Doctor, heal myself

October 22, 2007

I have alluded in previous posts to my gastroenterologist’s somewhat lackadaisical attitude to my impending colonoscopy. This is welcome in some respect, since it highlights that this is a common test… but it’s common for him, not me. So I would appreciate a bit more guidance, or at least recognition that this is rarely a pleasant experience for those involved.fleet_ez_prep.jpg

When he scheduled me for the procedure, he handed me a sheet with the following instructions:

  • Do not eat food or drink milk on the day before your procedure (DRINK CLEAR LIQUIDS ONLY). Clear liquids include [a list follows, concluding with “non-red gelatin desert [sic]”).
  • Purchase a Fleets [sic] EZ Prep Kit and take as directed.
  • Nothing to eat or drink after midnight.
  • NO ASPIRIN, MOTRIN, ADVIL, ALEVE, IBUPROFEN AND IRON FOR 5 DAYS PRIOR TO PROCEDURE.
  • A friend or relative to drive and/or assist you home MUST accompany you.

I get most of these, but largely because I’ve read up on this stuff online. But a few comments on these.

  1. “Non-red gelatin desert [sic]”? Are GI docs really not in the market to endorse Jello-brand products?jello.jpg It really did take me a second to figure out what a “gelatin des[s]ert” would be. It’s like Band-Aid or Xerox or Kleenex, doc—you can go ahead and say it. Sure, the legal wonks at the Jello company might come running (after ASCAP threatened to litigate the Girl Scouts, anything’s possible…), but I think clarity of expression probably wins the day when we’re talking about things as sexy as bowel cleansing.
    Also, as a snarky aside, I love the idea of a gelatin desert. I imagine that the Sahara would be lemon Jello, and the Mojave would be lime.
  2. I did get the Fleet[s] EZ-Prep kit, and boy does it look ez! Actually, from what I’ve read, this is actually one of the better preparations, relatively speaking. Better than drinking a gallon of disgusting gloop, for example. (I think that’s the Golytely prep, which wins the award for tackiest name. Not that “EZ” is much less disingenuous.) The EZ-Prep involves mixing two smallish bottles with some “flavor packets” (ugh) in about 12 oz. of water. That I can handle.However, my doc’s instructions to “take as directed” fall short a bit, since the instructions in the EZ-Prep kit say “take dose #1 at the time instructed by your doctor, and take dose #2 at the time instructed by your doctor.” Of course I called my doctor today to say, in essence, “instruct me, vis-à-vis the times,” and spoke with, not him, but his receptionist/office manager. She too was pretty nonchalant about the whole thing, almost disconcertingly so, and made me feel like I was an idiot for not understanding the EZ-Prep’s instructions. For the record: the EZ-Prep kit says to take the second dose no less than three hours before the exam, and to wait 10-12 hours between the first and second doses. My doc’s receptionist’s advice was to take the second dose “plenty early” in order to allow for, ahem, complete evacuation, even if that means “getting up earlier than [I’m] used to.” That’s fine with me, don’t me wrong; I just don’t think that I’m out of line expecting a bit more guidance on the issue.
  3. “Nothing to eat or drink after midnight.” Okay, but how do I reconcile that bit of wisdom with the fact that I have to drink, oh I don’t know, the second dose of the EZ-Prep kit? How do I reconcile that with the EZ-Prep kit’s instructions—which, remember, I’m supposed to follow, according to my doc’s instructions—to drink plenty of fluids up till three hours before the exam? Too many internal contradictions! Too much confusion!

Actually, there really isn’t that much confusion. Obviously I have to take the second dose, which involves 12 oz. of fluid, after midnight. I just think that maybe my doc could be a bit more explicit and clear about the whole thing. I know he probably goes up a dozen bums a week, but this is a first for me. Help me out here, doc. Hold my hand a bit.


Initial measures

October 21, 2007

Okay, so my colonoscopy is scheduled for next Friday morning. Since hearing that I’m going…wait, actually, that brings up another issue. I can’t say I’m going “under the knife,” since I’m not having surgery. But let me tell you, the prospect of a colonoscopy sounds a hell of a lot more invasive to me than most surgery. And “going under the knife” sounds like such an active thing, like I’m actually doing something. With a colonoscopy, though, it’s bascially the most passive thing in the world: I will doze quietly while someone crams a rubber tube through my bowels and takes a gander at what’s going on. Even better, he might even snip some things out of there! Hooray!

Right, anyway. So once I heard that I’d have to submit to this, I started looking around the internet (like one does) to find out as much as I could about it. It turns out that there are a good number of gastroenterology docs and centers out there with some pretty good info on what to expect, how best to prepare for it, and so on. This British doc, for example, gives a pretty good hour-by-hour guide as to what to do. It’s not applicable for me, but still, if I were his patient I’d be pleased with this level of detail. Harvard Health Publications has this little online tract, though frankly it doesn’t tell you all that much that you wouldn’t know from your own doc’s instructions. (“Arrange a ride home”? No kidding, Harvard Health Publications. That’s not really ‘advice’ as much as it is ‘required’.) On the other hand, this doctor’s tale of getting a colonoscopy is a bit reassuring for us layfolk.

Then there are the bits of casual advice (like the very thing you’re reading), such as this. And of course there are ample message boards with readers offering their advice (like here and here), and the occasional blog entry (like this one). From reading numerous such message boards, I think I can distill their collected wisdom thus:

  1. Baby wipes are key.wipes.jpg
  2. Stock up on reading for the bathroom.
  3. Everyone has a different idea about which laxative prep kit is (a) best or (b) worst, and what the best mixer/chaser combination is for the various preps.
  4. Did I mention baby wipes? They seem to be the one great piece of advice that circulates only by word of mouth, and not through doctors’ “official” advice. What’s the deal with that, I wonder. If you can warn patients about constant explosive diarrhea during the prep, surely you can add a little heads-up about baby wipes?

And so it begins

October 19, 2007

colonblow2.jpgA few months back I began having some weird stomach ailments: a little bit of nausea every once in a while, but mostly a general feeling of, well, grossness. These kinds of symptoms, as my doctor told me, could signify any of a thousand different conditions, from heartburn to stomach cancer. I thought: great!

I had a blood test, a urine test, and, ultimately, an ultrasound (in the wee hours of Easter morning, oddly enough, as there weren’t a lot of people scrambling for that appointment time). All the results: nuthin’.

Finally I took this crazy breath test. You breathe into a bag, blowing it up like a balloon. Then you mix this little packet of powder with water and drink it (it taste like really crappy Country Time instant lemonade), then wait fifteen minutes and breathe into another bag. This simple test revealed that what seemed to be plaguing me was a visit from my friend Helicobacter (“H.”) pylori, the funny little bug that causes many stomach ulcers. (The breath test works because the H. pylori turns acid into carbon dioxide. The lemon-flavored powder creates a bunch of uric acid in your gut, so if the second bag you breathe into has an elevated level of carbon dioxide, it’s because H. pylori created it. Elegantly simple, and brilliant!) After 14 days of antibiotics, the bug was dead.

A colonoscopy scope. Awesome!But the gross feeling kept on happening. That necessitated a trip to the gastroenterologist, who did an upper endoscopy. That procedure was a little bit freaky to contemplate, but it turned out to be a walk in the park. All I had to do was fast after midnight the night before, then head to the hospital and wait around a while. They put an IV in my arm while I read a book. Then they wheeled me into a room, gave me some oxygen through one of those thingies in the nose, and the next thing I remember I was waking up in the recovery room, feeling relaxed and groovy. I spent the rest of the day lying on the couch, feeling equally groovy—awake and alert but very relaxed—, and was pretty much back to normal by dinnertime. The only funny side effect is that evidently I made the same comments to my wife several times, not remembering that I had said them to her already at least once or twice before earlier in the day. The amnesia drug they give you so that you don’t remember the procedure, you see, lingers a bit. Weird.

So I have GERD, it turns out. No biggie—I’ve been on an acid-blocking drug for a while now, which seems to be doing the trick. I feel a whole ton better than I did.

But then, about two weeks ago, I noticed a little blood on the TP in the morning. That’s happened a few times before—doesn’t it happen to everyone occasionally?—but it seemed to happen a few days in a row. That kind of freaked me out, especially after an ill-advised trip to WebMD, where I immediately realized that I have colon cancer, Crohn’s disease, diverticulitis, and quite possibly leprosy as well.

So, in short: I have to have a colonoscopy, next Friday. I’m dreading it, of course, as everyone seems to. From cruising the web I’ve learned a lot about other people’s experiences, but only in minor, fragmentary detail. This wholly solipsistic blog is all about my experience, which I will describe in far too much detail. From what I hear, the prep is far, far worse than the procedure itself (and given my excellent experience with the upper endoscopy, I have to assume that the downstairs version of that procedure will be about the same). Maybe someone out there, Googling “colonoscopy experience” or something similar, will come across this blog and find it useful, or mildly amusing, or inflammatory, or something else entirely. In which case, success!

colonblow.jpgAs you might guess, the name comes from one of the greatest commerical spoofs on Saturday Night Live: Phil Hartmann hawking Colon Blow, the breakfast cereal with the largest amount of fiber possible…except for Super Colon Blow, of course. (“It would take 2.5 million bowls of your cereal…”) You can watch this masterful bit of television here (Flash) and here (Windows Media). Warning: may cause abdominal distention.