Tuesday, January 21, 2020

Everything You Wanted to Know About Getting A Colonoscopy - But Were Afraid To Ask


I recently had my first colonoscopy. I know a bunch of people my age who ought to have had theirs as well but are procrastinating. If you’re fifty or over and haven’t had yours yet, read this to know what to expect (and consider this your wake-up call). If you have had one, what better way to commiserate and have another good laugh at what you’ve been through? And if you’re not fifty yet, this’ll be a good dose of schadenfreude and a sneak preview of what you have to look forward to.

What is a colonoscopy?

A colonoscopy is a procedure a doctor carries out to screen you for colon cancer. Colon cancer is the third leading cause of cancer deaths. The lifetime risk of getting it is 1 in 23 for men and 1 in 25 for women. Early detection is key. Colorectal polyps are fairly easy to find and remove before they can develop into cancer. Details here.

What exactly is the colon?

The colon is one of those weird organs down there in your guts. It removes water from digested food and creates stool, which it conveys to the rectum. As this is already getting gross, I’ll leave it at that.

How does the doctor see in there?

Doctors have got a “back door” they use, through which they thread in a camera the size of your finger.

Which finger?

I forget. To be honest, I haven’t dwelled on that, for obvious reasons. But in all seriousness, the process is a hell of a lot less invasive and awful than chemo, surgery, etc.

Who should get a colonoscopy?

Anybody over fifty should get one, plus anybody with other risk factors like family history of colon cancer, or trouble with digestion, or if a doctor recommends it for any other reason.

Is there any legitimate excuse for a person over fifty not to get a colonoscopy?

Of course not. Don’t be lame, just get it done. As you’ll learn from this post, it’s really not that bad.

What is the preparation for a colonoscopy?

For a week, you have to eat refined food like white rice, white bread, pasta, etc. instead of good high-fiber stuff like whole grains, brown rice, beans, etc. (So, for a week you get an interesting tour into how so many clueless Americans eat.) Also off-limit are seeds, nuts, popcorn, iron, fish oil, and vitamin E. Then, 24 hours before the procedure, you’re not allowed to have any solid food. You can have light-colored juices or broth, or even Jell-O (but why bother)?

The other thing you have to do is completely remove every particle of food, and its downstream waste products, from your system. You do this by drinking four liters (more than a gallon!) of a prescription laxative drink.

Is this pre-op process straightforward and well-documented?

Well, that depends on where you’re having your colonoscopy done. The place I went to sent me a big packet of paperwork, and then I got a phone call saying, “We screwed up your paperwork so we just sent out a second batch. When you get the first packet, throw it away. Only read the second packet.”

Well, I received both packets on the same day so I had to figure out which was the evil twin. One set of documentation failed to specify when and where the procedure would take place, and who would perform it, though it did include a “Visit Date” that was wrong. The other packet at least had the procedure date, time, and location, though it also had a (different) wrong “Visit Date” listed. It also provided the doctor’s name, which was helpful, though it also provided a second doctor’s name that was wrong.

I called up to ferret out which packet was the correct one. Turns out, the packet lacking the when-and-where information was actually the right one. Having sorted this out, I requested clarification about the timing of the laxative drink, GoLytely. The directions say to drink 8 oz. every 10-15 minutes, and to “Take 1st dose (1/2 gallon) at: 4pm the day before” and “take 2nd dose (1/2 gallon) at: 5-6 hours before the procedure.” Well, my procedure time was 8 a.m. Did this mean I had to get up at like 1:30 a.m., and then roust myself again every 10-15 minutes until done, to finish 5-6 hours before, or do they mean at least 5-6 hours before? I asked if I could just be done with all the drinking—and its explosive result—before bed. (No, I didn’t put it so bluntly.) The gal answered, “Uh, well, um, I think … yeah, before bedtime should be fine … just, uh, go with that.” She really didn’t inspire confidence.

I called my big brother for a second opinion and he said, “Yeah, I got up every ten minutes for half the night—it was a total drag!” Keep in mind that you’re not just drinking this gross drink. You’re also rushing to the toilet. So this timing thing is important, and I’m here to tell you from personal experience, getting it all done before bed (in my case midnight) is A-OK. The doctor’s office didn’t send me away for incomplete evacuation, which had been my greatest fear (this having happened to someone I know).

Is the laxative drink really that disgusting?

At no point did the gag reflex kick in. That said, it’s pretty damn disgusting, perhaps even more so than bong water (but at least you’re braced for it; I’m pretty sure nobody has ever drunk bong water on purpose, at least no resolute non-pot-smoker like me). Here is a video of my very first 8-ounce shot of GoLytely:

It may or may not help to mix it with the flavor packet. I was on the fence about this, and my decision wasn’t helped by the packet instructions, which clearly say “Not for direct dispensing to the patient,” as thought the pharmacist is supposed to mix the flavor packet with the drink powder before I leave the pharmacy. Could there possibly be any skill involved in this operation? I can’t imagine, and yet the instructions are very clear on both the packet and the jug of drink mix:

The lemon powder smelled like that disgusting Country Time Lemonade mix. If I did decide to flavor my drink, I pondered, why limit myself to the lemon option? I could mix in the flavor packet from some Top Ramen, to have, like, shrimp flavor, or beef, or a combo. But ultimately I decided to drink it neat.

The first flavor to hit my tongue was like someone else’s saliva, but salted and slightly fizzy as though fermented. Then the aftertaste hit me like a thump: very chemical-tasting, like bleach or solvent. So yeah, GoLytely really is gross, but again, nothing that would make you hurl. The problem is, you have to drink nine 8-oz. glasses of this, ten minutes apart, for the first “dose” (i.e., session), and then, hours later, another eight 8-oz. glasses of it, so it gets mighty old.

By the way, my instructions didn’t tell me how many glasses to drink in the first “dose” so I had to do the math myself:

You said something earlier about the “explosive result” of this beverage. Can you elaborate?

Well, over an hour into my first “dose,” when I’d had eight 8-oz. glasses (i.e., 64  oz, almost two liters) of the miracle elixir, nothing had happened yet. I texted my brother with this worrisome update, and he wrote back, “Oh boy. Just you wait!” He wasn’t wrong. Five minutes later, I decided to take the throne and see if anything would happen. I’ll spare you the details, but an hour later I was still there. The word “hydrant” isn’t exactly right, but it’s close.

Hours later, after the second round of GoLytely, I again started feeling some serious stirrings down there, and suddenly (oddly) started to shiver. I ran for the bathroom, up a couple sets of stairs, with all the urgency of an action hero fleeing a building that’s about to explode. I made it just in time … it was so close I didn’t have a chance to close the door. My wife, from one nearby bedroom, and my daughter, from the other, burst out laughing simultaneously upon hearing the whooshing sound. If you don’t think this all sounds pretty funny, click this link immediately, and go read that post, before continuing with this report.

How will I know I’m ready for the colonoscopy procedure?

Trust me, if you’ve completed all four liters of the laxative, you’ll be ready (so long as you didn’t “cheat” and eat anything in the 24 hours before your procedure time). The official directions imply that you don’t need to drink all four liters if you have “clear rectal discharge,” but I find this to be a) gross, b) a needless thing to determine, and c) a great name for a rock band.

All this being said, in my case I can report that after my last toilet visit (which was, remarkably, at like 5 a.m., over five hours after my last glass of GoLytely), it looked like I’d only peed. So complete was the elimination, I lost four pounds. That’s after drinking about nine pounds of GoLytely. Do the math…

Will the nurses be hot?

This is a dangerous question to answer, but arguably the most important one in the entire report. Needless to say, your mileage may vary, but in my experience, these nurses were considerably hotter than the one who helped with my vasectomy. Perhaps this is by design … to encourage periodic colonoscopies, they’d want to make the whole ordeal as pleasant as possible, whereas with a vasectomy nobody wants to instill the wrong kind of, uh, attention.

Will I unexpectedly get disqualified from the procedure and sent home?

As touched on earlier, if you don’t follow the instructions and evacuate your system, you could be sent home. Other than that, I guess the only problem could be if your vital signs don’t look good. I had a tiny glitch in this department. After taking my vitals and wandering off, the nurse came back and said, “Um, are you a very active person?” At first, given recent events and current circumstances, I thought she was referring to my bowels. But then I understood, and said, “You mean, working out a lot? In that case, yes.” She replied, “Okay. I ask because your pulse was only 45 so we thought you might be on some … medication.” I assured her 45 bpm was normal for me, and it was smooth sailing from there.

Will they stick me with a big needle?

Of course they will, it’s a doctor’s office and you’re there for a “procedure!” They run an IV to administer the anesthesia. But they’re total pros. Two nurses discussed which vein to use … not because they couldn’t find a good one, but because my skinny arms presented an embarrassment of riches. “My husband is just like you,” one nurse said. “He’s got such great veins, I sometimes ask him, ‘Can I please run you an IV, just ‘cause it’d go so well?’”

Will they give me a drug to make me forget everything?

This will depend on where you get the procedure done. My brother, when he had his colonoscopy, did get the forget-everything drug (I think it’s typically Versed, aka midazolam) and didn’t like the aftermath … it really messed him up for the entire rest of the day. Myself, I hate the idea of any drug (even alcohol) messing with my memory. My brother mentioned that some people need colonoscopies somewhat frequently, and opt to skip the Versed. So I asked my doctor about this before the procedure, and he said they don’t use it anyway, and that the anesthesia I’m getting wouldn’t have any post-op aftereffects. “You could go for a run two hours afterward,” he said.

What is the actual procedure like?

They had me roll over on my side. This was probably the worst part because my ass was hanging out of the back of that backwards gown they make you wear, and it was kind of cold. The anesthesiologist warned me that it would hurt a bit when he injected the drug into my IV, but the pain was ridiculously minor, like being whacked lightly with a flower.

I lay there, deeply doubting that I would in fact fall asleep, because no anesthesia could be any match for the cold air hanging over my tuchus. So, preparing to be bored, I let my gaze fall on the patterned curtain a few feet from my face. The curtain seemed so unfamiliar. I wondered, did my wife buy new curtains at some point, and if so how am I just noticing? Moreover, why am I still in bed when I should be heading over to the—oh, shit! I overslept! I missed my colonoscopy and now I’ll have to reschedule and go through the GoLytely purge all over again! Total disaster!

Then I thought, wait a second here. Those are not bedroom curtains. That’s more like a hospital curtain. Oh, and I’m not in bed. I’m … oh, right, I remember where I am. This is where the nurses and anesthesiologist and doctor were getting ready to do the procedure. Meaning it’s over. I must have … slept through it. Just like I was supposed to, duh!

Is there an aftermath?

There was so little indication anything had even happened, I had to take the doctor’s word for it that the procedure had actually been carried out. I was handed a bunch of paperwork, which I only remembered to leaf through a few days later. It covers what they did, what they found, etc. My favorite sentence? “The patient is competent.” That’s the nicest thing anybody has ever said about me. I won’t comment much more about the report or the findings because that’s really none of your business. Plus, there are possibly (sometimes? often?) lab results that have to come back before one can conclude anything for certain.

I expected some physical discomfort after the procedure, but in fact there was none. They’d advised me to break my fast with a small, light meal, but I ignored that. I was starving and had a giant lunch, which went down without a hitch. I will say I was really, really tired for the rest of the day. I highly recommend taking the whole day off of work, as I did, for your colonoscopy.

How do I get home?

This is the one time I won’t tell you to get around by bike. This is also no time to get an Uber or Lyft, or even a cab (if you’re lucky enough to live in a place where you can just hail a cab from the sidewalk like in the movies). The clinic I went to requires that you show up with a chaperon to drive you home. Great idea, because you won’t want to hang around waiting for a ride, trust me.

Do I get a trophy?

What do you think this is, a kids’ soccer team where everyone gets a trophy, even the kids who just stood around? No, you don’t get a trophy. But you can get a certificate from Dave Barry; as he describes here, “If you, after reading this, get a colonoscopy, let me know by sending a self-addressed stamped envelope to Dave Barry Colonoscopy Inducement, The Miami Herald, 3511 NW 91st Ave., Miami, FL, 3317. I will send you back a certificate, signed by me and suitable for framing if you don’t mind framing a cheesy certificate, stating that you are a grown-up who got a colonoscopy.” Now, I don’t know if this offer is still good, or if it’s transferable from “Miami Herald” readers to albertnet readers, but you can download the certificate here and just forge Dave Barry’s signature. I won’t tell!

How long until my next colonoscopy?

Wow, you can’t wait to get back, huh? Well, the rule of thumb is every ten years until you’re about 75 or 80, after which they just put you on an iceberg and give you a nice push. That said, your future colonoscopy schedule will depend on what, if anything, they found the first go round.

This all sounds like a lot of hassle. Are you sure this is really necessary?

I watched a man die of cancer. He discovered his the hard way. Trust me, you don’t want that.

Damn dude, I thought this post was kind of funny until just now. What the hell?

I know too many 50-somethings who have been putting this off. Don’t be one of them. Just get this done, and then we can share GoLytely stories and have a good laugh!

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