A colonoscopy, part 2: The big day
I had a colonoscopy on Jan. 16, and in part one, last week, I talked about the days leading up to the procedure.
The morning of the exam, I got up at 5:30. I had to be at Mid Coast Hospital in Brunswick by 9:30, but I had to drink the remaining half of the Miralax mixture four hours before the exam.
My brother, Peter, picked me up at 9 sharp. I would love to have stopped at a McDonald’s for a breakfast sandwich, but of course that was out of the question.
After checking in, I was admitted to a small room where I changed into the requisite johnny, open in the back.
Each of the four times I’ve had colonoscopies at Mid Coast Hospital, I’ve been covered with a soft, warm flannel blanket while waiting to be wheeled into the exam room. (I love that, especially in contrast to my first colonoscopy at a hospital in Massachusetts, which I won’t name, where I sat on a cold metal chair for two hours before being led into a chilly room and laid on a cold metal table. There was nothing warm and fuzzy about that experience.)
A nice nurse, Ginny Boucher, set me up with the IV. This is one part of the whole procedure that I really dread. I hate needles.
Common practice seems to be inserting the IV needle into the back of the hand. Ouch. The first time that didn’t happen wasn’t fun. The nurse couldn’t find a vein, and after several attempts she switched over to the side of my wrist, just above my thumb. Painless. I have requested that site each time since, and the attending nurse has always been happy to comply.
And on that day, my new friend Ginny Boucher even applied a bit of novocaine first, and I felt zilch when she inserted the larger IV needle. Remember that.
Now – the big event! I was wheeled into the exam room, still relaxing on a soft mattress with a warm flannel blankie, and friendly nurses fawning over me.
Living alone, I don’t get fawned over a lot, so I really like that part. It’s very comforting.
In the exam room, I got all set up with heart monitors and one of the oxygen things they stick in your nose, and I was introduced to gastroenterologist Calin Stoicov, MD, Ph.D. He was ready to get that ball rolling.
I was comfortable and feeling pampered and spoiled, and they started pumping the meds into me. Then it’s like la-la land. Even if you’ve been dreading a colonoscopy for a month, at this point, with those relaxing meds flowing through, you’ll be happy.
Many patients start dozing off around this time. I remain awake and alert, if relaxed. That is determined, in part, by the type of sedation administered, Dr. Stoicov said.
Though most have sedation, one or two percent request none, he said.
“They may have no one to drive them home, or have plans for later in the day that would be made difficult if sedation was still present in their system.”
Some, who wish to be “out” for the entire procedure, request deep sedation. Dr. Stoicov said deep sedation is achieved with a medication called propofol.
“Propofol may be used for a patient with a lot of anxiety, someone with certain medical conditions, or who has had an unpleasant experience with a previous colonoscopy.”
Others are given conscious sedation.
“This is usually a superficial state, where the patient is made comfortable and relaxed, and if he or she expresses some pain, I can administer a little more,” Stoicov said.
One of those medications, midazolam, or Versed, usually induces some amnesia, too.
“Some patients fall asleep, some don’t, some watch it on the screen, some don’t, sometimes they remember the procedure afterward, sometimes they don’t,” Stoicov said. “My goal is to make and keep them comfortable.”
I’m one of those conscious sedation types who has never slept through it, and have always watched it on the screen.
The colonoscope, connected to a camera and video display monitor that allow the physician to view the entire lining of the colon, is inserted, and the movie begins on a large screen right in front of you. All that’s missing is popcorn and a glass of wine.
I find it fascinating to watch as the scope winds its way through. I understand why some (most) are squeamish about watching it, but there’s nothing gross about it, especially with those nice meds.
Dr. Stoicov wishes more would watch.
“If the patient wants to be involved in the process, I think it’s very educational,” he said. “You see your colon, you see what I see, and I can describe what I’m looking for. If my patients learn something from the procedure, it’s better for all involved.”
Polyps are mainly what the doctor looks for in a colonoscopy. There are precancerous polyps, or adenomas, and non-cancerous, or hyperplastic, polyps, according to Dr. Stoicov. Adenomas are found in approximately 30 to 35 percent of patients with an average risk for colon cancer: those with no family history of colon cancer or large polyps, and no history of Crohn’s disease or ulcerative colitis.
It generally takes five years for a polyp to grow from a small size to a possible pre-cancerous one. Patients with adenomas are usually asked to schedule another colonoscopy in three to five years. If non-cancerous polyps are found, the next procedure won’t have to be scheduled for 10 years.
As I watched the scope’s view of my colon, Dr. Stoicov described what I was seeing. He took several biopsies as the scope snaked its way through.
I have ulcerative colitis. Chronic inflammation of the colon is common in many ulcerative colitis and Crohn’s disease patients. If that chronic inflammation isn’t kept at bay, it can lead to changes that may eventually lead to colon cancer.
There’s no cure for ulcerative colitis, but luckily mine has been kept at bay through a prescription, sulfasalazine. Dr. Stoicov said my colon was in great shape, thanks to several years of no chronic inflammation. Yay. Not a single polyp.
According to Dr. Stoicov, in 2017, 95,000 people in the U.S. were diagnosed with colon cancer, the second leading cause of cancer deaths in the U.S. The rates used to be much higher; he attributes the lower rate to colonoscopies.
Around 26 colonoscopies are performed daily at Mid Coast Hospital, by two doctors. The procedure takes about a half hour, with some running up to an hour. Twenty-six cases of colon cancer were diagnosed there in 2017.
“In the U.S., only 65 percent of patients who should have colonoscopies, do,” Dr. Stoicov said. “Thirty-five percent of patients are not getting this done, for one reason or another. A colonoscopy has become much more comfortable than it used to be, and the prep is better than it used to be.
“Colon cancer is a preventable disease. We can stop it from happening. Will we get the rates down to zero? No, but we prevent a lot of it.”
March is Colon Cancer Awareness month. If you’re over 50, or have a family history of colon cancer, have ulcerative colitis or Crohn’s disease, notice blood in your stool, or have unexplained abdominal pain, do yourself a favor. Schedule a colonoscopy today.
And if you see Stuart Smith around the Boothbay area, give him a thumbs up. He’ll be visiting Dr. Stoicov on Friday, Feb. 2.
Peter and I went to McDonald’s for lunch on the way home. I had a Quarter Pounder with cheese, fries and a chocolate milk. It was delicious. Peter's not really a fan of McDonald's, but he gallantly sprang for a Filet o' Fish.