Probing Question

My brother had colon cancer at age 45. My doctor wants me to have a colonoscopy (I'm 35), but the thought of it just creeps me out. Is there any way I can get out of it? — A. Gold, New York, NY

In the future, you may be able to get out of this by swallowing a miniature robotic camera, but for now, colonoscopy is the still the best way to screen for colon cancer. It's a relatively simple procedure, actually. Taking a four-foot fiber optic tube, a doctor looks at every inch of your large intestine, starting from the rectum and finishing in the first part of the colon (called the cecum). It's a procedure that is ideal for screening for cancer, polyps (which can turn into cancer), and other conditions. Given that you have a family history of colon cancer, you'd be a great candidate to "ride the rocket."

The rule of thumb for who needs a screening colonoscopy is pretty simple. If you have a first-degree relative (mother, father, sister, brother) with colon cancer, you should have a colon screening when you're 10 years younger than the relative was at diagnosis. In your example, your brother was 45 when he was diagnosed, so you should have your colonoscopy done at age 35. People who have no risk factors for colon cancer can wait until they're 50 to have their screening done.

To get a good look at your intestines, the "scope jockey" needs a nice, clean bowel. A colon full of disgusting fecal matter will clog up the fiber optics and prevent a good exam. You want the doctor to be able to see every inch of colon to make sure you don't have any polyps (or worse), so doing a "bowel prep" is necessary.

Different doctors use different bowel preps, but most of them go something like this: you go on a "clear liquid" diet for 24 hours, and then drink a laxative concoction. Before long you'll have the most incredible case of diarrhea, so make sure you're at home and ready for it. This is manly diarrhea . . . it emerges with a force heretofore unknown in your experience, and it keeps coming and coming, as the laxative rolls through your bowels like a tsunami, dragging everything with it in its path. Ultimately, your bowel will be perfectly clean and delightful inside . . . you could eat off it.

After the delight of the bowel prep you may dread the colonoscpy itself but take heart—you'll be asleep during the whole procedure (or at least goofy enough that you won't remember it when it's over). The folks at the endoscopy suite will put in an IV in your arm before the procedure, and then they'll give you an injection (often a tranquilizer called Versed and a very nice narcotic called fentanyl); fight it as you might, within a few seconds you'll be under.

Now here's the great part . . . although you're only in light sedation, one of the effects of the medication is to make you forget everything that happens while it's in your system. To you it will seem as if you laid on your side, blinked your eyes . . . and it was over. Most people wake up wondering if they actually did the procedure—that's how incredible the anesthesia is. There is no sensation of time passing, no pain, no discomfort, and no feeling that anything was even done to you. It's pretty perfect.

After it's over, you'll feel rather normal, but you're really not. You can't drive because your reflexes are off, and you probably can't do any meaningful work. Just let someone drive you home and take it easy. Watch a movie that you can afford to forget later (because you might), visit a website that's meaningless to you, play a stupid video game, or just hang out for the day. Enjoy it. You don't get that many days in your life that you have to relax and aren't actually sick or otherwise indisposed.

So get it done—there's nothing to fear from the procedure, for the most part. Colon cancer is actually an avoidable disease when it's caught before it starts, so it's worth it. By the way, do you know the definition of a colonoscope? It's "a 4-foot tube with an asshole at both ends." Feel free to tell that one to the person doing your scope, I guarantee they'll think you're hilarious.

**Remember, don't do anything you read here without first consulting with your own health care provider.**

Dr. Steve is the resident medical expert for the Opie and Anthony and Ron and Fez shows, and the host of his own Sirius XM Radio program, Weird Medicine.

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