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Colonoscopy: The Inside Story

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About the cover

  D e s e r t   E x p o s u r e  September 2010


Page: 2

So here's how the American Cancer Society describes the non-virtual procedure: "For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope, which is basically a longer version of a sigmoidoscope. It is inserted through the rectum into the colon. The colonoscope has a video camera on the end that is connected to a display monitor so the doctor can see and closely examine the inside of the colon. Special instruments can be passed through the colonoscope to remove (biopsy) any suspicious looking areas such as polyps, if needed."

No wonder Katie Couric and Harry Smith were all over this procedure — it's basically TV of your insides!

I continued reading on the cancer-society website: "The test itself usually takes about 30 minutes, but it may take longer if a polyp is found and removed. Before the colonoscopy begins, you will be given a sedating medicine (usually through your vein) to make you feel comfortable and sleepy during the procedure. You will probably be awake, but you may not be aware of what is going on and may not remember the procedure afterward." I nodded at this last part — fine by me. In fact, couldn't the sedation start the day before? Just prop me up in the bathroom and knock me out!

"During the procedure, you will be asked to lie on your side with your knees flexed and a drape will cover you. Your blood pressure, heart rate and breathing rate will be monitored during and after the test.

"Your doctor should do a digital rectal exam (DRE) before inserting the colonoscope. The colonoscope is lubricated so it can be easily inserted into the rectum. Once in the rectum, the colonoscope is passed all the way to the beginning of the colon, called the cecum. You may feel an urge to have a bowel movement when the colonoscope is inserted or pushed further up the colon. To ease any discomfort it may help to breathe deeply and slowly through your mouth."

About this point in reading the website, I was already breathing pretty deeply. My wife assured me that her experience was nothing like this — she didn't feel a thing (or at any rate wasn't aware of anything she might have been feeling).

"The colonoscope will deliver air into the colon so that it is easier for the doctor to see the lining of the colon and use the instruments to perform the test. Suction will be used to remove any blood or liquid stools."

Suction, oh joy. Now I was imagining being televised and vacuumed, simultaneously.

The cancer-society website went on, "The doctor will look at the inner walls of the colon as he or she slowly withdraws the colonoscope. If a small polyp is found, the doctor may remove it. Some small polyps may eventually become cancerous. For this reason, they are usually removed. This is usually done by passing a wire loop through the colonoscope to cut the polyp from the wall of the colon with an electrical current. The polyp can then be sent to a lab to be checked under a microscope to see if it has any areas that have changed into cancer."

Televised, vacuumed and electrocuted. I could hardly wait for the fun to begin.

"If your doctor sees a larger polyp or tumor or anything else abnormal, a biopsy may be done. For this procedure, a small piece of tissue is taken out through the colonoscope. The tissue is looked at under a microscope to determine if it is a cancer, a benign (non-cancerous) growth, or a result of inflammation."

There was more, about possible (albeit rare) complications of a colonoscopy, but by this point in my boning-up, it was all I could do not to make a run for the border. Do they extradite people for fleeing their colonoscopies?

Having already set the Olympic record for colonoscopy postponement, however, I was determined to go through with it this time.

After dinner on Saturday, the reality of what was ahead hit me. We decided to splurge and dash out to Dairy Queen — I figured I could afford the calories, since I was about to start, well, you know. But the Blizzard menu there proved unusually daunting: Nothing with nuts, so my favorites like Snickers were out. Fruit should be safe, I thought, so I ordered the Strawberry CheeseQuake.

Not until my long plastic spoon hit a big, semi-frozen strawberry did I recall the pre-op prohibition on red-colored liquids (or Jell-O) for the next day. It's not some weird side effect of red dye number-whatever; I'd asked when accompanying my wife to her procedure. No, it's the fear that anything red still in your innards might be mistaken for bleeding.

The pre-op instructions didn't forbid day-before red foods, but I'd followed a better safe than sorry strategy. The last thing I wanted was to have to endure a rerun because I'd eaten ketchup with the waffle fries at dinner. So it wasn't worth taking a chance on strawberries, either. The Strawberry CheeseQuake would go into the freezer at home for a post-procedure reward; on second thought, I'd splurge with Oreo Cookie instead.

My wife made Jell-O and mixed up the four-liter jug of Nu-lytely for chilling. Bidding farewell to solid food, I went to bed and tried not to dream of being televised, vacuumed and electrocuted from the inside-out.

The fateful Sunday dawned. I drank a cup of coffee and checked my watch. Caffeinated beverages, thank goodness, are OK on "prep" day as long as you don't add cream or milk; the rule is clear, non-red liquids only (or Jell-O or popsicles). No milk or OJ at breakfast (much less cereal), and no wine with dinner.

Having been almost burned once, I decided to cheat just a little and wait until 8:10 a.m. to start guzzling the Nu-lytely. Eight o'clock came and went without a reprieve from the warden. Slowly I made my way to the fridge.

The jug felt heavy in my hand. You're supposed to drink 8 ounces every 10 minutes until it's all gone — at top guzzling speed, that means more than two and a half hours of Nu-lytely fun.

I'd heard horror stories about people struggling to down it all, and various tricks (mix with Crystal Lite, follow with a breath mint) for getting through it. The nurse at the hospital for my wife's procedure had told us about people who'd quit after drinking only half the Nu-lytely solution. That, it turns out, is the worst of all possible worlds: You still feel the effects, but not enough to be able to complete a colonoscopy. So you get to do it all over again.

In for a penny, in for a pound, as they say. I chugged my first of 15 glasses of Nu-lytely. (My first few glasses were a tad over 8 ounces, so I got a bit of a jump start. At one cup exactly, you'd need almost 17 servings.)

Here's what it's like: slightly salty, maybe a little thicker than plain water. Not nearly as salty or gag-inducing as drinking bicarbonate of soda for a queasy tummy. I chased it with a sip of white grape juice.

For me, the problem wasn't the taste but the sheer volume. It would be hard to drink four liters of anything, even your favorite beverage, in less than three hours. It's boring. It's water-logging from the inside. You quickly reach a point far on the other side of thirsty.

About an hour into the Nu-lytely, part two of the prep experience began. I will spare you the details of the succeeding 20 — maybe 21, I began to lose count — bathroom visits, except to reassure those dreading this procedure that you don't feel sick or nauseous. It's not like having the "stomach flu" or eating bad shellfish. It's just like having a tap turned to the full "on" position.

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