Wednesday, January 27, 2016

A Health PSA: My sedation-free colonoscopy

I am now part of the 1%. No, not the ridiculously rich 1%, I am now part of the 1% of Americans who voluntarily choose to have a sedation-free colonoscopy procedure. Why would I? My main reason was to avoid unnecessary medications but there are numerous other benefits as well.

If I had to describe my experience in a single word it would be: Hilarious

Why am I describing it? Because early detection can prevent you from developing colorectal (aka colon) cancer and increases your odds of survival if found early if you already have it. So, I wrote this post in the hope of making the procedure ok to talk about so that some of you who may be fearful or embarrassed about scheduling an appointment will realize the exam itself is really not a big deal and you'll feel comfortable enough to make the call.

I'll start at the beginning. One of the first things I did just before I turned 50 last year was to call my doctor and ask about scheduling a colonoscopy. It's always stuck in my mind as something you're supposed do when you hit the big 5-0. LOL the few friends I mentioned it to thought I was crazy to call and request one rather than wait for a doctor to tell me it was time.

Over the years I've eaten more than my fair share of gastrointestinal-healthy foods. All of those breakfasts of brown rice, barley, or farro porridge, dark leafy greens, pickled Japanese plums, and pickled radish were both because I think they're equally delicious and healthy meals.

The cabbage, kale, Brussels sprouts, brown rice, beans, and random vegetables many people have made fun of me for eating for years...  It was time to find out if all of my efforts to eat conscientiously were about to pay off!

The Bowel Prep:

I guess I was so excited to have my first colonoscopy I got confused and started my bowel prep a day early by accident. LOL. What the what? Who does that? Me! Fred pointed it out when he realized it (he knew the dates because he was my designated driver) but it was too late. I made the executive decision to stop the prep (I'd only taken some laxatives) and continue with the prep solution the next day on schedule, which meant not eating for 2 days instead of the required 24 hours. This paid off in the end when my Gastroenterologist complimented my prep as one of he best he'd ever seen. It gave my surgical team a great laugh when I told them what had happened.

Because I want you to have a positive experience here are some prep-tips nobody else may tell you about but I will:
  1. You can avoid a lot of soreness by the end of the prep if you follow just this one piece of advice: Do yourself a favor and get a package of baby wipes. Natural ones with no unnecessary chemicals or perfumes because this isn't the time to discover you have an allergic reaction to them. Trust me, you do not want to use toilet paper. Also, blotting is recommended over back and forth wiping motions.
  2. If you live alone and don't mind smelling up the bathroom (hallway, eek gads maybe your whole house or apartment) go for it! If you don't live alone and are worried about embarrassing odors that may be unleashed during your prep try this: Before using your toilet add 2-3 drops of essential oil into the toilet bowl EVERY SINGLE TIME before you use it (any scent will do or buy some Poo-Pourri). It will create a film over the top of the water that holds all odors beneath it. I learned this trick on the Crunchy Betty website.
  3. I brought my camping air mattress out of The Glampette and put it in the bathroom along with a pillow and blanket. It was easier than making a mad dash to the bathroom for the first two hours of the first 1/2 of the prep. When you have to go it's not like a normal bowel movement. You don't think to yourself "Oh, I need to go to the bathroom, after I finish whatever it is I'm doing." No! During a prep it's more like your colon suddenly yells at you: "YOU ARE GOING TO GO TO THE BATHROOM IN LESS THAN 5 SECONDS (and it will take less than 8 seconds to empty the entire contents of your bowel)!
  4. Mix your prep solution (adding in the lemon flavor packet) at least one hour before you have to begin drinking it then put in your refrigerator because it tastes better cold.
  5. If possible place a short stool beside the toilet and put your feet up while your relieve yourself. To sit upright is (surprisingly) an unnatural angle for our bodies to efficiently poop! The Squatty Potty website explains why in depth.
I made this illustration to show you what a colon looks like!

My No-sedation Request:

Spoiler Alert: The next images you'll see in this post are two small photographs of my actual colon taken by the doctor during my procedure. IMO i
t's not gross unless you think the inside of a squeaky clean pink vacuum hose is gross. Plus they were approved by my Mom and Auntie as "ok" to show the world when I ran this post by them first. LOL They're my official content censors. I included the pictures because I think it's important to demystify the process. I did't know what my colon looked like or was shaped like until after my procedure. The illustration above shows the outside, but the photos show the interior view. 

I'd called the doctor's nurse a few days prior to discuss the sedative given during the procedure because I've always had adverse reactions to narcotics (and lots of other medications in general). During the discussion she mentioned I didn't have to have pain meds or sedation if I didn't want them. . . What?????? No sedation? I liked the sound of that simply because I don't like putting chemicals in my body unless absolutely necessary. I know some of you are thinking there is no moment when medications are necessary than moments like this! LOL

After spending time on Google and talking to my procedure team I learned:

  • Most of Europe and some countries in Asia don't offer any sedation for colonoscopies.
  • There are two categories of people in the U.S. who typically decline sedation being those who have struggled with addiction and anesthesiologists.
  • Also, that only 1% of Americans choose non-sedated colonoscopies, possibly because most don't realize non-sedated is even an option.
  • From what I can tell (after reading pages and pages of articles online, here are just a few: 1, 2, 3, 4, 5, 6) is that most hospitals use conscious sedation but some are moving towards deep sedation using propofol which carries increased risks. I didn't like the sound of that. Hmmmm. I'd seen Katie Couric have her procedure on tv years ago. It couldn't be that bad could it?

I broke the news of my no pain meds/sedation decision upon my arrival. Everyone seemed quite shocked (like eyes got big and jaws dropped). They said it was very unusual for anyone to ask for no sedation or pain meds. I assured them I have a very high tolerance to pain by reciting a partial resume of injuries I've suffered through over the years. Though I did agree to an IV in the back of my hand so if I changed my mind they could immediately administer sedation and I'd be out in two minutes.

If you choose a non-sedated procedure be prepared to pass gas as needed. Your doctor is going to pump you up with air or water. If air is used (as in my case) to try to hold it all in will cause unnecessary pain. I had almost no discomfort because my doctor used less air than normal, enough to inflate my bowel for viewing but not as much as he would normally have done had I been sedated. On the plus side I will point out that if your bowel is empty the gas has no odor to it whatsoever so nothing to be embarrassed about in that department. What little I did pass made no sound at all.

My Dr. was also snapping photos as he moved though each section of my colon. After it was over he gave me a a printed sheet of 8 photos. It was like I went to a colon photobooth and had the pictures to prove it :D When I asked Fred to scan them for me for my blog he looked at me like I had a third eyeball growing out of my forehead. As I recall he said "Aw come on. . . You've got to be kidding!" I tried to explain to him the post would be like a healthcare PSA to encourage people to not be afraid of the procedure but he just shook his head and walked away. LOL It took months to get him to do it for me!

So here you go, these are two pictures of my colon. I don't know, to me they aren't really anything other than interesting. I had no idea that I had a body part that looked like the inside of my mom's old Hoover vacuum hose. So, as the procedure was taking place I happily chatted away with the team and watched my innards on the tv monitor. My doctor asked if I worked in the medical field. I'm not sure if that was because I was so relaxed or because I knew more than the average bear about what was going on. I replied "No, I just read Google a lot."

Was it Painful?

Do be prepared for some discomfort. The small amount I felt was mostly around a level 3 (on a scale of 1 least and 10 most). I felt a little discomfort around each turn and on the final fourth turn my discomfort level shot up to a 5-6 for all of about 3-5 seconds. If you've ever had food poisoning, the flu, or menstrual cramps they are usually a 10 and last for hours or days. So this? It was incredibly easy to endure.

• As I laid on my side it literally took less than a second for the scope to be placed. There was no uncomfortable stretching or pain of any kind. Zero. Zilch.
• The first turn going in wasn't so bad.
• Neither was the second turn.
• The third? I felt what can only be described as something foreign to my body pushing against me. I gasped out loud and proclaimed "I've never been pregnant but this must be what it feels like when a baby kicks inside you!" Which made everyone on my team LOL.
• The fourth turn was definitely the most uncomfortable. It lasted several seconds and then the Dr. said "That's it!" Everyone seemed quite pleased and a bit excited that I'd made it though with no sedation. At that point my reply was that it felt like the scope was near my left arm pit. I then realized I'd tensed up during that last turn. As soon as I relaxed the arm pit discomfort went away. LOL
• There was no pain at all on as the doctor began to retract the scope and the show started on the monitor. There was quite a bit of yellow liquid (excess stomach acid) but he said that was just fine. It suctioned out quickly and easily revealing a perfect viewing environment. That was when My Dr. complimented me on having done such a good bowel prep.
• There were a few seconds of discomfort at each turn when the colonoscope was withdrawn. Most were barely significant. The notable exception was the last turn out but then it was all done and the surgical team made me feel like a colonoscopy rock star!

The Results:

Right there in the procedure room I was told I have the colon of a 20 year old and there wasn't anything I need to be concerned about. Later I found out I can wait a decade before my next check-up.

Post Procedure:

After, I was whisked back to the same waiting room I started in. I got to skip the recovery room since I wasn't sedated. One of the nurses who checked me in came by and gave me an inquisitive look from the doorway. I nodded yes (to let her know I made it through with no meds), and she gave me a big smile and thumbs up.

The nurse attending me told me I could leave as soon as I passed gas. LOL

Aside from getting to watch the entire procedure while it's happening (which was pretty cool), saving some money by not using anesthesia, and being able to leave sooner, another great benefit of going sedation-free was I could eat immediately after the procedure was done. Having not eaten in almost 48 hours I was starving and had brought a bag of cheese puffs with me to eat on the way home :)

Also, while the prep is necessary for viewing during your procedure it is hard on your body clearing out probably most of your healthy gut biota (aka microbiome). To help it recover quickly it's good to eat fermented foods (like yogurt, miso, tempeh, sauerkraut, or kimchi), bananas, and fresh cruciferous vegetables like kale and broccoli, blueberries, and beans.

All in all it wasn't bad. Turned out I didn't even need to have Fred go with me. Since I wasn't sedated I could have driven myself home.

I know no-sedation isn't for everyone. We all have different pain thresholds and if you have other gastrointestinal conditions that are already painful I'm pretty sure non-sedated wouldn't be advisable. But for some of us it is not only possible but really not a big deal at all to go without pain meds or sedation. I'm sure you'll know what's right for you. Just please, if you're over 50 and haven't had one yet, I hope you'll consider scheduling your first colonoscopy. It could literally save your life and maybe even give you a few good laughs along the way.


This post is not intended to be a substitute for professional medical advice. Please seek advice from your physician or other qualified health professionals with any questions you may have regarding colonoscopy or any medical condition(s). This is simply my personal experience that I wanted to share with you to encourage others to be pro-active about their health.

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