March is National Colo-Rectal Cancer Awareness month. That's not the scary part. Colo-Rectal cancer discriminates against no-one and targets no one particular age-group. Contrary to popular opinion, you don't have to be a certain age group to be at risk for cancer. (Caveat: There are some types of cancers associated with certain races). That's not the sad part. We've heard recently in the news about the deaths attributed to colon cancer in far too many "young people", and based on the public's reaction to the news of Celebrities who lost their lives due to colon cancer, it seems that we've been blindsided by this statistic. Working in the medical field, I witness routinely the impact of this diagnosis on the patients entrusted in our care. It's all over social media posts, as well as in my circle of acquaintances (and their family, and their friends, and their acquaintances, and so on, and so on...), that regular folks like you & me are impacted daily as well. What's sad is that this is a preventable, treatable AND curable disease, and early screening is available but often not accessed for a variety of reasons.
Common misconceptions about colon cancer:
- "I am too young to get colon cancer". This is very much a fallacy and a costly one at that. I think we were all blown away by the news of Chadwick Boseman's death , for example, from colon cancer at such a young age.
- "Colonoscopies hurt". They don't actually. This is a procedure that is done under anesthesia so you are not consciously aware from start to finish which means you feel no discomfort during or after the procedure. Well, there is a lot of gas afterwards so be prepared! The anesthetic agent is short-acting so you usually wake up in the recovery area about 30' later, and - in my personal experience - it's a gentle awakening without any drugged, dazed, groggy, feeling. Of course, they do caution you to not make major decisions, sign contracts or agreements, operate heavy machinery or drive after the procedure.
- "Sorry, my butt is off-limits! Exit only!" Seriously, I can't believe we really have to address this but unfortunately I still hear this too often; it's NOT funny, and it's the poorest excuse ever. Period!
- "I will literally feel worse starving myself to prep for the colonoscopy". Granted, for those of us who don't routinely fast or do smoothie meal replacement drinks, it's a paradigm shift to not physically chew your food for a day and to just 'drink your meals' instead. No, you won't starve, and doing it the right way will ease and even prevent some of the discomforts you are anticipating with not physically "eating" all day.
- Sex: Colo-rectal cancer has been known to be more prevalent in males but is not limited to them only. It affects women as well (remember Farrah Fawcett-Majors & Eartha Kitt? They succumbed to colo-rectal cancer as well despite treatment).
- Race: African-Americans and Ashkenazi Jews (Jews born of Eastern European descent) show a significant higher incidence of colon cancer and mortality.
- Age: Yes, the incidence of colon cancer increases with age (90% occurrence after age 50, hence why they recommend colonoscopies when you hit the big 5-0), but various factors can put the younger population at risk, including family history and genetics, exposure to toxins, history of IBD (inflammatory bowel disease). EAO-CRC (Early Age Onset Colo-Rectal Cancer) is the term now used to describe those affected by colon cancer who are younger than 50 yrs old, so they are now considering lowering the age for screening colonoscopies to age 45 or younger.
- Diet: A diet high in red meat or processed meats, foods cooked at high temperatures and alcohol consumption have been linked to colon cancer. Low Vitamin D levels have also been associated with a higher incidence of this type of cancer.
- Smoking: Probably this will be the most acknowledged risk factor as it increase the risk of all forms of cancer.
According to the American Cancer Society, most colo-rectal cancers start off as changes in the lining of the colon and present as polyps, although not all polyps are cancerous. Over time, these cell can invade any or all of the mucosal layers of the intestinal wall, eventually invading blood or lymph vessels and spreading to other parts of the body. Changes in bowel habits, blood in stool, unexplained weight loss and fatigue are some of the common symptoms, but I personally know people and have taken care of patients who noticed no symptoms at all. There are at-home screening kits available so please consult your physician if you have any questions if this is right for you.
- Dietary modifications: Eat more unprocessed foods, fresh fruits and vegetables and increase your intake of fiber and whole grains. Reduce your consumption of alcohol and abstain from smoking.
- Stress management: Maintaining an active lifestyle is not only good for your physical health, it's a great way to reduce stress and support your mental well-being as well. Start slowly and gradually increase to tolerance.
- Early screening: Current recommendations are for screening colonoscopy at age 50, but they are now looking at lowering the age to 45 in specific populations who are at risk. Early identification is key.
Having just gone through this myself, AGAIN, (for a second time!), I can offer a couple tips to help prepare you for your colonoscopy. Disclaimer: This does not constitute medical advice; this was just my experience so please follow your doctor's recommendations for your procedure. I found what was helpful for me on the clear liquid prep day was to:
- Pace myself with the liquids (I found I got nauseous if I drank too much too fast).
- Now's as good a time as any to take a probiotic in the morning if you're not already including this supplement in your diet. Your gastro-enterologist will talk with you about any medicines or supplements you are taking that will need to be held prior to your procedure.
- Vary your flavors. I personally don't care for green or lemon Jello® so I opted for pineapple instead. I also abhor sports drinks, so as much as they were recommended, I thumbed my nose at them. Apple juice gives me heartburn so I substituted white peach and white cranberry juice instead. Sprite® or Ginger-ale® is always a good option as there is something to be said for a big, deep burp and was an excellent choice for a carbonated beverage. And my absolute favorite clear liquid of all time: coconut water! Get the one with no added sugar and you will have Nature's perfect electrolyte replacement, great for your before prep and to rehydrate after.
- Prep your liquids the night before. Along with the juices above, I included a jug of water with some citrus slices & mint leaves floating in it overnight for a tasty & refreshing infused water blend. Juices tend to to be loaded with sugar and I don't do sugar-free-anything so water is a welcome filler and cleanser and has no calories.
- Plain broth gets boring so I chose bone broth for nutritional value and jazzed it up with some Thai basil, lemongrass & kefir lime leaves for an exotic clear liquid broth. I was concerned about salt intake so I limited myself to 1 cup for lunch and 1 cup for dinner, all the while pretending to be in Thailand as I sipped this delicacy. And while we're on the subject of fantasizing, there is something to be said for mindful eating, so take your break and savor the moment and the flavors with each meal break. It'll make the experience a little more pleasant and tolerable.
- For texture, I "chewed" my Jello® so I actually felt like i was "eating" something. And surprisingly enough, a great chewable dessert treat can be those yellow or clear-colored Gummy-Worm® snacks (they actually melt after chewing). What can I say; old habits are hard to break.
- Speaking of chewing, I do recommend weaning yourself off solid foods couple days before, so for instance, I had no red meat the week before, had only 1 animal protein per day x3 days, bulked up on my high fiber foods, and did homemade cabbage & spinach soup plus steamed veggies 2 days before the actual prep day. This was just my personal choice as I wanted to wean myself off of my typical high carb, high animal protein, 3 solid meals per day (nope, not the best diet but hence why I do need to stay on top of my scheduled screenings).
- I would also add here that I feel like I should have stayed home the day of my liquid prep as - in hindsight - I don't think I was as sharp and energetic as I would have liked to be, and had to concentrate on concentrating on my tasks at work. I think for my next colonoscopy, if I am still working (I pray I'm retired by then!), I will stay home and relax..... And be closer to the bathroom (what goes in, must come out so if you're drinking all that liquid all day, then half your day will be spent running to the bathroom.
- I am notorious for being an overachiever so of course, I planned on going back to work the next day but quickly found out when the alarm went off and I leapt out of bed, that I had no energy to think much less do anything physical. I ended up having to call off work that day, and spent the day going from couch to bed and rehydrating in between. Next time I think I will schedule my procedure on a Friday so I can rest on the weekend.
- Last note: gradually wean back in your meals once your procedure is complete and you're fully awake and oriented. I rewarded myself with a delicious and healthy breakfast at my favorite local diner, but found I could only eat 1/2 of my plate (which is a good thing as a) I told myself my tummy shrunk, and b) I had leftovers for dinner that day (who has energy to cook?).
March, being National ColoRectal Cancer Awareness month, here are some links for further information on colo-rectal cancer:
In good health,
Dr. Audrey Steele, Acupuncture Physician