September 2, 2021

What You Need to Know About Colonoscopies

Show Notes

On this episode, Chuck Gaidica is joined by Dr. James Grant, Senior Vice President and Chief Medical Officer for Blue Cross Blue Shield of Michigan. Together, they discuss what you need to know about colonoscopies.

In this episode of A Healthier Michigan Podcast, we explore:

    • The importance of getting a colonoscopy.
    • How often you need to get one.
    • What the prep process looks like.
    • Myths about colonoscopies.

Transcript

Chuck Gaidica:
This is A Healthier Michigan Podcast episode 88. Coming up, we discuss colonoscopies and what you need to know about them.

Chuck Gaidica:
Welcome to A Healthier Michigan Podcast. This is a podcast that’s dedicated to navigating how we can all improve our health and well-being through small healthy habits we can start right now. I’m your host, Chuck Gaidica. Every other week, we sit down with a certified health expert to discuss topics that cover nutrition and fitness, health, wellness, a lot more.

Chuck Gaidica:
And on this episode, what we need to know about colonoscopies and hopefully let’s dispel some myths about them as well. With us today is senior vice president and chief medical officer for Blue Cross Blue Shield of Michigan Dr. James Grant, who’s recently documented his colonoscopy experience and he can give us some knowledge and also discuss the process and the importance of everybody’s “favorite tests.” Dr. Grant, it’s good to have you with us.

Dr. James Grant:
Good to be here, Chuck.

Chuck Gaidica:
Well, I know you’ve got a lot of experience. You’ve held numerous positions in organized medicine. You serve as chair of the delegation and section council on anesthesiology. You’re married to a doctor. I mean, this is something that you just kind of take for granted maybe in a way, but yet you’ve just done this yourself. So help us understand some of this about colonoscopies and why do we fear them so much. Just talking about it is kind of strange.

Dr. James Grant:
I think it’s the fear of the unknown. When you talk to people who’ve had colonoscopies, they’ll usually say it’s not the colonoscopy itself. It’s the prep. And actually the prep isn’t actually that bad.

Chuck Gaidica:
No, it’s not. And I was awake for mine. I watched it.

Dr. James Grant:
You did?

Chuck Gaidica:
I did.

Dr. James Grant:
Well, I’m an anesthesiologist, so we go to sleep for these kinds of things.

Chuck Gaidica:
Okay. All right. Well, let’s talk about your experience because we’ve got preconceived notions. It’s not a delicate topic. It doesn’t come up necessarily with friends that you’re kind of hanging out with, unless you get to a certain age when you start talking about all kinds of maladies, right? I mean, I don’t know what it is.

Dr. James Grant:
Well, Chuck, you also called this not a delicate topic. It is a delicate topic.

Chuck Gaidica:
Okay, I guess it is. Yeah. Yeah. Well, talk about this so we can… We’re kind of chuckling about this, but it is one of those things that just doesn’t come up all the time, and we really should have discussions buddy to buddy or the girls go out or something. I mean, there should be places that we can discuss what’s happening in our lives and it should be okay.

Dr. James Grant:
You’re right, Chuck. It’s just something that you know that you need to do. Because the thing about colonoscopies is if it’s caught early, it can save lives. That’s the thing we’ve got to always remember. You don’t have to do it every year. You don’t have to do it every six months like you go to the dentist. You do it every five to 10 years. And it saves lives. When we did the video in March, we had countless people. As a matter of fact, the video, Chuck, has had just shy of 8,000 views.

Chuck Gaidica:
Is that right? Wow! Well, talk about some of the basics. At what age should we start to think about getting a colonoscopy? What’s your recommendation?

Dr. James Grant:
About 45, and that’s what the American Cancer Society recommends. We have two extremes that we look at. We have 45. And then on the other end, we say people who are in good health with life expectancy of more than 10 years regularly should check for colon cancer until about age 75. And then about 76 through 85, we’re going to take a look at the patient’s preference, life expectancy, overall health. And then the American Cancer Society then says after 85, you don’t really need to get colorectal cancer screening.

Chuck Gaidica:
And what is the five to 10 year differentiation? Is that based on whether you’ve had a polyp removed? What is it that creates that difference between five-year checks and 10 years?

Dr. James Grant:
I think, Chuck, you hit it on the spot and that’s if you’ve had polyps, depending what you find when you’re in the colonoscopy. If it’s what we call a clean colon, they’ll probably say 10 years. If they found a whole host of polyps in there, maybe say five years. If there’s a lot of polyps and a family history and, and, and, and, they may even make it a little sooner. The return time period is probably that’s more individual dependent.

Chuck Gaidica:
Talk to us about your particular test and whatever you’ve shared in your video that’s appropriate. But for you, did you have any reason to be concerned or was this a routine check?

Dr. James Grant:
Mine was a routine check, and I did it because I want to lead by example. I did it, and I took a camera with me from the minute I started at home, started the prep, to the minute I got wheeled out of the hospital. I wanted to show millions of Michiganders, hey, it’s something that you should do. It’s something that will save lives. It doesn’t hurt. Once I got checked, I felt better. I felt better knowing I’m not going to get colon cancer.

Chuck Gaidica:
Yeah. Let’s parse this because you’re talking about it and I know you’re not purposefully dancing around it. Let’s talk about prep, and then what actually happens with the test so everybody can understand that it isn’t as big a deal. You’re saying it’s not. Let’s understand that.

Dr. James Grant:
Okay. People ask, “Well, what’s the purpose of the prep?” The purpose of the prep is so that you have a clean colon, so that the gastroenterologists, the colorectal surgeon, whoever you choose to do your colonoscopy, so that they can see everything. They can see all the walls and the linings, the mucosa of the colon. If you have stool in your colon, it’s going to make it really difficult.

Dr. James Grant:
As a practicing anesthesiologist for 30 years, I was an anesthesiologist for hundreds of endoscopies, and I’d see the endoscopist always struggle if there was stool in the way, or they couldn’t see what they wanted to see. A good prep, really it’s like a road. If you’re on the highway and there’s more things on the highway, it’s going to be tough to actually get through the highway. This makes it a clean, easy to visualize, easy to spot small things. The prep isn’t hard. It’s a lot of clear liquids the day before. Probably the hardest part about it is being hungry.

Dr. James Grant:
The night before you start with the prep, and yeah, you’re going to be in the restroom for a long time, but you’ll actually see the results when things look natural, and then all of a sudden, when things look very clear. But you know when things are clear, that you don’t have any stool left in there, and they can actually do a really good look at what’s in your colon.

Chuck Gaidica:
You do that kind of the day before. It is a day long, overnight process. You’re ready to go. You head to the hospital, and then you go in for the test. Take us through that.

Dr. James Grant:
You go into it can either be a hospital or an endoscopy center, and you’re going to go in. They’re going to ask you a bunch of questions. They’re going to ask about your medical history. They’re going to talk about your prep. They’re going to ask you if there are any problems with the prep. You’re going to get an IV, and the IV is so that they can give you some kind of sedative. That you’re going to go in, and then you’re going to go off to sleep. They’ll do the procedure. They’ll take a look. You’ll wake up. You’ll go over the results.

Dr. James Grant:
They’ll tell you if there were polyps. They’ll tell you if they found anything concerning. They’ll tell you if it was clean, and they’ll also tell you when it’s time to come back. A lot of places now will give you snapshot videos of what they saw in the colon, so that you had something you can take home as a souvenir and show all your friends and family at your next function.

Chuck Gaidica:
Oh gosh. But this is really interesting, because for many of us, it is a badge of honor when you come home and either your spouse or someone who knows you went for a test says, “Well, how’d it go?” And you want to say, in my case, I can just tell you, I did have a small polyp, right? And they said, “Don’t worry about it. It’s not a big deal. Everything is fine. We removed it.” And you kind of see either a video or a snapshot. It does bring some sense of…

Chuck Gaidica:
I have to tell you, for either me or my wife, it brought a sense of peace for us to each know about the results, right? Like, okay, everything is okay. It’s good.

Dr. James Grant:
No doubt.

Chuck Gaidica:
So we’re in the hospital or we’re in the endoscopy center, and they’re going to generally knock us out, so we’re not feeling a thing. The test happens. This is happening over what period of time? How long does it take?

Dr. James Grant:
They can take 15 minutes, 20 minutes, 25 minutes. I wouldn’t let the length that it takes be any kind of worrisome sign. Like I said, if you have a good prep and they don’t have to do any work to see what they got to see, it could be very quick. If they go in and it’s a sort of a poor prep and there’s lots of polyps, then it can take longer.

Chuck Gaidica:
And for some of us, this is not the case for me, and I don’t know about you, but for some of us and some buddies that I’ve talked to, they have a history in their family of issues, right? It could even be as dramatic as colon cancer. I think there’s this weird thing that happens to a lot of us for various reasons. I don’t know what it is that gums up the works where you say to yourself, “I really don’t want to know. My dad had it, but I don’t want to know.” Well, that’s counterintuitive to think that way.

Chuck Gaidica:
Because if somebody in the immediate family had issues, that’s probably a good kick in the pants for us to go, right? I mean, we should go get the test.

Dr. James Grant:
I put it like this. I know when I’m putting on weight, I don’t weigh myself. I do not want to see the number.

Chuck Gaidica:
Yeah, yeah. Right.

Dr. James Grant:
But it’s the same thing, and I understand. But on the other hand too, if you can get the colonoscopy, your anxiety will be relieved. You no longer have to worry, do I have colon cancer? Am I going to die from colon cancer? And it’s something that we can do. This is technology we didn’t have so many years ago. This is something if we catch early, we can actually take care of.

Chuck Gaidica:
Yeah, I’m following… I want to share for a minute. I won’t mention any names or circumstances, but I’m following a young woman who I used to work with who has colon cancer, and apparently there’s been a bit of a spread of the cancer. She’s having to get second opinions out of state. I mean, significant places that she would go. She’s been very forthright about the whole process and how she feels and how she’s down about it some days. The fighting spirit is crazy.

Chuck Gaidica:
You watch this and you read these posts which are dramatic, and you just think, my God, you feel for her, her family, a young family, and then she’s just wearing t-shirts that say “Check your colon. Get a colonoscopy.” For her, this is so real. And for some of us, we could just be a breath away, right, from getting a phone call or seeing some sign that we’ve got trouble. What you’re trying to encourage us to do is to prevent every bit of what I’m witnessing there with an old friend.

Dr. James Grant:
Chuck, what I’m encouraging is that you don’t have to wait to see a sign. If you get your colonoscopy when you need it, you catch it before there are signs. It’s when there are signs, it’s often at a point that it’s not as curable as it should be.

Chuck Gaidica:
What would those signs be? What should we be on guard for if we haven’t gotten in for our test yet?

Dr. James Grant:
I’d say the greatest sign that you’d see is blood in the stool. That’s the greatest sign. This is not something that all of a sudden you’ll have abdominal pain or anything else. You’ll see blood in the stool. But if you get your colonoscopy scheduled, colon cancer is not something that just grows incredibly rapidly. It’s something that’s slow growing. That’s why we have this cadence of this timetable for when you should get your colonoscopy.

Chuck Gaidica:
Yeah, that’s interesting. And relative to alternatives, if you watch enough cable TV, and I don’t know why I see the little white box, the Cologuard, the happy smiley face guy, they’re trying to make it fun, is that an alternative to a colonoscopy, or is that just another line of defense for us to consider?

Dr. James Grant:
It’s another line of defense. The issue with things like virtual colonoscopy, Chuck, is you can do it and the technology is actually pretty amazing. But then if they find something, you got to come back and have a traditional colonoscopy where they can take out the polyp or take a closer look at something. That’s why I went for the traditional colonoscopy right away, because I knew they would… If they saw a polyp, if they’d saw anything unusual, they’d go in there, they’d take care of it, and we’d be done. There’d be no repeat visit.

Chuck Gaidica:
Yeah. And for you personally, did you share in your video the outcome of the test as well? How did you do?

Dr. James Grant:
Knock on wood, I passed. They said to come back in 10 years.

Chuck Gaidica:
Yeah, awesome! For everybody who thinks about this and talks about it, obviously you’re saying in a lot of words, but not a big deal, right? That everything went well and it’s just something we need to assume is a good practice for all of us.

Dr. James Grant:
Yeah, it’s a good practice. Chuck, I used to ask this question all the time to the patients after… They come in. They were hungry. They just wanted to get their colonoscopy done. As the anesthesiologist, I had to be doing sort of a pre-anesthesia assessment. And I’d always ask them, I said, “Well, what do you want to do when this colonoscopy’s over?” Because they were pretty hungry and pretty famished and a little dehydrated.

Dr. James Grant:
I say, “What do you want to do,” and they’d all tell me the same thing. Not all of them, but a lot of them would tell me the same thing. “I want to go to the pancake house when this is done.”

Chuck Gaidica:
Really?

Dr. James Grant:
Really. Really. I said, “Do you like pancakes?” And so often they say, “No, but I have this feeling. I want to go to the pancake house.”

Chuck Gaidica:
Do you think that that was the reward part of our brain kicking in like, “I’m going to create my own trophy if everything goes well?”

Dr. James Grant:
I have no idea. I was always intrigued by the pancake house stories though.

Chuck Gaidica:
That’s an interesting upside. Maybe it’s a bonus for some of us. I don’t necessarily go to a pancake house, but it sounds like an okay idea. What are some of the myths that you also… You must have also seen people who would be laying there before you administer the anesthesiology. The myths that are rolling around in their minds that are creating angst. What are some of those that you can dispel for us?

Dr. James Grant:
Oh, there’s a lot. My colonoscopy can wait until after the pandemic. Well, it can’t wait until after the pandemic. I would say if you want me to tell you the honest truth, the worst thing about my colonoscopy now that I think about it was really the COVID test before I had to go in, because I got mine in March when really COVID was really peaking. And anytime someone goes into the hospital for a procedure, you get a COVID test. That was probably the worst part for me was the COVID test. Or you don’t need a call a colonoscopy because you don’t have symptoms.

Dr. James Grant:
Terrible myth. The prep is horrible. The prep is not bad. In the old days, it used to be drink gallons of this and gallons of that. Those days are gone. Now we have different preps that you have with like two 16 ounce servings. They’ll talk about, it’s painful. No, it’s not painful. I went to sleep for mine. I woke up and everything was done. “I’m not at risk for colon cancer,” they’d say. Well, if you have a call and you’re at risk for colon cancer. The risk I find interesting is women that they’re less likely to get colon cancer, and that’s not true.

Dr. James Grant:
Women are only slightly less at risk of colon cancer and gender really makes no difference in screening recommendations. That they’re expensive. They’re not expensive. And actually most payers cover most of it. They’re dangerous. My colon can be perforated. Do not get in the car because you could get into an accident. The risk of colon perforation is less than one in a thousand. Yet by contrast, one in 20 Americans will be diagnosed with colon cancer at some point during their lifetime. It’s too embarrassing.

Dr. James Grant:
It’s not embarrassing at all. We all have it done. We all have colons. It shouldn’t be embarrassing. And the last myth I’ve seen is, it can’t be prevented. It can be prevented. That’s what you got to remember. It can be prevented.

Chuck Gaidica:
Yeah, and what’s interesting too is some of those myths… And of course, we can all conjure up and ruminate about things forever. There’s no rhyme or reason as to why. But when you talk about the embarrassing part, it is because you’re not only discussing and people come up with jokes I’m sure to take the edge off, but you’re working with professionals, maybe yourself included, who are doing this all the time. There’s no new story to what somebody is going to see. You’re probably not going to be surprised.

Chuck Gaidica:
In a weird way, that sort of gives me some comfort like, well, these are pros. I mean, these people are doing this all the time. This is not a shocking thing for them. So why would I be embarrassed?

Dr. James Grant:
It shouldn’t be. As a matter of fact, you can go to an endoscopy center or in the hospital or into an ambulatory center, and you’re going to be in there with a long line of people who are having colonoscopies done. And they’re all there just like you. Sometimes I can remember during the height of my clinical practice, Fridays were a very busy day. I’d say, how many colonoscopies do we have, the number often was 70, 75, 80, 85 that day.

Chuck Gaidica:
Wow! I did have a buddy who gave me this feedback before he went for a colonoscopy, because he knew that I had a polyp removed. He said, “Oh, that’s the part that I’m afraid of, because that means they have to go in there and cut something out. Well, how does it heal? Does it hurt? Will it continue to hurt?” It was like, I had no idea until they told me. And then for days, there was no aftershock of that, right? I don’t know.

Chuck Gaidica:
You can explain the medical approach to how it’s all healing, but it seemed like one of those magical self-healing things. I had no knowledge that that had happened after the fact.

Dr. James Grant:
No. If you have a polyp in there while you were asleep, they put a wire into the scope and actually they either snare it off or actually cauterize or burn it away, so you’ll never even know. You don’t feel any pain with that at all.

Chuck Gaidica:
There was no after effect at all. Well, what else do you want to leave us with outside of the encouragement that we all need to go, which is probably the most important part and obviously good news that yours came out fine. But give us some takeaways here for the audiences we get encouraged by you.

Dr. James Grant:
Takeaways are no one should die from colon cancer if it’s caught early. Get your colonoscopy. Talk to your primary care physician. Get the name of either a gastroenterologist or a colorectal surgeon. Those are the two kinds of physicians that do colonoscopies. Get a name. Get in there. If you’re scheduled for a follow-up, do it. It will prevent you having any serious effects from colon cancer if it’s caught early enough, and that’s the only thing, because this is something that we can handle.

Dr. James Grant:
Thousands of Americans will die from colon cancer and thousands of them also unnecessarily will die from colon cancer.

Chuck Gaidica:
I appreciate all of that, because it is encouragement that we can all do this. And for me, who was it? Simon Sinek, doc, that said what’s your why? And for me, my why is when I look at that wall of photographs I have of my wife and my kids and my grandkids, and I think that’s my why. I mean, I want to be around to be with them and whoever we don’t even know in our family who’s coming in. That’s my why. I want to have a long health span and lifespan. That’s my why.

Dr. James Grant:
You got it, Chuck.

Chuck Gaidica:
Well, Dr. James Grant, it sure was a pleasure talking to you a delicate topic, and we appreciate not only you guiding us through it and giving us encouragement, but also sharing your own story. 8,000 views. Watch out. This could be a whole Netflix thing for you. I don’t know.

Dr. James Grant:
Well, take a look at it. That’s why I did it. If it saves one life, it was worth it to me.

Chuck Gaidica:
Yeah, all right. Well, thanks again. Dr. James Grant, senior vice president and chief medical officer for Blue Cross Blue Shield of Michigan. Take good care of yourself.

Dr. James Grant:
You too, Chuck.

Chuck Gaidica:
Thank you, and thank you for listening to A Healthier Michigan Podcast is brought to you by Blue Cross Blue Shield of Michigan. If you like the show, you want to know more, you can check us out online at ahealthiermichigan.org/podcast. You can leave us reviews or ratings on Apple Podcast or Stitcher. You can get old episodes, obviously this episode and upcoming episodes on your smartphone or tablet, and be sure to subscribe to us on Apple Podcast, Spotify, or your favorite podcast app. You stay well too. I’m Chuck Gaidica.