Better Living Through Colonoscopy

Fifty is the magic age when most doctors recommend getting that first colonoscopy. I got my first one a bit earlier, at age 49, after an immediate family member was diagnosed with advanced colon cancer at 46. She underwent surgery and chemotherapy and endured much pain, misery and fear.

I’m happy and relieved beyond words to say she’s fine now. But if it weren’t for her cancer at 46, I would have probably waited until 55, or maybe never before I volunteered for my first colonoscopy. I mean really, who wants a colonoscopy? Virtually nobody.

My first colonoscopy discovered a few polyps, one of which was pre-cancerous, in the exact area of my loved one’s colon cancer. Four sisters. Same results.

For what it’s worth, it takes about 10 years for a pre-cancerous polyp to blossom into full-blown colon cancer. Had I skipped that first colonoscopy, I’d have colon cancer right about now.

I must say, I was surprised. I was pretty sure I knew my body, outside and in. I was convinced that I’d have known if a precancerous polyp lurked deep inside me.

That’s called magical thinking, folks, and there’s no place for it when it comes to health screenings, which truly are a matter of (prolonging) life or (hastening) death.

I had my latest colonoscopy this week, and I’m delighted to report that all was clear. No polyps. No cancer or pre-cancer. I got a thumbs up from the doctor, so to speak.

With a few colonoscopies behind me, I am happy to pass along to you some tips to help your colonoscopy go smoothly. (Sorry. Couldn’t resist. I’ll stop now)

What’s that? You refuse to get a colonoscopy? Fact: Colorectal cancers are among those cancers where screening can actually be preventative, since it can lead to the detection and removal of polyps, some of which, left unchecked, could progress to cancer.

Now that you have that information, if you still refuse a colonoscopy for whatever reason, and you later get colon cancer, it’s on you to explain to your grieving loved ones that you are suffering from a preventable colon cancer because you declined a colonoscopy.

Moving along …

If you’re new to the wonderful world of colonoscopies, they’re really not that bad. In fact, most people will tell you – and I agree – that the worst part about the colonoscopy isn’t the actual procedure (if you’re properly anesthetized, which I’ll get to in a second).

Rather, the most memorable and challenging part, by far, is what needs to happen before the colonoscopy. In order for the doctor to run a scope up and through your nether regions to inspect high inside your colon, it must be squeaky clean and empty, granted, something that’s not its usual state. An unclean colon makes it impossible for a doctor to see inside your colon, just like it would be impossible to see through a windshield plastered in seagull droppings.

Never fear. Your pharmacist has something special to convince your body to expel the entire contents of your colon: a powerful, prescription laxative.

This laxative comes in a powdered form at the bottom of a plastic 4-liter (just call it a gallon) jug. You fill the jug with water and shake until it’s dissolved.

Because this was not my first colonoscopy rodeo, my gag reflect kicked in the moment I picked up the jug from the pharmacy, just from the sheer anticipation of it all. This liquid laxative has a high-viscous consistency that some people – like me – find literally hard to swallow.

I’ve met a few rare folks who have no problem drinking this liquid. They are the lucky ones. My hunch is they are probably fans of oyster shots, raw eggs and escargot, too.

You must drink the entire contents of the jug. I’ve heard horror stories of people who couldn’t bring themselves to finish all the solution, so when they went in for their colonoscopies, they were turned away because of – uh – poor visibility. Colonoscopies are no time for a half-assed effort. When it comes to drinking that solution, no matter how objectionable you may find it, it’s go big, or go home.

But first, you’ll receive written detailed instructions that dictate what you may and may not ingest seven days prior to your colonoscopy. Easy stuff.

I’ll tell you what the directions don’t. For one thing, the directions suggest that three days before your colonoscopy you should avoid eating nuts or fruits and vegetables with skins or seeds. The instructions also say that one day before your colonoscopy, switch to a clear liquid diet, which means no milk products, even in coffee or tea. No alcohol, either, no matter how clear (and tempting) it may be.

That all makes sense. However, I think one day of a clear diet is not enough. I credit my sister, whose pharmacist gave her this additional advice: Three, or even four days before your colonoscopy, cut way back on solid food (especially meats) and embrace a semi-liquid diet (hello, soup). This makes the cleansing process much easier, and less explosive and dramatic. It may mean the difference between channeling Johnny Cash singing “Ring of Fire” and needing the aid of petroleum jelly in the bathroom, and not. If you know what I mean.

Make sure that the day you’re drinking your liquid laxative, you arrange your schedule so that once you take that first fateful swallow, you are 100 percent home bound. There’s no going back now. Cancel all appointments. Do not leave the house. Shun company. Most of all, do not answer the door. The risk is too great that nature will not just call, but bellow when you’re standing — cheeks clenched — at your threshold talking to a Jehovah’s Witness. (On the other hand, that might be a guaranteed way to get on the JW do-not-knock list.)

There are some ways to make the laxative solution more palatable. I added two packets of lemonade Crystal light beverage mix, and used ice water, because the thought of more than a gallon of tepid liquid laxative was simply too much to bear. And then I kept the jug refrigerated between drinking sessions. Chug, chug, chug it, don’t sip it. Just get it over with. For some reason, I found it easier to tolerate if I closed my eyes as I drank. I don’t know why. It just made it less awful.

Once you start drinking, set a timer, because time will fly when you’re having this much fun. You’re supposed to drink 8 full ounces every 10 to 15 minutes, so if you drink it too slowly, then you’ll feel like you never get a break. Expect to see “results” within about 60 minutes. Your results may vary. Keep drinking.

If possible, schedule your colonoscopy appointment so it allows you to break up drinking the full gallon of solution over two days: 2 quarts the first late afternoon/early evening, and the remaining 2 quarts early the next morning. At first, I was distressed about this, because when I did the math, it meant that in order for me to finish all the solution to comply with the required four hours before my 10:45 a.m. appointment, I’d need to be done drinking by 6:45 a.m., which meant I’d need to start chugging at around 4:30 a.m. in order to drink eight, 8-ounce glasses of the lovely laxative solution every 15 minutes.

But this actually worked out better. The night before my appointment, I set my alarm for 4:30 a.m., and when I got up I only used a nightlight to see. I downed my 8 ounces of liquid, then set the alarm for 15 minutes and went back to bed where I fell immediately asleep until the alarm went off again. I repeated this process of drinking in a dimly lighted kitchen, then shuffling back to bed to fall back to sleep. Sleep was my reward for finishing each glass. Of course, eventually the solution kicked in, but by then it was after 6 a.m., when I would have been getting up anyway. For me, drinking in the twilight zone made it easier. I’m blessed with the ability to fall asleep on a dime. This system may not work for you.

Even so, I won’t push my luck. To quote comedian Dave Barry: “Never, under any circumstances, take a sleeping pill and a laxative on the same night.”

Duly noted.

Aside from drinking the solution, the issue of insurance coverage can be the next most vexing part of a colonoscopy. My insurance – Anthem Blue Cross – paid 100 percent for my laxative solution, and 100-percent for my colonoscopy. I was so happy! However, it turns out sedation is extra – anywhere from $600 to $1,500, depending upon what kind is used. And if there are any polyps, which will of course require biopsy, that would cost extra, too.

So the good news is that my insurance covers the laxative and the actual colonoscopy, but that’s the end of full coverage. That’s kind of like saying you win a free flight to Hawaii, but if you want a seat inside the plane – rather than on the wing – you’ll have to pay extra.

This was such a concern for me that when I arrived at the gastroenterology office, I actually had a conversation with the receptionist about whether I could go the budget colonoscopy route and forego sedation entirely. Apparently, it’s not recommended, especially for someone like me, who’s had three C-sections, which means possible scar tissue and adhesions. OK, fine.  Also, I remembered that with my first colonoscopy at 49, where I had conscious sedation, I under-reported my weight, which impacted my sedative dose, so I was pretty much alert enough to watch the screen (fascinating) through the entire procedure.

This time, I chose deep sedation via propofol. I remember nothing, and I felt nothing (although I’m sure I’ll feel plenty when my bill arrives). I wasn’t groggy, and felt great enough that my sister (my designated driver) and I celebrated the good news by going out to breakfast. Then I came home and slept the day away.

It was all worth it to say, once again, that I’m colon-cancer-free, and to know that I’m doing everything within my power to stay that way. Even if my insurance hadn’t covered the colonoscopy, it’s one of those screenings that are so crucial that it’s worth it to make payments for as long as a it takes to pay it off.

Besides, everyone knows that a colonoscopy costs less than colon cancer. Best of all, it could save your life.

I apologize for the TMI delivery for you hearty souls who made it this far. But as the self-appointed colonoscopy ambassador, I feel it’s my duty to remind you – dear ones- that colon cancer is both preventable (through colonoscopies) and treatable (if caught early).

I thank you for reading, and I promise I won’t talk about this again.

Until next time, which should be in about five years.

In the meantime, if you’re due for a colonoscopy, especially if, like me, you have a family history of colon cancer, I’m begging you to make an appointment. Tell them Doni sent you.

Doni Chamberlain

Independent online journalist Doni Chamberlain founded A News Cafe in 2007 with her son, Joe Domke. Chamberlain holds a Bachelor's Degree in journalism from CSU, Chico. She's an award-winning newspaper opinion columnist, feature and food writer recognized by the Associated Press, the California Newspaper Publishers Association and E.W. Scripps. She's been featured and quoted in The Wall Street Journal, The Washington Post, L.A. Times, Slate. Bloomberg News and on CNN, KQED and KPFA. She lives in Redding, California.

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