My wife was first to notice something was the
matter with my father. "He's tired all the
time," she said. "He's always asleep
on the couch."
"Well, he's seventy," I said, writing
off her observation to my father's old age.
I reminisced about how hard my dad worked when
I was a child. He was up and gone before I awoke
for school. He came home late. And after dinner,
he often fell asleep on the couch. Now retired,
nearly thirty years later, I felt he deserved
all the rest he wanted. But after my wife's comments,
I took greater notice. My dad was tired all the
time, and he seemed somewhat pale. So I brought
him to my hospital and had a doctor friend examine
When it comes to the diagnosis and screening
of disease, medicine relies on lots of expensive
gadgetry. Machines which cost millions perform
tests that cost thousands. But there is one diagnostic
tool, smaller than a credit card, which costs
about 25 cents, that screens for a malignant disease
that will occur in about 5% of all Americans.
The tool is made of cardboard. It's called a "fecal
occult blood test." It screens for "occult"
or hidden blood in the stool. This simple test
led my father's doctor to the right diagnosis.
My dad wasn't simply old and tired. He had colorectal
There are 150,000 new cases of colorectal cancer
diagnosed in this country every year, and 60,000
deaths. Just being an American may be a risk factor
since the average American diet, low in fiber
and high in fat, is associated with high colon
Fecal occult blood testing is not a panacea.
Having no blood in the stool does not assure the
absence of cancer. Only about 32% of pre-cancerous
polyps bleed before becoming cancers. And the
test can be deceiving. Rectal bleeding from hemorrhoids
or fissures will turn the card positive. And simple
drugs like aspirin or Advil can cause mucosal
bleeding and a positive test.
My father's positive screening led to strong
suspicion of a lesion in his bowel. Colonoscopy,
the use of a flexible scope to examine the large
bowel, is the diagnostic procedure of choice.
Not only is the gastroenterologist able to visualize
a lesion, he can biopsy the tissue and even remove
polyps through the scope.
My father's cancer was found early and he underwent
surgery to remove the diseased part of his colon.
He's alive, well, and seventy-six this year.
For those with a family history of colon cancer,
like me, yearly fecal occult blood tests beginning
at age 40 and colonoscopy at that age and every
five years after is suggested. The American Cancer
Society also advises annual fecal occult blood
testing and a screening sigmoidoscopy every three
to five years for people over 50. Scoping is important
since up to 60% of lesions can remain undetected
if occult blood testing is the only screening
My dad still falls asleep a lot on the couch
these days, and he deserves to. I'd like to sleep
there more often myself, but my wife won't let
me. She thinks she's the doctor. I guess when
it came to saving my dad's life, she was.