Dear Dr. Roach: I am an 80-year-old man in excellent health. I’ve had a colonoscopy every five years following my first in my mid-50s, in which five benign polyps were found. I was told colonoscopies are not recommended for men after 75, but I could continue if I wanted.
At my request, my general physician agreed that I could have an annual stool sample in place of a colonoscopy. What do you recommend?
R.L.
Colonoscopies continue to be the most accurate screening test for colon cancer, but there are some downsides. The preparation is uncomfortable, most people are sedated, and there is a small chance of damage to the lining of the colon. Stool samples, which can look for blood or colon cancer DNA (or both), are a reasonable alternative. The combination tests (such as Cologuard) have better accuracy than the standard fecal occult blood cards, but are still not quite as good as a colonoscopy.
When to discontinue colon cancer screening in an average-risk person remains controversial, with some authorities recommending 75 and others 80. Most authorities recommend against screening after the age of 85. These recommendations do not apply to high-risk patients, such as those with a history of colon cancer.
Dear Dr. Roach: I would like a solution to my hearing problems. Often, the approach is to get a hearing aid, which is a Band-Aid at best. From a cost perspective, I am in the process of purchasing my fourth set of hearing aids, which will cost more than $5,000. This is the same amount I paid for each of the first three generations, none of which is covered by my medical insurance. A surgical solution would cost me very little, since surgery is covered.
What are your thoughts of seeing an ENT specialist about possible surgical options, as opposed to continuing to purchase these hearing aids?
J.H.
Although there are many causes of hearing loss, we tend to break them down into two broad categories: hearing loss due to nerve damage and hearing loss due to poor conduction of sound in the ear. While hearing aids are the standard treatment, there are other options for some people.
A cochlear implant is appropriate in some people with hearing loss due to nerve damage when hearing aids are inadequate. This surgical treatment is safe and effective in appropriately selected older adults. Although they are expensive (the total cost may be between $50,000 and $100,000), the procedure is usually covered by insurance. However, I don’t recommend it to people who have excellent or even good results with hearing aids, since complications can occur.
In people with conductive hearing loss, an alternative to traditional hearing aids is a bone-anchored hearing aid. I have not had a patient undergo this treatment yet, and I have read that the initial placement is between $10,000 and $17,000, in addition to the cost of the device ($5,000 to $8,000). The quality of hearing is better, but you sure won’t save any money.
Your ENT doctor can certainly discuss these options with you, but if your goal is to save money, surgery is probably not the right choice.
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