Dr. Bill’s Colonoscopy

The following article was originally posted on my Quotes and Wisdom from the Top of the Mind newsletter and the response extremely positive with many readers suggesting that we add it to the Articles section of the site so that others may benefit.

Courage isn’t the absence of fear, but the decision that what we want is more important than what we are afraid of.
– Bill Crawford

In lieu of the traditional “quote and comment” this week, I thought I would write a few words about a procedure I recently had done with the hopes that this information might be of value to others who may be considering a colonoscopy, but have put it off due to their concerns about the experience. I probably should start by letting you know that I am a 57-year-old male who has had no symptoms that might indicate any problems in that area, but who does have a family history of cancer of all types (both of my parents died of cancer within about six months of each other when I was 21 years old).

Like many others, I have been told that having a colonoscopy would be a good idea for quite some time and . . . like many others, I had “just never gotten around to making it happen.” I am a person who believes in best practices, preventive medicine, and taking the advice we would give others, however, and thus with my wife’s encouragement, I finally began to research some of the physicians that were accepted by my medical insurance. After locating a doctor who specialized in these procedures and had a 5 out of 5 “patient satisfaction” rating on healthgrades.com, I began talking to friends and looking on the internet to see what others had experienced with respect to their colonoscopy. Here I found both a wealth of valuable information, as well as a few horror stories that made my skin crawl. Because I am not a big fan of horror stories, however, I decided to focus on the valuable information and do whatever I could to make the experience as comfortable as possible.

The first aspect of the procedure (and what almost everyone says is the most difficult) is the preparation which generally consists of being on a liquid diet for at least a day before the procedure. This, and the laxatives prescribed allow for the “cleaning out of the colon” (diarrhea) so that the doctor can accurately locate, and if necessary, remove any “polyps” or pre-cancerous growths.

In the not-too-distant past, this preparation included drinking very large amounts (up to a gallon) of what I understand to be a rather thick liquid laxative which many people reported to be almost intolerable. In fact, the nurse at Dr. Keith Fiman’s office said that when he (Dr. Fiman) had a colonoscopy, he had to drink this concoction, and reportedly swore he would never make his patients endure this. Instead, he prescribed two 1.5 ounce doses of FLEET PHOSPHO-SODA (actually it was an over-the-counter purchase) which turned out to be very tolerable.

Below are my recommendations for a colonoscopy experience of maximum comfort and minimum inconvenience:

  1. Select a physician who does this procedure all of the time and has a high patient satisfaction rating, and a facility that is set up for your comfort. If you are in Houston, I found Dr. Keith Fiman and the Physician’s Endoscopy Center to be an excellent choice.
  2. Schedule the procedure for early in the morning. This allows you to have breakfast after it is over and minimizes the potential that other procedures will delay your physician getting to you on time.
  3. The day before your procedure, you will be instructed to follow a “clear liquid” diet. The good news is that this includes Jell-O, broth, Gatorade, Coke, and even coffee and tea (although without cream). I don’t like coffee without cream so 25 hours before my procedure, I had my regular morning coffee with Jell-O as my breakfast.
  4. The rest of that day I had Jell-O, chicken broth, Gatorade, and Sprite whenever I was hungry, and it worked well in that I didn’t feel particularly deprived. They encouraged me to drink plenty of clear liquids that day, so I tried to have something around pretty much all of the time to sip on.
  5. At 4 PM on the day before the procedure, I was instructed to mix one 1.5 oz bottle of FLEET PHOSPHO-SODA with 4 oz of Crystal Light lemonade or ginger ale. I choose the lemon-ginger flavored version of the Fleet and mixed it with ginger ale, and it tasted just fine. They said to follow this with 8 oz. of clear liquid and I chose Gatorade…again, no big deal.
  6. Because I had read that you will spend A LOT of time in the bathroom after you take the laxative, I had prepared the room with a small TV and a VCR. I had also taped several of my favorite shows to watch while I was on the “throne,” and let my family know that I would be pretty much indisposed that evening. All of that worked very well, and towards the end of the evening, I felt thoroughly cleaned out and ready for bed.
  7. The one challenge with an early appointment time is that they want you to take the second dose of Fleet Phospho Soda three hours before you leave for your procedure. I fudged this a bit and took my second dose about two & a half hours before, but this still had me getting up at around 4:30 a.m. They also said to follow this with four, 8 oz. glasses of clear liquid, and this combined with the early hour was probably the worst of the experience. Still, on an inconvenience scale of 1 to 10, it was only about a “4,” and was over quickly. Of course, given that the Fleet is a laxative, I was once again “king of the commode” for a while. However, having programs to watch that I enjoyed made the experience no big deal.
  8. When my wife and I arrived at the Physician’s Endoscopy Center, I was taken back to the preparation room where I was instructed to change into one of those lovely hospital gowns that are open at the back (for obvious reasons). Here is where the attention to patient comfort and satisfaction by the center and the staff was a big plus. For example, once I was in my new gown, I was given a blanket that had been warmed in a dryer (nice touch). Plus, there was relaxing music playing in the room, and in general, the staff were very attentive and comforting.
  9. When it was my time, my bed was rolled into the room where the procedure would take place, and I met Dr. Fiman for the first time. Because this was just a screening procedure, I didn’t feel the need to have an office visit prior to the actual colonoscopy. Dr. Fiman was not only okay with this, he actually works with many of his patients this way because he feels it removes one more block (the hassle of an office visit, a co-pay, etc.) to someone coming in for the screening (he calls this “Open Access”). Imagine, physicians working with the patient to reduce the hassle and the cost…what a concept!
  10. He was very pleasant, explained what the procedure was all about, and asked if I had any questions. The only thing I wanted to ensure was that I felt and remembered as little as possible. I had learned from my research that the type of anesthetic they used was called “conscious sedation” which concerned me a bit because I frankly didn’t want to be conscious of anything! However, I had been assured by the staff that they could always give me more of the sedative if I was uncomfortable, and therefore I told Dr. Fiman to err on the “unconscious” side, and that my goal was to wake up and wonder if it had already been done.
  11. He smiled and agreed, and in fact, this is exactly what happened. The last thing I remember is the nurse telling me that they were going to start the IV, and then I awoke to see my wife, Georgia, sitting next to my bed. Never felt a thing! YES!!!!!!!!!!!!!!!!!!! 🙂
  12. Dr. Fiman came in shortly after I awoke and told both Georgia and I that everything was fine, and I wouldn’t have to do this again for another 10 years. Of course, given that I was still a bit “under the influence,” I actually don’t remember much of this conversation which is why they require that you have someone to drive you home after the procedure, and suggest that this person be in on the conversation with the doctor. Good idea!
  13. We then went by Blockbusters where I rented several movies to watch when I got home (my favorite, ironically, was “Sicko” by Michael Moore) and the rest of the day was a nice combination of food and rest, although towards the middle of the afternoon, I felt that if I had really needed to get something done, I would have been able to do so.

Bottom line, with research and preparation, this experience was nowhere near the uncomfortable ordeal I had feared. Instead, it was minimally inconvenient, and certainly worth the peace of mind I now have about the health of my colon. Basically, I decided that what I wanted was more important than what I was afraid of, and this decision allowed me to move forward in a proactive manner, and I’m very glad I did.

My hopes are that this recounting of my experience will give you or anyone you know information and motivation to do the same, or, as another of my favorite quotes says: “Worrying does not empty tomorrow of its troubles, It empties today of its strength.” Here’s to a choice that moves past worry and instead embraces the strength we need to face our fears and take care of ourselves in a way we would take care of someone we loved.