discuss your wife’s medical history. She has a history of breast cancer. She is also on metoprolol, a beta blocker commonly used to treat hypertension (high blood pressure), chest pain such as angina and other conditions as recommended by your physician. Because you don’t mention hypertension, hers was likely prescribed because of a cardiac history.

Warfarin is an anticoagulant that reduces the formation of blood clots in veins, arteries and the lungs. It is prescribed to prevent heart attack and stroke. Again, you don’t mention stroke or blood clots, so I interpret the warfarin prescription is cardiac-related, as well.

Has your wife had a change in bowel habits, abdominal pain, blood in her stool and a history of polyps, colon cancer or other intestinal suspicion that needs to be addressed or readdressed? Is this her first colonoscopy or has she had one or more in the past — perhaps with questionable results? If you can answer yes to any of these questions, this may be the reason why her physician is recommending a colonoscopy. With what appears to be a cardiac issue, possible hypertension and her age, I am not sure that her physician or gastroenterologist would have recommended the procedure arbitrarily.

Colonoscopy is a simple procedure recommended for everyone over the age of 50, with follow-up on a periodic basis, usually every five to 10 years. The procedure can detect cancerous polyps and a host of other problems, often nipping them in the bud. However, before committing to anything, I feel your wife needs to visit her physician to determine the exact reason for the recommendation. This holds true of virtually every procedure for everyone. The only way a person can make a decision is through education. So, become educated. Ask your wife if you can accompany her during the visit. Most often, two heads are better than one in sorting things out and for hearing everything that is said. If she disapproves, then she should go on her own with a list of questions that should be answered to her complete satisfaction.

To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I am a 74-year-old female in good health. Over the last few months my bowel movements have become consistently hard, small lumps. I mentioned this to my doctor during a routine check up and told him that I had been using stool softeners and Metamucil with little effect. I was told to take large doses of Metamucil (which I had been doing since the onset). I also tried your colon cocktail. I have not seen any improvement and know I shouldn’t have to strain as I do. Should I be concerned? This has never happened to me before and came on quite suddenly. I don’t drink a lot of water but no less than I have always done.

DEAR READER:
I urge you to see a gastroenterologist. Sudden changes to bowel movements (such as consistency, frequency, or color) that are not related to changes in diet or lifestyle need to be addressed. The specialist will examine you and likely order blood work, occult blood fecal tests (to determine if there is blood in your stools) and a sigmoidoscopy or colonoscopy to visualize the colon itself. It is important that this is done quickly to determine if the cause is something benign such as polyps or more sinister.

He or she will likely ask you if you have made any dietary modifications, started new medications or are currently taking anything that may now be causing side effects. If the cause is benign such as irritable bowel syndrome, or no cause is determined, your doctor may recommend increasing your fiber intake, occasional laxative use and increasing your fluid intake.

I also urge you not to strain because you may be causing damage to your colon. Straining can lead to hemorrhoids, anal fissures and other uncomfortable conditions.

To give you related information, I am sending you a copy of my Health Report “Constipation and Diarrhea”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Recently, while drinking the first of the 16 required glasses, I suddenly had a thought. I am willing to endure the taste as I consume each glass, but why must I continue to suffer during the 10 to 15 minute rest period between glasses? What I did was to prepare a glass of diluted soda pop and, after consuming each glass of the solution, I took a sip of my “secret” preparation, refreshed my taste buds, and immediately spit the remainder into the sink. The result was that I did not have to suffer the bad taste while waiting to repeat the process. When I told the nurses at the hospital what I had done, their immediate response was, “Why didn’t we think of that?” For that reason, I concluded that my “invention” might well be worth sharing with other long-suffering senior citizens. If they follow these simple instructions, everything will come out all right!

DEAR READER:
This is a great solution to a common and annoying problem. Many patients have complained to me about the taste of the preparation necessary before colon studies and have asked for something that will reduce the flavor. Until now I have not had a solution. Because I believe many will benefit, I am printing your letter.

In addition, there are new laxatives that are much easier to use than the old-fashioned types. Thanks for writing.

Recently, I started feeling tired and run down after normal activity. I consulted my medical doctor who ordered a colonoscopy and blood testing. The results of the colonoscopy were negative. Blood tests indicated my red blood count was four, so I’ve been taking iron pills for three months. It is still four. Where do I go from here?

DEAR READER:
A red blood cell count of four is hardly abnormal. I don’t believe you are suffering the symptoms of anemia.

When did the constipation and fatigue start? Do they coincide? Have you been diagnosed as having Irritable Bowel Syndrome (IBS) with constipation? (I would also like to add that having one bowel movement a month is a near physical impossibility, especially when taking Zelnorm, a drug used for the short-term treatment of IBS with constipation and milk of magnesia.)

Zelnorm shows improvement in most individuals who take it but can cause diarrhea. Milk of magnesia encourages evacuation. It seems to me that when taking both these medications, you would hardly be able to leave the house for fear of constant diarrhea. It also suggests that you may have an intestinal abnormality causing obstruction or a similar disorder.

You need to be seen by a gastroenterologist. I believe your symptoms are related to your chronic constipation. If the gastroenterologist determines there is no physical reason for the constipation and believes the fatigue is from your very slight anemia, you may wish to see a hematologist (blood specialist) for further evaluation.

To give you related information, I am sending you copies of my Health Reports “Irritable Bowel Syndrome” and “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR READER: Polyps are small growths that usually arise in the lining of the colon or sinuses. They are generally non-cancerous but rarely some types of polyps may be pre-malignant.

There is no clear cause for polyps except those associated with familial polyposis. This condition is caused by a mutated gene and therefore runs in families. These polyps have a high malignant potential and generally occur around puberty.

You don’t give your age in your letter and do not mention if any of the polyps were found to be cancerous. However, I believe that you would have been told if they were cancerous or pre-cancerous and would be receiving appropriate treatment if they were. I therefore assume that they are benign, harmless growths that you should not worry about.

Polyps are best treated by removal during colonoscopy. You appear to be receiving appropriate care and by having the procedure annually, as any new polyps are removed, your cancer risk is lessened. I don’t believe you are at a particularly high risk of cancer since you have been having regular removal of your polyps for over 6 years.

If you have any change in bowel habits, such as diarrhea or constipation, black stool, rectal bleeding or pain you should see your physician as soon as possible. These may be signs of intestinal abnormalities that should be tested immediately.

Make an appointment to discuss your concerns with your gastroenterologist (or the specialist who performs the colonoscopy). He or she is familiar with your case and is best suited to answer any questions you have. To make sure your have all your concerns answered, write a list of questions and bring it to the appointment. I am sure that your physician would be more than willing to provide written answers for you to take home.

To give you related information, I am sending you a copy of my Health Report “Irritable Bowel Syndrome”. Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.