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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


The Inside Story

That dreaded colonoscopy (and the even-more-dreaded day before) — what's it actually like?

By David A. Fryxell

This is not going to be one of those Katie Couric or Harry Smith colonoscopy stories. You probably recall how the former "Today Show" co-host and the co-host of CBS' "The Early Show" both allowed their colonoscopies to be televised in order to promote this important but squeamishness-inducing cancer-screening procedure. (Couric now also works for CBS — which, despite appearances, does not stand for the "Colonoscopy Broadcasting System." Though it would not surprise me if there were a Colonoscopy Channel somewhere on cable by now, between the Golf Channel and the Skydiving Network.)

For starters, this is the much more demure world of print; you will not see so much as a grainy black-and-white photo of me in a hospital gown. Then there's the fact that neither Katie nor Harry likely had so much trouble scheduling the procedure. (Although, as you'll see, the early-morning theme of both the "Today Show" and "The Early Show" does indeed continue in my own first-person journalistic saga.)

I was all set to do the right thing (albeit a bit late — you're supposed to get this test right when you turn 50) back in March, before my wife's turn on the table. I'd visited my doctor and gotten the referral to a local surgeon. I went for the pre-procedure exam at the surgeon's office, which mostly consisted of filling out a lot of forms following by a brief prodding and probing of my abdomen. My colonoscopy was scheduled and I filled my prescription for the "prep" goop that leaves your insides squeaky clean. I'd sworn off aspirin and ibuprofen and ratcheted down my diet. I'd cut out corn, nuts and seeds for three days prior to the procedure. The Nu-lytely prep powder was mixed with a frighteningly large amount of water and set in the fridge the night before (a tip from the pre-op nurse to help make it more tolerable for guzzling).

At eight o'clock on the morning before my colonoscopy, I was lollygagging a bit in the bathroom, trying to postpone the inevitable, when the phone rang. I was literally a walk down the hallway away from downing my first glass of Nu-lytely and launching into a long day in the bathroom when my wife hollered to say my procedure had been postponed. The doctor was sick — his hands were shaking, never a good thing in someone whose job it is to probe your insides — and I'd been given a last-minute reprieve.

I felt like one of those death-row prisoners who get a call from the governor after they've already been strapped into the electric chair.

After a few months, however, I was just ready to get the dang thing over with.

Because of a long-planned and non-refundable vacation (which I'd carefully scheduled after the original colonoscopy date), I couldn't reschedule until mid-June. (The original procedure had been smartly, I thought, planned for soon after my birthday; this would be just before our anniversary, so as not to interfere with any celebratory dining plans.) In the meantime, despite my best intentions to be a pioneer, my wife had her own colonoscopy; her experience went a long way toward alleviating my worst fears about what was in store.

The other thing I learned — almost the hard way — is that of the two days my surgeon does hospital procedures, Monday and Thursday, it's smarter to go for Mondays. They don't call you with the time you actually need to show up at the hospital until about noon the day before — or, for Monday procedures, on the preceding Friday. For Thursday appointments, that means The Call comes when you're well into the dreaded "prep" and there's no turning back.

When The Call came for my Monday procedure in mid-June, however, it was on Friday — when that gigantic jug of Nu-lytely and my day on the throne were still a day and a half away. So when the hospital told me I should show up at 2:10 — in the afternoon — for a procedure that would start (supposedly — you know how medical schedules slide) about 3:10 p.m., I had time to balk. That would mean no food all day Sunday, just liquids and Nu-lytely, and nothing at all — not even water — from midnight until mid-afternoon on Monday.

Nope, sorry, not happening.

The wonderfully understanding nurse at the surgeon's office agreed — since this was, after all, merely a screening procedure, not an emergency — to reschedule me for July. This time (since we'd arrived at this point originally due to the surgeon's illness), they'd let the hospital know that the surgeon wanted me scheduled as early in the day as possible. (Emergencies and diabetics who can't handle fasting very long get first dibs.) Great.

Then my father-in-law passed away at the end of June and all the carefully planned schedules in our lives went out the window. Although I figured I'd be back in time for my July date with the doctor, there was no telling when my wife could return. And I needed a post-anesthesia ride from the hospital, not to mention the moral support. So I called again and rescheduled again for mid-August. (Keep in mind that I also have to plan these things around Desert Exposure's monthly schedule. Tough to deliver bundles of papers, for example, while interrupting every 10 minutes to run in search of a men's room.)

The Call from the hospital came about 11 a.m. on the Friday before (I was still sticking with Mondays, just in case). Never before have I been so glad to be told I had to be somewhere at 6:30 in the morning.

So why go through all of this, anyway? According to a study by Dr. Thomas D. Sequist of Brigham and Women's Hospital in Boston, and colleagues, published earlier this year in the Archives of Internal Medicine, "Colorectal cancer is the secondary leading cause of cancer mortality [death] in the United States. Screening programs involving fecal occult blood testing, flexible sigmoidoscopy and colonoscopy lower the incidence of colorectal cancer by removing precancerous adenomas, detect cancers at more curable early stages and reduce colorectal cancer mortality." Although national guidelines suggest that average-risk adults age 50 and older should be screened for colorectal cancer, only 60% actually report up-to-date testing.

According to the American Cancer Society (www.cancer.org), "Regular screening can often find colorectal cancer early, when it is most likely to be curable. In many cases, screening can also prevent colorectal cancer altogether. This is because some polyps, or growths, can be found and removed before they have the chance to turn into cancer."

I'd read a lot about the new "virtual" colonoscopy option, which sounds great at first: Who wouldn't want to just go through this "virtually" (I envisioned one of those Wii games) instead of, well, you know? Unfortunately, I learned, you still have to "prep" for a virtual colonoscopy — and it's the prep that everyone says is the worst part. With light anesthesia, you're barely supposed to be aware that the actual procedure is happening.

Worse, because a virtual colonoscopy can't remove any polyps that might be discovered, if the surgeon does find anything, you have to go through the whole rigmarole again — non-virtually this time, if you get my drift.

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.

Nor do you need to worry about clogging the toilet. Trust me on this.

Hour Two of Sunday morning's adventure was spent in the bathroom, breaking every 10 minutes for another Nu-lytely dose, then sprinting back to the bathroom. It's pretty all-consuming as activities go. Don't plan to, say, trim the hedges in-between bouts. Wear loose-fitting pants.

I couldn't really celebrate the triumphant moment of downing the last damn drop of Nu-lytely, because duty called — again. By about noon, however, the sprints were becoming less frequent, and that afternoon I was actually able to sit in front of the computer instead of in the bathroom.

I'd fretted about hunger, but food was the last thing on my mind most of the day. The Nu-lytely liquid fills you up so much that there's no longing for breakfast or even lunch.

In fact, curious, I'd weighed myself after dragging out of bed on Sunday morning, and again after all the Nu-lytely was in me (or at least had visited my insides). In the space of three hours, I'd gained four pounds. Talk about "water weight"! It made sense, though, despite how rapidly my body was getting rid of everything in it: "A pint's a pound the world around," as TV chef Alton Brown ("Good Eats") is fond of saying. So the four liters of (mostly) water I'd consumed weighed almost eight and a half pounds.

Lunch was a little chicken broth, cleverly seasoned with some flavorings from the pantry that I then strained out using a coffee filter. After drinking juice and Gatorade to chase the Nu-lytely, I was already sick of fruity flavors. A couple of cups of tea were my afternoon effort to "push fluids," as the pre-op instructions repeatedly commanded.

Dinner was a rerun of lunch, followed by Jell-O — just to make sure I hadn't forgotten how to chew, if you can call that "chewing." Amazingly, I still wasn't really hungry. I longed for crackers, but more for the crunch and saltiness than out of hunger. I began to fret, though, that I might accidentally grab a handful of Wheat Thins or, even worse, cashews to snack on, strictly out of habit.

Bed came early — in part because of my 6:30 a.m. appointment, in part simply to sleep and get it all over with.

The drive to the hospital in an August morning rainstorm was probably more harrowing than the actual procedure. If your first colonoscopy still lies ahead of you, take it from me: Insist on being fully sedated, not some "twilight" state where you might risk being aware of what's happening. After the usual paperwork, changing into that flattering hospital gown (here, however, the opening in the back truly did make practical sense) and waiting for the surgeon to arrive, I got what the anesthesiologist called a "light" dose. Happily, it was heavy enough that one minute I was in the operating room and the next thing I knew I was in the recovery room.

I dreamed of blue doors. That's all I remember of the actual colonoscopy.

The surgeon told my wife in the waiting room that all went fine, and he'd removed one small polyp. (See? If I'd gone the "virtual" route, I'd have another date with Nu-lytely any day now.) That means I probably have to go through the whole routine again in three to five years, just to be on the safe side.

Heck, been there, done that. Honestly, the worst part was the worrying. And now that I know that, yes, I really can chug four liters of Nu-lytely in less than three hours, it's no big deal.

Isn't that right, Katie and Harry?


David A. Fryxell is editor of Desert Exposure.

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