Ask the Doctor @ Get Your Rear in Gear: Dr. Jack Brandabur discusses health, fitness and “virtual colonoscopy” as an option for screening.
Dr. Jack Brandabur
As part of our continuing series, Ask the Doctor @ Get Your Rear in Gear, we’ve invited accomplished gastroenterologist Dr. Jack Brandabur to talk to us about health and fitness, and to answer questions brought to us by readers. This month’s questions will focus on screening options including the “virtual colonoscopy” or CT colonography. Dr. Brandabur explains the procedure and offers helpful advice about understanding the differences between CT colonography and colonoscopy.
Dr. Jack Brandabur has practiced medicine at the Virginia Mason Medical Center in Seattle, Washington since 1991. He completed his medical training at the University of Cincinnati College of Medicine, and both an internship and residency in Internal Medicine at Virginia Mason Medical Center. He completed fellowships in both Gastroenterology and Therapeutic Endoscopy at the University of Texas Southwestern, Dallas. Dr. Brandabur is certified by the American Board of Internal Medicine with a subspecialty in Gastroenterology. He was voted one of Seattle’s Top Doctors by Seattle Metropolitan magazine in 2009.
Get Your Rear in Gear: Dr. Brandabur, you are an active runner. I understand that you recently ran the Rock and Roll Half Marathon and have plans to run the New York City Marathon next year. How does fitness play a role in your life?
Dr. Brandabur: It’s huge. I exercise because I like to stay active, maintain my weight, reduce stress and stay healthy. But I also have to practice what I preach. I have to set a good example. From the standpoint of fitness, there is no question my favorite book right now is “Younger Next Year: A Guide to Living Like 50 Until You’re 80 and Beyond” by Chris Crowley and Dr. Henry Lodge. It’s out in paperback and there is a version for both men and women. It contains great advice about making fitness and nutrition a regular part of your life. There is also quite a bit of information about the effects of exercise on your health. It’s a great read because it includes both the physician and the patient’s perspective.
Get Your Rear in Gear: Do you discuss diet and fitness habits with your patients?
Dr. Brandabur: I talk to my patients every day about diet and fitness. It’s not really a discussion that is specific to gastroenterology, but just overall advice and straight talk about good health and about the importance of staying active and maintaining a healthy weight. There was a really interesting study recently about the effects of bariatric surgery on the morbidly obese. Researchers found that as a result of the significant weight loss, patients were at a markedly lower risk of cancer. A similar study in Sweden confirmed those results in women, finding that they had decreased risks of both breast and colon cancer.
So, yes, I talk to my patients every day about diet and fitness. It’s really important stuff.
Get Your Rear in Gear: What does “Get Your Rear in Gear” mean to you?
Dr. Brandabur:
1. Get active
2. Get screened
Get Your Rear in Gear: Regarding screening procedures, CT colonography is a new option for patients. Can you briefly explain what that is, and how it differs from colonoscopy?
Dr. Brandabur: CT stands for computerized tomography. A CT colonography uses computer programs to recreate a computer view of a patient’s colon. During the imaging procedure, a thin scope is inserted to fill the intestines with air for better viewing, but it is less invasive than colonoscopy. CT colonography is a diagnostic procedure only, though. If lesions are found using CT colonography, then a colonoscopy is performed on another day to remove them.
Get Your Rear in Gear: Do you recommend CT colonography for your patients?
Dr. Brandabur: We do not routinely recommend it for screening for a number of reasons. As I mentioned previously, it is a diagnostic procedure only and the “miss rate” is still too high. If we find something during a CT colonography then the patient has to undergo colonoscopy at a later time. Nobody wants to do two preps.
Another reason that we don’t routinely recommend CT colonography is because no one pays for it. Currently, Medicare and Medicaid only pay for the procedure if there has already been a failed colonoscopy due to scar tissue or other mechanical blockage, or if the patient is too high risk to undergo sedation during a colonoscopy. The cost of CT colonography runs $1600-2000 and there are not many centers doing it.
Lastly, there is some concern about long-term radiation risk. The dose of radiation during a CT colonography is 2-3 times the normal radiation of a standard abdominal CT scan, so there are concerns about moving forward with younger patients.
CT colonography is a potentially promising technology in the future, but right now there are questions about accuracy, long term radiation risks, availability and cost. That having been said, it could be a reasonable option for select patients, but reimbursement issues are still a barrier for most. I would recommend that patients speak to their provider if they have questions.
Get Your Rear in Gear: You mentioned, “prep”. Is the prep the same for both CT colonography and colonoscopy?
Dr. Brandabur: Yes, the prep is just about the same for both tests. The only difference is that patients undergoing CT colonography have contrast added to the colon cleanse fluid which patients must consume the night before the test. The contrast helps to distinguish fecal matter during the CT imaging procedure.
Get Your Rear in Gear: What message would you like to give to readers?
Dr. Brandabur:
1. Get screened! Colonoscopy prevents cancer from occurring in the first place and if your colonoscopy is negative, we give you five to ten years off before you need another one, depending on family history, personal medical history and continued lack of symptoms. If you have questions about when to follow up, talk to your provider.
2. It’s all about the prep. If you don’t do the prep, we can only do so much for you during the colonoscopy. It’s really about taking responsibility for your own health. Talk to your doctor; let them know about your preferences for sedation. Let them help you take the fear factor out. There is no reason to be embarrassed or to worry about discomfort. Communication is essential. For example, if your colonoscopy is scheduled for later in the day, ask your physician about doing a split prep. And after you’ve had your first colonoscopy, there are things you can do to make your subsequent colonoscopies more effective. Be sure that medications and prep procedures from your first colonoscopy are evaluated so that changes or accommodations can be made if needed before your next procedure.
3. Know your family health history. Talk to family members and communicate with your physician. It can really help your health care provider to look for things and provide good care.
Read other Ask the Doctor articles:
Dr. Brandabur is misinformed about CT colonography, also known as Virtual Colonscopy. For finding polyps greater than 6 mm it is at least as good and in some studies superior to optical colonoscopy. At least two studies have suggested improved detection of colon cancer when compared with optical colonscopy. No scope is inserted. Carbon dioxide is introduced into the colon via a very small, soft rectal tube. Virtual colonoscopy is essentially risk -free; there is no risk of perforation and no sedation is required. Radiation doses are minimal and will have no effect on patients in this age group. Many private insurance carriers currently pay for this procedure. For patients who will not undergo optical colonoscopy virtual colonoscopy is an excellent alternative and will increase the numbers of screened patients. Since Dr Brandabur correctly wishes to encourage colon cancer screening, he should be enthusiastically embracing this technology which will without question save lives.