A couple of weeks ago on the Healthy Matters radio show we featured two of my colleagues from Dermatology, Drs. Jenny Liu and Erin Luxenberg. You’ll find us in the photo to the left in the WCCO studios in downtown Minneapolis getting ready for the show.
We’re obviously a pretty tense and serious group, eh?
As usual, we get way more calls, texts, and tweets than we can get to on the live broadcast. So for this blog post we are continuing the show, in a way, by having Dr. Luxenberg and Dr. Liu respond to some of the text questions from that show. So if we didn’t get to your question on the air, maybe we will cover it here.
In this post I simply want to invite you to read an essay I wrote which was recently published in a journal I admire. Called Intima: a journal of narrative medicine, it is a literary place where medicine is explored through story, narrative non-fiction, and art.
My piece is called “Don’t worry, at least we will die together” and is an account of an experience I had back in 2015 while in Jerusalem.
In addition to reading my piece, I hope you will explore Intima and immerse yourself in any of the outstanding works that were submitted. The journal, which originated at Columbia University in 2010, is a treasure that I hope many of you will come to know.
I haven’t posted much about my interest in Middle East issues, so I’ll give you just a bit of background. If you do nothing else, please click on the Intima logo above and check out my essay. For just a little more on my experience, keep reading. Continue reading →
As promised in my April 2 post, I plan to do a series of short posts about specific medical topics since I recently returned from “doctor’s school” in San Diego at the American College of Physicians meeting. Missed that post? Re-visit it at “Should you trust the latest medical advice?”
Today’s post will cover C. difficile infections, or CDI. This may be the ickiest post I’ve yet done!
First, a warning. What you about to read may make you go “Ewwww” and may make you wonder what kind of people actually talk about this stuff in polite company. I’ll tell you who talks about it . . . a bunch of doctors in a classroom on a sunny San Diego day. That’s who talks about it. Lucky for you, I’ll summarize here. Continue reading →
By yasmapaz from Puerto Rico, via Wikimedia Commons
I like dogs. And I like peanuts. But like many of you, I also have allergies. Many of us have a love-hate situation with dogs, cats, peanuts, pollen, dust, mold, trees, flowers . . .
Take a look at this puppy. Seriously, I can’t even stand the cuteness.
John B. Sweet, MD
So this past week on the Healthy Matters radio broadcast, I coerced my medical school classmate, Dr. John Sweet, into joining me in the studio. I’ve known John for years since we actually sat together in lecture back in med school. He listened to the professor. I just talked in class. Real surprise, there.
Anyway, John became a terrific allergist. So this week after the show, we decided to record a series of short videos in which John gives us a few nuggets of solid medical info about allergies. This post features two of those videos – one about pet allergies and the other about peanut allergies. (Spoiler alert: no one gets rid of their pet and yes you CAN give your little ones peanuts to help prevent allergies).
Not much reading on this post . . . you get to watch videos! We’re all about multimedia so let’s get to it. Continue reading →
The plaque in this photo above was a gift from a medical student and hangs on my wall right above my desk. It is a saying reportedly from Michelangelo that I use in teaching medical students and residents fairly often.
I even gave a speech to some graduating medical students called “I am still learning.” I don’t even think Michelangelo actually said this at age 87 but the sentiment still resonates. This post is about learning medicine.
This past week I’ve really been going back to school. I’m now back from several days in San Diego at the American College of Physicians Internal Medicine conference. ACP is my professional organization, and our annual conference brings many thousands of us together to learn about the latest in medical science, pick up tips for our practice from some of the country’s top experts, and re-connect with colleagues from around the world.
In the next several posts, I am going to highlight for you some of what I learned at the ACP conference in San Diego. Look for short posts in the coming weeks about:
Clostridium difficile infection
Menopause and depression
Pain control and opiates
Restless legs syndrome
Blood pressure in older adults
Weight loss and exercise
I’ll try to keep these future posts really short and helpful.
Quick reminder about the upcoming #ColonChat. It is THIS FRIDAY, March 24, from Noon to 1:00 p.m. Central Time. My colleague, Dr. Jake Matlock, will join me and others from the HCMC GI Lab for a fast-paced hour using Twitter to answer questions and bust myths about colon cancer. These are people who look inside intestines all day long so you know they are party-type of people.
It’s fun and informative! All you need to do is follow me on Twitter @DrDavidHilden during the hour. Tweet me your comments or questions during the hour using the hashtag #ColonChat, or if you tend toward the whimsical, you can use #ScopeItOut instead. Look for Dr. Matlock’s responses in real time during the hour. We’re bringing some nurses from the GI Lab to answer questions as well since we all know it is nurses who are the real experts!
Here’s a couple of myths we will shred to pieces during ColonChat hour:
Myth: Colon cancer is deadly so there is no point in looking for it. Wrong. We will tell you why it is important to screen for colon cancer.
Myth: Colon cancer is not preventable. The heck it ain’t! Find out why during #ColonChat.
Myth. Colon cancer is mostly a man’s disease. Nope. Women get it just about as often.
Myth: I feel fine and have normal bowel movements so I can’t have colon cancer. Most colon cancer doesn’t cause symptoms!
Myth: No one in my family had colon cancer so I’m not at risk. No no no! Although there is some genetic risk, most people who get colon cancer did not have a family member with it.
For lots more information on colon cancer, I invite you to check out my two recent previous posts on the subject. Here’s the links to them for you to check out, share on social media, and so forth.
True story. . . This past Saturday I set three alarm clocks in preparation for getting out of bed to do my Sunday morning Healthy Matters radio broadcast. It was the start of Daylight Saving Time here in the United States and the broadcast is done live. None of that sissy pre-taped business for me. Oh no. I drag my can down to the WCCO studios in chilly downtown Minneapolis to mumble my way through the show every Sunday morning.
But with that “spring forward” business with the alarm clock, I’m always worried that I’ll miss the show on this particular Sunday. So I set three alarm clocks.
You know what complicates the adjusting of the clocks ritual? It’s that the clocks are smarter than me. It used to be that before I went to bed on DST Saturday, I manually adjusted all the clocks. But now, most of them do it automatically. The nightstand alarm clock does. So does my backup alarm clock on my smartphone. But the microwave doesn’t. Neither does the one on the watch. So I go to bed not sure which device is going to change automatically and which ones aren’t so I get confused and some of them are correct and some aren’t and holy cow am I going to be an hour late and if I wake up at 3:00 a.m. and look at the clocks some are accurate and some are not and I’m going to miss the radio show and there will be the dreaded “dead air” time on the radio and . . . .
Dr. Jake Matlock. Now wouldn’t you want such a happy-looking guy doing your colonoscopy?
Hey, everybody. March is Colon Cancer Awareness Month and we’re going all in (bad choice of words when talking about colonoscopies, perhaps) here at Healthy Matters.
Here’s what we’re doing for Colon Cancer Awareness Month
On Friday, March 3, I wore blue clothes in recognition of #DressInBlueDay which kicks off #ColonCancerAwarenessMonth.
On Sunday, March 5, our live Healthy Matters radio broadcast will feature my colleague Dr. Jake Matlock. He’s a gastroenterologist who will help us unravel colon cancer screening and talk us through a colonoscopy from the guy at the fun end of the colonoscope. (In case you’re wondering, that would be you, my friend, at the no-fun end of the colonoscope!). Read more about Dr. Matlock later in this post. And be sure to tune in to the radio show Sunday, March 5, 7:30 a.m. Central time on WCCO 830 AM in the upper Midwest. It also streams live at WCCO.COM so you can listen anywhere in the world.
Right here on MyHealthyMatters.org, I’m doing posts to help keep you informed about colon cancer. If you missed my recent post (complete with pictures of me in a hospital gown), check it out – it was a popular post called “The one where I get a colonoscopy.” That post has lots of information about the various types of colon cancer screening.
Twitter chat. Later in March (date and time to be announced) we’ll be doing another Twitter chat in which we answer your questions in rapid fire tweet tweet tweet format. It’s fun and (hopefully) informative!
Here’s a guy you should meet
Check out my guest from the March 5 Healthy Matters radio broadcast:
That’s Dr. Jake Matlock. He’s a gastroenterologist at Hennepin County Medical Center and one of the best in the business at treating your various intestinal problems, among them colon cancer. He is an expert with a variety of scopes and skilled at what we call “advanced endoscopy” which means if anybody can get a scope into some dark and remote part of your innards, Jake can. He’s also a great teacher and “explainer of things.”
He was good enough to let me into the GI Lab where he works where I snapped a few pictures. Yes, that’s a real scope. It’s not as long as it looks. Yes it is. I lied.
So I’m fired up to have Dr. Matlock on the radio broadcast tomorrow (March 5). If you missed the show, the podcast will be available here so you can listen on your own device on your own time.
Jake and I did residency together quite a few years ago. I remember him as being the one who made us all just a little less anxious when he entered the room – he’s smart, good with a scope, and a good guy overall. You just get the sense that your patients are in good hands with him.
Famous people with colon cancer
In my last post about colon cancer, (which again, you can visit by clicking here) I described the why and how of getting checked for colon cancer. That post has lots of information, including the various types of tests you may consider. Be sure to read that post if you want to know more.
In this post, I won’t give any more medical information about colon cancer. Rather, I’m going to do something completely different and simply show you a few well-known folks who had colon cancer. Some of them died from it, others got test, treated, and are still going strong today. I think it is sort of interesting.
I’ve included a fact or two about each that I didn’t know but I found cool. I hope you do as well.
Charles M. Schulz
By Roger Higgins, public domain photo
The Minneapolis native and creator of Charlie Brown, Snoopy, and the gang had been having a serious of strokes from blood clots in his aorta. As part of his medical evaluation, they discovered colon cancer which had already spread into his body. You see, the presence of a malignancy (cancer) makes a person’s blood form clots more readily. I don’t know the details in Mr. Schulz’s case, but a big ‘ol clot in a huge artery seems like it was caused, in part, by the cancer. So the stroke could actually have been a manifestation of the cancer.
He died on February 12, 2000 and the last original Peanuts cartoon was published the very next day. He made it clear that he never wanted anyone else to draw his characters after he died.
Probably the greatest coach in the history of football, or maybe any sport, the great Vince Lombardi died of colon cancer when he was just 57 years old. He apparently said to his priest when near death that he regretted not having accomplished more in his life. Guess all those national championships weren’t enough!
I didn’t know this: Coach Lombardi demanded acceptance of everyone in his locker rooms, especially gay football players (he had a gay brother). In a book, his son said his father would “tolerate nothing but acceptance” on his teams. What an example from a true American icon – even back in the 1960s.
That’s the coach with Bart Starr. And though I’m a Minnesota Vikings fan now, I was born in Wisconsin and my mom has a picture of me as a toddler with a “Put me in, Vince” sweatshirt on.
Ruth Bader Ginsburg
From US Supreme Court, public domain
Yup, “Notorious RBG” (a name I just love) was diagnosed with colon cancer in 1999. She underwent treatment, including chemotherapy and radiation. And get this . . . after all this she embarked on a new strenuous fitness program. By her 80th birthday, RBG could do 20 pushups. She is so dedicated to her workouts that she calls her personal trainer the “most important person in my life” (since her husband died). Apparently this workout would challenge someone half her age. Go get ’em, RBG!
And RBG is still going strong, even after she had a second cancer, this time pancreatic. I want to be like her in so many ways.
From her birth on a cotton plantation in South Carolina, Eartha Kitt became a national treasure. Singer, actor, activist. You know the song “Santa Baby”? That was Ms. Kitt. She won three Emmys for her acting and she played Helen of Troy under the direction of Orson Welles. You know the song “C’est si bon”? Listen to Eartha’s version here:
Eartha Kitt was much more than the woman Orson Welles called “the most exciting woman in the world.” She also was a social activist and became involved in issues ranging from working with inner city kids in Los Angeles to peace issues to LGBT rights.
Eartha Kitt died of colon cancer on Christmas Day 2008.
I love the music of Debussy, even though I still remember struggling to learn “Clair de Lune” like so many people learning to play piano. Our son, Alex, can play “Prelude to the Afternoon of a Faun” – well at least he used to be able to (still practicing the piano, Alex?)
Debussy was a French composer in the late 19th and early 20th centuries and he wrote sounds that not many had heard before. But don’t call him an “Impressionist” – he hated the term!
Listen to Clair de Lune while reading the rest of this post:
Debussy was diagnosed with rectal cancer (a type of colorectal cancer) in 1909 and in 1915 he underwent one of the first colostomy procedures ever attempted. It didn’t go well and he was in quite a bit of suffering when he died at the young age of 55 in his Paris home during a German aerial bombardment.
You know who else had colorectal cancer . . . ?
Here’s who: 136,000 people in the United States. In just one year. People like you and me.
You can get this done. If you missed my overview of the ways you can get tested for colorectal cancer, see my earlier post by clicking here. It’s not as hard as you think!
If you live in Minnesota, Dr. Matlock and his team at the HCMC GI Lab would be happy to help you. Call ’em at 612-873-6963. Trust me, there is no one more skilled at this that Dr. Matlock and his team. All kidding and funny pictures aside . . . he’s really good!
Thanks for listening, for stopping by, and for hanging out with me at myhealthymatters.org. Go ahead and subscribe by e-mail if you like, and follow me on Twitter @DrDavidHilden
It seems that about 75% of my life involves nasal congestion with sinus pressure around my eyes. It’s probably allergies to various tiny stuff floating through the air. Not sure about that but I am so stuffy so much of the time that the makers of decongestants have taken to sending me thank you notes for my business.
I’m particularly stuffy in the winter months which I attribute to dust and mold and whatnot floating through the air – especially when Julie (my wife) turns on the ceiling fan in our bedroom. Which is every single night. Even in Minnesota. In winter. When it is 5 degrees outside. Let’s say she likes the place cool. You could hang sides of beef in our room.
At the risk of exposing marital disharmony over the ceiling fan issue, I think the fan clogs me up as it perfectly distributes dust and pollen and such around the bedroom and into my nose. It’s like a fertilizer spreader spewing dust onto me as I sleep! So I pop the decongestants and antihistamines. Yet my sinuses remain perpetually clogged. In case you’re wondering about the marital harmony situation . . . I claim the ceiling fanneeds to be turned off to save my sinuses. My wife claims I just need to vacuum and dust more often. See what I’m up against? How can you reason with such nonsense?
But I digress.
Basically I’m pretty sure I have chronic sinusitis which is a long-lasting inflammation of the sinuses and nasal passages. Inflammation, being my body’s defense mechanism against all airborne invaders, tends to clog up the works in my head. I won’t get into the issue of inflammation vs. viral infection vs. bacterial infection except to say that most of the time the problem is not bacterial and hence antibiotics are not usually needed. Continue reading →
See that brave patient in the picture? Yup, that’s me, just minutes from getting my colonoscopy at HCMC last year. I’ve been meaning to do a post about that experience and now seems as good a time as any. What with turmoil in the country and all, what could be better than to re-live the day somebody put a 5-foot long tube inside me to have a peek?
It must be on lots of minds if last week’s radio broadcast was any indication. The phone and text and Twitter (@DrDavidHilden) lines were full of questions about colon cancer and how to avoid it.
Here’s the podcast of that show for you to listen to if you missed it (Healthy Matters show #420 – 1/22/2017)
I like to have a little fun with most medical topics, and I gotta say that if there ever was a medical topic worthy of humor, it has to be getting a colonoscopy. I mean, really, think about it. It has all the ingredients of a comedy routine:
Gross part of the human anatomy. Check.
Flushing out the entire contents of your intestines. Check.
Baring your rear end to complete strangers while lying curled up on your side wishing you were literally anyplace else at that moment. Check.
Complete surrender of any sense of dignity you had walking in the door. Check.
Passing gas all day when it is over. Check.
What could be more fun?
But colorectal cancer really is no joke. In this post, I hope to accomplish three things:
Convince you that getting screened for colorectal cancer makes sense.
Introduce you to the various ways you can get screened.
Allay any anxiety you may have over the whole subject.
Colorectal cancer: the bad news
In all seriousness, getting a screening test for colon cancer is among the most effective things you can do for your health. In fact, amid all the unpleasantries people endure in an effort to stay healthy, this one ranks way up there in importance. So let me repeat, getting screened for colon cancer is important and potentially lifesaving.
Check out the sobering news on colorectal cancer:
It is common. Colorectal cancer is the 3rd most common cancer in men and women (skin cancers excluded).
It can be deadly. Colorectal cancer is the second most common cause of cancer death in men (behind lung cancer), and the third most common cause of cancer death in women (behind lung and breast cancer).
It is potentially treatable (and dare I say?),curable. Check this fact out – for those whose colorectal cancer is caught early, fully 90% will likely still be alive in 5 years. But for those with advanced cancer, only 15% will still be alive in 5 years.
A quick plug for some of the best medical information on the Internet. It comes from the Centers for Disease Control. For more on colon cancer from the CDC, click here.
It is largely because of that last bullet point that you should get screened for colorectal cancer. There is a dramatic difference in your chances of survival if you can only catch the cancer early on. That is true for most cancers, but it is especially true with this one.
This is a good time to point you toward the American Cancer Society’s Cancer Statistics Center. If you are curious about colorectal or any other cancer statistics, it is a great site to check out. You can sort the stats by your state of residence or type of cancer. It’s cool.
Ways to get screened
Hopefully I’ve convinced you of the importance of getting screened. Or maybe you didn’t need convincing in the first place! Let’s turn now to the various ways you can get the job done.
What you may not know is there are several ways to get your colon checked out. The one we all know and love is the colonoscopy but you may not know that it is not the only way to go. That surprises some people when I tell them that. There is a misconception floating around that the “best” way to go is the colonoscopy and that all the other methods are inferior. Not so, not so. It is the test of choice for many people (it is what I did) but it isn’t for everybody. And if the thought of an invasive procedure leads you to proscratinate forever in getting it, you are not getting the benefit of the test anyway.
As a wise person once said, “The best test for colon cancer screening is the one that the patient will actually do.”
So let’s look at the various tests you can consider:
FOBT and FIT tests
These are the tests in which you submit a little tiny stool sample and the test looks for blood in your stool that you can’t even see (hence the word “occult”). They are similar in that you usually can collect the sample at home, they are not invasive, and they are pretty good at finding hidden blood. They work under the principle that cancers and the pre-cancerous polyps in the colon tend to bleed.
FOBT stands for Fecal Occult Blood Test and sometimes has a little “g” in front of it (g = guaiac, so it looks like gFOBT). It’s the older one of the two and we’re seeing it used quite a bit less today. I think it will fade into oblivion . . . in favor of . . . FIT testing.
FIT stands for Fecal Immunochemical Test (sometimes written iFOBT with the little “i” = immunochemical). It is newer and uses a fancier approach to detecting blood proteins. It has the same advantages as the gFOBT but it has additional advantages over gFOBT in that it is probably more accurate and no dietary restrictions are needed prior to doing the test. Here’s a bit more on the FIT test.
Both of these stool tests need to be done every year. And if they find blood in your stool, you may need a colonoscopy after all! But they are a good choice for many people.
Photo: Nephron via Wikimedia Commons
This is the newest of the bunch. It works in a similar way to the FIT test above, but rather than look for blood, it looks for abnormal DNA in your stool. In other words, it is looking for the genetic “fingerprint” of cancer cells. Pretty cool, high-tech stuff here! The picture at left, though not of the DNA itself, is a biopsy specimen showing colon cancer cells. They are the angry looking cells throughout this piece of tissue.
This test needs to be done every three years but the data is not too certain on this yet since it is so new. It also may not be covered by your insurance. It is really promising though! We will be seeing a lot more of this one in the future, I think.
I’m not seeing too much of this method lately. It is sort of like a “mini-colonoscopy” in that a camera on a flexible tube is inserted into the colon. It doesn’t require the extensive colon flush, doesn’t need as much sedation, and complication rates are lower. Since it only looks at the lower part of the colon, however, it can miss any cancers that are higher up.
This test needs to be done every 5 years and lots of people get the stool tests in addition to it.
This is the one most of us think about. A specially trained doctor (a gastroenterologist – basically a really talented person with an inexplicable tolerance for looking at the nether regions of people) inserts a long-flexible camera into your intestines, all the way to the point where your large intestine (your “colon”) begins. Which is about 5 feet up there. Believe me, they are able to get a good look and simply see with their own eyes if you have a lesion (cancer or polyp). The advantage is that if they see something bad, they can either remove it entirely (like a polyp) or take a biopsy (to see if it is a cancer).
Cool picture time. Here’s a normal intestine as seen by your gastroenterologist (this one is actually in the rectum):
Photo: Melvil via Wikimedia Commons
Here’s an intestine with a polyp (don’t know if it is the pre-cancerous kind or not, but that’s why we take them out!)
The other advantage is that for most people, colonoscopy only needs to be done every 10 years, perhaps every 5 years if they see something concerning.
But there are disadvantages to the colonoscopy. There is a small, but real, risk of perforation, which is where the colon wall gets a hole in it. And this is bad. Remember, your colon is full of bacteria and other unpleasantness. The outside of your colon (in your abdominal cavity) is sterile. You really don’t want the contents of your intestines to spew out into your belly. That can lead to a condition called peritonitis which can lead to sepsis which can be very serious.
Fortunately, this is a rare complication (estimates range from 1 in 500 all the way down to 1 in 6000). And although big perforations usually require surgery right away, many small perforations can heal themselves.
I feel like I should mention this one (technically called CT colonography). It uses x-rays (a CT scan) to look at the colon non-invasively. Super tempting to go this route as it eliminates the invasiveness and thus the risk of colonoscopy. But I don’t see too many people getting the virtual test done. After all, it does expose you to radiation (albeit not a whole lot), and if it finds something abnormal, you still have to get the colonoscopy anyway.
I’ll end with my own story. I figure doctors who are counseling patients to get tested better be doing it for themselves, eh?
So I turned the magic age of 50 a while back and for most people, that is the age where all this colon talk gets real, real fast. I’m talking people at average risk. Others at higher risk (say your dad had cancer at an early age, for example) should do it sooner.
So I decided to go for it on a winter day last year. I saw my doctor (yup, I actually have a doctor that I see, though I have to admit it was turning 50 that prompted me to finally get a doctor of my own. Tsk-tsk, I know). He prescribed all the prep stuff which I faithfully did.
Have you ever done the colon prep? Many of you remember getting such a large volume of the prep solution that you practically needed a grocery cart to get it home. You’d go to the pharmacy to pick it up, and they would push to you across the counter like a zillion gallons of the stuff in big jugs. You’d swear there was a mistake, that you were only getting the prep for one person not the whole family. But it was real. That was the way we used to do it (and still do for some people as it does actually work). You drank the solution the night before the colonoscopy until it came out the bottom end looking just like it did going in the top end – like clear water.
My prep was of the newer kind. Instead of gallons of prep solution, I went the route where you pour an entire bottle of a laxative powder into a bottle of sports drinks and drink it down in a few sittings. Then you wait for the action to begin. And you spend most of the next 12-24 hours in the bathroom. This is a good time to get a supply of reading material and to tell your family to clear out of the place – for their own good.
Sometimes I think the people who devise these prep schemes are deranged.
So I did all that the night before my test. Then I show up for my colonoscopy to the GI Lab at HCMC, which is the hospital where I work. A couple points about that. First, why do they have to call it the GI Lab? Are they doing experiments in there? Second, it does take a bit of self-assurance to get your colonoscopy at your own workplace. I’m sitting there in a hospital gown with my rear end exposed for all the world to see when 2 or 3 people I see in the hallways all the time come in. Tough to maintain any sense of workplace decorum in that situation, I think.
So being the talker that I am, I try to make small talk with the nurse whom I know I will see a few hours later in the cafeteria line. He’s all professionalism, thankfully. And the doctor comes in, but I don’t make much eye contact with her, my backside being the side of interest, after all.
I assure the team that I will be watching my entire colonoscopy on the video monitor, just like Katie Couric did on live television a few years ago. And I really intended to watch because I was genuinely curious to take a gander at my own intestines from the inside out. That’s actually a pretty cool opportunity when you think about it. I thought I did a pretty good job staying awake. But then at one point I looked at the screen only to find out that the doctor was just finishing the whole procedure. She had done my entire colonoscopy and I dozed off for the whole of it!
I went home, had an uneventful day and made it to work the next day as good as new.
My point being: this was no big deal. To prove it, here I am giving two thumbs up:
Sure, the prep was not a walk in the park. But it was not that bad. The colonoscopy itself? Heck I slept through all of it. Did it hurt? Not in the least. Was it embarrassing? Naw. (Yours is not the first nor the last rear end they will see and trust me, they don’t care at all what yours looks like).
I should point out that for some people, the prep really is miserable. For some, the sedation is not as effective as they would like. The procedure can be uncomfortable for some people, even painful. And as I mentioned above, for some (thankfully not too many) there are complications. So your experience may not be just like mine.
But I find that most people, even those who worried about it in advance, the colonoscopy turned out to be much less unpleasant that they imagined.
So if you are over 50 and have not done this yet: my parting advice is to pick one of these tests and DO IT. So many illnesses that afflict us can’t be prevented. This is not one of them.
Drop me a comment below if you want. And subscribe by e-mail if you like what you see. I promise, no spam or junk mail!