it's time to get the colonoscopy

And yes, it's okay for us to talk about it. I give you permission.

Jun 14, 2022

Photo Courtesy of the John James Audubon Center at Mill Grove, Montgomery County Audubon Collection, and Zebra Publishing

I visited Haiti about 12 years ago. It was a beautiful country filled with beautiful people. The days were hot, like all tropical islands. But the island breezes (and lack of sun) cooled us off at night when we slept on the rooftops of buildings under the most extraordinary blanket of stars and listened to the sounds and drums of voodoo rituals in the distance.

I have so many fond memories of my time in Haiti. From visiting with elderly people who no longer had family to care for them to playing games with sweet, young orphans, I remember hoping that I was giving even a fraction of joy to the people I met as they provided me.

But visiting Haiti wasn’t the easiest adventure I’ve ever been on. From the nausea-inducing bus rides to and from the airport to the need for armed security at the compound where we stayed to witnessing extreme poverty and sickness, traveling around Haiti was not without its challenges.

Like the challenge of poop.

I’ll never forget a discussion we had with our hosts the first night in Haiti. A portion of the discussion centered around poop, and how everyone needed to let go of their need to keep poop issues private. Because everyone poops, right?

This need to be honest about poop was due to a few issues. First, running water was not always available in Haiti. The water to the compound was turned off at times. My memory is a little hazy on how it worked, exactly, but I think it was tied to the electricity, which was also turned off for periods of time. I can remember we’d go many hours without running water. There were days when we’d only be able to take bucket showers. From a girl who likes to shave her legs every day, this was not ideal. (Yes, I realize how this makes me sound, but I’m just trying to keep this post real and honest.)

Also, without running water, we couldn’t flush toilets. We were forced to pee on top of other people’s pee. This, of course, wasn’t an issue for the men, but for the women? Again, not ideal. But then you had the issue of poop. I truly draw the line at pooping on top of someone else’s poop. And to be perfectly honest, I don’t remember exactly how this was handled. I probably blocked it out. I think we were able to use buckets to fill the toilet tanks enough to make the toilets flush. But the point was to conserve water anytime you could, because water was extremely scarce.

The second issue surrounding water was the fact that you couldn’t drink just any water. You could only consume the water deemed drinkable by the hosts. I’d call this bottled water, but since I don’t remember actual “bottles,” it could have simply been water treated with those magic tablets to kill bad bacteria. But, as you can imagine, that water wasn’t always 100% safe. And people did become sick.

And this is when we, again, become a little more intimate with the subject of poop. Because everyone does it! And when you get sick from water or food, you tend to poop a lot, and then you need even more water to prevent dehydration.

Fortunately, I did not get sick, but friends of mine did. It was a whole thing.

And I tell you this story about poop in Haiti as a way to soften you up for my story about my first colonoscopy.

I don’t know when we became so embarrassed to talk about things that are 100% natural. Maybe it’s a whole Adam and Eve nakedness sort of thing. I’m not sure, but for the sake of today’s post, we’re going there.

We need to go there. Why? Because I care about you.

Why do we need a colonoscopy at a certain age?

Let’s consider the following stats and facts:

Colorectal cancer (which includes both colon cancer and rectal cancer) is the 4th most commonly diagnosed cancer, and the second leading cause of cancer death.
Colorectal cancer affects men and women equally, and people of all races and nationalities
However, those within the black American population are about 20% more likely to get colorectal cancer and about 40% more likely to die than most other groups. USPSTF points to inequities in the access and quality of screening and treatment as the primary driver for this disparity, not genetic differences. I truly hope we’re working on this as a society!
Often, those who are diagnosed with colorectal cancer have experienced no signs or symptoms associated with the disease. Colorectal cancer is definitely considered one of the silent killers.
The 5-year relative survival rate for stage 1 and stage II colon cancer is 90%; the 5-year survival rate for patients diagnosed at stage III is 71% and stage IV is 14%.
One in five colorectal cancer patients are between 20 and 54 years old. It can attack at even the youngest of ages.
In 2021 the USPSTF lowered screening age recommendations, men and women should begin screening for colorectal cancer at age 45, not 50. However, anyone who experiences symptoms of IBS or other gastrointestinal issues, or if you have a family history of these cancers, you should speak to your doctor about earlier screening (see previous point). My doctor told me at my screening that they’re seeing more and more cancer in slightly younger patients.
People with a parent, sibling, or offspring with colorectal cancer have 2 or 3 times the risk of developing colon cancer compared to those with no family history of the disease.
While most people diagnosed with colon cancer have no family history of the disease, those with a family history should begin screening at an earlier age.
Most importantly, with on-time screening and testing, colorectal cancer is preventable, treatable and beatable. But if you don’t get screened, you might not know you have colorectal cancer until it’s too late.

about the colonoscopy

Let’s move on to the actual screening—the screening that people notoriously paint as this terrible, awful, awkward event that they don’t wish to experience. Nobody wants to get a colonoscopy. I was definitely anxious about it.

But I’m going to be honest with you… The only people who paint it this way are those who have never experienced a colonoscopy.

Seriously, name me one person who has actually experienced the screening who told you that a colonoscopy was so horrible that they’re never having another one. Almost everyone I know told me before I got mine that a colonoscopy was no big deal. And they were right.

Are there risks in a colonoscopy? Of course there are. No medical procedure comes without risks. But these risks are extremely rare events. They are so rare that my doctor, who I found quite humorous, actually made a joke while I was lying on the gurney being prepped for my screening. He told me “since my last patient actually suffered from one of those rare risks, the likelihood of you falling victim to the same thing is extremely low.” Both the nurse and the anesthesiologist in the room gasped loudly and immediately began convincing me that he was joking. Nothing had happened before me. They were both shocked and relieved when I started laughing and said, “You’re lucky I, too, have a dark sense of humor!” Now that I think back on it, was he joking? I was pretty certain at the time that he was, but now, I’m not so sure. :)

I will also note that not all colonoscopies result in a clean bill of health. (Duh!) But if you get your screening timely, the goal is to either deal with potential issues before they become cancer or catch the cancer early enough to ensure you are in that 90% survival rate I mentioned above. Also, if there are no problems, you don’t usually need another one for ten years.

the prep

People will tell you that the prep is the worst part. For me? I hated fasting, which I suppose is part of the prep. I’ve never wanted a cheeseburger so badly in my life than at 2 a.m. the morning of my screening. And I rarely eat red meat.

The prep consisted of fasting a full day before the colonoscopy. My colonoscopy was at 7 a.m. on a Friday, so my last meal was dinner on Wednesday night. All day Thursday I was allowed a clear liquid diet, which for me consisted of tea, green jello (which I think is the grossest jiggly substance in the world), a few drinks of vegetable bouillon, which I stopped drinking after a few sips because it, too, was gross and had a disgusting amount of sodium in it and tasted like I was drinking the ocean in a cup, and water. Basically, I consumed nothing but water for an entire day.

Side note: They don’t like you to consume red, orange, or purple jello or popsicles because apparently they (the red, anyway) make your colon look like it’s bleeding profusely, which apparently isn’t fun for the doctor. A small part or me—the thriller author in me—wanted to try this.

At 6 p.m., I drank the first bottle of liquid prep (there are several types of prep—yours could be a different prescription), which was just a small bottle of raspberry flavored clear liquid. It smelled fine, but I’m not going to lie to you. It had an aftertaste that I suspect was similar to a Harry Potter Bertie Bott’s vomit jelly bean.

After drinking the first bottle of prep, I continued to drink plenty of water (five 8 oz cups of water). It took about 2 to 2 1/2 hours for this first bottle to kick in. So don’t freak out when you think it’s not working. I assure you it is and it will! Then around the 8 to 8:30 timeframe (just after the start of the first January 6 Committee hearing began), my bowels began to empty, clearing my colon. Some people say they poop between 6 to 15 times. Others claim that they just sit on the toilet for one long, continuous purging of the bowels followed by a couple of shorter stints. I was somewhere in between. I can’t remember, because I was so engrossed in the January 6 hearing.

Side note: Keep in mind, this cleansing of your colon does not feel like you feel when you have food poisoning or have a stomach bug. There’s no pain or sick feeling to this. So have entertainment ready and just let it happen.

I pretty much wrapped up that round around 10 p.m. and went to bed.

I did have a hard time sleeping, knowing I was going to have to get up in a few short hours.

Depending on the time you schedule your colonoscopy will determine what time you need to drink the second bottle of prep. I set an alarm for 2 a.m. I slipped downstairs in order to allow my husband to continue sleeping and drank the second bottle, followed by three 8 oz cups of water at that time. The second bottle of prep tasted much worse than the first. It was the exact same liquid, but because I was exhausted and already knew I hated the vomit jelly bean taste, the second bottle was a bit more difficult to swallow. I kept telling myself that I had no desire to go through a day of fasting or to do this prep again, and I pushed through the nastiness and exhaustion. In less than six hours, it would all be over.

It only took about fifteen minutes for the second bottle to kick in. And since I wasn’t sure how many times I would need to go to the bathroom, I slept the rest of the night on the couch near another bathroom so that my husband could sleep.

But I have to say, after 2 to 3 times to the bathroom, my bowels were pretty much done. I was cleansed and ready!

I set my alarm for around 6 a.m. and got a couple more hours of sleep. And when that alarm went off, I was still exhausted and so ready to get the colonoscopy over with. After a quick shower, my husband drove me to the office where the colonoscopies are performed.

the actual screening

For the sake of full transparency, I was a bit anxious about the procedure. I’ve not had a lot of experience with medical procedures, especially ones that required sedation. But as I told the doctor when he asked me what convinced me come in for the recommended screening, I told him people in my family have a habit of dying early, not of colon cancer, but other medical conditions. If I can cross off one possible fatal illness from my list by doing a painless screening, I’m going to do it. Also, both my husband and several of my friends who’d already had colonoscopies reassured me that morning that the hard part—the prep—was over.

And now that I’m on the other side of it, I agree with them.

The facility where I had my colonoscopy (and the same facility where my husband had his performed) was great. Since I had driven my husband there, I knew a little bit about what to expect already. And that was good, because Covid protocols still prevent your driver from entering with you.

I entered the facility on time at 7 a.m., and I was shocked to see that I wasn’t even the first to arrive. This facility was already performing screenings at that time. I didn’t see a sign that said “Get your 24-hour colon screening here” but I’m wondering if there was one. They started early!

They took me back pretty quickly—within 5 minutes. The one thing I wasn’t expecting was the requirement to take a pregnancy test. Funnily enough, you can be 100% certain there is no way on this earth that you’re pregnant, but the second someone requires you to take a test, you wonder: What if I’m pregnant? And the minute you wonder it, you know it’s not completely out of the realm of possibilities. (I wasn’t pregnant!)

The first time I witnessed a clinic like this (when my husband got his), I thought the number of people on gurneys, separated by curtains was strange. It reminds you a little of a hospital emergency room. But now that I understand the process, I get it. It’s efficient. It’s an assembly line of butt scoping, but it seems to work. This clinic had 62 colonoscopies scheduled that day.

I will also say that this clinic seemed like an extremely happy place to work. The nurses were all cheerful and music was playing. One nurse even asked that they change the song at one point because she needed to concentrate on something, and she couldn’t stop singing the song that was playing.

Behind a curtain, I was instructed to undress and put on a hospital gown. I stored my purse and clothing in a compartment beneath my bed/gurney. A nurse gathered my health information, took my vitals, and inserted the needle/I.V. apparatus for administering the anesthesia.

This was probably the worst part of the procedure for me. For some reason, a nurse struggled to insert this needle into a vein in my hand. She moved it around so much, that my hand was extremely bruised for several days. Then she tried again a little higher on my arm. And then another nurse finally used the vein on the inside of my elbow.

Once this was complete, I was almost immediately wheeled into the private room where the doctor would perform the screening. I really liked my doctor. A sense of humor has to be a prerequisite for a doctor who spends his days looking inside peoples butts. Am I right? Anyway, I found him to be funny (see above), but I also found him to be passionate about screening for colorectal cancers. He made it a point to tell me just how many people he sees for the first time who are over 60 and who already have late-stage colon or rectal cancer, and he thanked me for coming in at the recommended age. He did a great job of explaining the procedure and the various outcomes

There was no point during the morning that I felt scared or unaware of what was happening.

After the short conversation with the doctor, the anesthesiologist administered the IV conscious sedation. This type of sedation is not designed to put you completely under, but instead is designed to make you feel very sleepy, to make time pass very quickly, and for you not to remember much, if anything at all. Me? I felt like I got the best, deepest sleep that I’ve had in a very long time. I remembered nothing of the procedure and woke up behind another curtain.

The only thing I remember was one minute I was talking with the team, then the anesthesiologist said, “Just for fun, let’s see how far back you can count from 100. The record is 88.” I remember saying, “100, 99…” Clearly, I’m not breaking records.

When I woke up, I felt absolutely fine. A little tired, but lucid and in control. A nurse told my husband I tried to call him, but I know that I didn’t. I actually started voice texting him from my watch. I found this quite humorous since I NEVER voice text from my watch. But suddenly I knew how and did so very successfully.

What did I text him, you wonder? I texted him: I forgot where I was. Followed by: I’m so sleepy. Followed by: I’m hungry.

It’s important that your driver is someone you trust receiving the results of your colonoscopy, because I don’t remember anything they said to me afterward. They called my husband on the phone (again, because he wasn’t allowed in due to Covid protocols) and gave him the results. Plus they provided me with a written report, including pictures. I’ll admit, I could do without pictures of my colon. It’s weird and gross.

A nurse helped me dress and walked me to my car.

And that’s it. After the colonoscopy (and anesthesia), you are instructed not to drive for 24 hours, and to be honest, you feel just a bit foggy brained that you don’t want to. You’re also instructed not to sign legal documents for 24 hours. It was the doctor who told me that, and I immediately began wondering how to insert that into the plot of a novel. A legal thriller, maybe?

When I got home, I binged an entire Netflix series (Anatomy of a Scandal) from start to finish. I didn’t feel like doing much else. Oh, and I ate. A lot!

So, all in all, the prep is a bit of an inconvenience, and you probably need to take one day off from work for the actual colonoscopy, or from doing anything, really, but that’s it.

I know that this post won’t convince everyone who reads it to schedule their routine screening. And I also know it’s not as easy or as accessible for everyone as it was for me. Our healthcare systems have a long way to go. But if I’m able to help even one of you to overcome your fears of a colonoscopy, then I’m happy.

If you have any questions, feel free leave a comment below the post.

On My Terms

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