YOU NEED a COLONOSCOPY

While it is probably not on the top five worst things you can hear, being told you need a colonoscopy still engenders fear in most people somewhere around “root canal,” and “it might be the transmission.” Why is this? We know that colonoscopies are safe, effective, and they are one of the few preventive procedures that have been proven to save lives.

As a practicing physician of over 30 years, it seemed to me that if given the choice, most people would rather be inconvenienced for a day, then suffer through months of treatment for a preventable, and possibly terminal cancer of the intestines. So why do people still avoid, or delay their screening colonoscopies? To my logical mind, this just didn’t make sense. It was a clear case of the benefits of the procedure, far outweigh the risks.

As a practicing hospitalist, on a typical day, I have at least one patient requiring colonoscopy. Earlier in my career, we actually performed the endoscopic exams ourselves. This frequent exposure may be very familiar with all the aspects of a colonoscopy from the colon prep, the mechanics of performing the colonoscopy, and the potential risks of the procedure. Or so I thought, until the day I was told “you need a colonoscopy.”

It was surprising how anxious I was about undergoing a procedure that I trusted, knew was safe, and would order, with little additional thought. Logic had nothing to do with it, as my brain considered the different scenarios. Worse, I would undergo this procedure at a hospital where I had worked for over a decade, and personally knew all the people that would be directly involved with my care. I imagine that under sedation for the procedure, my mind would open up and spill secrets to the staff, like a spy given truth serum. While I liked the people I worked with, there was still the nagging doubt that somewhere deep in my mind, there were secrets that would spill out. As a healthy, adult male, there was the worry that I might not build a handle for the prep. Never mind, that many of my patients were frail, elderly, and had multiple other medical issues, yet handled the procedure well. There was the potential embarrassment of losing control of the bowels, and the inevitable need to clear large amounts of gas from the intestines after the procedure. Both of which would be embarrassing to a committed introvert. Then there was the issue of not knowing how to prepare. There was a fear that no matter how many times I read the well-written instructions, I would get it wrong. If you eat at the wrong time, or there is inadequate preparation of the bowel, then the whole process would have to be repeated. Lastly, I am a snacker. Some people eat three meals a day, while I eat a small amount throughout the day. How would I handle not eating? Sad to say that for me, this was one of the more important aspects of the preparation.

There is a tendency in medicine, especially when patients are hospitalized, to keep them NPO (nil per os, or nothing by mouth), too long, and too frequently. But, that is another topic for another day.

So, faced with the realization that I needed to undergo colonoscopy, what did I do?

First was denial. I’m healthy, I don’t need a colonoscopy. Forget, that I have a family history of colon cancer, or had hit the magical age of over 50. Then came the delay. I’m a busy physician, and taking the time to prepare for the procedure, somehow just didn’t fit into my schedule. Finally there was acceptance. In reality, it was gentle, but frequent badgering from my primary care physician and my wonderful wife, that led to scheduling the procedure. As the day approached for me to begin the preparation, my anxiety grew, and inventing excuses for why I would have to call off, became a daily exercise.

THE PREP: The day came for beginning the steps leading up to the colonoscopy. “Prep,” is an innocent sounding word, until you are faced with a large jug of liquid, designed to blow out all the contents of your intestines. It was questionable whether I would be able to drink all of the liquid, and at the speed that was instructed. 8 oz of liquid every 10 minutes can be daunting. Besides, many of my patients have described how foul tasting the liquid was, so you can imagine how exciting it was to enjoy this beverage for the first time. But, being a competitive person, I turned it into a contest. Eight ounces every 10 minutes? I’ll drink it in eight minutes! Keeping the liquid cold and using a straw, helped with the taste, and in general the taste was not as bad as I had been led to believe. Focusing on the timer, and the 10 minute intervals, made it easy to get through the prep stage.

Then the medicine started working. “Golightly,” someone in marketing has a sense of humor. To put it mildly, there was no difficulty clearing out the intestines. The experience did give me a better appreciation for the patient’s who have to undergo the preparation, while in the hospital, especially those who have difficulty walking or getting to the bathroom. It also increased my appreciation for the nurses caring for those patients. Overall, my imagination was much worse than the reality of the prep. 

THE PROCEDURE: Finally, the day arrived for my colonoscopy. While in generally good spirits, the anxiety about sedation returned. However, my team including nursing, nurse anesthetist, and gastroenterologist, kept me well-informed about the procedure. The IV medications were started, and I suddenly found myself waking up in the recovery area. In the past, one of my jokes about colonoscopies was that it was the perfect procedure. After a person was sedated, the only evidence the procedure was performed, would be the bill that they get later, and a tendency to pass gas for the next few hours. No pain, no discomfort, and if the staff are to be believed, no spilled secrets. The good news, a polyp was found and removed. We know if polyps are not identified and removed, that over time they can enlarge, and after reaching a certain size, the risk of cancer increases. My results returned with no evidence of cancer. The “bad” news, having polyps meant that I would need to undergo another colonoscopy in five years.

A few weeks ago, I received a friendly reminder from both my family practitioner and gastroenterologist. As we know, time flies. It has been five years since my last colonoscopy, and now it is time for a repeat procedure. This time, I’m armed with the personal knowledge that my earlier fears were overblown and the procedures much easier than expected. My Family physician was right, that a colonoscopy is low risk, identifies problems early, and saves lives. Make sure you are taking the right steps to keep yourself healthy not just for yourself but for your friends and family. Schedule a colonoscopy today.

If you are uncertain about whether you need a screening colonoscopy, or have additional questions about the procedure, check out MedLine Plus (U.S. National Library of Information) https://medlineplus.gov/colonoscopy.html or the Mayo clinic at https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569 for resources and finding an expert near you.