Friday, March 7, 2014

PSA: What to Expect When Having a Colonoscopy

In the past ten days I have done All The Adult Things: I had four cavities filled, I had a mammogram, and I had a colonoscopy.  I am not anywhere near the age where regular colonoscopies are recommended; I had my colonoscopy because of my ever-present stomach issues.  (Everything is fine, thanks.)

I felt nervous about getting a colonoscopy.  Aside from Katie Couric having one on-air, there isn't much out there in the way of personal accounts.  If you google "what to expect when having a colonoscopy,"  you will see mostly pdfs of instructions from various digestive disease centers.  The short version is that you will take a bunch of laxatives the night before and the day of you will be sedated right before the procedure.  Which is all true. me type A, but I wanted more info than that.  How long before the laxatives work?  How long will the whole thing last?  What kind of knockout drugs are you giving me?  I need ALL THE DETAILS.

Here is my experience.  I feel nervous publishing this, as I'm sure some people will consider this TMI.  If you come to this blog for my attempts at decor and are not interested in medical procedures that involve poop, now is a good time to stop reading and click onto something else. FYI, I am giving  far more information than I might otherwise, because I couldn't find anything on "how will I feel?" when I searched.  So if you are way grossed out by this, stop reading.

Of course, I am not a doctor nor do I play one on tv.  I am not handing out medical advice here; I'm just reporting what happened to me. Your mileage may vary. Also, there are many varying instructions on how to prepare for a colonoscopy, your doctor may do it slightly differently than what mine recommended.

800+ posts on this blog, and this will be the one that goes viral, you just watch.


When my doctor recommended that I have a colonoscopy, I made the appointment at his office, and was given a full page of instruction.  I skimmed it.  One of the instructions is that you can't eat anything the entire day before.

The day before, I couldn't find the sheet of instructions.  (Freudian avoidance.)  I called the office in the morning and asked if they could email me a fresh sheet. "Have you been following a clear liquid diet today?"  " I had oatmeal for breakfast."

"You'll have to reschedule."


I rescheduled, got my sheet of instructions again, and sat down and read them this time.  None of this applied to me, but if you take certain medications, such as blood thinners or diabetic medications, you will have to work with your doctor to adjust your dosage a week beforehand.  You may not take iron or aspirin for seven days prior to the procedure, or NSAIDS like Advil for 48 hours prior. If you use a c-pap machine or have severe obesity that might interfere with conscious sedation you will also have to work with your doctor to deal with that.

The instructions note that you may ingest only clear liquids the day before the procedure. Some doctors will let you eat breakfast before 9 am the day before, but not my doctor.  Clear liquids include tea or water or apple juice or coffee or broth, but not pulpy liquids, like orange juice, and not milk. You must also avoid red and purple liquids, so no red or purple popsicles, etc.

My procedure was scheduled for Wednesday.  On Monday night I had a delicious dinner of carne asada, quinoa with black beans and corn, sauteed spinach and an ENORMOUS piece of German chocolate cake, as I figured it would make up for Tuesday's calories.  Tuesday I had a few cups of tea, some water, and that was it.  I was grumpy about it.

As instructed, I bought THE BIG BOTTLE of Miralax (510 grams), one package of Dulcolax overnight tablets, and two 64 oz bottles of lemon lime (not red or purple) Gatorade.  Because I had my procedure scheduled for the afternoon, I was instructed to drink half the laxative in the evening, and half very early the morning of.  Tuesday evening I asked the Mister to come home early, because if one is about to drink 64 ounces of laxative, getting the kids ready for bed is inconvenient.

At 5 pm I took one Dulcolax tablet, which was supposed to work "gently overnight". (Ahem, foreshadowing.) At 6 pm, I mixed half the container of Miralax into one 64 oz container of Gatorade and got to drinking.  Drinking 8 full glasses of a drink you do not enjoy is not the easiest thing in the world.  The instructions suggested one glass every ten minutes.  I tried, but I started slowing down towards the end.  It took me about an hour and forty minutes to down all 8 glasses.

I texted my sister the picture below and told her I felt like Dumbledore. (In Book six Harry Potter forces Dumbledore to drink 10 glasses of green poison.)   Alternative interpretations were a macabre game of beer pong.

In the meantime, I gathered things to keep busy with.  I brought into the bathroom a small side table, some books, my laptop, the Kindle, baby wipes, an extension cord and all the chargers for my phone, computer and Kindle. My bathroom is kind of far from my bed, so I also brought in a husband pillow and a blanket.

As I drank the never-ending cups of Gatorade, I googled "what to expect" and did some texting with my sister.  If you have the sense of humor of a twelve year old boy, as I and my sisters do, some of the instructional pdfs are kind of funny---expect "high velocity, high volume" production of poop!

Around 7:30, the laxatives started to kick in.  All in all, the evening prep was not terrible.  Yes, there was a lot of "high volume, high velocity", but I spent the entire time less than two feet from the bathroom, and there was no painful cramping like one might get with a stomach virus. Also keep in mind I only did half the prep in the evening; if you had a morning appointment you would take twice as much, which might change the evening experience.  I felt a wee bit nauseous from the large amount of sugar I ingested, as both the Miralax and Gatorade are high in sugar, but it was not that bad.  I had plenty to read. By 9ish in the evening I was mostly expelling liquid.  Lots of liquid, but it was going better than I expected.  Around 10:30 it seemed like it was safe to go to bed.

And then.

(Skip the next paragraph if you are squeamish.)


(Abandon all hope, ye who enter here.)

At 2 am I woke up WITH URGENCY.  The sweaty, faint-y, horribly nauseated, clutching the garbage can to vomit while leaning against the wall and crying while simultaneously doing exactly what you think 64 ounces of laxative will do sort of urgency.  

That was the longest, most nauseated forty minutes of my life, and then I went back to bed.

If you are reading this in hopes of hearing "this colonoscopy is no big deal, I'll be fine, right, right, RIGHT???', right about now you are probably saying "oh dear."  I can't explain why it was fine for hours and then at 2 am BOOM. I have no idea if others experience the same thing. It felt very much like a low blood pressure episode (albeit one with extreme diarrhea). I assume the "gentle overnight " (harrumph) Dulcolax kicked in.  My doctor said it was normal, so I don't know.

At 6 am, I started drinking the remaining 64 oz of Gatorade.  UGH.  I was beyond grossed out, and my 2 am bout had me terrified that the same thing was going to happen again (what if it happened in the car on the way to the hospital??) (it didn't).  

It took me nearly two hours to drink the remaining Gatorade. The instructions mandated that I finish the Gatorade by 8 am, so I had to chug the last two glasses. (So gross.)  It kicked in pretty quickly the second time, probably forty minutes after I started drinking.  I did not have a repeat of the 2 am episode, but I did have lots of volume.  At this point my production was mostly clear liquid, which is what it was supposed to be.

I had to leave for the appointment at 11:30.  I was concerned about the forty minute drive. I was no longer laughing at the "consider wearing a diaper" instruction.  We left on our forty-minute drive to the hospital; we stopped at Target once to use the facilities.

We checked in to the clinic at 12:30 pm.  I hit the bathroom twice again (that was the last time). When you get a colonoscopy you are not allowed to drive home because of the sedation, or even take a taxi without a companion.  When we checked in the receptionist checked to make sure I had a person to take me home.

At 1 pm my husband and I were called back to the prep area. If you've ever had surgery, many hospitals will have a prep/recovery room where you go before surgery to get ready and after to be observed.  It is a large open room with a small nurse station, and a row of beds lined up against the wall around the room, and curtains between each bed for privacy. It looks like your average ICU.  Occupants of the room were me (39 year old hot chick) and 7 old men in various states of unconsciousness.  I pulled the curtains tight, got naked, put on the requisite hospital gown, open in the back, and hopped up on the bed.

A nurse came in and took our info (name, DOB, insurance, etc). She gave me a few blankets.  I always associate hospitals with being cold and nearly naked. I had brought socks in anticipation of this, but they won't let you wear a sweater for a procedure.

 Because a colonoscopy requires sedation, she started prepping my hand for an IV.  "Hmm," she said, "I can't find your veins."  I gave her an eyebrow that clearly said "go find someone who can."  She stepped out, and the resident fellow came in to give us an overview of the procedure and answer any questions.

Essentially, a colonoscopy is a doctor inserting a camera on a very long flexible tube into your rectum and through your intestine.  You are sedated before the procedure starts.  Without problems, the procedure itself will take 15-30 minutes, although getting sedated will add more time.  If they find polyps, they will remove them (which will add more time), unless they are too large, in which case the polyp will be biopsied.  How much time it takes will also vary by what problem the doctor is looking for, but usually it will take under thirty minutes.

After the resident answered our questions, another nurse came in and painfully bungled my IV ("I hear you didn't bring your veins to the party!"), and then another nurse came in and finally did it properly.  The doctor doing the procedure came in to see if we had questions.  I relayed my 2 am bathroom incident, and the doctor told me that I could have gone to a fancy spa in Newport Beach and paid $1000 for that, but he gave it to me for only $20 of drugstore laxative and he was throwing in a colonoscopy to boot, hardy har har.  Apparently "high volume, high velocity" has a broad range of normal interpretations.

The Mister went to the waiting room and I was wheeled into the procedure room.  The procedure room was small (not like a big operating room).  It had lots of monitors and a big tv screen for viewing the interior of my colon.  Aside from the fact I was laying on a gurney, it felt like waiting in a doctor's office.

Years ago I had an endoscopy, and that GI practice had an anesthesiologist on staff.  This practice, however, used nurse anesthetists (if that sort of thing is important to you).  I was asked to lay on my side. The nurse anesthetist hooked up the drugs to the iv, we had some small chit chat for a minute ("you're not giving me the same drugs that killed Michael Jackson, right?"), and nighty night, out like a light.  The sedative drugs used were Versed, Fentanyl, and Benadryl. From here on out I remember virtually nothing until about 6 pm.

After the procedure I was wheeled back to the recovery room we started in. The Mister said he waited about an hour in the waiting room before being called back to the recovery room.  The doctor and the resident fellow came back and gave the results to my husband.  I remember none of this, even though I was supposedly awake and conversing.

I had no stomach or bowel or any other irritation afterwards.  I felt normal but completely exhausted once back in the recovery room.  I vaguely recall getting dressed with difficulty, I kept losing my balance and I really just wanted to go back to sleep. (The Mister had gone to get the car.)  Once I was dressed I was escorted to a wheelchair, wheeled out to the pickup area by an orderly, and then we went home.  We left the hospital around 3 pm, so the entire thing start to finish was about two hours.

I slept the whole way home, or, I should say, I remember nothing of the drive home.  I have a vague flash of picking up the kids from the aftercare program.  The Mister reports from the time we left the hospital and the whole drive home I was babbling about paying the Verizon bill and other nonsensical things.  (In the event you have a deep secret, pick your take-you-home companion carefully.)  I walked inside the house and fell asleep on the sofa until about  6 pm.

I felt fine, if tired, once I woke up. I ate dinner with my family.  There were no food restrictions; I had pasta with broccoli.  I was totally exhausted, though. I managed to keep my eyes propped open till about 8:30, when I went to bed for the night.  I felt fine the next day.  My discharge instructions noted I should not drive, make important decisions, or drink alcohol for 24 hours, so the Mister drove the kids to school the next morning.

All in all, it was not the worst thing in the world, I guess.  The colonoscopy itself was fine; I remember nothing after getting wheeled into the room and had no pain associated with it, either during or after.  The prep was...not great.  Apparently nausea is a "normal" side effect of the prep, but I don't know if it is a common side effect. (Not a ton of people my age have had colonoscopies for me to ask.) I am thankful I don't have to do this again for ten more years.

And thus ends my exciting story about colonoscopies.  I hope that was helpful.  If you have any questions, leave them in the comments, I'll do my best to answer them.

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