Colonoscopy before tx?

[Cindy10]

Sorry to make a new post but had a question and did not want to interupt someone elses post. This question is for hubby.

48 yr male - hcv for 28 years, gt 3A, VL 60,000 compensated cirhosis (from stage 2 in two years).  Dont have all the labs results yet, but recent one showed

WBC 4.7
RBC 5.02
HGB 15.4
Platelets 75,000

She said they went even lower. Doc ordered tx, says he needs to go 48 weeks (we understand). He finish up some dental work, went to heart doc (thought he had murmur but didnt) all set to go. Just had updated lab work last week getting ready to start tx. NP called and said dont start tx yet doc wants to see you first. Blood counts are low and not even treating yet. She said he will probably order colonscopy first. My question is why? They did not do this for me. What are they looking for?  Any thoughts on this?   Thought we were all set to go but delayed now 4 weeks until doc see him.

Trying to guess what there are thinking, she was vague on phone. Just said want to make sure we have all our ducks lined up first!  

[mikesimon]

To be brutally honest with you I had idiots treating me pre-transplant and it's lucky I didn't expire at their hands. The first time I bled out was early January 1995. My PCP who had the blood work told me I was an alcoholic and I was still in a degree of shock so I almost believed him. It was April when I bled out again - I had a jerk for a GI too and I could have sued him for malpractice and had he treated me right I wouldn't have bled out again - and a different GI treated me for the varices. He was the first guy's partner if you can believe that. He didn't know what to say when I started questioning him but he told me the truth. I asked him why I had this problem and he said HCV. I asked him when that was discovered and he said January. I went back to my PCP who diagnosed me as an alcoholic and went off on him. It's a funny story - now that it's over - but I won't bore you with any more of it. It figures that a colonoscopy would be forgotten or overlooked or maybe he wasn't in the mood. Mike

[Kalio1]

oh, well that was a wrong guess by quite a margin
I'd guess you are right. It wasn't high enough on the hierarchy of importance.

[mikesimon]

I was cirrhotic and quite advanced, which is why I bled out from varices. Maybe there was so much distension in my esophagus that they figured there wasn't enough blood left to distend any vessels lower down - I'm kidding here. I don't think I was getting very good care at the time on a number of fronts so that's likely why the colon got overlooked. Mike

[Kalio1]

Maybe the reaaon they did not do one is your liver wasn't cirrhotic? I'm guessing here, I don't know if you had cirrhosis or not at that juncture.
I was just thinking maybe it wasn't that they "missed something" but that without cirrhosis being indicated they didn't feel there was a need for it? I've only seen it recommended for those with cirrhosis.

[nitramog]

I've been checked rooter to tooter every six months and 60 days when they are watching some thing, platelets and other tests have something to do with there desisions

[mikesimon]

Indeed, it appears that you are correct, which a little reseach would have revealed had I bothered to check first. I was right - it did slip through the crack - and I am really happy that I wasn't being treated by my surgeon at the time or I would be even more stressed than I am. That probably accounts for his bewilderment that I hadn't had a colonoscopy prior to transplantation.

<A HREF="http://www.medscape.com/viewarticle/506575/">Hepatobiliary and Pancreatic: Colonic Manifestations of Portal Hypertension</A>
Mike

[Kalio1]

I was told with cirrhosis they check "both ends" for varices.

[mikesimon]

From:http://www.mayoclinic.com/health/esophageal-varices/DS00820/DSECTION=6

Screening and diagnosis

If you have cirrhosis or other serious liver disease, your doctor may screen you for esophageal varices, sometimes as often as every year or two. These tests are usually used to look for varices:

    * Endoscopy. For this test, your doctor inserts a thin, flexible, lighted tube (endoscope) through your mouth and into your esophagus. If any dilated veins are found, they're graded according to their size and checked for red streaks, which usually indicate a significant risk of bleeding. An esophageal endoscopy takes about 20 to 30 minutes, and the risks are generally minor. The most common side effect is a sore throat from swallowing the endoscope.
    * Imaging tests. Both computerized tomography (CT) scans and magnetic resonance imaging (MRI) may be used to diagnose esophageal varices. Unlike an endoscopy, these noninvasive tests also allow your doctor to examine your liver and circulation in the portal vein. But imaging tests aren't as effective at finding varices as endoscopy is, and they're not as useful for determining which varices are likely to bleed. For that reason, they're most often used in addition to endoscopy or when endoscopy can't be performed.

[mikesimon]

I had 2 major bleeds from esophageal varices and after I had injections through endoscopy to disolve the varices I was monitored  with endoscopies every 3 weeks. After transplantation my surgeon asked me when I had my last colonoscopy. I replied that I never had a colonoscopy and he then asked how I got a liver transplant without having a colonoscopy. I replied that it must have slipped through the crack - honestly that's what I said. The point of this stupid tale is that I don't believe colonoscopy is the procedure used to check for varices - it's endoscopy to check for esophageal vavices but perhaps vessels can get distended elsewhere but I would think that I would have been checked if that's the case, considering I lost 4 units the first bleed and 4.5 the second bleed. Mike

[FlGuy]

Doc might just think that he's getting to the age at which he needs to be checked out top to bottom, so to speak. If your hubby has low platelets now, they'll probably go lower on tx and docs will be reluctant to do such testing with low platlets, low wbcs and maybe impaired PT time.  So, depending on how long tx is , those tests may be out for a year or more. I had both, endo and colon, shortly before tx, for two reasons.  The colon, because I was due.  The endo because of cirrhosis to see if anything was up in the varacies category.  Personally, I wanted to have a good baseline of where I was medically, knowing that tx was going to be a haul and I wanted the stuff that I needed to get done out of the way.  Also went to see an endocrine doc for his kind of stuff.  The scopes are not fun, but sooner or later hubby needs to deal with it.  My feelings were to clear everything out of the way to have the sole focus on tx.  In week 7 and still alive.

[northstar]

My doc had me get the colonoscopy and endoscopy same afternoon. Wheeeeeeee! Now theres fun!
They found some polyps, and now there gone,.....so it can be a good thing.

[Kalio1]

Maybe call the doc and ask why, but I know they sometimes check "both ends" for signs of varices, however he could have a totally different reason for doing it too, like the reason neptune suggests. I wouldnt worry too much that it is a "bad sign"

[Cindy10]

Thanks Kalio! I will see doc next week for me and I'll ask him!

Northstar, lucky you what a day that was! I've had an upper a couple times but that it cant imagine both in one day.
Your a trooper!

Fl Guy, glad to hear your doing well. I had not thought of it that way. Your right by the time he finishes tx he will be due for it anyway. Maybe he figured he would check it out now.
I was only concerned because it came up as part of the conversation about his blood counts. But I suppose better to be safe than sorry.

Hubby's not worried, he say he leaves the worrying to me, I do enough for both. He figured once he had the biopsy and endoscopy, how bad could it be.  He'll find out the day before ;-)

Thanks you guys, as always good to talk to others!

[Cindy10]

Very interesting, thank you for your thoughts on this, you too Kalio. Guess we will just wait and see, drives ya crazy waiting
all the time.  He too, thought it was strange, because of his age. But I said they must be looking for something else other than routine. When I get the lab work I'll check to see if thats on there.

Thanks again!

[neptune235]

Well, no--I don't know what to think.  I can only relate my own experience.

I had blood work drawn, they noted the rising AFP, then scheduled the colonoscopy and CT.  I was 47yo at the time, so too early to begin standard screening.  With all that being normal, then then scheduled the biopsy (my second, five years after a 1/1).

That bx showed advancing liver disease (3/3) and hence the reason for the rising AFP.

It sounded like the same pattern I went through, which is why I asked about the AFP.

But, it could, obviously, be for a bunch of differing reasons.

[Cindy10]

So you think this is normal, that they would want to do this before he starts tx?

[Kalio1]

glad the "other one" was normal, I hope this one is too! My husband just had one he said it wasnt bad at all. He even liked the stuff he had to drink because he likes lemon LOL

[neptune235]

It's a tumor marker--the level can rise due to hepc, or it can be an indication of a tumor, either on the liver or elsewhere.

My AFP started to rise out of the normal range--they did a colonoscopy, then CT of the abdomen.  All clear.

I've never heard of varices in the large intestine, only the esophogus, due to increased pressure in the portal vein.

[Cindy10]

Not sure what that is, dont see it on the last lab result. They could have the other day but I dont have those yet.

What is it?

[neptune235]

Did they do AFP blood test?

[Cindy10]

He already had the other one and that was pretty normal.

[Kalio1]

My undersatnding is they will be looking for varices. This can happen with advanced liver damage. They want to do one end but didn't mention the other? They also check for varices via your esophagus sometimes.

Soundslike he is just being thorough.