Thursday, September 25, 2008

My Colonoscopy: The Preparation

OK, the votes are in, and, by a vast margin of 1-0 (see the blog before last), they are in favor of me sharing about my recent colonoscopy experience.

This is not for entertainment purposes, mind you. It is simply to help someone (like me, three weeks ago) looking to see what this routine procedure is like from the patient's perspective.

It started with me overcoming my internal debate and calling the digestive health center to schedule the colonoscopy, after the requisite pressure from my RN wife and me getting a referral from my regular physician. (In my case, my colonoscopy was simply due to my age, now 51, and was meant as a baseline. I haven't had any problems that drove me to get one.)

The clinic staff was very polite and reassuring on the phone. They would send me an important packet with preparation instructions in the mail.

The packet came little more than a week before my procedure was scheduled. The instructions were detailed and clear as regards the prep.

The goal is to arrive at the outpatient clinic for the procedure (in my case, at 9:30 on a Monday morning) as "clean as a whistle." Preparation begins about 3 days before the procedure, by observing a diet mildly restricted -- no seeds or nuts, etc. Things that might get stuck in there and hang around for awhile.

Then, as of breakfast the morning before the day of the procedure, that's when things really get kicked into gear. Liquids only, then you drink the first of two potions ("Fleet Phospho Soda" or the equivalent generic, which costs about $4 or $5 for a 1.5-ounce dose at your drug store), designed to make sure your submarine has good visibility once inside.

I had actually been taking it easy food-wise for the past three days. No red meat, etc., which wasn't hard since I normally only eat red meat once a week anyway. This wasn't part of the instructions, I just thought it would be a good idea. And that wasn't hard, but I was a little nervous, so I went into the weekend fairly hungry anyway.

You have to understand that I am not one of those people who can't fast. I actually enjoy the occasional challenge of going without food for a full day, which I find helpful in getting my mind focused on other things, mostly of a more spiritual nature than my stomach. So, I can deal with being hungry.

My problem was that the day before Monday was Sunday (no duh, huh?), which is typically very busy for me. I was supposed to make some important announcements in front of the entire congregation during worship. One particular part of the instructions caught my eye: "After drinking your first 1.5-ounce dose of Phospho Soda, don't let yourself get too far away from a toilet." The instructions warned that this need could come on you very suddenly. So the thought of that happening while I was standing up in front of 200 people in church was sobering. I hence decided to push the envelope and wait until after church for my first dose. (And, I dutifully skipped the church picnic.)

Basically the prep is a clear liquid that you mix in 8 ounces of something drinkable. Looks like water, tastes like concentrated seawater. My wife, an RN with prior experience, recommended cold fruit juice. The thing to understand about this concoction is that the taste is the worst part. It's basically like drinking sea water, even in the juice. But, you force it down, knowing it's what you need to do, and gratefully it's over as fast as you can drink it, in my case about 2 minutes. You then drink another 8 ounces of juice just to clear the saltwater taste off your tongue. Plus it's recommended to take lots of fluids to replace what you're going to lose shortly.

A normal dose (for laxative purposes) of this stuff is a third of a bottle, half an ounce. So I suspected that a triple dose times two (recommended for just such a cleansing) ought to have dramatic results. I immediately sensed that wasn't far off the mark. The moment the stuff hits your stomach you start to feel some unusual motion. No nausea, or anything like that, just movement. A distant thunder. Storm brewing. Odd.

Instructions say it takes between 30 minutes and 3 hours to have your first BM. (You're supposed to call the doctor if nothing happens after 3 hours. I assume this means you need a plumber in a bad way.)

For me it was 45 minutes. Of course the first time (which I was rather hoping was the last -- foolish boy) is the worst, because that's where the heavy lifting is done. But don't think, "Whew, I'm glad that's over," because believe me, it's not. Your GI system is now revved up and the motor is running. The next few hours you will become well acquainted with your commode.

I had mild cramping (not bad) during this first run. After 3 or 4 hours I felt more or less normal, just a little tired of all the action, and thinking, "Wow, what on earth do you need a second dose for?" I guess it's just insurance.

Now you're on clear liquids only. Jello, broth, things like that. Whatever you put in pretty much comes out, in pretty close to the same state you put it in. The second dose tasted just as bad as the first, and had an almost immediate result. Each time you're a little clearer, until basically it's just a clear yellowish liquid.

The only other annoying thing that, and this was really about the worst of it, was that I began to get a little sore "down there." TP was the enemy. I found a little diaper ointment, discretely applied, helped a lot.

The second dose caused no cramping this time. And of course, if you're like me, by this time you haven't eaten for about 24 hours and you are hungry. But the good news is that I caught up on a lot of reading to try and keep my mind off my stomach.

The next morning, before the procedure, I just drank water, though they allow more (clear liquid, coffee, etc.). I'm not the kind of person who needs coffee, so I didn't bother.

I was glad the clinic called and asked, "We had an appointment cancel ... can you come in an hour earlier?" Rather not waste the time just waiting around.

So, the prep is done. The worst part is over ... and, as I said in response to my one comment, it's really not that bad. You just need to be prepared to do "nothing but" (no pun intended) for 24 hours before your procedure.

Next installment: the colonoscopy itself.

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