I’ve had two colonoscopies; one on January 11, 2007 and one on March 13, 2018. In the spirit of an English writing assignment, I will compare and contrast the two experiences. In addition I will offer some advice that I think will be useful for those who have yet to have had the experience. Since I am a math professor you should not view this as medical advice.
The main event “Cleaning the Area for Viewing” has not changed much. On Day -1, you only have clear fluids (see below for definition) . At 3:00 PM you take some DulcoLax (stool softener). At 5:00PM you begin to drink from a mixture of 64 oz of Gatorade and one 255gram bottle of Miralax. Eight ounces every 15 minutes until it is gone. In 2007, I was amused to see that the directions on the can said to “never under any circumstances take more than one capful.” In 2018, the laxative comes in a brightly colored plastic container, which brags that it contains 14 daily doses.
At about 6PM the party gets started, and regular trips to the bathroom continue until about midnight, when I was brave enough to try to go to sleep. In 2007 there was nothing new to do the next day, except to drink clear liquids stopping two hours before the procedure. In 2018, there is a 10 ounce bottle of Magnesium Citrate to be drunk four hours before the procedure. Fortunately, this corresponds to the standard dose and it gets its magic done in less than 2 hours.
What is a clear liquid? In 2007 the list included Coffee and Tea (no milk or cream). In 2018 these items were gone leaving water, soft drinks, Gatorade, fruit juices without pulp, chicken or beef broth, plain jello, popsicles (no sherbert or fruit bars). In short “any fruit you can see through and has no pulp” is acceptable as long as it is not RED or PURPLE for obvious reasons. A colonscopy is not a test on which you want to get a false positive!
Clear liquids are to keep you hydrated, but also to give you enough calories to get through the day.(See disclaimer above.) In this regard, popsicles and jello are worthless since they have 10-30 calories. Thinking it might be some sort of substitute for coffee in the morning, I tried some canned chicken broth warmed in the microwave. But after I had a few sips I noticed that the can said it had 30 calories per serving, 30 of which were from fat. The white grape juice at 150 calories for 8 ounces was sickeningly sweet, but a good source of calories, as was some 80 calorie lemonade (which had no pulp but taste like plastic) and to a lesser extent non-diet soda.
The biggest change in the prep routine came from the rules for a restricted diet on days -5 to -2. In 2007 the rule was just do not eat nuts, seeds, popcorn and corn. By 2018 this list has gotten huge. No non-tender meats, gristle, hot dogs, salami, cold cuts. No raw vegetables or salads, no artichokes, asparagus, broad beans, broccoli, Brussel sprouts, cabbage, cauliflower, mushrooms, onions, peas, sauerkraut, spinach, summer or winter squash, tomatoes, zucchini. No raw fruit (except for bananas), canned fruit, dried fruit, berries, melons, cranberry sauce, avocado, coconut. No bread with whole wheat, etc, etc
In short, you can eat tender cooked fish, poultry, and meat, served with green beans, cooked carrots, beets, apple sauce, ripe bananas, and cooked fruit (peaches, pears, apricots, and apples) if the skin has been removed. The exclusions listed above will test your culinary creativity. Only refined pasta is allowed but I interpreted this to mean that Stouffer’s Fettucini Alfredo was OK. While cauliflower was off the list I figured that it was OK to eat mashed cauliflower from the frozen foods aisle, which Oprah peddles as low calorie alternative to mashed potatoes. Rachel Ray’s recipe for cooked carrots are popular according to her internet site but went over like a Lead Zeppelin.
To try to end this rant on a happy note, let me talk about Day 0. As many veterans of the procedure will tell you, after going through the prep on Day -1, and now a low fiber diet on Days -5 to -2, the procedure is not bad at all. One of the reasons for this is that they give you something that makes you forget the whole thing. I once made a joke at a conference in Canada that this amnesia makes the procedure more fun than a faculty meeting. After the talk, a faculty member from York came up and told me that in Canada they don’t give you that drug. Damn socialized medicine.
I think that the drug they give you now has changed. In 2008 it was something like Rohypnol (aka roofies, the date rape drug). My wife Susan took one of her friends, Toni, to get her colonoscopy. One of the first things Toni said after the procedure was that Susan should see the movie Awakenings. Then a few minutes later she said it again, and then again, and again. In 2007, this made me very anxious about the procedure. I was afraid that after it was over would I suddenly wax philosophical about a woman I had me that had a “balcony you could do Shakespeare from.”
In 2018 they gave me Fentanyl. Yes that is the opioid you have heard about the news that is more deadly than heroin, but the nurse was giving me the injection. Wikipedia says it “is an opioid that is used as a pain medication and together with other medications for anesthesia. It has a rapid onset and effects generally last less than an hour or two.” It had the desired effect during the procedure, but when I left the office I was clear headed enough to give Susan driving directions to get home from a very unfamiliar part of route 54, where curiously 234 and 249 are on the same side of the street.
Hopefully, reliving my experiences has been amusing and told novices more about what to expect. This time the post has a bit if a point or to be a precise a small question for doctors: “The addition of the four days of pre-prep undoubtedly makes diagnoses more accurate but does that justify the time spent on a very restrictive and unpleasant low-fiber diet?” Couldn’t we compromise on two days, if I promise that everyone in the country will follow the directions.
I’m scheduled for my own second colonoscopy in a few days, so naturally I’m perusing the Web — that’s why I read your article. Thankfully, in my case the instruction is only, “Avoid consuming nuts, seeds, corn, berries & grapes for 5 days prior.” I saw a site (Kaiser Permanente, I believe it was) with instructions possibly even more restrictive than you state — and when I read it, my reaction was that I have almost nothing in the house that I can eat for the next few days. (Ack! I did what I thought was my preparatory shopping a couple of days ago, and I don’t feel like going out again.) However, I’ve decided I’m just going to obey the instructions I was given regardless of how overboard other hospitals/doctors may go. I may still peel apples if I eat any — not sure there.
To answer your question, “Couldn’t we compromise on two days,” I think the problem may be that there are many people who poop only perhaps once or twice a week. For them, the five-day prep really is necessary. I suppose they’re giving one-size-fits-all instructions. What we could perhaps do is reduce the prep period to only three days and give infrequent poopers a milder laxative for that time. I wonder if that would work.
The difficulty, of course, and the reason for being restrictive is that many things can potentially block the vision of the colonoscopy camera — including, apparently, potato and carrot skins, the leaves of brussels sprouts, and a whole pile of other foods. That’s my deduction, anyway.
Oh, and I’m in Canada and they tell me I’m to get Fentanyl and Midazolam, the latter one being an amnesiac — the York faculty member was wrong in saying it’s *never* used for colonoscopies in Canada, though that could easily vary from province to province, from hospital to hospital, and even from anesthetist to anesthetist.
Thanks for writing this! Everything I’ve seen up to this point is from a medical perspective, nice to have a first hand account of a colonoscopy. Makes me a little less nervous about mine next week. Like reading a review on Amazon haha, thanks!