Following up my last post — Learning to Say No to Doctors — I was interested to read results of a new study published by the Journal of the American Medical Association that reported up to 38 percent of colonoscopies performed on those between 76 to 85 years old (and almost 25 percent of those over 86) were potentially inappropriate under existing guidelines. I take a personal interest in this procedure because colon cancer played a significant role in my father’s decline and his death in October 2012.
The Texas study concentrated on screening colonoscopies — the kind many of us over 50 go through routinely every five or 10 years. Though these are standard procedures for most of us, they aren’t without their potential for complications. In fact, a study reported in June in the Annals of Internal Medicine noted that those over 80 were at 50 percent greater risk of problems than those 60 to 69 years old. Those older than 85 faced twice the risk of complications, which can range from bleeding to colon perforations and heart problems. But research has shown colonoscopies remain better at detecting cancers in the colon than less stressful procedures, such as sigmoidoscopies.
To be clear, in Dad’s case, there was a real reason for doctors to recommend the test. This wasn’t a screening test. Dad had been having digestive problems and a fecal occult test had come back positive for blood in his stool, and he ended up in the hospital five months later with what turned out to be colon cancer. While one could reasonably question why a patient would turn down a colonoscopy in such a situation, Dad’s other health issues (beyond his age, at 89), including diabetes, kidney failure and congestive heart failure, put him at the highest risk for potential complications. Plus, he just didn’t want to go through the prep. He was still of sound mind and I always respected his right to make his own health decisions.
Honestly, at the time, his choice relieved me. At the top of my fears was whether his kidneys could handle the flooding and purging. And I dreaded the idea of having to aid him through the many bathroom trips. At the time, his balance was already compromised. I was eyeing the possible expense of hiring a nurse for the night — at 186 pounds, Dad had a good 30 pounds on me, and I wasn’t sure I could manage him in a weakened state on my own. Plus, there was the obvious potential for a disastrous mess.
Of course, I’ve second-guessed my decision to not push Dad harder to have the test. However, I’ve also thought not having the test might have gained him an extra five months of freedom and enjoyment — one last summer of fried food and ice cream, and feeling the sun on his face from his chair on my back deck. Would the test have discovered a cancer (colon cancers grow slowly, so it’s unlikely that it would have been merely at the polyp state in April), pushing up the need for a surgery that still would have landed him with a colostomy bag and a recovery from which he never, well, recovered? His colostomy wasn’t at the site of the tumor — instead, it was required so the surgeon could access the tumor site, so it would have been needed, regardless.
And this is why the conversation about invasive tests and other procedures can be so difficult when we’re talking about our parents and other loved ones for whom we might be caring. A truly informed decision in these cases needs to be based on the very hard realization that even the most aggressive treatment is unlikely to make their life much longer, so quality over quantity becomes a guiding principle. At least that was the principle Dad and I used. There is no single “right” answer in these situations, no matter what a doctor might tell you. There’s only the answer that’s right for the patient and those who love him or her.