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A Colonoscopy Story

by Bill L.

Greetings! If you are 50 or older (45 or older if you have a family history of colorectal cancer), please take a few minutes to read this page.
 

Colon cancer is the second leading cause of cancer deaths, after lung cancer. But when caught early, it's 90% curable. 

With this web page, I hope to help people understand what a colonoscopy is (from my own lay person's perspective), why it's done (primarily from a colon cancer perspective), and help alleviate the stigma attached to the exam by letting folks know what it's like to have one. Of course, everything I've written here is either my personal observation or in some cases just my opinion, and does not constitute expert knowledge or even absolute factual accuracy. Your best resource for information on health in general and colonoscopy in particular is, of course, your own doctor.

Introduction

You probably came to this page through a web search on colonoscopy or through a link from a page dedicated to intestinal health or even cancer. You're probably also facing the potential of having a colonoscopy yourself in the future--possibly very soon--and you have questions. And if you're like me, you're feeling uneasy, a bit squeamish, or just plain nervous about it. I'm certainly not one for invasive procedures, and the idea of someone looking up your back side with a 4-foot implement is strange and can be rather unsettling. But it's not as strange as you think--or at least not uncommon. Thousands of these procedures are done in the USA alone every day. The doctor who gave me my first colon exam does about 20 of these examinations a week. And he also told me that a large percentage of the colonoscopies he performs are voluntary, not physician-prescribed. That is, many patients actually request the exam of their on volition because they see the need. And the need is real: colon cancer is the second leading cause of cancer deaths, after lung cancer. And caught early with this test, it's 90% curable.

What It Is

A colonoscopy is an examination of the internal walls of the colon for inflammation, polyps (protrusions), diverticula, restrictions, cancer, and other irregularities. The examination uses a long flexible tube called an endoscope (or colonoscope in this case) that has a light source and a tiny video camera on the end. The endoscope can also be used to take tissue samples (biopsies) or remove polyps (small protrusions from the intestine wall) if any are found. The colon must be empty for the examination, so a half-day or so cleansing period is needed during which a strong laxative and a large amount of clear fluids (no solids) are consumed. During the actual examination the patient is usually mildly sedated for comfort (a relaxed patient is also a more cooperative patient) and air is introduced into the otherwise deflated colon for better visibility and ease of manipulation of the colonoscope. The sedation is also accompanied by a pain killer, though some patients opt for neither the sedative nor the pain killer.

Why It's Done

Many colon health issues that requires a close, internal examination of the colon could warrant a colonoscopy. Other methods exist, such as a barium enema, but the colonoscopy is less unpleasant and gives a better view than the barium approach (and also allows ready access for other procedures). Virtual (non-invasive) colonoscopy is also an option in some cases, but it still requires an empty colon (the process of which most patients say is 90% of the unpleasantness of colonoscopy), and if polyps or other abnormalities are found a conventional colonoscopy would still be needed.

Health concerns that call for colonoscopy include ulcerative colitis, Crohn's disease, diverticulosis, restrictions or blockages, unexplained bleeding, polyp detection and removal, and others. But one of the most outstanding reasons for colonoscopy is the early detection and treatment of colon cancer. Today's statistics show that regular colonoscopic screening starting in middle age (50 for most adults, 45 or younger for those with a family history of colon cancer) can address 90% of colon cancers by catching them in the polyp stage. Not all polyps are cancerous or will necessarily become cancerous, but since one cannot tell which are which, any polyps that are found during the exam are removed. And with colon cancer being the second leading cause of cancer deaths in this country (behind lung cancer), that means an immense number of lives can be saved by a relatively simple procedure -- if the disease is caught early. In my particular case, I have a family history of colon cancer, so at age 44 my physician recommended that I get started with the screening regimen.

What It's Like

I don't think any two people have quite the same experience with the procedure. By and large, in my readings and online conversations beforehand, I'd learned that it is not generally all that bad. Most will tell you the preparation (no solid food, distasteful laxative, drinking lots of fluids, having diarrhea for a day, and maybe a sleepless night) is the worst part. For the average patient, the exam itself is usually relatively smooth-going. It's also over quickly, or so it seems under sedation. When no polyp removal or biopsies are involved, the examination takes 10-20 minutes. 45 minutes seems to be about the maximum when there are other issues involved. My own experience went like this (be advised, we're talking about intestinal stuff here, so I'm going to be pretty frank about some indelicate things)....

The Office Visits

When I hit my 40s a few years back, I kind-of knew it wouldn't be long before my physician advised me that a colon examination would be a good idea. I do have a family history of colon cancer (father, at age 62), so the recommended starting age for screening moves from the usual 50 or so back to about 45. Fecal occult blood (FOB) tests, that detect hidden blood in the stool (that can be caused by bleeding polyps or other abnormalities, not necessarily cancer), are routinely done on adults, though these usually indicate a problem exists that has already made some progress. I read somewhere that the FOB test improves one's odds of detecting and surviving colon cancer by about 17%. Another test that is available is the flexible sigmoidoscopy, wherein the interior of the last third (the sigmoid) portion of the colon is examined. This, however, leaves two-thirds of the colon unexamined. The current "gold standard" is the colonoscopy, wherein the entire colon interior is examined and minor corrective procedures can be done simultaneously. My physician suggested I start right in with this test, and referred me to a specialist (gastroenterologist).  The gastroenterologist (GE) is ultimately the one to decide if the procedure is warranted, and is also the one who performs the actual exam. That office visit came some weeks later, and the GE concurred that a colonoscopy was appropriate in my case. We discussed a few of my questions and he gave me a set of instructions on how to prepare for the exam. He then set up an appointment for me at an outpatient surgery clinic at a local hospital.

The "Prep"

On the day before my 8:15am appointment, "prep day," I worked in the morning and took the afternoon off. I had eaten very lightly the day before to help make the pending clean-out process a bit easier, though the preparation regimen did not call for that. Per instructions, I ate a restricted breakfast on prep day and drank only certain allowable clear fluids. I could have also had a restricted lunch, but skipped it. At about 3pm, I mixed 1-1/2 oz. of Fleet's Phosphosoda into some Mountain Dew and downed it. (Phosphosoda is no longer available due to concerns over the stress it can place on the kidneys.) There are other preparation options such as Golytely or Nulytely that come in large jugs and need to be consumed over a period of a few hours. Most people I heard from preferred the Fleet Phosphosoda, that would come in a small bottle of concentrated liquid. It had a peculiar salty taste, something like Alka Seltzer Plus. Not pleasant, but tolerable. Much soda pop and fruit juice followed my first dose over the next few hours (I avoided caffeinated beverages after the first glass or two). The next 1-1/2 oz. of Phosphosoda came at 8pm, also followed by clear liquids. Staying near a bathroom was very important. Eventually, by late evening, it seemed the laxative had worked so well that by about 11pm a glass of white grape juice went all the way through me in just 5 minutes. I guess that meant I was "clean." All in all, I drank about 100 oz. of fluids (3 quarts or so) during my wash-out period. I expected I might have to visit the potty a lot through the night, but that wasn't the case (only once or twice). But my quivery colon, thoroughly wet inside with this foreign Phosphosoda solution, was a bit irritable and made it hard for me to sleep. Worry about the next day's proceedings didn't help, either. And having had no balanced meals for a full day also made me a little jittery. So it was a restless night. But it could have been worse -- I could have been "on the throne" all night.

The Exam

The next day, my wife, our pre-schooler, and I left for the hospital, allowing an hour for the trip. The commute traffic was slower that we anticipated, and made for more anxiety on my part, but we got there with about 2 minutes to spare. (Our almost-3-year-old wanted to hold my hand through most of the trip, which probably did more good for her apprehensive daddy than it did for her!) The hospital allowed 45 minutes for sign-in and pre-operation preparations. After waiting a short while in the lobby, a young nurse called me in to the pre-op area and measured my heart rate and blood oxygen level, the latter with a little clothes pin-like thingy they clip onto your finger. She then led me to an alcove with a gurney and a curtain, and gave me a bag for my clothes and a hospital gown (open back) to put on. I obliged, and climbed up on the gurney. She then had me lie down, and hooked me up to an IV tube with a simple dextrose drip (no drugs). She took my blood pressure (that was high -- I was pretty nervous) and set me waiting for the doctor to arrive for my 9am exam. At about 5 minutes to 9, she and another nurse wheeled my into the adjacent surgery room where the two began more prep work. The other nurse was a bit older and, as it turns out, was helping train the younger one in the art of colonoscopies. Ok by me.... The second nurse began to confidently chat about the equipment, the room, the sedative, the video monitor, the procedure, and other things, and the pleasant distraction made my blood pressure drop. They hooked up an automatic blood pressure collar to my arm, put an oxymeter on my finger, put on a nasal oxygen supply tube, and connected two syringes to the IV tube (the sedative Versed, plus a pain killer). I joked that I had more wires connect to me than my computer at home, and got a good chuckle. The older nurse spoke of the time she'd had an operation while under Versed, that only makes you drowsy and mellow. Apparently she got so light-headed and loose she talked her head off, so the surgeon had her put under with a general anesthetic. A bit more chatting and preparation work went on around me, and then the doctor came in, right on time. After we all exchanged some friendly greetings, I asked what gas is used to inflate the colon. "Oh, just air," they said. "If you use helium, will I lose weight?" I quipped. They though about it for a second, then laughed. As the conversations between doctor and nurses went on, they apparently gave the syringes a squeeze or two. The first nurse asked if I was feeling the sedative. A bit groggy by then, I said yes. They rolled me onto my left side, and the doctor sat behind me to begin the exam. He took a rubber-gloved finger and.... well, did some poking. He must have started with the colonoscope right after that -- I could hardly tell. But up on the video monitor a burst of red appeared, then the tunnel-like view of the colon interior I'd seen on a number of television segments about the topic appeared. Forward ho!

Most of the examination is actually done on the way out; they work first to get the tip of the colonoscope to the connecting point between the small and large intestines, then begin slowly backing it out, making careful observations along the way. Generally speaking, in a normal and healthy colon (conditions such as colitis or Crohn's disease complicate matters), there are two things that might or might not cause discomfort during this process -- getting the colonoscope around the two bends in the colon, and the induction of air. Polypectomies and biopsies (I had neither during my procedure) don't hurt because the inner lining of the colon has no pain receptor nerves. For me, I don't recall rounding the corners as being a problem. On the other hand, on a few of occasions when the doctor pumped me up, either to get a better view or open the corners wider for passage, it did hurt--basically a crampy gas pain. I grimaced, groaned, and wriggled a bit, and the doctor told the nurse to put a bit more of the pain killer into the IV feed.

As the doctor went along, he would make the occasional comment to the nurses, though I don't remember anything specific. I sometimes watched the monitor, sometimes drifted. I made a few small comments, but I could tell the doctor wanted to concentrate on his work (and I wanted him to, also!) so I mostly kept quiet. Before I knew it, it was over (a total of 10 minutes on the "inside"). They rolled me onto my back, took off some of the wires and plumbing, and rolled the gurney into an adjacent recovery room. There they removed the IV and let me lay around for a while. A bit later a nurse came gave me some cranberry juice to drink. After more time passed, she came by and had me sit up and climb off the gurney to get dressed again. Once I was dressed, she took me to an adjacent sitting room to wait for the doctor to come and give his comments. My wife and daughter came in to join me there. When the doctor came, he said he saw no irregularities, all looked well, and that my next exam could be in 4-5 years. He said I should go off with my family and get something into my stomach, and that I could immediately resume my normal diet (with no avoiding of aspirin, alcohol, or any other foods), though resting for the remainder of the day seemed a good idea.

Afterwards

Post-exam, I had no rectal discomfort (even after the previous evening of going to the bathroom that made me kind-of sore) or anything like that, during or after. A lot of the air stays behind, and that can be uncomfortable, but it comes out eventually. The Versed sedation does leave a lingering drowsiness, so driving (operating heavy machinery, etc.) is out for the remainder of the day. Versed also can produce some amnesia, causing memories of the exam experience to fade, so it's a good idea to write down what the physician tells you afterwards if no one is there to help you remember. On the way home, the three of us went to a local restaurant for brunch. It was a nice relief to have the colonoscopy behind me (so to speak) and the results turn out well. The next day, the hospital called to see how I was doing. Fine, thanks! They asked if there was any cramping or bleeding, fever or problem urinating. No, I seemed fine. But I was so empty it took another day for my system to, um, get going again.

So there you have it. All in all, the test involved some apprehension, some inconvenience, some embarrassment, a bit of "yukkiness", some minor discomfort (with a couple ouches), and a day and a half off work (nice to have the break, actually). If you're looking ahead to your first exam, I hope this account of my own first exam helps to demystify it all somewhat. What was the hardest part? For me, mostly the worry about all the unknowns. Would the laxative make me nauseous and sick? (It didn't.) Would I be "clean" enough? (Apparently I was.) Would the procedure be painful? (Just a cramp or two.) Would they find polyps or even cancer? (They didn't.) Would there be a procedural mishap? (There wasn't.) Some people also say the loss of control at the hospital is scary, since you turn all that over to the staff once the pre-op preparations begin. But I found the staff to be quite accommodating and very efficient, and the environment itself felt well-controlled and trustworthy, so it turned out that being at the center of so much sophisticated and careful attention was actually (and unexpectedly) reassuring rather than unnerving. I'll be doing this again in a few years, to be sure, and I certainly hope it all goes as well then, too (though I think I'll advise the attending doctor beforehand about the cramping I get from air induction). It all turned out pretty well this time, a very real answer to prayer.

In A Nutshell

Based on comments from others as well as my own experience, I can say this exam is just not something most people would have reason to fear. My favorite quote on the topic comes from a lady I communicated with online when I went searching for comments about the exam. She had colitis and needed a colonoscopy every year or so. I asked her what she felt about having the exam. She said, "It's not something I look forward to, but it's certainly not something I dread." And the potential benefits you get for your trouble (considering what this exam can catch and potentially cure) are so huge, it's pretty much a "no-brainer". Please, if you're in the age group or risk category where this test is appropriate, talk to your doctor about having the exam. Don't let yourself die of embarrassment.

Bill's tips

Here are a few pointers I've learned about the prep and the procedure that you might find helpful.
  • Be informed (like you're doing here). Knowing what to expect ahead of time can make a big difference in easing apprehensions.
  • Don't be afraid to ask questions of the clinic staff, or to tell them you're nervous or uncomfortable. Their job is to help you.
  • Pick a morning appointment. Statistics show that polyps are more effectively detected during morning exams.
  • Aim well on the potty. Things might get pretty forceful, so shoot for the water (and not the exposed porcelain) or you'll have a big cleanup job on your hands.
  • When drinking your clear liquids, beware that one can get too much sugar, caffeine, and/or carbonation. Sometimes plain water is the best thing.

More Info

There are lots of very good resources on the web describing the procedure, along with the needed preparation. The most encouraging thing for me before my exam was seeing Katie Couric of NBC's Today Show go through her first colonoscopy with relative ease. An online version of the video can be seen on this page. I highly recommend it. There is also the Colonoscopy.com site, a great resource for information and discussion. Also there is the Colorectal Cancer site. Additionally, searches for "colonoscopy" on HealthWatch.com, WebMd.com, and Health Central will yield very good information. Here is a link to virtual colonoscopy information. And here are some testimonials from visitors to this page. Oh, and if you want to see the lighter side of having a colonoscopy, here's Dave Barry's essay on his own experience. It's hilarious!

# # #

Footnote, Feb 2004

Well, folks, I just had my second colonoscopy, four years after my first. Like the first, it went pretty smoothly. The prep was the "worst" part, but not that bad. This time my appointment was at 2pm, so I started my Phosphosoda regimen at 5pm the previous day with my second dose at 6am on appointment day. My stomach was a little queasy on the morning of the appointment, primarily because of lack of food, I think, but ginger ale seemed to cure that. My exam was at a different clinic this time with all different personnel. I was very pleased with how nice the nurses were with their bedside manners, calming attitude and attention to detail. The doctor, whom I had not met prior to the exam (my consultation had been with a nurse practitioner), was very friendly and informative. He told me exactly what he was doing as he went along, and was very good about answering my questions. He was being quite thorough so the exam took 20 to 30 minutes. I watched the whole thing on the video monitor, very interested in the process. There were definite moments of discomfort when he had to inflate my colon for passage of corners or closer examination of sections, but they accommodated me be releasing pressure as soon as possible and adjusting both the Versed and the pain killer to help. Thankfully, when it was all over, there were no polyps or irregularities. The doctor said I should be examined again in another five years.

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