Saturday, November 17, 2012

Can We Talk Privately?

This past week kind of wore me out!  I know you can tell in my blog posts when I'm rushed....sorry about that.  Because I work at a surgical center, this is a very busy time of the year.  You see, people who have met their insurance deductibles throughout the year decide to have surgeries and procedures they've been putting off.  If they get those surgeries done before the end of the year, their insurance company picks up more of the bill.  That makes sense to me.

One of the procedures that people put off and put off and put off is a colonoscopy.  Who can blame them?!  Have you ever had a colonoscopy?  Do you wonder what it is like?  Do you prefer to NOT wonder about this subject and wish I'd not bring it up?  Too bad!  OK, if you are a young person (under 50) and aren't having any symptoms associated with your colon such as cramping, bleeding, diarrhea, etc. I will excuse you now...  UNLESS, you know and love someone who is 50 or older or experiencing any of those embarrassing symptoms.  If that is the case, buck up and read on because it could mean saving someone's life.  And just so you know, colon cancer can happen at a younger age.  I've cared for several colon cancer patients in their 30's, maybe even 20's, but it is much less likely at that age.  It is more likely after age 50 so that is why the recommendation is to start screening for it then.  However, if you have a family history of colon cancer, talk with your doctor about an earlier screening.

Colon cancer often begins as a little polyp on the inside wall of a colon (large intestine means the same thing as colon).  The little polyp is kind of on a stalk, like a mushroom or something.  Many polyps are not the cancerous type, or even precancerous, but some are.  When found early during a colonscopy the doctor just snips it out of there and, Ta Da, that often is all that is needed to cure a person's colon cancer.  It is done before they even wake up!  If left there, though, a cancerous polyp will eventually grow into a mass and invade the wall of the colon.  If still ignored it can grow through the wall and from there the cancer cells can travel and start trouble in other places in your body, such as your liver.  That is what it means for cancer to metastasize.  It means it has left the boundary of the original site.  Obviously, the earlier a cancer is found, the better chance for an easy cure.  The process of growing from a precancerous polyp to a cancerous mass can take several years, leaving a nice window of opportunity to stop it.  It would be foolish to miss that chance.

Back when the show, ER, was a hit I used to watch it and see all the dramatic things they did in the emergency department to save lives.  I was working in a GI Lab at the time, the place where colonoscopies were performed daily.  I complained to Mike that we saved lives every day but no one ever makes a hit TV show about that!

This is a topic about which I can give you some insight from both a patient and a nurse perspective.  In the past I had a job where I gave sedation to patients during their colonoscopies and I have also had several of my own.  I have dealt with Crohn's Disease as well as recurring Clostridium Difficile so I am no longer too squeamish when discussing colons and bowel habits.  I've also worked many years as a chemotherapy nurse so I know a lot about what it is like for people with colon cancer.  So, be brave and read on.

Anyone 50 or older should have a colon screening to check for colon cancer.  I know, I know... there are plenty of you thinking you'd rather just die from colon cancer than have this done.  People have actually told me that.  That is only because they are not aware of the misery of colon cancer.

The preparation for a colonoscopy is the worst part but at least you get to go through that in the privacy of your own home.  Different doctors prescribe various methods of cleaning out your colon.  None are fun.  They all involve depriving yourself of food for a day or two.  Additionally, you are required to drink a lot of clear liquids to flush yourself out.  I wish that were it.  It's not.  You also have to drink some salty tasting stuff that gives you potent diarrhea.  Trust me on this one.  You do NOT want to start drinking the stuff before you are safely tucked away in your own home the evening before your procedure.  If you have more than one bathroom in your home you may want to tell you family which one you will be using and ask them to use another.  It would be bad to be running to the bathroom only to find the door locked.  Last time I had a colonscopy I just took a book and a chair to the bathroom so that when the magic started I was close to my destination.  Be prepared, this phase of the joy can go on for hours with many bursts of activity (aka diarrhea).

By the time you report for your colonscopy you are feeling pretty dried up.  Your insides are likely quite pristine.  Your back door may feel raw.  The good news is that the worst of the process is now behind you (pun intended).  It's true, though.

You will have to get into a hospital type gown and yes, you have to leave your underwear off.  I get asked that question from time to time.  You will have an IV started on you.  No one really likes that but it won't be more than you can endure.  When you are taken to the procedure room you will be asked to lie on your left side.  It is nice if you have a blanket or sheet over you.  The nurse or anesthesiologist will administer lovely medication through your IV line.  I've had colonoscopies done where light sedation was given and at times I was a bit of aware of what was going on.  Usually now, though, it is done with a deeper sedation and you won't know a thing.  When the medication begins I kind of like the little whirly feeling but it is just a second or two and I'm asleep.

During your nap a scope will be threaded into your large intestine so the doctor can look around.  Air is infused through the scope to open up the colon.  You don't need to think about all that, though.  The next thing you will know is that someone is telling you it is over and time to wake up.  I really didn't like that part because I wanted to sleep more but there is time for that later.  Because there are different medications used, there are different waking up experiences.   Some types are out of your system pretty fast, for the most part.  Others kind of linger and you may not be really even remember how you got home.

Everybody needs to pass air after a colonoscopy. My mom didn't allow me to say fart so let's just say you are going to need to putt-putt, toot, whatever you want to call it.  Because you are all cleaned out still, it won't smell bad.  Let it go.  Although the doctor tries to get all the air out as he/she removes the scope, some is still left behind.  It's just air so don't be shy.

Be forewarned that any type of sedation or anesthesia leaves you a bit untrustworthy as your perception or memory may be a bit off.  For instance, someone I once helped afterward thought that a window was an aquarium for a bit.  After I had one of my colonoscopies I did a funny thing.  Mike brought me home and took care of me.  Neither of us knew, though, that while I was relaxing in the recliner and entertaining myself with the computer, I was up to no good.  The next day I read my e-mails and was surprised to see one telling me my shoes had been shipped from Zappos.  What shoes?  I followed the link and saw a pair of shoes that looked vaguely familiar but cost a lot more than I would normally spend on shoes.  Yep.  I'd ordered them while under the influence!  The worst part of the story is that I kept them.  Well, they were really cute!

I like to put a photograph in each post but I'm a little concerned about the photos coming to my mind for this post.  Maybe you could click here to see Katie Couric getting a colonoscopy while still awake.  Or click here to see a drawing of a colon so you know just what I'm talking about.  I think I'll just stick on another photo of me in a pair of scrubs.  Pretend I'm the nurse about to start your IV.  Don't worry; this will only hurt a little.


OK, so now go and make that appointment!  I won't argue with you that it is fun.  It's not really that much fun.  You might feel embarrassed and uncomfortable for a bit.  It is sooooo worth it, though.  Be brave and just get it done.  It is so much easier than later dealing with the regrets and the "if onlys".  Plus, you must might get a cute new pair of shoes out of the deal!