Maggie McKay (Host): When you get to a certain age, it's important to schedule a colonoscopy as a preventive measure. But if you've never had one, what can you expect? How do you know when you need one and so much more. Let's find out with surgeon Dr. Amy Bair from Cumberland Healthcare. This is Healthier You, a podcast from Cumberland Healthcare.

I'm your host, Maggie McKay. Thank you so much for being here, Dr. Bair. I can't wait to talk to you and learn more about this.

Amy Bair, MD: Hey, thanks for having me. I'm excited too.

Host: So for people who don't know, colonoscopy sounds scary. You hear tales from your friends and you know, people blow it out of proportion. But why is colon cancer screening so important?

Amy Bair, MD: Well, colon cancer screening is important because we're all at risk. As we age, the body's natural ability to heal itself starts to falter. So even if you don't have anybody in your family who has colon cancer, you're still at risk. Two out of three people who develop colon cancer, don't have any family history, and so the only way we can prevent colon cancer in those folks is by starting screenings before the age when people typically develop colon cancer and find polyps and remove them so they can't turn into cancer later.

Host: And what is that age generally, because I know they changed it a few years back.

Amy Bair, MD: Right. So traditionally, most people who were at low risk, which there's various risks that we'll talk about too, but for normal folks who don't have any high risk features that they know of in their family, we used to tell everybody age 50, unless they were in certain high risk populations like Native Americans and African Americans who have higher risk. They were traditionally told 45, but now we're recommending 45 for everyone, even at low risk. Because over the past 20 some years, since the 1990s, the incidence of colon and rectal cancers in younger people under the age of 50 has been increasing by one to 2% per year. So if you think of over 20 some years, increasing one to 2% per year, that's a lot of people are being diagnosed with colon cancer younger than the age of 50 now.

Host: And who needs to screen for colon cancer?

Amy Bair, MD: Well, everybody needs to screen once they get, you know, to a certain age, which like I said, is 45, for people of low risk and it's younger, depending on certain high risk family history. But there's different options. Not everybody has to do a colonoscopy. There are other options too that are kind of a two-step process. If you find something on something else, then you need a colonoscopy, or you can go straight to the colonoscopy as the gold standard.

Host: What does a colonoscopy involve? Is it painful?

Amy Bair, MD: You know, it's not for most people. You do hear stories, you know about those rare occurrences where people have complications, but for most folks it's not a big deal. I've had one myself. Most people, you know of a certain age have, and the first time is kind of scary just because you don't know what to expect.

So when I meet you, I try to walk you through kind of what's going to happen and, and to be able to know what to expect. But it's really, sedation is done very well. We have CRNAs that give you a little cocktail of medicine, so you're pretty chill and sleep through it most of the time and don't feel a lot of pain and most folks, unless there's some problem in their colon, that gives us trouble, it's not very traumatic anyways, and it's really not a bad experience. Most folks tell me, Hey, I could do that every day. It's not a big deal.

Host: Well, from experience my, both my parents had colon cancer, so I had to start getting them early. I've had five, Dr. Bair. So I have to say to me, the worst part is the prep. Because if you have a weak stomach, it's not fun. But, for people who have never done it, tell them what the prep involves.

Amy Bair, MD: Yeah, so again, that's usually the worst part for most people. The good news is there's different preps out there that you can explore. So if you've had difficulty with one, maybe a different one, might not be as bad. So you can talk to your provider if it's somebody besides myself, if you've had a bad experience with one prep, maybe trying a different prep.

But the one I like to use, which is the same one that I took when I had a colonoscopy, is MiraLax, which is just a powder that mixes up in whatever you like to drink. So that's what it tastes like. It's not nasty. And a couple laxative pills. And that does a pretty good job for most people, unless they have real severe constipation or some people that can't take the prep because they have real bad kidney disease or something like that.

But the prep, at least the one that I took wasn't too bad. But everybody's a little different in which medicines kind of affect them different ways. So like I said, there, there are a couple different ones out there. So if you do have a bad experience with one, which, like I said, most of the time, it's not too bad anymore with some of the newer preps, you don't have to drink so much with. There's some options to try next time if you don't have a good experience.

Host: That example you just gave sounds so easy. MiraLax plus some laxatives. I'm, I think I need to change doctors. I'm just kidding. Or I'll come to you. Are there other options instead of a colonoscopy for colon cancer screening, I've often thought that while I was doing the prep.

Amy Bair, MD: Yeah, absolutely. Unfortunately for you, there's not, because of your high risk family history, we really don't recommend anything other than colonoscopies for high risk folks, but for the other two and three people who don't have that family history; the Cologuard test, which is an easy test to do cause you can just send your, we put an order in and they send you a box in the mail and you collect some stool and you send them back to them.

So there's no prep to take, there's no work to take off. There's no sedatives or any of that stuff. So it's easy to do. And there's some other types of imaging, specialized CAT scans and things that are available in bigger cities. Those tests are what I call two-step tests. So the first step is detecting if there's something maybe abnormal in the colon, and then if it does detect something, then the next step is a colonoscopy.

So it's a easier test, if you will, which is great because that targets some folks who either don't want to do a colonoscopy, or just don't feel like they have time to take to do it. But then if we find something abnormal, that kind of lets you know that you really need to do it. So yeah, there are options, but the best option is still considered to be the colonoscopy.

And definitely for any high risk folks who make polyps or have had colon cancer or have family history of colon cancer or have inflammatory bowel disease, those things that we know they're more likely to get cancer. We only recommend a colonoscopy.

Host: So if someone you know tells you about a complication they had when they got their colonoscopy, should you be scared?

Amy Bair, MD: Of course it's scary, but in general, those complications are extremely, extremely rare. So there are times when people have their colons rupture and have to have surgery to take care of that. There's very rare times when other things like spleens can rupture during colonoscopies. But we're talking one in like 4,000 colonoscopies for something like that to happen.

And usually there's something else going on, some problem in the colon, or it's an elderly patient that's had trouble with cancers or polyps and they're still having to get those colonoscopies because of that high risk when they were younger. That as they age and things start to thin out on the inside, just like they do on the outside with thinning skin. Those complications become more common in the elderly, but they're still extremely rare and the good news is most of the time, surgery can fix that. It's an emergency surgery, but your intestines have already been prepped, you know, you've already had your fluid challenge and cleared everything out, so there's not a bunch of stool in the belly when we go in to fix that.

It's usually a fairly quick recovery. Of course, you know, it can get worse. Older people are tend to have, you know, sometimes heart attacks and strokes and things after surgery, but those are extremely rare. For the most part, even if there's a complication, it can be fixed surgically and people do well. So the short answer is don't be scared. It's extremely rare, but if something happens, you might need surgery to fix it.

Host: That's what I tell all my friends. Just man up and do it and get it done, because it's so worth it and we're so lucky we have these preventive measures to take.

Amy Bair, MD: Well, that's the thing. Colon cancer is extremely common and colon polyps are extremely common, and these things that can happen during a colonoscopy are extremely uncommon. So you have to kind of balance the risk of getting cancer versus this extremely small risk of something happening during the colonoscopy.

Host: Right. Dr. Bair, is it accurate that colon cancer is one of the most preventable cancers?

Amy Bair, MD: Yeah, and it's actually one of the only preventable cancers, if you will, because for most people, colon cancer starts as a polyp. So if you have your colonoscopy and you get your polyps removed, that prevents them from turning into cancer later. I always say most because there are some genetic problems that some folks, some families have where they develop cancers very rapidly and they kind of bypass the, the slow growth part of that process. But for most people, it can be completely prevented essentially, if you keep up with your colonoscopies.

Host: Another reason to get it done and make that appointment. Where do you see patients and where do you do the colonoscopies?

Amy Bair, MD: I am at Cumberland Healthcare in Cumberland on Monday, Wednesday, and Friday, and I do my procedures there.

Host: So if someone would like to find out more, where would they go?

Amy Bair, MD: They can just call the hospital at (715) 822-7500 and make an appointment to see me or discuss it with their primary care physician and get a referral either to myself or go to cumberlandhealthcare.com.

Host: Thank you so much for taking the time and taking some of the dread out of the prospect of getting a colonoscopy and sharing why it's worth it in the big picture.

Amy Bair, MD: Thanks for having me.

Host: Again, that's Dr. Amy Bair and again, for more information as she said, you can go to cumberlandhealthcare.com. If you found this podcast helpful, please share it on your social channels and check out our full podcast library for topics of interest to you. This is Healthier You. A podcast from Cumberland Healthcare.

I'm Maggie McKay. Thank you for listening.