DEAR DR. DONOHUE: Will you talk about colon polyps? I had polyps removed during a colonoscopy. My doctor recommends another colonoscopy in three years. I have retired, and my insurer has declined to cover my colon because I had something removed from it. I will have to pay for the colonoscopy. When I was working, the insurance company insisted on colon procedures for preventive care. Please advise. – A.C.

ANSWER:
Polyps are small growths sprouting from the lining of many organs. In the case of colon polyps, some of them turn into colon cancer. The problem is that a doctor looking at the polyp cannot tell if it has the cancer potential unless the polyp is removed and viewed with a microscope.

More than 150,000 new cases of colon cancer occur yearly in the United States, and every year there are more than 50,000 deaths from colon cancer. Colon cancer and colon cancer death can be eliminated by removing all suspicious polyps.

Guidelines urge everyone to have a first colonoscopy at age 50. If a polyp is discovered that measures more than two-fifths of an inch, if the polyp has microscopic evidence of dangerous changes or if a person has three or more polyps, that individual is told to have a repeat colonoscopy in three years. Otherwise, if all is well, the next colonoscopy can be delayed for 10 years.

I don’t understand your insurer’s unwillingness to insure your colon, since the company is less likely to lose money on you because you have been conscientious in having the examination and its follow-up. Perhaps a telephone call to the company can get it to change its decision.

If the company won’t budge, I’d still have the scope exam, even if the money has to come out of your own pocket. The assurance that all is well is worth every penny.

The booklet on colon cancer explains this common condition in detail and its treatment. Readers can obtain a copy by writing: Dr. Donohue – No. 505, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My husband has been on the blood thinner Coumadin for five years. At first, the doctor adjusted the dose every time he had his blood checked. His current doctor has kept him on the same dose for two years. I cannot figure out if this is right or wrong. My husband’s visits to him are quick, quick, quick, and no questions can be asked. Enclosed is a sample of his lab reports. Can you explain the prothrombin numbers? – B.D.

ANSWER:
Blood thinners don’t actually thin the blood. They keep it from forming clots when it should not. They’re anticoagulants. The pro (prothrombin) time – your husband’s lab test – measures the activity of prothrombin, a clotting factor in the blood. If the number is low, your husband needs more medicine. If it’s high, he has too much medicine on board and could bleed excessively.

In order to standardize the test results, labs throughout the world now use the INR number, the international normalized ratio. The ideal INR number is between 2 and 3, unless the doctor has told you otherwise. You don’t have to pay attention to the prothrombin time number. Concentrate only on the INR number. Your husband’s numbers are good.

DEAR DR. DONOHUE: When I was a child, a few days before Christmas my mother was not home. I was left alone with my father. He grabbed me and threw me on the sofa and proceeded to give me the most miserable whipping. I could not get this terrible event out of my memory until I married. Since then, I have had flashbacks that lead to holiday depression. Now I have them all year long. Am I suffering from post-traumatic stress syndrome, and should I see a therapist? Or do only soldiers returning from war get it? – H.B.

ANSWER: Anyone who has gone through a terribly traumatic experience can suffer from post-traumatic stress disorder. Yes, see a therapist. This is greatly affecting your life. You need to be rid of the memory – something you are unlikely to achieve without help.

DEAR DR. DONOHUE: I have been suffering from pain that spreads from my left shoulder blade, around my side and to just below my left breast. There is no skin rash. I wonder if this could be shingles. Do the shingles ever not come to the surface? If it is shingles, what is the treatment? – B.K.

ANSWER:
A rare form of shingles called zoster sine herpete causes shingles pain without any skin rash. Its diagnosis is difficult. Proof lies in documenting a rise in antibodies to the shingles virus. A blood specimen has to be taken at the onset of the pain and again one or two weeks later. If the level of antibodies has risen, that’s evidence that shingles has occurred without a rash.

How long have you been suffering from the pain? Shingles pain that continues for more than a month after the appearance of the rash is postherpetic neuralgia and comes from nerve damage. Even though you never had a rash, if your pain has been going on for six weeks, you might have postherpetic neuralgia. The Lidocaine skin patch can often alleviate this pain. Oral medicines like amitriptyline, Neurontin and Lyrica are also effective for some people.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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