“Ideal” practice helps this FP thrive ample, the first case study involved a 31-year- As a young solo doctor who often feels like old with Crohn’s disease—a specific contra- a black sheep in the larger family physician indication for colon therapy. Therapists certi- community, I very much appreciated Dr. fied by the Global Professional Association for Susman’s editorial, “The rebirth of the solo Colon Therapy (http://GPACT.org) are taught family doc” (J Fam Pract. 2011;60:510). Were to give extensive health background ques- it not for the support of the Ideal Medical tionnaires before administering colon hydro- Practice (IMP) community, I do not think I therapy, so it is difficult to determine whether would be in clinical medicine at all, as I know the therapist or the patient was at fault for fail- I could not be happy on the hamster wheel of ure to disclose her health status. Other case traditional high-volume primary care prac- reports the authors cited described isolated tice. IMP has provided the guidance and events that either involved people who already support that enabled me to open a solo full- had severe health problems or could not be at- spectrum integrative family medicine prac- tributed to colon hydrotherapy with certainty. tice in Rochester, NY, right out of residency. While there is no denying the paucity of Because of the skills and knowledge I studies on the potential benefits of colonic have developed through such resources as irrigation, it is unfortunate that the authors monthly conference calls, e-mail listservs, chose to omit the few studies that have been Web forums, and a national conference, my conducted. One study found that daily wa- patients can truly say, “I get exactly the care ter irrigations in patients who underwent There are risks I want and need when I want and need it.” sigmoidostomies for rectal cancer were not inherent in And I’m happy, earning approximately the associated with alterations in the colonic most, if not median income for an FP in the area while mucosa structure.2 Others determined that all, medical maintaining a work/life balance that allows colonic irrigation was an effective alternative treatments, me and my husband to raise 3 boys, all under for the treatment of persistent fecal inconti- whether given the age of 5. Truly, it is my solo low-overhead nence after dynamic graciloplasty3 and low by an allopathic practice within the IMP virtual community anterior resection for a rectal carcinoma.4 In doctor or an that allows me to thrive—not merely survive. addition, the potential benefits of colonic irri- alternative health gation have been shown in rats following the practitioner. Emily Queenan, MD induction of pancreatitis by intraduodenal Rochester, NY injection of sodium taurocholate.5 There are inherent risks to most, if not Colon cleansing: Not dangerous all, medical treatments, whether given by an if done right allopathic doctor or alternative health prac- As a scientist and certified colon therapist titioner. However, the huge number of colon with a colon hydrotherapy practice, I was con- hydrotherapy sessions performed worldwide cerned by the lack of objectivity in your re- has resulted in a vast database of testimonials cent article, “The dangers of colon cleansing” to the positive effects of this therapy. (J Fam Pract. 2011;60:454-457). The authors cited literature describing adverse effects as- Melisa Bunderson-Schelvan, PhD Missoula, Mont sociated with common laxative preparations used prior to colonoscopy exams, such as oral 1. Fiorito J, Culpepper-Morgan A, Estabrook SG, et al. Hydrotherapy sodium phosphate or polyethylene glycol, but compared with PEG-ES lavage and aqueous sodium phosphate as bowel preparation for elective colonoscopy. American College of neither one is generally used by patients look- Gastroenterology Annual Meeting; Las Vegas, Nev; October 2006. ing to colon cleanse to “enhance their well- 2. Galliani I, Santi P, Barratta B, et al. Effect of water irrigations on human colonic mucosa structure after sigmoidostomy. Dis Colon being.” Ironically, the use of colon hydrothera- Rectum. 1987;30:453-456. py is growing in popularity as an alternative to 3. Koch SM, Uldao O, El Naggar K, et al. Colonic irrigation for def- ecation disorders after dynamic graciloplasty. Int J Colorectal Dis. these laxatives for colonoscopy prep,1 yet the 2008;23:195-200. authors made no mention of this. 4. Koch SM, Rietveld MP, Govaert B, et al. Retrograde colonic irri- gation for faecal incontinence after low anterior resection. Int J The article also contained jumps in logic Colorectal Dis. 2009;24:1019-1022. that misrepresent colon cleansing in general, 5. Sulkowski U, Boin C, Brockmann J, et al. The influence of caecos- tomy and colonic irrigation on pathophysiology and prognosis in and colon hydrotherapy in particular. For ex- acute experimental pancreatitis. Eur J Surg. 1993;159:287-291.

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