Initiation into middle age: Colonoscopy

20 June 2024

For starters, let me just say that there is nothing wrong with me as I write this. I used the tag "cancer" up there because this post talks about cancer screening. Also, as I finish and polish this post up a few days later I found out that nothing unusual was found, "You're good, see you in ten years."

Second, I'll try my best to not be gratuitous given the subject matter. Believe me, the prospect of writing about the far end of my gastrointestinal tract does not thrill me. I'll try to give the topic the gravitas it deserves, but let's face it sometimes a little humor is needed. Just take it as given that I won't go into terrible amounts of detail on certain things (besides, there's no shortage of places on the Net where that is available).

Third, I am not a medical doctor and this is not medical advice. However, I am of the considered opinion that regular cancer screening procedures are important, and if you are able to have them done at regular intervals you should. Healthcare in the United States is a bad joke at the best of times (something I'm not writing about at the moment for personal reasons) but I have a working hypothesis that catching bad things earlier means much less bullshit later.

Fourth, getting a colonscopy isn't nearly as bad as it sounds. The worst part is the prep the day before. It's not even particularly embarassing. The actual procedure isn't really much to write home about, but I'm going to write about it anyway in the hopes that it reassures folks out there.

If you haven't guessed by now, when I started to write this I was in the final prep stages for my first colonoscopy. I've picked up working on it in the days following. As you may or may not be aware (and if you hit the previous link, you should be) this is a medical procedure where a fiber optic surgical scope is inserted into your large intestine for visual inspection, and if need be tissue biopsy may be carried out for laboratory analysis. Said insertion takes place through the orifice you think it does which, surgically speaking, isn't quite as simple as it sounds due to what that particular part of the body does. To put it another way, if you get something on the lens of your camera you're not going to be able to see a whole lot, so the easiest thing to do is minimize the potential mess.

Three days before I started dialing my usual diet way down because a pre-requisite for a colonoscopy is a low-residue diet. To that end I had to cut out a lot of stuff; everything high in fiber had to go. Everything with seeds or whole grains had to go. Pretty much all the fruit I had around the house was out. In short, if it could reasonably be mistaken for an anomaly when viewed on the backdrop of the tissue of the large intestine I couldn't eat it. It kind of sucks, but there's a lot that can fill in for it. White bread (mostly toast in the morning) and peanut butter or butter (Earth Balance, actually) worked pretty well for me for breakfast. I've been eating a lot of chicken lately as well (not much in the way of spices but sauces work decently well); no vegetables but white rice. And lots of water.

The morning when I started writing this (the day before I went into the hospital) I went on an all-liquid diet. Lots of gelatin, coffee (thank the gods), water, and mugs of chicken broth were on the menu. Truth be told it sounds much more daunting than it really is. I think it was the shakeup in my usual routine more than anything else. It's kind of boring, really - it doesn't really feel like food from the process even though it does mostly satisfy like food. Sugar keeps you going but it's not actually fulfilling. Mostly it was the waiting to start the final step of the process, which was drinking four liters of PEG-3350, which is polyethylene glycol 3350 in aqueous solution. I was fortunate enough to have some lemon-lime flavoring that didn't have aspertame in the house so it wasn't as bad as it could have been 1. It's kind of syrupy and was neon yellow-green, kind of like antifreeze.

Just before each dose of turbo-lax I ate a handful of Gas-X tablets (affiliate link) and a dose of ondansetron. The former is to prevent gas (which is apparently a problem when cleaning your gut out), the latter is to minimize the possibility of nausea (which, I can definitely see could be a problem). The Gas-X tablets in question are 125 mg each, and eating three at a time seemed to help. As always, consult your physician.

Drinking four liters of anything, rectal rooter or otherwise isn't easy. I was supposed to get half of it down between 1700 and 2100 hours local time in eight fluid ounce doses (which works out to about half a drinking glass, more or less). It's possible but takes a certain amount of concentration because you feel full the entire time. Also, it hits pretty quickly. From the time I started until the first... well... sign that it was working was a little over half an hour. Then it was twenty to twenty five minutes between dashes to the bathroom. I camped out in my office because it's about ten feet away from the bathroom, and the proximity became an important factor. In a lot of ways it was like having food poisoning, only without the fever or stomach cramps. After the second or third dash to the john it was all liquid and stayed that way for the rest of the night.

The first half of the jug of PEG-3350 took about three hours to get down. It's possible and advisable to get into a pattern and just go with it. Get up, get a glass of turbo-lax, take big sips 2, run to the bathroom, rinse, repeat. I made sure to have a stack of books in there to keep me company and finished Surely You're Joking, Mr. Feynman! (affiliate link) in a single night. This was in between hanging out in my office and dinking around online - cleaning up my archives, deduplicating files, testing my backups - the usual stuff that gets done when there's nothing else to do. I also had some stuff playing in the background, mostly Troma Films' finest because there was little point in listening to anything that required a great deal of brainpower. It was silly, fun, and kept me distracted.

It was after the first dose of turbo-lax was down that I had to sit down and figure out when to start the second dose. My colonoscopy was scheduled for 1000 hours on Thursday. The last time I could have anything (liquid or otherwise) was 0600 the same day. So, when to start in on the second half of turbo-lax so as to be done in time? This worked out to be around 0300 that morning. Yep, if you haven't guessed already it was an all-nighter, which is something you really should prepare yourself for. That meant about three hours to drink the other two liters of PEG-3350. It's possible but it turns into an endurance challenge around the time the birds start singing again. Also, let me just say that modern artificial coloring is a horrifying thing and you should take solace in the fact that this isn't a fact you can test for yourself under normal circumstances. 3

I had to be at the hospital by 0830 the next morning to check in, do the paperwork, and handle the last dose of rectal rooter. When they called me into the back it was pretty standard outpatient stuff: Strip down, put on a hospital gown, hair net, and those stupid slipper socks that don't fit anyone, get an IV inserted, and kick back on a gurney to wait. I made it through about a third of Survival of the Richest (affiliate link) by Douglas Rushkoff before they wheeled me into the... I guess it was technically an operating room. If there's a word for a room in which outpatient procedures are performed, I don't know what it is. Anyway, they had me lay on my side and, and then the anesthesiologist plugged a syringe full of milky lavender fluid 4 into my IV and pressed the plunger.

The next thing I knew I was being wheeled into a recovery room. It was like somebody threw a switch and I went offline, then turned me back on. To quote Mae Dean, "Okay, that is fucking weird." Zero time lapse. I'd had half-baked thoughts of saying something weird when I woke up, asking about reversing the polarity of the neutron flow or something, but there was effectively zero room for anything like that. Off. On. I looked at the results just now and, start to finish, the colonoscopy took about thirteen minutes. That's it.

There isn't much else to write about this experience. I got home and napped for an hour or so, until lunch arrived. I think I had a bagel sandwich for lunch and then went back to bed until 1900 or therabouts. I then got up and ordered myself a pizza (which tasted amazing after three days of blandness and liquids) for dinner, ate maybe three quarters of a pound of raisins because I didn't realize how hungry I was, then polished off half of the pizza and went back to sleep for another twelve hours. I'm fairly sure that it wasn't due to the propofol because I didn't feel muzzy or hung over, but I was tired because I'm too old to be pulling all nighters. That and having your digestive tract in fast-forward for half a day requires more energy than you might think because the abdominal muscles involved in peristalsis tend to operate in a leisurely manner and are unaccustomed to running in triple time. As for how long it took my digestive tract to get back to normal operation (without going into too much detail), it only took about a day.

  1. My sense of taste is terrible but I do have most of the equipment. 

  2. Rectal rooter really does look like this. 

  3. I would advise avoiding anything that is red or possibly purple colored when you're on the liquid diet. Your inner ten year old might find it hilarious but I think it might make things more difficult than they need to be on your physician. 

  4. Intuitively it seems really bad for fluid that isn't transparent going into an IV. In a hospital setting this isn't the case.