May 29, 2003

Q My doctor has suggested that I have a colonoscopy exam. I have read many articles about virtual colonoscopy, and it appeals to me — no scopes, no discomfort. What do you say about virtual colonoscopies?

A “Virtual” is a word that is in danger of being overused. It indicates that an artificial substitute can replace the real McCoy. A virtual colonoscopy is one done without using a scope. A CT scanner creates pictures of the colon that are said to rival the view a doctor obtains with a colonoscope.

Virtual colonoscopy has definite advantages. As you say, there is no scope — no body invasion. A colonoscope exam, however, is not major trauma. It might be a bit uncomfortable, but it is not painful.

Virtual colonoscopy also has its disadvantages. If the scan detects a polyp, then the doctor has to resort to a scope exam to remove the polyp for microscopic examination for cancer changes.

Virtual colonoscopy is not as reliable at picking up small polyps as is the real colonoscope.

Many people complain about the preparation for a colonoscope exam more than they do the actual exam. It entails cleaning out the colon with potent laxatives. Bad news for the virtual colonoscopy fans. They have to endure the same colon cleansing that real colonoscopy requires.

Virtual colonoscopy is not available in all hospitals. Furthermore, you must find out if your insurance policy covers the cost.

Want to know what I would choose? I’d take the regular colonoscope exam until the virtual exam is ready for prime time. One scope exam is good for 5 to 10 years.
 

Q This past summer my 44-year-old son was stricken with Still’s disease. He was very ill, and it took the doctors a week to come up with the diagnosis. Is there a simple explanation for this disease? What can you tell me about it?

A Still’s disease usually strikes people younger than 35, and it most commonly strikes children. In children it is also called juvenile rheumatoid arthritis.

It is arthritis in adults also, but it is arthritis with some distressing features.

Often patients develop a salmon-colored rash on the trunk, the upper arms and the thighs. The rash comes and goes. Most of the time it appears when the temperature rises, as it often does in this illness. Joint swelling and pain are, of course, prominent symptoms. The cause of it is unknown, but it often follows on the heels of a respiratory infection such as the common cold. There might, therefore, be an infectious cause or an immunity cause, the immune system having been turned on by the respiratory infection.

Some Still’s patient show a complete disappearance of all symptoms within a year. Another group attains a remission but has unpredictable relapses. A third group must contend with it on a long-term basis.

Aspirin is often the drug of choice for this disease. Anti-inflammatory drugs such as indomethacin and ibuprofen serve as alternatives to aspirin. In the very sick, cortisone medicines must be prescribed.
 

Q Have you ever heard of a condition where a person develops a fungus in the stomach from using antibiotics? I know an individual who claims she feeds the stomach fungus when she eats carbohydrates and starves the fungus when she restricts her diet to green vegetables and carrots. Her complexion has turned orange from the carrots. This person sees a doctor who has convinced her that she is allergic to all foods except for green vegetables and carrots due to the stomach fungus. What do you think?

A I think that your acquaintance has gotten most bizarre advice. Furthermore, I think a diet of only green vegetables and carrots is going to land her in nutritional disaster. The fungus idea makes no sense. I hate to break the news to her, but carrots and green vegetables do have carbohydrates. She needs a second opinion — quickly. —2003 North America Syndicate Inc.

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