Colonoscopy, or: Mount Vesuvius followed by blissful sleepytime!

Alternate title: How I survive 8 hours on a toilet, then enjoy the most relaxing 30 minute nap of my life

I still haven't decided if gastrointestinal doctors are genuinely caring, or sociopaths.

If you have Crohn's or some other form of Inflammatory Bowel Disease (IBD), or if you're 50 or some multiple of ten beyond that, chances are you've had one or more colonoscopies. If you're even luckier, and have active and/or moderate-to-severe IBD, there's a good chance you've averaged at least one colonoscopy per year (my current record is two in a year!).

I'm prepping for my (by my count) 8th colonoscopy tonight, and while I still have the energy, I figured I might as well write something about the process, in the hope that I can make the process slightly better for you. There's something about sitting on a shiny white porcelain object that makes one wax eloquently about... human waste?

For starters, the Molotov cocktail

In my earlier post The Joy of Crohn's, I dug up and used the following image as an illustration of the effects of Colonoscopy-specific laxative treatments:

Geyser Eruption

There are many different laxative treatments these potentially-sociopath doctors choose to inflict on patients. Here are a few I've used:

  • Suprep: I just chugged 16 oz. of this an hour ago. You ultimately drink a Big Gulp's worth of some of the most gut-wrenching substance possible. You might want to wait until afterwards to read the warning label, which reads: "The osmotic effect of the unabsorbed ions, when ingested with a large volume of water, produces a copious watery diarrhea."
  • Golytely: I'm certain the marketer who named this product never used it. There is nothing 'lyte' about it.
  • Dulcolax The slogan on the box reads "Gentle, predictable overnight relief". That may be the case for someone following the dosage on the back of the box (1 tablet per day max). But after experiencing the outcome of four pills at once (as instructed by the doctor), this slogan would be more fitting: "Terrible, unpredictable overnight eruption of poo".

Suprep's effect - copious watery diarrhea

I've also used Fleet phospho-soda, and some other forms of treatment that use more than one drug in the same family, but as I get closer to my tenth colonoscopy, I wonder if it might just be easier to go on a week-long clear liquid diet!

The sad fact is, your bowels have to be 100% clear before the colonoscopy. And forcing out all matter inside your intestinal tract ain't pretty.

The morning-of, a.k.a. 'The Purge, Chapter 2'

Most doctors require an equivalent dose the morning of the Colonoscopy. And if you're lucky, and have an early colonoscopy, you realize all to late that the directions say "take another dose of the explosive solution four hours prior to the colonoscopy. And so you wake up at 4 or 5 a.m. and repeat the entire course of the previous night's events.

The procedure

Assuming you're not stuck on the toilet waiting for the last bit of the explosive concoction to force its way out, you make it to the endoscopy center drained of energy and about six pounds underweight. To rub salt in the wound, the directions state "NO WATER, NO FOOD, NO HAPPY THOUGHTS." I think I might've took a little liberty with that last stipulation, but that's about what I got out of it.

While you're still trying to wake up without your normal dose of caffeine and some form of nutrition, the nurse hands you a hospital gown and asks you to strip down, leaving your backside exposed, and hop into bed. The best part of the prep is the fact that you can usually score a warm blanket or two. Those things are amazing.

But then you realize you'll have a garden hose stuck up your butt in a few minutes.

After an anesthesiologist asks you if you're prone to dying when you're put under (thankfully, no), and a nurse gets you started on an IV, you're wheeled into a slightly-chilly room (thank God for that warm blanket!) then told to lay down on your side, with your bare bottom sticking right into the doctor's face. (Maybe GI docs have good reason for being sociopaths.)

The anesthesiologist then shows you a little tube of white milky substance, connects it to your IV, then (if you're me) you say something extremely humorous and witty about... mmm... what's that...

The after-procedure

If you have IBD, or are otherwise comfortable with scatalogical humor, then what follows the procedure is one of the most relaxing wake-up rituals you could imagine: you are able to pass volumes of gas as copious as the volume of excrement you passed the night before! Thankfully for those in your vicinity, these are no silent-but-deadly (SBD) farts, much more in the loud-but-harmless (LBH) range.

You usually come out of the fog of nothingness (that's what I'm calling it—I've never remembered anything between the milky-substance moment and Symphony de toot Allargando) wishing you could get right back to it and stay there another eight hours. But the nurse says "no" and you're forced to stand up on sea legs, get on your clothes, and get carted out in a wheelchair.

The Memory

So life goes on, and the doctor either tells you he couldn't find your intestines, or you'll lead a good long life (or, usually, something in between). Unless the doctor took some samples for later biopsy, you likely won't feel anything but hunger—and that is quickly satiated by your next meal, at which you'll ravenously consume whatever edible substance is within range, as your poor stomach continues its protest against famine.

I think due to the fact that you get anesthesia, and you feast on whatever food you can after the procedure, you'll end up with an overall positive memory of the full experience. At least I do.

But the next time you crack open a bottle of Suprep, and that very slight cough-syrupy odor hits you, the more negative memories will rush back in.

Pro Tips for Prep

Since I've done this a few times, and since I've aggregated a list of all the little things that make my bowel prep experience at least halfway decent, I thought I'd also list the things I do:

  1. I have a small space heater (this Holmes heater, to be precise) that keeps the bathroom about 8°F warmer than the rest of the house. It's nice because you can get quite cold while you're dropping off a percentage of body weight into the toilet!
  2. I have an extension cord plugged into the GFCI outlet in the bathroom. Into it, I plug in my:
    • MacBook Pro: so I can do some work (or procrastinate and write this blog post...)
    • iPad: I usually watch 2 or 3 movies in the course of the prep time, and the iPad is the best way to watch them.
  3. I have a Gatorade and my 32 oz. water bottle on the sink counter next to me. Gotta stay hydrated!
  4. I use a Table-Mate table to use for my laptop and iPad. These things aren't just for old people!
  5. I have a bidet (specifically the Luxe Bidet Neo 320—which allows hot/cold mix, so you don't either freeze or burn your bum). This is soooooo much nicer on a purgitized bottom than sandtoilet paper. Many IBD patients have one, and I just got one for my birthday (woohoo, what a present!).
  6. I keep a stash of either Lifesavers or Jolly Ranchers on the counter, as they help keep my taste buds normalized, and they're on the clear liquid diet.
  7. While it's not stated in most doctors' directions, you should try to lighten your diet at least a day or two before the prep, so the bowel prep drug doesn't have to shove through half a chicken, beef stroganoff, and a gallon of milk! I usually switch to a lighter diet (like the BRAT diet) a couple days before, and this helps make the prep a lot less messy and painful!

Comments

My god, this was both funny, and relevant, since I turned 50 and a colonoscopy is on my agenda in the future.

I came here for Raspberry PI goodness, and ended up with a session of scato-humor. Nice surprise.

If you haven't read it yet, I recommend finding Dave Barry's column on his first colonoscopy. It's hilarious.

I've had two colonoscopies so far, and not experienced that amount of flatulence afterward that you report. I did have such flatulence (a 45-second fart, to start with) after I had a lower-GI series w/barium enema upon leaving the Navy. That was awkward, because when I hobbled to the restroom across the hall that was labeled as reserved for barium enema patients, it was in use, and the orderly had to lead me around the corner and up a floor to the next nearest one.

After my first colonoscopy, I had an interesting time coming out of the anesthesia. Well, actually, everyone else had the interesting time. Apparently, I was lucid, joking and flirting with the nurses, falling back asleep and saying the exact same things every time I woke up for almost half an hour.

that amount of flatulence afterward that you report.

Yeah, most of the time there's not an issue, but maybe 1/4 colonoscopies I remember having quite the air capacity!

labeled as reserved for barium enema patients, it was in use

AAAH, worst nightmare! It's soooo hard to keep that stuff in after you're finished. I can't imagine not having the restroom right next to the procedure room ready to go.

I was lucid, joking and flirting with the nurses, falling back asleep and saying the exact same things every time I woke up for almost half an hour.

Yeah, it seems like this also only happens 1/4 of the time for me—the last few colonoscopies I just woke up gradually, for about 5-10 minutes, and there was nothing else. But my wife recounts the stupid joke I kept repeating every minute or so after the first Colonoscopy after I had met her!

Also, after my surgery... apparently I would say the same thing every time I woke up after general anesthesia, about once per 5 minutes—for about 3 hours. Needless to say, I was probably more impressed with my words of wisdom than whichever relative was sitting by my bed at that time!