Posted by: drrozkaplan | June 1, 2010

The Dreaded Test

I had my colonoscopy last week.  I’m telling you this most intimate information so that perhaps, if you have been putting it off, you, too, will go get your colonoscopy.

Who should get colonoscopies?  If you are 50 (or older), have no close relatives with colon cancer,  and have not had one yet, you should get your first screening colonoscopy.  It is the best test to look for colon cancer AND to PREVENT colon cancer.  This is because precancerous polyps may be found and removed during colonoscopies.  If no abnormalities are found during your screening test, you don’t have to have another one for TEN years.

If you have a close relative (parent or sibling) with colon cancer, or a strong family history of gastrointestinal or breast cancer in multiple relatives, talk to your doctor.  You may need to begin colon cancer screening before age 50.  The starting age and frequency of testing depends on who in your family had cancer and what kinds of cancer your relatives had.

If you have had previous colonoscopies showing polyps or inflammation, your gastroenterologist probably has recommended that you return for another colonoscopy within 3-5 years.  Those with significan Inflammatory Bowel Disease (Ulcerative Colitis or Crohn’s Disease) are at increased risk for colon cancer and have frequent colonoscopies.  And patients with symptoms such as lower abdominal pain, diarrhea, constipation, blood in the stool, or change in bowel habits, may be referred for colonoscopies to diagnose the cause of the symptoms.

Whatever the reason for a colonoscopy, most people dread the whole thing.  I know I was dreading it, even though it was not my first one.  And those of us who are ‘veterans’ will tell you, it’s not the procedure itself we dread, it the preparation the day before, otherwise know as ‘THE PREP’.

The first part of the prep is not eating after breakfast the day before the procedure.  You can have clear liquids-water,  tea, coffee, juice, broth, jello (not red), soda until midnight, then nothing.  I don’t find this so terrible, though for me it’s hard to concentrate after lunch when ‘lunch’ was ginger ale.

The second part of the prep is the ‘bowel cleanse.’  Usually, the instructions from the doctor say to start this in the late afternoon the day before the colonoscopy.  For this, I suggest locking yourself in your bedroom/bathroom if possible.  Tell your family, or anyone else you live with, that they may not bother you except in the case of a major emergency- such as the cat being on fire or a toddler driving the car.  Even then, someone else should try to extinguish the cat first before bothering you.

The actual preparation for the bowel cleanse may vary. In previous years, I got the Go-Lytely prep.  It sounds so cheerful, so happy, like little elves skipping around in the park, doesn’t it?  It’s not.  It’s a gallon jug of salty, slippery liquid that can be flavored with a lemon-lime or orange flavoring, and is a little less vile if it is very cold when you drink it.  Unfortunately, the flavoring does not really cover up the taste or the texture of the stuff, and you have to chug an 8 oz. glass every 10 minutes until you finish it.  Once it starts to work,about an hour after you start it,  you get a pretty vigorous bowel ‘cleanse’, but until then, well, I’d say you feel like you’re going to explode.  Go Lytely does contain the proper balance of electrolytes to replace what you lose from your colon, making the prep safe, but YUCK!!!!

The second ‘prep’ option, which I’ve never tried, is laxative pills, taken with a large amount of water.  Apparently there are 36 large pills, to be taken 3 at a time, with a full glass of water.  I’ve heard this is a pretty miserable experience, and not too many GI docs are using it around my area, maybe because it doesn’t give as good a prep as the liquid solutions.

There is a small volume prep, Fleet’s Phospho-Soda, which is just a little bit of liquid taken with four tiny dulcolax pills, but there is risk of kidney damage and electrolyte imbalance with this prep, except in the healthiest of patients, so most doctors have stopped using it.  Really, I’m happy about that, because despite the fact that it is much easier to take this prep, I do value my kidneys quite a bit.

Finally, there is the one that seems to be in favor now, the one I had this time around, and that everyone seems to agree is the best because it works well, is very safe, and is better tolerated than Go-Lytely.  It involves  4 dulcolax tablets, 64 ounces of Gatorade  (make sure it’s not red or purple, or it might cause discoloration in the colon, making the colonoscopy harder to interpret) and 238 grams of Miralax, a laxative powder that can be obtained over the counter.  Miralax.  Another suggestive name:  the Miracle Laxative!  I don’t want to upset you, but there is no miracle involved here.  Miralax is polyethylene glycol- in essence a plastic product- which is not absorbed into the body, but simply stays in the colon, pulling water from the body into the colon to produce liquid bowel movements.  If you take enough of it (and 238 grams is PLENTY- the usual dose is 17 grams), you’ll get quite a purge.   The Gatorade provides the liquid and electrolytes to keep you hydrated and in balance.  It’s less volume than the gallon of Go Lytely and I guess I would have to say it tastes somewhat better (I used the lemon-lime Gatorade.   Still, the idea is to drink it all as quickly as you can.  I’m an obedient type, so I gulped it all within a half hour.  And then…felt pretty terrible until it started working.  And in my case, it took a while.  Longer than the Go Lytely.  The directions from my doctor said it would take 1 to 4 hours.  I’d say it was at least 2.  Those were not the best 2 hours of my life.  Nor were the ensuing 4 hours.  I didn’t feel sick anymore, but suffice it to say, I got no rest.

Here’s the good news.  The next morning was a breeze.  Once the prep was done, it was all easy.  My husband went with me to the endoscopy suite.  (Remember, you must go to your colonoscopy with a ‘responsible adult escort’.  This is because you can’t drive yourself home after sedation.  You may feel completely alert, but you can’t be trusted!)  We checked in at 7:30.  By 7:45 I was in my hospital gown, the nurse had taken my vital signs and the anesthesiologist had taken a history.  By 8:00 I had an IV in my arm and I was on the colonoscopy table.  My doctor came in, we chatted for a couple minutes, and then I got a shot of propafol.  Next thing I knew, I was back in the recovery area waking up.  Fifteen minutes later, my doctor came in to tell me everything was normal, and I was discharged.

So there you have it.  The good, bad and ugly of colonoscopy.  I’m being honest.  The prep kind of sucks.  But it’s not something you do that often.  The rest, well, there are alot of things that doctors do to people that are worse, and that don’t accomplish as much.  This is one of the few things you can do to actually prevent cancer.  Seems to me like a no-brainer.

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Responses

  1. Hi Dr. Kaplan,

    Thanks for telling about your colonoscopy experience, I have a colonoscopy coming up in 3 days and I was a little nervous. I am nervous because Iam only 26 and afraid of the results my doctor will find. The reason for my exam is because I recently began to find traces a blood when I use the restroom, also I have abdominal pain on my lower left side with chills and weakness. The weird part about it all is this all happens randomly and it just began this year. I’am kind of anxious to get the exam over with so I can get down to the bottom line about what is going on.

    • hope you’re ok!

      • Thank you, turns out everything went OK…thank God! Turns out I just have internal hemorrhoids and I just need to increase my fiber, I will see how it goes. :p

  2. In answer to your comment about the laxative pill prep– the laxative pills that used to be used were prescription laxatives by the name of OsmoPrep or Visicol, sodium phosphate in pill form. My thought is that that prep has fallen strongly out of favor since 2008 when the FDA required a boxed warning be placed on these products due to the increased risk of acute phosphate nephropathy. Since the risk for this increases in pts over 55, those with colitis, pts who are dehydrated (and who isn’t while doing bowel prep?!) and those on ACE inhibitors, ARBs, diuretics and possibly NSAIDs… that probably covers a large percentage of those undergoing colonoscopies to begin with…

    Plus, in this day and age of malpractice– especially in this geographic region, who wants to be the doctor who prescribes the riskier prep when there are safer alternatives available?

    As an aside, I actually used this form of prep for my 2nd colonoscopy– and despite having vomiting with the last 2 doses– found it substantially easier than the liquid prep… but I like my kidneys intact :-)


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