Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

[n2doc]

MERRICK, N.Y. — Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.

That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.

“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”

In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.
more
http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?_r=0

[BrotherIvan]

1. Yet many here are claiming the cost of healthcare is from people getting these tests

Not from the medical complex which is charging too much. Can someone please point out where in the ACA we address these costs? Thanks.

[davidn3600]

21. I dont believe ACA does much of anything to reduce costs

The purpose of the law was not necessarily to make healthcare cheaper, but to expand it to make sure everyone has access.

Cost is a different ball of wax and far more complicated.

[ProSense]

54. Here,

"Not from the medical complex which is charging too much. Can someone please point out where in the ACA we address these costs? Thanks."

...information on colonoscopies and the ACA:

Here’s one way Obamacare changed today
http://www.democraticunderground.com/1251288922

[marions ghost]

2. Excellent Article

-----Read the whole thing at the link!

[matt819]

3. Article really hits a nerve on medical care costs in US

Edited to change title, which copied the title from the previous post.

Good article, part of a series.

The problem of addressing THE HEALTH CARE SYSTEM - bold, all caps, spoken out loud in scary voice - is where to begin. Depending on who you are, where you are, insurance coverage, etc., it's tough to know where to begin. Costs, of course. Lack of transparency. No effective free market options - really, are you going to shop around for surgery?. Insurance.

This article addresses the 30,000 foot view to some point, but it really brings it home for individual medical consumers and the problems they face, in a way that pretty much most of us here can appreciate on a personal level.

[liberal_at_heart]

4. we need single payer healthcare. We need to force clinics and hospitals to disclose prices and

we need to create a system that makes it easy to shop around and compare those prices.

[adieu]

18. You shouldn't shop around

This is your body, fergawdsakes. You think you should get a cheapie colonoscopy at Al's Kwik-e Colonoscope-R-Us? Prices should be pretty much the same anywhere around the country.

And certainly, considering how Jiffy-Lube and Oil-Changers gouge their customers by billing them for services not provided, we MUST NEVER have a for-profit medical system.

I don't mind a for-profit optometry store, because all I'm buying there are glasses, and you know whether the glasses you bought works or not. There's very little medical uncertainty in buying glasses (or even contact lenses). But how can you accept or trust a person who says, "Tests look fine, but look at this x-ray (you don't know how to read x-rays), see these dots? They could be trouble. How about we schedule a intra-fulmenitic scan to check out those dots. Could be nothing, but we can't be too careful, right?" Then they hit you with a $2000 bill for checking something that they either know is nothing of concern or they don't even bother to do the checking. You sit in some BS contraption and then they say, "Well, looks all right. But come back in 6 months and we'll revisit it."

What are you going to do? If it's a for-profit business that you just went to, do you trust their claims or do you go looking around for another doctor to check things out? If the other says it's not worth considering, who do you trust? And what if you already paid $4000 for the scan and some additional tests? How do you get that money back, if at all?

It's disgusting. Medical services must be non-profit and be publicly funded. We're far rich enough to fund medical services for all people in the US, including illegal aliens, and not require any additional taxes or fees. Just cut the insurance providers and the pharmas out of the loop.

[liberal_at_heart]

22. Hospitals are charging hundreds of dollars for an aspirin. We need to be able to

identify the hospitals that are charging what they should be charging so we can go to them.

[adieu]

24. But that same hospital

could charge *you* $100 for an aspirin, but charge *me* just $10 or even $1. There's currently no rhyme or reason. And if you go to a hospital (as if you have a choice here in some cases) where you know a friend was charged only $1 for aspirin, you could still be charged $100 for your aspirin, not that you go to a hospital to get an aspirin.

It all depends on your health care coverage, your insurer, your ailment and a whole host of other factors. If you're over a barrel in your ailment, then they know they can squeeze you. If they know you earn such and such amount, they'll squeeze you.

[liberal_at_heart]

27. then that needs to be part of the transparency.

If they charge one person $100 for an apirin because they have different insurance then let them post a chart that says for this insurance you will pay this and for this insurance you will pay that. Doing this will also help us shop around for better insurance(although as I stated above I think we should have single payer healthcare, but even so we still need transparency). We should know what we are being charged. Knowledge is power.

[graywarrior]

5. Holy shit!

[ismnotwasm]

15. Bad!

[graywarrior]

19. Thank you. Thank you very much.

[Skittles]

45. those cats are in my FACE again

I WILL KICK TAUNTING FELINE ASS I TELL YOU

[graywarrior]

53. Are you yelling or just excited to see me?

*wink wink*

[Rosa Luxemburg]

6. Healthcare in America is an industry - a profiteeering crime

you pay by the stitch. The American people are happy not to do anything about this situation.

[2bornot2b]

7. Guess how much it costs for a colonoscopy in Hong Kong, one of the most capitalistic places on earth

In a government hospital, it costs ...

HK$150 - or less than US$20 !!!!

[SCVDem]

8. Talk about taking it up the....

Well, you know!

[longship]

9. "Please roll up your sleeve and bend over."

I get that all the time. It's like Dr. Jellyfingers all over again.

"I can't seem to find anything wrong with you, Mr. Babar."

"Well, I'm sure it's not for the lack of looking."

Let's all sing a chorus of "Moon River" in honor of Dr. Jellyfingers.

[Spitfire of ATJ]

10. It's aliens, I tell ya.

[meow2u3]

11. Bush brain scans are largely an unnecessary money maker

I wouldn't be surprised if the doctors ordering colonoscopies have stock in the companies that sell the devices.

[awoke_in_2003]

12. BOHICA, literally. nt

[progressoid]

13. i just cancelled my appt for one. Can't afford it.

Greatest heath care in the world!

[Honeycombe8]

14. This just makes me sick.

Colonoscopies are big business these days. I keep getting pressured to have one by my GYN and GP. I have refused so far. It's a racket, as far as I can tell. Yes, I might get colon cancer. I also might get a lot of things I'm not being screened for (brain cancer, bone cancer, etc.). But I'm not high risk, and I do another test, as well as try to live a low-risk lifestyle.

They are so insistent that I figure it's the money and not the need of the test.

There is a risk associated with colonoscopies. Risk must be weighed against benefit. It's a good test. But it's my decision, not anyone else's. And unless the dr is going to pay whatever I may have to end up paying, and unless the dr is going to come pick me up and take me home, it's none of his/her business.

[DesertFlower]

16. i'm 71 and never had one either and

have no intention of having one. i stopped pap smears and mammograms years ago too.

i don't get flu shots either.

[Honeycombe8]

17. Great minds think alike. I've read flu shots may present a problem for "mature" folks.

I've also read that the need for pap smears ends at a certain point, and they should be given/taken only every several years before then. My GYN still insists on doing that every year.

I get mammograms, since there is SOME breast cancer history in my family, but the radiation concerns me. I started getting pressured in my 30's to get mammograms! Imagine that! Not only is there no need for that at that age, all that radiation poses a risk (although small).

It's really a profit racket. Sometimes I ask myself, when a dr recommends something...would this dr be recommending that if it were free? Sometimes I know he wouldn't. Still, it works. They beat you down by continuing to ask or insist, year after year.

[DesertFlower]

20. no history of breast cancer. i did get

a pneumonia shot. back in late 80s early 90s had pneumonia 3 times in 4 years. have some scaring on my lungs.

i had a doc years ago who made me sign my name saying that she recommended a colonoscopy.

my primary doc understands how i feel and he doesn't bug me. i made my feelings very clear on our first visit.

i've also instructed my granddaughter who has my medical power of attorney that if i have a heart attack and they want to do open heart surgery she is to tell them "no -- just keep her comfortable". my 2nd executor who is a friend has been told the same thing.

i'm probably going to get "flamed".

[SlimJimmy]

25. I'm not going to "flame" you, but I wll say this. Once I turned fifty, I had the procedure done

because we have a history of colon cancer in the family. The procedure went smoothly, the doc said everything is okay and see you in ten years. For me, it was worth the cost since we have that history.

For others, it's their call. But I would always caution on the side of knowing, rather than hoping my generally healthy lifestyle would keep me safe.

[DesertFlower]

29. no history of colon cancer either and to be honest

if i had it i wouldn't want to know. same with other illnesses. i have several health problems -- nothing that will kill me, i.e., CFS/ME, IBS, herniated discs, scoliosis. i spend a lot of time lying in bed watching tv or occasionally posting on DU.

my dear husband of almost 42 years passed last year from an inoperable brain tumor (glioblastoma). he came home from work -- had a seizure and 3 months later he was gone. between feeling crappy most of the time and losing my soul mate i don't have much of a desire to live. right now i'm here to take care of my cat. after that....... who knows?

[SlimJimmy]

38. I can understand you desire to "not know" if anything is wrong. Many people I know have that

view. I'm just one of those persons that like to be as proactive as possible. And since I had a history of that type of cancer in my family, I erred on the side of caution.

With that said, I wish you the best in your current situation. Losing someone we love is a difficult and painful time. Remember, though, that there are always people out there that care what happens to you, want to offer support, and wish for you a meaningful life. I'm certainly one of those folks. Stay well, try to take it a day at a time, and give the kitty a hug for me.

[DesertFlower]

39. thank you for your kind words.

[liberal_at_heart]

32. My father thought looking out for his general health meant he didn't need to go to the

doctor. Come to find out he has been experiencing mini strokes. He didn't even know he had had them until he started losing some vision and went to the eye doctor.

[SheilaT]

26. I'm with you, just a little younger, 64.

I basically never go to a doctor, other than four years ago when I tripped in my driveway and broke my arm (non-displaced hairline fracture). I do not get flu shots, and interestingly enough, I never get the flu. Maybe that's because I DID get flu decades ago, several different times, and now have good immunity.

I am going to see about getting the shingles shot. For me, personally, it seems like a good idea. My younger son actually got a case of shingles several years ago when he was 20, poor thing.

I am aware I have somewhat high cholesterol, and a few years ago my blood pressure spiked, but I refuse to medicalize those conditions and keep falling back on the fact that I'm still the healthiest person I know. I still do headstands at my age.

[Curmudgeoness]

31. I see your problem.

You have a GYN. Just stop going to him/her.

I have never been pressured to have anything done, although if I feel that it is a good idea, I will agree to it. I have never had a mammogram, I haven't had a Pap test for 20 years. I did have a colonoscopy last year, and that was nearly 10 years after they told me it was time to have one at age 50. But I had to be given a very good reason for it, and beyond the fact that my mom died from colon cancer, the doc did have a good enough reason for me to agree. I ended up with GERD, and had to go to a gastro doc to see what was causing me problems. He was insisting that I have the colonoscopy at the same time I had the endoscopy. I refused. He was shocked and asked why. I flat out told him that if we did find cancer, I was not going to treat it, and since I felt fine, I did not want to find something and ruin what life I have left. His response was that the colonoscopy can find pre-cancerous polyps, that can be removed and prevent the cancer. Made sense.

What I am saying is that it is possible to say no, especially if you have a good reason for refusing and the doctor has no good reason for insisting beyond "it is recommended". Do your research on what is and is not right for you to do. Doctors are just covering their asses.

[a la izquierda]

47. Um, my friend fortunately had a mammogram...

at 35, which detected cancer in both breasts. She had no family history.

[Honeycombe8]

55. There are ALWAYS exceptions, but mammograms @ that age are NOT recommended

by the cancer org., whatever it's called. The reasons being cost vs. benefit (almost no benefit), and harm vs. benefit (there's almost no benefit, and there is harm from being radiated). The radiation does a bit of damage every time you're exposed. It builds up over the years. There are few cases of breast cancer in that age group among people who are not high risk. It's possible your friend was high risk for some other reasons, or that there is a family history she's unaware of (few of us know what our great grandparents suffered from). Then there's the exception.

I was finally talked into getting one in my 30's, to use as a base of comparison for later mammograms. Later, when I requested the films to use for comparison...guess what? They don't keep mammogram films that long! It was a lie all along. It's just a racket.

I ask myself: Would this dr insist on this test, if it had to be given for free?

[lunasun]

30. There is a risk associated with colonoscopies

what are they?
I never heard anyone mention it.....do u mind saying ?
(besides a big medical bill )

[Curmudgeoness]

34. There is a risk of puncturing your colon

which will dump shit into your torso, and that is very serious if not fatal.

I did ask my gastro doctor about the chance of this, and he said that it could happen but was not something that happened often. When I said that was not reassuring, he said not to worry, if it happened, he would have me in surgery to repair it in no time at all. Lovely.

There is always the chance also of reactions or other problems with anesthesia, as will any procedure.

[roamer65]

37. They also don't sterilize between uses, they only disinfect.

[Jim Lane]

43. What's the difference between sterilize and disinfect? (n/t)

[roamer65]

52. Steam and pressure that kills all bacteria and virus.

Versus just soaking in a disinfecting solution which may not get them all.

[Honeycombe8]

56. Damaging the colon, and risk from anesthesia, if they use that.

Any invasive medical procedure has a risk. No exceptions. The risk may be small, but it's there.

And cost is no small thing. That is always a consideration. Cost vs. benefit.

[lunasun]

64. thank you all & learned some things here I usually don't hear about

...as usual....
Wondering if most folks are counseled about the risks before the procedure( or maybe they do sign some form ) .

[Nimajneb Nilknarf]

49. There are families where entire generations of siblings have died of heritable colorectal cancer

For their descendents, siblings, and cousins, getting screened for the disease is worth whatever it costs.

[Honeycombe8]

57. Of course. The normal rules don't apply to those high risk cases.

High risk people have a separate set of rules. For example, if a person is not a high risk for colon cancer, there are other tests besides colonoscopy that are okay to use, according to the cancer society. If you are high risk, though, a colonoscopy is what is recommended, it being the best and most complete.

[exboyfil]

51. My dad died from colon cancer at 66

that was not caught in time. I am 50 and have had two colonoscopies and one sigmoidoscopy. I plan to have them the rest of my life - every five years.

[Honeycombe8]

58. You are in a high risk category. The normal rules don't apply to you.

I and most others are fortunately not high risk. Doesn't mean we won't get it. We might. Might also get a brain tumor, lung cancer, a rare carcinoma, melanoma, or any number of things. There are no guarantees.

[Flatulo]

23. Hospital conglomerates are a big part of the cost problem.

Once venture capital started buying up all the hospitals in a geographic region, and of course, paring the nursing staff to the bone (where will the money come from to pay off the principals), insurance companies lost a lot of negotiating power, since they were always dealing with the same people. There's no real competition when all the facilities are part of the same system.

Hospital conglomerates produce absolutely nothing but huge profits for the investors, and human misery for the employees and patients. When Vanguard bought up all our local hospitals, there was a bloodbath of epic proportions. Patient outcomes suffered terribly, until the nurse's unions struck to restore sane staffing levels.

You want some guy with a business degree dictating how many nurses are in your ward?

[adric mutelovic]

28. Mind-boggling

Other systems are more efficient when it comes to cost.

[riderinthestorm]

33. My sister coded on a colonoscopy. Destroyed her liver AND kidneys. These are NOT benign tests

There are risks and performing them "for profit" disgusts me.

Our family had no history of colon cancer but my RN sister was persuaded that at 60 yrs old she better be pro-active. So she scheduled the colonoscopy.

Don't EVER let anyone pressure you into a test that you think isn't necessary.

She recently had a double kidney/liver transplant with all THAT attendant cost, pain, and woe.

[roamer65]

35. A colonoscopy definitely can be a double edge sword.

On the one hand you want to make sure that you don't have colon cancer, but you do run the risk complications especially perforation. They are treated too casually by providers, IMHO. I said no to one recently and was glad I did. It wouldn't have helped the diagnosis one bit. I've had two of them that has been enough!

I hope your sister is well

[riderinthestorm]

40. 15 months post-op and she IS doing well!! Thanks!! nt

[Nimajneb Nilknarf]

50. That's why it's always important to choose one's doctor carefully for any risky procedure

Generally the doctor who has done the procedure the most times is the one least likely to make a bad mistake.

[riderinthestorm]

72. Cal Pacific Med Center in San Francisco. One of the best out there

No mistakes were made. She simply reacted terribly to the meds, drugs and the procedure. There is a statistical risk with any procedure. She just hit the bad lottery.

[Honeycombe8]

59. What does "coded" mean? You mean it punctured her colon?

So sorry to hear that. That has been a concern of mine, about colonoscopies. A risk, though small, may be fine IF there's a good reason for the test. I haven't been convinced, yet.

[riderinthestorm]

71. She died during the procedure. "Code blue" means an emergency resuscitation team is needed stat

They didn't puncture her colon - she simply reacted very, very badly to the meds and the procedure.

Since a colonoscopy is usually a routine procedure and she wasn't in a part of the hospital associated with high risk procedures, it took a med team 10 minutes to get there so she suffered massive organ failure in the mean time.

[Honeycombe8]

73. Oh, no. I'm so sorry to hear that. Wow, that's scary. (shudder)

Every time I think of getting cosmetic surgery, as I have gotten older, I consider the risks associated with any procedure, even seemingly safe ones.

[riderinthestorm]

74. She had undiagnosed hemolytic anemia so she basically hemorrhaged as soon as they took 1st polyp

She contracted Hep C as an RN student decades ago which was a non-issue for so long she never gave it a thought.

Turns out her "chronic exhaustion" (which is what sparked the physical, which is why she was recommended for a routine colonoscopy) was really a much bigger issue.

Nobody was at fault. Nobody was sued.

But don't let anyone be fooled: this is a surgical procedure and there ARE risks....

(and CO$T$!!!)

[ileus]

36. All those charges and healthcare groups still lose money.

[ThoughtCriminal]

41. I hope that by the time I have to have another one

I don't have to spend a day trying to drink a few gallons of lemon-lime yak spit.

[Submariner]

42. Next time get prescribed SUPREP

$82 for 2 pints of a citrus/licorice tasting yak spit, instead of 2 gallons.

[Honeycombe8]

60. I've read there is now a virtual colonoscopy. I don't know if it's being used yet.

It'll be interesting to know if it's as thorough, when it starts being used widely.

[ThoughtCriminal]

68. As I understand it...

You still have to go through the same prep (yak spit) - which is actually the most unpleasant part of the procedure. And if the virtual colonoscopy shows anything suspicious, you have to go through it again with the traditional method. I'd rather just do it once and have the polyps removed at the same time.

[Sugarcoated]

44. We thought there was no history of colon cancer in our family

and then my sister was diagnosed with stage 4 colon cancer, passed away 13 months later. I had my first colonoscopy at 37, and polyps were found. If I'd waited till the recommended 50, they very well could've developed into cancer. That's probably how it happened with my sister, but polyps at an earlier age that took years to grow into tumor(s). I've had them every 3 yrs since, which I think may have been a bit much, but since no more polyps have developed, the next one's in 5 yrs.Colon cancer is very curable caught early...what my poor sis went through was heart breaking, but she was misdiagnosed with IBS because she was so young. I say get at least a test at 40, you want to catch it early. If nothing's there, don't have another for 10 years, maybe longer. I think it's a great diagnostic tool.

[Skittles]

46. so sorry about your sister, Sugarcoated

you did good; when I had my first they found two polyps, and I urged my 11-months younger than me brother to get one - he waited three years and they ended up taking 14 inches of his colon out due to a mass - horrible to think what might of happened if he'd waited even longer

[Sugarcoated]

62. Wow, your brother is extremely lucky.

My younger brother has had them regularly, the older one waited years after our Sis died (she was 36) he didn't really talk about the results. I think they may have found some things, but luckily early enough. I get my pap smears, mammograms, etc. That's just me, I'm not telling anyone else to, but I think it's risky to shun check ups and baseline tests. Thank you Skittles, btw, the world is much less fun without my girl.

[Skittles]

70. definitely keep up with those checkups!

it's always good advice

[Honeycombe8]

61. There are less riskier, less invasive tests that are almost as good.

There is no need for a non-high risk person to get a colonoscopy. There is always the exception...a person can get anything at any time (brain tumor, melanoma, a rare carcinoma, lung cancer). There are no guarantees.

But if someone is concerned and wants to be tested, there are several tests that are almost as good as colonoscopy but cost a lot less and have less risk (or no risk).

I am tested every year in a non-invasive way, at my annual GYN exam. I would guess that your sister was not, given her age. Had she been so tested, that test WOULD have picked up her colon cancer, although at a later stage than a colonoscopy would have. And that test would've cost her ins. co less than $100, and would've been free to her (part of her preventive annual GYN exam). Risk vs. cost vs. benefit.

[Sugarcoated]

63. It's not as risky as it's being discussed here

but yes, any invasive procedures have risks. Colonoscopy requires no cutting, and if the Dr knows what he's doing, the chances for problems is very minimal.

What non-invasive test are referring to?

[Honeycombe8]

66. I have the fecal test, which finds cancer but not polyps.

There's a list of the tests on the American Cancer Society site. There are several tests that find cancer AND polyps. Then there are some tests that just find cancer.

The ones that find cancer AND polyps:
Colonoscopy
Barium enema
Sigmoidoscopy
Virtual colonoscopy

The ones that find only cancer:
Fecal occult blood test
Fecal immunochemical test


http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-tests-used

I am over 50, so colonoscopy is what's recommended for me. However, I've chosen not to do that. That's my choice because of my personal situation, my beliefs, etc. Most choose to get it. I am not high risk in any other category besides age. Instead, I do the FOBT yearly. The main problem for me is....I have no one to pick me up, so it's a huge deal for me to get anything done where I can't drive home. It requires me imposing on a friend to take off work (which costs them). I would do it, if I had to. But I don't feel it's necessary. I also feel I'm already at risk enough from all the radiation from repeated mammograms, and an x-ray treatment I rec'd at birth. I don't want to take on more risk from medical testing. I could end up getting colon cancer. But I could also get brain cancer, MS, melanoma, lung cancer, or anything at all. I'm just as likely to get those things. So I do normal checkups, mammograms and such, but I have drawn the line at having every orifice in my body tested in such a way that I need anesthesia.

[Silver Swan]

67. I avoided a colonoscopy for fifteen years

But when I was 65 I was diagnosed with breast cancer.

I decided I was more afraid of colon cancer than breast cancer, so I scheduled a colonoscopy. It did find some polyps, which were removed, and I am to return in five years.

Two days before I had mine, a friend had one, which perforated her colon, requiring surgery. I didn't hear about that until later.

[cbdo2007]

48. I think this is for tax purposes and they can write off the difference as a "loss"

so they pay less taxes. Example - They bill $7,500 even though insurance will only pay $3,500 = $4,000 "loss".

[Jim Lane]

65. No, it wouldn't affect their taxes.

A cash basis taxpayer would have reportable income only on the amount actually received.

The hospital is more likely an accrual basis taxpayer, and would indeed have a deductible loss, but would have reportable income for the full amount of the bill. The artificially inflated deduction would merely net out the artificially inflate income. The net increase in taxable income would be the amount actually received, regardless of the amount of the initial bill.

[Cronus Protagonist]

69. I'm having a colonoscopy on Tuesday

This will be my fourth this year. I've also had a barium enema, a CT scan and a sigmoidoscopy, and I had a tumor removed that was larger than a golf ball, smaller than a tennis ball, as well as a few polyps. The tumor removal with colonoscopy cost just over $6,000 and included the procedure full anesthesia as well as an overnight stay in the hospital and all the meds. That price was limited by Obamacare and also Obamacare paid for it, and I am extremely grateful and relieved to be fully cured. Thank you Obama!

Tuesday's colonoscopy is the follow-up after the tumor removal. I know it's good because I'm now symptom free and my malnourishment is gone, so this next colonoscopy is just to clean up the details, if any.

I would advise anyone who gets a recommendation for a colonoscopy from their doctor to get it. Just do it. It's not painful, just a little uncomfortable. The laxative pre-op prep is the worst part of it.

During the procedure, I usually crack jokes all the way through. Once you get over the fact that there's 6 people in the room all looking up your butt, it can be quite amusing. At least I try to make it so.

Why rush into a colonoscopy? Well, if you do have cancer, it might only be on the mucosal layer of the colon, if you catch it early. Once it's breached the wall of the colon, the cancer can spread, most likely to your liver, and then the prognosis is short and fatal. So get it before it grows a stalk and breaches the colon. Just do it. And do it early. It saved my life.

And if you like Star Trek stuff, as I do, a barium enema fluoroscopy is amazing - you can see your entire colon in full 3D in real time, moving on the screen as you move. It's fascinating, as I'm sure Mr. Spock would say. The worst part about that procedure is the balloon up the ass and the gas coming out of all orifices afterwards. Oh, and afterwards, you shit all white, just like I'm sure the Pope does!