Sunday, February 28, 2016

My Favorite Colonoscopy

When I turned 50 years old, my doctor told me to get a colonoscopy.  Since I had not done a mammography in four years, I shelved the idea of the colonoscopy in my ‘to do when I get around to it one day’ list. By the time I finally did get around to that long-overdue mammography, the colonoscopy had migrated and disappeared into my ‘I forgot’ drawer.

About a year later, while reading the Wall Street Journal, a one-page ad in bright colors caught my attention The ad featured a full-page photo of Katie Couric, a well-known U.S. journalist. Katie was wearing a white long-sleeve blouse, black pants, a big smile and her arms were crossed.  The largest word on the ad was printed in white on a blue background and stated: “Really?”  My curiosity was spiked.  ‘Really, what?’ And why were her arms folded? I took a few extra seconds to scan the smaller text below. Thankfully, the ad writer had made an effort to minimize the verbiage. So I actually read the entire text. In a nutshell: colon cancer is the second leading cancer killer. And it can be prevented. I tend not to like cancers but I do like those cancers that can be prevented. So what would I need to do to prevent this second-leading cancer?
A colonoscopy and, if present, immediate removal of any polyps.
Polyps might turn malignant and are easy to remove during a colonoscopy.  Polyps that are remove cannot turn into colon cancer.

So, why not?

I am a big advocate of preventive medicine. A sound decision today can save you much hassle in the future. Fair-skinned and green-eyed, I had always been a great candidate for skin cancer. As a child I had been sunburned to the point of crispness. Burned, I had not been able to find a painless resting position while trying to fall asleep. My male classmates always knew that a slap on the back after a weekend on the ocean would – to their delight -  elicit a loud yelp from me. So it was not surprising that twenty years later, in fact shortly before getting married (getting married can be stressful), a dermatologist diagnosed skin cancer. It’s never a good sign if the doctor calls you personally...  
We had caught it early; it was removed, and that was that.

Katie Couric’s admonishment made me dive into my bulging ‘oops, I forgot’ folder and dig out the gastroenterology referral list my doctor had once given me. Some ads do affect a reader’s behavior. I reached for the phone and called the first recommendation on the list.

“What is your insurance number?” Kim, the colonoscopy scheduler asked. “We cannot find you; you will have to call our billing department!” she informed me. Since the first available appointment was three weeks out, I suggested: “Let’s just go ahead and make that appointment.”
“Must be quite a money maker!", I thought.  Three weeks out?  Was this procedure so much fun that people were lining up out the clinic door to their turn? Was this like standing in line for your favorite ride at the amusement park?  I would quickly find out it was anything but….
“We will send you the prep instructions by mail”, Kim informed me.

A couple of weeks later, I found a thick envelope in my mailbox. Inside were five single-spaced pages full of instructions. The tone was officious and domineering. Do this, don’t do that, and if you don’t show up with a driver who will stay throughout the procedure, the colonoscopy will be cancelled. On the spot.  Too bad.
And: taking a bus or taxi home after the colonoscopy was NOT an option. (Uber, anyone?)

And this was not the only stipulation. I was advised to acquire a “protective ointment such as Preparation H, Desitin, or A & D ointment to soothe and protect the anal areas as you will start to have frequent bowel movements”.  What was I getting myself into?

The day before the procedure my diet was to consist solely of ‘foods’ that are devoid of nutrients and high in artificial flavorings, additives and colorings: ice cream, Gatorade, popsicles, Kool-Aid, jello-o, PowerAde, 7 Up or Sprite, fruit juices made of concentrates and high in added sugar, powdered lemonade and hard candy.

This did not make any sense to me. The reason I was getting a colonoscopy was to ensure that my colon was healthy. And a diet high in (organic) vegetables and fruit and low in processed, synthetic ‘foods’ is the most beneficial diet to ensuring a healthy gut. Doctor’s orders were anything but supportive of a healthy gut!

And why did I need a driver? Who decided that the only way to have this procedure was with sedation? In Europe and Asia colonoscopies are done without sedation. Without sedation I would drive myself to the clinic and drive myself away afterwards. Why sedation? A sedation-free colonoscopy was not even offered as an option.

I am not squeamish and am fine with a moderate amount of pain. When my dentist wants to change out an old filling, I ask him to do it without numbing me up. He’s been changing fillings for decades and I know he will not hurt me unnecessarily. He’s does not have a problem working without numbing me up and I do not have to deal with a paralyzed cheek for hours after the dental visit. 

I reread the colonoscopy instructions. They seemed absurd. I felt like I was being treated like a brain-dead piece of meat. How about a person-to-person conversation about the best way to prepare for a successful procedure? Here I was receiving a set of instructions in the mail without any human interaction.

I called the clinic and canceled. 

I needed to do more research. Sending me written orders by mail and expecting me to blindly following instructions was not going to work. I do not drink artificial sports drinks and, at age 50 plus, I was not going to start. It felt as if I had been asked to go to a lung screening and as part of the prep I was supposed to start smoking.

After educating myself I decided that I would only do the colonoscopy if I could find a gastroenterologist who was willing and comfortable to do one without sedation. Nor was I going to slug 64 ounces (one entire gallon!) of Gatorade before the procedure.

I checked with my husband’s GP. By coincidence he also does colonoscopies.
“I’ve done 33,000!” he boasted.
He was advanced in years.
“How depressing,” I thought.
“Would you be comfortable doing a sedation-free colonoscopy?” I asked. “Not a problem for me!” he confirmed reassuringly, “I’m on the pain-free end of the endoscope!”
I was not encouraged.

I had two distinct goals that I wanted to achieve if I was going to undergo this – to me – physically and spiritually invasive procedure:

i.               present a ‘clean’ colon.
‘Clean’ is not the right adjective. My goal was to present a colon that was not, in any way, obstructed by feces. I did not want to have to repeat the procedure because the doctor ‘could not see’, nor did I want him to miss any polyps because his visibility was not 100%. Also the threat by the insurance company that I would have to pay US$1,000.00 out of pocket if the procedure had to be repeated was highly motivating that I ‘get it right’ the first time.
ii.             I did not want to be hungry during the prep. Ever. Hunger makes me very grumpy. The goal was to provide my body the most supportive, nutritious diet possible given the circumstances (no solids the day before). I had no desire to lose weight.

So this is what I did: three days before the procedure I decided to go easy on solids and take a break from meat and diary. Since the second set of instructions concurred with the first set in forbidding any food that is red or purple, I decided that the last day I would allow myself red and purple food would be three days before the procedure.  Strawberries, blueberries went in the juicer no later than 72 hours before. I could easily survive without this fruit for a couple of days. Since beets are wonderful at staining everything red, I decided to completely avoid them.

I placed my first-class Breville juicer on the kitchen counter and headed to the grocery store to raid the produce aisles of organic vegetables and fruit. 

My shopping cart brimmed with organic spinach, broccoli, cauliflower, mixed greens, cabbage, melons, apples, grapes, blueberries, strawberries and pineapples.  Since I did not want to feel hungry but, at the same time, wanted to slowly empty the intestines, I decided on the following regiment:

Day 3 before the procedure:

Green tea and honey: no limit
Distilled water with slices of cucumber and lemon: no limit
One large pasta dish with garlic and cooked tomatoes for lunch
Freshly squeezed fruit and vegetable juices: no limit
Freshly squeezed orange, grapefruit and pomelo juice with a moderate amount of pulp

Day 2 before the procedure:

Green tea and honey: no limit
Distilled water with slices of cucumber and lemon: no limit
                 Since it was winter, I preferred warm to hot water
One large baked sweet potato with lots of butter and salt.
                                  I only managed to eat half the potato and felt full.
Probably my stomach had started to shrink by Day 2.
Freshly squeezed fruit and vegetable juices: no limit
Freshly squeezed orange, grapefruit and pomelo juice with a moderate amount of pulp: no limit

The day before the procedure:
No more solids
             By that time any solids from the previous 48 hours had most likely      been digested and excreted
Green tea and honey: no limit
Distilled water with slices of cucumber and lemon: no limit
2 tablespoons of unflavored magnesium citrate.  This is commercially sold as “Natural Calm”.
Freshly squeezed fruit and vegetable juices: no limit

I decided to forgo the freshly squeezed citrus juices as I was worried the pulp might hinder colon visibility and some of the instructions had admonished against any ‘orange-colored’ drinks

I had found one article by an MD on the Internet that suggested using magnesium citrate instead of the more invasive Miralax to cleanse the colon. When I finally managed to connect with my gastroenterologist on the phone and explained that downing 64 ounces or one gallon of Gatorade was not within my realm of doable, could I use magnesium citrate instead, he countered that he would get me a prescription for Suprep. I figured that since the doctor and I were in this together and I wanted a successful procedure, I should meet him half-way. When I informed him that I was going to follow a mainly liquid diet of freshly-squeezed fruit and vegetable juices three days before-hand he laughed and told me that it was not necessary to take ‘such drastic measures’.  ‘Drastic measures?’ I thought. Following your instructions and filling my body with artificial flavors and additives and then using a ‘bowel prep kit’ to forcefully remove any heavy meals I had eaten 24 hours before sounded more drastic than slowly easing the body into a lighter, highly nutritious and health-supporting diet.
I still wanted clarification on one important issue: I had read that sedation was not required for the removal of polyps since the large intestine was not lined with nerve cells. Just in case, I asked the doctor.  He confirmed.  No pain when removing polyps.

After talking to my gastroenterologist I decided to contact the doctor who had recommended using magnesium citrate. I found Dr. David Blyweiss’ phone number on the Internet and gave his clinic in Florida a call.  Rather than blindly follow any instructions published in an article on the Internet, I wanted to find out first-hand how much magnesium citrate he would recommend an average weight adult female take to ‘cleanse the colon’. The doctor was seeing a patient and his nurse recommended the daily recommended dose on the ‘Natural Calm’ bottle. In order to cleanse the colon this would not be enough.  Without seeing me, the good doctor was not willing to give any recommendation.

I called the customer service number for ‘Natural Calm’ to get more clarification. The friendly man on the phone advised me to check with my doctor (back to square one).  He also explained that the recommended daily dose was an average between the ideal dose for a woman and a man. Thus the dose the company was recommending was slightly higher than the ideal recommendation for a woman and slightly lower than the ideal recommendation for a man. The recommendation was based on average weight for men and women.

Finally I decided to call the lab that manufactures Suprep. I wanted to know on which weight they were basing their recommendation of drinking two 6 oz. bottles of Suprep. If they based it on the average weight of an American man, then I would drink proportionally less.
The lady on the phone was very friendly.  It took several rounds of repeated questions before she shared with me that the dosage was based on a 150 lb. man. What average American man only weighs 150 lbs.? I thought.  When you look at the recommended weight in elevators in the U.S., the assumed weight for an American man was much higher!  Whereas a dozen Thai man could easily ride an Otis elevator, in the U.S. the elevator preferred half that number in American riders.

‘Well,’ I thought, ‘if the Suprep dosage is based on 150 lb., then surely I can get away with drinking 20% less of the stuff?’  The lady from Braintree Laboratories also kindly shared with me her expert experience that in most cases one 6 oz. ‘did the job’, in other words, the patient ‘pooped clear’.

The evening before the procedure I bravely downed the diluted 6 oz. bottle and waited.  And waited.  And waited.

Since I had only eaten a plate of paste and half a sweet potato in the preceding 72 hours I had very little to give. After several hours I finally felt the urge and was dismayed that the color of the watery discharge was as dark as dark chocolate. I love chocolate and I had stopped eating any chocolate three days earlier. ‘At this rate I will never ‘poop clear’’, I thought with dismay.

With greater than usual interest I closely scrutinized the color of further discharges. I made sure to drink plenty of fluids. The dark brown seemed to most reluctantly change to a less dark brown and then an ‘average’ brown. At four thirty the next morning a call of nature woke me. Sigh, still not clear. According to the instructions no fluids were allowed four hours before the procedure. The colonoscopy was scheduled for 9 a.m.

Reluctantly, not wanting to have to repeat the procedure, I downed the second and final 6 oz. bottle. As before, I only took 80% (since I weighed 80% - give or take - of that 150 lb. fictitious man).

The next morning the discharge was clear.

In a nutshell, the gastroenterology team had not seem such a ‘clean’ colon in a long time, no polyps were discovered, the anesthesiology nurse kept himself (since he was not administering any sedation) and me distracted by telling me about his four-year stay on Oahu, the pain was very manageable – just take slow, deep breaths – and I was given a complimentary tour of my large intestines: ‘Do you want to peek into your small intestines? Now this is the opening to your appendix!  And here, that’s what the world looks like when you look through your anus from the inside out…”

I was discharged with a highly welcome: “We’ll see you in ten years!”  and sent home with a souvenir picture of the inside of my gut.

How to Stop Dreading Your Colonoscopy
By David Blyweiss, M.D., Advanced Natural Medicine
November 19, 2012