THCB

The (Great) Colonoscopy Experience

Today, as Kathy finished her last radiation therapy appointment, I had my first screening colonoscopy – a rite of passage for new 50 year olds.

Although a bit of a personal issue, I’m known for my transparency and I’m happy to share the experience so that others approaching 50 know what to expect.

The preparation is the hardest part.   Three days before the procedure, it’s recommended that you reduce the quantity of high fiber foods you eat – fruits, vegetables, nuts etc.  For me that was particularly challenging since my entire diet as a vegan (who tends to avoid white flour, white rice, and white sugar)  is high fiber.    I moved to soups and brown rice.   A day before the procedure (really 36 hours), you move to a clear liquid diet – apple juice, broth, and tea.   In my case I drank a cup of vegetable broth and apple juice every 3 hours.

At 7pm the night before the procedure, the real challenge begins.  The bottle of magnesium citrate reads “a pasteurized, sparkling, laxative”.   Sounds so appealing.   The first dose is 15 ounces.   The bottle warns that the maximum therapeutic dose is 10 ounces in 24 hours for adults, but colonoscopy is a special case.   The 15 ounces of laxative is followed by 24 ounces of clear liquids over the next 2 hours.   Keep in mind that you have not eaten any solid food for 24 hours at this point.   Sparkling laxative followed by broth and apple juice is not Chez Panisse.

A few hours after the laxative, the intestinal rumbling begins.    You’ll have a rocky night with an urgency to jog to the nearest bathroom every few hours.   By morning the intestinal cramping will have subsided and then you get to repeat the process!  Six hours before your procedure, you’ll drink another 15 ounces of mag citrate followed by 24 ounces of clear liquids over 2 hours, then nothing by mouth for the final 4 hours.    Given the 36 hours without solids and 30 ounces of mag citrate there’s nothing really left in your body, so you’ll move the clear liquids through your system quickly.    You’ll arrive for your procedure just as all the cramping has stopped.

The procedure itself is the easy part.   There are multiple sedation options – nothing at all, versed/fentanyl, and propofol/monitored anesthesia.

I received propofol, which works quickly and clears quickly.   I have no memory of the anesthesia, but when I awoke I thought I had just come in from chopping wood on the farm.   The nursing staff were very understanding.   In a few minutes, I was walking, dressed and back on the iPhone, doing conference calls and answering email.    I did avoid work with chain saws and signing a new will.

The Boston Endoscopy Center, where I had my procedure, uses an electronic record called Gcare, which captures images and reports.   The BIDMC enterprise systems are fully interfaced to Gcare, so all endoscopy information is immediately available to patients and providers. By the time I returned home, I had access to all the images above. The report was simple and to the point

“Medications: MAC Anesthesia

Pain rating: 0/10

Indications: Screening for colon cancer

Procedure: The procedure, indications, preparation and potential complications were explained to the patient, who indicated his understanding and signed the corresponding consent forms. A physical exam was performed. Moderate sedation was initiated by the physician. Continuous pulse oximetry and cardiac and blood pressure monitoring were used throughout the procedure. Supplemental oxygen was used. The patient was placed in the left lateral decubitus position.The digital exam was normal. The colonoscope was introduced through the rectum and advanced under direct visualization until the cecum was reached. The appendiceal orifice and ileo-cecal valve were identified. Careful visualization of the colon was performed as the colonoscope was withdrawn. The colonoscope was retroflexed within the rectum. The procedure was not difficult. The quality of the preparation was good. The patient tolerated the procedure well. There were no complications.

Findings:

Mucosa: Normal mucosa was noted in the entire colon

Impression: Normal mucosa in the colon

Otherwise normal colonoscopy to cecum

Recommendations: Colonoscopy in as long as 10 years as per the recommendation of Medicare. If you develop symptoms such as bleeding, or if a relative develops colon cancer, this interval would change. Get regular checkups with your primary doctor to check for hidden blood in the stool

Additional notes: The efficiency of colonoscopy in detecting lesions was discussed with the patient and it was pointed out that a small percentage of polyps and other lesions including colon cancer can be missed with the test. Degree of difficulty 2 (5 most difficult).

FINAL DIAGNOSES are listed in the impression section above. Estimated blood loss = zero. No specimens were taken for pathology.”

Done for another 10 years!

As July draws to close, both Kathy and I are celebrating.  We’ll have a high fiber vegan meal and welcome the simpler August ahead of us.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. He’s also the author of the popular Life as a Healthcare CIO blog.

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16 replies »

  1. I took a Cologard test because there were no local doctors that participated in my insurance plan. My test came back positive and I had to arrange for a colonoscopy to see what was going on.
    My two concerns were the prospect that Colon cancer was a possibility and that I had a long ride to take after the preparation and didn’t want to have an “incident”.
    The following should give you insight to many of your questions.
    I am 61 years old 6′ tall 270 lbs. Last exam about 10 years ago
    This is what I ate to try to have a good PREP
    Five days before Colonoscopy
    a light breakfast /1 tsp Metamucil 8 oz water /Covid 19 nasal swab as required for Hospital
    a light lunch / 1 tsp Metamucil 8 oz water
    Dinner broiled chicken Breast and mashed potatoes / 1 tsp Metamucil 8 oz water
    Four days and Three days before Colonoscopy
    Breakfast 3 Hard boiled eggs / white toast / 2 tsp Metamucil 8 oz water
    Lunch Broiled chicken Breast and mashed potatoes / 2 tsp Metamucil 8 oz water
    Dinner broiled chicken Breast and mashed potatoes / 2 tsp Metamucil 8 oz water
    Two days before Colonoscopy
    Breakfast 3 Hard boiled eggs / white toast / 2 tsp Metamucil 8 oz water
    Lunch 3 Hard boiled eggs / white toast / 2 tsp Metamucil 8 oz water
    Stopped eating at NOON ( 18 hours before recommended fasting period)
    PREP DAY
    8am Had a Black coffee then mixed and refrigerated Gavilyte – G
    9am had usual Morning Movement
    11 am started purge with 8oz of Gavilyte – G every 10 minutes
    it was unpleasant (salty) but NOT undrinkable ( Keep it COLD )
    nothing…. nothing….a full feeling…a full bloated feeling…a full uncomfortable bloated feeling…
    1320 Finished last Gavilyte – G then BOOM NUCLEAR EXPLOSIVE SYMPHONY
    at this point your bowels will ruthlessly betray you without notice…
    -wear disposable under garments if you can
    -stay in the bathroom if at all possible
    – don’t point your fully loaded cannon in any other direction except the toilet because –
    your bowels WILL betray you WITHOUT notice!
    I lost track of time then suddenly it was 3pm. Things began to calm down a bit.
    I was running fairly clearish fluids as described in other posts you probably have read
    8 pm took 2 laxative pills as prescribed but the urgency had diminished. After the last few hours it was hard to imaging that I had ANYTHING at all left in me. I stopped ingesting fluids at 11pm
    DAY OF PROCEDURE
    Slept without incident woke up at 0630 had a controlled clearish movement and again at 0730.
    My biggest concern was the 3 hour ride I had to take ( I won’t bore you with the details of my insurance ) I did wear a protective undergarment and brought a change of clothes but the ride there was without incident. I only made ONE rests top as a precaution.
    12:45 Sedation began 1:45pm Woke up in recovery
    Result 2 polyps removed one small / one Large 1 1/2”
    The Dr. said I has a sub optimal clean out. I don’t know how!?! ( maybe next time I will have to do a two day Preparation) but he was able to complete a full exam.
    Three hour ride home without incident.
    One week later the Doctors office called to tell me that the biopsy came back negative but they want me to come back again in one year. I think because of the sub optimal clean out.
    I hope this was helpful.

  2. Great site. I recently had a colonoscopy and was told that an anesthsiologist would attend me,,,long story short they substituted a nurse (sure, she was a crna) and the colonoscopy was a painfuly disaster..not completed and my gastro said that I probably have cancer but that I need another colonoscopy with a real anesthesiologist not a nurse (crna)..I will NEVER get another colonoscopy! Be careful and do not consent to a non-anesthesilogist doing your case (the so-called anesthesia care model where one anesthesiologist supervises 4 crna nurses) can be a nightmare that can literally kill you.

  3. I love the patients MIGHT feel embarrassed,about farting but its ok ..everyone does that.. how about HUMILIATED showing your asshole and dick and farting in front of total strangers oh its so funny ..NO it isn’t should I go take a shit in the lobby to get over being treated like a dog

  4. If there has been any “terrible abuse” during the colonoscopy, you better change the doctor. I would like to make a point in how simple and easy this procedure is by my own experiences. I have had colonoscopy six times and never have I had any sedation or drugs used. They are quite simply not needed at all. I understand that people may have fear about this invasive procedure but, provided that the doctor knows what he or she is doing, uses the latest and most advanced technology, there is no basis for fear as the process does not include pain, only discomfort. Usually that discomfort is due to the air that the doctor needs to pump in in order to allow the device to move and also in order to see those colon walls propertly. It is the patients own action by frequently letting this air out that makes it really tolerable. But here again, some patients may feel embarrassed about this as well. It is a good thing to remember that this is no social gathering but a medical situation and passing gas will certainly bother anybody around. Another instance where some uneasy felling may occur is when the doctor is maneuvering around the colon bends but that is only for a very short period of time and here the doctor’s experience and sensitivity towards the patient plays a big role. My last experience was the easiest of them all as the doctor had this new equipment and used carbon dioxide in lieu of plain air and that meant that there was no bloating feeling whatsoever. So my point is that you are allowed to choose to be sedated but it only makes it more difficult for everybody. But there is absolutely no reason either for drugs to be used nor for any fear to be felt.

  5. Be careful: the so-called “sedation” that is most often given for colonoscopy is a dangerous sham..Versed (midazolma) is given to cause temporary amnesia (it has no pain-relieving properties and forces patients to lie imobile in agony unable to communicate). the only reason that this awful drug continues to be used is that it causes temporary amnesia-the patient is rushed out the dorr, confused and unable to remember the terrible abuse, until they get home and have nightmares, PTSD and perhaps long-term memory loss. I have the FAP gene, highest risk for colon cancer, a medical degree and will NEVER get a sedated colonoscopy with the usual drugs (versed). It’s not worth it.

  6. It’s not a problem. I worked out all day, running and to the gym. Very thristy and not too hungry. At 6:00 PM per my instructions I chugged the solution in 8oz increments every 20 minutes and by 10:00PM all was done. I went to bed and slept well. Then back at it at 3:00AM for round two. Again, no problem. Real key, chug the stuff and let it work. Then off to doctor. Worst part was IV. Take juice or sport drink for drive home, you’ll be thirsty. I ate a banana too. No problem and was on the golf course that afternoon.

  7. You don’t get much more transparent than that. (Even seemed more real than my own experience last fall.)

    Must add that my doctor had some great tablets (albeit horsepills) instead of the liquid. Maybe worth asking.

  8. I’m glad your experience was as good as it was.

    My wife recently went for her 2nd colonoscopy in 10 years. The experience was marred by the cost of the prep, Suprep. Apparently it is a patented prescription that costs $71 after Medicare insurance paid their part. That is ungodly expensive considering that it is only a combination of sodium, magnessium and potassium sulfate salts. Makes us wonder what what the motivation was to avoid plain magnesium citrate that only costs $6 for the same prep.

  9. This is really helpful for those patients who will also undergo colonoscopy and are experiencing anxiety. The details of your experience are very clear that they can picture out what to expect about the procedure.

    On the other hand, I am glad to know that everything turned out well in the end. That you will enjoy more of the life with Katie and being a vegan.

  10. “The report was simple and to the point” and complete template from beginning to end.

  11. I’ve had seven colonoscopies going back to 1993. My mother was diagnosed with colon cancer at age 61 and ultimately died from it at 80. Polyps were found in one of my early procedures but none since. It’s still recommended that I get a colonoscopy every five years with my next one due in 2014. The anesthesia was always versed which worked fine for me. Since I’m well down the learning curve now, even the preparation isn’t too bad anymore. Knowing what to expect and being mentally ready for it helps a lot, I think.

  12. I’ve had 3 colonoscopies due to polyps. In the interests of promoting evidence-based screening (unlike PSA tests and mammograms), I found the prep a bother, but I did not have the cramping you report. Also, the use of propofol has exploded recently and is now being discouraged as unnecessary due to the added expense for the anesthesiologist, although that message has probably not reached physicians yet. That said, there are legitimate reasons to use it in the case of someone who develops vomiting with fentanyl (that would be me).
    All in all, the peace of mind is worth the bother of the procedure, IMO.
    Glad yours was negative!!

  13. I salute you for your bravery in sharing such a personal and intimate experience with your readers! ; )

  14. Glad everything came out all right John! Your pasteurized, sparkling, laxative is called “GoLytely” here in Minnesota and it is anything but!

    Nice to hear Kathy is doing well.

    Chelle

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