Colonoscopy

I had my first colonoscopy yesterday, due to some ongoing symptoms I won’t divulge here. It wasn’t nearly as bad as I expected based on what I had read online and heard in passing (so to speak … so many puns available for this kind of thing …). Reading about other people’s colonoscopy experiences (especially this one; read it in reverse) did help me in preparing for my own, so here’s my story.

The official instructions I received said that on the day before the procedure (i.e., Sunday, the day of the prep), I could have a light breakfast, plus as much clear liquid as I desired — which included non-red/blue/purple jello and popsicles, black coffee and tea, and soup bouillion — and then after taking the prep, only the clear fluids. Knowing that the intention of drinking a gallon (4 liters) of electrolyte solution — the Golytely ‘prep’ — was to thoroughly cleanse my bowels (whoo-ha!), I thought it might make sense to eat lightly for several days before the prep, to have less bowel ‘material’ to clear.

So, on Friday, three days pre-procedure, I had no breakfast, a lovely buffet lunch of mostly seafood and salads, and for dinner I split one small appetizer (a yummy crab fritter) with my spouse, and had a glass of white wine while listening to some jazzy music at a local venue.

Saturday, two days pre-procedure, I ate a very light and bland breakfast (2 scrambled eggs and half an English muffin), no lunch or snacks, and about 2 cups of rotini pasta with soy sauce and one soy hot dog with a little cheese for dinner, with a small glass of white wine. Again, pretty bland. No snacks afterwards but plenty of water and tea all day.

Sunday, the day of the dreaded prep, I had some black tea in the morning while hanging out in worship service, a little water, then nothing until THE PREP, which I started at 3, an hour before the time specified in my instructions. I usually go to bed early and was hoping to preserve my sleep as much as possible, without constant trips to the bathroom.

My prep was Golytely (get it?), the gallon of saline electrolyte solution to be drunk 8 oz. at a time, every 10 mins. Besides eating lightly and blandly, well ahead of time, I did several other things that I think helped the prep go smoothly:

* I had asked my nurse if a little Crystal Light could be mixed with it; the manufacturers’ instructions say nothing can be added, but I had read online of people adding Crystal Light and that sounded good to me. She told me, off the record, that I could add up to one tub to the mixture; she recommended the lemonade flavour.

* I made the solution, with the Crystal Light Lemonade mixed in, the night before I needed to ingest it, so it had a good long time (about 20 hours) in the refrigerator chilling.

*  I started drinking the Golytely at 3 p.m. I drank an 8 oz. glass and actually, it tasted fine to me. It was the hottest day we’d had here so far this year, in the mid 80s, and the solution was almost as refreshing as cold lemonade. Seriously. Nothing like as bad as I’d heard. Not soapy. Though my instructions said to drink it every 10 mins, I stretched it to 15 min. intervals.

I had my first serving of Golytely at 3, and the next seven servings  — I was measuring roughly, so it turned out that a serving for me was actually closer to 10 oz. — every 15 mins. thereafter. The instructions are to drink each serving all at once, not sipping it, and that worked fine for me. But after two hours, with about 80 ounces inside me and with nothing coming out, I was feeling full to the brim with liquid. I wasn’t nauseous, but I was rather bloated and I couldn’t drink anymore, so I waited a half-hour, until 5:15, and chugged down another dose. Still nothing. I started Googling to find out how long it should take before the first bowel movement. The Golytely site said things should be moving in an hour. I was getting worried.

By the way, during the time I was drinking, I watched an episode of “House MD,” walked around and weeded the garden, sat in the sun and read a book, did several crosswords, ran up and down the stairs doing the usual household things. In short, other than being tethered to the kitchen, I lived my usual life. I also did my regular half-hour weights workout right before starting the whole procedure.

At 5:30, with still nothing happening and no room to ingest more liquid, I called the hospital for the physician on call. By the time he called me back, about 45 mins. later, I could report success! Approximately 2 hours and 40 minutes after starting the prep (90 ounces in), it began to work its magic.

Not to go into too much detail, but magic it was! About 20 more oz. and 3 hours later (8:30ish), I was done. Even the first bowel movement was mostly liquid, and after the first four bowel movements, everything was pretty much clear. I had no cramps, no pain of any sort at any time. I ate an orange popsicle and some orange jello to celebrate, drank some water, watched a Poirot, and settled in to sleep.

I got up around 2 a.m. to go once more (very little), and from then until I got up around 7, my stomach made gurgling, burbling sounds that kept us pretty well awake. (The dog, as usual, slept fine.)

The instructions for procedure day (Monday) allowed 1-2 glasses of clear liquid but nothing within 2 hours of the procedure, which was scheduled for 12:15. I drank about 8 oz. water from 8-9 a.m., then nothing else but a stick or two of (non-red/purple/blue) sugarless gum, which I had cleared with the nurse. I was thirsty and restless, ready to get the colonoscopy over with. I worked in the garden, weeding and watering, took some photos, did a short workout, cleaned both toilets :-), and generally occupied myself until the golden hour.

We arrived at the clinic (a separate building near the hospital) at noon. I gave the receptionist the medical history form I’d completed and she gave me a form asking questions about the prep, including “Did you have a good result?” :-) It also asked whether I drank all the prep (no) and if no, how much did I drink. I drank about 110 ounces in total, a little more than 3 liters. We had a very short wait, of about 5 minutes, just long enough for me to witness a woman post-procedure who was shivering, her teeth chattering, and who said as she was led by the nurse through the room, “I was awake for the whole thing.” Yikes! That’s exactly what I didn’t want to be.

After I’d undressed, donned the back-tying gown (made of rather heavy fabric) and the fun, colourful socks I’d brought with me (bring socks!), and stowed my belongings in a “tamper-proof” plastic bag, I met my prep nurse, Erica, whose manner was comforting, warm, and calm, and who gave me plenty of time to respond to her questions and to ask her questions about the procedure. She had me lie down comfortably on a wheeled cot, took my vitals (BP, pulse, temperature, O2 saturation; listened to heart and lungs), and went through my medical history and asked for clarification and elaboration of some of it (mainly about my arrythmia). She prepped and inserted an IV port in my hand, in a vein near the top knuckle of my right ring finger. I felt only the first little sting of the needle to find the vein, then nothing when she inserted the actual IV port. She hooked me up to a saline drip, which I couldn’t feel.

I asked her about the Versed (Midazolam, a benzodiazapine) and Fentanyl (an opiate) I would be taking via the IV during the procedure, stressing that I wanted as much as they could give me so that I was not alert during the procedure. She said I’d be awake — i.e., “breathing on your own,” which to me isn’t  necessarily a sign of being awake, as I breathe on my own every night while I am asleep … — but that I would be comfortable and in no pain, of that she could assure me. (Previously, another nurse there, by phone, had told me that I would be awake and that I would know what was going on but that I wouldn’t care.) As soon as she was finished and leaving the room, another nurse, Rachel, came in to wheel me in my comfy cot to the procedure room, which was filled with machines and monitors. Also cubbyholes labeled “large forceps,” and such.

Rachel didn’t have Erica’s bedside manner — she seemed sort of depressed to me, maybe she was just tired — and didn’t speak much as she got me situated, put the pulse thingy on my finger, and attached transmitters to me so they could monitor my cardiac function throughout. When I mentioned my desire to avoid pain, she said I might feel some cramping when the scope went around corners. That was (scary) news to me, after what Erica and the other nurse had said. I could see on the monitor that I was slated to receive “moderate sedation,” which I guess is the norm.

Erica came in, squeezed my shoulder, and wished me good luck.

Geoff, another nurse, came in and chatted too loudly and casually for the psychic space I was in just then. I felt vulnerable and anxious, which was partly from not knowing what would come next, and also, I think, from what felt like the subtly oppressive and overbearing presence of the room. What kept me from getting really worked up was my tiredness, from lack of calories and nutrients, and from lack of sleep the night before. I just didn’t have a lot of resistance available. Geoff and Rachel did engage me in conversation as we waited about 20 minutes for the doctor to show up. (They had to page her.) We talked about our dogs, mostly (after their question, asked separately by each, “What do you do for work?” fell flat), and then Rachel and I talked about how we each came to live where we’re living. At some point, I think when she said that her parents divorced when she was 18, Rachel reminded me of my youngest sister, and as I was making that connection, I saw my pulse drop to about 70. We also found that we both had family living in the same very small town about 500 miles away. Small world.

The doctor (Dr. S.) entered, sat near me, and briskly began to tell me all the bad things that could happen. She does about 1,000 colonoscopies per year and finds about 40% of people have polyps. Removing polyps can be dangerous: from 2% to 4% of people have complications from polyp removal that might require emergency surgery or another scheduled colonoscopy to remedy. She told me that there is a 5% polyp miss rate and a .5% cancer miss rate.

She also brought up the fact that I had called her office last week to talk with her nurse about why I needed this procedure. (Sidebar: That nurse, Chris, was great, chatted with me for about 20 minutes, went over my medical history, explained why based on that history she thought the colonoscopy was needed — which my primary care physician had not done and for which she wanted to charge me $100 for a phone consult! Chris was reassuring, detailed and forthcoming in her information and tips.)

Dr. S. said that based on my recent medical history, she thought I needed this done. Her tone seemed mildly reprimanding to me. By this time, of course, I was in the room, seconds from the procedure; obviously, her nurse’s arguments last week had been persuasive or I wouldn’t have been there. Why reiterate now, except to berate? Maybe she meant it as reassurance, but her manner was not reassuring, it was aloof and businesslike. As she spoke, she was rapidly making notes, not looking at me except briefly every now and then. She never smiled, or I couldn’t detect it if she did. She seemed to be reading a script, which I’m sure she was, performing five or so of these things each working day. I hoped that she was like my dogs’ former vet, a man well-known both for his excellent veterinary care and for his dismal people skills.

For about 5 minutes, I just lay there while Dr. S. did something at a terminal behind me. By now (in fact, since shortly before the doctor came in), I had a little oxygen nose tube, which was irritating. I kept taking it out and trying to readjust it so it felt better. Finally it did. I heard Dr. S. tell Rachel and Geoff that I was ASA1, or something like that, and I asked what it meant. Rachel told me that level 1 meant that I was at the lowest sedation risk. I asked her to give me all she could. :-) Then she did.

Geoff asked me turn onto my left side, and he removed the blanket and gown from my backside. I mentioned that I have sciatica in my left leg and he asked me if the position was hurting. It wasn’t and I remember thinking that if it was, it wouldn’t be for long! The last thing I recall is either Rachel or Geoff asking me how I was feeling. The first time I said I was a little dizzy or woozy, the second time I said I was getting sleepy (or maybe vice versa), and then I went into the happy world. I’m not sure of the exact time but it was about 1 p.m. (I think they paged Dr. S. at 12:40 or so.)

The next thing I was aware of was being in the prep/recovery room again and being asked about my spouse coming in with me. I think I told the nurse (another one, Holly) his name, so they could call him in the waiting room, and then he was there. It was 2 p.m. I was feeling groggy, sort of very sleepy and a little dizzy. Not too unpleasant. I was still hooked up to the IV when my spouse came in (he says — I don’t recall). Holly told me that they hadn’t found anything of concern during the colonoscopy and she gave me some papers. She told me no driving or alcohol for 24 hours (the first nurse, Erica, also told me this). She unhooked me and said I could get dressed and go when I wanted.

I’m missing parts of this because what I remember next is looking down on the bed and seeing my clothes in their “tamper-proof” plastic bag, and I don’t remember standing up. It was sort of like being in a dream, when you can’t recall how you got from point A to point B. I remember that I was unsteady standing up but I managed to get dressed, apparently, per spouse, without help. I remember leaving the room, thanking Erica, who was standing in the hallway outside the room, and feeling quite unsteady on my pins as we took the elevator down and walked to the car. I was a bit clammy, like when I have a minor case of the flu, and when we hit the outside air (still in the mid-80s), I felt too warm and slightly nauseous.

The feeling cleared quickly and from then on, it was clear sailing. Oh, did I mention that I had not one moment of gas or bloating (that I’m aware of) after the colonoscopy? My spouse had had a half-hour of it after his so I was expecting some, but I felt great immediately. The only lingering effect is a bruise on the inside of my right knee, which must have come from the pressure of it on my left leg, due to the position I was in for the procedure.

When we got home, my spouse encouraged me to eat but I was too sleepy. I went to bed from 2:30-4:30, woke up feeling great, and we went out to dinner, where I had more mostly bland food (ravioli, small salad, diet Coke). Then we took a short walk downtown and I had most of a glass of iced tea at a cafe. We ran a couple of errands while walking, and when we came back to the car to go home, I sat on something we had bought a half-hour earlier and thrown onto the front seat (a box of pasta), which is unusual behaviour for me — not to recall that something was in that seat, and not to notice that it was — and a sign that I was still a bit foggy, I think.

I had a couple of small bowel movements in the evening, mostly liquid. My stomach gurgled off and on. I slept well and woke up very early (5 a.m.), thanks to my deep naps of yesterday.

This morning I had my usual soy sausage, tea, and juice with vitamins. My stomach is still gurgling from time to time but I’m feeling fine.

Based on my experience, and remembering that I am not a medical professional!, I recommend, if you are in good health, either juice-fasting or eating a light and bland diet for at least 2 full days prior to the procedure (3 or 4 days of light eating might be better). Add Crystal Light to Golytely — that’s unofficial, of course, as the Golytely people say it’s verboten. (NuLytely has its own “flavour” packs — from what I read online, orange is the best bet.)  In any case, make sure the stuff is thoroughly chilled. You might not have to drink all the liquid, if your movements are clear (straw-coloured with little particulate matter). Stay near the toilet for about 5-6 hours from the time you start the prep but don’t be surprised if it takes 2-3 hours to get things moving. My urges to go weren’t sudden but they were pretty constant, about every 15 mins for a couple of hours. Bring socks with you to the procedure, especially in winter (but many medical centers are cold year-round). Don’t plan to do anything much for at least 3-4 hours afterwards, and in fact, another instruction from Holly was that I shouldn’t do anything requiring judgment for the rest of the day/evening, like cooking. I did actually cook three things around 8 p.m. without any trouble, but my spouse was there in case I spaced.

All in all, a pretty good experience, one I wouldn’t mind repeating, and I can’t say that about many medical procedures.

17 June update : So, I’m trolling around online, now that I have the official report of my colonoscopy and its findings in hand, curious about how much Fentanyl and Versed other people got. I got 200 mcg Fentanyl and 10 mg Versed “in small aliquots” (bit by bit through an IV), and based on my online research (e.g.), that seems to be a lot, like twice the normal dose, for which I am very grateful. As noted in my procedure report, “She tolerated the procedure well.” (I hope that’s not some doctor shorthand for “It was awful but she can’t remember and we’re not telling.”)

Anyway, came across this hilarious and factual-sounding colonoscopy story from poopreport.com and felt it would be a disservice to keep it to myself.


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3 thoughts on “Colonoscopy

  1. Very insightful and amusing article :-) Enjoyed the read. (I’m up for one in 2 days, so this lightened my spirits.)

  2. Just read your story, it made me feel much better about getting my colonoscopy tomorrow. I have the same fear as you about not being knocked out. I don’t want to hear anything or feel anything. My doctor is making me go two days without solids, only clear liquids. Then the day before the procedure I drink the Golytely beginning at 4pm. I don’t know if I will be able to drink it all but I am trying!

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