Are You Too Old for a Colonoscopy? One Doctor Weighs In.
It's a question many face as they age: At what point do the benefits of preventative screenings like colonoscopies outweigh the risks? Dr. Keith Roach tackles this very concern in his "To Your Health" column, offering some thoughtful insights on a complex decision.
The Colonoscopy Conundrum:
J.G., a 78-year-old with a history of high blood pressure and a past aortic valve replacement, wrote to Dr. Roach seeking advice. He'd had a negative colonoscopy in 2003, but a 2013 colonoscopy revealed a 3-mm tubular adenoma (a type of polyp). His 2019 colonoscopy was clear. J.G. is understandably concerned about the risks of repeated colonoscopies. Is it time to stop?
Dr. Roach's response is nuanced. The standard recommendation would be to consider another colonoscopy around age 82 (in 2029, for J.G.). He acknowledges that many people might choose to discontinue screenings at that age. But here's where it gets controversial... Dr. Roach states that if J.G. were his patient, he'd likely advise another colonoscopy, primarily due to the previous tubular adenoma. These types of polyps can, over time, develop into colon cancer.
He reassures J.G. that while colonoscopies do carry risks, his existing conditions (high blood pressure and valve replacement) don't significantly increase those risks, in Dr. Roach's opinion. If the subsequent colonoscopy is negative, then, according to Dr. Roach, J.G. could confidently discontinue future screenings, as the likelihood of developing colon cancer within his remaining lifespan – even if he lived past 100 – would be minimal.
Dr. Roach emphasizes that he would respect J.G.’s decision to forgo further colonoscopies. However, he believes that for relatively healthy 82-year-olds with a history of premalignant polyps, the potential benefit generally surpasses the potential risk, even if the most recent colonoscopy was clear. This is because even small polyps can sometimes be missed during the procedure.
Discussion Point: Some might argue that at a certain age, the focus should shift from preventative measures to quality-of-life considerations. Is there a point where the anxiety and potential complications of a colonoscopy outweigh the benefit of potentially catching a slow-growing cancer? What are your thoughts?
What Exactly Is a Fever? And When Should You Worry?
We've all been there: a nagging feeling of being unwell, followed by the inevitable temperature check. But what exactly constitutes a fever, and when should you be concerned? Dr. Roach addresses this common question in his column, offering clarity and practical advice.
A.O.A. writes to Dr. Roach, noting that they typically run slightly below normal temperature and seeking guidance on when to worry about a fever.
Dr. Roach clarifies that while 38 degrees Celsius (100.4 degrees Fahrenheit) is often cited as the fever threshold, it's not a universal truth. Body temperature fluctuates based on several factors: time of day (lower in the morning, higher in the afternoon), age (older individuals tend to have lower temperatures), and individual variations. And this is the part most people miss... A more accurate indicator of a fever is an increase of 1-2 degrees Celsius (1.8-3.6 degrees Fahrenheit) from your individual baseline.
Large studies have shown that the "average" person's temperature falls between 36.6-36.8 degrees Celsius (97.9-98.2 degrees Fahrenheit), meaning many people are actually below what was traditionally considered "normal." Furthermore, the range of healthy temperatures is quite wide, with 99% of studied individuals falling between 35.3-37.7 degrees Celsius (95.5-99.9 degrees Fahrenheit).
Elevated temperatures are often linked to infections – viral, bacterial, fungal, and parasitic infections can all trigger a fever. However, it's crucial to remember that non-infectious causes can also lead to elevated temperatures. Heatstroke, certain medications, excessively high thyroid hormone levels, and bleeding within the brain can all cause dangerously high temperatures.
So, when should you worry? Dr. Roach suggests that a low-grade fever (typically 37.5 degrees Celsius/99.5 degrees Fahrenheit, or 38 degrees Celsius/100.4 degrees Fahrenheit) accompanied by typical cold symptoms is usually not a cause for alarm. Acetaminophen (Tylenol) can be used to manage the fever. Higher fevers, however, warrant a call or visit to your doctor.
But here's a crucial caveat: Dr. Roach emphasizes that a person can have a severe infection without a fever. Older adults, in particular, may not mount a strong fever response. Therefore, signs of serious illness (such as cough and confusion, which can indicate pneumonia in older individuals) should prompt immediate medical attention, even in the absence of a fever.
Food for Thought: Given the variability in body temperature, do you think relying solely on a single temperature reading is the best way to determine if you're sick? Should we all be tracking our baseline temperatures to better identify deviations? Let us know your thoughts in the comments below!
