Friday, October 22, 2021

I just wanted to pop in and tell you some of the non-icky details of my colonoscopy

(NOTE: This is a very long post. I'm not sure I would endure the whole thing if I were you, but I at least wanted to warn you up front.)

Hi, it's me. One time my Cleveland Foundation co-worker Jennifer Cimperman described me as "earthy," which is a word her mother apparently uses for people who aren't shy about sharing personal details. I am proudly earthy.

I should also mention that the headline is a lie. There are no details of a colonoscopy that aren't icky, but I hoped you would read the first couple of sentences before deciding whether to soldier on or bail before things got messy.

So, if you're still with me, here's how it all went down...

First, let's establish that I am a couple of weeks away from turning 52, which means I was nearly two years late when I underwent my first screening colonoscopy this past Monday. Actually, if you go by relatively new guidance from the American Cancer Society that such screening should begin at age 45, I was seven years late.

Either way, I should have done this earlier.

I didn't put it off because I was scared of the procedure, though. On the contrary, I am weirdly fascinated by new medical experiences. When I got my first root canal a few years ago, the endodontist had to politely tell me not to ask any more questions so he could actually finish the procedure.

As my wife will confirm, I was really into the specifics when it came to my colonoscopy and the associated prep.

Because of course it's the prep about which everyone has horror stories. And rightly so, given what's involved. The whole goal is to completely clean out all 5 feet of a decidedly unpleasant part of your body: your large intestine.

To do this, you abstain from all solid food the day before your procedure. You're limited to a "clear liquid" diet, which I found out doesn't mean you can only have clear-color liquids. Permissible options include broth, popsicles (no red or purple), Jello-O, sports drinks, black coffee or tea, and water. Or at least that was the stuff I had.

That in itself was a bit of a challenge, though I was never as hungry as I thought I would be.

You also have to ingest a certain amount of medicinal liquid designed to really get things moving, if you know what I mean.

It used to be that this liquid was an unpleasant, chalky potion that in and of itself was nauseating. They have apparently advanced the technology, though, because all I had to drink were two 10-ounce bottles of something clear and watery called magnesium citrate.

Now don't get me wrong. You don't want to drink magnesium citrate if you don't have to. It's not especially tasty. But I mixed it with ginger ale and it was fine (apparently the bitter taste is masked well by ginger ale or lemon-lime soda).

You don't drink this stuff all at once, either. You take in 2 ounces or so every 10 minutes, and the two bottles are consumed six hours apart. You also swallow four stool softener pills along with the first bottle.

That's all easy enough, but I still managed to screw it up. After you drink magnesium citrate, you're supposed to also drink a large amount of clear liquid, ideally water. At least four full glasses.

I forgot that part. After I finished the first bottle of magnesium citrate and took the pills, I sat back and waited for something to happen.

I waited four hours for something to happen. And nothing did.

Then I remembered the part about the water. Once I drank that copious amount of H2O, things did in fact happen.

Oh, they happened.

This is the part where I'll try and skip the icky, but suffice it to say that the sheer physics of the process are horribly illogical. And by that I mean the input/output ratio makes no sense. I think there were traces of Thanksgiving dinner 1981 that passed out of my digestive system.

What comes out way, way, way exceeds the amount of food you've taken in over, say, the past week or so. I still can't understand it.

They tell you you'll be spending a lot of time in the bathroom, and they are correct. I was up until midnight doing what I had to do to get my colon nice and clear.

SPOILER ALERT: As it turns out, I did not do a good enough job with this, and I blame the four-hour delay in drinking the water. This oversight would come to have longer-term consequences for me, as we will see below.

Anyway, there were some small aftershocks the next morning, but the bulk of the work was completed the previous day.

My procedure was scheduled for 1pm, and you're supposed to stop eating or drinking four hours prior. Which meant I was finished ingesting anything (even a breath mint) by 9am.

Interestingly, I didn't feel especially tired or weak at that point despite my meager diet of the previous 30 hours. I was actually pretty active that morning. I went and got an e-check on my car, then drove to the BMV to renew both my license and registration. I also spent an hour cutting our grass, then broke out my work laptop and did Goodyear stuff up until almost the moment we left for the endoscopy center.

You have to have someone drive you there, by the way. There's a chance you're not going to be in any condition to drive yourself home after the procedure, thanks to the anesthesia, so Terry had to come with me as I checked in so I could prove I had separate transportation.

I won't go into the boring details of how they get you ready for the actual colonoscopy other than to note the following:

  • You have to remove all clothing except your socks and put on a gown that, of course, opens in the back. As I told the nurse, "Oh yeah, that makes sense."
  • Speaking of the nurse, she was very pleasant. She and I share a birthday. She stuck some sensors on my shoulder/upper chest and forearm, and also inserted a needle into my hand for the IV. Nothing especially unpleasant.
  • Once she left me by myself in my little hospital bed, I had to wait a long time. Or at least it felt like a long time. I thought I would go straight into the procedure room, but it was 30 minutes before they came and got me.
There were a couple of assistants in the procedure room along with the nurse anesthetist and Dr. Khatami, who served as captain of the S.S. Roto Rooter that day. They were all very pleasant despite the fact that they do something like 35 colonoscopies a day (I asked).

We made small talk for a couple of minutes before they instructed me to turn and lay on my left side and bring my knees up toward my chest, which better facilitates the procedure from an anatomical perspective, as you might imagine.

I asked the nurse to fold my pillow for me so I wasn't laying quite so flat, which she did. And that's the last thing I remember, because that was the point when I went night night.

Or at least I think that was when I went night night, since it's definitely the last thing I remember. It could be that we had more conversation and they had me count to 10 or whatever, but I don't recall anything like that happening. If it did, the memory of it was wiped out by Propofol, a wonderful anesthetic often referred to as "milk of amnesia."

I woke up back in the same curtained-off area where they had prepped me. I felt wide awake as the nurse told me my procedure was finished and asked me a couple of questions. I guess I answered them, but then, despite how I felt, I went right back to sleep.

Then I woke up again and she asked if I wanted water, and I said yes. She brought me water, I drank it, and again I fell asleep.

I woke up a third time with the empty water cup laying at my side, and this time I stayed awake. I can't describe how suddenly sleep overtook me those two times after the initial wake-up. I clearly had a good amount of Propofol still in my system.

But then I guess I was fine, because I was able to stand up and get myself dressed. I felt a little tired, but nothing too terrible.

After another wait, Dr. Khatami came by to debrief me. The good news: Everything he could see looked fine. No concerns about anything he came across while touring my colon.

The bad news: My clean-out the previous day had not been as thorough as he would have liked, even though I insisted I had followed everything to the letter except drinking that darn water. But that was apparently my downfall, because there was still a lot of "stuff" in there that prevented him from visualizing my entire large intestine.

The result? Instead of being told I was good to go and to come back again for another screening in 10 years, I was instructed to come back "in 3-4 years" so they could take another look. And, adding insult to my injured ego (I thought I had been a model patient), next time I will have to undergo a two-day prep.

Two days.

I should have known this prep had been too easy. So many other people describe the experience as miserable and exhausting. For me it had just been inconvenient, though certainly very active in terms of restroom trips.

I was even given a few photos of the inside my colon, and in a couple of them you can see areas where waste material covers what should otherwise have been the easily viewed inner lining of my intestine.

Graphic evidence of my failure as a colonoscopy subject.

Oh the shame.

We'll try it again in 2024...