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Medical Forum / General / General / March 2008Ping: Dr. McCollister:
Good to see you haven't completely disappeared from the ng. Things seem to be deteriorating on usenet--not just here, but on other ng I participate in. You may have missed my post from 3 or so weeks ago about a Japanese study about polypoid vs. sessile or depressed intestinal cancers, and wondered what you thought of the implications. I wrote then: Saw in the NY Times today an article about a Japanese study published in JAMA about flat and depressed colonic lesions. Does this mean next time I get a colonoscopy by gastroenterologist won't be happy with phosphosoda prep? Just out of curiosity, if a significant number of cancers arise in sessile lesions, wouldn't we have heard about this a long time ago? Just wonderin', Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Good to see you haven't completely disappeared from the ng. Things seem > to be deteriorating on usenet--not just here, but on other ng I [quoted text clipped - 12 lines] > Just wonderin', > Steve The problem is that when we find a colon cancer, we don't really know what kind of lesion it arose from. As the genetics of colon cancer become more clear, however, we are finding that lesions we once thought trivial can indeed be potentially dangerous. In many or most of these cases, the lesions have been difficult or impossible to see at conventional colonscopy. Narrow band imaging scopes will help us to see those lesions, but that is expensive stuff and won't be widely available for awhile because of the cost. IMHO, the Half-lytley or Miralax/Gatorade preps actually work better than phosphosoda in terms of visualization. Additionally, Fleets has been implicated in rare cases of phosphate-induced renal failure. If you google "Fleets phospho soda" you'll see that several of the first hits are from malpractice attornies. Unless your gastroenterologist has balls of steel (most don't), he'll likely stopped using phosphosoda altogether on advice of legal counsel. HMc > The problem is that when we find a colon cancer, we don't really know what > kind of lesion it arose from. As the genetics of colon cancer become more [quoted text clipped - 13 lines] > > HMc I actually had heard that about renal toxicity--I guess I dodged a bullet. ;-) I don't have a strong family history of colon ca (possible in one grandparent--they didn't tell me much, and she died years later of a CVA). My wife forced me to go at age 53 (3 years ago) and my GE kind of waffled about how often it should be done. I guess I have a couple of years to think about it. Thanks, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Good to see you haven't completely disappeared from the ng. Things >> seem to be deteriorating on usenet--not just here, but on other ng I [quoted text clipped - 29 lines] > > HMc Totally agree with Howard. I had fleets phospho soda once and it totally tore me up (bleeding and raw) and there was no way I could do it all over again the next morning like suggested. My last gastro told me it was banned from the market but it sounds like some docs still use it. I asked for saline solution for my last colonoscopy from a surgeon, and it was much milder and I didn't get raw (if you can stand drinking all that salt water without vomiting. The colyte or half-lytley is also better than the phospho soda. I'd say the saline solution is the least damaging for me (but I go forty times to the water closet and it wipes me out no matter what I use). Don't like colonoscopy preps :-) . I would never take phospho soda again. Pete > Totally agree with Howard. I had fleets phospho soda once and it totally > tore me up (bleeding and raw) and there was no way I could do it all over [quoted text clipped - 8 lines] > > Pete Don't know where you're posting from, but in Brooklyn phospho soda is OTC. Sorry you had a bad experience--my brother has had 2 colonoscopies, one with Go lytely and once with phosphosoda, and he found the latter much less unpleasant. Perhaps the Half lytely is easier to take. As far as efficacy, my gastroenterologist couldn't resist sitting me down afterwards and showing me his "beautiful" pictures of my bowel. I'm no expert, but it looked pretty clean to me. I don't think anyone LIKES colonoscopy preps, but mine was certainly no worse than I expected. Wouldn't want to discourage anyone having it done. I'll probably ask my doc about the narrow band imaging scopes Howard spoke of. The article in the NYT (I assume the original paper in JAMA as well) said that the findings of carcinoma apparently arising in flat or depressed lesions put into further question the usefulness of the so-called "virtual colonoscopies"--but frankly they really didn't sound like a good idea to me in the first place. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Totally agree with Howard. I had fleets phospho soda once and it totally >> tore me up (bleeding and raw) and there was no way I could do it all over [quoted text clipped - 26 lines] > colonoscopies"--but frankly they really didn't sound like a good idea to > me in the first place. I agree about virtual colonscopy. Even our radiologists no longer think it's a good idea except in rare circumstances. As to preps, our switch to Miralax/gatorade has been interesting. Generally, I think most patients that have had both it and Fleets prefer the Gatorade. However, I have no worries about using Fleets PhosphoSoda in patients that prefer it, as long as they are not in the well-publicized risk category for phosphate-induced renal failure. CoLyte and GoLytely are full 1-gallon preps. Half-Lytely and the cheaper/more popular Gatorade/Miralax preps are two quarts. From an endoscopist's standpoint, I'm fine with either. I think the Gatorade/Miralax prep is a little more effective. HMc > I agree about virtual colonscopy. Even our radiologists no longer think it's > a good idea except in rare circumstances. [quoted text clipped - 11 lines] > > HMc Food for thought. ;-) Thanks, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001
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