“Inside Out, Outside In, Perpetual Change”

I recently had my second colonoscopy in January, and my wife is having her’s this week so I feel as if I have become a bit of an expert on this important screening test. But I realize that many of you may have questions and fears about a procedure that is new for you or that you have not had in a number of years.

So as my public service to my blog readers, here are my 20 questions and answers for everything you wanted to know about colonoscopies but we’re afraid to ask.

1. Why must I have a colonoscopy? — A. This is a complicated question which has to do with family history, genetics, risk of colon cancer etc. However, the simplest answer is because Katie Couric says so.
2. How often should I have a colonoscopy? — A. The standard rule is once every ten years starting at age 50. However, depending on family history and any malignant or pre-cancerous polyps encountered more frequent colonoscopies may be needed. And of course if you are a masochist, the answer is as often as possible.
3. Will it hurt?—-A. No it shouldn’t. You will be “sedated” which means you may be asleep for most of it until it hurts so much it wakes you up. Actually, it only hurts if you really THINK about what is being done to you. The sedation helps you not think about that and instead makes you think you are watching someone else’s procedure.
4. What is the worst part of the procedure? —-A. Not the procedure itself but the 24 hours BEFORE when you must prep for the colonoscopy. More on that later.
5. What is the best part of the procedure? —- A. Hmm. Let me think about that and get back to you.
6. What is the most interesting part of the procedure?—-A. When I woke up in the middle and thought I was watching a scene from the movie “The Great Escape”
7. What is a polyp?—-A. In addition to being an excellent Scrabble word, a polyp is an abnormality in the colon, which is usually benign. My doctor found and removed one polyp which was only two millimeters in length. For those of you that are challenged by the metric system, a millimeter is 1/1000 of meter, and a meter is about 40 inches in length , so 2 millimeters is less than a tenth of an inch. Wow! How the heck did he find that?
8. Do I have any dietary restrictions BEFORE my colonoscopy?—-A. About 3 days before you must eliminate nuts, seeds and red liquids from your diet. Also, though not ordinarily noted, wax paper, red plastics , AAA batteries and peanut shells are to be avoided as well.
9. What do I need to do the day before?—-A. You need to shift to an all-liquid diet starting 24 hours before.
10. That’s great , I remember coming home from the dentist as a kid and having an eggnog and an ice cream milkshake for dinner ! Sign me up! A. Umm. Sorry failed to note that this is a CLEAR liquid diet which pretty much limits you to water, Gatorade, Sprite, Apple juice, white grape juice, clear beef or chicken broth and lime or lemon popsicles. In other words lots of sugar, salt and flavoring. Amazing how quickly you will get sick of that stuff. And worst of all, NO ALCOHOL allowed. I mean I get wine, beer, whiskey and dark rum, but vodka, gin and light rum are the very definition of clear liquids!
11. Anything else I need to do, the day before?—-A. About 24 hours before you need to start drinking a gallon of TriLyte solution. (interestingly and fittingly, my spell check wanted to me to replace TriLyte with “toilet”).  Other common names for TriLyte include witches brew, gagorade and Lysol. You need to drink 8 oz of this stuff every 15 minutes for the first two hours. ( which is the first half-gallon) . Then 4 hours before your appointment you repeat the process . Sadly, they don’t tell you this until AFTER you have set your appointment time. Since mine was at 8:30 am, it meant that I had to get up at 4:30 am to start drinking the stuff.. What a great way to start the day!
12. Does it taste good?—-A. I guess that depends. I have heard of stories of some who relish drinking it and say things like “mm, mm good, yummy limeade”. I’ll admit that these seem a bit more like Greek legends than real stories. My own experience is a bit different, for the first split second it does taste like limeade, but after that like a combination of Kaopectate, prune juice ( and I hate prune juice!) , aluminum foil and a hint of manure. But I learned quickly that the trick was to down each 8 oz glass as if you were chugging a beer or tequila shots in college, without stopping for air. This has several effects . One it allows you to drink it without tasting it , assuming you have a good chaser on hand, mine was Sprite, which helped. Second, if you have a very good imagination you could pretend you were getting rapidly drunk in college and your classmates were cheering you on with every glass you chugged.
13. Have they tried other flavorings?–—-A. Yes , but they have largely been failures . Red raspberry left too many patients feeling like vampires. The experiment with dark chocolate was for obvious reasons very brief.
14. Any side effects from drinking TriLyte? —-A. Huh. Can’t believe you asked that. You are drinking the stuff as prep for your colonoscopy, so what do YOU think the main side effect is?
15. Ok, then aside from the obvious effect of the prep solution, are there any other side effects? —-A. My stomach felt and sounded like high tide on Atlantic Beach.
16. Should you drive yourself home after the procedure?—-A. I recommend that someone else drive you. It is particularly important not to have to drive back home after your appointment because you will still be under the effects of sedation. A bigger problem will not be the “driving” as is often assumed, but rather that you won’t be able to find your car because you won’t even remember what it looks like. However, the biggest problem is that sedation acts like a truth serum which means your spouse can ask and get true answers to all kinds of embarrassing and “potentially dangerous to your marriage” questions. For this reason, I advise having a total stranger take you home.
17. What about driving TO your appointment ?—A. While you won’t be sedated at this point, I still wouldn’t recommend it. Consider you will have not eaten anything for more than a day at this point , you will have slept very little , you will likely be dehydrated, and your stomach and intestines will feel like crap (or perhaps I should say “no more crap”) so you probably won’t be too good with heavy machinery! However, you will probably be in better shape to drive than most yellow taxi drivers in New York City.
18. Does it matter who your gastroenterologist is? —-A. Yes of course. The name is very important. Mine was Dr. Lo, who I felt was aptly named.
19. How do you know whether your gastroenterologist is good?—-A. It’s actually hard to know. Not like you can look up the ratings on “Yelp”, ( though the name suggests you could) . However, if your doctor comes into the waiting room holding a large mechanical drill and says “Next” , that is probably not a good sign.
20. After answering my first 19 questions, I am not exactly encouraged to get a colonoscopy, why should I schedule one?—A. In all seriousness, anything that you can to do to avoid or catch cancer early is important to do. My polyp was pre-cancerous so it was good to know that it was removed (albeit it means I must come back in 5 years rather than 10 years). And just think what a pleasure regular checkups with your doctor will seem in comparison!