Wednesday, November 22, 2006

More information about colonoscopies and other screening procedures

Here's some Good To Know Info from the blog of the same name, about colon cancer and what you can do to avoid it. Dr. Razavi is a medical doctor at Google and her blog is well worth a read.

Tuesday, November 21, 2006

Biopsy Results

I am pleased to inform you that your colon polyp evaluation by our pathologist shows hyperplasia. This is a benign finding that menas the tissue is not a "true polyp" and you are at no increased risk for colon cancer.

I had gotten a pretty strong sense from the doctor that he wasn't too concerned by what he'd found during the colonoscopy, but I'm still glad to see the results on paper.

And to reiterate what I said early on, I still feel this test was appropriate, with a significant family history of colon cancer, it really did make sense to do the test, and that history will not weigh on me in the years to come between now and the next colonoscopy. That is a comfort indeed.

Sunday, November 19, 2006

Three Days after the Colonoscopy

Still a few days before the polyp biopsies are back, yesterday I had my first elimination after the colonoscopy. There was no blood, which was nice, I'd been almost told to expect some, and given an indication that I should worry if I saw blood in quantities like "a half a cup at a time". I'd probably have been alarmed at much less than that, but at least so far, no blood at all. Hooray.

Thursday, November 16, 2006

Several hours after the colonoscopy

I've been a bit sleepy but by all accounts am now functioning pretty normally now, I ate around noon, have no pain, discomfort, or even odd sensations other than having had a little more gas than usual. What a simple and basically pain-free procedure!

The Procedure

(This was written about 12:15.)

Arrived for the procedure about 8:20, where a nurse went through what would happen, double-checked I'd followed the critical prep instructions, got me undressed, in a gown, under a blanket, and a saline IV started.

I hadn't thought about that, but the saline IV makes sense, you don't want a dehydrated patient, and I was told to stop drinking fluids entirely starting at about 3 this morning, so the IV gives back a little of that fluid without getting in the way of the procedure. It also gets one cold, thank goodness for blankets. And socks, you're allowed to wear socks--why did I leave the colorful stripy socks at home today?

I was walked into the procedure room, nurse carrying the IV, got down on the exam table. There I met the doctor performing the procedure for the first time. He went through was going to happen--that they were going put both air and then water into me to open things up for the endoscope, etc., then they
moved me over onto my left side, and started the quote-good-drugs-unquote, Versed or something like it.

I don't have memories of most of the procedure, but I have a pretty clear memory (accurate or not) of seeing one polyp before and after removal, moreover, my memory roughly matches one of the Polaroids that they provided after the procedure. I remember being wheeled out of there, but I don't recall actually feeling any sensation of the endoscope in my anus at any time. Studies have shown that there can be some level of "false memories" during Versed, so ...dunno.

The doctor explained to me that they'd removed four things, two of which were likely polyps, the other two might have been or may not have even been up to that stage, all four were removed, the biopsies will be done in 7 days. I remember this from the procedure room and it matches what is written down on the paperwork I got from them. At this point they also provided me the aforementioned Polaroids.

Got wheeled back into another room where I rested, was eventually allowed to dress (in the adjoining bathroom). I have a bit of a memory of being walked out of the building, and a seemingly mostly coherent set of memories from the way home. I definitely feel spacey, a slight bit of balance, and I think I am still having bits of short-term memory drop-out, but all in all if anything this was a less strong dose of the amnesia, and a relatively pleasant procedure. I've already eaten, there's no nausea, no pain, definitely some gas but no cramping, so I'm in a very good space indeed.

Heading out...

Slept well, a few noises from the tummy, not super-hungry, if I were allowed I'd probably have some coffee or water but I'm not feeling either need strongly. It's about 7am here, procedure starts at 9:20, hope to be back home around noon.

Wednesday, November 15, 2006

Am I hungry?

Lisa asks:

So, I'm curious. Are you less hungry after drinking all this junk? More hungry because it's processing things quickly? Never were hungry at all, because you never eat seeds and fibrous material or dairy anyway?

That's an awfully good question. Now, I should start by noting that I had to switch over from the no-seeds, no-peels diet last night, and have today just been drinking the icky fluid, plus white grape juice, water, morning coffee (no milk!), yellow gelatin and broth. Given the amount of "food" that I've eaten, I'm feeling not at all full but surprisingly not starved.

I'm actually quite comfortable, too, right now I am having to head to the bathroom quickly on a very regular basis, but really have no other significant discomforts.

Victory is mine

The jug is now empty, all the TriLyte (ten and a half glasses) has been consumed, and I'm definitely a lot cleaner inside (and still getting cleaner) than I was. The liquid did get pretty unpleasant to drink, but after the break I had no more trouble with nausea. I found that rinsing with plain water or white grape juice (which I'm allowed) helped clean out the flavor between doses--I could have drunk the grape juice, but I was drinking more than enough already.

Vaseline is proving helpful at keeping my anus from feeling raw.

I had only the bits of nausea, never had any cramping or other side-effects. A bit of mild "feeling chilly", but that's partially not having eaten quite as much and the effects of constantly consuming cold beverages, and nothing that a blanket doesn't handle perfectly well.

And that is, by all accounts, as bad as this entire process is going to get. Hooray!

I can continue with clear liquids (clear broth, yellow jello, soda, tea, coffee, water, fizzy water, etc.) through 3am as I wish.

Taking a break.. six, part way through, the nausea became acute. Following instructions I'll wait a half hour and then return to the glass-every-15-minutes schedule. My movements are now essentially liquid, but there's still a lot more to clean out. The nausea is already passing, and for the most part this has been a fairly minor annoyance.

Four down, almost halfway through the jug

Getting harder to drink the stuff, it is causing ... motion. A few hints of nausea but they've passed quickly so far.

First glass of TriLyte down

It's not as bad as I feared, it's like a mild solution of flavored dishwashing liquid. No biggie.

Preparation for Colon Blow II

Noon: 4 Ducolax. It's now 12:08 and the gurgling has begun, recalling the sounds of the baby monsters in the movie Aliens. No discomfort, just sound effects. The 4 liters of TriLyte starts getting consumed in about two hours.

On Conscious Sedation

I don't know if "conscious sedation" is universally used for colonoscopies, but I've had it (for an upper endoscopy) in the past, and I found it interesting.

The really odd thing about conscious sedation, for me, was the amnesia. Most of us have seen television shows or read books about people experiencing a loss or lack of memory of events, but it's another thing entirely to experience it, and my upper endoscopy some years back was my first such experience.

I do remember being wheeled into the room for the procedure, the IV starting, and then....

...I was asking "did they find anything?"

"No," the nurse replied kindly, "did you know this was the fourth time you've asked?"

I didn't. I noticed I was lying in bed in the recovery room, and ... hey, how did I get dressed?

It is a curious thing, and it's difficult for me to know how much of this feature of conscious sedation is keeping the patient from the memory of the pain or discomfort of the procedure, and how much of it is just a side-effect of an otherwise effective medication. I don't know the answer, I'm curious to know the answer, anyone know?

Today's SNL reference is brought to you by

New Improved Colon Blow.

Preparation for Colon Blow

In addition to dietary restrictions, before the colonoscopy I need to clear my entire GI tract. Yesterday Mary asked me if I'd need to have an enema, I pointed out that the process I'll go through today was sort of like an enema with the fluid going in the other side, I'll be taking laxatives, fluids and TriLyte according to a set schedule which will leave me needing to be near a bathroom for most of the afternoon and evening.

As I reread this, it sounds like I'm complaining, and to be honest, I'm not. I'm sure this isn't, and won't be, a pleasant process, nausea, bloating and cramps are common parts of the "flushing" experience before a colonoscopy. But I really do look at this as being easier than having colon cancer, and easier than having more intrusive surgery, and from that perspective, it's almost a relief to know that polyps--tissue that might later become cancerous, will be able to be addressed sooner (if necessary) rather than later.

About an hour ago I prepared the TriLyte. This is a prescription medicine that consists of a 4-liter plastic jug (like a big plastic milk jug) with a bunch of powder in the bottom, and a couple of "flavor packets". Preparation consists of adding a flavor packet (one of the provided five flavors) to the powder already in the jug, filling the jug with water, mixing it, and cooling it. It sounds simple, and it is, but there is something a bit intimidating about filling a gallon jug of something that I know I'm going to be drinking later today.

There are five flavor packets, orange, lemon-lime, cherry, citrus berry, and pineapple. I'm told that the nature of the electrolytes in the TriLyte solution are bad enough that these will only slightly aid the palatability of the fluid, and while I got a couple recommendations that the orange was the "least chemical" of the bunch, I've boldly decided to go for the citrus berry. You'll also want to chill the liquid if you can before drinking it, I'm told, apparently this makes the taste less awful. I did add warm, not cold water, when I mixed the TriLyte to get the powder to dissolve completely (that took more shaking of the jug than I expected), but it'll have a few hours to chill in the refrigerator before I get to enjoy it.

Oh, and the mixture looks ... soapy!

Oh, anticipation.

Preparation: Diet

After scheduling, the first part of the colonoscopy, and in many ways the hardest, are the days prior to the procedure itself. The instructions for this prepatory period ran three pages, and the prep process will interfere with your life, particularly on the day of and before the procedure. The prep does make one wonder whether a virtual colonoscopy would have been a simpler place to start.

Tomorrow is my procedure, here's what I've been asked to do so far:

Four days ago (five days before the procedure), I needed to stop taking aspirin. The colonoscopy comes along with bonus possible polypectomies, if polyps are found in the colon they may be biopsied and/or removed at the time, this can lead to bleeding, and aspirin can keep the body from stopping that bleeding naturally.

Two days ago the first real dietary restrictions started, I was asked to stop eating "nuts, seeds and foods with a peel." A list of examples was included (e.g., popcorn, fennel seeds, grapes, beans, raspberries." The restrictions go on to note that "Fibers, seeds and peels" can clog the colonoscope. Fair enough, in practice this gets a bit ambiguous. Whole ginger is fibrous, so is bok choi. Rice is a seed, is cooked rice okay? (As it turns out, cooked white rice without other additives is apparently okay, that one I asked.) It becomes tricky to think about eating at a restaurant, so I've mostly ended up eating primarily at home.

Starting yesterday, anti-inflammatories became part of the "don't consume" list, again this relates to reducing the risk of serious bleeding.

And now we get to today, the "no solid food or dairy products" day. Now, instead of a list of things not to eat, it becomes much easier to talk about what one's allowed to still eat. Many liquids are still on the list--clear broth, black coffee or tea, soda (although see the color restrictions below), water, white grape juice, apple juice, lemon jell-o. Things with red, green or blue dyes are complete no-nos, the dyes will persist in the gut and make it more difficult to see what's going on in the GI tract. No orange juice or dairy, either, whee. I'll be allowed all these things until about 2am tomorrow morning, then nothing, not even significant amounts of water, until the procedure six hours later.

That's the restrictions, there is another process that will be happening today that I'll cover in another post--that's the process of really flushing out my gut prior to the colonoscopy. But that's the subject of a post later today.


I'm a 45-year old guy, photographer, I've got three grandparents who had colon cancer. For my birthday this year, my doctor got me a visit to the GI department for a colonoscopy. People rarely talk about colonoscopies, I thought it might be helpful to demystify the process a bit.