Sunday, 4 March 2018

Seven Tips For Your First Colonoscopy

It always feels like a gamble googling anything medical.

Depending upon where you end up you may very likely in minutes conclude that your symptoms are signs of something terminal that has been waiting to get you from the moment you were born, that your condition is unrecoverable, and if it is operable, it will be merciless.  I love facts (It comes with the job.) but rarely does a statistic, a description or a new word for the vocabulary bring me comfort.

I therefore will not waste your time or further worry you by describing the pipes involved in colonoscopy (but those of the investigator and of your own good self) nor the names of the sedatives or which side you will lie on first.   That is not what this post is about.  It is about me, saying to you, "I understand that sensation of sleepless nights, of worry about what will be found, the morbid curiosity in what it will feel like and who will be there and whether or not the hospital has done away with three-quarter-length, floral print gowns, or if they have replaced them with something even more garish."

I know that my five golden rules of living with Crohn's was very useful to some individuals and maybe these tips may help if this is your first colonoscopy.   I've been there many times in the last thirteen years and there is a general pattern that can be predicted and prepared for.  I hope the following tips bring you some comfort, and if they do not, at least provide you with a distraction through proactivity.  That is my golden rule about Colonoscopies.

Please do share your own tips.

Tip one - Get Perspective


Recognise that this is the most difficult tip to accomplish (there is some perspective for you!) so it is important you accept the following points.

  • It is worth it. Either you will be told that your pipes are spotless and you can go back to your life with a spring in your step or there is something that needs addressing and the sooner you know, the sooner you can be treated.
  • The procedure is never as bad as the weeks waiting beforehand - or the bowel prep (see tips three and four).
  • The risks are minimal.  The worst thing that could happen is perforation of the bowel which is a minimal risk and if it does occur, you are in the best place and will have immediate treatment.  That is a scary thought but you should face that fear, get some perspective, and then you can move on and you already most of the way there to getting through this.

Tip two - Inform others


There are at least two people you must inform.

  • Your line manager:  You need to take the day off from your colonoscopy.  Don't be a hero - well, still be an amazing, iridescent individual but take the whole day off.  No one will think better of you for saying you will be back at work for three in the afternoon, only to find yourself not returning to the office until the following day.  The best way to be reliable is to be clear about when you can't be relied upon so be realistic. Once the adrenalin wears off, you will be weaker than you expected from the lack of food. Rest.  
  • Someone with a car:  The optional sedation requires that someone be with you for 24 hours, you are unable to legally drive and leaving the hospital is on the promise you will not use public transport.  You may not need a sedative, but if you do need one, you will want to know someone is there for you that can take you home.  It is worth pulling in that favour in case you need a sedative. 

Tip three - Eat well, until you can't


You are provided with a set of instructions on what and when to eat. Around two days before the procedure you must stop eating food high in fibre including red meats, vegetables, brown rice - and all the other healthy stuff.  Failure to comply means food in the bowel during the procedure and a wasted effort.  However, before that deadline, eat well.  Don't drop your broccoli intake too early: keep being healthy up to the two day deadline.

...and then... *drumroll*

Once you move to a low fibre diet enjoy a wide selection of highly-processed foods that suddenly become the doctor's order to consume.  Let me know what you find.  The internet is a great source for such culinary solutions.

The final phase is a liquid diet and most people get rather low at this stage. There is only so much lemon squash one can drink.  I recommend miso soup.  You can buy the expensive sachets (make sure remove the seaweed using a tea strainer) but a cheaper alternative is the purchase of a margarine tub from the Asian supermarkets for relatively little and just dissolve in hot water.  Westerners always put too little paste in their mug, be generous.  Failing that, OXO cubes work a treat.  You need something other than sweet and the miso will help wipe away the taste of the bowel prep.  Speaking of which...

Tip four - Get your cups ready


Bowel preperative recipes have significantly improved over the last ten years.  They used to be bloody awful - which I assumed at the time was the idea.  Your discerning bowel blows out its contents and then continues to pass the prep until it feels like you are having a wee.  It is not nice but that's all.  You are going to have every last drop and I am going to explain how.

  • Make the prep in a large jug. 
  • Chill it in the fridge.  You usually make a litre and then consume it over an hour (check your instructions and adapt as appropriate).  
  • Get yourself six mugs and a pint glass.
  • Decant the contents of the jug into five of the mugs. Pour a little bit at a time into each and then return to the first, this prevents a Russian Roulette scenario emerging with one cup containing all the electrolyte whilst the others just lemony water.
  • Line them up, perhaps on the window ledge to your bathroom.
  • Get yourself a pint of squash and a miso soup.
  • Set a timer for 10 minutes.
  • Using a straw, drink one of the cups (it helps if you put the straw as far back in your mouth as possible, keeping the liquid away from the tip of your tongue).
  • Reset your timer.
  • Every 10 minutes,  drink a cup of bowel prep.
This is by far the best method.  You are able to track your progress without becoming morbidly occupied in the exercise.  I am critical of our society's gamification of activities through smart phones  and the effect it is having on our ability to concentrate, but in this scenario I encourage you to access a feeling of success in putting down the now empty mug and fist-pumping the air.  

To those of you who have been on or near the sea and gotten sunburnt despite the fact you felt cold in the wind, you know that your body can sometimes deceive you into a false sense of security.  Despite all the liquid you have drunk, you will be dehydrated.  I know it feels like you have had all the water you can stomach but unfortunately it is passing through you too quickly to be absorbed correctly.   Remember to stay hydrated.  Dispense the squash/miso in a similar manner to the bowel preperative in order to measure your progress.  

Tip five - Pack right


My last colonoscopy involved three waiting rooms, the surgery room and another two waiting rooms within the space of two hours.  Pack right to get the most from it.

  • Hat: your body is running low on power.  Don't get cold.
  • Slippers: the one item of clothing you can maintain.  It's a great help for morale.
  • Book: you never know.  You might get the chance to read.
  • Smartphone:  many will say to leave valuables behind and I would agree that entrusting your wallet and house keys to whoever accompanies you is a great idea, but keep your smartphone. As professional as the staff are, both you and whoever accompanies you need to know that they can text each other should they need to.  Also, I find that I am forever having to quote information back to each of the staff (I had to give the telephone number of next of kin three times in thirty minutes - fortunately I save that sort of information on my smartphone).

Tip six - Introduce yourself


Once in theatre, despite the flurry of activity, staff will set aside time to introduce themselves and to make you feel at ease.  Capitalise on this by recognising that this is your allotted time to build rapport with them. Introduce yourself, state any concerns and ask your questions.  A rapport is necessary as you will be awake and to an extent helping them help you make the investigation as easy as possible.

Tip seven - Eat the biscuits!


You've earned it.  You'll also need some sugar in your system to receive your debriefing.  This is your best opportunity to ask questions: whilst all the information and a specialist is in front of you.

If you have any questions about any of the above, you are welcome to get in touch.

My best to you

Sam

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