516   charlieharrington.com

Notes on My Colon Cancer

Refreshing Comments...

Fellow readers: Do not be afraid of a colonoscopy. Do not avoid it-- in fact, look forward to it. They are easy and painless. Waking up from the anesthesia I felt more relaxed than I ever have in my life. Also, the prep of clearing your system will reset your digestive system and you'll feel like a new person. I think the prep cleared out whatever it was that was causing us to investigate my digestive system in the first place.

The night before mine, I googled to see if I could find anything that would make me feel less anxious and uncomfortable and I couldn't. Well, fellow reader, I hope this comment and the article put you at rest when it comes to doing this important and necessary procedure.

Recommend anyone considering this to ask your doctor about using a sedative instead of general anesthesias.

As best I can tell general anesthesia for colonoscopy for low risk appears to be a cultural custom especially prevalent in the northeastern USA.

Anesthesia has many more possible side effects than sedatives and ought to be avoided unless needed (this applies to any unneeded treatment).

Plus if you’re awake you can actually watch the scope going, it’s cool! Not painful at all. Agree there is no reason to fear colonoscopy but there is also no reason to undergo general anesthesias for it either in most cases

I had a colonoscopy five years ago here in the UK without any anesthesia and it was perfectly fine. Walked into the theatre wearing a gown and a pair of shorts with a flap at the back, and hopped up onto the bed. Somewhat embarrassing with a half dozen nurses standing around various bits of kit and more monitors than NASA.

They asked me if I wanted to watch, then angled one of the monitors so I could see what they were doing. Laid on side, knees up and relax. Blimely is my bum really that hairy? Don't normally get to see if from that angle.

It feels weird and a little uncomfortable at times, but certainly not painful - even when they found a polyp and removed it with a remote lasso tool of some kind. This later turned out to be harmless.

As is normal for Brits, there was a lot of humour, with the women discussing the latest TV soap opera whilest doing their thing with the "dynorod" tool. As they pump in a gas of some kind to keep the bowl inflated while they work, they tell me it's okay to fart whenever I need. Boy, I think I've got a bad job sometimes. Whatever the nurse with the pointy end gets paid - it's not enough.

It's not exactly pleasant, but necessary and quite interesting to watch inside your own body (not as interesting as watching surgeons put stents into my heart, but that's another story).

Totally agree with Graeme, nothing to fear and massive win if they find things before it's too late. Don't hesitate!

Same. Had one under light sedation a few years ago (switched to biannual stool screening for occult blood subsequently) and I'd say the discomfort was similar level to having a tooth filled under local anaesthesia. Not fun, occasional moments of mild discomfort, outweighed by the novelty/this is cool factor of getting to see the inside of my own guts.

I will note that general anaesthesia generates lots of extra billable hours (anaesthetist! extra nurse/assistant anaesthetists!), which might be why US hospitals are so keen on it and NHS hospitals are less so.

I had one a few years back and it was amazingly painful. Nonetheless I would choose it over getting knocked out.

This may sound like a strange sentiment, but years ago I broke a bone on a weekend and they put my arm in a sling at the emergency room. I got to see a doctor on monday and he said - you have to move your arm. "Move it every day, otherwise you will lose your range of motion. Let pain be your guide".

Completely different advice than I expected (I expected to keep it immobilized as much as possible until fully healed)

So I wonder if I was knocked out - would they damage something while they're looking around without my hints?

Good point. I could say “whoa that’s uncomfy” and the doctor would react.

There are risks to colonoscopy, primarily in older patients. You can get a perforated bowel.

Quite plausible that where sedation is warranted this reduces the risk. But that would depend upon whether the cause of this perforation is even amenable to patient/doctor feedback.

The doctor's experience matters a lot here. Try to find one who has done several thousand colonoscopies. Going around the corners in your colon is a potential source of pain, and more experienced doctors do this best.
Oh my. That was exactly what they said to me. I was like OOWWW and they said "hey look at the screen, we are going around the corner!"
We badly over-use general anesthesia. Next to antibiotics it might be the most over-used thing in medicine. When you scratch the surface of the neuroscience of general anesthesia you will never want to experience it in your life if you can help it. It's effectively a controlled coma, and though we can control it, we don't know the precise mechanism of action. (Like so many things with the central nervous system it was discovered by trial-and-error.)

If you're having a medical procedure and the physician mentions general anesthesia, always ask if IV sedation works as an alternative.

Meanwhile, up here in Norway you have to beg and grovel and almost pretend to have a panic attack in order to get a one-off benzodiazepine-based IV sedative while taking a gastroscope down your throat.

An acquaintance of mine with Down's syndrome, no less, couldn't do a gastroscopy to investigate a quality-of-life issue that was assumed to be benign, due to this. Boggles my mind, honestly.

General anesthesia might be over-used, but some healthcare systems go too far in the other direction too.

I always had issues with gastroscopy (I guess mostly panic and uncontrollable reflexes), but recently I discovered that there’s an option to do it through nose instead of mouth (of course, with a thinner tube) — highly recommend it for people like me!
One of the vast number of reasons to prefer a nonsocialized Healthcare market: choice.
Socialized healthcare systems often have room for a private sector, so you can have both.

You can also go to other doctors in a socialized one, if their treatment (style) does not fit your cause.

Also, in my experience there's lots of choice in most socialized health care systems.

I had a gastroscopy in Austria, the Doctor asked me if I'd like a general anesthesia or rather a local, nerve blocker - mostly to avoid the gag reflex.

He said that it may not be as pleasant without the anesthesia, but I still opted for it and am really glad I did. While it really was not pleasant, I was up and going again in about half an hour.

Nah... that has more to do with how medicine is practiced versus how it's paid for. I'd bet you'd have troubling finding any doctor willing to sedate for an endoscopy in that country.

It's just "how it's done". Just like the US has it's own unique methods that seem odd to Europe.

Oh, you can do it privately instead. Costs $500 or so, but there's as much choice as the market allows for. My description was how it's normally done in the public system.
I had shoulder surgery a few years ago, and I had to argue with the doctor to get him to do a nerve block instead of general anesthesia. He never suggested it - I researched the options myself and found that patients who did the nerve block recovered faster and better, and yet right up until I rolled into surgery, the doctor was trying to convince me to do anesthesia. Sadly, I think the reason is that anesthesia makes patients easier to manage during surgery, which makes the doc’s job easier even if it is ultimately worse for the patient.
Some of that is just inertia. Things are done a certain way and everyone is comfortable with it. Throw in a new method and everyone gets nervous. You might even have trouble finding an anesthesiologist who has done enough nerve blocks to be comfortable with it. And even if you do, your doctor has maybe never worked with them before.
Like Propofol ???.

Don't it just turn on the chlorine tap on a neuron to open so that the voltage is now much lower and it will inhibit the signaling ???.

It is the natural mechanism of a neuron so I don't see what side effects there could be - it is like pulling a jumper wire from one pin to another pin on a board to get a voltage right.

Great point and I see that commenters above are suggesting conscious sedation (benzos) instead of general, which would probably be propofol in this case. Both benzos and propofol act at the same chloride channel...
I’m an emergency physician and we use all of the above medications with the exception of general anesthesia.

Benzodiazepines are considerate anxiolytics whereas propofol would be considered moderate sedation. Neither of these require airway control (intubation) because people tend to keep breathing on their own and we really would much prefer that.

With general anesthesia, you cannot protect your airway whatsoever and will need some form of airway control via either endotracheal intubation or LMA.

Thank you for the knowledge. I'm an M3 who hasn't had surgery, EM, or anesthesia rotations yet. Probably should have thought about the airway though...
In most procedures I've observed (or experienced first-hand), a combo of Versed (a benzo) and a small amount of Propofol for the "milk of amnesia" effect is lumped under the term "conscious sedation".

The patient is aware, can breathe on their own, and can respond to basic commands, but is relaxed, with a much higher pain threshold, and has no memory of the event.

That sync with your experience, doc?

I'm not sure what you're trying to argue here. We don't know the "precise mechanism of action" of ANYTHING related to consciousness or subjective sensations. We don't even know why Tylenol works. That's not a reason to avoid it.

For the overwhelming majority of patients, you simply fall asleep, avoid discomfort, and then go on with your life. Weighing that against the risks of a traumatic or very painful wakeful experience is not trivial.

I also steer people away from Tylenol and toward NSAIDs when possible because of the potential (though generally unlikely) risk of liver damage.

What I'm trying to argue is that "one step away from death" is a state we too-often in American medicine treat as hum-drum.

> Plus if you’re awake you can actually watch the scope going, it’s cool! Not painful at all.

For sure! My first colonoscopy I was sedated and enjoyed watching the screen. In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. My second colonoscopy my doctor sedated me again, but put me further under for reasons that remain a mystery.

Also, a year ago we buried my brother-in-law at age 53. He was diagnosed stage 4 at age 48. DO NOT DELAY your colonoscopy. I think 50 is too late to wait.

> For sure! My first colonoscopy I was sedated and enjoyed watching the screen. In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. My second colonoscopy my doctor sedated me again, but put me further under for reasons that remain a mystery.

It was the 15th time that week he'd heard the "rectum, damn near killed them" joke and he didn't feel he needed another aspiring comedian on the operating table.

> In fact, I remember I was making HILARIOUS jokes the entire time.

Jimi Hendrix remembered he was playing MUCH BETTER guitar when he was on acid.

Until he heard the recordings....

I remember asking my doctor (I was sedated, but not 100% asleep) to look for the iPod I lost about 10 years ago....

I must admit, the experience wasn't awful. It was like getting an intestinal reset. Getting completely cleared out from the fast and prep. I felt like a new man, and very well rested after the "twilight" sedation.

I only wish they could have given me a copy of the video of the procedure for my YouTube channel.

> In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though.

This is the primary purpose of the "sedative".

I had samples taken from the interior of my stomach via a machine that went down my throat. It was an intensely unpleasant experience; you're trying to vomit for most of the time the cable is there.

Anesthesia was not even recommended, but they really wanted me to take something that would inhibit memory formation. I asked if people who took the drug struggled or retched any less. "No." (I declined to take it.)

This is also how women were drugged for childbirth in the mid-20th century. No anesthesia, but memory inhibitors so they couldn't remember what had happened. That was eventually "discovered" by the press and became a huge scandal. I don't get how the approach persists elsewhere.

The philosopher Stanley Cavell asked in one book if it was OK to torture someone who was given drugs to completely forget the experience.

Aside from potential lasting effects from trauma remembered or not, and so on, I always thought: It would still change the doctors.

If I recall correctly, "general anesthesia" is actually a combination of multiple drugs with different purposes; some that inhibit memory formation, another to put you to sleep, and another to I guess relax the muscles etc?
Not sure about the drugs, but during anesthesia, you will be completely unconscious, and inhibiting memory formation is a side-effect of that. Sedation is when you are still (more or less) conscious, but relaxed. But between these two terms there are several levels: https://en.wikipedia.org/wiki/Sedation#Levels_of_sedation
> during anesthesia, you will be completely unconscious, and inhibiting memory formation is a side-effect of that. Sedation is when you are still (more or less) conscious, but relaxed.

The concept of anesthesia is that you don't feel pain, not that you're unconscious. If you're unconscious, it's "general anesthesia"; if you're not, it's "local anesthesia".

Colonoscopies are much more pleasent that having a probe sent to your stomach. Going up from behind, you are sedated, for the stomach you have to stay awake to "swallow" the probe. ut hey, I guess it still beats surgery, chemo therapy and potential fatal cancer down the road.
> This is also how women were drugged for childbirth in the mid-20th century...

Can you provide any additional information on this? I can't find anything online. Maybe I'm using the wrong search terms.

>Also, a year ago we buried my brother-in-law at age 53. He was diagnosed stage 4 at age 48. DO NOT DELAY your colonoscopy. I think 50 is too late to wait.

The rate of new colorectal cancer diagnoses has been increasing for those under 50 years old, despite the rate falling for the older population. I don't know if they've narrowed down a major cause. My pet theory is obesity.

The usual recommendation to start screening at 50 is for asymptomatic people with no increased risk. If you have symptoms, family history of colorectal cancer, or enough other risk factors[0], bring up screening with your doctor. As somebody else mentioned, you could do fecal occult blood tests (FOBT) or other non-invasive tests if you're worried about colonoscopies.


Second this. There is evidence that anesthesia causes brain damage. This shows up in the data most for babies and small children, and the elderly, where you can see it on IQ tests and chance of dementia. It's more pronounced with multiple surgeries. It may be that it's damaging everyone's brains, but it's just not as noticeable for adults. One study with twins showed about a 1.5 point IQ loss from a major surgery.

Of course, 1.5 IQ points is not likely to dramatically change the course of your life, but I would absolutely not get it if the procedure could be done under sedation.

On top of this, IIRC, we (meaning doctors and medical science) have basically no idea how anesthetics actually work. For instance, xenon gas has anesthetic properties. Xenon. Gas. How's that for weird?
Oh yes... I remember the aftermath of getting emergency surgery for an appendicectomy: after breezing through a major Calculus exam before that, I struggled for months waiting for the cloud of confusion and forgetfulness to lift. And to this day I’m not sure it ever did
Its such a weird thing. After a while, you begin to wonder if you just learned to work around it. I too bad a similar experience, just s/snowboad/motorcycle/.
I'd love to see the study for this and how they controlled for the fact that being sick enough to require general at a young age probably will ding your IQ a couple points. I'm guessing they didn't do a randomized controlled trial.
One of the studies I saw was from Sweden and it looked specifically at twins where one had been injured. This is probably about as close to an RCT as you can get. That said, it doesn't separate the anesthesia from damage due to the injury itself, or the trauma of the surgery.

Still, getting anesthesia for something like a colonoscopy or a root canal strikes me as a very disproportionate risk given the evidence.

AGAIN, these data points apply to using something like a fluorinated gas, which is what you'll get for major surgery, not Propofol, which is what they'll give you for a colonoscopy.
It takes 10-15 minutes for a regular colonoscopy, for such short time, does the side effect of anesthesia actually comparable to the "major surgery" that can easily last 5-10 hours you mentioned?
I always get the same stuff Michael Jackson was using. You fall deeply asleep for the duration, wake up pretty refreshed, only downside is that I am usually besides myself for the rest of the day. Good thing you aren't allowed to drive for the next 24 hours.
Could you post any resources that discuss this? I don't doubt that you could be correct. After a quick search I wasn't able to find any material online that really supported this claim. There is the well-known condition of 'Postoperative cognitive dysfunction', however that doesn't quite line up with the kind of brain damage you're describing.
Does this include the anesthesia given to us at the dentist? The one they give you in a shot to numb the tooth. I couldn't live without that.
No. That's local anesthesia. It's called a "nerve block". The anesthetic is injected right next to a nerve. If you imagine pain as starting somewhere, then, "travelling" upstream to your brain, the anesthesia basically interrupts signals from the point where the injection takes place.
I think local anesthesia does not lead to these effects (as far as we know), I also would be surprised if it does. One thing I remember when you also use N20 (laughing gas) you should either check or just take vitamin B supplements (it seems to deplete your vitamin B storages)
I once had an endoscopy without any sedatives or anesthesia and that really sucked. The doc stuck a large tube down my throat and had me gagging for what felt like an eternity. After the procedure I needed a few minutes to wipe the tears that started forming from my eyes and gain some composure. This was done in Poland. If a colonoscopy is anything like that then not sure I'd want to be doing them regularly.
I was offered anesthesia for the endoscopy as well and I was glad I refused. The whole thing was over in 10 minutes, the actual endoscopy was about 2 minutes of serious discomfort. I gagged a couple time, the rest of the time I held steady, but the nurses also complimented me for powering through so I don't think it's expected to be easy. It was a weird and humbling experience.

If you feel like you're relaxed enough to be calm when someone does something to you that your body will tell you is going to kill you, then it's not so bad. They sedate your throat to kill the gag reflex, but it doesn't work 100%.

The upside for me was that it was over so quickly, and I could go on with my day, was allowed to drive, etc.

Yeah, I didn't have my throat sedated, that might have helped. I was able to go on with my day shortly after the procedure as well but the 5-10 minutes it lasted wasn't the most pleasant for sure.
My wife took no sedation when she had one, so I was shamed into doing the same when I had one a couple of years later. It was unpleasant, but not actually painful, and over quite quickly. Would opt for no sedation if I had to get it again

I went for no sedation during a colonoscopy too, but after a while it got too painful and I asked for some

I've got it done without sedatives 10 years. It was quite a ride. They went only half way and I had enough. It was literally a gut-wrenching experience.
Funny, I am considered high risk and have had it done annually for about 15 years. None of my doctors ever mentioned a sedative as an option, let alone anesthesia. And it has never been a big deal. The risk associated with anesthesia is way too high to justify it for this kind of procedure.

Once every few years they find a suspicious polyp and snip it of / cauterize the wound, all with just local numbing. Still nothing worse than stubbing a toe, and certainly not worth the risk of using sedatives.

I got mine done three years back at 36 (I've had gastric issues, and my mom has colorectal cancer) - didn't use sedatives or anesthesia. Pain tolerance is relative, so my own experience wouldn't carry over.

I can understand if some people want sedatives, but anesthesia is pretty high risk like you were saying.

So much "high risk" in this thread, yet its used all over the place in United States and not a single shred of evidence to be found anywhere here...
I did some googling; here's some studies on death rate due to anasthesia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147285/ ; the latter does highlight that the incident rate has dropped a lot since the 1940's. Another one on "anesthetic awareness", or waking up during the procedure / recalling things without being able to respond, which happens 1-2 times out of 1000: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900098

"Not a single shred of evidence to be found" -> "I didn't actually look but like telling people they're wrong lol"

Its not my responsibility to look for evidence if you're making the claim.

If you want to come into a thread telling people that are already apprehensive about a procedure "please don't do X its dangerous!" when an _actual_ first google will give you a Mayo Clinic saying its perfectly fine, then you need to provide some fucking evidence.

Your evidence is unconvincing, but good job being condescending.

I have ulcerative colitis so have had many many colonoscopies. General anaesthetic is never used in UK but twilight sedation is normal. I refuse this as (after an unpleasant gastroscopy) I can't stand having tubes stuck up my orifices while I'm unable to fully intellectualise what's happening. They're usually happy to give a bit of fentanyl instead.

My experience is that GI doctors enjoy chatting during the procedure but specialist nurses (who often perform minor endoscopies) are usually not very communicative.

Had Fentanyl for both mine…

Colonoscopy was generally OK, and it's quite interesting to see both what your insides look like, and the radar image of the path the scope takes.

The prep the day before is the worst bit IMV

They regularly use Propofol which is not the same as general anesthesia. I've waken up (in pain) on Propofol. Pretty much impossible with a GA fluorinated gas. General Anesthesia is a very monitored situation as it's potentially very dangerous (you have to be put on a ventilator).
This is something I've been wondering for a while, perhaps someone here knows. I've had two colonoscopies, and my understanding was that what they used was a sedative, but I was definitely totally unconscious. What's the line between sedation and general anaesthesia?
Medically, anaesthesia is a "balanced triad" of three elements: analgesia (pain relief), narcosis (sleepiness), and muscle relaxation. It's a spectrum: we talk about having various "planes" of anaesthesia that are in principle relatively woolily defined but in practice oddly specific. An example would be the difference between a "light" form of general anaesthesia for a relatively non-invasive procedure -- such as a broncoscopy, which can be performed under heavy sedation; and something where unexpected movement can have catastrophic effects, such as surgery on the spine. It is rare, but not terribly so, for some surgical stimuli to cause local responses or motion, even when the patient is "completely under", ignoring local reflex arcs which may (or may not!) be affected by the anaesthetic agent.

A good, modern anaesthetist in a western hospital has access to an incredible array of information about their patient, ranging from their complete physiological state to the partial pressures of anaesthetic gasses going into, and out of, their lungs (and thus in their blood stream). This largely means that the horror stories of the past about people "waking up and being unable to move" -- the triad becoming unbalanced and muscle relaxation ± analgesia being (barely) adequate, but narcosis clearly not -- remain in the past.

I've probably waffled incoherently enough, but it's worth reiterating that anaesthesia is a _field of medicine_ in its own right. There are literally thousands of approaches, drug combinations, and "gotchas" to deal with, in all sorts of situations -- right the way from the straightforward and simple to patients with massive facial injuries where it is very difficult to know how to intubate them without causing further damage. Drug combinations are prescribed on the basis of the patient, the indication, and local rules and availability (including toxicity to the operator and cost -- many anaesthetic gasses are carcinogenic if you're exposed to them for a long period of time in trace amounts, which occasionally becomes an issue).

Re: the content of this article --- if you have blood in your stool, see your doctor. (S)he won't be embarrassed about shoving a finger up your arse, and the outcomes range from "eat more fruit", or "don't have anal sex for a little while" to lifesaving surgery.

Thanks, that's very interesting! And yes, I definitely agree about seeing your doctor. We're often unreasonably embarrassed about things like this, but a good doctor will have no problems putting people at ease. And obviously the outcome can be really bad if something serious goes undetected.
100% agree. I've had several colonoscopies without anesthesia. This does not make me a badass (npi). It merely reflects that the fear of this procedure is completely out of proportion to the reality. It's a little bit uncomfortable in the same way that being gassy after a big meal is uncomfortable, but it's less painful than a flu shot.
Colonoscopies aren't quite general anesthesia in the US (generally, I'm sure there are exceptions). General anesthesia as being completely unresponsive to external stimuli and potentially needing supportive measures to make sure you maintain your airway.

What they tend to do is "conscious sedation". Basically load you up with a sedative and painkiller - midazolam and fentanyl as an example. You're not completely out of it, you can breath on your own and will show some response to stimuli. But you won't remember any of it due to the amnesia from the sedative.

While I’ve never had a colonoscopy I’ve had versed. It makes me all relaxed and forgetful. Seems like it’s the much better option that fentanyl
They're different drugs. You'll definitely want the pain relief Fentanyl provides if you're getting cut open, such as for endoscopic surgery.

(Fentanyl gets a bad rap because it's very dangerous as a street drug. In a healthcare setting it's a wonder drug, superior in almost every way to morphine.)

Propofol or ketamine are both safe, low risk, and have minimal side effects when used correctly.
Is propofol not a general anaesthetic? That's what I was given for my colonoscopy. Totally knocked out, and when I opened my eyes again it was all over.

Side note: I was never warned about a particular effect of propofol. They started pumping it in and told me to count down from 10. At about 5, I suddenly felt this horrible searing, burning pain in my IV-connected arm that I felt spreading throughout my body. Thinking something was terribly wrong, I opened my mouth to say I'm feeling awful pain, but by then I was already falling unconscious. So I only consciously felt the pain for a few seconds, feeling totally fine (besides grogginess) when I woke up, but it was panic-inducing and some of the worst pain I've felt.

Apparently it's pretty common for propofol. I think they might have told me I might feel a little discomfort, but they didn't mention the possibility of sudden, dramatic pain, for some reason. I could've grit my teeth through those seconds if I knew it was possibly going to happen, but I feared that I was having an unexpected severe allergic reaction or something, so I spent those few seconds absolutely terrified.

Propofol is definitely used as one of probably a cocktail of drugs required for various levels of sedation (AKA “general anesthesia” in this case).

I’ve experienced the exact same pain you’re talking about but with IV antibiotics. No nurse or doctor could actually explain why it was happening to me, other than to say the IV had “gone bad.” Because I was in the hospital for so long, they eventually switched me to a PICC line. Absolutely zero pain with that.

My own experiences with propofol involved either the PICC line, or maybe some kind of arterial line or something (I was unconscious when I was first sedated during this incident).

There can be a number of things covered by the phrase "gone bad", ranging from phlebitis (inflammation of the vein) to infiltration (where the catheter becomes dislodged from the vein (or pokes through it)) and the IV fluid leaks into the surrounding tissue.
I'll second the "do not be afraid".

At my first, I was offered the option of minimal sedation, which I took. Then my doc offered to put up an extra monitor so I could take the tour, as it were. It was fascinating.

By now, I've had 9 colonoscopies. My brother had colon cancer, hence the maybe higher frequency than usual. They've all been either non-events or pretty interesting.

If you have any symptoms at all, get the procedure done. Immediately.

If in doubt, take it. better be safe than sorry, especailly since colon cancer usually takes time to became really bad and can be treated rather easily when caught early. Also agree that 50 is too late. Case in point, I had colon cancer when I was 28. Turned out well, but 6 months of chemo therapy is nothing I want to repeat, and I had the easy therapy.
I just had a colonoscopy a few weeks ago because of some minor bleeding. Ended up just being hemorrhoids and a small polyp. Definitely worth having the peace of mind.

The worst part or the prep was not sleeping much that night because I was up until 3am. Watching TV most of the night was relaxing, though. After the procedure I took it easy all day while the propofol effects wore off.

Don’t wait to have a colonoscopy. The prep isn’t that difficult!

I’ve got Crohn’s so I’ve had my share of colonoscopies, completely agree that the procedure is a breeze. And now that propofol is the standard it’s that much better, the older versed/morphine combo really hammered you. The prep is the worst bit and it’s better if you prep well for the prep; wet wipes, bidet, water bottle anything, some good reading material and a good even free from other disruptions (you’ll be disrupted enough...)
Fellow sufferer here. My doctor ordered one for me when it wasn't really called for (MD, not gastro). I'd had one recently and kind of rolled my eyes. Did I really need it? They found high dysplasia tissue (cancer precursor). Now I have a permanent ileostomy but I'm still walking around being a father and what not. If you have Crohn's, do not avoid these!
I had a colonoscopy almost two weeks ago (a 3-year follow-up on having a large not-quite-cancerous-yet polyp removed), and got in a lot of Factorio the night before.

So in a sense it wasn't that different than a regular night of staying up till four in the morning playing Factorio, except that I had to drink a gallon of stuff that tastes like diluted seawater. I had forgotten how gross that stuff is, but in the end that was the worst part.

Here in the UK you just get pain relief, and are generally conscious for the procedure - though gas and air is available if it is uncomfortable. It caused me no pain at all, was quick and easy and I'm pleased I went ahead with it.

My father found he had bowel cancer from a routine fecal occult test they were sending to all men above 65 in my area. He took some convincing to do the test, but found he had cancer and was swiftly operated on. My older brother found he had it far younger, about 52 and his was far more advanced when it was discovered, and 5 years of treatment later it won't be something they can cure. So it is pure chance my father's was caught so early and was so successful.

After speaking to my gp they agreed to start my colonoscopy cycle at 40 - with one every 5 years until I hit 55 and then likely more frequently.

I was a little nervous but it was totally fine and I feel freed that it is one worry that is if not behind me, that is controlled.

Top tip is to follow the instructions of the laxatives well and eat nothing except a broth or miso soup, and it will be far easier on your gut.

By far the worst part is what they refer to as the “bowel prep” i.e. strong laxatives. A top tip is to coat the affected area with Vaseline before starting!

That and the sedation depends on whether you’re getting a “flexible sigmoidoscopy” or a full colonoscopy. The latter is the full 1.5-2 metre insertion to inspect all the way to where the small intestine starts, which typically involves sedation (though conscious). The former is usually preceded by a home enema rather than laxatives and done with pain relief only.

My suggestion is to only wipe your butt the first two times during the prep. After that, use a shower nozzle (or a bidet) for the other dozen bowel movements...
> Here in the UK you just get pain relief, and are generally conscious for the procedure - though gas and air is available if it is uncomfortable. It caused me no pain at all, was quick and easy and I'm pleased I went ahead with it.

Not necessarily, you can get the Good Stuff that knocks you out during the procedure in the UK (I have), but I'm not sure what the criteria are for getting it, if any.

Thanks for that comment. I once, out of nowhere, had a bad bout of panic attacks and subsequent health anxiety. Every symptom(which were themselves manifesting) led me to believe I was dying. Literally the only thing that helped was googling the symptom + "anxiety.". I felt like an idiot googling 'random pinching pain anxiety', but found all kinds of accounts. After reading hundreds of poor folks in my shoes describe everything I was going through, the symptom faded, and I felt peace. Really weird time for me for sure. But just know people reading random comments can really put minds at ease.
Cannot confirm; my girlfriend had a sigmoidoscopy (similar) and she experienced it as traumatizing and violating. I don't believe she got any anesthetics admitted; pretty sure it's not standard.

Please don't romanticize invasive diagnostics. If you want to advocate for the occasional bowel purge or using anesthetics to sleep have at it though. But also, general anesthesia should be avoided as much as possible, it's not a trivial matter.

In the UK it's uncommon to be anaesthetised for for endoscopies or colonoscopy. I've been offered either midazolam or gas & air for colonoscopies and pretty sure my last couple of endoscopies were done without anything.

The movicol prep stuff they give you isn't ideal either; you've got to drink a lot of odd tasting fluids that then give you basically explosive diorama which can be awful in itself. It also causes some people to explosively vomit as well (it's designed to make your body want to eject it asap) which really isn't fun when it's trying to escape both ends at once.

The actual procedure isn't amazing either. A camera down either end is uncomfortable at best ranging to extremely painful (short term) as they try and get round the corners in your bowel. There's also the potential it to go wrong in some nasty ways or for odd side effects, and at absolute best, you're still stuck on a table trying to make polite conversation with 2m of camera tube stuck up your bum.

Can confirm your refusal to confirm; none of it's a thrilling or trivial experience.

I'm in the UK and I had a good level of sedation for mine. I wasn't even asked, just told that was standard.

I wasn't knocked out but I might as well have been as I didn't feel any pain and kept kind of drifting off half to sleep. It was completely fine and I'd not worry at all about getting it done again.

I really did not need to read this the week before I have a camera put in my stomach. Crap.
I’m about to have it done in a few weeks. Hope yours goes well.
Just to calm your nerves. I had mine done today and, despite the intermittent choking and gag reflex, it was actually completely fine. Turns out I have Barrett’s esophagus, maybe caused from acid reflux and stress I've had since a kid. Slight increased cancer risk so I'll be getting this procedure more often from now I guess. Hope yours all goes well!
Yes, this, totally this. Even the bowel prep [was] easy and painless [for me -- added this edit]. It's a good excuse to just binge a show, too.

I think the traditional guidance has been to go for your first colonoscopy around age 50. My doc mentioned that they're recommending that move down to 45, because they're seeing more and more young people with issues. You should bring this up with you doc if you have any similar symptoms or if there's any family history of colon cancer.


the bowel prep is easy and painless

Bullshit. I've got Crohn's, and have had more colonoscopies than I can count since age 13. About 75% of the time, I'm throwing up due to the prep. The prep is the WORST part.

It has gotten better over the years. If you go for one, do NOT let them give you the jug full of powder. I've had much better luck with prep-o-pik.

The other PITA is they generally won't let you go for the procedure by yourself, since you're under anesthetic and don't trust you to get home OK. That means you have to find a friend who is willing to wait 2+ hours for you.

Yeah, drinking a gallon of anything that fast is no fun, but the laxative they gave me was terrible. The worst part was that I tried drinking it cold, which made it sit in my stomach and build up, so I ran out of space to drink more. I heated it up, which got things moving again, but made it taste even worse.

I will say though, after having the colonoscopy, my general bowel symptoms(never ending gas, mostly) improved dramatically. I'm thinking about doing a chemical cleanse every year just to keep things working fine.

You reset your microbiome; I think this is what the colon cleanse people are trying to achieve. I usually try to take good probiotics and eat right (avoid processed foods, especially sugar) after to try to establish good gut bacteria.
I've tried all kinds of probiotics, different kinds of fiber, I regularly eat yogurt and kefir, even prebiotics. I've had normal diets, and low-carb diets(not keto). Nothing ever made a significant difference until I did the cleanse. It wasn't even a natural cleanse. It was 2 gallons of chemicals.
My doc. said he always uses the pills with water to prep for his own colonoscopies. I did the same (I believe the pills were named OsmoPrep) - 4 pills every 15 min with 8 oz of lukewarm water. Not pleasant but quite tolerable for me, and I will again ask for pills the next time.
My prep was a stimulant, I think Bisacodyl, followed by a gallon of polyethylene glycol solution (they had me use sport drinks that weren't red).

I didn't particularly enjoy it, but it wasn't a problem.

I think people will have different tolerances to different protocols.

Good advice, and I've edited my comment above to clarify. I've only had to two rounds of bowel prep so far - albeit on two different types of prep stuff. Had the jug the first time. I'm sorry to hear about your experience with it.
The laxatives make you puke? Is it from the flavor/consistency or something else?
After a while, its like your system realizes what you're putting into it and just eventually rejects it. Its not a squeamish thing. I can always swallow all of it. Its just that it comes back up some time (~1 hour) after drinking when I'm near the end of the prep.
> They are easy and painless.

They usually are, for most people. But for me the first time I did it was the most painful experience ever. So painful in fact that they had to abort it and book me for another time and that time I went under.

That was before my surgery and when my intestines were all over the place. That being said, after my surgery in which they corrected the placement of my intestines, it was painless. That time, the last time I did it, I chit chatted with the doctor and nurse and it was funnily a pretty relaxing experience since I'd gotten some mild drugs before because I was nervous it would hurt as it did the fist time.

I have done a colonoscopy 3 times.

Absolutely agree. I got one a few weeks back, the colonoscopy itself was painless, the prep is the worst part. They found some benign polyps, which were removed. Yes, people, if you have a history of colon cancer please talk to a gastroenterologist ( my dad was diagnosed with colon cancer in early Feb and I had to get it asap since it's hereditary) Colon cancer is the most common type of cancer and recent guidelines have changed the age of getting a colonoscopy from 50 to 45.
Colonoscopy is absolutely painless. However, in my case, when I woke up, they took forever to tell me the results (about 30 mins), so expected the worst. I'm an incredible patient person, but in this case I got up of bed and screamed to the nurses: "can you just tell me news now? I can handle it." I later realized they were just having a printer problem, and the doctor had left and they couldn't reach him to speak to me, but everything had come out ok. But I hope people are told the news immediately after they wake up (whether good or bad); some of us have been contemplating impending death since being referred for colonoscopy. They were the longest 30 mins of my life. I've never screamed at somebody, and I wonder whether the anesthesia had anything to do with it.
In US, if I have no symptoms, can I just get it done as a preventive care? I doubt that wothout a referral. Has anyone done that? I m approaching 40 and wondering
Maybe? I think they're recommended for everyone at 50 years, but for anyone else I don't think they would normally recommend getting one unless you have some symptom or family history of cancer.

Getting a genetic test might be another option if cancer is what you're worried about. Not as accurate as a colonoscopy, though.

I would take 5 colonoscopies instead of gastroscopy any day... It really is not a big deal. I was a quite high but I managed to actually watched the camera feed during procedure. The only problem later on was that I had trouble of putting my clothes on and do anything that needed little effort for at least one hour, because of the wonderful drugs.
It isn't that common in america but most of the world does colonoscopies without anesthesia. Without complicating conditions there is little more than minor discomfort and without anesthesia are very quick and much less expensive. With a little searching you should be able to find a doctor who will do the procedure that way.
Interestingly, colonoscopies here in DK are mostly without anesthesia. I prepared by looking at mostly-American sites where some doctors said 90% of patients prefer full anesthesia, and the rest some other sedative drugs.

The procedure was 20 minutes, painless and slightly uncomfortable where the nurse had to push on my stomach to help the probe round the guts, that was like some brief constipation. You get to your appendix from the inside and physically realize how much the colon takes up in your body.

BTW, in Denmark, a 40+ yo patient with rectal bleeding that cannot be physically confirmed as hemorrhoids by the GP would likely be referred to the emergency cancer track, with I think, 2 weeks before all the tests have to be finished.

I didn't know it was painful enough to require anesthetic. Consider me mildly more relieved.
It's uncomfortable but not painful really. I've had a few as I have celiac disease. Let's say that you don't have to worry about choking like with a gastroscopy, which I "luckily" had booked for the same day as the colonoscopy. I've never been sedated or had any anesthesia for either, it's really only the air afterwards that's painful, but that's not worse than when your stomach is upset during a flu or something.
It isn’t. Considered better too do it under a milder sedative in most cases I think as there are fewer side effects.

I checked and general anesthesia seems to he a custom used in some regions of America. I’ve had 3 colonoscopies and been awake for each one. They aren’t painful in the slightest and you get to watch them on screen! Anyone who gets one should talk to their doctor about sedation options.

I don't think it's a matter of being painful necessarily (though it might be, depending on what they do), but rather most people just don't want to be awake for what is at best a socially awkward experience. I've had several, and I'm grateful to have been unconscious. (They had to wheel me back in once without sedation to take another look around a biopsy site to make sure I wasn't bleeding too much. It was kind of interesting, but not terribly pleasant.)
My understanding is that in many places they are regularly performed without anesthetic so they must not be that painful.
They do pain research on people getting colonoscopies because it varies so much. A lot of people do find it unbearably painful. It's a relatively small fraction though.
> They are easy and painless. Waking up from the anesthesia I felt more relaxed than I ever have in my life.

Alternatively, you can opt for no anesthesia/sedative, if like me your major concern is lingering after effects (and a fear of going under). I had a colonoscopy and an EGD in the same visit, really wasn’t a big deal. Also quite fun to see your insides on the monitor — gave me peace of mind to see perfectly uniform pink healthy flesh, as opposed to some of the craziness you can find on YouTube.

The prep juice tastes so nasty but you are right about feeling refreshed. After the colonoscopy I had intense cravings for a cheeseburger and milkshake, but let me tell you that was a mistake! It gave me the worst acid reflux. Keep in mind your insides are virgin again after the prep juice. It causes you to shed the lining of your stomach, I'll be smarter next time.
>Also, the prep of clearing your system will reset your digestive system and you'll feel like a new person. I think the prep cleared out whatever it was that was causing us to investigate my digestive system in the first place.

I had the exact same feeling afterwards. The issue has disappeared since, and that was 2 years ago.

As a data point: I met a service technician for colonoscopy equipment (in good spirits) and he said he wouldn't recommend one.

From my past experience, I'd recommend MRI over anything else (especially CT scans), though it's apparently not as useful in diagnosing bowel stuff as colonoscopies.

These are almost lateral approaches and very different from each other though, with MRI being more like a sonar scan and colonoscopies more like sending a submarine equipped with a camera into the depths.

Both can be very useful and helpful in aiding diagnosis with more data points.

Case in point, I have had an MRI (which showed nothing), several CT scans (which showed temporary blockage) and both methods have not really led to a conclusive diagnosis.

I have a family history of colon cancer, so get them done periodically. The procedure isn't terrible, but the prep is worse. Pretty sure I need seat belts for the toilet for that day. Otherwise... meh. Beats dying.
I second this - I've had about 10 colonoscopies/endoscopies in my life (due to a medical condition) and it went well each time, no pain as steve said. The prep is also an opportunity for cleansing of the digestive system.
Can you get colonoscopy without any symptoms for family history of colon cancer?
I'm in the US, and have had one colonoscopy at age 33 (to rule out cancer, I had rectal bleeding). It was hemorrhoids, but will have another any month now because of family history of polyps and colon cancer. And I'll have one every 5 years even if I have zero symptoms.
You should specify where.

For example in Germany you can get a colonoscopy paid by the health insurance without any specific reason every 5 years from the age of 50. You can always get one at any age for no reason if you simply pay yourself.

Most insurance policies won't cover a colonoscopy without symptoms or family history, and most gastroenterologists won't recommend one in that situation anyways.
> Also, the prep of clearing your system will reset your digestive system

[citation needed], especially because gut flora isn't something you necessarily want to reset.

That prep is awful! I've had many colonoscopies. The procedure is fine, but oh! That prep tastes horrible!
The day before the colonoscopy, patients are asked to drink a laxative solution that's generally some combination of magnesium citrate or another compound. The taste is generally pretty bad, but you can mix it with some kind of non-colored drink or flavoring powder (or just hold your nose and chug)
Also propofol is fun. :^)
Burned my hand bad when it went in. Felt like someone took a jackhammer to it, repeatedly.
Never had this issue, sure, your hand gets warm and then just dose of. Quite pleasant actually, the rest of the day kind of sucks for me, so. But I do get why people take for non-medical reasons, no idea how you will be able to fall asleep without so, if you use it that way to often.
Bracing for a passel of autointoxication links to bubble to the top of Hackernews, accompanied by anecdata of the form "I started giving myself coffee enemas and my chronic headache/gout/acne simply vanished".
Since "becoming an adult", I've lived in three cities in two countries, which means that've generally had no idea who my primary care doctor is or was, only that I'd need to find one to give me a referral to get this wart on my foot removed.

F?%k, this is way to relatable. Same as the author I'm an expat which hasn't had a GP check in 5 years, not counting getting a dermatologist procedures. I feel like this is an experience of a lot of expats. Those of us coming from small towns mostly had a GP from when we were 6 all the way until we left the town for good. It's difficult to get that relationship with someone else and I'm afraid that it might be a contributing factor to people getting less checked. Also, in my case all the family members went to him, so he kinda knew the family history. I still mourn for him, he would always greet me at the door of his office with something like "wtf, you again? why are you here?". He was an excellent diagnostician...

Same here. I feel odd hearing the commercials nudging me to "ask my doctor..." - I don't have a "my" doctor. I just go to the nearest network clinic, they have my details on the computer and whoever is attending that day looks at them.
Not only expats; I've moved a few times but hadn't bothered to change my GP for over 5 years because I never needed it (thankfully). The last time I needed it was because the skin on my hands was fucked (cold + dry air and a newfound habit of actually washing my hands; vaseline cream helped) and chronic neck pain (treatment didn't help, but changing my backpack apparently did?).

Anyway I bought a house a few years ago and I'm a bit more settled so I've moved to a local GP, and I hope to never need it.

Relatable to a lot of people in the military. Pretty much every visit is with a new person who doesn't know you, they just know the record they reviewed minutes before.
I’ve read that there are some emerging theories of a bacterial component of colon cancer, which I find interesting [1][2][3]. A friend, also in his 30s, recently was diagnosed with colon cancer and it seems like doctors are really noticing an increase in colon cancer among a younger population. It just seems so young to be dealing with it. Regardless, I’m glad the author is recovering and found it early enough!

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625019/

[2] https://www.hindawi.com/journals/jo/2019/5636272/

[3] https://www.healio.com/news/hematology-oncology/20200127/gut...

My fiance was diagnosed in her 20s. Still relatively rare at that age, but the doctors noted there's significant increases in prevalence in young people.
Same here, I was 28. Started to wonder if that could be connected to Tchernobyl, I was in Kindergarten back then. Since t didn't change a thing for me, I never looked for studies around this, so.
Did you live near?
No, luckily. But in a region in Germany that was quite heavily affected. Enough to still have radiated mushrooms and as a result radioactive wild boar, to level that they have to tested on an individual basis. Most cannot be consumed and have to treated as radioactive waste. Again, no idea if that's true, and I honestly don't care that much really. It's just a curious coincidence, if you ask me.
Gut biome is IMO one of the most interesting (and gross) areas of medical science at the moment; this morning's news mentioned a 1 million research starting to investigate gut biome and diabetes.
I feel you on this. I found out I had kidney cancer after my appendix decided it was time to go. I only had 3% of my left kidney removed and that is it. No chemo or anything just sore for a few weeks.

And man do I have guilt and felt like a fake cancer survivor. My experience was so minimal compared to a lot of people. But I realized I am a cancer survivor because of all the mental anguish cancer puts on me. It’s nothing I can ever explain, it is just this super terrible feeling of not knowing. Is my cough metastasized cancer? Probably not but my mind sure loves to think so. Having to deal with my own mortality was a big thing. I wonder if dying of old age causes as much stress and anxiety as knowing you have cancer and could die.

Stage 3 thyroid cancer survivor here at a similar age to the author. I totally feel like a fake cancer survivor but it's definitely turned me into a hypochondriac. I had to get a colonoscopy recently due to my GI issues and some of the symptoms were similar to the ones for colon cancer. I've tried to move on after 2 surgeries, RAI, medication adjustment but mentally it's been tough. I have to get tested regularly to make sure there's no recurrence. The stress and anxiety have been extremely tough to deal with for someone who has been mentally tough all their life.
Same here. TT at 32 last week. Also got a colonoscopy about 5 years ago for (unrelated?) GI issues. What are you looking at for screening going forward?

I'm hoping the median synthroid dose im on ends up working out, but I still have to wait for pathology and RAI.

Edit: if it makes you feel any better all the docs/surgeons ive talked to have expressed that if they had to choose a cancer to get, it'd be thyroid.

Fist bump. In my first year screening, they still found some thyroid tissues in the thyroid bed that hasn't been fully destroyed by RAI. I have an ultrasound and blood work in another 3 months. My synthroid dosage was too high initially as per plan which caused a lot of anxiety, heart racing, GI issues etc. After they lowered it, it's more manageable. RAI is a pain due to the low iodine diet and quarantine but there's no other choice. In my case, it had spread to the lymph nodes so had to get RAI. Hopefully, you don't have to go through it. This is one of the good 'cancers' for sure but it's still life changing in a lot of ways.
Fuck, that sucks. I hope you have someone to talk to, because that constant enxiety can wear you down. In my case it was a very good friend, close family had enough on their hands already to cope with.
I would never have believed it, but cancer changes you. And I can totally relate to the experience, while I wnet through chemo, it was an easy one. Seeing all the others, successfully going through it felt kind of like cheating to me, e.g. I never lost my hair or a lot of weight. Other had to be brouht to the brink of death in order to survive.

One thing I realized was, that I was less afraid of death itself, but rather the process of dying which can be a rather lengthy and ugly thing. Worst thing to happen, eve wirse than the initial diagnosis, was the moment a couple of months after I inished chemo. Some hemorroids started to act up again, and it was a quite realistic scenario that the cancer was back. Damn, I was destroyed by that. The initial diagnosis didn#t realy surprise me, for some reason I kind of expected that after all the tests they did. The potential second one caught me completely off guard, it took me a couple of months to recover from that. looking back, I'd say that was the worst part of the whole thing.

I had a partial nephrectomy several weeks ago due to kidney cancer. You're 100% right about the various feelings that come along with the experience.

Good luck - remember the recurrence rates are comparatively low once you get past a few years.

> And man do I have guilt and felt like a fake cancer survivor.

Just a data point from an third-party observer with no reason to lie to you: your survivor guilt [0] is normal, but you've done nothing wrong and your experience with cancer is valid and I appreciate you talking about it. It's easy to fall for the trap of minimizing your problems after comparing yourself to other people, and it takes courage to be vulnerable and honest about the things that get you down sometimes.

TL;DR: Thanks for your comment.

[0]: https://en.m.wikipedia.org/wiki/Survivor_guilt

> Is my cough metastasized cancer? Probably not but my mind sure loves to think so.

The same when an immediate family member has gone through or died of it.

Instead of being a survivor it’s more like a countdown due to the similar hereditary and environmental factors. Doctors will say “no, don’t worry about that”, the same people could be writing an entry in a scientific journal after your case finally appears.

“Hereditary and Environmental links in X cancer”

God damn it! I get upset when reading this article! The doctor mentioned at the beginning of the article is obviously not doing his job! "Don't worry about it?!" "you don't need another physical exam!?"

Making assumptions without examination is incredibly unprofessional and carries with it potential critical consequences.

If you have an issue and bring it to your doctor and your doctor fails to follow up with an examination and makes assumptions, it is time to find another doctor.

Yep, I was in almost exactly that situation and the doctor said something along the lines of "it's almost always a hemorrhoid, but we'd better schedule you for a colonoscopy just to make sure" and sure enough there was a tumor that wasn't cancerous yet, but could very well have become so and killed me in a few years if nothing had been done.

(It runs in the family apparently; my grandmother on my mom's side was from a large family, with seven or eight siblings. They all died of colon cancer. She got it too, but since she went to the doctor with her symptoms instead of staying at home, they were able to remove part of her colon before it got really bad and she lived for many more years.)

Moral of the story: go to the doctor if you're bleeding from unexpected places.

Thank gd that caught in time in your case. I was beyond the not-yet-cancerous stage when I had the "better have good look now"colonoscopy. Still early enough to still be around, so!
Also, he wrote:

> Not bright red, more like muddy-red. Poopy-red.

Hemerroids are usually a very bright obviously blood-like red. I appreciate he wrote the above description with the benefit of a lot more knowledge than he had when he first saw a doctor, but they should've asked about the colour even if he didn't offer it, and that should've raised extra suspicion immediately.

This happened to someone I know recently. She was a little younger than OP and repeatedly told her doctor how she had symptoms which could potentially be colon cancer but she was repeatedly told not to worry as she was too young and it was probably just haemorrhoids.

This went on for about a year I believe. Things got worse and when test were done she found out she had stage 4 cancer and probably only had a few months to live.

If you have symptoms which could be cancer regardless of your age insist you have the right tests done to rule it out. Most cancer is very preventable in its early stages.

Yep this is exactly what happened to my dad. He had bloody stools, told no one but his 80-year old doctor who said “relax it’s just hemorrhoids” without verifying his claim. This went on for years until he was diagnosed with Stage IV and died five years later at 51. Just one colonoscopy even a year sooner may have saved his life.
I was diagnosed at age 41 with colorectal cancer. My GP had ignored my complaints about it a year earlier, and dismissed it (without a rectal exam) as "probably hemorrhoids." A year later, he thought better of it and sent me for a consult with a specialist who instantly spotted a 5cm mass in my rectum.

A year later, while doing a followup from my surgery, I mentioned how cavalier my GP was to the surgeon who saved my life. He said that many doctors don't really think of colon cancer for anyone under 50 unless there's a family history.

That was 15 years ago, and the medical community has generally understood that colorectal cancer can occur far earlier than previously expected.

Many doctors just aren't very good. I went to an allergy doctor about perfume allergy. They told me it was incurable and probably won't get better, just avoid perfume. I started doing my own research. I found a study result that showed that perfume allergy is psycho-somatic. Then I learned stress reduction techniques and used them to cure myself.
This was a good read.

I have Crohn's disease and in 2015 had 5 ft of small intestine and half of the adjoining colon removed.

Unfortunately my insides were so fucked up that they had to properly open me up (i.e. not keyhole, more doorframe). Then I got sepsis after the operation and was in the high-dependency unit (US equivalent is ICU I think?) for a bit. That was fun. I was there for a few days, but remember about 2 hours of it. My family visited apparently, I had no idea, but I was talking to them, so I'm told.

I couldn't walk for weeks, other than staggering around (which they encourage you to do otherwise the scar tissue will heal too tight). The wound took about 3 months to properly close up, I had a nice deep hole in my abdomen for much of that, you get used to the gory stuff.

I'm generally better now though. Crohn's still dictates much of my daily life though, but you learn to live with it.

Similar situation here. I was traveling, which made it even worse - I literally collapsed at the airport out of fatigue, which turned out to be severe internal bleeding. Thankfully didn't get any further complications although if I had delayed, it would have definitely put me at risk for colon cancer.

It's actually funny that the doctors in my case actually detected polyps in my intestine when I was 18 (showed symptoms since I was young, but all the doctors in India just waved it off as stress - for a 14 year old!). But again, they just waved it off for a long time and gave me meds that suppressed the symptoms. It was only when I was on work travel that the wonderful folks at the Zurich university hospital pinpointed it. Got a second opinion, and indeed it was Crohn's. Indian doctors just kept discounting it because Asians have a lesser tendency to get it, but recent research shows that your diet factors more than where you're from.

My only advice to anyone in my position or similar would be to take full control of your health and try to get the best possible treatment, instead of trying to reinforce your biases. Had I not been able to get checked at a much better facility then, I might have been in a far worse position now.

Don't count on family to be of help as much either, unless it's a spouse. For what it's worth, around the same time as that incident, my grandfather passed away at a ripe old age of 94. He previously complained about stomach aches and toilet issues, often getting grumpy af, but family members just brushed it away as signs of old age (including my parents). In the end, when he was shifted to a proper hospital in India during his final hours (quite literally), the doctors surmised that it might have been stomach cancer all those years. But of course, by then it was too late to take a biopsy and he passed away with the next couple of hours. That advice about recording your family health issues in a notebook is spot on.

Thank you for writing this experience so wonderfully. I can really relate to this journey. Lost my brother to Colorectal cancer 2.5 years back, he was 27 at the time. What happened with Boseman happened with us 15 years earlier(Stage III transitioning to IV). We didn't have any family history of cancer. He was wild type for all kind of known mutations (KRAS, NRAS and BRAF) for the cancer. In simple terms, doctors didn't know what exactly caused his cancer.

I'm also at a good risk of getting it at some point probably. I'm 23 rn, last colonoscopy didn't show any polyps fortunately. Trying to maintain a healthy diet and lifestyle. Every cancer writeup is kinda scary for me.

At the time of diagnosis, my brother was going through stressful situations(his startup, personal life), not able to focus much on physical and mental health. I'd like to know if Chris thinks there was something else that triggered/fueled his cancer apart from genetics.

I'm very sorry to hear about your brother.

Glad to hear you are staying on top of your situation.

As far as triggering my cancer, I have no idea. And I don't think anyone is going to give me any more clarity than that. I don't think it's possible to do so. What they have told me is that more and more young people are getting colon cancer, and they aren't quite sure why.

Thanks for the response. Yeah, medical science is still so much limited when it comes to cancer. I did lot of research on Integrative cancer care post our experience and realized how positive changes to lifestyle impacts the mind and body. Now trying to help others going through similar challenges through self hosted support group sessions.

I've subscribed to your writings, looking forward to them. I'm also a Software Engineer professionally. :)

Nots on da Vinci robot:

High-tech surgical robots aren’t an improvement over traditional operations. [1] For some patients, the robots may be worse. [2] and [3].

[1] https://www.nytimes.com/2019/03/11/health/robotic-surgery-ca...

[2] https://well.blogs.nytimes.com/2013/09/09/new-concerns-on-ro...

[3] https://www.nytimes.com/2013/03/26/health/salesmen-in-the-su...

Not to discredit the potentially valid concerns of these articles but it's not quite accurate to say these aren't an improvement.

I'm a few weeks out from a robotic assisted surgery related to kidney cancer and the recovery time is significantly shorter in duration (6 weeks instead of 3-6 months) than the non robotic surgery. My understanding is that the DaVinci surgical robot also allowed them to be more precise with how much tissue they removed as well.

Hopefully the medical community can get a better sense of when it's appropriate to use such technology but it would be a mistake to dismiss the benefits because of misuse by some surgeons.

FWIW (and not to stop you from getting a colonoscopy—you should!), I have had symptoms like this on and off through adulthood (20 years or so).

For this reason and a couple other IBS symptoms, I've gotten two colonoscopies, one capsule endoscopy, and one sigmoidoscopy in my day. And all have come back negative for anything whatsoever.

Again, if you've got symptoms, see a doctor. But if you're like me and freak out at everything and assume you're dying at the drop of a hat—it's likely not something awful.

Thanks... I've had bloody stools before, (I'm 32), but when the doctor checked, they found a fissure, which I guess was good enough for them to explain the bleeding... Well, now the symptoms are back, and no fissure to be found, so I'm seeing a gastroenterologist tomorrow. Fingers crossed, but I'm thinking I'll get to find out how painless a colonoscopy really is.
You can also get "fecal occult blood tests". Which has nothing to do with the devil, but it's a test which can detect blood hidden in your poo. There are at home test kits. These are as simple to use as dabbing a stick in a turd a couple of times and waiting for the result. Similar to a home pregnancy test.

Our local bowel cancer charity recommends these. If positive, get a colo(no)scopy. If negative, retest in another year or two. These are sent out to everyone over 50 IIRC. They're also recommended to anyone who is younger and possibly at risk.

Thanks for mentioning these. Ordering one now. Didn't realize I could do them from home without a doctor's visit. Last time I did one I had to go to the doctor to get it like 6 years ago.
> They're also recommended to anyone who is younger and possibly at risk.

This! If you have cases in your family, genetical disposition or not, get them as soon as possible. My doctor recommended at least 10 years before the earliest case in your family, which would put my kids at 18. Missing a cancer diagnosis early on is probaly the worst thing you will regret in your life.

This is scary. I had an upper and lower endoscopy several years ago, doctor cut out a sizable but not yet cancerous polyp. He told me to get another colonoscopy after three years (or was it one?) but I haven't done it yet. The last time I went to a doctor to do it was maybe two years ago. She said, "You're too young, how could you have had a polyp?" and sent me home with a take-home DIY stool sample kit instead.

I didn't have insurance, so I just ignored it. Now I live in Taiwan where everyone has insurance but I STILL haven't done it. I'll make an appointment today.

I was afraid to read it - but I'm truly glad I did. I know I'll be closely "inspecting" my poop going forward. I had just started examining my testicles after reading yet another account of testicular cancer.

His library [1] is also worth checking out!

[1] https://www.charlieharrington.com/library

Thanks! I've been writing these #3Sentence reviews of everything I read and posting to Goodreads for over a year now. It's just fun to go back and skim this little library for a quick taste of where my brain's been traveling.
Nice write-up, I'm happy to hear it was only stage 2!

Colon cancer runs rampant in my family. My dad was a stage 3 survivor (it's now been 12+ years), however his younger sister (my aunt) just died about 6 weeks ago after an 18 month battle. She was a former nurse, and had basically missed getting one of her regular colonoscopies. At that time, she was supposed to go every 5 years and I think she went 10 - too long for her age. She ended up with a blockage, which by that time meant things were realistically too late. She was only 64 and in otherwise excellent health. A second, younger aunt on that side suffers from diverticulitis and has had bowel surgery.

The cancer gene also runs on my moms side; an aunt there had both colon and breast but survived both. So, I'm pretty much screwed. As a result of those risk factors and various symptoms, I've personally had two colonoscopies (one just a month ago).

I'm close to 40, and I had a 2mm polyp removed. There's a high chance that such a polyp would have developed into colon cancer within a few years. I'm now on the 3-year plan for colonoscopy checks. The good news is, in general, colon cancer is one of the most successfully treated diseases if caught early enough. Gastroenterologists will tell you that there's no excuse to die of colon cancer if you get regularly checked.

What I would tell people is to get checked by age 40. If you have any symptoms don't hesitate to call a gastro and get in for a check. For most people, it is hemorrhoids or something else - but I've got a friend (39 years old) who was diagnosed with stage 4 colon cancer - the point is this thing is hitting people in their 30s, so it needs to be taken seriously if you're symptomatic.

On the topic of prep, it's not that bad. It's basically 24 hours of suckage because you're on liquid diet for a day, and taking the prep that evening (typically split-prep, some before bed, some in the middle of the night). Try to schedule your colonoscopy for the first thing in the morning so that you don't have to go more than a day without solid food.

(edit: spelling correction)

27 at the moment and reading this thread has gotten me worried as I have a family history of colon cancer. Both of my parents get checked regularly and have had polyps removed. I wonder if I should just go or if it isn’t realistic to worry about it at my age yet.
As I already tweeted the author please consider getting tested for Lynch syndrome if your family tree is full of colon cancer. It will make a major difference knowing the result when talking to the doctors from my experience. Good luck.
I'd talk to a doctor or two. I posted above about a friend diagnosed with stage 3 at 45 who passed on at 49. She too had a family history (aunt, uncle, grandmother)
About a decade ago companies were promoting virtual colonoscopy. This converted a cat scan into a tube video using advanced computer graphics. You still had to do the bowel-prep agony for a clear view.

If the virtual kind saw a problem, it would be followed by the regular camera kind.

They were cheaper than a gastroentreologist. But for some reason they never caught on with doctors or insurance companies.

There's also Cologuard which uses a stool sample to determine if there is any cancer DNA present - if so then a colonoscopy is ordered. Much cheaper than a colonoscopy but a lot of insurance hasn't covered it, though that seems to be changing as the insurance companies realize they could save money.
I just lost my mother-in-law to cancer. It's just a few years ago it was my father-in-law (also cancer). And a three other family member within the last ten years. Definitely was the case for the most recent three that it was discovered much much too late. I cannot advise strongly enough to have even the minor thing check and checked again.

In the case of my MIL, the biopsy first came back as a fungus which we _now_ know was an impossibility.

Like so many other commenters, I had my scheduled colonoscopy and it was a walk in the part except drinking that horribly disgusting prep liquid. That was gross, but I've probably had worse in my young and very stupid years.

I've had the blood bit off and on (mostly off lately, but it happened again recently for a day), but I've always been told by doctors that it's just hemorrhoids, I'm too young to get cancer.

Then Chadwick died, and I'm like, man, he got diagnosed with Stage 3 the same age I am now, and I'm in terrible shape compared to him.

I'm thinking I should probably get a colonoscopy next summer, after this wave of Covid dies down again. Wouldn't be surprised if I at least have some pre-cancerous polyps.

Don't wait until next summer. There's no guarantee that covid numbers will be under better control. Giving a potential cancer/tumor a whole year to grow and spread is IMO a bigger risk than covid.
Don't wait till next summer, the 5 year survival rates between stage 3 and stage 4 are huge. You have to catch this early.
I second this. Lost my brother 2.5 years ago to CRC, what happened with Boseman happened with us 15 years earlier. He was 27. After a year long of chemotherapy for treating Stage III, his cancer returned within 15 days. No family history of any kind of cancer. It's extremely aggressive in young age. Might sound scary but please get screened earlier if possible. It can mean life and death.
Just had a colonoscopy a little less than two weeks ago. The office was definitely less crowded than last time I had one (pre-covid). Now's a good time to beat the inevitable rush, and you might be safer with fewer people around compared to if everything opens up again but covid isn't fully under control.

If you think of each day that goes by a 1% chance of getting cancer, that might work as a motivator. (I don't know if that's an accurate probability, but really I wouldn't risk it. I had a nasty bleeding tumor removed a few years back and it was no big deal because it was caught early and hadn't become cancerous yet. If I had waited a year things might have turned out a lot worse.)

A back of the envelope calculation would say colon cancer poses a higher risk to you than the coronavirus.

The Infection Survival Rate of COVID19 for those 20-49 is 99.98%, according to the CDC:


0-19 years: 99.997%

20-49 years: 99.98%

50-69 years: 99.5%

70+ years: 94.6%

This gives a death rate of 20 out of 100,000 people for the 20-49 age group who get COVID19. And there is no guarantee you will contract COVID19.

I don't know what proportion of people with your symptoms have colon cancer, but I assume it's unfortunately much larger than 20 out of 100,000. The survival rate for colon cancer is highly dependent on how early it is diagnosed.

FWIW, I had to get Covid tested and cleared before both my colonoscopy and my surgery. My hospital has been very serious and strict about covid, and I felt safe to proceed as a result.

Like others, I encourage you to bring it up with your doc and ask about getting tested.

I'm thinking I should clarify some things here.

They did visually confirm inflamed external hemorrhoids a few years ago. I think they also took a stool sample and didn't find any blood in the stool itself, I believe (can't remember what else they tested in the stool), and when it happens it's usually after some significant walking (i.e. a long walk with the dogs), and it's bright red and not mixed in with the stool, so I've been inclined to agree with them.

I had blood almost 20 years ago back in college too, and it took forever for the situation to calm down because I had to walk so much to get from class to class every day (like a 15 minute walk between every class), so I was constantly irritating it. Back then I never got it checked out because I was too embarrassed, just tried to hide it as best as I could.

And when it was really bad a few years ago it was when we were living in a townhome with a dog and I had to go walk him for 15-20 minutes 4 times a day every day, so it was a similar issue to back in college. It's been pretty rare since then (I've only had it happen twice the past two years, and the most recent time it was after we returned from a 3 hour hike).

So I'm pretty sure it's more just the hemorrhoids. I do still want to get it checked, but Covid is more of a concern since I have some risk factors that could lead to a poor outcome. And I'm not even saying wait until Covid "goes away" or anything, just until next summer when it's likely to go down to a somewhat manageable level again (<5% positivity rate), at least in my state. Currently we're about double that.

EDIT: Also another commenter made me aware that you can order and get at-home Fecal Immunochemical Tests (which I'm pretty sure was what I got at the doctors several years ago) to help detect blood within the stool, so I went ahead and ordered one. If that comes back positive, I'll schedule a colonoscopy right away.

Er, actually after consulting with my doctor, since apparently insurance companies aren't required to cover it before the age of 50 and they can cost up to $4000. Maybe with a doctor recommendation insurance will cover it.

Get. Tested.

I recently lost a close friend to bowel cancer in his 30s. He'd been ignoring blood in his stools, and it was stage 4 before it got picked up.

Don't find excuses to put it off.

That's how my fiance found it. Had been happening on and off (mostly off) for 10 years before someone finally recommended a scope. Even then she was in her 20s.
Get it now. Don't wait. You want to catch cancer early, as early as possible. Ideally with colon cancer you get it before things get cancerous and you can avoid major surgery and therapy afterwards. And a couple of months can be all it takes to make a difference.

As other already said, a colonoscopy isn't really bad. It deffenitly beats having cancer by an order of magnitude!

Is there a list anywhere of procedures you can undergo that are worth asking for? Beyond the standard blood pressure, temperature and listening to your heart which feel very comprehensive.

I really feel like I'm due an MOT on my body.

Great article. My father had a colonoscopy for a polyp (luckily non-cancerous). We were extremely worried, and it was so sudden that I couldn't read up on it.

Does anyone have recommended reading for basic cancer knowledge? I'm 32, know nothing, no family history of cancer AFAIK, but I have a large family and I want to start preparing and getting information. Thanks in advance!

It's a tough read without much prior knowledge but the seminal work is: Hallmarks of Cancer by Hanahan and Weinberg (I think this is an updated version: [1]).

It introduces the fundamental features of all cancers. Every cancer ends up with pretty much all of these traits because of strong survivorship bias. Those that don't develop these traits die off.

[1] https://www.cell.com/fulltext/S0092-8674(11)00127-9

If anyone is fighting CRC or is a caregiver, I highly recommend The Colon Club boards (https://coloncancersupport.colonclub.com/index.php). I was on the forum to discuss my mom's CRC, and there's a lot you can learn from there (such as side-effects, experiences, trials, insurance etc). Not to mention the emotional support and inspiring stories.

For trials, there's also https://trialfinder.fightcrc.org/ - created by Dr. Tom Marsilje (a cancer researcher) - who had an inspiring journey both as a patient and researcher.

The specific robot used was likely the da Vinci Xi. https://www.youtube.com/watch?v=_q-YQwFjIj0

Nice explanation of how a robotic sigmoid resection is performed: https://youtu.be/LpzxfMRlBVk

Firefly perfusion assessment time-stamp: https://youtu.be/LpzxfMRlBVk?t=1527

Disclosure- Intuitive employee with no specific knowledge about this case.

Thanks for the suggestions. I do plan on watching these videos about how the robot does what it does, but only after I put a little more time between me and my surgery!
Something to note. You do not have to be "sedated" for colonoscopy. I have had two and requested no sedation for the last one. It is mildly uncomfortable, but not painful.

The "sedation" is not really anesthesia, but rather a drug that messes with your short term memory (and makes you goofy). If you don't like the idea of somebody messing with your brain circuitry, ask not to be sedated.

Do get the anesthetic though.

As a cancer survivor, paranoia saves lives. If something seems out of order, go see a doc.

"Not bright red, more like muddy-red."

That's the giveaway, right there. Bright red blood on your toilet paper is usually just hemorrhoids. Uncomfortable but treatable and not life threatening.

Deep red or "muddy red" blood on your toilet paper means the blood came from deeper within your intestine, and it should always be checked out regardless of how young you are. If your doctor refuses to do so, get a new doctor.

This is highly inaccurate. If you have rectal cancer, the blood will be bright red.

The bottom line is that if you ever have ANY bleeding from your anus, or in your stool, visit your doctor immediately.

(15 year survivor of colorectal stage 3 cancer)

I said "usually" on purpose. Rectal and anal cancer are real things but they're less common than colon cancer in the general population.

I agree with your advice: Any blood in your stool should be checked out. Don't let your doctor talk you out of it.

Thanks for this - you're a phenomenal writer. Informative, funny at times, and most importantly vulnerable. Glad to see you're doing well!
Thanks - I've been reading a lot "about writing" recently, mostly as a distraction from editing my novel about robots and childhood. I think this is a common pattern for struggling writers - "if I just READ about WRITING, then that's almost as good as actually sitting down and DOING THE WORK." All that said, I just finished John McPhee's "Draft No. 4" and highly recommend. McPhee's a master of "creative storytelling" and I tried to incorporate some of his advice into this post (plus some gifs).
If the author reads this (or anyone else cares to chime in), are there any other symptoms that were/are noticed?
You can Google and see more symptoms. Things like unexplained weight loss and overall fatigue are signs. They also say "gas" can be a sign, and I actually did notice I was "tooting" a lot more than normal, although after a certain amount of time, you forget what normal is. I'm not sure if that itself was another symptom, but it certainly was part of my overall feeling of my situation that did lead me to book the doctor appointment.
Colon cancer usually comes with incomplete evacuation, traces/bloody stool, any surprising/major change in bowel habits. Many other diseases have similar symptoms(IBD) so it's difficult to distinguish a bit. In general, any kind of inflammation in body could be a trigger to cancer.
I commented quite a little bit in this thread, but I guess it doesn't hurt to write a summary. I was diagnosed with colon cancer ten years ago at 28 without any family history. It started inocent enough with blood in the stool. Sure enough, I was too young to have cancer, so that hemoroids for a year. It did suck so, that really were hemorroids, because that explained everything. Until it became to frequent, and my doctor recommended a colonoscopy. It was a cancerous polyp, caught early, so.

I had surgery where they removed around 30 cm of my colon and some lymph knots, one of which had cancerous cells. went on to get 6 months of easy, as compared other people I saw and met, chemo therapy. The worst part was, when roughly one month after the chemo finished I again had blood in the stool, a lot of it. At that point I was on a high, after all I just finished chemo and survived, right? Damn, that sucked, worse than the initial diagnosis, back then I almost expected it. Luckily, it wasn't cancer, but it took my months to recover from that scare. looking back, I'd say that was harder than everything before, also because people around me kind of got the hard time going through cancer. They didnt really get why the fact not having cancer was so much harder for me.

What I did learn from that is, that I'm less afraid of death than I am from the process of dying, if this makes sense. And that life is too short to care about certain things. It changed me, and then it did not, it is hard to describe. The things that really helped me was my son, aged 3 back then, having a wife that regularly kicked my ass when I needed it. Especially the one time I was cloe to give up (silly me, but it made sense back then). And having a good friend to talk to about stuff that wasn't for families ears.

One thing, so, that very very few people got was the stress and hardship cancer means for ones family. As a patient you can get, and are offered, all the support from your environment. Your family not so much. And man, was I an ass sometimes back then.

Luckily, I have no genetic preposition for cancer. Still, my kids will get colonscopies aged 16. better be safe than sorry, and a cancer diagnosis is nothing you want to miss. I undertand why people are afraid of the diagnosis, but this is nothing that can be ignored. The earlier cancer is caught, the easier the treatmen and the better the chances of survival. And sometimes, a couple of months can make all the difference.

So yes, get a colonoscopy early, as early as possible and do not wait. Coloniscopies are no big deal, the worst part being the prep and even that got better over the years. And even you find it intrusive and unpleasant, which some people do, it still beats surgery, chemo therapy and potential death.

I cannot stress this enough: Learn your family's medical history and write it down in a note on your phone. You'll be asked for this info 10,000 times before every single appointment. But, more importantly, your family history can be a signal to you and your docs whether are "higher-risk" for certain conditions.

Doctors I've seen don't really care about anything beyond parents and siblings for family history. They wouldn't bother with grandparents' siblings, as referred to by OP.

Has this changed recently, or is it different for some conditions?

Well, the software I had to use didn't allow for grandparent's siblings (so I added those in the notes). But it did ask for grandparents (also also aunts, uncles, and cousins). My mom's one of nine, so this took quite some time!
Colonoscopies are both terrible and awesome at the same time, but you can make it go a lot smoother (pun intended) by avoiding tons of hard to digest food in the two days leading up to the prep, and being very hydrated on prep day.

Alas, I don't have a colon any more, but when I did, I wrote: https://www.jeffgeerling.com/blog/2017/colonoscopy-or-mount-...

Hey Jeff. Your blog's great and I can relate to a lot of it. I somehow avoided an ostomy after having a vast amount of my guts removed, but I sometimes wish I did have one. Do you think your quality of life has improved since having one?
The usual recipe is a colonoscopy at age 50, 60 and 70. To be supplemented by other yearly blood or DNA (cologard) tests.

If you have family history or symptoms you accelerate the schedule.

The problem is that in lots of countries you can't possibly know your history because the medical system is low quality, people just die and you have no idea why your relatives have died.

And if you are diagnosed with cancer - its basically a death sentence unless you have somewhere few hundred thousand dollars laying around, because the best operation surgeons can do in your country is cut out appendix like it is 1990s.

>people just die and you have no idea why your relatives have died

This system actually has advantages. From an outside perspective, it seems like Americans spend an awful lot of time in doctor's offices and obsessing over health issues (a strange way to spend one's life), when the end result will be the same.

Glad you're doing well man, and thanks for sharing your experience with us. As someone who has never liked anyone near his butt -- I feel like I should get over it and get tested on a regular basis -- and will remember to take book. Also will make sure it's real god damn book -- I mean how bad ass is that, reading about the exploits of the world's most famous samuarai while waiting for surgery. Wishing you good health!
MUSASHI is so good! I'm still about 3/4 of the way through it. It's so heavy to carry I was worried it would be over my 10 lb limit during recovery haha, but I'm all good.
Prepping for the colonoscopy is worse than the procedure itself. Get a good doctor, the risks are low but not 0 and, of course, you can google up the worst outcomes. A dear neighbor was diagnosed with stage 3 colon cancer at 45 years old and departed us at 49.
It's hard to believe any doctor could dismiss bleeding from the anus without referring it to be investigated. And yet they do. This is the second time I've heard of a doctor dismissing such symptoms which then turned out to be cancer.
Had one when I was 23.

Cue severe embarrassment when the nurses came around to to my bed to "administer" the colon cleansing procedure , believe nowadays they give you a laxative to drink the night before.

Got a mild sedative and it was not painful at all.

Had one when I was 24[1]. I got a sedative, but was wakeful enough to watch the procedure on a screen above me. The worst part was when they pump air into your ass to widen the colon, and all you want to do is fart it right out.

[1] - Turned out to be polyps, non-cancerous.

Is it ever appropriate to start the chemotherapy every if you are pretty sure it’s only stage 2 like in this case? I feel like I would be paranoid enough to not risk it.
Not sure. My meeting with the "survivorship" clinic is coming up, and I'll be discussing that with them, among other things I'll need to do to stay on top of this. Obviously there is a physical cost to chemo, and they don't want to overprescribe if not needed. So, in my case, I don't think I'll be getting it, but that may change over time.
OMG. How did we survive without colonoscopies in the past. What people miss is that these treatments are invented by out of work surgeons. In this case, out of work surgeons who used to do open heart surgery but were obsoleted by catheters, statins, and blood pressure medicines. They had to find something to do to pay for the wife's Mercedes. Hey. Guess what we found. Colon cancer ! Anyway, by the content of this thread, everyone is more interested in the finest pain medication available by prescription.
Both grandfathers had colon cancer in the age before colonoscopies. One had the lower part of his colon removed, which he had to live with for decades afterwards. The recommendations for colonoscopies are not a joke or get-rich scheme - they save lives.

As for this comment:

What people miss is that these treatments are invented by out of work surgeons.

The technology was actually invented by a gastroenterologist at the University of Michigan in the 1950s based on pioneering research of Narinder Singh Kapany on fiber optics. Ignoring the fact that there are very few "out of work" general surgeons, most colonoscopies are not performed by general surgeons but by trained GI specialists assisted by technicians and specialized equipment.