Colonoscopy Part 2 - My Experience

Please see my post here on some reasons to get off your behind and take care of your behind. There is plenty around the internet to describe individual experiences with colonoscopies.  I'm adding to that body of work only to share with you some things I wished I had known in advance to discuss with my doctor PRIOR to having my colonoscopy.  While my typical approach to 'stuff' is to do a reasonable amount of research to ensure that I have a full understanding of whatever it is that I'm embarking upon, I had not planned on scheduling a colonoscopy at the time of my doctor's visit. But given that I had blow past the recommended screening age, I was scheduled before leaving the office.  And scheduled for Monday no less.  Accordingly, I was not prepared (by my standards) to understand the backdrop of the procedure and the prep. 

Here are some things I offer up and centered on the following:

Thing 1: Focus on the desired health outcome of a colonoscopy which is to optimize the circumstances leading to the detection and removal of existing polyps.  Optimizing your health outcome experience requires that you and your provider fulfill respective responsibilities.  It is your responsibility to both understand and follow your provider's instructions. It is your provider's responsibility to follow accepted clinical practices/guidelines for the procedure. If either or both of you fail to uphold your end of the deal, then your health outcome may be compromised. 

Thing 2Equip yourself with knowledge.  There is lot on the web.  I recommend reading from the New York Times (and found elsewhere on the web) written by Dr. Douglas K. Rex  the following

10 Questions You Need to Ask About Colonoscopy  

Just click on the title to be transported to the article. It is excellent and should be required reading for every new colonoscopy pioneer.

Thing 3Understand the differences among a better, good and bad colon prep. (Read Thing 1!)

From cited article:  split dosing
All I can control is what I'm in charge of -- delivering a clean colon to my procedure.  Look at that beautiful, shiny colon on the right.  That is the better colon prep, which is a combination of  (1) diet (clear fluids day before procedure--see general observations below) and  (2) using what is called split dosing. (Split dosing involves a wash and rinse cycle that is spaced out so that the rinse cycle provides a final rinse within 6 hours of scheduled procedure.)   I saw this picture and was determined that my colon, too, would shine and glisten for the doctor.  Unfortunately, I had not read the 10 Questions article, and I was not adequately prepared to ask my doctor about anything.  (Hence my fervor in imploring you do do so).

Nevertheless, I took initiative to use the split dosage prep as the prep that I used (Movi-prep) had excellent instructions and was packaged in a way to do this.  I'm unsure why I was not given that choice particularly when it seems to be the preferred clinical guideline though many providers do not recommend.  A reminder again why coming to the doctor's office prepared with sound questions is important. 

From cited article: single dosing
At the risk of being a colon snob, I did not want my colon to look like the colon on the left going into my procedure.  The colon on the left is taken from a colon treated to the single dosing.  (Taking the dosages back to back.)

I began my Movi-prep at 6 p.m.  It takes1 hour to drink the 32 oz in 15 minute intervals of 8 oz for each purgative.  I then had to drink 16 oz of clear liquid. If I was following the single dosing schedule, I would have followed that up at 8:30 p.m. with another purgative.  Instead, I self-prescribed a split dosage, and got up at 3:30 a.m. to begin my second dosage to be compliant with last liquid admonitions and maintaining the <6 hour interval to my procedure.

Here are some generalized observations on my experience.  Each of us have different health profiles, accordingly, everyone's experience is different.  Nevertheless, being forewarned with information is being forearmed.

  1. Diet prep:  There are some recommendations to follow a low residue diet 3-5 days before the clear liquid diet required the day before the procedure.  I at least followed this diet for Saturday and strictly adhered to the clear liquid. Had I researched this more thoroughly, I would have followed a longer time frame.
  2. Split dosing:  do ask your provider about this scheduling for the product that is recommended for you. 
  3. If you are really nerdy and want to understand read about colonosopy prep solutions, you can find that here. You can learn about Isosmotic, Hyperosmotic and Adjunctive agents and what the efficacy and risk profiles are for each.
  4. Your mileage will vary:  I began my first dosage at 6 p.m. but did not get any 'action' until 8:30 p.m.  I did not experience nausea, but I chalk that up to having a low-volume prep and at least having a low residue diet for 24 hours prior to my clear liquid day.  I did not experience debilitating cramps nor untenable gas.  I was very concerned about both having read too many internet horror stories.  Again, your mileage may vary.  The less that has to get flushed out the better; accordingly if you are used to eating a high fiber diet, moving to a low residue diet will make this initial wash easier, and I would presume make the rinse more efficacious.
  5. My final rinse output was clear with just a bit of flecking (think of sprinkling a pinch of ground flax seed in your toilet.  I saw different things on the internet about the qualities of the last output, one to even say that flecking was not acceptable. I shared with the nurse my result, and she said that it was fine.  Further, the pictures that I have show a clean colon (though that may have been enhanced with irrigation.) I know that this falls into the category of TMI, but the point of this post is to be objective and transparent and not demur on this important consideration.
  6. Pre-procedure hunger:  I was surprised that I was not hungrier.  I was very systematic in my fluid intakes comprised of coconut water (not to be confused with coconut milk which is a no-no); herbal tea, chicken broth (heated), green-tea ginger ale, italian ice and white grape juice concentrate.  Admittedly, I awakened from a dream of ham when the alarm went off for round two.
  7. Association:  There is a negative association between the things that I chose to hydrate myself with during my prep and the results of that prep.  Basically anything that you consume gets linked to the outcome, and the outcome is pretty virulent.
  8. Post-procedure hunger:  The sedative was extraordinary. I had no nausea.  Surprisingly, I was not very hungry for the balance of the day.  Again, low residue is your friend in this time period of procedure recovery. 
  9. Grading of prep:  Given the importance of the prep to the health outcomes, I would suggest that each report have a grading scale. As bowel prep is such an important part of the procedure, it would be in the provider's best interest to comment on prep and to give valuable feedback to the patient on the efficacy of his/her preparations.
  10. Overall:  My only point of comparison was my husband's colonoscopy prep 9 years ago.  He complained loudly, and found his prep solution near-intolerable.  I believe that the prep solutions have come far.  
My expectations for my discomfort far exceeded what I experienced.  The procedure itself was a snap, and I had no angst.  The personnel at the Virginia Endoscopy Group were friendly and professional.  I am glad that I had a meeting with my gastroenterologist prior to the procedure v. being referred with no prior face to face.


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