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A firsthand look at the colonoscopy

My butt could save your life.

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Not my butt, per se, but what's in my butt.

What's in my butt at the moment is a tube with a camera and light on the end. It is snaking its way up my colon, which photographically looks like the Lincoln Tunnel, searching for a little cave-dwelling bioterrorist I've named Osama bin Polyp.

I am not awake, but on Cloud 18, and learn all this later.

The camera finds bin Polyp and projects his image onto a video monitor. He looks like a tiny white bump, the size of a yogurt-covered raisin, but in real life he is much smaller, maybe three or four times the size of the period at the end of this sentence. Snip.

It will take a few days for the lab results: Will it be benign? Precancerous? Malignant?

What then?

But first, a few more words about the junk in my trunk —and yours.

• • •

Journalists don't pay enough attention to butts — unless they happen to be attached to J. Lo or Kim Kardashian. Butts are embarrassing. We don't talk in public about what can go in them, or come out of them.

Our journalistic inhibitions may have cost people their lives back when we were first writing about HIV-AIDS. Do you remember how we described, so as not to offend you, the means of transmission? We used the catch-all phrase "exchange of bodily fluids." One of the things we meant by that was anal sex. Yes, it's true, Martha, for some folks that hole is an entrance, not just an exit.

It is also the most reliable doorway to a long and healthy life, one free of colon and rectal cancer, the kind that killed one of my closest friends, Janie Guilbault, the kind that has threatened the life of my beloved pastor, the Rev. Robert Gibbons, 58, who required major surgery to remove "a big chunk" of his colon after a test discovered lots of little terrorists. "Father," I told the literate priest after Mass, "congratulations, you are now one of the only people in America who knows how to use a semi-colon."

The rest of this essay seeks to inspire you to talk with your doctor about a colonoscopy. If you are 50 years old, you should have one. If you have a family history of colon cancer, your doctor may prescribe one earlier. If you are polyp-free, you can wait 10 years to have another. If they find something, or you are in a high risk group, your doctor will recommend that you get checked more often.

Elaine Mueller is the chief nurse at the office where I got my colonoscopy, the Suncoast Endoscopy Center. Her grandfather died of colon cancer, then so did her mother. Never screened or cognizant of a genetic risk, her mother was diagnosed at the age of 62 and died fours years later.

The colon cancer math prescribes that, with a family history, you should subtract 20 years from the date of a close relative's diagnosis. So Nurse Mueller was first screened at 42. They found no polyps then, but did discover precancerous terrorists in her next test. So, for the rest of her life she will be screened at least every three years. "I'd rather do that," she says, "than not see my grandchildren."

• • •

Now as a participant/journalist in search of the truth, I will stipulate that my butt is not as famous as Katie Couric's, or as attractive. Katie, whose husband and father of her two children died of colon cancer, had a famous colonoscopy on the Today show, which you can view on YouTube — an appropriate name if there ever was one.

Katie's advocacy over the years has saved many lives, and this essay will be the greatest thing I ever write if one of you reading it gets tested and is saved by early detection of the disease.

The actual procedure of getting a colonoscopy is easier than getting your teeth cleaned. The annoying and inconvenient part comes the day before, known euphemistically as prep day.

Here's how it went for me:

The night before prep day, I took two tablets of Ducolax, a stool softener. I slept easily.

I got up on "prep" day (mine was a Sunday) and washed up, brushed my teeth, took my regular meds and enjoyed a clear liquid breakfast. Two hours later I drank an 8-ounce bottle of a lemon-flavored liquid, magnesium citrate, designed to begin the process of emptying my colon. The liquid went down easy. Not long after, I had my first BM (Big Moment) of the day, the first of about a dozen or more trips to the bathroom. The first movement (why do I suddenly hear Beethoven's Moonlight Sonata?) felt normal, but subsequent ones produced looser and looser stools and the final visits nothing but almost clear water.

To enhance this process, I drank most of a 64-ounce bottle of cold Gatorade with a laxative powder, Miralax, added to it. The medicine did not much alter the flavor of the drink, though it thickened it a bit, making it a little harder to drink.

Later I knocked down a little Jell-O, ice pops, chicken broth. I never felt sick to my stomach or dehydrated.

Going that often makes your butt hurt, of course, but, as advised, I used a barrier cream, A&D ointment, which cooled any burning sensation.

This was my second colonoscopy, 11 years after the first one, and it seemed even easier than I remembered. Some additional tricks of the trade:

1. Keep a fragrant candle burning in the bathroom. If you want to be funny put some yellow crime scene tape across the doorway.

2. Invite your family to spend the day out of the house. This is a courtesy, which my wife took advantage of by seeing a play and having dinner with the cast.

3. A big-screen television in high definition rules, especially on prep day.

The following morning I woke up after a good sleep, showered, brushed my teeth and put on a pair of shorts and a golf shirt. Since I was going under anesthesia, I needed a designated driver, so my wife accompanied me, as I had done for her a few months earlier. I'll admit it, I was hungry and just a little nervous.

We checked in to the clinic at about 9. Two hours later I was in St. Pete Beach wolfing down a delicious Belgian waffle covered with fresh strawberries. My empty stomach gurgled with delight.

Oh, I guess I skipped over the important part. It was so easy I almost forgot it.

When I got to the clinic I did a little paperwork and was led inside where I talked with a nurse, who answered all my questions. How will I feel after the procedure? You will feel fine, maybe a little groggy. Let your wife drive you around. Can I go back to work today? It's probably better for you to stay home and take it easy.

I changed out of my clothes, but was allowed to keep my shirt and socks on, which left me cozy and comfortable after I slipped in to a hospital gown. Nursie started an IV. In came the anesthesiologist, who asked me some questions about allergies and medications and told me about the happy juice, Propofol, he would squirt into my IV tube.

I was rolled into the procedure room, met the doctor briefly, a man who projected the impression that he had done many of these, and would do many, many more. (The clinic, with two doctors, averages 20 colonoscopies per day, 100 per week, more than 5,000 per year.)

I told a little joke to the nurse: ''I guess your boss is not a Buttinski. He's an In-butt-ski."

"Haven't heard that one before," she said, as if she had heard many others.

"We're going to turn you on your side, Roy, and tuck a towel under you. We're going to turn everything with you. You comfy?" A minute or so passed. "Okay, Roy, we're about to administer the anesthetic. It's going to work quickly . . ."

"We never look at your butt," said Nurse Mueller later. Only at the video screen. How comforting.

I don't think I have the words to describe the odd but wonderful feeling that happened next. As if no time had passed at all, I was sitting in the recovery room chatting with a nurse looking at photographs that captured me all the way to Munchkin Land. I had no sensation from the procedure. No pain. No bleeding. No cramping. No memory. No dreams. Just a lovely feeling of well-being and mission accomplished.

The test had gone well, said the nurse. Before the procedure they blew air up my butt (not smoke?) to open the empty colon and reveal every nook and cranny. The scope has two headlights, a magnifying lens on a videocamera, and a tiny forceps at the end, along with a mechanism that lets the doctor steer the tube through the colon on its search and destroy mission.

The nurse showed me the photographic image of Osama bin Polyp, discovered hiding in his cave and eliminated. It was a small polyp, an adenoma, which would be sent for biopsy.

Sorry for the next part, which is a little gross, but the mostly pink tissues were encrusted with some residual fecal matter, which was flushed out of me during the procedure. A nice side-benefit, like getting a free carwash with your fill-up.

"You also have a hemorrhoid. The best thing to do is not strain when you're going. And eat plenty of fiber."

The doctor's office called me the next day to see how I was doing. They called again a few days later with the lab results, and I was surprised at my level of anxiety. "It's benign," she said. "But it's the type of polyp that can become precancerous if not detected and treated early." I was good to go, so to speak, with no other action necessary than returning for another procedure in about three years.

She advised me to alert my two younger brothers that I had a polyp removed and encouraged them to be checked.

"Hey," I told my brother Vincent, "I had a colonoscopy this morning. I thought about you the whole time."

"What did they find up there?"

"Would you believe my head?"

Vinnie is 56 and has never had a colonoscopy.

In three long e-mail messages I described my experience for my friends and colleagues at work, encouraging them to get tested if they met the guidelines. I had about a dozen conversations, most of them punctuated by laughter, about their anxieties, inhibitions and fears.

I'm telling them what I'm telling you. Don't wait. Trade a day of comical inconvenience for the chance to see your grandchildren walk down the aisle.

Roy Peter Clark teaches writing at the Poynter Institute, the school for journalists that owns the St. Petersburg Times. He can be reached at rclark@poynter.org. Times researcher Caryn Baird contributed to this story.

>>A LOOK INSIDE

Colonoscopy facts

A colonoscopy screens for colorectal cancer and detects colorectal lesions and polyps before they progress to cancer.

It is performed with a colonoscope, a thin, tubelike instrument that has a light, a lens for viewing and a way to remove tissue to be biopsied.

According to the American Cancer Society, there were an estimated 112,340 cases of colon cancer, 41,420 cases of rectal cancer and 52,180 deaths from both combined in 2007.

Beginning at age 50 people of average risk should have a colonoscopy and then repeat it every 10 years.

In the days before a scheduled colonoscopy, avoid red, orange or purple foods and drinks, which can look like blood during the screening.

For more information, see the CDC's page on colon cancer at www.cdc.gov/cancer/

colorectal.

Sources: American Cancer Society, Mayo Clinic, cdc.gov

A firsthand look at the colonoscopy 09/13/08 [Last modified: Tuesday, September 16, 2008 1:58pm]
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