Crazy Diagnosis on a Routine Colonoscopy 

This man did an optional side mission and potentially saved someone's life!

Doc Schmidt just browsed his way into a cancer diagnosis while sightseeing in a guy's digestive track. Well done, Doc! Does this mean a better chance of recovery for the patient having caught it early?

A similar thing happened to my mother. Here in Canada, seeing a dermatologist is a 6-month wait, minimum (unless the primary care physician has found something that they believe justifies a priority appointment). My mother waited her 6 months and went in for some minor dermatitis on her face that was annoying her. But she did mention to the doctor that she had a spot of altered skin on her upper arm (the front-facing part of her bicep), and wanted it looked at. The dermatologist looked, and she felt it warranted a biopsy. And then 3 days later, on a Friday night, she left a message on her voice mail telling her to expect a call from CancerCare on Monday (I guess trying to soften the blow, but it meant a weekend of speculating about what kind of cancer she had). And it turned out to be one of the rarest, but also the deadliest skin cancer known - Merkel cell carcinoma (MCC). Bad news, right? The incidence of this in the population is just 4 in 1,000,000, and it metastasizes extremely quickly, killing people within months to years of their diagnosis...if not caught _extremely early._ Her cancer was caught in situ, which is the earliest form, and she had the cancerous tissue, and the sentinel lymph node excised 3 weeks later (the lymph node was removed and sent to pathology to be sure that the cancer hadn't spread into the lymphatic system...the node was clear). But let's be clear here...if this doctor hadn't done her due diligence, she'd be dead. Her GP had actually *never heard of this cancer before,* so even if she'd been worried enough (as the spot grew and changed) to request another dermatology referral, it would have been another 6 months until she saw a specialist...and by then it would almost certainly have been too late. As it stands, she's 5 years cancer-free (which is about the elapsed time after which they say it's unlikely to return), so this story ended up a sort of a bad-news good-news type of thing...she got a rare and deadly disease, but was SUPER lucky in that it was caught when it could be dealt with successfully.

It's crazy how often my surgeons do something just like you're describing and incidently find something concerning. Well done, Doc.

Funny story. In 2005, my husband, who was 61 and was having abdominal pain, had his first colonoscopy. The doctor found an 11cm by 7cm NHL tumor. After a year of chemo and radiation, he was cancer free. In 2012, we found a melanoma, it was tiny and after removing a huge chunk of skin he was again cancer free. In the fall of 2021, he was sick again. Actually, his GI track was never right again after the NHL. This time, a CAT scan showed a huge liver tumor and nodules in his liver. It turned out to be stage 4 colon cancer. He did chemo and got 2 more years, was mobile and able to do a lot for most of the 2 years. I don't know why he would never do another colonoscopy.

This info is so valuable! Thank you Doc!! 💙 From a nh lymphoma survivor (6 yrs remission) to a current temporary ileostomy chic.

New fear unlocked: symptomless lymphoma just hanging out in my small intestine where no one may ever find it

That certainly is crazy! I would have never even known it was possible for lymphoma to be detected that way...

It’s a delicate balance between looking for rare things that may be there, and coming up with a false positive. This time I’m glad it worked out

Look at God working through you guys!

My cat had this problem! It wasn’t in the ileum, but she had lymphoma in her small intestine. We couldn’t treat it, so we just gave her some meds and comfort measures. She was always RAVENOUSLY hungry. She’d eat anything. She didn’t have a killing instinct before but now she’d catch a mouse and eat it right in front of me. She used to be obese but ended up losing all her weight and became tiny. She died at age 15. So I’m wondering if this guy’s only symptom was an increased appetite, because that’s what it was like for her.

I heard of a woman coming into the ER with simple abdominal pain and they ended up catching a diagnosis of stage one pancreatic cancer. An absolute miracle.

I have had severe Crohn's Disease for 39 years, multiple surgeries resulting in roughly have my small intestine being removed, etc. Because of the severity of my disease, a previous bowel cancer scare, and stories like this I usually have a colonoscopy every 2 years and I also have my GI do an EGD as well to check things out in as much of the upper part of the GI tract as possible. I figure the colonoscopy prep covers the EDG prep and the small amount of extra time under anesthesia is worth it for the peace of mind knowing something like this is more likely to be detected. Of course, my medical history allows my Doctor and Insurance to justify the costs. My question to you, Doc Schmidt, are you aware of any studies that would justify combining both as a single screening procedure for asymptomatic patients or at least those patients a history of GI issues? I know studies on colonoscopies and cancer detection have led to a lowering of the recommended age to start screening colonoscopies.

As I write this comment, my father is in the hospital undergoing a surgery to have a growth removed from his colon. He had a colonoscopy done 2 years back which didn't reveal anything concerning. I am guessing that doctor at the time didn't go as far back as this dr. did. So good on ya for doing a thorough job. May your content inspire others to do a thorough job as well.

When the intuition works, it's simply the best!!! :D Fantastic story! Hope that person recovers!

Ive tried to get a gastro to look at my small intestine (because of intermittent b12 and vitamin d deficiency, as well as frequent diarrhea), but they never do. Sigh.

Wow, what a twist!

God bless and keep you. You will make a great doctor when you finally finish. Please always keep doing that little bit extra for your patience, and saving more lives, and families. As a widow, I wish my husband's doctor would have done the little bit extra to save his life, or at least extended it a little longer. Please keep helping others from being widows too soon. 👵☮️🖖

I hope that guy bought a lotto ticket. Holy hell.

Ok you’re messing with my mind because I’m having a colonoscopy tomorrow.

Great on ya, doc! Exactly the type of thing I want my GI doctors to do for me, though of course I hope to avoid this kind of diagnosis.

An incidentaloma that was truly significant! Bravo, Doc!

So proud of you!

I am so proud of you!!!

Nice catch. Hoping for the best for the patient.

Glad you caught it!

I love docs like you 😊

Good call to go in TI! We always tried to do it, cheering when successful.

Wow! Great job! This reminds me I’m due for my next colonoscopy next year.

Excellent pick up! Look forward to meeting you one day at DDW!

Nice catch, doctor 💪

Doc I love your videos. They're both entertaining and educational. Thank you for taking the time to make them, Much appreciated.

Nice catch, Doc!

great work!!

Nice catch!

This is life saving information

Awesome Dr. Excellent work

Thanks!

So are you always going to scope through to the small intestine Regardless if it’s called for or not? If it only takes an extra 5 minutes and the hospital isn’t charging by the inch, I say why not!

Wow. My husband and I are both 47 and we're going to get screening colonoscopies this year.

Good catch, Doc! Weird how listening to your gut (aka - clinical intuition) usually yields high value results!

Now I want to find out if they did that on my last colonoscopy.

I had a capsule study last year along with a colonoscopy and upper endoscopy. Easy peasy.

I would say that was worth a cake or box of chocolate

That one time where the guy was lucky to be examined by the fellow instead of the super-experienced doctor.

Wowza!

It feels like that should be made standard procedure. Like, if you're already all the way up there and the person is paying for the exam, why not poke into the intestine and take a quick looksie? Even if it is tricky, you are getting that practice in (just like you were doing).

That's scary!

I hope that the patient wasn't Hank Green 😮. But if it was,Yay Doc Schmidt!❤

Wow! Shows it definitely doesn’t hurt to just have a peak!

Oh wow

Wow. And I thought my intussusception-causing lipoma in my ileo-cecal valve that was found incidentally was a cool story😅

@Doc Schmidt Hey Doc, did the guy survive the diagnosis?

Was the primary in Galt?

Would you have found it doing a routine colonoscopy, without looking through to the small intestines? If not, although not routine, should this peek while there anyway become routine? GREAT catch!

can someone explain how the fellowship system works? is it part of residency or is it something you do after?

SD self diagnosis

Can a Gastroenterologist give an order to the nurses to administer an enema until clear for a patient, especially when your going to under go a colonoscopy in a week or two.

A friend has an embedded mass that has to be surgically removed. She says the Dr thinks its Ca 😢. My obgyn asked when was my last one, I said never, now I'm making the appointment for mine, I'd rather have the colar gaurd. Dr Schmidt, what's pros and cons of colo gaurd v/s colonoscopy? After working in medsurge in a hospital, I see a good amount of people admittiled with perforated bowel, and end up npo and an ng tube, I'm convinced the Drs caused this.

What a weird place for lymphoma to hang out.

How do you help patients that have gone through sexual trauma?

was it a MALT from some sort of autoimmune disease?

Woohoo! 🙌

Coincidentally, RU-vidr Hank Green was recently diagnosed with lymphoma. 😮

I have Crohn’s and have a stricture at my ilium so my GI doctor can’t get through to the small intestine.

So... was the guy okay?

I have to do a colonoscopy soon, Im gonna ask the gastro to take a peek 😊

... was your patient Hank Green??

"It's especially hard if you're a fellow, like me!" For a moment I was thinking you meant "fellow" like "guy/dude" and was wondering why the doctor's gender mattered lol

Depending on the precise type of lymphoma, it may be completely curable!

There is an interesting debate on whether it is actually desirable to find asymptomatic cancers. Once you find them, they are inevitably going to be treated and those treatments involve significant risk and suffering for the patient. If there are no symptoms, the treatment is obviously of no immediate benefit. The only benefit is if the cancer would, in the future, have caused problems and wouldn't have been treatable at that point. A lot of cancers never cause a problem since they are slow growing and the patient dies of something else before they get big enough to be a problem. Those that do cause a problem can often be treated effectively after symptoms develop. Ignorance may be bliss with most asymptomatic cancers.

not really all that routine anymore is it?

Might make you wonder how many you might catch if that became routine part of screening your already there. Might be a good study to do

Crazy story. I hope the patient got useful treatment out of it. But I have a question: ethically speaking, did the patient's consent cover that extra invasion?

Very strange. I wonder how many lymphomas are spotted on colonoscopy, probably very few.

this is why i AM doing SD

👏👏👏👏👏

A ladybug inside a colon ?

I mean to be honest why wouldn't you? You've already got the patient out, you've already got the scope in . Just check the small intestine regardless because you never know and you're already there.

And yet a lot of doctors refuse to do pretty routine checkups for very obvious ailments that end up killing the patient because they’re too stubborn to listen to their patients

you should look into my colon theres like a war going on

I had no idea you could get cancer in your small intestines.

Yep, geriatric family member presented with impacted bowel last week, samsies, Lymphoma just beyond TI. Family contact me (the bowel nurse) "impacted bowel, yeah that can happen....... Small bowel....? That shouldn't happen" post surgery now, no stoma and recovering well awaiting pathology result.

Colonoscopies aren't routine on the receiving end.

By the hand of God.

Woo, that was the Lord. Follow the Lord.

💰💰💰💰💰🏦

That's cool. What's it's like being a b hole doctor?