My colonoscopy!

What really happens in a colonoscopy.

I went in for a 50-yr-olds screening colonoscopy. I got the usual medical euphemising in the patient education stuff they give you. Here is what really happens:

  - you have a diet the week before ('low fiber' which means mostly food that's not usually considered healthy, no fruit or vegetables, yay BBQ and mashed potatoes!) and the night before (and morning of) you drink about a gallon (4 liters) of saline water (w/ PEG)  in order to cause extreme emptying diarrhea (the good kind?) to clean your digestive tract of everything, everything, mostly poop. Nope, not mostly. All poop. You'll spend a lot of time on the toilet with a grumbling abdomen wondering if maybe you're gonna... oh... oh... just went. Don't try to judge if it's a fart or poop. It's gonna be poop. Drinking the prep is not bad at first, doesn't taste bad at all. Just nearing the finishing mark on the humongous jug, you just really don't want the next swallow, twice as worst as the last.

And then they put a tube up your butt.

(from UVA Health, there's a camera and light to see, and tool to cut off a polyp. How they get it back  out for a pathology analysis  I'm not sure, I don't see a grabber)

- The instructions and descriptions say things that are recognizably true from a technical point of view or afterwards (oh... that's what they meant) but are confusing, misleading, or incomprehensible without that experiential knowledge. So here goes for full disclosure:

• the procedure is they put a long metal snakey tube up your butt, slowly, for about 6 feet (roughly the length of your large colon up to the cecal valve to the small intestine. The tube has a camera on the end to look for abnormal growths (polyps). If they find one, they have a tool at the end (next to the camera) to cut off or burn off he growth.
• the 'prep' is to clean out your intestines of shit. All those instructions are to make sure that you can get rid of any shit. When they say 'low fiber' in the diet and on food packages and all that? Fiber just means 'isn't digested' or more literally 'comes out in your poop'. You think your shit don't smell? You'll realize it does.
• Make sure you do the prep right. Because if there's shit in your colon, and the doc can't see the walls of your colon well, then they'll say 'fuck it, bad prep, I'm taking a smoke break' (ha ha, they don't take a smoke break, doctors as a whole don't smoke). And you have to do that prep all over again. 
• But don't freak out about the prep. (I'm using the prep' for the few days of preparation by eating a low fiber diet and the gallon of liquid to drink the night before and morning of). Not eating, and only drinking the day before wasn't bad at all. I had jello for meals and italian ice for dessert. But you kind of forget about hunger. People would be polite and say 'Oh this pulled pork BBQ sandwich with hot sauce and a side of collard greens and butter smothered garlic mashed potatoes isn't very good." I knew it's great, but I can take a day off. Also, despite it not having a taste at all, you'll get a but sick of the liquid by about quart two. But that's why you take it in stages, half the night before and half the day of.

- the process and procedure at the hospital I went to was frankly luxurious,  I felt like I was at a Marriott. OK, I probably have low standards. You get a gown (that's the embarrassing butt-exposing one) and a robe (that's the one that makes you feel like a king even though it is essentially the same material and color as the gown just opens the other way. Full disclosure, I spent a lot of mental time trying to distinguish the gown and the robe, both the words and the objects. I agree with what the nurses claimed, that the prep was the words except for maybe putting the IV on my wrist (it hurt, and people kept coming up to shake my hand and I really didn't want to use that right hand). Oh also, I didn't care for the vital stats monitor which, though accurate (says I) on my blood O2 and pulse (both excellent!), gave me HBP (I don't think I was nervous about the procedure), and the respiratory rate monitor whose alarm kept going off as though I was inhaling at 6 times the normal rate. I believe the monitoring that makes me look good.

- the forgetting medication (Versed) really worked. Before the drug was administered, I vaguely remember the nurses all talking real fast, when giving me info or even small talk (so the drug was not retroactive, erasing events before ). At some point in the procedure room, I was laying on my side joking with the nurses. The joke was... dammit, I can't remember! was it about how I said I had practiced subtracting by 7 starting from a hundred and they said "oh, you won't have to do that", and I blinked and I was a bit woozy on my back with a nurse telling me it was all over I could go now. Presumably my hour in the recovery room after the procedure (I mean extremely invasive butt tube exploration) was already over. As an experiment, I had my son (who drove me back) ask me (I asked him before hand) three random words for me to try to recall later in the afternoon without internal repetition techniques. I remember asking him to tell me the words in the car. But later that afternoon, I could only remember one. I remember asking him to ask me this (on the drive back, and I also remember most of our conversation then). So essentially I remember most things about after I 'woke' up, except maybe a few details. I'm writing this only a couple hours afterwards (in case the forgetting drug is actually working and at some point the whole day will be erased (or never fully stored (or whatever the current metaphor is))

The words he came up with were 'big giant possum', and I could only come up with "the second word is 'big', the third word is weird, and the first is sort of boring like the second one".  It seems strange that I wouldn't remember the one word that really stands out. Maybe it stood out that the first two words weren't weird (I know... weird right?) But for the most part, I am fairly confident I remember the car ride back home with him, telling him which lane to be in to be prepared for the exit, not this one but the next.

Anyway, the whole process is a great mix of low-tech and rocket science (drink salt water? camera on a tube? where brain surgery is all rocket science), and it saves peoples lives. If you have polyps, which are what become things that are cancer (technically: polyps are precursors to adenomatous neoplasms), then the polyps are removed, and that's that. You may have a predisposition to them, so you'll probably be scheduled for a follow-up colonoscopy much sooner if you have polyps (in three years rather than ten. But the magic (sorry, the science) is that it's sort of .. cured. Like skin cancer, if you remove it early (and that's the whole point of the colonoscopy), you're removing the cancer before it has spread so it is 'taken care of'.