Colonoscopy for Dummies (or Why I Cannot Drink Sunkist Orange)

I don't remember why it was the subject in the office one day--probably something about health in general--but I made the claim that I had probably had more colonscopies than everyone else in the office combined.  I'm pretty sure I've had at least eight by this point.  All at once, that struck me as funny, sad, and astounding.

Sometimes, I forget that procedures like this have not been an important part of peoples' lives.  The other day, I was in a conversation with friends and genuinely forgot that diarrhea was not the only way to rapidly lose water (it's hot where he works, which means sweating), rattling off some tips to help and earning a few confused stares.  I've had to take very close stock of how loose my stool is for long periods of time and that is the way my brain is subsequently trained; most people have not.

Given that I'm facing another colonoscopy today, I thought I might share some of my experience, dispel some myths, and otherwise include a few tips.  Before I do, I will certainly point out here that I am not a doctor and any questions that you might have regarding your own health/body should be directed toward such an authority.  

Plus, this also distracts me from how hungry I am at the moment of writing this.

The Procedure Itself:

So what is a colonoscopy?  To be blunt, they're sticking a camera up your butt.  This also entails a little inflation with air to help make it easier for those performing the procedure to see.  Additionally, there are components of that camera that can take samples of any suspicious tissue, checking for pre-cancerous cells, for example.  This can be the difference between explaining art to someone and taking them to see the portrait itself, where the doctor can now see symptoms (tracking progress in my case) by noting signs of inflammation, bleeding, cancer or pre-cancerous areas, and overall getting a fuller picture of the health of this part of your body.  While this sounds unpleasant, in the States we tend to have a nice, happy cocktail of drugs, commonly Versed (generic Midazolom) and fentanyl or maybe propofol.  Versed prevents your brain from making new memories, and fentanyl is a pain inhibitor.  What this means is you're doped up in some lovely ways and won't remember a damn thing.  

I stress "in the States" because in other countries, they don't bother with the anesthesia unless it is asked for specifically.  It's an uncomfortable pressure, sure, but then you don't have to worry about getting a ride home or losing the rest of your work day.  I've had a few lesser procedures where I was awake and had some kind of scope (once for radiography and another to confirm that my ostomy had reattached well with a simple camera, which I narrated for my doctor because I could tell what was looking at).  I have theories as to why we go right to the drugs in the US (they will do it without them if you press), which include padding hospital CEO pockets and simply not wanting to deal with people that have a camera up their butt.

All in all, though, the procedure, again, is not that bad.  Your doctor has seen plenty of butts and has been sharted on or worse, so you are far more embarrassed about this than anyone else in that room.  Ask for another warmed blanket and relax.

The Bad Part:

The prep, however, can be six shades of miserable.  The thing is, if you want a clear view of the colon, well, you need to clear out all of the normal stuff.  And you never know how much poop you can store in your body until it comes shooting out of your ass at a startling velocity.  You're hungry since you need to be on clear liquids for the entirety of the day before and into the day of the procedure in addition to a raw butt.  What people complain about the most is drinking a certain level of ill-flavored sludge.  Most of the time, when someone is getting a colonoscopy, they are given about a gallon of liquid to drink.  It can be thick, it can taste nasty, and all around it feels like it never ends. 

I haven't done that version of the prep since I was twelve.  Ah-ha!  Did you know there was an alternative?  When I was a certain shade of sick, where imbibing anything in my stomach was intolerable, I remember looking at the jug of liquid with a lot of despair.  And between myself and my parents, we asked.  Sure enough, there was one. 

The nurse suggested that I mix it with something we had on hand, which happened to be a can of orange Sunkist. 

*glare* You...

I still had to drink some, but significantly less, though the nurse warned it would taste pretty disgusting.  She was right.  Imagine orange soda with half a shaker of salt.  Evidently, it worked by reverse osmosis, that the substance was so salty that it pulled water out of my system and into my colon.  In any case, it worked at liquefying my insides to help clear out the crud.  Ever since then, as I'm talking to the doctor or the scheduling staff, I ask if there's something else other than the normal jug of liquid.  The last few times, it's been pills instead, taking four every fifteen minutes for a period of time paired with a cup of some clear liquid.  But I get to choose the liquid, meaning it could be apple juice or tea instead of something that just tastes...off.  If you're younger and specifically if your kidneys are happy, it's worth asking to see if you can follow suit. 

Regardless of what you do, though, there is a very particular rumble, as your whole gut seems to shift down a few inches, and that prep is EFFECTIVE.  Fun perk, though:  I tickle Andy and tell him he can't tickle me back because "I might poop."  He doesn't like that as much as I do.

Tips for the prep:
1.  If the alternative sounds good to you, it's worth asking.
2.  Make yourself comfortable and be close to a bathroom (seriously, don't start the prep at work).  You'll need to at least figuratively buckle in once that prep gets everything moving.
3.  Grab some Preparation H wet wipes for your chaffed butt and sit in the tub. Around my fistulas or whenever my butt is irritated, I also use a product called Calmoseptine which is like adult diaper cream in some of the best ways--both for pain relief and soothing the angry skin.
4.  Surround yourself with some good distractions.  I've got Civilization V, Netflix, and a blog post, myself.
5.  Drink some extra fluids the day before you start the prep, trying to ensure against dehydration by giving yourself that boost.  And certainly, too, drink more while you can.
6.  Allow yourself to be sullen for a while.

Grumpy pants are on in full force

On the procedure day itself:
1.  Drink as long as you can.  Staying hydrated will help start the IV and otherwise keep you through.
2.  Be early to the hospital.  And make someone else drive.
3.  Be sure that you follow instructions prior to the procedure--nothing is worse than going through the prep and having to turn around and go back home to do it again another day.
4.  Ask you doctor questions.  Know what is being put into your body, and ask as many questions as you'd like.  You have a right to understand and know what to expect.
5.  Be polite to your nurses and medical staff.  Yes, you're hangry and annoyed, but one should always be nice to your hospital staff, if only to get additional warm blankets.

What it means today:

All in all, it's not that big of a deal.  The risks are minimal and the potential rewards are good.  It's just damned inconvenient.  The thing is, though, I'm really looking forward to hearing some good news.  I feel as thought we been making good progress in my disease, but it would be nice to have further, visual confirmation on that.  I have been in this same flare event now for about seven years.  Seven years trying to get my symptoms truly under control.  This has involved three major medication switches, surgery, cleanup when surgery failed, and lots and lots of poking, prodding, and tears.  Crohn's is something that is never completely over, but I long for a little bit of peace.  Even if it's just symbolically, a little peace would be nice. 

I want to know where that place is, the place where everything is the best it can be for me.  If I can find that place, then it would be a frameshift in my mind, that I could find out finally what are the things I have to accept as "just going to be a thing" and what are the things I can fight to make better.  It would take away the uncertainty, knowing when and what to fight for.  Logically, I know that place doesn't really exist, that there's always an element of guessing and trying, but I feel that wish pushing from my heart to my throat all the same. 

This is a progress marker for me, making it to another checkup.  I'll be doing a colonoscopy every other year in my current treatment plan, checking in on progress and screening for some other fun components I'm more predisposed to as a result of my disease (like colon cancer).  I can look at the resulting pictures and tell you what's good, what's bad, and what some of those weird shapes are.  I know roughly how quickly my body responds to the prep.  I've had to set some parameters for myself on when it's time to see the doctor, when it's not worth going to ER (because they won't be able to help in some circumstances), and when it's time to simply put up with it.  The rest will hopefully come in time.  And a level of peace will hopefully find its way sooner still.

And for now, I'm planning what I will eat this afternoon as soon as I'm able to.  I've landed on "milkshake" but have not yet decided on a flavor...