Monday, November 18, 2013

Everything You Wanted to Know About a Colonoscopy But Were Afraid to Ask!

When we all reach the magic age of 50 it becomes time to get the dreaded "C" procedure ... drum roll please... the COLONOSCOPY. Well, I'm here to tell you that you can relax - I've had mine and it really was not a big deal. The anticipation of the procedure is much worse than the procedure itself. In fact, the before and after are worse than the actual procedure. But there are some important tips that I can give you to help make your procedure go as smoothly as possible (yes, pun intended, lol). These tips are the result of extensive research that I did before my own procedure. Some of these are direct instructions received from the endoscopy center and others were things I discovered on my own. So if you're ready to find out everything you ever wanted to know about a colonoscopy but were afraid to ask, I'm happy to share my experience with you. Because of the important information, this is a long post, but if you're one of the inquiring minds that wants to know... read on...

7 Days Before Your Procedure
  • Consultation or Pre-Procedure Appointment. Depending on how your doctor or endoscopy center works, they may schedule you for a preappointment or consultation prior to scheduling your procedure. This is so you can go over the prep and the procedure itself, ask any questions, and get your prescription for the prep solution.  I found this very helpful since I knew a little bit more about what to expect (although they don't tell you everything, interestingly enough).
  • Fill Your Prescription for the Prep Solution. You may have heard horror stories about how awful the prep solution tastes. I know I had heard nothing but horrible things from everyone about how they could barely get the solution down and how horrendous it was to drink. I'm here to report that there is a new prep solution recently approved by the FDA that is very easy to drink and doesn't taste bad at all. It is called Prepopik and to me it tasted like ground-up Sweet Tarts mixed with water - just a little bit sweet & sour, but the taste is quite pleasant compared to other prep solutions used previously. Because it's new, your co-payment could be higher than the older more established prep solutions, but because of the taste and small amount you have to drink, I think it is well worth it to pay more for this prep solution (I have a PPO insurance plan and my co-payment was $30 for this solution - worth every penny). So be sure to ask your doctor to prescribe this for you if possible:

  • Stop taking ALL NSAID medications (Nonsteroidal Anti-inflammatory medications) Examples include: Advil, Aleve, Aspirin, Celebrex, Excedrin, Feldene, Ibuprofen, Indocin, Mobic, Motrin, Naprosyn, Naproxen, Orudis, Relafen, Toradol. This is important because all of these are blood thinners and can cause excessive bleeding if it is necessary for the doctor to remove polyps during your colonoscopy. If you need to take a pain reliever it is okay to take Tylenol/Acetominphen which I did take.
  • Put yourself on a Low Residue Diet. Going on a low residue diet before beginning your colonoscopy preparation can give a better clean out and make the prep less dramatic with less cramping. The more thorough your prep the more clear/accurate your exam will be. A low residue diet means avoiding any foods that are high in roughage or fiber. You will basically go on what I call a "White" diet - you will be eating all things white, bland, and processed - white bread/rolls, white rice, processed refined low fiber cereals, cottage cheese, cream cheese, swiss cheese, eggs, canned fruit, canned vegetables. Avoid high-fiber grains such as whole wheat, oatmeal, bran cereals, brown rice and popcorn, no salads, no raw fruits or vegetables. If you normally eat a very healthy high fiber diet like I do this will DRIVE YOU CRAZY. But just remember, it's only for seven days. And I do think my colon prep was shorter with less cramping because of doing this. For more details on a low residue diet, click here.
  • This includes Eliminating Seeds & Nuts. It's especially important to avoid any foods that have seeds or nuts. I read a blog post from a gastroenterology nurse who ranted about how problematic seeds & nuts are because they often are not successfully removed during the prep and then clog the scope during the colonoscopy. Remember, all of these foods should be avoided: strawberries, raspberries, cucumbers, tomatoes, flax seeds, and chia seeds. These foods made from them could contain seeds as well: jam, jelly, tomatoe sauces, whole grain breads, rolls, muffins.
  • Eliminate Caffeine and Alcohol. There are mixed recommendations about whether or not to avoid caffeine  and alcohol - but because I had read some articles that stated caffeine and alcohol can irritate the colon, I chose to eliminate those completely during the seven days prior to be safe. 
  • Purchase all the clear liquids that you will need to drink before your procedure. Don't wait until closer to your procedure to buy them in case you can't find the flavors you want - the clear protein drinks can be hard to find in flavors that are not blue or purple.  NOTHING BLUE OR PURPLE because these can stain the lining of the colon and make the exam more difficult for the doctor to analyze. Besides plain water, examples include: Powerade, Gatorade, Orange Soda, Ginger Ale, Sprite, 7-up, Crystal Light, White Grape, Apple Juice, Decaf Tea / Coffee, Kool-Aid, Tang, Vegetable Broths, Lemonade, Clear Protein Drinks (from Ensure, Isopure or Cytosport).  These are the clear liquids that I chose to drink and it helps to give yourself a good variety so you don't get bored - you will be drinking ONLY clear liquids for a full 24 hours and it's very important to stay hydrated. Personally I recommend Powerade/Gatorade because of the electrolytes, the Ensure Peach Clear Protein drink to make sure you're still getting protein and adequate calories, and peppermint tea because it soothes the stomach.  These are the items I chose to drink:

  • Lastly, purchase a pop-up box of baby wipes and either Desitin, or Tucks hemorroid cream. These will be important after the prep solution begins working. Trust me on this one - you will need these:

The Day Before Your Procedure
  • Stay home from work if you can. I took a sick day and rested all day, laying in bed, watching movies. I recommend doing this because you won't be eating any solid food, and resting will help you limit how many calories you are burning. Resting will also be helpful because depending on how your body responds to the prep solution you may or may not get much sleep that night.
  • Completely Clear Liquids Only. The day before your procedure will be on a completely liquid diet along with whatever prep solution your doctor has prescribed. You will want to follow your doctor's instructions to the letter and when they say ONLY CLEAR LIQUIDS they really mean it. This is to make the prep easier on you and to also ensure that the prep is thorough - your colon needs to be completely cleaned out in order for the doctor to have a clear view of any abnormalities like polyps or other issues. Drinking plenty of clear liquids throughout the day is very important so you don't get dehydrated. Remember, nothing blue or purple!
  • If you get a headache because you are hungry, my doctor did tell me it was okay to take Tylenol/Acetaminphin, but you'll want to confirm that with your doctor. I'm used to eating every 2-3 hours on a normal day, so only having liquids was challenging for me and I did get a headache - being able to take Tylenol definitely helped.
  • You may or may not have to stop taking medications - it depends on what you are taking - your doctor will give you instructions on whether or not to take your regular medications the day before your procedure.
  • Books, magazines, or a Kindle or iPad. Before taking the prep solution, collect some magazines or a book or ebooks on your Kindle/iPad and put them in your bathroom near the toilet. You will appreciate having something to distract you when you are stuck on the toilet. And trust me, you will be. You won't want to be far away when the prep solution starts working.
  • Change into loose comfortable clothing. You'll want to be in your comfortable PJs or sweats before taking the prep solution. I recommend two-piece PJs or sweats as opposed to a night gown or night shirt - you won't want to have to be holding that up when you are experiencing the worst part of the prep.
  • Exercise Mat, Pillow, and Heating Pad. You may want to have a thick padded exercise or yoga mat, pillow, and heating pad right next to your bathroom. More on this under "Effects of the Prep"...
  • The Actual Prep Solution. Okay ladies - this truly is the worst part - the actual colonoscopy is pretty effortless compared to the prep. Your doctor will give you instructions on when and how to take your prep solution, but this is how my doctor had me do mine. My prep process was split into two parts (the first part taken at 6pm the day before and the second part taken the day of the procedure 3-4 hours before). I took the first part of my Prepopik solution at 6pm the night before my procedure. This involved mixing the first packet of Prepopik with 5 oz of cold plain water - cold water makes it taste the best. It's also recommend that you drink it with a straw and so I did.  Then every 10 mins after that I drank an 8oz glass of water until I had consumed five glasses. I drank Propel-lemon flavor because it tastes better than plain water. So Glass One at 6:10pm, Glass Two at 6:20pm, Glass Three at 6:40pm, Glass Four at 6:50pm, and the final Glass Five at 7pm. Drinking ALL of the water is very important. The way the prep solution works is to draw water from your body into your colon to liquefy your bowel movement. If you don't drink the extra water you run the risk of getting dehydrated - so make sure you drink all the water!  Yes, you will feel like you are going to float away, but it is very, very important so don't skimp on the water!
  • Use the Tucks or Desitin cream now.  Using it before the prep solution takes effect will help minimize any uncomfortable burning and irritation. You will also want to reapply it throughout the the next phase when the solution starts working.
  • The Effects of the Prep Solution. Depending on your body and whether or not you chose to go on a low residue diet, the solution may work right away or it may take longer. For me, the solution began working  right away at 7:10pm - 10 mins after drinking the last 8oz glass of water. In my mind I had imagined that the stools would start out getting softer and gradually turn loose - oh boy was I wrong. There was nothing gradual about it. It was instantly loose stools at the beginning which very quickly turned to complete, violent diarrhea. The point of the prep is to clear out your colon, and trust me, they aren't kidding.  Imagine the worst stomach flu you ever had that gave you diarrhea and multiply that by ten. Seriously.  This is no joke.  It will be the worst, most violent diarrhea you've ever experienced. You may or may not have stomach cramping - I did have some during this first round of prep. This is where the padded yoga mat, pillow, and heating pad came in. At the height of the "cleansing" I was literally laying on my side, on the padded mat & pillow, with a heating pad clutched to my stomach to help with the cramping, on the floor right outside my toilet. I also felt nausea and had my husband get me a big pan just in case (fortunately I didn't need it, but it certainly felt like I might). This part for me lasted for 90 mins which was relatively short. So by 10pm I didn't have to go to the bathroom any more, the cramping had diminished, and I was able to collapse into bed and actually sleep. I was definitely exhausted and very weak. My thoughts are that if people do not go on a low residue diet for the seven days prior, this part of the prep could end up lasting much longer - I've heard people say they were up all night going to the bathroom. I was very grateful that the worst of it only lasted 90 mins for me.
The Day Of Your Procedure
  • Nothing to drink. If your appointment is in the afternoon like mine was, after 8am you are not allowed to have anything to drink except the rest of your prep solution and the water that goes with it.  This is why it is so important to drink a TON of clear fluids the day before.
  • Second part of the prep solution. If your prep was divided into two parts like mine was, you will take the second part 3-4 hours before your scheduled procedure. I was scheduled to check-in at 1:30pm so I took the second part of my Prepopik at 9:30am followed by the five 8oz glasses of water every ten minutes. The second part began working at 10:50am but was much less violent then the first part - which makes sense since there shouldn't be much left in your colon at this point. You still will have diarrhea and you will still need to stay close to the bathroom, but you may not have any cramping at all at this point (I didn't have any and wasn't nauseous). However, this second stage was more drawn out for me and I continued to need to use the bathroom over the next 4 hours.
  • Driver. Because you will be heavily sedated during the procedure you will not be allowed to drive yourself home so you will need someone to take you and bring you home.  
  • Comfortable Loose Clothing. Be sure to wear comfortable loose clothing to your procedure. You'll want bottoms that are easy to put on/pull up (elastic waist preferred), a comfortable loose top, and slip on shoes.  The person there with you who is driving you home will also be the person that will be helping you to get dressed after the procedure so they will thank you if your pants and shoes are easy to get on!
The Actual Procedure
  • Getting Checked in and your IV started. Unfortunately due to some unexpected emergencies in the morning, even though I was told to check in at 1:30pm, I wasn't taken back for my procedure until after 3pm. For me this equaled more random time to get anxious about the procedure so by the time they finally took me back I was quite nervous, exhausted, and weak from not eating or drinking. I was allowed to keep my loose top on and only removed my stretch yoga pants. Then I was asked to put on the hospital gown and laid down on the hospital bed. Then they hooked me up to a blood pressure cuff, a variety of electrodes on my chest, and an oxygen monitor on my finger. Lastly, they attempted to start my IV to give me fluids. The standard procedure is to put the IV in a vein in your right hand. If you have any difficulty with needles - ask them upfront to just put the IV into your arm instead (like where they would insert the needle to draw blood). They tried putting the IV in my hand - which hurt like hell by the way - and even though it was in place at first, they lost the vein. At this point, because I was so exhausted and stressed from waiting, I actually had a mini meltdown and began to cry. They called in a senior nurse to do the IV in my right arm instead which was was much easier and almost painless compared to my hand. They gave me fluids intravenously for about 20 mins before wheeling me into the procedure room.
  • In the Procedure Room. After being wheeled into the procedure room and hooking my various vital devices into the monitor, they asked me to roll over onto my left side, facing the monitor showing my heart rate, blood pressure, oxygen levels etc. Then the nurse explained that she was going to start my IV sedation (which was a cocktail of the narcotic painkiller Demerol and the sedative/hypnotic Versed). This is called Conscious Sedation - and they say the combination of drugs will leave you conscious - i.e. breathing on your own but will cause temporary amnesia. The nurse said that the drugs would probably sting going in and they most definitely did. But this only lasted a few seconds and then I was out. I mean REALLY OUT. The last thing I remember was feeling the sting and looking at the monitor to check my heart rate and that was it.
  • In Recovery & the Results. They explained before the procedure that I would not remember anything about the procedure or the first 30 mins in recovery and they were 100% correct. Right after the procedure, the doctor comes and explains what he found and what was done but you will not remember any of this - your driver will be listening and asking any pertinent questions and you will also be given all the information plus after care instructions in writing. So, I remember absolutely nothing about the procedure or the recovery. Apparently during my recovery, when I was awake but still very much "under the influence" my husband had the nurses completely cracking up. He asked, "She won't remember what I say to her right now, right?" The nurses assured him that I would not. I kept asking, every five minutes, "What did the doctor say?" and my husband, the consummate comedian, kept saying "You have one month to live". And then five minutes later I would ask again and the cycle of laughter would continue. Good thing I don't remember any of that! He had to help me get dressed and I was only allowed to leave once I was able to pass some gas (which is standard protocol). My memory begins with walking out to the car and driving home. The good news was that I did not have any polyps (which can be the beginning of colon cancer) and only some minor internal hemorrhoids which required no treatment. Because I was given a clean bill of colon health I don't need to do another colonoscopy for 10 years (yay!).
  • Post Procedure. So for the next 48 hours I had quite a bit of gas which is normal but uncomfortable (they pump air into your colon during the procedure to make it easier for the doctor to view your colon). Because I had no polyps I was allowed to go back to a high fiber diet right away but I think I was a little too enthusiastic about eating and the gas was quite painful at times - be prepared for that. Looking back I probably would have been more gradual with introducing solid food, starting with soup and a light meal before more complex proteins and carbs. My first meal was a Tomato & Mozzarella Panini with a Mocha Frapp from Starbucks, which probably wasn't the best choice. But hey, it was what I wanted! By the second day I finally took some Gas X which helped. I also did not have a bowl movement until four days after my procedure (which also is normal) so don't be surprised if that happens to you.
So after having just gone through this myself, I can tell you, it really is nothing to be afraid of or worried about - so don't put off having it done. Colon cancer is treatable if caught early so ladies - make that appointment and just get it done! I hope this information was helpful for you!