File this post under the category TMI.
About fifteen years ago, I had my first root canal. Back in the day, root canals were these horrific events. When I finally had one done, it wasn’t a big deal at all, no more than a usual filling. Technology, techniques and materials had advanced so much that it had become a fairly routine procedure. I’ve had two of them now, and the second was even easier than the first.
Along the way, I also learned how to avoid root canals. Various dental professionals coached me to take lots of anti-inflammatories just after a jolt to the face, or if that familiar first wave of jaw pain began. This, they say, is to protect the nerves in the root from the swelling and eventual death and decay (and the second, much more painful and irreversible wave of pain days or weeks later), necessitating the root canal procedure. Works for me, and that second root canal was the result of my ignoring that advice. I’ve had much more severe facial trauma than that one, before and since.
Scroll forward to this past week. After having hit the big 5-0, it was time for the screening colonoscopy. As with the root canal, the hype was much more overblown than the modern procedure. The prep, as it is called, which cleans the colon so that the doc can do his job, was said to be a deathmarch of drinking a gallon or more of a noxious fluid, with explosively formed penetrators the unenviable result.
Again, the hype, for both the prep and the procedure, was much worse than the reality. The colonoscopy was scheduled for Thursday afternoon at 2:30. Per the instructions for the prep, I was to stop eating solid foods Wednesday morning at 7AM. Being the type-A personality that I am, when I am not napping, I had my last meal at 9PM on Tuesday. Wednesday morning, I had a hearty meal of white grape juice and lemon jello. By Wednesday afternoon, I was as sugared out as I could get from grape juice and various yellow and green (no reds or blues) jellos.
Wednesday evening at 7PM, the prep was to begin in earnest. Having a popup engagement schedule itself for 9PM (that is its own story), I decided to start the prep early around 5PM or so, freeing my bowels for later attendance. Instead of a gallon of noxious stuff, this newer prep, known as SUPREP, consists of two little 6 ounce bottles of salts, plus a 16 ounce measuring cup. The evening before the procedure, one pours one bottle into the cup, adds water to make 16 ounces, and drinks that plus two more cups of water over the next hour, for a total of 48 ounces of fluid. The morning of the procedure, the process is repeated with the second bottle.
It wasn’t the best flavor I’ve experienced, but I’ve had worse. It could have been better if they had left out the cherry medicine flavor, which dredges up all sorts of childhood medical memories. I downed all three cups within a couple of minutes.
And then waited. And waited. An hour passed, and still nothing other than feeling like I drank almost a half gallon of water. No nausea, or anything else from the long list of side effects. Audrey watched me expectantly. I watched me expectantly. We played cards. I read. I napped. I laughed.
Did I mention I laughed? That seemed to pop the cork, just a little bit. I headed for the toilet, but no, a false alarm.
Almost two hours in, the symphony began in earnest, but still, I’ve had worse (such as the aftermath of Desert Storm seagull passed off as KFC). It seemed as if nothing was actually going on, at least not to the level one might expect. Lots of high-velocity mini-streams, but no pain, cramping or discomfort to really speak of, other than a diaper rash, noted later, from a more or less constant spray of salt water.
By 7:30 PM, all the excitement had, uh, passed. By 8 PM, I couldn’t tell that anything was really different, other than a gurgle on the horizon here and there. We went to our meeting and returned, and still no further excitement.
The night was uneventful.
The next morning, I began the second round at the precisely appointed 7AM. This time, perhaps because of stomach shrinkage, I had to taper the third cup off over about twenty minutes after chugging the first. I also had a little extra water, just in case, stopping at 8AM because I was also to have a throat endoscopy at the same time (they assured me before and since that the instruments were different, and that in any case the throat would be done first).
Again, about an hour passed with no activity. I began to become concerned that the prep was not working. Situps, pushups, jumping jacks, crunches, deep knee bends, all for naught. However, over the next two hours, a series of relatively unremarkable expulsions gradually became cleaner and cleaner, until the last two or three were optically clear and the color of light yellow bile (the nurse seemed pleased when I later described it this way). Success was mine at last, again without any discomfort other than a growing diaper rash. A quick shower left me feeling sparkly clean, inside and out.
The worst part of the entire experience was placing the propofol IV before the procedure. Apparently, dehydration during the prep makes the veins harder to find. The third attempt was a success, and I was wheeled into the room. Sure enough, there were two endoscopes there, but I was unable to tell them apart. The team assembled and the first layer of anesthesia was administered through the mask. Feeling the first effects, I said, “ooh, here we go” and then took a deep breath. The next thing I knew the doctor was yelling at me “WAKE UP!” and Audrey was laughing. There not being a funny taste in my mouth and a quarter in my pocket, I assumed that her laughter was an expression of relief. Especially since I had no pocket for the quarter.
I remember hearing conversations while out, but remember nothing about them. It was if I had been taking a nap for a long time in a crowded place, but also for no time at all. The IV had been removed, and I had no pain anywhere; just a slight hoarseness and some pin pricks on my arms. I thought about asking the attending nurses for hugs all around as the kazoo music played in my head. Wickey scratch.
Propofol, as you may recall, is the Michael Jackson drug. I did not recall this, and was clueless about its notoriety until Audrey and the anesthesiologist were discussing it before the procedure. Unspecified pain killers were also to be administered; my developing the sweats and a bit of tweaky paranoia the next day made me wonder whether they were opiods. That would have been good to know in advance. According to paperwork they gave us, I was to be considered legally DUI for at least 24 hours, but the effects were said to last as long as 48 hours. During this time, no critical decisions were to be made, checks written, equipment operated, grass mowed or so on.
Even if opiods had been administered, it must have been a very light dose. I had no nausea or discomfort at all. That evening, I had some soup and homemade ice cream. By the next day, three little pin pricks on my hands and arm, and big bruise on my forearm where the second IV attempt had failed, was all that remained. I also ate normally that day, and a day later, my digestive rhythms had returned.
Despite all the hype out there, it was a very positive experience. As with the root canal, modern materials, techniques and tools make having a colonoscopy no longer a big deal. The key advice I can give is to take three days to have it done: one for the prep, one for the procedure itself, and another for the recovery. In my case, because I tend to snack on nuts and things while I work (inside my head), I sequestered myself in the other building, well away from anything but a mini-fridge stocked with juices and jello. I spent most of the prep day in my man cave reading, sleeping, drinking juices and generally just relaxing.
Overall, this colonoscopy was the best vacation I’ve had in a long time.
Update: commenter ed357 on Knuckledraggin recommends Cologuard, a non-invasive at-home sampling test. Looks like a great technology. Our gastroenterologist said that sort of test should be done once a year, and that a much more accurate non-invasive screening test should be available in five years or so.