When do screenings become unnecessary?

Dear Dr. Roach: For many years, I have had a screening colonoscopy due to a history of colon cancer in my mother. Over the years, I’ve had polyps, and some were precancerous. I just turned 85, and my physician assistant does not recommend another colonoscopy because of my age. What do you think about stopping colonoscopy due to age? — M.J.S.

Age is only one factor to consider when deciding whether to recommend a screening colonoscopy. In my opinion, the decision needs to be individualized — even though 85 is a reasonable time to stop, there may be some very healthy 85-year-olds I still would consider screening. For most people, though, the potential harm of a colonoscopy outweighs the benefit over age 85.

Dear Dr. Roach: I have taken hydrocodone for several years for back and leg pain. I was bothered by opioid-induced constipation, until I read about magnesium. I have not had a problem since, and I have told many friends, who all have had the same success. — N.B.H.

Treatment for opioid-induced constipation should include plenty of water, regular activity and eating foods with fiber. If people still need help, then a medication like magnesium hydroxide or magnesium citrate is a reasonable choice. I wish I could say I had 100 percent success rate with them, but they don’t work for some and cause too many side effects in others. Other laxatives, such as polyethylene glycol (Miralax) or lactulose, are helpful in some. Some people prefer suppositories. There also are newer treatments, such as methylnaltrexone (Relistor) or lubiprostone (Amitiza).

For people taking opioids chronically, it is wise to periodically review the risks and benefits of continuing to take them. They work well for some people at reducing pain, but not at all well for others, and there’s always a risk for side effects and addiction.