Dear Dr. Roach: After my doctor moved, my new doctor would not order me a colonoscopy because I had turned 90. Are all doctors like that? My family is loaded with cancer. My mom had two colon cancer surgeries and died at age 99. Why can’t I make my own decision about it? I would rather not wake up from a test than to have cancer. I lost my daughter at age 56 to this beast.
J.B.
Screening for colonoscopy (a test performed to detect cancer in a person with no symptoms) is not recommended in people past the age of 85. This is because the colonoscopy is a bit riskier in people who are older, but also because the harms of screening come right away, while the benefits usually take years to become apparent. Most people over 85 will have more harm than benefit from a colonoscopy.
However, guidelines are only a starting place. You may be one of the few people who would have greater potential benefits than risks of the procedure, due to both your family history of colon cancer and your family history of exceptional longevity.
I very seldom make a flat refusal to consider a patient’s strong desires for screening. You should receive a good explanation of why the benefits are smaller and the harms greater than they were when you were younger. Also note that it may be difficult to find a gastroenterologist willing to perform the procedure, as the guidelines do not recommend a screening colonoscopy at your age.
Dear Dr. Roach: I am 50 years old and have rheumatoid arthritis. I am treated with methotrexate, celecoxib and Tylenol. I have severe pain in the hip, and I am afraid I might need a hip replacement. Is there any stronger medication to keep me from needing a hip replacement? How long does it take to get over it?
D.A.
Rheumatoid arthritis is one of the most common of the inflammatory forms of arthritis. It is an autoimmune disease that can attack many tissues of the body — not just the joints, but the lungs and heart (among others) as well. The early use of methotrexate (ideally within weeks of diagnosis) and the newer biological agents to treat RA have been effective in preventing the severe joint damage we commonly used to see 30 years ago. Far fewer joint replacements are done for rheumatoid arthritis now; the vast majority are for osteoarthritis, where we don’t yet have effective treatment to stop joint damage.
Unfortunately, once joint damage is done — for example, if RA wasn’t diagnosed early or effective disease-modifying treatment not begun quickly — the damage cannot be reversed. Joint replacement may still be necessary. Hip joint replacement for rheumatoid arthritis by experts has a better than 90% success rate.
“Getting over” a hip replacement is a process, but one that begins quickly, with most people walking (with help by a physical therapist) the day of surgery. Within a few weeks of surgery, most people begin to feel recovered, but will continue to improve over the next six to 12 months. In my experience, predictors for good outcomes include people who remain active as much as possible prior to the surgery and then work hard in physical therapy and at home after surgery.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
