A Doctor writes ...

From my GP today:

Dear Mr Seel

Thank you for your letter regarding your family history and suggestion for enhanced screening. I think this probably would be a sensible idea and I am sure the family history would fall within the referral guidelines for the enhanced screening. If you would like to go ahead with this please let me know and I can arrange the referral. The enhanced screening involves an endoscopy which is a fibre-optic camera which can look inside the bowel.

If you would like to discuss this in more detail before me making the referral please arrange to speak to me.

Here are some of the highlights from Wikipedia.

"The pain associated with the procedure is not caused by the insertion of the scope but rather by the inflation of the colon in order to do the inspection. The scope itself is essentially a long, flexible tube about a centimetre in diameter, i.e. as big around as the little finger, which is less than the diameter of an average stool.

"The colon is wrinkled and corrugated, somewhat like an accordion or a clothes-dryer exhaust tube, which gives it the large surface area needed for digestion. In order to inspect this surface thoroughly the physician blows it up like a balloon, using an air compressor, in order to get the creases out. The stomach, intestines and colon have a so-called "second brain" wrapped around them, which autonomously runs the chemical factory of digestion. It uses complex hormone signals and nerve signals to communicate with the brain and the rest of the body. Normally a colon's job is to digest food and regulate the intestinal flora. The harmful bacteria in rancid food, for example, creates gas. The colon has distension sensors that can tell when there is unexpected gas pushing the colon walls out—thus the "second brain" tells the person that he or she is having intestinal difficulties by way of the sensation of nausea. Doctors typically recommend either total anaesthesia or a partial twilight sedative to either preclude or to lessen the patient's awareness of pain or discomfort, or just the unusual sensations of the procedure. Once the colon has been inflated, the doctor inspects it with the scope as it is slowly pulled backwards. If any polyps are found they are then cut out for later biopsy.

"Some doctors prefer to work with totally anesthetized patients inasmuch as the lack of any perceived pain or discomfort allows for a leisurely examination. Twilight sedation is, however, inherently safer than general anesthesia; it also allows the patients to follow simple commands and even to watch the procedure on a closed-circuit monitor. For these reasons it is generally best to request twilight sedation and ask the doctor to take his or her time despite any discomfort which the procedure may entail. Tens of millions of adults annually need to have colonoscopies, and yet many don't because of concerns about the procedure.

"It is worth noting that in many hospitals (for instance St. Mark's Hospital, London, which specialises in intestinal and colorectal medicine) colonoscopies are carried out without any sedation. This allows the patient to shift his or her body position to help the doctor carry out the procedure and significantly reduces recovery time and side-effects. Although there is some discomfort when the colon is distended with air, this is not usually particularly painful and it passes relatively quickly. Patients can then be released from hospital on their own very swiftly without any feelings of nausea."

Something to look forward to before Christmas! Here is what my 23andMe health report has to say about my Colorectal Cancer risk.

Nigel Seel
4.2 out of 100 men of European ethnicity who share Nigel Seel's genotype will develop Colorectal Cancer between the ages of 15 and 79.

Average
5.6 out of 100 men of European ethnicity will develop Colorectal Cancer between the ages of 15 and 79.

And here's the caveat.

The 23andMe Odds Calculator only takes into account effects of markers with known associations that are also on our genotyping chip. Keep in mind that aside from genetics, environment and lifestyle may also contribute to one's risk for Colorectal Cancer.

Bastinado

Last night my foot hurt. Let me restate this: last night, in bed, my right foot was extraordinarily painful. My first thought was diagnosis. The entire foot was very tender but nothing about the shape felt odd: no breakages, no swelling.

I reviewed the events of the evening. I had accompanied Clare to six o'clock Saturday Mass so she could watch Andy Murray in the Australian Open final Sunday morning. I must have stepped off a curb awkwardly coming back and not noticed at the time. But God, how it hurt this Saturday night!

My mind wandered to the Spanish practice of bastinado, the beating of prisoners' feet as a form of discreet torture, leaving no marks. I had reflected in the past that maybe this didn't sound so bad, but I was learning just how many nerve endings the foot actually has, all exquisitely tuned for pain.

When I was doing research into Artificial Intelligence in the 1980s, I had read Daniel Dennett on pain. He said that if you concentrated you could make the pain go away. Fine.

So I really thought about it and sensation gradually congealed as a red-hot wire through my foot. Dennet was right: as I focused my attention the pain transformed into mere data. But as he further observed, pain is ultimately so excruciatingly tedious that you can't stay focused forever.

I normally avoid pain-killers. Don't mask the pain, I say to myself, it's your body trying to tell you something. But all my body was communicating at that moment was that I wouldn't be getting any sleep tonight. I put the bedside lamp on - ten past one a.m. - and tried to stand. The pain was shocking and I couldn't put any weight on the foot. Nothing for it, I poked Clare: "You awake?"

She was now. Clare has a bedroom pharmacy of little white tablets: I pleaded for pain-killers. A few minutes later a barely conscious wife offered me two lozenge-shaped pills which I instantly swallowed. God knows what they were, maybe vitamin pills. Within half an hour I was away with the fairies.

This morning with only the slightest twinge I strolled to the paper shop, a twenty minute round trip. What is it with feet?

+++

My three samples were duly posted off to the NHS yesterday for checking. I expect to get a letter telling me whether I have colon cancer or not around February 14th. How romantic is that?