A colonoscopy experience (Dec 9th 2014)

On the afternoon of  December 9th 2014 I had a colonoscopy at Musgrove Park Hospital, Taunton. The referral was based on family history, as my father had colon cancer in his forties, and again in the last years of his life.

The process starts with food restriction to empty the colon, but they give you a laxative preparation to make absolutely sure. And so the evening before, I downed the first litre of MoviPrep, with further in store the following morning.

MoviPrep One (evening, Dec 8th 2014)

17.30: Clare and myself mix sachet A (the active stuff) and sachet B (the citrus flavouring) in a large jug and add a litre of water, stirring to dissolve. I then retire to the spare bedroom next to the toilet where I spin up the St Matthew Passion on my phone and relax in the recliner. I have an hour of drinking ahead.

17.40: I start on the first 250 ml. On the net, some reported that the stuff was so foul that you had to hold your nose to swallow it. Not so: I'm pleasantly surprised to find it tastes like a cold lemon drink from a rubbish supermarket. Quite drinkable but crass.

18.15: Halfway through. No effects whatsoever (except I've been to the toilet to deal with the vast reservoirs of liquid I'm ingesting). I pause to reflect that there are others out there who right now are working their way through a litre of laxative and wondering like me about their proximate future. Then I return to sipping, and more of the Leipzig choral baroque.

18.40: An hour into the mission and it's all drunk. The stuff seems to get thicker and more gelatinous towards the end and the taste way too repetitious. However, it's still quite doable. But now what? Feeling no effect whatsoever.

19.05: OK, just got a feeling. Yep, it's off to the toilet - not in a rush but .. you know .. when it's time .. . Over the next 45 minutes I'm back five times and the results are steadily more liquid. Of course, I haven't eaten properly for a couple of days but I suspect I'm losing the last of my friendly bacteria. I feel an odd sense of shame. I'm betraying them.

19.45: It's over. Much shorter period than I thought. It's just over two hours since I started the process. I give it another hour or so and then head for the shower.

MoviPrep Two (morning of the next day, Dec 9th 2014)

I thought I was done by mid-evening last night but the process doesn't really stop completely. A trip to the toilet just as I was going to bed, and also a little activity as I got up (05.30 since you ask). Definitely worth wearing those underpants in bed for, as they say, peace of mind.

05.55: The solution is made up and I start to sip with a hot green tea chaser. Glenn Gould's Prelude in C major tinkles softly from the mini-speakers as I wonder whether this session will be a repeat of last night's. After all, I now have the chemicals in my body, don't I?

06.45: God, I am so sick of lemon!

06.50: Yep, it's started. Much more quickly than last night!

...

8.20: To sum up, the whole process is not as bad as I anticipated. Everyone's experienced diarrhoea after food poisoning. This is a little like that, but sanitised and safer, with no abdominal pain. Still, I'm glad it's over - I crank up Boston's 'More Than A Feeling' to celebrate.

The Colonoscopy (later)

Musgrove Park Hospital, Taunton on a chilly winter's afternoon. The staff seem to expect me to sedative-up, but I'm determined to stick to 'gas and air' (Entonox). They insert a precautionary cannula in my hand regardless.

In the procedure room, the doctor splashes some jelly onto the relevant area and off we go. The whole thing takes about half an hour and for almost all this time I'm alert and watching the monitor. The doctor is standing at my waist manipulating this tube with what seems alarming physical force: I mostly don't feel a thing.

There is an odd moment when he seems to have a little trouble getting around a corner and a pain grips my abdomen like someone squeezing my guts in a vice. I suck madly at the Entonox nozzle and the pain eases up, or maybe it just goes away naturally. I really don't like gas and air, it makes me feel dizzy and 'out of myself'. Luckily after that one spasm of pain I never needed it again.

So again, nothing like as bad as I had anticipated and I didn't regret missing the sedative at all - I remember the whole thing! Perhaps I got lucky or the doctor was particularly skilled. It reminded me of the dentist: mostly it doesn't hurt .. but you're always a little tensed up in the expectation that the next moment it might.

Result: I had a small polyp removed (no pain receptors in the gut!) which will be biopsied. If there are any issues with it (3-5 weeks to find out) they'll probably get me back in three to five years for another look. Otherwise I'm off the hook for colonoscopies.

My colonoscopy report

Update: you may believe that once you've had the procedure it's all behind you, so to speak. But think: to prepare your colon you flushed away all those symbiotic gut bacteria. It will take a week to get your colon back to the status quo ante (keep taking the Yakult!). Till then you will feel your abdomen to be quite queasy, maybe a little sore and certainly not in a restful state.

---

And the NHS letter with my results.

A Doctor writes ...

From my GP today:

Dear Mr Seel

Thank you for your letter regarding your family history and suggestion for enhanced screening. I think this probably would be a sensible idea and I am sure the family history would fall within the referral guidelines for the enhanced screening. If you would like to go ahead with this please let me know and I can arrange the referral. The enhanced screening involves an endoscopy which is a fibre-optic camera which can look inside the bowel.

If you would like to discuss this in more detail before me making the referral please arrange to speak to me.

Here are some of the highlights from Wikipedia.

"The pain associated with the procedure is not caused by the insertion of the scope but rather by the inflation of the colon in order to do the inspection. The scope itself is essentially a long, flexible tube about a centimetre in diameter, i.e. as big around as the little finger, which is less than the diameter of an average stool.

"The colon is wrinkled and corrugated, somewhat like an accordion or a clothes-dryer exhaust tube, which gives it the large surface area needed for digestion. In order to inspect this surface thoroughly the physician blows it up like a balloon, using an air compressor, in order to get the creases out. The stomach, intestines and colon have a so-called "second brain" wrapped around them, which autonomously runs the chemical factory of digestion. It uses complex hormone signals and nerve signals to communicate with the brain and the rest of the body. Normally a colon's job is to digest food and regulate the intestinal flora. The harmful bacteria in rancid food, for example, creates gas. The colon has distension sensors that can tell when there is unexpected gas pushing the colon walls out—thus the "second brain" tells the person that he or she is having intestinal difficulties by way of the sensation of nausea. Doctors typically recommend either total anaesthesia or a partial twilight sedative to either preclude or to lessen the patient's awareness of pain or discomfort, or just the unusual sensations of the procedure. Once the colon has been inflated, the doctor inspects it with the scope as it is slowly pulled backwards. If any polyps are found they are then cut out for later biopsy.

"Some doctors prefer to work with totally anesthetized patients inasmuch as the lack of any perceived pain or discomfort allows for a leisurely examination. Twilight sedation is, however, inherently safer than general anesthesia; it also allows the patients to follow simple commands and even to watch the procedure on a closed-circuit monitor. For these reasons it is generally best to request twilight sedation and ask the doctor to take his or her time despite any discomfort which the procedure may entail. Tens of millions of adults annually need to have colonoscopies, and yet many don't because of concerns about the procedure.

"It is worth noting that in many hospitals (for instance St. Mark's Hospital, London, which specialises in intestinal and colorectal medicine) colonoscopies are carried out without any sedation. This allows the patient to shift his or her body position to help the doctor carry out the procedure and significantly reduces recovery time and side-effects. Although there is some discomfort when the colon is distended with air, this is not usually particularly painful and it passes relatively quickly. Patients can then be released from hospital on their own very swiftly without any feelings of nausea."

Something to look forward to before Christmas! Here is what my 23andMe health report has to say about my Colorectal Cancer risk.

Nigel Seel
4.2 out of 100 men of European ethnicity who share Nigel Seel's genotype will develop Colorectal Cancer between the ages of 15 and 79.

Average
5.6 out of 100 men of European ethnicity will develop Colorectal Cancer between the ages of 15 and 79.

And here's the caveat.

The 23andMe Odds Calculator only takes into account effects of markers with known associations that are also on our genotyping chip. Keep in mind that aside from genetics, environment and lifestyle may also contribute to one's risk for Colorectal Cancer.