Do you know that a health conscientious person like Dr Oz had a pre-cancerous polyp removed during his colonoscopy exam?  

Do you know that colon cancer is not a pleasant way to die[5]?  

Do you know that if you are 50 years old or older, you should have colonoscopy exam done every 10 years?  

If all your answers are no's, you'd better read a companion article "Colon Cancer and Its Prevention" first.  In this article, I will share my own experience of taking a colonoscopy exam.  Hope this will help remove some of the fears that you may face for this intrusive exam.

Dr Oz

At Dr Oz's TV show, he had his colonoscopy exam recorded and broadcast in public because he wanted people be aware of the importance of this procedure .  Unfortunately, he has been found to have a pre-cancerous polyp (i.e., mushroom-like).  Note that it is estimated that it could take colorectal polyps to turn into cancer in about 10 years.

Under the good care of his surgeon, that polyp was successfully removed and sent for biopsy.  The diagnosis came back from the biopsy was positive [4].  Therefore, Dr Oz needed to go back for follow-up examinations regularly.

Even Dr Oz who is well-known for eating and exercising well, he cannot escape the shadows of colon cancer.  Therefore, taking colonoscopy exam after 50 years old or older is essential and can be life-saving for you[6].

My Personal Experience

The entire stay at the hospital only took about 2 to 3 hours.  After checking in, I was asked to lie down on a bed.  After some simple check-ups by the nurse, she started an IV to prepare me for the general anesthesia.  While lying and waiting, I've overheard an elder telling the nurse that she tends to be sedated easily and she asked the nurse to make sure wake her up after the exam.  I guess this was not her first time  However, you can tell she was nervous.  So was I.  This colonoscopy (or general anesthesia) was my first time.  I tried to calm myself down by breathing exercise[2].

After being pushed into the procedure room, I was still awake and both doctor and nurses chatted with me.  I told the doctor that I watched Dr Oz's TV show and he told me that he was incidentally with Dr. Oz last week.  Anyway, my general mood was relaxed, but with a bit anxiety.  Then the nurse told me that I'll be put in general anesthesia and she then proceeded with that.

I had a good sleep, which describes how I felt during the procedure.  But, I was not fully asleep because I remembered I saw something during the procedure.  I guess I've tried to open my eye to watch what's going on.  After I became awake, I was already in the recovery room.  I was fine and soon be released from the hospital.  My wife had driven me home as required.

Colonoscopy Preparation

As described above, going through the exam in the hospital is not very story-telling.  However, the preparation before the exam is.  The whole preparation experience can be described as if you had a very bad diarrhea.

The colon must be free of solid matter for the test to be performed properly.  So, most hospitals ask patients to go through a 5-day preparation procedure (note that each hospital's medication and diet instructions may differ).  Here I describe what I've gone through [3].

1. 5 days before the procedure

   • You have to stop products containing aspirin and Plavix (clopidogrel) 5 days prior to the procedure.

     • Speak with your prescribing physician before stopping if one of these medications has been prescribed for a heart condition, stroke or clotting disorder.

   • Acetaminophen (Tylenol) can be continued or used as a pain reliever.

2. 3 days before the procedure

   • You need to stop taking Coumadin (warfarin).

     • Speak to your prescribing physician before stopping to see if they prefer that you use an alternative anticoagulant.

     • Make sure the doctor doing your colonoscopy knows if you have been on Coumadin so that you receive instructions for when to restart anticoagulation.

   • Stop eating nuts or seeds of any kind and foods with a peel because they can clog the colonoscope.

     • Examples include

       • popcorn

       • peanuts

       • fennel seeds

       • poppy seeds

       • grapes

       • beans

       • YouTube Video

       • tomatoes

       • green peas

       • corn

       • blueberries

       • raspberries

       • watermelon

3. 2 days before the procedure

   • Stop taking anti-inflammatory medicines such as Aleve, Motrin, Advil, Ibuprofen and Naprosyn (Naproxen).

     • This is to minimize risk of serious bleeding if a polyp is removed or a biopsy taken.

4. 1 day before the procedure

   • Take a vacation day. 

     • You need to stay closer to the rest room.

   • Stop eating solid food and dairy products.

   • Start drinking clear liquids in the morning and through the day.

     • Be sure to drink plenty of fluid to avoid dehydration.

       • No red, blue, or green flavors

       • Lemon popsicle and jello are ok.

       • No alcohol, dairy products or orange juice

       • If you are diabetic, talk with your primary care physician about adjustments to medications while on this clear liquid diet.

         • During the preparation period, monitor your blood glucose when you first awaken and every 3 hours after that.

         • You will need a blend of products with and without sugar to keep your blood glucose in balance.

     • Examples of clear liquids include

       • black coffee or tea without milk/creamer

       • soda (7-Up, Pepsi, etc.)

       • Gatorade

       • propel

       • water

       • Calistoga

       • clear juices (apple, white grape, white cranberry)

       • clear broth

   • Morning

     • Mix Trilyte/Colyte by adding drinking water to the indicated line near the top of the gallon jug.

       • Shake until powder is mixed with the liquid.

       • Add one flavor package to the gallon jug to make it taste better.

   • Mid-day

     • At 12:00 noon, take 2 Dulcolax (bisacodyl) laxative 5 mg. tablets by mouth.

     • Between 2 and 4 PM

       • Begin drinking the Trilyte/Colyte solution

         • Drink a large glass, about 8 ounces, every 10-to-15 minutes until half of the gallon bottle is empty, then drink the remainder of the bottle over the course of the evening.

         • Stay closer to the rest room.

           • Bowel movements may begin about 1 hour after the first glass and may continue 2 to 4 hours after you finish the last glass.

         • Feelings of bloating, nausea, or chilling are common after the first few glasses.

           • If the nausea becomes acute, stop drinking the Trilyte/Colyte for 30 minutes, then start drinking again every 15 minutes as before.

           • You may experience some cramping.

     • Continue to drink clear liquids during the day until 3 hours before the procedure.

       • More liquids will result in a better colon prep and will help prevent dehydration

5. Day of the procedure (colonoscopy)

   • Take a vacation day. 

     • You cannot work the whole day.  Frequent bowel movements may continue after the procedure.

   • You may drink clear liquids until 3 hours before the procedure.

     • If you drink liquids within 3 hours of your procedure, except sips of water to take medications, your procedure will be canceled!

   • If you're diabetic, check your blood glucose before you leave home and report the reading to the nurse when you arrive in the Procedure Suite.

   • Do not take your usual blood pressure medicines the morning of the procedure since the bowel preparation causes mild dehydration.

     • Take your heart medicines 3 hours before your appointment with sips of water.

Check List

• Schedule your appointment probably 6-months in advance

  • The waiting list is long.

• Take two days off from your work  (i.e., the day before and the day of the procedure)

• You should have received a Trilyte/Colyte prescription at least one week before the procedure

• Purchase 2 Dulcolax (bisacodyl) tablets, 5 mg each

  • You need it one day before the procedure.

• Purchase clear liquids (for example, 1 to 2 gallons of apple or white grape juice)

  • You need them one day before the procedure.

• Purchase one gallon of drinking water in case you prefer it over tap water

  • You need to use it to mix Trilyte/Colyte powder with.

  • You need them one day before the procedure.

References

1. Video: Colonoscopy

2. Breathe Deeply to Activate Vagus Nerve

3. PAMF website

4. Dr. Oz's Colonoscopy Finds Pre-Cancerous Polyp: What Can He Teach Us?

5. Lessons I’ve learned from a colon cancer patient by Allen Perkins, MD

6. What’s scarier than a colonoscopy? 

7. Richard Rubenstein: Overcoming Rectal Cancer

   • A routine colonoscopy in 2007 saved Richard Rubenstein’s life.  Watch the video embedded in this article for his testimonial.

8. Study: At-home screening test for colon cancer a good alternative

   • Fecal immunochemical test (FIT) is highly sensitive for detecting colorectal cancer, and people were good about conducting the at-home test annually for four years in a row.

9. Remove or Refer Before Resection: The Case for Endoscopic Management of Most Large Polyps

10. How Long Does It Take Colon Polyps to Turn Cancerous?

11. Gastrointestinal Endoscopy Associates (or Capital Digestive Care)

    • Under the direction of a skilled executive leadership team, Capital Digestive Care has grown to be the largest private practice gastroenterology group in the Mid-Atlantic. Representing more than 80 physicians, nurse practitioners and physician assistants and more than 200 employees, the group sees more than 75,000 patients annually and performs one out of every two outpatient colonoscopy procedures in the Washington Metropolitan Area.

12. What To Look For When Selecting a Gastroenterologist

13. What kind of doctor is best for a colonoscopy?

    • A gastroenterologist is a doctor who specializes in treating conditions of the gastrointestinal system and is trained to perform colonoscopies.