Colonel Wortman: [on the phone] Colonel Wortman here, General Kelly's aide. Now listen carefully, this is an order. Take the General's body, put it in a Jeep, and drive it up to G sector.
'Radar' O'Reilly: Uh, sir, there's no fighting there, just diarrhea.
Colonel Wortman: [covers phone] I'll provide the fighting.
—M*A*S*H, “Iron Guts Kelly” (10/1/74)
WARNING: I tried to be light-hearted about it, but the bottom line (heh) is that there’s gross clinical stuff ahead. Read at your own risk.
I’ve had to disappoint the folks at the Red Cross Blood Donation centers for the past several months, on doctor’s orders.
Whenever I go to see my doctor, she usually orders bloodwork for me before the visit, so she can check on my cholesterol and blood sugar levels. I have a family history of high cholesterol, and my A1C, which is a number that represents your average blood sugar levels over a certain period of time, has historically been high, but not high enough to put me in the diabetic range. So she likes to keep her eyes on that stuff, and while we’re siphoning off my arm, let’s check a few dozen other things.
On my last few visits, however, she saw something that concerned her, specifically that my blood counts were a little low. Not low enough to be considered anemic, but still kind of mysterious. She had a few suggestions for my diet, and for some vitamins I could be taking, but the numbers weren’t really budging (much like my A1C—no matter what I do, it doesn’t go up or down by any significant amount). They did one of those basic quick tests for occult blood but came up with nothing. So finally my doctor decided that it was time for me to get both an endoscopy and a colonoscopy and see if that reveals anything. Since I crossed that Big Five-Oh a couple of years back, she’s been kind of hot for me to get the colonoscopy done anyway as a kind of Thing To Do When You’re Fifty-Plus.
Off to the gastroenterologist I went, where they set me up with a “consultation”. That basically means meeting the guy who’s going to do the procedure and being handed a bunch of forms to complete and bring back on the day of the procedure. Among those forms is the preparation procedure for these things. Let me share the highlights with you:
There’s actually a timeline written down for this stuff. First thing is, the day before the test, you’re basically not eating any solid food at all. The closest you get to solid food is plain gelatin or popsicles, and everything you consume can’t be red or purple. So, no cherry Jello if you’re going to have Jello. Lemon is fine. You can have coffee or tea, but no milk or nondairy creamer. Everything else is broth, juice, water, or Gatorade.
First up on the timeline is the laxatives. They used to give you a prescription for some high-powered laxative, but now it’s all over-the-counter stuff. So you go out and you buy some laxative tablets, plus some powdery stuff. And at around noon you take the tablets along with plenty of liquid. It’s also at this time that you’re supposed to mix the powder with a quart of Gatorade. I cheated and used Powerade because I don’t like Gatorade. In the long run, it doesn’t appear to have made much difference. You don’t drink the Gatorade mixture just yet; you just “refridgerate” it. (That’s what the instructions say.) At 1:30 you drink 8 ounces of the Gatorade stuff, and repeat every hour till it’s gone. So the 32 ounces of the Powerade, plus the powdered stuff, makes a beverage close to 44 ounces altogether, so you’re doing this about a half-dozen times.
Now, you kind of expect horrible things to happen, like you’re going to have horrific cramps and then explode and spend the entire rest of the day in the bathroom. What’s more, you kind of feel like a ticking time bomb that’s going to go off at any moment, but it’s not really like that. On the other hand, you’re definitely inducing diarrhea, so there’s that. And—AND! Don’t count on going anywhere once you’ve taken those pills. In between the Gatorade drinks, you’re supposed to keep taking on fluids so you don’t dehydrate yourself. I was actually drinking enough that I had to pee a lot, too. It also made drinking the Gatorade stuff a bit of a chore, because you’re filling up on other drinks in-between the Gatorade stints. I was glad to be done with that stuff so that I could relax and drink the un-treated Powerade and Crystal Lite lemonade.
(Full Disclosure: the prep sheet told me to use specific brands of laxatives; I was in a supermarket and bought the store-brand knockoff equivalents. Same drugs, same dosage, same effects, MUCH less money. I also bought the store brand version of Crystal Lite, I think because I was on a roll at that point with the generics. And, as I mentioned, I used Powerade instead of Gatorade, but it wasn’t because of the cost although Powerade happened to be on sale; I just like it better than Gatorade.)
The first few times you’re in the bathroom it’s pretty much what you expect. In my case there weren’t the attendant cramps that usually come with it, so from that standpoint it’s not so bad. And you’re not so incontinent that you have to run to the bathroom at top speed, but you don’t get a lot of warning. Also: if you think you have to pass gas, DON’T. It’s a trap. Fortunately this occurred to me before I learned the hard way, if you know what I mean.
When you get to the end of the evening, the urgency goes away but you often still feel the need to go now and then. By that point, however, you’re expelling very little, and it’s mostly clear or pale yellow, with maybe a few flakes of fecal matter that managed to hang around. Early on, I was worried that I might be doing this all night and that I wouldn’t get any sleep, but the fact is that it’s all pretty much done by then.
The next morning (procedure day), I woke up and my abdominal muscles were a little sore, largely (I think) because when you get to those last couple of times, you’re actually pushing a little bit. You’re also a little bit sore down below, but that’s to be expected; it’s been practically traumatized.
So just as a lark, I weighed myself before and after. Right before taking the tablets, I weighed myself, and then again after waking up. Without getting into specifics, I’ll share that I lost 2-1/2 pounds. I was going to do an hour-by-hour, but I realized that the numbers would get goofy because of all the fluids I was taking in. Also, I don’t really get along well with our scale; it’s digital and a pain in the neck to turn on. But it occurred to me after that weighing that that’s not nearly as much of a difference as I thought there’d be, I don’t know why. I guess I thought that feces weigh more than they actually do. Which sort of leads me into wondering why people with eating disorders will resort to laxatives; there’s not a lot of return for all that misery. You’d think they would figure that out early on.
Wife took me to the doctor’s and they looked over the paperwork I’d completed. The paperwork included:
- A list of All The Bad Things That Could Happen and Why We’re Just Sending You To the Hospital if Anything Goes Wrong
- Information about Advanced Care Directives and how those don’t really apply to them
- Information about Living Wills and how those don’t apply either
- Acknowledgment that I’d received HIPAA privacy information (I hadn’t, but signed anyway; I know the drill)
- A page asking me about any allergies I had
- A page asking me about medications I take regularly.
They took me into the Procedure Room and had me take off everything but my socks and put on a hospital gown. “Don’t bother tying up the ties, because we have to connect all the leads and stuff to you, still. Just sit up on the edge of the bed and you can cover yourself with this blanket.” The blankets in this place, incidentally, are nice and toasty-warm. Before long, I’m being swarmed by several different people. One person is connecting all the telemetry, another is putting in an I.V. line, and the third is the anesthesiologist, who is reviewing the medications and allergies with me. She tells me that she’ll be giving me Propofol, which is the stuff that took out Michael Jackson. The difference between this and typical anesthesia, she says, is that it’s a genuine sleep, with dreaming and everything, because it hits the brain’s sleep center. If you’ve ever had general anesthesia, you know that you pretty much lose the time: you’re in one room and then suddenly you’re in another. With Propofol, you don’t remember feeling sleepy, but you DO dream. The other thing is, when it wears off, you wake up pretty quickly; you’re not eleven kinds of groggy and stuff. Once you’ve been up for a couple of minutes, you can walk right out. So they had me lie on my left side, and kinda-sorta posed me with my left arm out in front of me and my right resting on my hip. Someone put a Bite Block in my mouth (so I don’t bite down on the endoscope), then they shot me up with the Propofol. I was warned that there might be a bit of a burning feeling in my arm, and for me it wasn’t a burn but more like an electrical tingle, and in retrospect that’s pretty much the last thing I remember thinking about before I was awakened.
So I can’t tell you anything about the procedure itself, other than it doesn’t go very long at all, maybe an hour altogether, counting the pre-game stuff. I’d walked in shortly before 10 AM and walked out just after 11 AM. The doctor said that everything looked good, although he’d removed a few small polyps, and he’d send everything along to my internist. “So there was nothing that would explain the anemia?” I asked.
He corrected me: “You have some low blood counts, not anemia. But no, there wasn’t anything that would explain it.” So from the blood standpoint I’m kind of wondering if I’ve just got A New Normal going on for myself.
Let me sum all this up for the uninitiated: colonoscopy sounds pretty scary and embarrassing and such, and maybe it’s scary because it’s often used to look for scary stuff. And while you’ve got the Necessary Evil of the preparation process, the whole thing really isn’t so bad. I’m not saying it’s great, or it’s something I’d want to do every weekend, but I don’t think I’ll be going in with the same level of trepidation should I have to go another time.