Scheduling a colonoscopy or GI procedure can seem daunting if it is your very first time. Many patients admit that their hesitation to visit their gastroenterologist is an obstacle, but they are unsure of what to do about it. Wouldn’t it be convenient to have a manual that provides understandable information regarding digestive procedures and diseases?
Dr. David Novick, of Digestive Specialists in Kettering, Ohio, has met this need. Dr. Novick’s book, A Gastroenterologist’s Guide to Gut Health: Everything You Need to Know About Colonoscopy, Digestive Diseases, and Healthy Eating, is scheduled for publication in April 2017. The purpose of the book is to educate patients on gastroenterological issues as well as provide nutritional guidelines for optimum GI health.
Dr. Novick sat down to discuss his new book, which promises to be useful for patients and physicians alike.
You mentioned that your goal was to write a medical book that explains GI conditions and procedures in understandable terms. What methods and organizational strategies do you utilize in your book to make complicated procedures, conditions and terms seem more approachable?
In my practice, I can sit down with my patients and have a detailed, purpose-driven conversation. I attempt to do something similar in my book by using tools such as text boxes and bullet points to organize the information, and I include a glossary to provide definitions of the terms. I also use tables, diagrams and even pictures that were taken during GI procedures.
When I talk about bowel prep for a colonoscopy, for example, I provide a table that explains the various types of preparation. I include the differences in cost, volume of liquid that must be consumed, and an explanation of the benefits and drawbacks of each. I also cite some common side effects and provide instructions for dealing with them. Finally, at the end of each chapter in the book, I highlight key points or take-home messages to emphasize the main ideas.
I also try to include some lesser-known tips that prove to be very valuable, such as tips for the colonoscopy caregiver. Many people may not realize that, because they will be sedated for their colonoscopy, they need a driver to take them to and from the procedure, and that driver also needs to clear his or her schedule. GI procedures take time, and we don’t want to rush anyone’s procedure. I like to explain the “why” in questions such as, “Why can’t I take a taxi home after my colonoscopy?” I explain that patients should not take a taxi because taxi drivers lack the personalized care that a caregiver provides. A caregiver will take time to get you settled at home and make you comfortable, and this also factors into the colonoscopy experience. If you have never had a colonoscopy before, you need to be made aware of this important information.
How is the book organized?
The first seven chapters are about colonoscopy and colon cancer. The second half of the book provides information about digestive diseases and nutrition. It is quite comprehensive in the topics that it covers. Here is a quick run-down of the colonoscopy chapters:
- Chapter 1 introduces the colonoscopy procedure and the decision to schedule a colonoscopy. It also outlines the bowel preparation.
- Chapter 2 explains the types of anesthesia that are used for colonoscopies.
- Chapter 3 gives information about the various kinds of polyps. I show pictures of polyps and landmarks. They are not distasteful, but satisfy the curiosity of patients who want to see what polyps look like.
- Chapter 4 explains the process of “waking up” from the colonoscopy.
- Chapter 5 is a more academic chapter that gives evidence for the validity of the colonoscopy. In easily understandable language, I review five published studies that support colonoscopy in its role in prevention and early diagnosis.
- Chapter 6 includes the risks associated with colonoscopy, as well as screening alternatives such as stool DNA testing, flexible sigmoidoscopy, fecal immunochemical testing, CT colonography and double contrast barium enema.
- Chapter 7 is about what to do after a colon cancer diagnosis.
- Chapters 8 through 20 cover a range of digestive diseases, including ulcers, celiac disease, irritable bowel syndrome, ulcerative colitis and Crohn’s disease, hepatitis C, cirrhosis, and gallbladder and pancreatic diseases. There are also chapters on healthy eating and how to get the most out of your doctor visit. I think this book could be very useful for GI doctors’ waiting rooms, for patients as an at-home resource, or for anyone interested in modern medicine.
Is there one chapter or portion of your book that you believe is most valuable for patients?
I want my readers to understand that colon cancer is preventable through routine colonoscopies. It is safe to say that no one looks upon a colonoscopy with anticipation, but when patients learn how integral this procedure is in saving lives, they tend to view it differently. I think it is important to understand the various barriers to colonoscopy, and I want my readers to do some self-analysis as to how they feel about the procedure. These barriers are also discussed in Chapter 6.
Some barriers to colonoscopy are fear of discomfort (of the prep as well as the procedure), fear of embarrassment, lack of privacy, fear of danger (complications during the procedure), fear of the unknown, lifestyle issues (feeling too busy to schedule the procedure), and financial issues. Another barrier is the fear that colon screening will not actually prevent cancer. Some recommended screenings such as mammograms and prostate exams are not effective in preventing cancer, and although they may reduce the death rate by detecting cancers earlier, this benefit is surprisingly modest. However, colonoscopies actually do work in detecting and preventing colon cancer, and research proves this fact. As colon cancer screening rates increase, colon cancer incidence and mortality is decreasing.
Because colonoscopies are so important, how should your readers go about selecting a gastroenterologist to perform their colonoscopy?
I address the topic of quality issues in the book. Patients need to look for three factors in selecting a gastroenterologist. The first and most important quality measure the adenoma detection rate. A physician's adenoma detection rate is the proportion of individuals undergoing a complete screening colonoscopy who have one or more adenomas, or benign but potentially cancerous polyps, detected. Patients should expect that a physician should have a minimum adenoma detection rate of at least 20 percent in women and 30 percent in men. The higher the adenoma detection rate, the lower the rate of cancer detection in the years following a colonoscopy.
A second quality measure is the rate of cecal intubation. This term refers to the completion of the insertion process of the colonoscope to begin the colonoscopy. Research has proven that a considerable percentage of colon polyps are located in the proximal colon, including the cecum (the last parts of the colon reached by the scope).
Another quality measure is withdrawal time. This refers to the amount of time that it takes for a gastroenterologist to remove the colonoscope after reaching the cecum, or the beginning of the colon. High adenoma detection rates are usually associated with a longer withdrawal time.
It is likely that these quality measures will be available on physicians’ websites in the near future.
Would you care to share your own adenoma detection rate and how you track it from year to year?
My adenoma detection rate ranges from about 42.8 to 54.6. My practice uses a registry called GI QuIC, and we post quality issues so our patients can access this information. When I do a post-colonoscopy report, GI QuIC includes a drop down menu where I put some basic information like risk factors (such as a family history of colon cancer or polyps or a personal history of colon cancer or polyps) or what I found in the procedure. The report is not complete until I receive any applicable pathology report, but after we receive the report, I can give a recommendation for when the colonoscopy should be repeated. GI QuIC has been a useful tool in our practice because it helps us know if we are giving accurate recommendations for follow-up.
How can our readers find your book?
The book will be available at Barnes and Noble and Amazon beginning April 8, 2017. I am also anticipating that the book will be available in e-version. In the meantime, I have created a trailer for the book with the help of my Digestive Specialists staff. We enjoyed making the video, and we added a little humor to make the subject matter of the book more approachable.
Dr. Novick is Board Certified in Internal Medicine and Gastroenterology. Dr. Novick has been practicing Gastroenterology with Digestive Specialists in Kettering, Ohio since 1991 with a special interest in Hepatology (Liver Disease). Dr. Novick is the author of more than 65 medical publications on hepatitis B and C, liver cirrhosis, colon polyps and related subjects, and is a 2014 Erma Bombeck Writing Competition Award Winner.
Learn more about Dr. Novick by visiting his personal website, his YouTube channel, and his Facebook page.