Wednesday, December 31, 2003

Preventing the growth of polyps

By Dr. Mitchell Hecht
Knight Ridder Newspapers

Q. I have been getting colonoscopies yearly since 1999, the year my older sister passed away from colon cancer. Each year, polyps have been found and removed. Is there anything I can do to prevent their growth?

— R.G., Merrick, N.Y.

A. As long as you’re having regular colon surveillance, removing any colon polyps seen, you’ll be fine. Colon cancer doesn’t just show up. It starts out as polyp, an outgrowth of tissue from the wall of the colon.

Although your polyps seem to grow rather quickly, most polyps grow over several years; the time it takes from the beginnings of a polyp to early colon cancer is estimated to be 5-10 years.

What causes polyps? We’re not certain, but it definitely appears that genetic factors play a part. Beyond that, we know that a diet high in saturated fat and cholesterol increases the risk of colon cancer. A high fiber diet helps to speed the passage of stool through the colon, so there’s less time for the colon lining to be exposed to various toxic substances formed by intestinal bacteria. Fresh fruits and veggies contain anti-oxidants which may protect the colon’s lining. Age is a definite risk factor. Colon cancer is pretty uncommon before the age of 50, but rises rapidly as we age.

By the way, not all colon polyps are precancerous. Some are “hyperplastic” and have no malignant potential. But you can’t tell just by looking at them. They need to be removed and sent for biopsy.

Two new technologies are available to screen for colon polyps. The first involves swallowing a video capsule and taking pictures along its path. While it may be an option for low/average risk folks, its limitation is that any polyps seen cannot be removed. Virtual colonoscopy uses CT scanner technology to take 3-D images of the colon. Its limitations are that small polyps might go undetected and any polyps seen cannot be removed.

Q. Can you write about diabetic neuropathy? — M.M., Allentown, Pa.

A. One of the complications from years of diabetes can be permanent nerve damage — especially of the feet. While some folks simply lose the feeling in their legs, others may experience painful burning that can be quite debilitating. But diabetes doesn’t just stop there. Other nerves may be permanently damaged, including the nerves that supply the heart, brain, eyes and digestive tract.

Once the damage is done, there’s nothing we can do to reverse it. That’s why it’s so important to identify folks who are diabetics and don’t know it. Most folks who are diagnosed with diabetes probably have had it for a few years before it was picked up on bloodwork.

A fasting blood sugar of 126 or higher on two or more occasions means you have diabetes. But we do see diabetics with fasting blood sugars under 126. A helpful test for suspected and known diabetes is called a “hemoglobin A1C.” Although not intended as a screening test, it gives a ballpark average of blood sugar control over the last 3 months. A reading of 6.0 percent or greater means you’re a diabetic. Good control of diabetes is a reading of 6.5 percent or less. The better the diabetic control, the lower the risk of long-term complications.

Controlling pain from diabetic nerve damage is difficult. Oxycontin is a very powerful narcotic with great pain control, but with potential for abuse when used long-term. One surprisingly effective approach is to use anti-seizure medications like Topamax, Lamictal and Neurontin. Some have found relief with a low dose of the antidepressant Elavil, 25-50mg at bedtime — even if there’s no depression. Capsaicin cream, an extract of the pepper plant, can cause numbing relief of a burning diabetic foot. One last treatment that’s sometimes overlooked is to improve blood sugar control. Those with sub-optimal diabetic control often find dramatic relief from diabetic leg pain by simply taking more medication to lower their blood sugars into an acceptable range.