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?
Simple.
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:
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