Thank you for reading this far, as any column with the word “colonoscopy” in its title is likely to invoke a strong page-turning reflex in most people. Nevertheless, I’d like you to keep reading, particularly if you’re approaching your 50th birthday (or beyond). I hope that writing about my experiences will demystify things a bit and make it easier for people to get screened. First-person medical stories are actually a bit of a business magazine tradition: Andy Grove (who was, at the time, CEO of Intel), wrote a cover article for Forbes in May 1996 describing his personal experiences with prostate cancer.
According to the National Cancer Institute, colorectal cancer is the fourth most common cancer in both men and women, following cancers of the skin, breast (in women), prostate (in men) and lung. In 2008, approximately 150,000 new cases of colorectal cancer will be diagnosed in the United States, and about 50,000 people will die of the disease. As with all forms of cancer, early detection leads to the best long-term outcomes.
Like a lot of people, I planned to have a baseline colonoscopy the moment I turned 50. Ninety percent of these cancers are diagnosed after age 50, so it’s a good time to take a look around and see what’s there (or not).
Also like a lot of people, I kept putting off making the appointment. Finally, I scheduled an appointment with Dr. Richard Auld of Sonoma County Gastroenterology Associates (www.giassociates.net) here in Santa Rosa.
Once you schedule an appointment, the doctor will send you an information packet. The most important part deals with preparing for the procedure. For a doctor to make a good inspection of your colon walls, it needs to be clean, which means flushing out your digestive tract. It turns out very salty water is the best way to do this. It also turns out that the prep is probably the nadir of the whole process.
In the bad old days, you’d drink a gallon of a salty solution called GoLYTELY. This preparation is still required in some cases, but the newest prep technology is a $20 over-the-counter product called Phospho-soda, which reduces the amount of salty stuff you have to drink (although I think it may be a lot saltier). In my case, the prep started 24 hours before the procedure itself with a diet of clear liquids (and nothing with red or purple in it, since those may temporarily stain the inside of you—who knew?).
Fifteen hours before the procedure (about 5 p.m.), I drank my first dose of Phospho-soda. It’s 1.5 ounces of liquid which you add to the clear liquid of your choice (apple juice, in my case) and drink down. Other than being very salty apple juice (a strange but not awful combination), it wasn’t very bad.
The low point of the exercise is the second dose of Phospho-soda, which is taken four and a half hours before the procedure. For me, an 8:15 a.m. appointment meant waking up at 3:30 a.m. to take it. The dosage is the same: 1.5 ounces in a glass of clear liquid. I found the second dose harder to take, because I knew how salty it was going to taste. But I drank it down in four or five gulps and went back to sleep. That’s also the last liquid I could drink before my colonoscopy.
I got up about 6:30 a.m., made a couple of visits to the bathroom, showered and left for my 7:30 check in. Although you can drive yourself to your appointment, you need to have someone pick you up (for reasons that will become clear).
At the office, I checked in, was led to a bed, changed into my backless hospital gown and laid down to await developments. The nice nurse painlessly started an IV and wheeled me into the procedure room where an oxygen feed was looped over my ears. I exchanged pleasantries with Dr. Auld, and then they injected the combination of Versed and Fentanyl into my IV, inducing a state of “conscious sedation” (or “twilight sleep” as it’s known in the dental biz).
I don’t remember anything after that. Versed (a brand-name form of midozolam) isn’t only a sedative and anti-anxiety drug, it also makes you forget stuff. Fentanyl is a powerful, morphine-like drug, so you don’t have much discomfort or pain to forget anyway.
As he traversed my colon, Dr. Auld found and removed two tiny polyps, both of which were benign. This means I won’t need to visit him again for 10 years.
I have some nice pictures of my colon (the doctor has to document that he traversed my entire large intestine with his endoscope), but I don’t remember getting dressed, making a smart-alek comment to the waiting room crowd as I exited or the drive back home. Once home, I ate a sandwich, took a long nap and went out to dinner with my family.
Virtual colonoscopies attempt to accomplish the same task using magnetic resonance imaging (MRI) or computer tomography (CT) technology, avoiding the need for sedation. Virtual examination, however, may not be as good at detecting flat or depressed lesions in the colon, common flaws that have recently been shown to have a higher linkage to cancer than polyps. Plus, you still have to do the same prep as for a normal colonoscopy. As a result, I’d choose a “real” colonscopy over a virtual one if given the choice.
There’s lots of information about colonoscopies online. The Gastroenterolog Associates website above is as good a source as any you’ll find online. Google Video and YouTube have a number of videos you may find informative, funny or gross, depending on your state of mind.
Here’s the bottom line: if you’re 50 or older, or have other risk factors for colorectal cancer, get a colonoscopy (with your doctor’s endorsement, of course). For the most part, the only memory you’ll have will be the preparation (which is a bit tedious, but not particularly horrible) and the taste of the first solid food you eat afterward.
