Colonoscopy.net.au

For anyone that has or hasn’t had a colonoscopy, this is priceless.

Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami Herald.

Colonoscopy Journal:

I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy.

A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis .

Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner.

I nodded thoughtfully, but I didn’t really hear anything he said, because my brain was shrieking, ‘HE’S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!’

I left Andy’s office with some written instructions, and a prescription for a product called ‘MoviPrep,’ which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America ‘s enemies.

I spent the next several days productively sitting around being nervous.

Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn’t eat any solid food that day; all I had was chicken broth, which is basicallywater, only with less flavor.

Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-literplastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons). Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes – and here I am being kind – like a mixture of goat spit and urinal cleanser, with just a hint of lemon..

The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, ‘a loose, watery bowel movement may result.’

This is kind of like saying that after you jump off your roof, you may experience contact with the ground.

MoviPrep is a nuclear laxative. I don’t want to be too graphic here, but have you ever seen a space-shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything.. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.

After an action-packed evening, I finally got to sleep.

The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, ‘What if I spurt on Andy?’ How do you apologize to a friend for something like that? Flowers would not be enough.

At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the heck the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked.

Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep.
At first I was ticked off that I hadn’t thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house.

When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point.

Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand.

There was music playing in the room, and I realized that the song was ‘Dancing Queen’ by ABBA. I remarked to Andy that, of all the songs that could be playing during this particular procedure, ‘Dancing Queen’ had to be the least appropriate.

‘You want me to turn it up?’ said Andy, from somewhere behind me.

‘Ha ha,’ I said. And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.

I have no idea. Really. I slept through it. One moment, ABBA was yelling ‘Dancing Queen, feel the beat of the tambourine,’ and the next moment, I was back in the other room, waking up in a very mellow mood.

Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that It was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.


On the subject of Colonoscopies . . .
Colonoscopies are no joke, but these comments during the exam were quite humorous. A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:

1.. ‘Take it easy, Doc. You’re boldly going where no man has gone before!’

2. ‘Find Amelia Earhart yet?’

3. ‘Can you hear me NOW?’

4. ‘Are we there yet? Are we there yet? Are we there yet?’

5. ‘You know, in Arkansas , we’re now legally married.’

6. ‘Any sign of the trapped miners, Chief?’

7. ‘You put your left hand in, you take your left hand out . ..’

8. ‘Hey! Now I know how a Muppet feels!’

9. ‘If your hand doesn’t fit, you must quit!’

10… ‘Hey Doc, let me know if you find my dignity.’

11. ‘You used to be an executive at Enron, didn’t you?’

12. ‘God, now I know why I am not gay.’

And the VERY best one of all:
13. ‘Could you write a note for my wife saying that my head is not up there?’
 

I have had a lot of request to do scopes on a Saturday morning. I will be doing a list at John Fawkner hospital this coming Saturday on August 27th.

I normally like to see all my patients beforehand so that full informed consent can be obtained. I can see my patients before hand at:

The Clinic Footscray (Wednesday) – Aug 17th and 24th
1st Floor, 91 Paisley Street, Footscray 3011 Tel: 9687 2271 Fax: 9689 6008

John Fawkner Private Hospital Consulting Rooms(Monday – Aug 22nd)
267 Moreland Road, Coburg 3058 Tel: 9385 2285

Caroline Springs Specialist Centre Suite 3-5, 224-226 Caroline Springs Blvd, Caroline Springs 3023 Tel: 8361 7655

Please bring along a referral from the general practitioner. (If you have seen me before, you would need a new referral if the last referral letter from your GP was more than 12 months old)

If it is not possible to come for a consult before hand or it is an urgent referral(ie acute bleeding from haemorrhoids) – please contact me directly through the rooms.

For more information about the procedures and the bowel preparation please see www.melbournesurgery.com

http://seriouslyreallyseriously.blogspot.com/2010/11/sparkling-clean-colon.html

A patient told me to look this up in YouTube…

http://www.youtube.com/watch?v=BBMsPNI6EZE

Many condition can cause rectal bleeding. It is important that you exclude a serious cause first by speaking to your doctor!  Risks symptoms for a more serious cause include having clots, blood being mixed with the stools, having lots of bleeding, bleeding frank blood, passage of mucus, increasing age(the older you are the higher your risk of bowel cancer), presence of anaemia and loss of weight

Causes include:

1. Bowel cancer – in particular a rectal cancer or cancer in the sigmoid colon

2. Polyps in the bowel – especially large ones in the rectum

3. Haemorroids – this is quite common but it is important to speak to your doctor about it and be examined throughly to exclude more serious cause

4. Inflammatory bowel disease eg proctitis, ulcerative colitis, Crohn’s disease

5. Anal fissure – usually there is a lot of pain when or after opening the bowels(but be warned : rectal cancer invading into the anal canal can also be painful)

6. Trauma to the perianal tissue

Lifetime risk of developing bowel cancer in Australia by the age of 85 years old:

1 in 10 men

1 in 14 women

Medial age at diagnosis: 70 years old

Risks in next 5 years:

30 year old person – 1 in 7000(less than the risks from a colonoscopy of perforation and serious bleeding)

40 year old person – 1 in 1200

50 year old person – 1 in 300

60 year old person – 1 in 100

70 year old person – 1in 65

80 year old person – 1 in 50

The risk is also greater for people with a family history of bowel cancer

INSTRUCTIONS FOR COLONOSCOPY

DAY BEFORE TEST

Have a light breakfast(but do not have any grain bread or anything with seeds in it)

12:00 Noon

Have a light lunch – (eg soup, sandwich). YOU MUST NOT EAT AFTER THIS

3:00 pm

Start taking the COLOCAPS BALANCE

Swallow down 5 capsules with a glass of clear fluids(eg water, black tea or coffee without mild, cordials, strained fruit juices without pulps, jelly, clear soup)

If morning procedure,

Continue taking 5 capsules every 15min until all 65 capsules have been taken

If afternoon procedure,

Continue doing these until there are 20 capsules left.

Leave 20 capsules to take on the morning of the test – every 15 minutely from 7am until 8am. You can continue to have clear non-alcoholic fluids up to 4 hours prior to the procedure

INSTRUCTIONS FOR COLONOSCOPY

DAY BEFORE TEST

Have a light breakfast(but do not have any grain bread or anything with seeds in it)

Dissolve GLYCOPREP in ONE litre of water and place in fridge

12:00 Noon

Have a light lunch – (eg soup, sandwich). YOU MUST NOT EAT AFTER THIS

3:00 pm

Start drinking the GLYCOPREP solution – drink 1 glass every 15 minutes. (Slow down if nauseaous)

5:00 pm

Mix 1 sachet PICOPREP with water and drink. Drink at least 1 litre of clear fluids(eg water, black tea or coffee without mild, cordials, strained fruit juices without pulps, jelly, clear soup) over the next 2 hours

7:00pm

Mix 1 sachet PICOPREP with water and drink. Drink at least 1 litre of clear fluids over the next 2 hours

DAY OF TEST

Morning examination – Do not eat or drink anything. Take usual medication with sip of wter.

Afternoon examination – Drink lots of clear fluids up to 4 hours before procedure.

One of the interesting things working in Australia is the English we use – even today after nearly 20 years here, I am still learning the language.

Just the other day, my theatre nurse was saying “this whipper snapper is having a double banger this arvo”.  I could see that my registrar(who is an international medical graduate) had no idea what she was talking about. I sort of had to guess what a whipper snapper is…

Anyway, a double banger(also called a top & tail or top & bottom) is a gastroscopy and colonoscopy.

Whipper snapper – I am told that this is a term we refer to someone who is younger. But in this case, we were referring to a “young” elderly man!

To all the medical students and doctors taking the AMC exams who may be reading this, don’t worry – this will should not come out in your exams! Imagine getting a question like this in “layman’s terms” – “Please discuss with this whipper snapper who has family history of  bowel cancer the pros and cons of doing a double banger”

Oh.. and by the way, “arvo” means afternoon – learnt that years ago, when my colleague told me he was taking the “arvo” off and handing over the pager to me.

An elderly patient was referred with rectal bleeding thought to be from haemorrhoids(The patient has just had colonoscopy <2 years ago by a gastroenterologist which showed only haemorrhoids and was otherwise reported as normal) The patient’s bleeding had not really settled at all since the previous colonoscopy and the patient’s bleeding was attributed to the haemorrhoids reported in the colonoscopy. The patient was referred recently for the haemorrhoidal bleeding and a colonoscopy was performed. A low rectal cancer measuring about 5cm was found(the cancer was arising from a tubulovillous adenoma, located just above the anal canal, the tumour can be felt on rectal examination – mobile, T2 on MRI). Fortunately, this could be treated with a transanal excision of the rectal cancer and the patient recovered quickly from the surgery.

The points to learn from here is that :

1. One should not always assume any rectal bleeding is due to haemorrhoids- especially if this persist despite treatment of the haemorrhoids. (If haemorrhoids have been bleeding up to the colonoscopy, it would be a good idea to band them at the end of the colonoscopy) If symptoms persist, reinvestigate or refer on.

2. A rectal examination is still useful even in the 21st century- As Norman Browse’s book on Symptoms and Signs of Surgical Diseases says “”Every patient with a rectal complaint should have a rectal examination”". This still holds true today. Be thankful that there are gloves these days – I have heard in the past in places where gloves were not easily available, doctors used to put soap into their fingernails before doing the rectal examination. ( A good tip is to double glove the hand doing the rectal examination – that way you can throw away the top glove after the rectal exam before doing anything else)

3. On colonoscopy, care must be taken to look carefully at the anal canal and what is just above. Sometimes faeculent fluid can obscure the view – this should be sucked out. A J manouvre at the end in the rectum is also useful. In fact during my training, I remembered one of my mentors telling me how he heard about a case of a low rectal cancer being missed during a colonoscopydue to too rapid an insertion.