The on-going, first-hand tale of a journey through medical oncology... and what happens after.

Saturday, March 22, 2008

Colonoscopy 101 (warning - long post!)

These procedures are now a regular part of my life. And if you have any family history of colon "stuff" (polyps, tumors (benign or malignant), etc.), you should get one as early as your 40s. Please do so. It is so much easier than the alternative of finding out later when there are chemo- and radiation therapies to endure. That said, here is how it goes [my commentary will be in square brackets].

Purchase two (2) bottles of 1.5 oz (45 ml) Fleet Phospho-Soda at any pharmacy, in the laxative section. [This is easy, but be sure to get the 1.5 oz. bottles and not the enema squirt bottles. Each 1.5 oz. bottle cost about $4 US.]

One week before procedure: Do not take IRON, vitamins, or herbal supplements; try to avoid food with seeds (flax seed, popcorn, nuts, berries, etc.); take your usual medications UNLESS stated by your physician (aspirin and Tylenol are OK); EXCEPTION: Ask for special instructions if you take major blood thinners such as Coumadin, Warfarin, Plavix, or Aggrenox or if you take insulin or other diabetic medications. [Apparently, these things affect how your colon behaves or its interior lining - you don't want any micro-tears from sharp seeds, or funny colors from supplements when they inflate your colon with an inert gas prior to the camera look-see!]

Three days before procedure: Stop taking fiber supplements (Metamucil, Citrucel, etc.) [You definitely want the laxative to clean you out without fiber supplements working to stop you up.]

Two days before procedure: Eat lightly (chicken, turkey, fish and soups); avoid red meat and fatty foods; NO SOLID FOOD AFTER 5:00pm. At 5:00 pm begin clear liquid diet (water, coffee, tea (NO milk or cream), clear fruit juices (apple, cranberry), soda pop, Gatorade, bouillon, popsicles, Jell-o (avoid the color RED); avoid alcohol. My doctor recommends drinking at least one liter of Gatorade today and tomorrow. [After my experiences with a lower abdominal resection and the partial bowel obstruction, this was not such an ordeal. And it is only for 36 hours or so... you can do this.]

One day before procedure: Continue clear liquid diet; NO SOLID FOOD; it's important to drink at least an 8 ounce glass of clear liquid each hour you are awake. 9:00am - Pour 1.5 ounce bottle of Fleet Phospho-Soda into a 4-8 ounce glass of cool clear liquid (ginger ale or 7-Up is recommended). Drink and follow with an 8 ounce glass of water. ** Stay near your restroom from this point on. ** PHOSPHO-SODA doses must be 10 hours apart. 7:00pm - Repeat dosage of Phospho-Soda as previously described. [This stuff is vile. It is the most distasteful part of the ordeal - for me even more distasteful than the evacuation that it causes! My advice: refrigerate the Phospho-soda, add as little "cool clear liquid" as you can, and drink it quickly. Have the full glass of water ready to rinse the taste out of your mouth. And concerning the proximity to a bathroom - this is an imperative! Also, it's a good idea to heed the suggestion about Vaseline/Desitin described below.]

Day of procedure: Continue clear liquid diet up until one hour before your exam, then nothing by mouth until after the procedure. Wear loose comfortable clothing. Please keep all valuables at home; be sure to bring your insurance card. [You will only partially remember stuff after you are in the recovery room. The comfortable clothing is to make getting dressed easier afterwards (you are wearing a gown, t-shirt and socks during the procedure).]
IV sedation will be given to you for this procedure. You MUST bring a driver with you to wait in the waiting area during and after the procedure so that the doctor has someone to talk to regarding your release instructions. You CANNOT take a bus or walk home. DO NOT work, operate heavy machinery, or drive until the following day. [Absolutely good advice. I do not remember getting dressed, getting into our car, or arriving at home. I remember waking up in my recliner. Scary.]

What if I have major medical changes between the time I schedule my procedure and the procedure date?
Please notify our nursing staff as soon as possible so we can make any adjustments to new medications or possibly change your preparation routine. If you are having heart issues you may need to delay your scheduled procedure until your cardiologist feels it is safe.

What if I accidentally take my vitamins within 7 days of my procedure?
If you take potassium or folic acid with your prescription medications, please continue. If you accidentally take multi-vitamins, just do not take any more. If you are taking an IRON pill, you may need to reschedule your procedure because it will leave black tar on your colon wall.


What do you mean by clear liquids?
If you put a liquid in a clear glass and hold it up to the light, you should be able to see a newspaper through it. It cannot have any solid in it whatsoever.

After I take my first PHOSPHO-SODA preparation, I begin to have clear bowel movements. Do I still need to take the second dose?
Yes. You still need to take the second dose to ensure proper cleansing of your colon for the best visibility possible.

What if I can't find anyone to drive me home after my procedure?
By law, we cannot release you without a ride home. You cannot ride a bus or walk, but you can take a taxi or medical transport if you absolutely cannot find someone to give you a ride. Our doctors prefer that you have someone in the waiting area during and after the procedure so they have someone to speak with regarding your release instructions and if there are any complications. The sedation used during the procedure can cause slight amnesia so you may not remember anything.

You should coat your rectum with Vaseline or Desitin before you start drinking your laxative to help with irritation. Reapply after every bowel movement. [Good advice - I wish I had heeded it!]

Our doctors highly recommend drinking Gatorade or Powerade the day before your laxative preparation and during the preparation to prevent dehydration. [Yes. You will be amazed at the volume of liquid that Phospho-Soda causes you to release. Totally amazed.]

Restriction of activity - the intravenous sedation you have received will slow your reflexes and affect your judgment.
1. Do not drive a car, operate equipment, or work around sharp objects until the day after the procedure
2. Do not make important decisions or sign important papers for at least 24 hours.
3. Do not drink alcoholic beverages for 24 hours.
4. The day following your procedure: resume full activity.

Diet - you may eat and drink normally one hour after the procedure.
Treatment for common effects - bloating, excess gas, or mild abdominal discomfort: rest, eat lightly, and use a heating pad.

NOTIFY DOCTOR - If you have any of the following:
1. Fever or chills
2. Severe abdominal pain or new chest pain
3. Spitting up or vomiting blood
4. Passing blood by rectum (2-3 tablespoons is OK)
5. If IV site becomes infected or is painful

I received a nice little summary and a copy of the pictures taken of my insides. Interesting. I hope this is useful information for all of you out there in blog-land!


Anonymous said...

Thanks Ed, I'm having one 2 days from now and this was definitely helpful! JMC

Anonymous said...

The test is a little uncomfortable, but sedation is not required. Most places insist on giving the amnesia drug Versed so that you can't move or remember the pain......but a lot of people (especially women0 eventually remember the rough treatment and have haunting nughtmares for life. find someone who will take a little extra time and do it without amnesia drugs like Versed. A little painkiller (fentanyl) is ok if you want, but the amnesia drugs (Versed/midazolam) are only used so that they can do the exam quickly, roughly and get you out the door in a daze. then the fun starts, hours, days weeks later. don;t be a victim..get the exam...write on the consent: no versed.........

maddy said...

I am a woman, and I've had a colonoscopy with versed. I had no nightmares, no memories of rough treatment, no pain. Nothing. I've known tons of women who've had colonoscopies, and none has ever mentioned "haunting nightmares for life" or for five minutes. None has ever even brought up the subject. Pretty alarming post. Everyone I've known who has had colonoscopies has complained about nothing but the restricted diet before hand.

Anonymous said...

I am scheduled to have my first colonoscopy in 6 days. I was shocked to hear the Doctor say he could get me in on that day, but so be it. I was told to only go liquid on the diet one day before. No red or orange colored liquids. I am reluctantly going camping tomorrow and will be camping 2 days before my procedure. I am worried about not being prepared. Should I reschedule??? Thanks in advance!

Ed said...

Anonymous - I am not a doctor, so any advice you receive here is just another human voice. Your doctor knows much more about your situation than I do! That said, you MUST have a clear bowel prior to the colonoscopy. Camping before the procedure is fine, as long as it does not interfere with the preparation for your colonoscopy! In fact, the distraction may be nice. But you do have to prep those bowels. Are you thinking of postponing the camping trip or the colonoscopy? My prep takes about two days, so I am wondering what is different about your prep work? Whatever the answers are - get the colonoscopy. It is something that should not be put off.

Good luck!

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Anonymous said...

I hate medical stuff and won't do sedation after a neighbor was really messed up (she's a doc) after getting Versed. I'm a 55 year old guy and when Michelle my nurse practitioner told me that I was getting a colonoscopy, I said that I wouldn't do the sedation and thought that that was the end of it. A few days later, a wonderful doc named Christi called me and sent me the prep; then she spent forever reassuring me that the colonoscopy would be o.k. unsedated. I did the prep, drove to the hospital and they had me change. A young nurse, she was great, gave me one tapwater enema "just in case" and after I was done hooked up my IV and covered me with a heated blanket and told me to take a nap. She put in an IV "just in case" and the doc came in, asked if I had questions and in went the scope. No drugs, she talked me thru it. Not bad. No drug amnesia, no nauses, just a lot of farting. The doc noticed that I was tired and had the nurses give me a snack, then told me to pee and get into bed. No kidding. She put the side rails up and told me to take a nap. Hours later, I woke up, feeling greatand drove home.

Anonymous said...

I go on my clear liquid diet tomorrow (along with the laxatives... my colonoscopy is the day after tomorrow) and have been following the dietary restrictions to the best of my ability. Tonight, I accidentally ate two organic wheat oreo type cookies - and I know wheat is a no-no for 3 days before the exam. Will this cause a problem in my appointment?

Anonymous said...

I've had the procedure with zero "haunting memories" and have never - ever - heard of anyone else who has. I suspect this poster may be a victim of something else entirely: perhaps sexual abuse they are in denial about. No one should be dissuaded from having a colonoscopy because of that person's post.

Lisa said...

I have had 2 colonoscopies, both with versed and I thought it was great. I remember counting down from 10, got to about 7 and the next thing I remembered was asking the Dr. when I was going in and he told me it was all done. Procedure very, very easy. The prep is by far the hardest part.

Anonymous said...

Before you get a colonoscopy with Versed (midazolam); take a look at some of the hundreds of horror stories about the long-term amnesia that this drug can cause. Sure, it's only a problem in 10% of patients; but how lucky do you feel? I doubt that hundreds of patients would report horror stories about Versed if it wasn't true. My friend (an ICU nurse) got Versed for her colonoscopy and can't remember her kid's birthdays months afterwards.

Anonymous said...

Female age 56 and had my first and last colonoscopy a week ago. Previously had upper scope with versed and did not want that again. Same doc pressured me into having it again so he could hurry the procedure along. I woke 1/2 thru procedure in the worse pain I have ever had. Doc did not address the pain and it was awful. Required ER visit the next day to check for perforation and then another day in bed on strong pain killers. Now diagnosed with post traumatic stress syndrome and fighting daily to get back to who I was before this test. Do a lot of reasearch and find a doctor that is not in a hurry. There is a wonderful drug out there called propofol that is much better than versed. In my case it would not have made any difference since his haste caused extreme pain for days. I will never have this test again, never.

ybchick said...

Thank you so much for the helpful info Ed! I am 40 but my father passed away from colon cancer at 58 and my mother had breast cancer at 52 so I have a double whammy against me. Going in for procedure in two days because my doctor says I have a much greater risk. I'm a little nervous but reading your post has helped ease my anxiety. Good luck and good health to you in the future!

Anonymous said...

I've had probably 15 scopes - my first being without sedation. Only one sedated scope was undermedicated and remember that it hurt (I have conditions that make my bowels hyper sensitive). Trust me, that fleeting memory (versed causes amnesia so if properly dosed you will not recall anything) is nothing compared to the suffering without meds. The original blog is spot-on and humorous - good job!

Anonymous said...

You say drink clear liquid up to an hour before procedure. You should not be drinking anything on the day of the procedure as there is concern about aspirating into the lungs.

Anonymous said...

I had a sigmoidoscopy 15 yrs ago. As is the routine, I had it unseated. I still have occasional PTSD moments related to that event. I know PTSD because I have had it from other events in my life. Anyway, related to that flexible sigmoidoscopy, I refuse to submit to the barbaric colonoscopy procedure. The prep from hell, way beyond that for a sig, is also a deterrent. I accept I will die from something, plus there is no history of cancer in my family, and I am healthy.
Sure, it's a risk, but life is a risk. Plus all the hype about a routine screening test that has 10x the risk of significant untoward events compared to other screening tests sounds like the largest risk is that the doctors won't get that desired new Mercedes Benz if low risk people opt out of this barbaric test.