Colonoscopy Prep: How to Survive It

Tuesday, March 6, 2007

If you haven't had your first colonoscopy yet, let me tell you what you can expect. (Note: don't read this while eating.)

But before I do that, I've got to say that every adult needs to have this procedure done. If you are 40 and there is a history of colon cancer in your family, pick up the phone and call your doctor for an appointment. Colon cancer is highly treatable if caught early, and there is evidence that colonoscopies can prevent (or deter) colon cancer by removing pre-cancerous polyps early. If you are 50 and there is no history of colon cancer in your family, you still need to have this done. Those TV commercials promoting colonoscopies are right; it could save your life.

The thing about colonoscopies is that the procedure isn't bad at all. You won't feel or remember a thing. It's the prep beforehand that makes you suffer. Basically, the prep consists of about 24 hours of starvation and expulsion. Believe me, when it's all said and done, you gain a real appreciation for eating.

I had my first colonoscopy within a month of my 40th birthday, in 2004. That was when I learned what the prep involves. The day before the procedure, you are on a clear liquid diet all day after a "light breakfast." (Consequently, all you think about that day is food – because you can't have any.)

In the early afternoon you have to drink this horrible saline solution that is so disgusting it makes you gag. For my 2004 procedure, I drank the two small bottles (about 45ml each) of Fleet Phospho-soda a few hours apart. Beginning about 2-3 hours later, I spent the rest of the day, evening, and part of the night running to the bathroom. (It helps to have diaper cream and Tucks pads on hand for this memorable event. It's true.) After a certain point, it's all liquid. And when it's ready to come out, there's no waiting. You have to get to the bathroom immediately.

So it's not pretty. Not only are you feeling lightheaded from lack of nutrition, but you're suffering through a couple dozen of these "colon blows" (as a guy at work this week called them). As I found out from another guy at work, that phrase is from an old Phil Harman SNL skit that I hadn't seen until I discovered a clip of it on the Internet tonight. There were quite a number of colon jokes at work this week. . . .

Back to the prep: When the clean-out process is finally all over, late at night, you lie in bed thinking about how good a big greasy hamburger would taste right now and how you aren't sure if you can wait another 12-15 hours to eat. Eventually you do stop thinking about food and fall sleep, dreaming of tuna noodle casseroles.

The next morning, after a couple more quick trips to the bathroom, you get someone to drive you to and from the procedure. This day is the easy part. You are put to sleep and don't remember a thing. When you wake up, you feel a lot like a happy drunk. You're totally stoned and, if you're like me, you'll find yourself making jokes with the nurses. You won't remember much of what you say or do for that first half hour in recovery, but you certainly do feel good all over.

Unfortunately, my 2004 procedure didn't go as well as expected because apparently my colon wasn't as clean as it should be. The doc did remove about three pre-cancerous polyps, so despite the horror of the night before, knowing that they removed something that shouldn't have been there made it worthwhile.

However, because the view wasn't as clear as it should have been, I was instructed to have another colonoscopy in a year. That wasn't what I wanted to hear. The thought of going through that again was enough to make me gag. That year went by quickly.

About 13 or 14 months later I had my second colonoscopy, in May 2005, when I lived in NYC. This time I opted for the 1-gallon jug of diluted solution, thinking that since the two little bottles didn't do their job, maybe this would. Although it didn't taste as bad, it was a mistake. Have you ever tried to drink a full gallon of fluid in a very short period of time? Not to mention, each glass of that stuff has to be followed up by at least one glass of water. Beginning at 2pm I had to down all of that fluid within about three hours. I also had to take 4 Dulcolox tabs somewhere in that timeframe.

I'll never forget, by the time I was on my last liquid dose, I could literally feel the fluid backing up into my esophagus. I was standing over the sink, jug in hand, thinking "Where the hell is this dose gonna go?" I was right. There was no room for it anywhere in my GI tract. Naturally, I threw up almost immediately upon drinking it—all clear liquid, right into the kitchen sink. Not much I could do about that. I was actually glad to get rid of some of it. And at least I was done with the ikky concoction.

Then I continued the bathroom ritual for the rest of the evening and late at night. I remember thinking that I didn't know why they wanted me to start taking the stuff as late as 2:00PM since it kept me up until about 12:30 at night. I made a mental note: Next time, start earlier in the day.

The results of my 2005 colonoscopy were such that my doctor insisted I sign up for my next procedure in 2-3 years. How unfair. My brother only has to have his done every five years. Why am I having them so frequently?

Well, that first two years went by pretty quickly, and here I was on Monday of this week, facing my third colonoscopy, just three months shy of that 2-year waiting period. I decided to get it over with now, but I spent the entire weekend dreading it.

By this time, I was a seasoned colonoscopy veteran. My doctor had already put me on an extremely high-fiber diet two weeks earlier for unrelated reasons. Unbeknownst to me, this was a big help in reducing the amount of time spent "prepping" the night before. When I say "high" fiber, I mean 25-40g of dietary fiber a day. That is a lot of fiber. To get in 40g, you have to eat ten apples, or four bowls of All Bran cereal. I did the All Bran cereal every day, lots of fruits and vegies, and took supplements (like Konsyl, Metamucil, Fibercon, etc.). Trust me, it really helps clean out your system! I don't know why GI doctors don't recommend this to anyone getting ready for a colonoscopy.

I also took another tactic, at the suggestion of my sister. My colonoscopy was scheduled for today (a Tuesday). So on Saturday I cut back to eating nothing but fresh fruits, vegetables, and really soft foods. On Sunday I cut out all solid foods and had nothing but liquids—tomato soup, a frozen fruit bar, red Jell-o, a fruit smoothie, fruit juices, vegetable broth, coffee, non-herbal tea, and a few hard candies. That brings us to Monday, prep day, when all I had for breakfast was ½ an apple. The rest of the day was the usual clear liquid diet – white grape juice, diet 7-Up, apple juice, chicken broth, green Jell-o (no red or purple foods are allowed), etc.

Another thing that helped: instead of starting at 4:00PM like this doctor's instructions said, I started the prep at 1:00PM. I'm glad I did because the whole clean-out process took right up until my bedtime at 10pm. Nine hours. It's an exhausting process in and of itself, so having to stay up half the night to endure it is like adding insult to injury. (This time I'd opted for the two 45-ml bottles of saline laxative and 4 Dulcolax tabs, although the nurse did say they have a third program now where you just take 32 pills—I wasn't ready to try that.)

I have to admit, I think my sister's idea really helped, as did the high-fiber diet which had done a good job of cleaning me out the week before. The expulsion wasn't nearly as voluminous as in the past. That's the nicest way I can think of putting it. (The truth is, it turned from solid to liquid after just two bathroom visits, so it was much easier and quicker to expel and caused less damage on the way out.)

I'm no doctor; I'm just telling you how it went for me after doing this three times in three years. Oh, and in case you're interested in knowing how much waste you're carrying around, I lost 4.5 pounds between Monday morning and Tuesday morning!

This time the colonoscopy results were good and the prep "adequate," although I feel like they sent me home too early (I was still very woozy and wobbly from the anesthesia). Not to mention, I had a raging headache that kept me in bed up until dinner time. I was also nauseated for some reason afterward, so I wasn't able to eat for several hours more. I just slept instead, with my kitty on the pillow beside me, watching over me. After my NYC procedure, I remember walking at least 10 blocks to the subway, stopping for groceries, and then working (from home) that afternoon. So something was different with the anesthetic this time around that left me feeling ill most the day.

The good news is that I don't have to have my next colonoscopy for another five years. Yay! That's what I wanted to hear. Tissue biopsies were performed on multiple red spots, but the doc suspects that those were a result of the prep. I'm not concerned. No polyps, no growths, and nothing harmful going on in there. What a relief. I really do feel better knowing this.

Sorry to gross anyone out with this posting, but you never know who it might help. Like I said, the prep is uncomfortable, but what's one day of discomfort every 5 or 10 years (for most people) if it adds 20 or 30 years to your life?