There is no debate that colonoscopies are vital for the early detection and treatment of cancers of the colon and rectum. Colorectal cancer is the third most deadly cancer among American men and women. The American Cancer Society recommends people begin regular colon screenings at age 50 or earlier if they have a family history of the disease or are presenting bothersome symptoms.

But the procedure is no cakewalk. It involves a one- to two-day prep of cleansing the bowel with a laxative solution that can make patients sick, if not uncomfortable. For the procedure, patients are sedated and a surgeon runs a thin, flexible scope into the colon to look for signs of cancer or polyps, which can be immediately removed.

Because of the uncomfortable nature of the exam, doctors worry that too few people actually have colonoscopies. And those who require follow-up exams may be less inclined to go.

Researchers analyzed data from 3,627 participants in a National Cancer Institute-sponsored trial and found “significant underuse” of surveillance colonoscopy among those considered high-risk for colorectal cancer. Within five years of an initial colonoscopy, only 58.3 percent of patients with advanced precancerous growths had a follow-up colonoscopy, which is typically recommended every three year for such patients.

But even more surprising, researchers also found what they called “substantial overuse” of surveillance colonoscopies among people considered low-risk for colorectal cancer.

“This is a clear example of an intervention not being utilized in relation to the risk,” said Dr. Robert Schoen, senior investigator of the study. The report appears in the latest issue of the journal Gastroenterology.

Source: Reuters

SOURCE: Fleet Attorney › Too many colonoscopies performed on those at low risk for colon cancer

That is one reason why colon cancer has become the second leading cause of cancer-related deaths among U.S. men and women combined. Colon cancer is highly treatable if caught early. But symptoms of colon cancer are often unnoticed or nonexistent until the disease progresses into later stages.

Regular colon screenings with a colonoscopy are recommended for people beginning at age 50 and earlier for people with a family history or who have symptoms such as blood in the stool. But colonoscopies are intimidating.

The process involves sending a probe into the colon while the patient is sedated. To prepare for the procedure, patients must spend at day or two cleansing their bowels, which can be uncomfortable and confining. But enduring such procedures to ensure good health is a small price to pay.

If people would have regular checkups and screenings, and heed the advice of their doctors, Graber says, more diseases could be diagnosed in their earlier, more treatable stages. Graber recommends that everyone adopt a more proactive approach to their health care by having an open dialog with their primary care physician about their general health and their personal and family medical history.

SOURCE: Fleet Attorney › People should be more proactive with their health

The study focused on the rate of interval colorectal cancer in patients participating in the Polyp Prevention Trial Continued Follow-up Study, a four-year multicenter, randomized, controlled trial designed to examine the effects of a low-fat, high-fiber, high-fruit and vegetable diet on the recurrence of colorectal adenomas, or precancerous polyps. The University of Pittsburg study on the occurrence of interval colorectal cancer appears in the January issue of GIE: Gastrointestinal Endoscopy, the monthly scientific journal of the American Society for Gastrointestinal Endoscopy.

“Despite regular colonoscopy, interval colorectal cancer may occur,” says study lead author Robert E. Schoen. “We set out to examine the rate at which these interval cancers appear.”

The study found that nine cases of colorectal cancer were diagnosed over 7,626 person-years of observation, or a rate of 1.2 per 1,000 person-years of observation. In patients involved in the study who developed colorectal cancer, 78 percent had a history of precancerous polyps. The majority – about 78 percent – were detected at an early stage and thus were considered highly curable.

Colonoscopies are the “gold standard” for detection of colorectal cancer. Screenings are recommended for all individuals beginning at age 50 or earlier for people with a history of colorectal cancer or who are exhibiting symptoms such as blood in the stool. During colonoscopy exams, doctors can detect and remove polyps, some of which can become cancerous if not removed.

SOURCE: Fleet Attorney › Study shows need for thorough polyp removal, continued surveillance

The study, which was conducted by researchers at Sungkyunkwan University School of Medicine in Seoul, Korea, found that when patients drank 2 liters of warm water just prior to a colonoscopy, doctors were able to examine an average of 98.4 percent of large intestine surface. Doctors reported only examining an average of 90.6 percent of large intestine surface in patients who drank 2 liters of cold water prior to the procedure, and 92.2 percent in patients who had no water at all.

Sixty-four participants included mostly male patients, each about 33 years of age, and generally of normal weight. The patients either drank warm water, cold water, or no water along with the standard sodium phosphate solution normally prescribed for colonoscopy preparation. Ten to 11 patients in each group had previous abdominal or gynecological surgery. Twenty-one in the warm water group, 17 in the cold water group, and 17 in the no-water group, had irritable bowel syndrome, a chronic condition that can cause pain, bloating and bowel irregularities.

Under normal circumstances, patients who undergo colonoscopies are generally sedated. However, for the study, patients agreed to forgo sedation during their exams. Those who consumed warm water, in particular those 40 years of age and younger and those with irritable bowel syndrome, reported less pain both during the exam and two hours after the procedure. Patients in the warm water group also required less time for insertion and withdrawal of the examination probe.

While the findings are promising, researchers say that more studies should be done to determine how drinking warm water affects the bowel.

SOURCE: Fleet Attorney › Drinking warm water prior to colonoscopy proves effective

Colorectal cancer is the third most common cancer among men and women in the United States, and is among the most deadly of cancers. In an effort to improve those statistics, doctors began recommending that people have regular colon screenings, such as colonoscopies, to look for signs of the disease. Screenings are recommended beginning at age 50 or earlier for people who have a family history of colorectal cancer or are experiencing symptoms such as blood in the stool.

However, colonoscopies are intimidating. The procedure involves sending a tube with a camera on the end through the rectum and into the large intestines. Patients are sedated during the process, but they must prepare at least a day before the procedure by taking large amounts of laxatives to cleanse the bowel before a colonoscopy.

Between the uncomfortable prep required and the thought of the procedure itself, many people opt to go without. Studies show that less than 20 percent of the people who should be screened for colon cancer actually have a colonoscopy.

Which explains why companies like EDP Biotech are working tirelessly to find a more patient-friendly test. (Not to mention that approval of such a test would mean millions, if not billions, for the company that lands a suitable alternative to colonoscopies.)

EDP Biotech’s ColoMarker test involves adding a chemical to a small blood sample. The reading takes about 30 seconds, and the results are revealed on a computer screen. The test detects a certain marker in the blood that indicates if a patient is clear from colon cancer or needs further testing, perhaps by a colonoscopy.

In tests of 2,400 patients, the ColoMarker detected every case of colon cancer during treatable stages. The company is currently seeking FDA approval and hopes to have the ColoMarker available to the public in one to three years.

Source: WBIR.com

SOURCE: Fleet Attorney › Blood test to detect colon cancer seeks FDA approval

The newly released report includes data from the National Cancer Institute (NCI), part of the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Cancer Registries (NAACCR). The data shows a 3 percent decrease in new colon and rectal cancer cases in men and a 2.2 percent decrease in women. Deaths from colon and rectal cancers dropped 3.9 percent in men and 3.4 percent in women.

Using modeling projections of colorectal cancer rates, authors of the report say that with accelerated cancer control efforts in the United States, such as quitting smoking and having regular colonoscopies, as well as more effective chemotherapy treatments for the disease, overall deaths from colorectal cancers could be reduced by 50 percent by 2020.

“This report shows that we have begun to make progress reducing colorectal cancer. Yet, colorectal cancer still kills more people than any other cancer except lung cancer,” said CDC Director Thomas Frieden, M.D. “Reducing smoking further can bring lung and other cancer rates down, and improved colorectal cancer screening can prevent colorectal cancer.”

SOURCE: Fleet Attorney › NCI report: new cases of colon, rectal cancer deaths declining

The new test can detect more than 50 percent of pre-cancers and 85 percent of cancers, compared to 85 and 90 percent of cancers with a colonoscopy, says Kevin Conroy with Exact Sciences Corp. There is no day-long prep required, as with colonoscopy procedures, and the cost of the test is far less expensive – $300 to $400 compared to $2,500 for a colonoscopy.

The new test is expected to undergo clinical trials in 2011 and be submitted for FDA approval in 2012. While Exact Sciences isn’t the only company working to develop more patient-friendly screenings for colorectal cancers, it is the only one that focuses on stool-based DNA testing for cancers of the colon and rectum.

“We’re taking it through an FDA clinical trial and then we intend to commercialize it broadly throughout the U.S., and then eventually globally,” Conroy said.

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, with more than 106,000 new cases of colon cancer and 40,000 new cases of rectal cancer reported in 2009, according to the American Cancer Society. Regular colon screenings are recommended for people beginning at age 50 and earlier for people with a family history of colorectal cancer or who are experiencing symptoms such as blood in the stool.

Source: Milwaukee-Wisconsin Journal Sentinel

SOURCE: Fleet Attorney › Less invasive alternative to colonoscopy set for 2011 clinical trial

ACS and the task force recommend colon screenings beginning at age 50 with one of three tests – colonoscopy every 10 years, a sigmoidoscopy every five years, and a stool blood test annually. ACS also recommends a CT colonography or “virtual colonscopy” and a barium enema every five years. But the Preventive Services Task Force recommends stopping the regular screenings at age 75 unless advised by a physician. It also recommends against screenings for adults older than 85, as “there is moderate certainty that the benefits of screening do not outweigh the harm.” ACS has no recommendations on an upper age limit for colorectal screenings.

Cancer screenings are recommended based on their potential for saving lives by detecting disease early. However, such tests can be physically and emotionally trying, especially for the elderly, which leaves physicians and patients weighing the risks of the screenings against the benefits.

Not only do colonoscopies carry a higher risk of complications such as colon perforation among the elderly, the bowel preparation can also be uncomfortable and sometimes dangerous for older patients. For example, the Food and Drug Administration (FDA) issued a black box warning on oral sodium phosphates, or OSPs, a type of laxative used to clear the bowel before procedures such as colonoscopies, after numerous patients developed a serious kidney injury following use of OSPs. The solutions are no longer recommended for use among older patients as they were more likely to develop the condition than younger patients.

The recommendations are primarily for people who do not have a family history of colorectal cancer. Every patient’s situation is unique, and both ACS and the task force suggest patients discuss their options with their physicians.

Sources:
American Medical News
Associated Press

SOURCE: Fleet Attorney › Task force advises stopping colonoscopies for elderly

Attorney Russell Todd Abney

In October 2007, Little ingested the product in preparation for a colonoscopy without knowing that the solution had been linked to permanent kidney damage and renal failure. After using Fleet, a type of laxative known as oral sodium phosphate, or OSP, Little began having complications and suffered from acute renal failure. According to the complaint, the condition has caused her to suffer extensive pain, emotional distress and a reduction in her ability to enjoy life.

Though Fleet was aware of the risk of serious kidney injury associated with the use of its OSP products to cleanse the bowel prior to procedures such as colonoscopy, the company did nothing to warn consumers, according to the complaint. In December 2008, the Food and Drug Administration, responding to numerous reports of kidney injury associated with OSPs, issued a black box warning for prescription brands Visicol and Osmo Prep, made by Salix Pharmaceuticals. In turn, Fleet, which sold over-the-counter OSP products that are not as closely regulated by the FDA, pulled its products off store shelves.

The Little lawsuit states that Fleet, which was aware of the risks, was obligated to discuss with Little, her physicians and other consumers and physicians the risk of severe kidney injury. As a direct result of the defendants’ “malicious and/or intentional conduct,” Little suffered severe personal injuries and related damages. Little and her husband, Willie, are asking for compensation for injuries and emotional distress caused by ingesting the Fleet product.

Read the Little complaint.

SOURCE: Fleet Attorney › Woman who suffered serious kidney injury files suit against Fleet

Videotaped colonoscopies

The study involved videotaping without their knowledge seven experienced endoscopists during 8 to 10 colonoscopies. The same endoscopists were then videotaped with their knowledge during 8 to 10 more colonoscopies. Those colonoscopies were graded based on various parameters, such as quality of the examination and length of time taken.

The average inspection time for colonoscopies performed while physicians knew they were being videotaped was longer (7.3 minutes) than when endoscopists were not aware they were being taped (4.9 minutes). Overall quality scores were also higher in the videotaped-aware group, with 3.8 vs. 2.9 on a 5-point scale. Significant improvements were also noticed in examinations of folds, distension and clean up when doctors knew they were being taped.

While videotaping colonoscopy procedures is not standard, given the study outcomes, “perhaps systematic video recording of colonoscopies will be considered” in the future, Dr. Rex says.

SOURCE: Fleet Attorney › Videotaping colonoscopies results in better physician performance

Doctors have been working to improve the technology used during the screening, and according to reports at the annual meeting, their efforts have paid off. One improvement is a disposable device that is passed through the instrument channel of a standard colonoscope, called a Third Eye Retroscope, or TER. The scopes let doctors get a better view of the areas they may otherwise miss with standard screening equipment.

Studies on the use of TER have found the new technique gave doctors 13 percent improved diagnostic yield. In the study of 300 patients, researchers concluded that 15 of 136 precancerous growths and 34 of 257 polyps would have been missed had it not been for the TER.

Another plus is high-definition technology in colonoscopies are giving doctors an even better view of the colon than traditional “white light” colonoscopies. One study included 2,400 patients, half of whom underwent standard exams while the other half had high-definition exams. Thirty percent of precancerous lesions were found in the high-def group compared to 24 in the standard-def group. High-definition is not available at all facilities but should become more widely available as facilities upgrade to newer machines.

SOURCE: Fleet Attorney › Advances in technology improve accuracy of colonoscopies

The study performed at the VA Medical Center in Phoenix, Ariz., cites inadequate bowel preparation by the patient prior to colonoscopies as resulting in earlier follow-up colonoscopies than when adequate cleansing is performed.

“Endoscopists’ ability to detect colonic legions, especially the flat or depressed ones, is greatly linked to the quality of bowel preparation. For years, we have emphasized the importance of adequate bowel preparation for patients to help ensure the detection of adenomas during colonoscopy, especially on the right side of the colon,” explains Dr. Veronika Karasek. “This new finding suggests that endoscopists are taking into consideration the quality of preparation when recommending a follow-up interval, regardless of the findings of the examination.”

As gastroenterologists consider the importance of bowel preparation, they are also evaluating new formulations of bowel preparation products for their patients. In December 2008, the FDA issued a black box warning on prescription brands of a type of laxative known as oral sodium phosphates, or OSPs. Fleet, maker of a popular over-the-counter brand of OSP, also pulled its products from shelves. OSPs were linked to a serious type of kidney injury known as acute phosphate nephropathy.

During the seminars, researchers at the American College of Gastroenterology presented papers evaluating new bowel preparation formulations and approaches.

In a pilot study led by Dr. Ron Palmon at the Mt. Sinai School of Medicine, researchers evaluated the safety and efficacy of Polyethelne Glycol (PEG) plus ascorbic acid (Moviprep) compared to magnesium citrate for bowel preparation before colonoscopy. The randomized study included 90 patients and found that overall colon preparation was excellent or good for 92 percent of those receiving the PEG and ascorbic acid solution, as well as 86 percent of those receiving the magnesium citrate formulation. Sixty-two percent of the patients given the PEG and ascorbic acid formulation indicated that it was easy to fairly easy to take, compared to 82 percent of those given the magnesium citrate formulation.

The study also showed a significant improvement in the quality of bowel preparation when using split dosing with either preparation. Split-dosing involves doses given both the night before a procedure and a few hours prior – versus traditional dosing, given the day before.

“Both PEG with ascorbic acid and magnesium citrate provided good to excellent colon cleansing in almost all the patients we evaluated,” explained Dr. Palmon. “The fact that patients were, for the most part, able to tolerate these products and found them relatively easy to administer suggests that they may be an alternative to phosphosoda. Regardless of which formulation a clinician chooses to recommend, we must all reinforce how vital proper procedure preparation is to colonoscopy.”

SOURCE: Fleet Attorney › Researchers consider new options in colonoscopy prep products

Dr. Rina Rosin-Arbesfeld of Tel Aviv University’s Sackler School of Medicine has reformulated an antibiotic that has reduced the sizes of polyps in about 80 percent of mice. On average, the mice that were given the drug lived about 30 percent longer than mice that were not treated with the antibiotic. Dr. Rosin-Arbesfeld hopes these findings will lead to a preventative therapy in the suppression of polyp growth, and in stronger doses, in combination with chemotherapy and radiation, to fight existing cancers.

“Our new drug may be able to slow down polyp growth so that it never manifests to full-blown colon cancer,” says Dr. Rosin-Arbesfeld.

Using out-of-circulation and old generation antibiotics, such as that used in Dr. Rosin-Arbesfeld’s research, means that treatment with the antibiotics will not interfere with antibiotics currently used to treat bacterial infections. And it should also speed up the approval process for clinical trials, as it has previously been on the market. TAU’s commercial transfer company, Ramot, has filed for a patent for the new use and discussion is already underway with potential partners about experimental human trials of the drug.

Source: Science Blog

SOURCE: Fleet Attorney › New drug shows promising results in treatment, prevention of colon cancer

The computer model helps hospitals and clinics find the best combination of staff, equipment and rooms for the number of patients the facility expects. This, in turn, helps facilities determine the optimum number of patients it can see on any given day. This formula can be difficult for facility managers to determine because issues such as how long it takes to perform a procedure or how long it takes patients to recover can vary depending on the patient and the procedure.

Researchers used mathematics as the basis of studying systems in order to make them more efficient and effective. The model will benefit colonoscopy facilities, making them better able to handle scheduling. But the real beneficiaries will likely be the participating facilities’ patients, who will likely spend less money for the procedures and spend less time sitting in the waiting room because of it.

Researchers are currently working with the University of North Carolina hospitals to implement the model with plans to eventually make it available for general use.

Source: Science Centric

SOURCE: Fleet Attorney › Computer model aims to make colonoscopy facilities more efficient

Colonoscopies can be lifesavers, identifying colon and rectum polyps even before they become cancerous. Doctors recommend patients begin regular colon screenings at age 50, or earlier if they have a family history of or symptoms suggestive of colorectal cancer, such as blood in the stool.

Somewhere between age 75 and 85, your doctor may discuss ceasing your regular colonoscopy screenings. This is because the risk of complications increases among older patients. Serious complications are rare, but include perforations during the exam and adverse reactions to the laxatives used to cleanse the bowel prior to colonoscopy.

Earlier this year the Food and Drug Administration (FDA) issued a black box warning on some products used to prep the bowel prior to procedures such as colonoscopies. Those products, called oral sodium phosphates, or OSPs, were available both as a pill prescribed by doctors and solutions available over-the-counter, such as those made by Fleet.

While the FDA deemed that the over-the-counter OSP products were safe when used in lower doses as a laxative, when used in higher doses to cleanse the bowel many patients began to suffer from serious kidney injuries. The kidney injuries often occurred within a day or two, but sometimes as much as weeks or months later. One diagnosis specifically for patients who suffered ill effects from OSPs is acute phosphate nephropathy.

While the reaction most often occurs in older patients, younger ones are not immune. As a result of the black box warning on prescription OSPs Visicol and Osmo Prep, Fleet withdrew its over-the-counter OSP solutions from the market.

Since then, numerous lawsuits have been filed against the makers of OSP products for not fully warning about the risk of serious kidney injury. “In some cases, these serious adverse events occurred in patients with no pre-existing health factors that would have put them at risk for developing kidney injury,” says Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

SOURCE: Fleet Attorney › Colonoscopy prep important, but beware of OSP solutions

Colonoscopies serve an important purpose – identifying colon polyps even before they are cancerous, in some cases virtually eliminating one’s chances of getting colorectal cancer. Because most cancers of the colon and rectum don’t present symptoms until the later stages, when it is most deadly, doctors recommend patients receive regular colon screenings by colonoscopy beginning at age 50 or earlier if they have a family history or are showing suspicious symptoms.

The procedure is generally safe. One of the biggest concerns expressed by patients is colonoscopic perforation (CP), or bowel perforation caused by equipment used during the colonoscopy exam. While CP is an important part of the benefit-harm calculation of colonoscopy, especially those who do not present symptoms, the risk of CP is rare, occurring in only 1 out of 1,700 procedures.

One study pulled data from more than 10,000 patients undergoing either a colonoscopy or flexible sigmoidoscopy at the Faculty of Medicine Siriraj Hospital in Bangkok, Thailand, between January 2005 and July 2008. It found that over that 3.5-year period only 15 CPs occurred among 10,124 patients who underwent the procedure, or 0.15 percent. Variables such as patient gender, emergency endoscopy, anesthetic method, and the specialty or experience of the endoscopist did not seem to play a role in the outcomes. However, patients over 75 years of age and those who received therapeutic endoscopy were at higher risk of CP.

Older patients also are more likely to suffer from a severe adverse reaction to a type of laxative that is either prescribed to patients or sold over-the-counter to cleanse the bowel prior to a colonoscopy. That type of laxative, known as oral sodium phosphate, or OSP, has been linked to a serious form of kidney injury known as acute phosphate nephropathy. Prescription brands of OSP, such as Visicol and Osmo Prep, now carry a black box warning, and over-the-counter OSP products, such as those made by Fleet, have been pulled from store shelves. While older patients and women are at higher risk from kidney injury from OSPs, younger patients have also experienced kidney problems often weeks or months following use of the OSPs.

SOURCE: Fleet Attorney › Study puts colonoscopy risks into perspective

During a colonoscopy, a doctor inserts a long tube with a camera on the end through the rectum and the intestines to look for polyps, signs of early colon cancer. The procedure can virtually remove the risk of colon cancer if detected early, making regular colon screenings a must for individuals age 50 and older and earlier for those with a family history or who are showing signs of colon cancer.

The second bowel cleaning some physicians recommend prior to a colonoscopy follows the day-before rigors of drinking a laxative solution or taking a pill that purges the bowels of its contents. Doctors have found that even after the bowel has been prepped the day before and no more food consumed, sometimes a collection of dead cells, bacterial secretions, mucus, bile and other debris collect in the bowels during the night and can interfere with the physician’s view during the procedure. The second cleansing is usually preformed about five hours before the colonoscopy is scheduled, requiring some patients to wake extra early to “get moving.”

But one word of caution about the bowel cleansing process. Take a close look at the laxative your are prescribed or told to purchase over-the-counter by your doctor. A type of laxative often used to cleanse the bowel before colonoscopies, called oral sodium phosphates, or OSPs, have been linked to serious kidney injury. In some cases, the injury has resulted in kidney failure. The finding has resulted in a black box warning on prescription brands of OSPs, such as Visicol and Osmo Prep, and the removal of over-the-counter Fleet OSPs. If you have experienced kidney injury days, weeks or even months after taking OSP products to cleanse the bowel, you may have a claim against the manufacturer.

Source: Boston.com

SOURCE: Fleet Attorney › Second bowel cleansing recommended for colonoscopies

Colorectal cancer has the second highest overall cancer death rate. But it is easily treated if caught early. The best way to screen for colorectal cancer is through regular colonoscopies. U.S. health experts recommend people get regular colonoscopies beginning at age 50, or earlier if they have a family history or are showing signs of colorectal cancer, such as blood in the stool. But only about half of the people who should have the procedure actually have it done. Researchers say it is because the procedure is embarrassing, uncomfortable and may cause injury.

Both the standard and virtual colonoscopy require patients to first thoroughly cleanse their bowel. Doctors usually prescribe a laxative or recommend an over-the-counter product that is taken a day or two before the procedure. One of the most common laxatives used to cleanse the bowel is a product known as oral sodium phosphate, or OSP.

OSP is known by the prescription brand names Visicol and Osmo Prep, and OTC brands made by companies such as C.B. Fleet. Earlier this year, the Food and Drug Administration (FDA) issued a black box warning on the products after studies showed a link between OSPs and a serious kidney injury known as acute phosphate nephropathy. The condition can cause the kidneys to fail and some patients have had to rely on dialysis treatments.

Source: Montreal Gazette

SOURCE: Fleet Attorney › Virtual colonoscopy shows promising results

Pauly Polyp, developed by Theda Care, uses humor and a bit of attitude to convince people age 50 and older to get a colonoscopy. When you enter the site, aptly titled “I Don’t Want A Colonoscopy,” you enter “Excuse Central.” Just type in an excuse and Pauly Polyp sympathizes, but then offers a helpful tip, “Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Schedule your colonoscopy today and kick colorectal cancer in the end.”

If you need to convince a loved one to get screened, consider sending him a Pauly Polyp e-card:

You spend a lot of time
In the bathroom anyway.
Get a colonoscopy.

Though the cards are humorous, they drive home the message that having colonoscopies are critically important.

Want a more intimate relationship with Pauly Polyp? Friend him on Facebook or follow him on Twitter.  As one Pauly Polyp fan writes, “If you are faced with the colonoscopy, don’t sweat it. The day before sucks. The procedure itself is a breeze.”

The fan is right. Colonoscopies are generally safe procedures, but do keep in mind that some risks have been associated with some products used to cleanse the bowel prior to colonoscopy. These products, known as oral sodium phosphates, or OSPs, are available by prescription under the brand names Visicol or OsmoPrep, and were available over-the-counter in solution from by Fleet. Earlier this year the Food and Drug Administration (FDA) issued a black box warning on OSPs after studies linked the use of the products to a serious kidney injury known as acute phosphate nephropathy.

Just make sure to talk to your doctor about the risks, and your concerns.

SOURCE: Fleet Attorney › Pauly Polyp encourages regular colon screenings

The New England Journal of Medicine says that a colonoscopy colorectal cancer screening is one of the few preventive services shown to reduce future health care costs.

“We know screening for colorectal cancer is good health policy, and makes good economic sense,” commented ACG President Dr. Eamonn Quigley. “When screening procedures detect colon cancer early, nine of ten patients beat the disease.  In the absence of screening, colon cancer is usually found too late and many patients die.  Those are starkly different outcomes that we have the power to change.”

It is the racial minorities, uninsured Americans and Medicare patients who should be tested but are not being screened appropriately, according to the ACG. ACG is committed to national policy changes to improve access to colorectal screening and increased use of these proven prevention strategies, including reversing Medicare’s massive cuts to reimbursement for these tests since the benefit was first introduced, as well as to payments in the ambulatory surgery centers where many screening tests are performed.

“We can point to impressive milestones indicating a trend moving in the right direction, yet much work remains,” Dr. Quigley said. “We will continue to champion the lifesaving potential of colonoscopy and work to expand access to lifesaving screening tests.”

SOURCE: Fleet Attorney › ACG applauds Obama’s support of colorectal screenings

Beginning at age 50, or earlier for those with symptoms of colorectal cancer or a family history of the disease, we should have regular colonoscopies. However, half of the Americans who should have a colonoscopy don’t have the procedure because it is just too, well, gross. “It’s just the idea that someone is going to be examining the rectal area. They’re just uncomfortable with it,” says patient Adwinna Heads.

The team of researchers put their minds – and hands – to samples of fecal matter to see if a non-invasive technique could identify cancer early. Early on, colorectal cancers have no symptoms at all, which makes it such a deadly disease. What the researchers found is that they could diagnose early stage colorectal cancers in patients based on stool samples alone. This finding suggests that people who have the stool sample test performed may be able to avoid colonoscopies all together.

That is good news considering many people are squeamish about the procedure. Not only does it involve a day of preparation in close proximity to a toilet, it also requires another day for the procedure to be performed. The invasive process has few risks, but some bowel cleansing solutions used in the preparation have been linked to a serious kidney injury known as acute phosphate nephropathy. The type of product is known as oral sodium phosphate (OSP) and is in prescription brand tablets Visicol and Osmo Prep, as well as OTC products such as Fleet Phospho-soda and Fleet Accu-Prep.

SOURCE: Fleet Attorney › Stool sampling may detect gastrointestinal cancers early

The study focused on a trend in the United Kingdom toward reduced sedative use during a colonoscopy in an effort to improve safety. Researchers recruited 109 patients, both male and female, to undergo colonoscopies. One hundred and three procedures were performed. Forty-three of the patients in the study received midazolam, is a very short-acting benzodiazepine that has potent anxiolytic, amnestic, hypnotic, anticulvulsant, skeletal muscle relaxant, and sedative properties.

Every two minutes during the exam patients were asked to grade their level of discomfort from 0 to 10 with 0 being the least uncomfortable and 10 being the most uncomfortable. The mean overall numeric rating scale score was 4.7. Men scored a mean rating of 4.0 and women a 5.2. The median peak score was 7. Discomfort was usually highest at the beginning of the procedure, while in the sigmoid colon.

The study found that discomfort scores were higher in patients with irritable bowel syndrome and diverticular disease. Patients who received midazolam were also more likely to express discomfort than those who received buscopan, an anti-spasmodic that works by relaxing the muscles in the wall of the gut, or nitrous oxide, an anesthetic and analgesic commonly known as laughing gas. Patients who had a preceding gastroscopy also expressed greater discomfort.

Researchers say the results also indicate that midazolam neither relieves discomfort nor makes patients forget the procedure, but some patients, such as those with a previous gastroscopy, females, and those with irritable bowel or diverticular disease may benefit from increased analgesia.

SOURCE: Fleet Attorney › Study of factors that contribute to discomfort during colonoscopy

The research sprang from a national program launched in the UK in 2006 to screen all men and women ages 60-69 with a fecal occult blood test (FOBT), a test to identify blood in the stool. Researchers found that less than 60 percent of eligible people were being tested.

To determine one’s attitude toward colorectal screenings, the researchers asked more than 11,000 people their impressions of FOBT, colonoscopies and whether they were exhibiting any symptoms of colorectal cancer. What they found was that 14 percent of the people reacted negatively about colorectal cancer screenings in general. Thirteen percent said the FOBT was “unacceptable” and 55 percent said colonoscopies were just as bad. Those who were most turned off by the procedures were men, older people and people of South Asian decent.

Those with the best attitudes about colorectal screenings were those who suffered from at least three symptoms usually associated with colorectal cancer and those of Black Caribbean decent.

The survey results pave the way for “culturally relevant screening strategies” to be developed,  Dr. Taskila said.

SOURCE: Fleet Attorney › South Asians more likely to shun colorectal cancer screenings

Colonoscopies

Sure, the procedure can cause anxiety. Just the thought can make you cringe. And then there’s the process one has to endure to cleanse the bowel even before the procedure begins, a practice that can take a day or more. This involves taking a pill or drinking a solution that forces the intestines to purge their contents.

While an important procedure, it is not without its comics. This week, Sacramento Arts & Entertainment Examiner N.E. Frances, who was preparing for her own colonoscopy, compiled a list of humorous colonoscopy videos. If you’re preparing for a colonoscopy and are feeling a little anxious, check out the colonoscopy humor here.  It’s guaranteed to take at least a little of the stress out of the procedure.

Humor aside, colonoscopies do serve an important purpose. Colorectal cancer is the third leading cause of cancer-related deaths in the United States among men and women combined. Caught early, the disease can be curable, which is why regular colonoscopies are important. Colon screenings are recommended for people beginning at age 50 and younger for those who have a family history or are exhibiting symptoms, such as blood in the stool.

Risks from the procedure are low – about 0.35 percent.

Some patients may also suffer from complications from their bowel-cleansing solution. Recently, the Food and Drug Administration (FDA) issued a black box warning on prescription Oral Sodium Phosphates (OSP) such as Visicol and Osmo Prep because some patients who used the products suffered from a severe kidney injury known as acute phosphate nephropathy. Over-the-counter OSP solutions, such as those made by C.B. Fleet, have been pulled from the market. While the risks with OSPs is higher among older patients, most doctors have turned to other, safer laxatives to prep the bowel before colonoscopy.

Don’t be afraid to talk to your doctor about any concerns you may have about the bowel cleansing process, or the colonoscopy procedure.

SOURCE: Fleet Attorney › Humor takes the anxiety out of colonoscopies

A colonoscopy is a screening for colon and rectal cancers which, if detected early, is highly curable. It is recommended that individuals start screenings at age 50, or sooner for those at higher risk of colorectal cancer or with a family history of the disease.

The study found that a low number of people – about 6.9 per every 1,000 – who had colonoscopies experienced a serious gastrointestinal event, such as perforation or bleeding within 30 days of having a colonoscopy. Among those who experienced a gastrointestinal event, the risk was more than twice as high among adults older than 85 than among those ages 66 to 69. Patients with a history of chronic health problems, such as stroke, chronic obstructive pulmonary disease, atrial fibrillation or congestive heart failure were more likely that those without those conditions to experience a serious gastrointestinal event following a colonoscopy.

The solutions used to prep the bowel prior to colonoscopy may also cause greater risk for the elderly. Earlier this year, oral sodium phosphate (OSP) products Visicol and Osmo Prep received a black box warning from the Food and Drug Administration after receiving numerous reports of a serious kidney injury following use of OSP products. The agency also warned against over-the-counter OSP products, like those made by Fleet.

Use of OSP may cause a form of kidney injury known as acute phosphate nephropathy. Reports show that the elderly may be at greater risk of developing the condition than younger individuals.

The U.S. Preventive Services Task Force advises against colonoscopies among adults over age 85 because the risks of the procedure appear to outweigh the benefits.

Source: Cancer Consultants

SOURCE: Fleet Attorney › Elderly at greater risk of complications following colonoscopy

Since the late 1800s, Fleet Phospho-soda has been used as an over-the-counter medication to treat constipation. However, in the 1990s, doctors began prescribing Fleet Phospho-soda as a bowel cleansing agent to be used prior to colonoscopies and other gastrointestinal procedures. It is believed that this practice began at the direction of C.B. Fleet Company, the makers of numerous over-the-counter laxatives, and that C.B. Fleet Company informed doctors that patients could safely and effectively use the product in this manner.

Use of Fleet Phospho-soda as a bowel cleansing agent required doubling and, in some cases, tripling the amount of product that was needed for constipation in order to completely clean the bowels for the planned procedures. Use of the product in this nature caused some persons to develop phosphate toxicity and resulted in renal or kidney failure and injury.

It is unknown how many people have actually suffered renal failure from these products, but according to Ben Locklar, shareholder with Beasley Allen, the medical community did not learn about a possible connection between OSPs and renal failure until it was too late for many people. Though C.B. Fleet Company had received a number of adverse event reports associated with its products, the company was slow in notifying physicians and users of the dangers associated with the products’ use. In 2003, an article appeared in the New England Journal of Medicine, documenting the case of a woman with acute phosphate nephropathy following OSP bowel cleansing. Other articles making similar connections followed over the ensuing months.

Following additional study and review by physicians, and at the FDA’s urging, C.B. Fleet Company modified its label to encourage adequate hydration to help flush the product from the body and to help reduce the risks to users’ kidneys. In May 2006, the FDA issued an alert that identified OSP bowel cleansing agents as a cause of acute phosphate nephropathy (or nephrocalcinosis) and provided guidelines to health care providers about the higher risk patients and the need for adequate hydration.

Despites the FDA’s efforts, additional reports of renal failure were received, resulting in oral Fleet Phospho-soda being pulled from the market. Subsequently, the FDA required a warning for Visicol and Osmoprep, two other OSPs. These products are now only available by prescription.

Kidney failure may not manifest itself until months after a person has taken an OSP. If a person suffers renal failure after using one of these products, he/she should consider that the OSP played a role in the injury and should discuss this possibility with his/her physician. A medical test can help to make this determination.

As a result of the use of these dangerous products, untold numbers of people have suffered renal or kidney injury. To date, a large number of cases have been filed against Fleet Phospho-soda. It is anticipated that more cases will be filed as physicians and patients are made aware that renal failure could have resulted from the use of an OSP.

SOURCE: Fleet Attorney › Longtime laxative no longer available over the counter