03 16th, 2017
Remember that kids’ book “Everybody poops“? It’s one of those inconvenient and embarrassing truths. But sometimes you have to talk about it. This is one of those times. Colonoscopies are nothing to be embarrassed about, and I’m posting this to help people who are facing their first colonoscopy to overcome the fears they may have developed from hearing third-hand horror stories.
You know you’ve reached an age milestone when your doctor starts telling you that you need to have a new medical test.
Oh, you’re 21 now? Scoot closer to the end of the table, it’s time to start getting pelvic exams and pap tests.
You’re 40? Mammogram time, let’s squish those melons.
So you’ve turned 50? Oh shit, you’re due for a colonoscopy.
I hit 50, got that advice from the doctor and promptly proceeded to ignore it for several more years. I’ve always felt that particular orifice was meant to be an egress, not an ingress, so getting a camera on a hose shoved up in there wasn’t ever going to be on my bucket list. I hoped that if I just ignored the doctor, I could get away with not getting it done.
Last year I started working out regularly and began to take a more serious interest in my health. In May of last year I went to the doctor for a full physical exam, bloodwork, EKG, etc. My doctor, who I really like, mentioned the colonoscopy again, and gave me a referral to one of several local gastroenterologists. I ignored it–until mid-December, when she mailed me a letter hinting that I’d better get the colonoscopy done if I wanted to keep her as my doctor. I started calling the phone numbers on that referral sheet and made an appointment to go see the gastro doctor who could see me the soonest. I was scheduled for an initial consultation appointment at the end of January, 6 weeks from the date of my call.
The appointment didn’t go so well–the gastro doctor was running so far behind schedule that the receptionist actually told me to go to lunch and come back in two hours, When I came back he was STILL running late, and I wasn’t put into a room for another 30 minutes. That was almost enough to put me off of the whole thing. But while I was at lunch, I called the other doctors on that referral sheet again, and *none of them* could see me until late April, a full three months later.
So after lunch I went back to the doctor’s office and continued to wait. The doctor finally showed up, and turned out to be hilarious. He started apologizing/venting the second he came in the room. He was running late because every patient he had done a colonoscopy on that day had had at least 30 polyps, and that put him way behind schedule. Damned inconvenient polyps! I promised I’d try to have as few as possible. He was well spoken, and very interested in answering any questions I had, not only about the colonoscopy, but about the acid reflux that has bothered me on and off for years.
After a long discussion during which I found out that I had been incorrectly told by two different doctors how to take Omeprazole and Famotadine (both different kinds of antacid medications), he decided that I should have an endoscopy test at the same time as the colonoscopy to look into the acid reflux problem as long as I was going to be under anesthesia anyway.
When he asked if I had any other concerns, I mentioned that I had a painful hemorrhoid and asked if he could remove it. His response was a shrug and a “Maybe.” When I was done sputtering, he explained that some hemorrhoids are really classified as skin tags and have to be removed by a surgeon. He would have to see it, and now was not the time. He still had patients waiting back at the hospital that he had to go back and finish scoping–he had left them to come to his office to see the patients who had been waiting all afternoon for him there. My first thought was that this guy needs a clone…
He told me to remind him about the hemorrhoid on the morning of the procedure. I said I’d put a note on my ass to remind him. We laughed, he gave me the info sheets about the dreaded “colonoscopy prep” and much simpler endoscopy prep, and I left. His nurse called me the next day to schedule my tests. I asked for the earliest morning possible appointment for two reasons–one, I was afraid I’d be viciously hungry after fasting for over 24 hours and didn’t want to go any longer without food than absolutely necessary, and two, I didn’t want to risk ending up stuck waiting all day for him to finish a dozen other people with potential multiple time-consuming polyps. The soonest she could get me a first-of-the-day appointment was March 15, another six weeks away.
So I had six weeks to look at that colonoscopy prep sheet stuck to the front of my fridge. The sheet said that the day before the test I was to be on a clear liquid diet. I was to avoid all solid food, and to avoid eating or drinking anything containing red, orange, blue or purple food coloring. And six hours after taking two Dulcolax laxative tablets, I had to drink 64 ounces of liquid mixed with 8.3 ounces of Miralax laxative powder within two hours.
“OMG, 24 hours with no solid food? I’m going to starve to death. And how will I ever choke down that nasty prep solution? I’m going to be miserable.”
I had thoughts like this every time I walked past the fridge and saw that prep sheet. I finally stuck the prep sheet to a magnetic board inside a cabinet so I didn’t have to look at it constantly. But the date was still marked on my calendar and etched into my brain. The ugly thoughts didn’t stop. Watching a Facebook friend fret and complain about her upcoming prep last month didn’t help me either. She bitched and moaned online all day on the day she did the prep. All of *her* friends told her that the prep was the worst part, but the test itself was nothing to worry about. I watched the thread for a while, hoping to pick up some useful tips. There weren’t any; just a lot of whining. I finally blocked that thread because it was just making me more anxious.
A week or so before I was scheduled to do my prep, I finally started looking online for suggestions on how to survive it. I found several blog posts that were very calming. One of them suggested going on a soft food diet a few days before doing the prep to make the process easier on the body. A quick Google search turned up a hospital’s “low fiber” diet for colonoscopy prep. Basically it was the reverse of a typical healthy diet–they suggested eating things high in white flour with no fiber, no fruit with skins or seeds, no tough meats, no nuts, no vegetables. Finally–a good excuse to not eat healthy for a little while! I had pancakes for breakfast three days in a row, lots of eggs and potatoes, creamy peanut butter and white bread, and mushroom soup for lunches and dinners.
One of the bloggers also suggested taking as long as necessary to finish drinking the prep solution, to avoid possibly making oneself vomit from drinking too much liquid too fast; several of them also suggested drinking it as icy cold as possible, and to drink it with a straw if necessary to keep from tasting it. Other suggestions included making lemon Jello or buying lemon Italian ice to have some “food” to chew during the clear-liquids-only prep day.
When I finally went to the grocery store to get prep diet ingredients, I bought the Dulcolax and Miralax, and too much of everything on the ‘allowed’ clear liquid diet list–a jar of chicken bullion cubes, a two liter bottle of Sprite, 64 ounces of white grape juice, TWO 64 ounce bottles of apple juice, a 6 pack of 12 ounce white-colored cherry-flavored “Frost” Gatorade, a box of frozen lemon Italian ice, a box of lemon Jello, and 3 boxes of Knox gelatin. Side note–eons ago I went to a party where I met the man I eventually married. He was sticking Knox blox to the bottom of a glass topped coffee table to see how long they would stick before falling off. Walking past the Jello display at the store, suddenly I *had* to make Knox blox. It turned out to be a pretty good idea, even if it made way more than I needed or wanted.
“Prep day”: I started my morning with 32 ounces of icy cold water. Yum. Then I boiled 3 cups of apple juice, mixed a 4th cup of cold apple juice with the contents of a whole box of Knox gelatin, and added the boiling juice to that. I put that in a 9×13 baking pan and put it in the fridge to set up. I weighed out half of the Miralax powder on my kitchen scale and added that to the other half of the 64 ounce bottle of apple juice. While I was mixing it, I stuck a damp finger in the Miralax powder and tasted it all by itself. It had no discernible flavor at all! The other half of the Miralax went into an empty distilled water jug. I added 16 ounces of white grape juice and 16 ounces of the white cherry Gatorade; I used to like cherry-grape juice as a kid, so I figured this might taste similar, and it did. Both of those bottles went back into the fridge to stay cold. Then I left to take a family member to an appointment.
By the time I got home, the Knox gelatin mix was firm enough to cut up. I portioned it into bite sized pieces, ate some and put the rest in a plastic storage container. Then I started in on the rest of the first bottle of apple juice. At noon exactly I took the two Dulcolax, and waited. And waited. And waited. 90 minutes later things moved a little, but it was completely normal. Then nothing else. For 3 1/2 hours, nothing at all happened. Worried, I took two more Dulcolax at 5pm.
At 6pm I poured an 8 ounce glass of the apple juice prep mix and cautiously tasted it. It tasted–like apple juice. It felt–like apple juice with a little vegetable oil in it, just a hint of ‘this is wrong, it’s too thick to be apple juice’. Drawing on an old and long-unused college-era skill set, I downed the whole glass as fast as I could. No problem drinking it, just a hint of weird sliminess on my tongue. I poured some Sprite in a glass and drank a little bit. It tasted *vile*, bitter and harsh. I wasn’t sure if it was a bad bottle, or if it was the combination of apple juice/Miralax/Sprite was causing the bad taste. But it cut the sliminess. So for the rest of the prep, I used the vile, nasty-tasting Sprite to cleanse my palate after each dose; I swished it around and spit it into the sink. I tasted the Sprite again the next afternoon–it was the Sprite. It was mostly just carbonated water. Leave it to me to pick out the one bottle of Sprite in Meijer that didn’t have enough lemon-lime syrup mixed into it.
I set a timer, and every 15 minutes I poured another 8 ounces, chugged it down, and gargled with Sprite immediately afterward. 6:00, 6:15, 6:30, 6:45. I should have been ready to start the second bottle of mixture at 7pm, but somehow there was one glass worth of mix left in the apple juice bottle. I had measured out the apple juice-4 cups, 32 ounces. I had measured how much the glass held before I started drinking. It held one cup of water, 8 ounces. But somewhere along the line, adding 119 grams of Miralax to 32 ounces of apple juice produced 40 ounces of prep solution, or five 8-ounce glasses.
Just before 7pm the Miralax started working. Not violently, no cramps, just a sudden ‘gotta go NOW’ urge to get to the bathroom. The urges came about every 10-15 minutes for several hours. I drank the rest of the prep solution between bathroom visits.
One of the blogs I read suggested setting up a phone charger in the bathroom, so I could watch movies or play video games on my tablet while I was stuck in there. It also suggested getting some Vaseline or diaper cream to apply to the area in question, as well as some diaper wipes; apparently it can get sore after being wiped so often. The suggestion continued by saying it was best to apply the cream or ointment *before* things get started, so the skin is protected, and re-apply after every bowel movement. I followed the suggestions using hemorrhoid cream with a pain reliever in it, and had no pain or irritation at all. Even the constantly-painful hemorrhoid made it through the prep undisturbed.
At 7:15 I started on the grape juice/Gatorade mixture. It was a lot easier to drink than the first mixture, and didn’t have any hint of oiliness or slime to it at all. If I ever have to do this again, I’ll just go with that and skip mixing it with apple juice. I finished the second bottle at 8:15. I continued to drink water every hour or so all evening to prevent becoming dehydrated. I wasn’t supposed to have anything at all after midnight, so just before the witching hour I drank a huge glass of water. The effects of the prep didn’t begin to slow down until midnight, and I couldn’t actually go to bed until around 2am.
When I was almost finished drinking all the prep, I began to get cold all over. I think it was from chugging half a gallon of icy cold liquid so fast. I put on a heavy sweatshirt, but my hands were still painfully cold for a couple of hours. During that time my fingers shrunk in diameter so I was able to pry my wedding rings off, which was a requirement. The prep sheet said that no jewelry could be worn during the procedure, no exceptions. Taking off my rings was probably the worst part of the whole prep for me–I Never Take Off My Wedding Rings.
I was pleasantly surprised to find that I never got hungry all day. I think it was because my stomach was constantly full of liquid from noon on. If I wasn’t drinking the prep solution, I was drinking apple juice or water. I only ate a few pieces of the Knox blox, and never did make up any chicken broth or eat any of the Italian ice.
The next morning I woke up still not hungry. I was very thirsty, but I couldn’t have anything to drink. The prep sheet said I could brush my teeth, which I did with a wet toothbrush without toothpaste. As soon as the water from the toothbrush hit my tongue, I suddenly became ravenously hungry. And the prep continued to work as soon as I woke up. I was quite empty by the time we left for the hospital.
Upon arrival, after I checked in and was properly identified and my insurance info was recorded, I was assigned a 6 digit number. Many other people were also waiting in the same area. A large TV screen on one wall displayed a long list of 6 digit numbers. My number shot right to the top and I was the 3rd person called after we sat down. When the nurse called my number, I yelled “Bingo!”. As she walked me through the doorway to the surgical ward, I sent up a quiet thanks to the scheduling person who got me an early slot.
The nurse took me back to a very pretty, sunny private room where I was instructed to disrobe and put on a hospital gown. I pulled a piece of waxed paper with some neon yellow gaffers tape stuck to it out of my coat pocket and put it under my phone on the bedside table. After I was gowned up and in the bed, the nurse came back and inserted the IV in my arm. That was the second worst part of the whole procedure. I Hate Needles. But she was great and I didn’t even feel it. Once the IV was in, she brought my husband in to wait with me until it was my turn. After she left, I had him help me apply the neon yellow tape to my ass.
The note written on the tape, as promised, read: “Please remove the hemorrhoid…and the tape. Thanks. :)”
The procedure itself was anticlimactic. After an hour and half in the pretty room, my doctor came in and apologized for the delay. Apparently his first two patients had a total of 22 polyps between them. I promised again to try to have as few as possible. A string of other doctors, nurses and anesthetists came in and asked me the same questions: Name, address, birth date. When did you last eat solid food? When did you last drink anything? Are you allergic to anything? Did you fully complete the prep procedures as directed? What did your most recent bowel movement look like? (For the record, it looked like bright yellow urine, which is what it’s supposed to look like when the prep is successful…)
When I had answered those questions enough times, they had me give my glasses to my husband. Then they rolled the bed with me on it out of the room, down a long hall and into the operating room. Without my glasses on, staring at the ceiling as the bed rolled made me a bit queasy. I had to shut my eyes until the bed stopped rolling. The nurses put incontinence pads under my head and my butt (remember, I was getting both ends scoped), had me lay on my side with my knees pulled up in the fetal position, and they put a bite guard in my mouth. Then they put an oxygen mask over my nose. When the doctor came in, the anesthetist started some kind of gas flowing into the mask, turned on the IV anesthetic, and I missed the whole thing.
I woke up back in the pretty room, where my husband was waiting with a container of yogurt with inulin powder mixed into it that we had packed for me to eat after it was over. I knew they would be offering the patients cookies and fruit juices after the procedure. But I wanted the first thing to go through my newly cleaned gut to be fresh Lactobacillus acidophilus (gut) bacteria and Fructooligosaccharides to feed them. While I ate the yogurt, he filled me in on what I’d missed.
When I was returned to the room, the doctor had come in briefly and gone over his findings with “us”. Allegedly I made noises and said words, but I don’t remember a thing. He found one polyp, which is now off to a lab to be examined. I told him I would try to have as few polyps as possible–I only failed by one! The hemorrhoid was gone; apparently it was the kind that fell under his jurisdiction to remove. The tape was gone too. The doctor left two souvenir postcard pictures of my esophagus and colon, including a full color picture of the polyp. I briefly considered sending the polyp photo to the White House as my postcard for the Ides of March postcard protest, but I couldn’t think of anything coherent to write on it. Plus it has my name and birth date printed on it…probably TMI for that purpose.
As soon as the nurse decided I was sober enough to leave, she had me get dressed while my husband went to bring the car up to the door. She walked me out to the car and sent us on our way. We went directly to the nearest decent restaurant, where I ordered an omelet with fresh wilted baby spinach in it, and whole grain toast. The textures of the still-slightly crunchy spinach and crisp toast were heavenly. From the time they took me back to the operating room to the time we sat down to breakfast in the restaurant was two hours. Half an hour after leaving the restaurant, I was at home, sound asleep with my dogs. Now all that’s left to do is wait for the lab results on the polyp, and figure out what to do with all the leftover juice, Gatorade and Knox blox.
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