Dear Dr. Gott: I just turned 50, and my doctor keeps talking about ordering a colonoscopy for me. I’m not sure I want to undergo one and haven’t even asked what one entails. Can you enlighten me?
Dear Reader: This is a simple same-day procedure, meaning that you will enter the hospital in the morning, have the procedure performed, and be discharged a short time after the sedative wears off.
Colonoscopy is preceded by a preparation that will be explained by someone from your doctor’s office. You will be given a solution to drink that will remove all solids from your digestive tract. Following that, you will be restricted to drinking liquids such as clear soup broth, fruit juice, ginger ale or tea the day before. You can work or function as you would ordinarily but will find yourself spending a fair amount of time in the bathroom.
After you check in at the hospital, you will receive a sedative through an IV tube to help you relax. Once in the operating room, your doctor will insert a flexible tube with a camera known as a colonoscope into your rectum. Air will inflate the colon as the colonoscope advances. Images from the camera will be sent to a computer monitor that he or she watches throughout the procedure. If polyps or unusual tissue are noted, small tools can pass through the scope to remove the questionable material so the tissue can be biopsied. The whole process usually takes an hour or less. You will then be taken to the recovery room, and once the sedative wears off, will likely be free to go home. Because of the sedative, it will be necessary to have a ride home. Some patients experience temporary gas and bloating following colonoscopy because of the air introduced into the rectum, but this is normal. Your physician will advise you to report to him or her if pain, bleeding, fever or other symptoms occur.
At your next appointment or through a telephone conversation from your physician, you will be advised of the results. If all is well, you will likely be cleared from further testing for five to 10 years. Colonoscopy can be a lifesaver. It can detect cancer in its early stages, and any lesions can be removed early. Because of your age, your physician is timely with his recommendation. While the procedure may be mentally daunting, it can save years of treatment when cancer is detected early.
To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at AskDrGottMD.com.
Dear Dr. Gott: Is there some difference in the throat, mouth or salivary glands of a man from a woman that makes it necessary for them to always spit? You don’t see most women doing this.
Dear Reader: Not to my knowledge. There are some traits men (and women) have that are rather unattractive, and spitting is one of them, particularly for men. I can understand that if a man chews tobacco, he might have an increased urge to spit.
Belching, chewing food with your mouth open, scratching and tooting are but a few of the more mild things one should never do when not alone.
Dear Dr. Gott: My 23-year-old son was diagnosed with bipolar illness about a year ago. He is taking Depakote and Abilify and seems to be doing rather well. Are there long-term
side effects from these
medications, and what causes this mental illness, anyway?
Dear Reader: Side effects of Abilify include a possibility of tardive dyskinesia (TD), involuntary, repetitive movements of the limbs, trunk and facial muscles. Abilify has been around for fewer than 10 years, so long-term effects are essentially unknown. But the product has so far been shown to have a much lower risk of TD when compared with older antipsychotic drugs.
Your son may also experience weight gain, which can likely be controlled through diet and exercise.
Bipolar disorder generally requires lifelong treatment, even during times when a patient is seemingly symptom-free. A person will likely be under the guidance of a psychiatrist and perhaps a therapist or psychiatric nurse. Medication helps by balancing emotional ups and downs and may include antipsychotics, antidepressants, anticonvulsants and a number of others. Finding the right medication or combination thereof may take some time; however, it will be worth the wait. Alternative therapies that can be used in conjunction with prescription medications include massage therapy, acupuncture, certain herbs, yoga and tai chi.
The exact cause of bipolar disorder is unknown, but it appears to occur more often in relatives of people who also have the disorder, suggesting a possible genetic component. The condition, once known as manic depression, causes mood swings that can occur several times a day or once or twice a year.
There are three subtypes known as type I, type II and cyclothymia. The severity of symptoms varies from person to person and is based upon which type of disorder he or she has. Cyclothymia is the mildest type that can include disruptive depression and hypomania, a condition of overexcitement. Subtype II may be associated with irritability and periods of depression. Bipolar I is associated with manic episodes that can be both dangerous and severe. A person may have difficulties at work, school or interacting with other people. Depression, manic symptoms and hypomania can also occur at the same time, and are known as mixed episodes.
Symptoms for the bipolar patient might range from agitation, ADHD, irritability, risky behavior, rapid speech, poor judgment and performance at work or school, to periods of euphoria, an increase in physical activity, increased urges to perform specific tasks and an increase in sex drive. The depressive phase may include sadness, suicidal thoughts, anxiety, insomnia, fatigue, loss of interest in one’s surroundings, an inability to concentrate and feelings of guilt.
In order for a person to be diagnosed as bipolar, he or she must meet the criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as published by the American Psychiatric Association. In simple terms and depending on the subtype, a cyclothymic disorder must last two years or more with several hypomanic episodes and periods of depression but without a full manic, major or mixed depressive event. Bipolar II is based on at least one major depressive and at least one hypomanic episode. Bipolar I is based on having at least one manic or one mixed episode.
Manic episodes are defined as abnormally and persistently expansive, elevated or irritable moods that last a week unless hospitalization is necessary. Then there are symptoms a psychiatrist will look for to further substantiate the diagnosis. Hypomanic episodes are defined as moods of worsened irritation that last at least four days and are distinctively different from the usual nondepressed mood. Again, specific subrequirements must be met. With major depressive episodes, a person must undergo five or more specific symptoms over a 14-day period with specific features being met. Mixed-episode diagnosis is based on manic and depressive events nearly every day for at least seven days.
Because your son’s care should be under the direction of a psychiatrist, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.