Wednesday, December 14, 2016

The Successful Patient: Surviving the Colonoscopy

It's that time of year when I begin to think of the new year. It's time to look back on the current year in terms of my health, and to plan for the next year. Most physicians now have some form of online chart for their patients, and as part of that chart, they list things patients can do to maintain good health. That list usually includes preventative check-ups and procedures. Among those preventative procedures is the much maligned but essential colonoscopy.

A colonoscopy is a medical procedure that's recommended for everyone starting at age 50 and done every ten years thereafter. It's possible to have a colonoscopy for other reasons; e.g. if a doctor needs to see the colon to determine the cause of gastrointestinal symptoms. The purpose of this procedure is to examine the interior colon surface for any abnormalities such as polyps or inflammation. This procedure commonly screens for colon cancer.



Any time a doctor performs an invasive procedure on the human body, it has the chance of being unpleasant and carries its own set of risks. Doctors have worked hard to develop preparation procedures and techniques for the actual colonoscopy to make it as easy and comfortable as possible for the patient. Nevertheless, the thought of sticking something up one's behind is not pleasant. So, how to survive it?

Preparation:

Following the doctor's instructions for the bowel prep cannot be emphasized enough. The bowel prep cleanses the colon so that the doctor will be able to see the interior surface clearly. Shirking on the bowel prep or not following the diet instructions can result in cancellation of the procedure (to be re-scheduled and to go through the bowel prep again), and/or your doctor's unhappiness with you. Think of it this way: it is in your best interests to get this right.


The bowel prep usually involves taking a powerful laxative, either in pill or liquid form, over several hours the day before the colonoscopy. Your doctor will also give you a specific diet to follow the day before that includes eating nothing at all after a certain time, depending on when your colonoscopy is scheduled the next day. Tip: Schedule your colonoscopy in the morning, first thing if possible. It's easier to sleep through the fasting part, and you'll be able to eat sooner the next day.



The laxative will make you run to the bathroom a lot. This could result in a very sore bum if you don't take measures to prevent soreness. I usually begin by using Vaseline to coat the anus, and I use baby butt wipes instead of toilet paper after each bathroom visit. I drink a lot of water also, eat jello (not red or purple in color), drink apple juice, and suck on hard candy (not red or purple in color). And I make plans for my first meal after the colonoscopy.

Colonoscopy:

In the past, my doctor has given me written instructions as well as an itinerary for the day of the procedure telling me when to arrive and what to expect. It's necessary to arrive at least an hour before the actual procedure because there is more preparation involved. You will be asked to disrobe and put on a hospital gown. A nurse will insert an IV in your arm for the sedation and pain killer medications. Yes, you really won't feel much of anything once you have the medications. The nurse will also ask you questions regarding your bowel prep, allergies, and any possible GI symptoms you're having. My doctor has usually stopped by to talk about the risks and possible side effects, and to receive my informed consent for the procedure.

colonoscopy scope

Next, you will be moved to the procedure room, usually by wheelchair or gurney. A procedure nurse will be with you at all times. You can choose whether or not to watch the video feed of the colonscopy -- yes, the tip of the scope has a camera so that the doctor can see the colon's surface. It's also equipped with an instrument that can take biopsies of the surface. Feel free to ask questions whenever they occur to you of either the nurse or the doctor. I usually want to know what medications they'll be giving me. The doctor will tell the nurse to begin administering the medications through the IV.  And you are set for the procedure.

Experienced doctors will be watching the patient as well as the video monitor during the procedure. They'll notice if a movement causes discomfort. My doctor has actually re-positioned my lower body in order to alleviate my discomfort. I didn't feel a thing for the rest of the procedure. I choose to watch the monitor usually and ask questions about what I see there. I know a lot of people who doze off during the procedure. It takes about 30 minutes.

After the procedure, you'll be rolled into a "recovery" area where your nurse will give you some juice. I found it hilarious after my first colonoscopy that my nurse kept asking if I'd passed any gas yet. Well, the reason for that question is this: passing gas signals that the intestines are functioning. They want to make certain that they are functioning before letting you leave. It is a requirement, also, that you have someone to drive you home afterward and stay will you for a few hours. Once you've passed that all-important gas, the nurse will remove the IV, and you will be free to dress.



My doctor usually meets with me before I leave to give me the report and discuss his findings. This could be good news or bad. I have already known the results because I watched the monitor during the procedure. But if you dozed off during the procedure, now is the time to ask any questions, voice concerns, and discuss next steps.

Aftercare:

I always ask, no matter what the procedure, what aftercare I need to do. The doctor usually will give written instructions, including symptoms to watch for that could indicate a problem. The most common problem is an inadvertent perforation of the colon, and the doctor will probably talk about the symptoms. Also, bloating, fever, abdominal pain, and nausea signal a problem. The doctor will usually give you instructions about what to do if you develop any problems.


After my colonscopies, a friend has driven me home and we've enjoyed a pleasant visit for a few hours that has included a light meal. It's not really a good idea to eat a four-course heavy meal after a colonoscopy. I've usually not been that hungry anyway. Cream soup of some kind and a sandwich has usually hit the spot. Hot cereal is another good meal. The pain-killing medication will wear off after a couple hours. I'm usually happy about that. Feeling loopy is fine during the procedure, but not afterward.

You've Survived! 

Life returns to normal quite fast after the procedure. If there's any soreness, treat it with Vaseline or some other ointment or cream. And now you won't have to think about a colonoscopy again for ten years. Congratulations!





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