San Antonio Express-News (Sunday)
Improvements in colostomy; a cool reception to thermography
Q: I am responding to a recent letter from a reader anxious about undergoing a colonoscopy. One of her concerns was a possible perforation requiring additional surgery and a temporary colostomy. You reassured her that the probability of such an occurrence was very low.
I have seen this fear often. No doubt, it comes from most people having no experience with the procedure and/or from negative portrayals in the media. Yes, a colostomy is major surgery. But it is also a lifesaver that, after an initial period of learning and adjustment, does not interfere with quality of life, work or pursuing most activities. There are cases where individuals have refused this kind of surgery and eventually died. The image of “the bag” can be that frightening.
I have an ileostomy (a connection between the small bowel, or ilium, and the outside, through the skin, as opposed to a colostomy, which is a connection between the colon and the outside) as a result of years of ulcerative colitis creating precancerous, fast-growing lesions in my colon. I delayed surgery for a year, because of fear. Thankfully with education, I made a good adjustment in a matter of weeks.
Today I co-lead a support group. We see a lot of new joiners, but tend to lose members after a few weeks. Why? Because by that time most say they are fine and don’t need the group.
Modern medicine and spaceage materials have produced appliance products that are nothing like those from earlier times. Today’s are thin, deodorized and gentle to the skin. They adhere well and allow bathing, swimming, sexual activity and exercise. Most people continue with an unchanged life after recovery. Many would be surprised to learn there are wellknown celebrities, politicians, and sports figures who have had this surgery. In fact, with over 750,000 surgeries a year in the U.S. (including both bowel and bladder diversion), it’s probable that everyone has come into contact with, or knows, someone who has.
I urge physicians to confront fear surrounding ostomy surgery with reassurance and education. I’m not suggesting that anyone be pushed into a major surgery if they are uncomfortable. But every important decision should be made after receiving as much education and information as possible.
A: I thank this reader for her thoughtful letter and think it’s important enough to publish.
Q: My daughter-in-law tested positive for COVID-19. She agreed to do the infusion therapy. She is fine now but still part of the study. She is under the assumption she doesn’t need the COVID-19 vaccine. Your thoughts?
A: With many infections, such as measles, infection leads to a lifetime of immunity in virtually all people. Unfortunately, getting measles (like getting COVID-19) can cause serious complications and even death, which is why vaccination is much preferred.
Not all infections provide lifelong immunity. Although infection from COVID-19 does lead to some immunity, it appears that the immunity is often short-lived and specific to the variant a person was infected with. It is very clear that people can get COVID again fairly quickly. More importantly, they appear to be susceptible to the new variants that are spreading across the country and the world. A vaccine is absolutely indicated for people who have had a case of COVID.
Most people can get the vaccine as soon as the symptoms have resolved; however, people like your daughter who were treated with antibodies need to wait 90 days after infection to get the vaccine.
Q: I’m a healthy woman. I recently had a whole-body thermography exam that highlighted my thyroid rather dramatically.
Should I get a blood test for my thyroid and/or an ultrasound?
A: Thermography is a technique looking at differences in skin temperature. Back in the 1970s, it was found that breast cancer can lead to warmer temperatures on the skin overlying the tumor. Unfortunately, there still has not been any evidence that thermography has any advantages over mammography. Recent research suggests there may be a role in the future for thermography, possibly in combination with mammography, but the data on breast cancer show poor accuracy.
An overactive thyroid gland also may lead to high blood flow and warmer skin temperatures. So, theoretically, thermography could be used to diagnose thyroid tumors and hyperthyroidism. Again, there may be potential in the future, but in my opinion, thermography is not an appropriate screening test in a healthy person.
Although I recommend against getting a screening thermography exam, now that you have documented an abnormality, your doctor may feel obligated to do an evaluation. Since the whole thyroid was abnormal by thermography, rather than a specific area, as it would be in the case of a tumor, a set of thyroid function blood testing may help relieve the anxiety you must feel with this abnormal test.
Screening tests need to be proven both safe and effective. False positive tests lead to anxiety and unnecessary follow-up testing. False negative tests can keep a person from coming to the doctor to get evaluated. Screening tests require a very high level of evidence before they can be recommended, and thermography is not yet ready for use in screening.
Q: Can you explain diabetes and gangrene? I am prediabetic, and the second toes on both feet have some tiny black spots on them. I will see my primary care physician soon.
A: Gangrene is a name for localized death of body tissues. There are several different types. Gas gangrene is a rapid, lifethreatening infection caused by virulent micro-organisms, such as group A streptococci or Clostridium perfringens. Gas gangrene is, fortunately, uncommon these days, as it is often a complication of delayed treatment of wounds.
It is called gas gangrene because the bacteria make gas, which can be felt under the skin. This is usually very painful. Treatment is rapid, and extensive surgery along with antibiotics, and hyperbaric oxygen is a sometimes-useful additional treatment. This is the type of gangrene least associated with diabetes.
Dry gangrene is caused by poor blood flow, usually to an
extremity. People with longstanding, severe diabetes are more at risk for this due to damage to both small and large blood vessels. The skin appears dark and dry. Treatment usually includes surgery to improve the blood supply if possible; without it, the damaged tissues won’t heal.
Wet gangrene is a life-threatening emergency requiring immediate surgery. People with diabetes and nerve damage (neuropathy) are at higher risk for this, because they can injure themselves without knowing it. The tissue appears wet, swollen
and blistered, and may have a bad odor.
While dark spots on the toes could possibly be gangrene, it would be very unlikely in a person with prediabetes. Your primary care physician or diabetes educator should be instructing you on what to look for on your feet (you should do a quick check every day) and to come in promptly for any worrisome signs. People with diabetes may
also benefit from regular foot care from a podiatrist, who can help prevent foot problems from developing.