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Colonoscopy Secrets Revealed...
Posted by: John Rose ()
Date: December 03, 2017 09:39PM

I just received this Comment on my YouTube Channel and had a chance to re-watch this Video - Colonoscopy Secrets Revealed that I made ~17 months ago and I knew that some of you guys might enjoy it as much as I and truth honesty have.

truth honesty 1 hour ago
Hey John, a video of yours from about a year ago was in my recommendations list, I thought it was very helpful and connected a bunch of previous topics you were covering, [] great video thanks!

Btw, the observations I made 17 months ago about the person I started talking about at the 12:34 MM [] still applies today. Everything this person does is potentially Controlled Opposition.

Edited 1 time(s). Last edit at 12/03/2017 09:40PM by John Rose.

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Re: Colonoscopy Secrets Revealed...
Posted by: Tai ()
Date: December 03, 2017 11:37PM

Hi John,
Good video.

Just a few comments.
1) early on around 2 minutes, you talk about old mercury fillings being ok. What I learned though is that the amalgam shrinks over the years and bacteria can cause decay under the filling which can worsen over time. More on this topic another time.
2) you mention the new stuff can be worse than the old stuff. yet if the old stuff contains mutagens and carcinogens, then how can that not be worse, especially since diverticulosis, polyps and colon cancer are such a concern?
3) you didn't really go into detail about the side effects of colonoscopies. Of course, people who absolutely need them, must get them. Yet, knowing the side effects can inspire people to be proactive about their health to avoid letting themselves fall apart to the point where they need one one day. Taking good care of the colon hopefully will keep one out of trouble.


The most common side effects are cramping pain and abdominal swelling caused by the air used to inflate the colon during the procedure. This air is expelled shortly after the procedure, and these symptoms generally resolve without medical treatment.
If a biopsy is performed during the procedure, the patient may see small amounts of blood in the bowel movements after the examination. This may last a few days.
Though rare, there is potential for the colonoscope to injure the intestinal wall, causing perforation, infection, or bleeding.
Although this test is very helpful in finding the cause of many digestive diseases, abnormalities can go undetected. Factors that can affect this include the completeness of the bowel preparation before the procedure, the skill of the operator of the colonoscope, and the patient's anatomy.
When this test is performed, the patient will be given sedating medications to make the test more comfortable. Whenever a medication is given, a risk of an allergic reaction or side effect of the medication itself is present. These IV medications are given under medical supervision, and the patient will be monitored during the procedure to lessen the risk of medication-related complications.


Side effects of screening colonoscopies
According to 'The Annals Of Internal Medicine,' the rate of serious complications from colonoscopy screening is “10 times higher than for any other commonly used cancer-screening test.” This number doesn't include deferred complications, such as internal bleeding, severe anemia, heart attack, stroke, pulmonary embolism, pneumonia, kidney failure, intestinal obstruction, and others.


Possible Colonoscopy Side Effects
Colonoscopy recovery is usually short and uneventful, requiring no more than a day off work. However, a colonoscopy can result in complications, including:
 Ongoing bleeding following a polyp removal or biopsy
 An inflamed abdominal cavity lining, a condition called peritonitis
 Bloating, vomiting and/or nausea, usually resulting from the bowel cleanse prep
 Rectal irritation
 On rare occasions, perforation of the intestinal wall, which can lead to peritonitis

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Re: Colonoscopy Secrets Revealed...
Posted by: John Rose ()
Date: December 04, 2017 12:39AM

Btw, the observations I made 17 months ago about the person I started talking about at the 12:34 MM [] still applies today. Everything this person does is potentially Controlled Opposition.

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Re: Colonoscopy Secrets Revealed...
Posted by: Tai ()
Date: December 04, 2017 12:51AM


Colonoscopy Complications Occur at Surprisingly High Rate
Approaching 2% within a week of 'scoping

by Cheryl Clark, Contributing Writer, MedPage Today
February 16, 2016

When Harlan Krumholz, MD, saw a friend rushed to the hospital "with shaking and chills" one day after his colonoscopy a few years ago, he wondered how often this procedure results in such scary, adverse events.
"For about 12 hours he was very, very sick," Krumholz recalled. And it seemed "a bit much to think the colonoscopy was unrelated; maybe there was a micro-perforation, or a contaminant in the IV" used to administer sedation during the procedure.

It struck Krumholz, director of the Yale Center for Outcomes Research and Evaluation (CORE), that the frequency and severity of harm from this common cancer screening, performed in roughly 14 million people each year, were poorly quantified. It probably varies widely among facilities, depending not just on the skill of their clinicians, but on many other factors related to how the facility functions, he thought.
So Krumholz, whose team has multiple Medicare contracts to develop pay for performance measures for healthcare settings, went to work.
"I came back to my group and said, 'We need a measure for this,'" he said. "How often does this happen and how much does it vary among the outpatient centers? Probably the people who performed his colonoscopy didn't even know he showed up in the emergency department. Because today, there's no feedback to let them know.'"
The Yale team developed a risk-adjusted measure that now has been incorporated in two Centers for Medicare & Medicaid Services quality reporting programs. It provides a count of all healthy fee-for-service Medicare beneficiaries 65 and older who, for any reason, experienced an unplanned visit to the hospital within 7 days of their outpatient colonoscopy -- regardless of whether a polyp was removed or biopsy performed.
As a kind of test, Krumholz and colleagues applied the measure, which factors in the patients' procedures and conditions in the prior year, to Medicare claims databases in four states (New York, California, Florida, and Nebraska) that track unique patient identifiers. With that, they could see what care patients required within 7 days of their colonoscopies.

Two of Every 125 Patients
What they found might surprise many, although it's not out of line with the literature: 1.6% of 325,000 otherwise low-risk healthy patients who had a colonoscopy in the year 2010 experienced a complication serious enough to send them to a hospital or emergency department within 7 days.
For some, "that 1.6% may not seem high," Elizabeth Drye, MD, director of quality measurement programs at the Yale center, said in an phone interview. "But not when you think of how so many healthy people have these procedures. It's important for us to know how many could be having a bad result."
The Yale team's results were published as the lead article in the January issue of the journal Gastroenterology, accompanied by a video interview with Drye.
What's more, the team found wide variation in the rates of emergency visits and hospitalizations across facilities, from 8.4 per 1,000 up to 20, she said.

Extrapolating to a national population of 1.7 million Medicare fee for service beneficiaries undergoing colonoscopies each year, Drye and colleagues estimated about 27,000 would have an unplanned hospital visit within 7 days. That does not include Medicare Advantage enrollees or younger patients 50 to 64 who have an adverse reaction from their colonoscopy bad enough to send them to the hospital.
A lot of things can go wrong even after colonoscopy in an outpatient setting, such as a hospital outpatient department or an ambulatory surgery center.
Perforations or lacerations can cause bleeding and hemorrhage or even infections that don't show up for a day or more; sedative drugs can cause reactions resulting in hypoxia, aspiration pneumonia, and cardiac arrhythmias. Abdominal pain or nausea can also result, possibly from preparation, Drye said.
As early as next year, all Medicare-approved outpatient facilities will have their scores for the measure -- "ASC-12" or "OP-32" as it is now called -- publicly reported on its website.
CMS said in its specifications manual that such transparency "will reduce adverse patient outcomes associated with preparation for colonoscopy, the procedure itself, and follow-up care by capturing and making more visible to providers and patients all unplanned hospital visits following the procedure." Eventually the measure will probably be used to determine amount of Medicare reimbursement to those facilities.

It also will provide "transparency for patients on the rates and variation across facilities in unplanned hospital visits after colonoscopy," CMS said in its rulemaking documents.
The intent is "not to put a label on a facility that looks better or worse," she emphasized. "What we're doing is making this visible to doctors, to gastroenterologists and surgeons and their facilities, so they know what is happening to the patient ... something they don't know now."
When the data becomes public, it will also help physicians determine where to refer their patients.
Beyond 7 Days
Most colonoscopy adverse events occur within 7 days, but even more occur beyond the 7-day period. In a mid-2014 handout, the agency said: "Hospital visit rates after outpatient colonoscopy range from 0.8 to 1.0 percent at 7-14 days." And in its rule establishing ASC-12 as a reporting requirement, it estimated the range of hospital visits is between "2.4 to 3.8% at 30 days post procedure."

But Drye noted also that the risk is even higher on a per-person basis, because one must consider that patients who undergo colonoscopies at recommended intervals -- every 10 years, or every 5 years if polyps are found -- would have from three to six colonoscopies before age 76.
Additionally, the measure also only captures the risk for healthier patients; Those with conditions such as diverticulitis or inflammatory bowel disease, and those with serious chronic illnesses are more likely to experience complications from colonoscopy were excluded from this measure's denominator.
"We were very conservative,"
Drye said. Also, the 1.6% meshed more or less with what they found in medical literature, where a variety of studies using different time frames and definitions of "hospitalization" found rates of colonoscopy complications ranging from .8 to 3.8%.
Rates were somewhat different between hospital outpatient departments and ambulatory surgical centers, Drye added. Their study found that the ASC measure scores "ranged from a minimum of 6.5 per 1,000 procedures to a maximum of 13 per 1,000." Hospital outpatient department averages were slightly higher "with a minimum of 7.3 and a maximum of 16.6 per 1,000."
Public reporting will be a good thing, said Joel Brill, MD, a quality measurement expert referred by the American Gastroenterological Association.
"This forces, or at least helps to begin a dialogue of what percentage of the endoscopists' (and facility's) patients actually have an emergency department or hospital visit within the week," said Brill, of Predictive Health LLC in Phoenix. "Ideally, it should be zero."
And if it isn't, he said, "you need to look at the root causes of why that would occur, and would you could do to bring it down."
Providers should be asking, "what kind of preparation was used, what type of scope did you use, what were the comorbid conditions, what type of sedation or anesthesia – ask all those questions first to find out what's going on. And if there's something there, we need to modify or change our practices," Brill said.
The measure is part of the movement toward value, Brill acknowledged. "We clearly have to move toward avoiding potentially avoidable complications, and that includes avoiding unnecessary services that could have been prevented up front. This could be tipping us off to that."
CMS began collecting this data early last year, and in recent months outpatient surgical centers received their first confidential reports to show how they measure up. Those numbers are not being publicly reported, to give centers a chance to compare themselves and improve before the data go live next year with updates for 2016.
Gastroenterology groups seem comfortable with the new transparency, even though some proceduralists will need to change their practices.
Disbelief Common
Though still, some physicians expressed skepticism, saying they don't see such high rates of complications. Brill thought the actual complication rates are much lower than what Drye found. "It's still a very low risk procedure," he said.
Some emergency room physicians concur.
"(It's) very unusual in my practice at UCSD [University of California San Diego]," said James Dunford, MD, a long-time emergency room physician who now serves as medical director for the city's fire and rescue department. "I know of one case in the past couple of years, and naturally it happened to an MD during a routine screening exam."
Drye acknowledged widespread disbelief that complications are that common. "These outcomes really aren't visible to anyone right now, just like hospital readmissions weren't visible until we started reporting them."
But others say those numbers are quite plausible. Ryan Stanton, MD, an emergency physician in Lexington, Ky., said he was "not surprised. The most common complications I see are perforations that are usually small, diverticulitis and bleeding."
Lorrie Metzler, MD, an emergency physician in New Orleans, wrote that she has not seen "a lot" of patients in the ED with complications, although, she added, she has "seen some with massive GI bleeds after polypectomy."
For Krumholz, the numbers will tell an important story about quality in outpatient settings that has for too long gone unreported. "It's a big area of growth, but a largely invisible area with regard to performance. It's important for us to have a sense of what is being achieved."

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Re: Colonoscopy Secrets Revealed...
Posted by: Tai ()
Date: December 04, 2017 01:06AM


The size, location, and seriousness of the hole can vary, and each colonoscopy perforation has different treatment options. Small perforations often seal themselves off, so they may only require a few days in the hospital with close observation. More serious bowel perforations may require a surgery and possible repair or removal of the damaged area. Rarely, a colostomy bag may need to be placed temporarily or permanently after the damaged bowel is removed. Loss of life is also a possible complication of serious bowel perforations, but this is very rare.


This case involves a healthy sixty-two-year-old female patient with no significant past medical history who presented to a medical facility for a routine colonoscopy to remove polyps. She was discharged shortly after the procedure. She returned to the medical center’s emergency department accompanied by her daughter around two hours later complaining of heavy bleeding from her rectum and severe abdominal pain. While waiting to be seen in the ER, she went to use the restroom. When she did not return to the waiting area after a long period of time so her daughter went to look for her. She was found unconscious in a cubicle, in a pool of blood. She was rushed from triage immediately, at which time a sigmoidoscopy was performed, with clips placed in the area where polyps have been previously removed. After the procedure, the patient continued to have symptoms of abdominal pain and showed signs of a distended abdomen. A CT scan was ordered to investigate the persistent abdominal symptoms but it was not read until four hours later. Four hours later, antibiotics were administered for a suspected surgery-related infection. Once the surgeon in charge of this patient’s care was made aware of the evolving details, the decision was made to perform an exploratory laparotomy. The team found a perforation of about 1 cm, and a large dose of antibiotics was administered intra-operatively. The patient deteriorated postoperatively as the staff had difficulty maintaining the patient’s blood pressure within a normal range. The patient passed away within a few hours of the laparotomy.

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