Should You Keep Getting Colonoscopies? A Doctor Weighs In
Imagine being told you need a procedure that could save your life, but also carries inherent risks. That's the dilemma facing many older adults when it comes to repeat colonoscopies. Let's delve into a real-life scenario and understand the expert's perspective.
The Question:
Dr. Keith Roach received a letter from J.G., a 78-year-old man with a history of high blood pressure and a bovine aortic valve replacement. J.G. had a negative colonoscopy in 2003. However, a 2013 colonoscopy revealed a 3-mm tubular adenoma, which was removed (polypectomy). His 2019 colonoscopy was negative. Now, he's concerned about the risks associated with undergoing more colonoscopies. What should he do?
The Doctor's Advice:
Dr. Roach acknowledged that the standard recommendation would be to consider another colonoscopy around age 82 (in 2029). He also stated that at that age, it's a reasonable decision to stop screening altogether. But here's where it gets controversial... Dr. Roach said that if J.G. were his patient, he would likely advise him to undergo another colonoscopy due to the previous tubular adenoma. Why? Because these types of adenomas have the potential to develop into colon cancer over time.
He reassured J.G. that while colonoscopies do carry risks, his specific conditions (high blood pressure and valve replacement) wouldn't make the procedure overly dangerous, in his professional opinion. Dr. Roach added that if the next colonoscopy were negative, J.G. could safely discontinue future screenings because the probability of developing colon cancer in his remaining lifespan – even if he lived past 100 – would be very low.
Dr. Roach emphasized that he would respect J.G.'s decision if he chose to forgo future colonoscopies. However, he believes that for most healthy 82-year-olds with a history of pre-cancerous polyps, the benefits typically outweigh the risks, regardless of a recent clean scan.
So, what are the key takeaways?
- Individualized Decisions: Medical advice should always be tailored to the individual. Factors like age, health history, and personal preferences play a crucial role.
- Risk vs. Benefit: It's essential to weigh the potential risks of a procedure against its potential benefits. In this case, the risk of colon cancer development versus the risk of complications from a colonoscopy.
- The Importance of History: A past history of adenomas significantly influences the decision-making process.
What's YOUR opinion? Do you think J.G. should get another colonoscopy? Or is it reasonable to stop screening at his age, given his recent negative result? Share your thoughts in the comments below.
Decoding Fevers: When Should You Worry About Your Temperature?
Ever felt that unsettling heat radiating from your skin and wondered, "Do I have a fever?" It's a common question, and the answer isn't always as straightforward as you might think.
The Question:
Another reader, A.O.A., asked Dr. Roach a fundamental question: What is a fever, and when should you be concerned about your temperature, especially if you typically run slightly below normal?
The Doctor's Answer:
Dr. Roach explained that while 38 degrees Celsius (100.4 degrees Fahrenheit) is traditionally considered a fever, this isn't a universal rule. Body temperature fluctuates throughout the day (it's lower in the morning and higher in the afternoon), varies with age (older adults often have lower temperatures), and differs from person to person. And this is the part most people miss... A significant increase from your baseline temperature (even if it's below 98.6F) could be considered a fever!
Large studies have found that the "average" person's temperature is actually between 36.6-36.8 degrees Celsius (97.9-98.2 degrees Fahrenheit), meaning many people are below the previously accepted "normal." In fact, 99% of people studied had temperatures ranging from 35.3-37.7 degrees Celsius (95.5-99.9 degrees Fahrenheit).
What Causes a Fever?
Elevated temperatures are often triggered by infections – viral, bacterial, fungal, or parasitic. However, non-infectious causes also exist. Heat stroke, certain medications, excessively high thyroid hormone levels, and bleeding within the brain can all cause dangerously high temperatures.
When to Seek Help:
Dr. Roach advises that a low-grade fever (around 37.5 degrees Celsius/99.5 degrees Fahrenheit, or 38 degrees Celsius/100.4 degrees Fahrenheit) accompanied by typical cold symptoms may not be cause for alarm. Acetaminophen (Tylenol) can usually help. However, higher fevers warrant a call or visit to your doctor.
Crucially, Dr. Roach notes that a person can have a serious infection without developing a fever. This is especially true for older adults who may not mount a typical fever response. Therefore, signs of a serious illness, such as cough and confusion (which could indicate pneumonia in an older person), require immediate medical attention even without a fever.
Key Takeaways on Fevers:
- It's Personal: What constitutes a fever depends on your baseline temperature.
- Context Matters: Consider accompanying symptoms.
- Age is a Factor: Older adults may not always exhibit fever, even with serious infections.
Here's a controversial thought... Should we be more focused on changes in individual temperature rather than relying on a single "normal" value? Is the traditional definition of a fever outdated? Let's discuss in the comments!
