I posted the following on my Facebook page…

The day that boxed chicken broth actually tasted good.

Well, folks, today is D-day… for me anyway. Yesterday, I had no joy taking massive amounts of laxatives and then drinking 1/2 gallon of thick, salty water (GoLytely). I honestly felt that I couldn’t continue to drink the stuff; every gulp down wanted to come right back up. I pushed forward because what are you going to do?

I had a fear that the salty potion would do nothing, or not enough, as that is what happened to Julie several months ago, and which caused her to have to repeat her colonoscopy this last Monday. This time around, it included only two days of clear liquids and what could only be described as a draconian bowl prep. I felt terribly sorry for Julie and selfishly did not want to repeat her descent into Dante’s lower rings of hell.

Thankfully, my fears were unfounded, and I am eternally grateful that the distance between my bed and the bathroom is short. My advice to anyone who has to undergo this tortuous procedure is: if you think that sorta maybe you should approach the porcelain throne… Do not hesitate! Run! Leap! Go! You may not be given a second chance.

I know many of my Facebook friends are over 50, and so you have experienced the joy of the GoLytely solution or some other toxic waste preparation. I am speaking to the choir. For me, the worst part of the whole thing was drinking that stuff; it wasn’t the fasting or even the going. (and going, and going).

Last night, I had an undeniable craving for boxed chicken broth. Normally, I think that stuff is pretty insipid and flavorless. I have mentally classified it as colored water when I use it in cooking. However, my body wanted it, so I downed two steaming mugs of the stuff. I’m not sure if it was starvation or possibly electrolyte imbalance, but it tasted delicious. I’m aware that my broth desires will quell after I again assume that I am eating foods that go beyond Sprite and Jello.

I finished another half a gallon of “stuff” this morning… starting at a sprightly 6:30 AM, and it wasn’t very long before Nature was once again knocking at my door. To be frank, I had to pause this little missive at least three times during its writing to answer it. My hope is that my evacuation adventure will be completely over by the time that I have to drive the 15 minutes to the “drilling site.” I don’t want to have to bring a second set of sweatpants with me.

At 12:30, I’ll be under the knife. Well, not exactly… I’ll be under the probe. I already told Doctor Strangelove that he better drug me well as during my last experience ten years prior, I was aware of everything; I just couldn’t speak. There are just some things that no human should see, including high-definition video of their insides.

On a more serious note, I’m getting this test because I failed a Cologuard test. I wouldn’t mind it at all if you would say a little prayer for me that the positive was caused by a minor issue as opposed to the big “C.” More on that later.

Oh, as many of you know, I avoid concentration forms of sugar as I seem to be addicted to sweet things. However, post-procedure, I’m grabbing a vanilla milkshake… no judgment, please!

Peace

Mike

I was attempting to be humorous, but the real message of the post is hidden in the little paragraph that is the second from the last.  I had failed a Cologuard stool test, and I was getting a colonoscopy to rule out colorectal cancer.  I tend to treat my personal issues lightly with others, even when things concern me on a deeper level.  I’m not one to pull out the sympathy card; that is just not me.  

I was especially concerned as I was still dealing with my wife’s cancer.  If the healthiest person in the world could get cancer (my wife), how about me?  I was worried that my kids couldn’t deal with another ill parent. I currently run the house, from cleaning it to buying groceries for it.  My family depends on me. If I became ill, I would be letting them down.

I wanted to take you through a more realistic version of my colonoscopy journey.  I don’t give medical advice in these posts; they are for entertainment and educational purposes only.  Always follow your doctor’s advice. 

This would be my third colonoscopy.  My first was slightly delayed at age 51, my second was at 61, and I was up for my third one this year.  However, I was given the option to do an at-home Cologuard test instead. Since my last two colonoscopies were normal, this seemed like a good choice.

My doctor ordered the test, and it was delivered to my door a week later.  The test itself was more complicated than I thought.  Fortunately, it came with excellent instructions that included pictures and diagrams.  You have to set up a “hat” in the toilet to collect your solid waste, making sure that you have enough but not too much (easier said than done).  You then have to take a portion of that sample and insert it into a test tube container that has a fluid inside.  Further, you have to pour a jar of liquid on the remaining sample to preserve it.  Lastly, you have to make sure that everything is sealed properly so nothing leaks.  The package has to be taken to UPS within a day for the test to be valid.  It was a pain in the…well, you know what I mean.

It takes several weeks to process the sample, and the results are sent to your doctor.  I was certain that mine would come back negative, so I was shocked when it returned positive.  I did a quick research on the reliability rates and found that 8% of those with colorectal cancer can have a negative response, while 13% of participants can have a false positive response.  That meant that I had an 87% chance of having colorectal cancer!  Within hours of getting the results, I got a long message in My Chart from my wonderful primary care doctor, Dr. Lee.  He said that the test was positive for cancer and that I had to immediately schedule an appointment with a GI doctor to have a colonoscopy.  Crap (joke intended).

I told a few people close to me about the test results, and they universally told me not to worry and that I didn’t have cancer.  Most said they knew someone who had a positive test that turned out to be a red herring.  However, in all cases, they were referring to a more primitive test that looks for occult blood in the stool.  The Cologuard test not only tests for blood but also looks for specific DNA that cancer cells produce.  This double test should be more sensitive and more accurate than the old guaiac/FIT (blood in stool) test from the past.  

I’m not sure how I felt about their responses.  In my heart, I understood that they were trying to quell my fears.  However, in my current state, their comments felt dismissive. My nature had me agreeing with them to make them feel better. I was soothing their fears instead of the other way around. I felt a bit cheated; so much of my energy and efforts in the last year had been devoted to my wife’s illness. So many individuals showered her with love, gifts, and attention. I felt that everyone’s goodwill had already been spent, and there was nothing left for me.  However, I didn’t want to hear doomsday predictions either.  I think I wanted sympathetic ears that allowed me to process my feelings without judgment. I did not want their interpretation, stories, or predictions. I just wanted to be cared for. I wanted to be important… enough. 

However, that was not the case, and it was up to me to soldier on.  I think my actions were represented in the above Facebook post.  In it, I tried to make everyone feel comfortable and safe before I timidly mentioned to them that I was worried that I may have cancer.  

I must take responsibility for some of my reactions as I have long understood that my role was to be healthy and never sick, and that job started very early in my life.  If you have a rudimentary understanding of family dynamics, you know that family members often have defined roles.  In my family, there were those who were sick and those who were healthy.  Special attention was given to the sick ones.  However, all of those “jobs” were filled by the time I came on the scene.  My brother had prolonged effects from childhood polio and received a lot of attention from my mother.  My sister had rheumatic fever as a child and was prone to getting ill. My dad regularly brought her special gifts. My mother was watched over by everyone; she had very brittle type I diabetes and was near death on a frequent basis.  I have many memories of being woken in the middle of the night and told to get out of bed by my father, who would be in a panic state.  My mother would be dripping in sweat and moaning with her head lying on the kitchen table.  An ambulance would be called, and she would be rushed off to the hospital; I never knew if she would return. My older siblings and my dad would take the next day off, but I was sent to school.  I guess that they believed that I wasn’t impacted by the crisis because I was only a kid.  I can assure you that I was impacted, but I went to school as that was what I was expected to do. 

My father told me that something as simple as a common cold could kill my mother, so I was in constant fear that I would bring home a bug and be responsible for her death. Events such as these primed me to place others’ needs ahead of mine. I learned early that my job was to provide support and care.  I was not to demand attention. I have worked hard to become a more balanced person. However, the illness thing is especially powerful for the above reasons. It can return my behavior to a former time.

So, with all of this going on, I assumed my usual role of being capable and confident.  It would be around six weeks between my GI visit and the actual colonoscopy, and a lot of other things would be happening in the interim that required my attention. 

My poor wife was suffering from the aftermath of receiving massive amounts of radiation post-surgery. She, too, was now seeing a GI specialist who had advised a colonoscopy to assess the radiation damage.  She had followed her prep instructions to a tee, but when she went for her colonoscopy, she wasn’t completely cleaned out.  She had to schedule another colonoscopy, and this time, she had to follow an absolutely terrible two-day cleanse that involved only clear liquids for two days and an obscene amount of laxative assaults that included Ducolax, Miralax, and the dreaded “gallon of misery.” Her colonoscopy would be two days before mine.  My energy needed to be directed to her, and I made sure that she had every comfort, this included making batches of various flavored Jello. Thankfully, her second test turned out well, with no significant abnormal findings.  I was greatly relieved.

I was already in the throes of my early colonoscopy prep, which started over a week before the “cleansing” part. I made sure not to use any NSAIDS, like ibuprofen, as some doctors feel that these pills can make it difficult to control bleeding if a biopsy is necessary.  Other doctors think that taking aspirin is no big deal. Blood thinners like Coumadin are known to pose a risk and must be modified before such a procedure. 

I stopped all vitamins and supplements.  Some vitamins contain iron, which can darken stool and make it difficult for the GI doctor to properly visualize the colon. Some supplements interfere with coagulation, so they are banned for the same reason that NSAIDS are prohibited. Days before my prep, I had to avoid fibrous foods, foods with skins, seeds and nuts, and dairy products, as all of these things can potentially stick to portions of the gut and mask potential areas of interest. Additionally, fiber can actually clog the ports on the colonoscope.  

Lastly, I was encouraged to have a very light dinner the evening before I started the cleanse.  This was not a problem as I ate almost nothing the days before my prep and very little the day before. Why did I eat so little?  That is a topic for another day.

The day before the procedure, I was allowed to consume only clear liquids, but I had to avoid any food dyes that were red, blue, or purple.  I did quite a bit of research on this colorant issue, and this restriction seems to vary from clinic to clinic.  Most ban the color red as it can look like blood in the colon. Yet, some GI docs think that red coloring isn’t a very big deal. Some ban orange, while my clinic said that color was OK.  Other clinics allow blue, which mine did not.  It is important that you follow your physician’s guidelines, which may be different from doctor to doctor.  It is just 24 hours of your life. 

I normally try to avoid a lot of sugar, but I made sure that it was present in the clear liquids that I would be consuming.  I had bought a lot of stuff for Julie, and plenty was left over for me.  I had apple juice, ginger ale, chicken broth, some frozen Italian ice, and Jello available.  There was still some Jello in the fridge that I had made for her procedure, but it was starting to get rubbery, so I made a couple of new boxes for myself.  We also had a couple of those little squeeze bottles of water flavorings from Julie’s procedure. Additionally, I picked up a pack of individual lemonade mixes. My bowel prep was unflavored, and I could do some experimenting to see if there was any way to make it taste more pleasant. The night before my fast, I filled the gallon jug of GoLytely with water, shook it to mix it in the powder, and placed it in the fridge.

As I mentioned above, I had a fear that the prep wouldn’t work, as Julie had just experienced that. I’m old and slow, and my gut likes to take its time.  I adapted one of her treatments and took some Dulcolax before my last real dinner. Holy cow, that did a number on me, and I visited the bathroom ten times that night. Even after ten trips to the bathroom, there was still particulate matter in my “offerings.”  What can I say… I am full of it.

The next day it was clear liquids as described above.  Of interest, there is a small study that found that small amounts of certain low fiber foods eaten on fasting day did not interfere with bowel preps and made the experience much more tolerable for the patient.  However, follow your doctor’s protocol; you don’t want to have to repeat this test. I wasn’t very hungry, and one day of a liquid fast wasn’t too bad.

The evening started with the formal prep, and I took out my gallon of “stuff” from the fridge. From past experience, I knew that I didn’t want to flavor the entire bottle, as too much or the wrong flavoring could make the experience worse.  Instead, I flavored each glass individually and tried several different concentrations of orange, mango/pineapple, and lemonade.  For me, ½ strength lemonade worked best to partially mask the salty taste of the vile stuff.  Worse than the salt was the texture of the liquid, which was very viscous and almost slimy.  Our primitive brains protected us from toxins, and I think mine was shouting, “Don’t drink that vile, slimy, salty stuff; it isn’t good for you!”  Honestly, each gulp wanted to return to where it came from.  I tried a psychological trick and reframed the experience by remembering a fruit nectar that I had when traveling in Hawaii.  It had a similar viscosity, but under those circumstances, I enjoyed it.  Reminding myself of the similarity somehow made a bit of a difference.  With lemonade mix and a cognitive fix in hand, I was able to drink the stuff, but it was still a nauseating experience.  

YouTubers have a few other suggestions.  One common one is to use a straw.  Another suggestion is to chase a few sips of the goop with a more tasty drink, like apple juice.  You take two or three sips of the laxative, then a sip of apple juice, then repeat. Another suggestion is to suck on a hard candy after you finish a glass. Make sure that the candy isn’t a forbidden color.

I was doing what was called a split prep.  I was to drink ½ of a gallon at night and another ½ gallon early in the morning.  This was in contrast to my last cleanses, which had me drinking the whole gallon at once.  Apparently, the split prep is better tolerated and more effective, which is why most doctors now use it.

I started to research different bowel cleansing methods and came up with a surprising number of different protocols.  It seemed that the most popular was the gallon jug of PEG (polyethylene glycol) plus electrolytes (brand GoLytely).  However, different docs had different methods.  Some split the dose 50/50, others did a 75/25 split, and still others had their patients drinking the entire bottle at once. 

The gallon prep seems to be the most hated, but it also seems to be the most prescribed.  That is likely for several reasons.  First, It is balanced and less likely to mess with the patient’s electrolytes.  Normally, this isn’t a big deal, but it can be a problem with patients who have chronic illnesses like kidney or heart disease. Second, it is cheap, which means that it won’t be an issue if a patient has to pay for it.  Third, because it is cheap, insurance companies are more likely to approve it. Fourth, it has been proven to be effective in most cases. 

The second most popular method on YouTube was “home brew,” where the user mixes an entire 8 oz bottle of Miralax with 64 ounces of Gatorade or a low-sugar fruit juice.  Some doctors felt that this was slightly less effective than the gallon of goop, but still pretty good.  I found their comments interesting as Miralax is PEG, and the active ingredient in the gallon jug was also PEG at the same milligram amount.  Perhaps the lower volume of liquid made the difference; studies have shown that drinking a few extra liters of water causes a more complete evacuation.  The Miralax protocol often had the patient take some Dulcolax pills earlier in the day.

A number of patients on YouTube said they preferred this method, likely due to its reduced volume.  Unless you are a water drinker, getting down half of a gallon of fluid in a couple of hours is not pleasant.  Drinking ½ of a 64 oz Gatorade can be better tolerated.

I recall hearing about a protocol that used magnesium citrate. However, I couldn’t find reports of people using this method.  This treatment typically starts with Dulcolax tablets in the morning, followed by a bottle of mag citrate at 6 PM and another one the morning of the test.  

I also found some protocols that used a combination of Dulcolax, mag citrate, and Miralax.  That combo seems quite potent and not for the faint of heart. 

There is also SuPrep, which is a low-volume prescription solution, and SuTabs, which are pills. These could be alternatives for people who just can’t drink glass after glass of goop.  They are magnesium-based laxatives, and you still have to drink water after you take them.  However, drinking good old H20 has to be better than drinking a salty, viscous fluid. SuPrep and SuTabs can be expensive preps.

Neither Julie’s doctor nor my doctor mentioned any of these alternatives options during our initial visits. 

The gallon jug is the most balanced, least likely to cause electrolyte imbalance, and is cheap. Unfortunately, it also seems to be the most disliked.  If you feel like you can’t do it, it is reasonable to talk to your doctor about options; most options require you to drink less fluid.

Lastly, if you have bowel issues, like chronic constipation, you should mention those problems to your doctor.  Neither of ours asked about such things, so you may need to be proactive. Also, if it is 5 hours after you started your prep and you have no signs of movement, you should probably give your doctor a call to see what else you can do.  Remember, if you don’t clear, you will likely have to reschedule your colonoscopy, and you will also be given a more rigorous prep. 

Let’s get back to me. I started the prep by drinking a single glass and setting a timer for 10-minute intervals.  I wanted to give my body time to tolerate the solution, but I also wanted to push the endpoint up so I wouldn’t have to deal with hours of drinking it.  It took me a little over an hour to finish ½ of the gallon, and at around 2/3rds point, I had to “go.”  For me, the warning was slight, and I’m very glad that I immediately heeded it; otherwise, I would have been cleaning up a mess.  Although almost uncontrollable, the good news was that there was no cramping.  Here again (TMI warning), I was amazed that I was still eliminating solid fragments, and that went on for some time.  Eventually, my results looked more like brown gravy, then a murky yellow liquid, then a clear lemonade.  I’m being graphic, just in case you have to go through this.  I want you to know what to expect.  

I started my prep at 5 PM, and the ordeal was mostly over by 9 PM.  I went to bed and slept.

My procedure was at 12:30 PM and so I was instructed to start the second ½ gallon at 6:30 AM.  This time I went straight for the lemonade flavored mix and got the stuff down a bit faster.  I was expecting to see the light yellow stool color again, but instead I got a fairly murky dark yellow.  I believe that I was flushing out secretions that had built up over night.  However, at about halfway through my “experience” I was running clear yellow again.  

As far as food was concerned, both my wife and I were somewhat selective.  We didn’t use everything that we bought, but it was nice to have options.  I had a cup of black coffee in the morning and two little cups of Italian ice throughout the day.  I put some of my homemade Jello in a bowl, ate that for lunch, and had some chicken broth around dinner time.  I really enjoyed the chicken broth, which suggested that I needed electrolytes.  If you are going the Jello route, I would advise you to make it yourself instead of buying it premade.  The commercial stuff is often rubbery, and it is typical to get a variety pack that contains a lot of red and blue, which you can’t eat.  Making Jello is super easy; you just have to remember to cool it hours before you want it so it can gel.  I was surprised at how tasty the Jello was as I hadn’t had plain Jello in decades. Lastly, I should have been drinking more water, but I could only consume so much fluid.  I was already on overload.

It is suggested, and I agree, to dress very casually.  I wore sweatpants, a tee shirt, and a hoodie to the procedure. After a preliminary evaluation by a nurse and a very brief interview with the anesthesiologist, I was wheeled into the GI suite, and the anesthesiologist administered a drug into my IV. Within 30 seconds, I was out.  During that time, the doctor inserted a 4-foot-long flexible hose (the colonoscope) in me, which not only allowed him to visualize my colon but to pluck polyps and take biopsies if needed. Luckily, I was completely unaware of anything that he was doing.  I woke up in the recovery room.  The test itself was an absolute breeze.

Colorectal cancer is now the third leading cause of cancer deaths in the US.  It used to be a disease of the elderly.  The only exceptions were people who had a rare genetic mutation.  However, for an unknown reason, it is on the rise in younger adults.  I saw YouTube videos of men and women in their 20s and 30s who were having bowel issues but were dismissed by their doctors because they were too young to have cancer.  It turned out that they did have colorectal cancer, and they all stressed the need to be your own advocate when it comes to your health. When I started getting colonoscopies, I was advised to start screening colonoscopies at age 50.  That has now changed to age 45, and sooner if you are having symptoms.

Long-term changes in bowel habits (constipation or diarrhea), bloating, pain in the abdomen, blood in your stool, black stools, extreme fatigue, unexplained back pain, problems having a bowel movement, feeling a lump in your abdomen, stools that are as thin as pencils, and unexplained weight loss, could be warning signs and should be evaluated. Naturally, many of these symptoms are nonspecific, so don’t automatically assume that you have colon cancer if you have back pain. However, if that back pain is persistent and without cause, it makes sense to explore it further. The one symptom that everyone asked me about was blood in my stool.  If you have that, it may be hemorrhoids, but don’t assume that it is; get it checked out.

If the doctor finds polyps, he can remove them during the colonoscopy.  Most bowel cancers start as polyps, so this can be a simple cancer cure.  The polyp will be sent to pathology to determine if it is normal tissue, precancerous, or cancerous.  If it turns out that the polyp is cancer, further treatment will likely be recommended.

Bowel cancer is graded in stages, with late-stage cancer spreading outside the colon and often to the liver and lungs.  This level of cancer has a high mortality rate, which is why getting a colonoscopy is so important.  Early discovery has a very high survival rate. 

I watched a number of individuals on YouTube who had Stage 4 colorectal cancer who were doing well, some being in remission.  However, their treatment involved a variety of things, including radiation, chemotherapy, and surgery.  All of that can be avoided by getting regular colonoscopies.  Yes, the prep sucks, but not nearly as bad as some portray it.  It is one day in your life that could give you many years of life.  It is worth it. If you can’t stand the thought of drinking a gallon of goop, you now know that there are a multitude of other treatments that can enhance the evacuation experience.

Do what you can to make the prep day as pleasant as possible.  Wear clothing that is comfortable and comes off easily.  Make sure that you are close to the bathroom.  You will be going a lot so have quality TP, as well as some sort of barrier cream such as Vaseline or A and D ointment.  I’m fortunate as I have a bidet, I can’t tell you what a difference that little gadget made.  

Give yourself permission to do whatever you want. Read, watch videos, listen to music, or just sleep if that is you jam.  I took a shower right before I went for my procedure, but also felt the need to take one on my return a few hours later.  There is no right or wrong here, just do your thing.  

So what about my test? My particular doctor talks to the patient’s driver, not the patient.  This makes some sense as the patient is still groggy from anesthesia.  However, I would have liked to be part of the conversation. With that said, the great news is that my colon was clear, not even a polyp. I was one of the 13% who got a false positive. Whew.  

I celebrated by going off my sugar restriction for a day and got a delicious vanilla milkshake for lunch.  Every sip was pure joy made sweeter by the knowledge that my colon was healthy.  

Peace

Mike