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Thread: *** OFFICIAL *** Colonoscopy Thread

  1. #101
    Owner Dan Druff's Avatar
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    I successfully convinced the insurance to reduce my entire bill to...


    ZERO POINT ZERO

    This includes the $65 for that pointless first telemedicine visit in late October. I already paid that, but it will be refunded to me.

    Big improvement from the nearly $500 they wanted from me.










    Would have been nice if I had no polyps, though. That part still sucks.

     
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      Walter Sobchak: THE HEBREW HAMMER

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    I just took 4 5mg Dulcolax and I am about to start drinking 64oz mixture of Gatorade and MiraLAX. Procedure scheduled for 9:45am tomorrow morning. 41 years old, history of cologne issues in the family. Will report back.

     
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      IamGreek: Good Luck Sir

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    Quote Originally Posted by BartHanson View Post
    41 years old, history of cologne issues in the family. Will report back.

     
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      splitthis: Smells great

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    I used to laugh at people who got colonoscopies in their early 40s with family histories, but recent research shows that's actually the right thing to do, as strange as that sounds.

    My girlfriend, brother, and sister all got colonoscopies in their early 40s due to family history. I did not. I waited until a hair before age 49 (too long), and had the alarming result of four polyps, with one being early-stage precancerous and small, and one being mid-stage precancerous and large! Oops.

    While I ended up barely catching mine in time, obviously I waited far too long, given the slowness in both polyp growth and polyps transforming into cancer. It's likely the big one started to grow in my early or early-mid 40s.

    Anyway, Bart is doing the right thing, despite only being 41. He's even doing the right (easy) prep.

    I had a phone conversation with him yesterday where I gave him some tips on not getting screwed billing wise.

    Given his age, it's very likely his will come out clear, but better safe than sorry. Good luck.

  5. #105
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    Quote Originally Posted by BartHanson View Post
    I just took 4 5mg Dulcolax and I am about to start drinking 64oz mixture of Gatorade and MiraLAX. Procedure scheduled for 9:45am tomorrow morning. 41 years old, history of cologne issues in the family. Will report back.
    Good luck. You and Tuchman were my go to entertainment back 15 years ago when I actually had cancer and was getting colonoscopies every six months. Wife would go to sleep and I’d sit there until 4AM est watching that Mike dude who bankrolled the pit games with his mom dust off buy in after buy in. Barry whatever. Allen iirc? You’d take a few polyps for the games to be that good again.

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    Quote Originally Posted by BCR View Post
    Quote Originally Posted by BartHanson View Post
    I just took 4 5mg Dulcolax and I am about to start drinking 64oz mixture of Gatorade and MiraLAX. Procedure scheduled for 9:45am tomorrow morning. 41 years old, history of cologne issues in the family. Will report back.
    Good luck. You and Tuchman were my go to entertainment back 15 years ago when I actually had cancer and was getting colonoscopies every six months. Wife would go to sleep and I’d sit there until 4AM est watching that Mike dude who bankrolled the pit games with his mom dust off buy in after buy in. Barry whatever. Allen iirc? You’d take a few polyps for the games to be that good again.

    Hahahah! I won money off of "Corporation Mike" in a Trump election bet this year. I had to chase his ass down to collect in California. He's a good dude though, he is opening a casino in Ventura as we speak.

    Colonoscopy was easy. Relatively painless. Worst part was the "emptying" the day before. I'm still not close to regular. Only had to do the Miralax and Gatorade + magnesium citrate. Level of anesthesia was "deep sedation" one step down below general. Unconscious but with no tube down the throat. I haven’t talked to the doctor yet but the nurse said all was normal. Part of the reason why I did this at 41 was is there is a history in my family, and I was diagnosed with internal hemorrhoids when I was 20 years old. Occasional blood in the stool.

    Druff, coincidentally, Khalwat is having a colonoscopy tomorrow: https://twitter.com/gaijinity/status/1371950055872159747

    Druff took the time to talk out all the ins and outs with me the day before over the phone, which was very helpful and I am appreciative. Billing headache story to follow however.

  7. #107
    Owner Dan Druff's Avatar
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    Given your association with khalwat, I was shocked when he didn't know you were having a colonoscopy! I was sure that the two of you discussed it and both decided to go forward with it.

    khalwat told me that my radio segment about it partially inspired him to do it. He has no family history and had a referral he hadn't acted on since last year, but my segment encouraged him to call and schedule the actual procedure, which takes place tomorrow. He's 50 but with no family history.

    If they said yours was "normal", that probably means clear, but you want to talk to the doctor.

    My doctor was the first person I saw when I woke up, but perhaps she was there to talk to me because I had those polyps.

    Interesting that you aren't regular yet. That was one problem I didn't have. After the colonoscopy, I didn't have any further diarrhea. However, I had a lot of fatigue both the day of the procedure and the day after. Most people (including my dad) described the propofol sleep as "very relaxing" and "refreshing". I didn't feel that way. I woke up tired, and remained that way for 2 days.

    I also had pain in the colon area which lasted about a week, but after 3 days it started decreasing. I have no permanent after-effects from it. Within a week, I felt the same way I did before the procedure. My pain was apparently uncommon.

    Hope yours indeed was clear, Bart. Unfortunately, you're not out of the woods yet, as most people with polyps start getting them after 45.

  8. #108
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    I have insurance with Ambetter from Superior Health of Texas, on an HSA 201 Bronze plan with a $5800 deductible. Colonoscopies are covered as preventive care if you are over 50 years old according to their "Preventive Services Guide". According to this guide all ages are also covered IF patients are at "high risk for colorectal cancer due to a family history of physical factors." https://ambetter.superiorhealthplan....ntiveGuide.pdf

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    The gastroenterologist was well aware of the need to code this procedure as a screening (he even brought the idea up to me) as opposed to a diagnostic test. I spoke with the hospital and the codes used were Z80.0 CPT 45378. These are the correct codes for the screening version of this test. Because of my family history, I believe I should not owe any cost sharing.

    Texas hospitals, however, do something a bit strange and I have seen it happen several times now. In advance, they will contact the patient's insurance company (on special provider line) to find out if the insurer claims that the patient will owe any cost sharing. In this case Ambetter informed the hospital that this procedure did not need a preauthorization but that I owed the cost because I had not met my deductible. The hospital informed me that they would absolutely not do the procedure if this money was not collected in advance. I spoke with several people at different levels of the hospital administration. Interestingly enough the hospital quoted me a pre negotiated rate of $1,080 vs $3500 cash rate.

    I spent about 3 hours on the phone with Ambetter customer service yesterday to no avail. I confirmed that the correct screening codes were being used but they would not let me talk to their special provider line or talk with claims, because there was no claim, and the procedure did not need a preauthorization. So my option was to back out. However, I had already started the gutting process and concluded that nothing more could be done a day away from the procedure and I didn’t want to put it off. Druff will probably think I am nuts for doing so but I have confidence that if this truly is supposed be covered because of my family history that I can get the payment back, via the claims department. It might be a process where I will have to request the notes from the gastroenterologist to prove the family history. BTW the anesthesia charge was not taken in advance.

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    Interesting thread and thought I would chime in.

    Firstly congratulations for getting this all resolved both physically and financially.

    I often here stories about the costs of medicine/ treatment in the U.S and the pricing model and complexity just blows my mind.

    Living in England I can say with 100% certainty that everything that occurred here would have been done totally free of charge and in a timely fashion on the NHS, in fact the idea of paying for it in itself seems absurd. The NHS is one of the great pillars of our social fabric and does a fantastic job despite all the pressures it is under, however, the point I am wishing to make is that we do not exclusively have the NHS and we do in fact have a private sector working alongside.

    The private sector in particular excels in specialist scenarios and does provide a 'fast track' option for some surgeries but is seldom actually needed but does provide another option in conjunction with the NHS, even in the private sector the costs are massively lower compared to the U.S.

    From what I understand even a basic prescription can cost a fortune whereas here we pay £ 9.15 for a prescription that is reduced to zero if you are financially poor, and if you have ongoing repeat prescriptions this is also often free of charge.

    But I speak from within a country that has had a working NHS for over 70 years and I understand to incorporate a system similar in the U.S would be very tricky based on a whole host of different factors ranging from population , which is far more, the overall size of the country ( you have states bigger than my entire country ) and general mindset.

    Anyway , what i'm getting at is the fact that if the U.S were able to incorporate a similar model to the UK then you 100% would look back and think 'how did we not do this sooner'

    Once again congrats on the all clear

     
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    Quote Originally Posted by Dan Druff View Post
    Given your association with khalwat, I was shocked when he didn't know you were having a colonoscopy! I was sure that the two of you discussed it and both decided to go forward with it.

    khalwat told me that my radio segment about it partially inspired him to do it. He has no family history and had a referral he hadn't acted on since last year, but my segment encouraged him to call and schedule the actual procedure, which takes place tomorrow.
    yep, gonna be a star on the world's tiniest screen tomorrow!

    Man that "super bowel cleaner" shit is no joke.

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    Quote Originally Posted by nutty007 View Post
    Interesting thread and thought I would chime in.

    Firstly congratulations for getting this all resolved both physically and financially.

    I often here stories about the costs of medicine/ treatment in the U.S and the pricing model and complexity just blows my mind.

    Living in England I can say with 100% certainty that everything that occurred here would have been done totally free of charge and in a timely fashion on the NHS, in fact the idea of paying for it in itself seems absurd. The NHS is one of the great pillars of our social fabric and does a fantastic job despite all the pressures it is under, however, the point I am wishing to make is that we do not exclusively have the NHS and we do in fact have a private sector working alongside.

    The private sector in particular excels in specialist scenarios and does provide a 'fast track' option for some surgeries but is seldom actually needed but does provide another option in conjunction with the NHS, even in the private sector the costs are massively lower compared to the U.S.

    From what I understand even a basic prescription can cost a fortune whereas here we pay £ 9.15 for a prescription that is reduced to zero if you are financially poor, and if you have ongoing repeat prescriptions this is also often free of charge.

    But I speak from within a country that has had a working NHS for over 70 years and I understand to incorporate a system similar in the U.S would be very tricky based on a whole host of different factors ranging from population , which is far more, the overall size of the country ( you have states bigger than my entire country ) and general mindset.

    Anyway , what i'm getting at is the fact that if the U.S were able to incorporate a similar model to the UK then you 100% would look back and think 'how did we not do this sooner'

    Once again congrats on the all clear
    nutty, the topic of the NHS is something that frequently comes up when I discuss socialized healthcare.

    While I've never lived in the UK and don't have personal experience with the NHS, I hear wildly differing reports about it. Some, like yourself, seem to really like the NHS. Others detest it, and decry its slowness and refusal to authorize many tests and specialist visits.

    However, the NHS' own website admits that it's an 18 week wait for specialists and tests: https://www.nhs.uk/nhs-services/hosp...es-in-england/

    I also read a report from 2019 which said that the NHS has been routinely exceeding the 18-week wait time!

    This isn't bad for colonoscopies (since they aren't urgent, and polyps cause no pain), but an 18+ week wait for a specialist and tests can be horrendous if you're suffering from a non-life-threatening issue which interferes with quality of life. This is a huge flaw in the NHS, and in socialized systems in general.

    I experienced this exact complaint when I joined Facebook groups for my LPR condition in 2018. People with LPR in the UK complained that their GP (general practitioner) didn't even know what LPR was, and that they were denied referrals to ENT doctors. They were all denied endoscopies. They all expressed jealousy that their American counterparts could see ENTs within a week, and they could get whatever test they wanted. These weren't people trying to be political -- they just wanted to get better! It was very eye opening.

    I will concede that the American medical billing system is a disaster, and needs MAJOR reform. Neither party seems interested in tackling this. Surprisingly, Trump actually had a minor interest in fixing this, and a little legislation was passed to improve things, but it wasn't nearly enough. But he was the first President to want to tackle this problem. Too many Democrats just want to push for socialized medicine, and too many Republicans just want to leave the system as-is (or roll back Obamacare). Both are incorrect.

    I absolutely do NOT want a system where a gatekeeper decides whether I can see a specialist or get tests, nor do I want one with those kind of waits.

  12. #112
    Owner Dan Druff's Avatar
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    Bart,

    I'm not going to be as critical of your decision to pay as you might think. You had an undesirable situation at that point -- either back out the appointment and battle with your insurance company (possibly for months) until you can get them to guarantee the hospital that it will be fully covered, or get the procedure and risk getting fucked on the back end (no pun intended). Both choices suck, but you had to make one.

    As I said on the phone, while I'm not familiar with Texas healthcare, I am pretty sure I figured out why you were billed in advance.

    Since you're 41 years old, the hospital suspected your insurance company will refuse to cover the procedure as preventative, and thus you will owe your part. They're afraid you'll refuse to pay at that point, so they collected the $1080 you're projected to owe (in the worst case scenario) up front. If you were over 50, I'm guessing they wouldn't have asked for a penny.

    So, yes, the bright side is that you have a good chance of getting your insurance company to honor the claim after the fact, and pay you the money back. The downside is that you've lost all of your leverage. Once you've already paid, both the hospital and the insurance company are less likely to help you.

    In general, I always advise people NOT to pay anything in advance to doctors/hospitals for anything except office copays. You have an incredible amount of leverage in medical billing when you're the one holding the money. As I mentioned on the phone, I've talked down a lot of unfair/bullshit/scammy/confusing medical bills simply by refusing to send a penny until they make it right. Since many people actually DO stiff doctors and hospitals for medical bills, they're always hungry to take ANY payment if you're willing to give it to them, which makes your negotiating position strong. Once they hold the money, they give you a big fat middle finger.

    Definitely contact your insurance provider now and get the process going regarding the claim. Ask for a supervisor. Don't just let some first-level scrub on the phone direct it, as they are often wrong.

    Also, they were correct that it didn't need a preauth (preauths are only for procedures which aren't covered at all unless authorized). It's just a matter of whether the procedure is preventative (zero patient responsibility) or diagnostic (you pay the negotiated rate, and it applies to your deductible). You want the former. Keep pressing until you get the entire $1080 back.

  13. #113
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    Quote Originally Posted by Dan Druff View Post
    Quote Originally Posted by nutty007 View Post
    Interesting thread and thought I would chime in.

    Firstly congratulations for getting this all resolved both physically and financially.

    I often here stories about the costs of medicine/ treatment in the U.S and the pricing model and complexity just blows my mind.

    Living in England I can say with 100% certainty that everything that occurred here would have been done totally free of charge and in a timely fashion on the NHS, in fact the idea of paying for it in itself seems absurd. The NHS is one of the great pillars of our social fabric and does a fantastic job despite all the pressures it is under, however, the point I am wishing to make is that we do not exclusively have the NHS and we do in fact have a private sector working alongside.

    The private sector in particular excels in specialist scenarios and does provide a 'fast track' option for some surgeries but is seldom actually needed but does provide another option in conjunction with the NHS, even in the private sector the costs are massively lower compared to the U.S.

    From what I understand even a basic prescription can cost a fortune whereas here we pay £ 9.15 for a prescription that is reduced to zero if you are financially poor, and if you have ongoing repeat prescriptions this is also often free of charge.

    But I speak from within a country that has had a working NHS for over 70 years and I understand to incorporate a system similar in the U.S would be very tricky based on a whole host of different factors ranging from population , which is far more, the overall size of the country ( you have states bigger than my entire country ) and general mindset.

    Anyway , what i'm getting at is the fact that if the U.S were able to incorporate a similar model to the UK then you 100% would look back and think 'how did we not do this sooner'

    Once again congrats on the all clear
    nutty, the topic of the NHS is something that frequently comes up when I discuss socialized healthcare.

    While I've never lived in the UK and don't have personal experience with the NHS, I hear wildly differing reports about it. Some, like yourself, seem to really like the NHS. Others detest it, and decry its slowness and refusal to authorize many tests and specialist visits.

    However, the NHS' own website admits that it's an 18 week wait for specialists and tests: https://www.nhs.uk/nhs-services/hosp...es-in-england/

    I also read a report from 2019 which said that the NHS has been routinely exceeding the 18-week wait time!

    This isn't bad for colonoscopies (since they aren't urgent, and polyps cause no pain), but an 18+ week wait for a specialist and tests can be horrendous if you're suffering from a non-life-threatening issue which interferes with quality of life. This is a huge flaw in the NHS, and in socialized systems in general.

    I experienced this exact complaint when I joined Facebook groups for my LPR condition in 2018. People with LPR in the UK complained that their GP (general practitioner) didn't even know what LPR was, and that they were denied referrals to ENT doctors. They were all denied endoscopies. They all expressed jealousy that their American counterparts could see ENTs within a week, and they could get whatever test they wanted. These weren't people trying to be political -- they just wanted to get better! It was very eye opening.

    I will concede that the American medical billing system is a disaster, and needs MAJOR reform. Neither party seems interested in tackling this. Surprisingly, Trump actually had a minor interest in fixing this, and a little legislation was passed to improve things, but it wasn't nearly enough. But he was the first President to want to tackle this problem. Too many Democrats just want to push for socialized medicine, and too many Republicans just want to leave the system as-is (or roll back Obamacare). Both are incorrect.

    I absolutely do NOT want a system where a gatekeeper decides whether I can see a specialist or get tests, nor do I want one with those kind of waits.

    I can only speak from my experience and others I know and you would be right in stating that it has flaws, this has been perpetuated by an increasing population and a need for other surgeries / experiences that never really occurred in any frequency a decade ago such as gender realignment or cosmetic procedures, this has put a strain on the system but rest assured if i am ill I will get seen and treated. We also have a part of the NHS that allows you to turn up for accidents and emergencies on the day and get seen, you may have a wait but this is seldom more than 6-8 hours in total.

    Also as mentioned if you did have a more specialised requirement then you have the option to go Private where waiting times are pretty much eradicated, whilst many here sigh at the costs of some of these it is still a fraction of the costs compared to the U.S and like with all good systems this provides options and choices.

    One thing for certain is we not have a system of gatekeepers and there are choices. The NHS is under immense strain at present , largely because of Covid but it has not buckled and is still performing. the fact that we finally pushed through Brexit has also meant that we have delivered over 30 million vaccinations ( about 37 people in every 100) compared to Europe which is struggling with about 10 million vaccinations / country on average.

    But to summarise it's not perfect but I for one am very happy with it and rest assured if you ever make the journey 'across the pond' and suffered a serious illness you would be treated.

  14. #114
    Owner Dan Druff's Avatar
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    BUMP

    Remember that billing issue I was telling you guys about?

    Looks like the Rhode Island governor must read PFA.

    Rhode Island just made it illegal for in-network insurers to charge for age 45+ colonoscopies. Basically the exact same thing which happened to me would be illegal in Rhode Island, which would protect those who are less knowledgeable about the insurance industry, and wouldn't know how to fight it (which is most people).

    http://www.rilegislature.gov/pressre...e3e9&ID=371539

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    Also, apparently a device was just approved to identify precancerous polyps, rather than counting on the doctor catching all of them.

    https://www.wired.com/story/ai-help-...-colon-cancer/

    Polyps sometimes get missed during colonoscopies, especially if the doctor is tired or distracted. (This is one of many reasons to get them early in the morning, rather than at the end of the day.)

    This AI device would automatically "see" dangerous looking polyps and alert the doctor to them.

    I think there's a good chance they didn't miss any with me, because they spent 40 minutes inside my colon, whereas the average procedure takes 10-15 minutes. When I woke up, I thought, "There's no way it was 10-15 minutes, it feels like I've been sleeping at least an hour", and indeed I had been asleep for over an hour. I didn't understand where the time went, until I got home and saw that the procedure took 40 minutes.

    Anyway, this device might be in use by the time I get my next one in 2024.

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    This is something I personally have never for the first 41 years of my life ever really overly thought about, or cared about.

    Some might say that I kinda just lived life a little recklessly maybe but in my mind it wasn't being reckless. I was just being me, immune to certain things and possibilities ever happening maybe. Or situations that I didnt think would ever involve me maybe, I was blind to it all. Now it is all real as can be to me, and some of it is scary. Like Cancer, or the thought of actually having it for example. And for the first 41 years of my life I did breeze through it health wise, never had any issues, literally nothing, pretty much a beacon of clean health I guess. No diabetes, asthma, nothing so it wasn't anything I ever thought about maybe or focused on. Then last year happened, and for me that was a changing point. And now Medical things, and health things I realize how serious they are. And for me, I try not to worry about a bunch of maybe things, and focus on if I have to be worrying, worry about some actual, real things that may or may not be affecting me. I don't worry about the maybes, or what-if's myself but that's maybe just not how I am.

    IDK but I defiantly know that I do now, have a much more real perspective of all this Medical stuff and me now, then ever in my life before. Last January so only about 15 months ago I got the real wake up and the hey, you aren't that special or different then anyone else wake-Up Call.

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    Quote Originally Posted by garrett View Post
    This is something I personally have never for the first 41 years of my life ever really overly thought about, or cared about.

    Some might say that I kinda just lived life a little recklessly maybe but in my mind it wasn't being reckless. I was just being me, immune to certain things and possibilities ever happening maybe. Or situations that I didnt think would ever involve me maybe, I was blind to it all. Now it is all real as can be to me, and some of it is scary. Like Cancer, or the thought of actually having it for example. And for the first 41 years of my life I did breeze through it health wise, never had any issues, literally nothing, pretty much a beacon of clean health I guess. No diabetes, asthma, nothing so it wasn't anything I ever thought about maybe or focused on. Then last year happened, and for me that was a changing point. And now Medical things, and health things I realize how serious they are. And for me, I try not to worry about a bunch of maybe things, and focus on if I have to be worrying, worry about some actual, real things that may or may not be affecting me. I don't worry about the maybes, or what-if's myself but that's maybe just not how I am.

    IDK but I defiantly know that I do now, have a much more real perspective of all this Medical stuff and me now, then ever in my life before. Last January so only about 15 months ago I got the real wake up and the hey, you aren't that special or different then anyone else wake-Up Call.
    If you don't have a family history, you can probably wait until 50 to do this.

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    Quote Originally Posted by khalwat View Post
    Quote Originally Posted by Dan Druff View Post
    Given your association with khalwat, I was shocked when he didn't know you were having a colonoscopy! I was sure that the two of you discussed it and both decided to go forward with it.

    khalwat told me that my radio segment about it partially inspired him to do it. He has no family history and had a referral he hadn't acted on since last year, but my segment encouraged him to call and schedule the actual procedure, which takes place tomorrow.
    yep, gonna be a star on the world's tiniest screen tomorrow!

    Man that "super bowel cleaner" shit is no joke.
    I guess your wife didn't pull you away for a quickie during your prep like she did that time you were on radio and had to leave for a while lol.

    Hope it went well.

    SOBCHAK SECURITY 213-799-7798

    PRESIDENT JOSEPH R. BIDEN JR., THE GREAT AND POWERFUL

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    Me and Mama got our Cologuard results today-both Negative. Just couldn't bring ourselves to colonoscopies cuz a friend of our died after having his intestine punctured. He suffered a horrible death. Wishing all those who have them a good outcome. We know it's rare occurance but.......

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    Quote Originally Posted by IamGreek View Post
    Me and Mama got our Cologuard results today-both Negative. Just couldn't bring ourselves to colonoscopies cuz a friend of our died after having his intestine punctured. He suffered a horrible death. Wishing all those who have them a good outcome. We know it's rare occurance but.......
    Just curious, was your friend's doctor sued for malpractice?

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