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The Doctor is in: Procedures

By Dr. Jim Ferguson
It’s hard not to write about something on your mind or something that’s in your body.  I have a family history of colon and prostate cancer and as a result my doctors have their way with me on a regular basis.

I no longer watch NBC because of its bias, but as I was flipping channels I learned that Matt Lauer and Al Roker were to get prostate cancer screening tests during their morning TV show.  By the titillating tone of the advertisement, I assumed their screening test wasn’t a PSA (prostate specific antigen) blood test.  After all, it was on the Today show that Katie Couric had her first colonoscopy.  I suspect the boys were to have the ever so popular DRE or digital rectal exam.  Recently, I similarly assumed the position and steeled myself for the probing.  My doctor said, “Jim, I’m sorry.”  Glancing over my left shoulder and through gritted teeth, I managed a growl, “Doc you’re not as sorry as I am.”

Cancer screening is an important aspect of medical care and is a major focus of the Annual Wellness Visit now mandated by Obamacare.  Never mind that competent physicians have always advised their patients of appropriate cancer screening tests as they monitored and treated other conditions at a fraction of the cost now expended.  We now have an additional expensive layer of bureaucracy to organize screening tests that our children and their children will be forced to repay.

Most of my readers understand that the biggest hurdle of a colonoscopy is the prep.  By the time you present for the examination the worst is over.  I have to admit that my doctor’s purgative protocol was a big improvement over preps I’ve endured with previous examinations.  In my personal experience the worst prep is the “gallon jug” purgative regimen.  One of my gastrointestinal colleagues admitted to me that after he experienced the gallon-jug prep for his colonoscopy he no longer uses it with his patients.

I believe we are too quick to complain and slow compliment those who do a good job.  The staff at Fort Sanders Hospital took good care of me and I told them so.  And I survived my scope with a good report.  Years ago Demerol and Versed were given as sedation for colonoscopy examinations.  Propofol is the sedating drug used these days.  I’ve had both regimens and Propofol is better as long as it is used by professionals in a controlled situation.  You may remember that Propofol was the drug used by Michael Jackson’s doctor to put him to sleep every night.  Jackson died and the doctor went to jail.  I went to sleep in ten seconds and awakened twenty-five minutes later with only minimal side effects.  Case in point, I’m writing this essay after my procedure and sedation.

I’ve written before that threes resonate with me.  I’m Trinitarian and Becky says I can always find three options for any situation.  A couple of weeks ago I wrote about three patients who had fallen and broken hips and pelvis.  This week it seems that breast cancer is unfortunately the diagnosis in three of my patients.  Sometimes older ladies resist going for mammography or doctor’s examinations.  That is a mistake because breast cancer risk doesn’t decline as you get older.  However, a mammogram isn’t enough.  Three years ago an eighty-eight year old lady came to me as a new patient.  She reported two hospitalizations in the previous six months.  She told me that none of the numerous doctors who cared for her examined her breasts.  I did so and she had breast cancer.  She is alive today because of a careful examination.

No test is perfect.  If designed for screening purposes a test needs to be very sensitive, and we have to accept some false positives.  On the other hand, some tests are designed to be very specific and would be poor screening procedures because many subtle abnormalities might be overlooked.  The bottom line is that you and your doctor are a team and should be the ones who decide what is best for you.  This should not be done by an insurance company or a politically motivated President.

Screening tests help, but most of us know what we should do to stay healthy; it’s not rocket science.  We shouldn’t use tobacco or over eat.  We should exercise and wear seat belts.  Diseases that run in your family matter and influence healthcare decisions, even screening tests.  Illicit drugs kill the soul and the body.  The Spirit is foundational.  William Penn, the founder of the Pennsylvania colony said three hundred years ago, “Those who will not be ruled by God will be ruled by tyrants.”  Mr. Penn understood that Spirit trumps State.

As a conservative I believe in the freedom of choice, but acceptance of the consequences of those choices.  If you use street drugs and develop health problems you should be rescued once and offered rehab.  If you refuse then tough love must reign and you will have to go to the end of the line for any additional help in a world of limited resources.  Jesus said that the “poor will always be with you.”   I believe this applies to the poor in spirit as well as imperfect health and limited abilities.

Our erstwhile president crows about equality; this is a utopian concept.  In a Republic we are supposed to have equal opportunity under the law.  But how can we trust a man or his minions who violates the procedures of the Constitution and its laws?

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