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Saturday, September 16, 2017
Health / Nutrition ...

I recently survived my second colonoscopy, and so I thought that I would share my experiences, so that they might help someone else going thru this (just as I myself was helped by the many people who have shared their own colonoscopy experiences on a wide variety of websites). I had my first one at age 53 and the results were “clean”. My second one should have taken place last year (ten years after . . . hmmm, wasn’t that a band that played at Woodstock? Just to show my age . . . ). But I dragged my feet. I finally got up the nerve to make the arrangements, so I was scheduled for September 11, just about 2 weeks before it would have been 11 years from my last one. The doctor didn’t reprimand me about that, as he was probably happy that it wasn’t even later (or that I did it at all — I know another guy around my age who has gone past his 10 year colonoscopy anniversary, and he has no intent to get one anytime soon).

I don’t think that anyone likes the day before a colonoscopy, when you have to restrict yourself to a clear liquid diet and swallow down some vile stuff that will purge your guts of anything but clear liquid. In preparation for my first colonoscopy, I was advised to drink down two bottles of phospho soda diluted with ginger ale (about 3 hours apart). I wasn’t crazy about the taste, but I managed to get it down and it worked its magic just as expected.

But it worked only too good — in the evening, I started feeling very sick and weak, and I became dizzy and nauseous (even though there really wasn’t anything left in my stomach to throw up!). I tried to call the doctors office answering service to cancel the procedure, and I was one step away from calling EMS. But somehow I stuck to the fast and leveled out after a few hours. I managed to get some sleep, and even more important, I managed to get up the next day and recoup enough strength to go thru with the procedure. I got thru it OK, but the evening before was pretty much a nightmare. Only years later did I realize that I was experiencing dehydration — even though I was still drinking liquids, I didn’t drink fast enough to sufficiently replace the lost fluids and electrolytes that got flushed out of me by the phospho.

Obviously, I wanted to avoid dehydration this time around. I knew enough this time to make sure that I keep forcing liquid stuff down my throat, including some electrolyte replenisher (most people like Gatorade for that, but I went with the industrial-strength stuff, i.e. Pedialyte). I was also nervous about the fact that I was now 11 years older and starting to lose stamina. Was my body going to get me thru a day of fast and flush, and still have the strength to walk into an outpatient center the next day for a relatively major medical procedure? And be mentally coherent enough to answer all the questions and sign the documents and listen to all the instructions during the procedure preparation?

And now a new wrinkle — phosopho soda was banned from colonoscopy prep a few years after I used it, as there were more and more cases of kidney damage from it (luckily there weren’t any signs of such damage during my semi-annual physical check-up tests during the past 10 years). A wide variety of different preps were available, including the relatively popular Gatorade / Miralax / Ducolax trio using all over-the-counter stuff (my brother had a colonoscopy about two years after my first one, and he was instructed to use this combo — he said that it worked well, and didn’t have any unexpected side-effects). But my doctor (same doctor that both my brother and I used a decade ago) was now prescribing Suprep to his colonoscopy patients. He said that it wasn’t too hard to use, and gave good results. And it even had a cherry flavor! Well, I had never heard of Suprep before, but I had no objections.

Of course, a few days later I got around to checking out Suprep’s reputation on the Internet. And it turned out that even though some people gave Suprep a good rating, a whole lot of other people found it to be quite vile. No one challenged its efficacy — no one claimed that Suprep did not work for them (none that I could find). Most people claimed that it did the job quite quickly !! But a lot of people complained about the taste — some even claimed that it made them nauseous and that they couldn’t finish the first dose, or get down the second dose (6 hours later, for Suprep). Some even threw the stuff up after drinking it. And of course there are some YouTube videos showing people drinking the stuff, and the stars of these productions clearly show their angst during the process. In the realm of writing, you can find a lot of colorful descriptions of the Suprep drinking experience. It has been described as metallic, salty, briney, and even swamp water with a hint of cherry. Suprep comes in a 6 oz bottle and you dilute it with water to 16 oz before starting to drink it. In order to make the stuff go down easier, it is recommended that you chill the mixing water in your refrigerator, and that you use a straw when you drink it down, as to keep the mix in back of your tongue as much as possible. Also, it is recommended that you have something ready to gargle (Listerine) or suck on (e.g., candy or a cut lemon) between sips, as to wash the awful taste out of your mouth ASAP.

I followed the first two recommendations, but it turned out that I did not need the third. Perhaps some people’s taste buds are more sensitive than others, and maybe my own are more on the insensitive side. Because I really didn’t find the Suprep mix to be all that terrible. Yes, it is still medicine, it is not pleasant. You wouldn’t want to drink this stuff as an after-dinner cocktail. But it wasn’t all that hard for me to get down and keep down. To be honest, it didn’t taste much worse (to me) than Pedialyte. If you have a colonoscopy coming up and you want to practice to get ready for Suprep, get some strawberry-flavored Pedialyte and drink some of it (straight, unmixed). If you can handle Pedialyte, you should be OK with Suprep.

So how did Suprep work for me? Well, as I said, you get to drink two doses of Suprep over the course of your colonoscopy preparation day. Most gastro doctors (along with the general instructions that come in the Suprep kit) assume that you will drink your first dose of Suprep in the early evening, maybe around 5 or 6 pm; and then 3 to 6 hours before your appointment time, guzzle down the second dose. Since a lot of colonoscopies are performed in the morning, this could mean getting up around 3 am and doing the second flush-out in the dark of night, or as the sun is starting to rise. Luckily, my doctor has a different policy; his instructions were to have your first dose around noon, and then do your second one 6 hours later. That made more sense to me. You thus have enough time to get fully cleaned out, and avoid possibly having to go just after you leave home or are in the waiting room.

I got started a little late, around 1 pm, and it took another 25 minutes until I was heading for the bathroom. After another 30 minutes, things settled down, the action seemed to be over. A lot of matter and liquid had come out of me, but it was not nearly clear in color. There was still more junk down in my colon, for the second round to handle. Actually, I was mildly concerned at that point about how well Suprep was working for me. Would my colon really be squeaky clean and ready for the lights and cameras the next morning, if the second round wasn’t any better than the first? I decided that it wasn’t my problem; I would just follow instructions and go whatever did or did not happen. If things weren’t as clean as my doctor would have liked, well hey, I followed his instructions!

Now actually, I’m going to admit that I did take some liberties during the preparation. No, I didn’t eat any real food, but I was concerned about getting some nutrition. Basically, just about everything on the approved list for the prep is a mix of salt and water or sugar and water, with some caffeine also allowed (coffee and tea without milk). There is also Jello on the list (so long as it isn’t red), but as a vegetarian, I won’t eat gelatin. So, I did some research ahead of time as to what I might be able to drink that would provide some vitamins and even some protein, and yet not violate the clear-liquid rules (including no fiber, nothing red-dyed, etc.). And also, was there something Jello-like that a vegetarian could eat (that also wouldn’t mess up a colonoscopy)?

As to nutrition — I decided to get some Ensure Clear Supplement, the apple-flavored Institutional version used in hospitals. My searches indicated that there were a few gastro doctors who said that Ensure Clear would be OK so long as it wasn’t the stuff with red or purple dye (although my own doctor did not have it on my approval list). I saw Ensure Clear in some local supermarkets and drug stores; but it was always the blueberry-pomegranate flavored stuff, which had a reddish color to it. So no good, too red.

But with some searching you can find some places to buy the yellow-ish apple flavored institutional version, including eBay, and Betty Mills. It’s around $2 to $3 for an 8 oz box, but it has a good mix of vitamins and a bit of protein. The description of it on the official Ensure / Abbott Labs web site says quite clearly that Ensure Clear Apple is appropriate for clear liquid diets and bowel preparation.

So, I bought four boxes, and they arrived in the mail a few days before my procedure. I used three of them over the course of my preparation day; basically, morning, noon and night. The protein in Ensure Clear is described as a dairy whey isolate (and there isn’t much of it, only 8 grams per box). According to some web searching, whey isolate is not white and chalky like regular milk protein, but is a clear brownish substance that is rapidly absorbed. I figured that even if any of this protein were to be left in my gut, it would be mixed pretty well with liquid, and shouldn’t obscure the view of my colon (I hope).

As to the Jello question — probably the most popular vegetarian Jello substitute is agar jell. There are a number of sites showing how to make agar jello, so long as you have some agar powder available (luckily I had ordered some out of curiosity a few months before). It’s pretty simple to make; you mix 2 cups of whatever liquid you want to jell (so long as it isn’t red) with 1 teaspoon of agar powder, then heat and stir the mix for a few minutes as it boils, then pour into a cup or mold as you would do with regular Jello. I tried making a small batch with water, corn syrup and lemon extract, and it turned out rather well. So that was going to be my jello treat on preparation day.

Oh, people on the web have asked, can you substitute agar jel for regular Jello during a colonoscopy prep. And there doesn’t seem to be a clear answer. One person with some knowledge seemed to think not:

Animal-based gelatin is digested into individual amino acids, which are water soluble. In contrast, agar is not digestible at all by humans, and passes through the gut as indigestible fiber. It seems like a bad idea to eat anything indigestible before a colonoscopy.

But I decided to go ahead with my agar lemon jello anyway. I only ate a little; the four servings that I had added up to one cup, with one teaspoon of agar in it. When you look at the nutrition tables for agar, 1 teaspoon has very little fiber in it, less than 0.1 g. And anyway, my agar jello was clear, and I chewed it into tiny pieces. How much would a tiny piece of clear jell mess up a colonoscopy probe? And anyway, if the Suprep did its job, all of that would be gone by the time I got to bed.

So, those were my little unauthorized deviations from the approved list. By the same token, I took some extra precautions that were not on my doctor’s list, but other doctors seem to enforce. Such as not eating anything nutty or grainy within the last 3 days, and cutting back on high-fiber foods during that time. It seemed to make sense.

Now, back to the Suprep saga. I did my first Suprep round in early afternoon, and although it did start to clean me out, it seemed to have stopped working after an hour. By evening, I had eaten my agar and drank most of my Ensure Clear Apple. So, if the second Suprep didn’t really come on like gang-busters, would I be fully prepared for the scoping tomorrow? It was time for the second act.

I got the second glass of Suprep mix down OK, no gagging or wanting to throw it up (which some people reported on the second round). Then I waited. But not for long. It turned out that Suprep Act II was indeed coming on like gang-busters! An hour had passed and a lot of liquid had come out (and I was drinking replacement liquid as fast as possible, even brought a bottle of water to drink on the toilet). But the Suprep didn’t stop this time. It seemed like I was back on the pot every half hour or so for some more “waterfalls” (as I described it to the doctor the next morning). For what ever reason, the 2nd dose of Suprep was working a lot more vigorously than the first. So long as I could stay ahead of dehydration by drinking enough water, tea, vegetable broth and Pedialyte, I was clearly going to have a well-cleaned out colon for the next morning.

Oh, some notes as to what liquids I drank. Again, most of the stuff on the approval list involves regular table sugar / sucrose (e.g., soda, ice pops, candy, etc.). I have read a lot of bad stuff lately about sucrose, especially the fructose component of it; it plays a number on the body’s metabolism. The more natural alternative seemed to be glucose (the stuff that they give intravenously in hospitals when patients can’t eat). But I couldn’t find any liquid glucose — the closest thing is said to be regular white corn syrup. So that’s what I went with, a mix of corn syrup and water. It seemed a lot gentler, I didn’t get that “crazy” feeling that too much regular sugar causes.

As to the vegetable broth — the approved list says that you can drink “clear broth”. But that is actually an unclear question — what is clear and what is not clear enough before a colonoscopy? Some chicken stocks and broths are relatively clear, but there are varying degrees of “soupiness” to them. The vegetable broths in stores also come in a variety of “cloudiness”. It’s hard to say what is OK and what is not. I finally used a “vegetable stock” that was a little bit cloudy but you could still see a spoon in it for at least an inch or two, and mixed in some of my own water that I had boiled broccoli in. That cut down on the saltiness. Then I put in some more water, and mixed in some corn syrup. It didn’t taste too bad, so I actually enjoyed this stuff after heating it up. It had something of that “warm soup” feeling of reassurance to it.

By 10 pm, I was feeling pretty tired; not dizzy, but not ready to do anything either. I started wondering if I was going to feel strong enough the next morning to get out of bed and get myself ready for my brother to pick me up. I went to bed soon thereafter, but I couldn’t get to sleep — I was worried about whether I was going to have the strength in the morning. Obviously, by not sleeping, I was only making the situation even worse !!! And then, around midnight, I found out that the Suprep had not finished its work yet, so I got up and was back in the bathroom again. Before dawn, I got up and made at least another two visits to “the can”. I finally got some sleep, maybe 4 hours worth, but it was not a good night overall.

And yet . . . my body rallied with the morning sun, as it had 11 years before. I was able to get up around 6:30 am and get dressed. I wasn’t dizzy, I could repeat my Social Security number and my date of birth. And I knew who the President was (unfortunately). My weight was just about normal, which was a good sign — I had drank enough water to replace what had come out, thus avoiding dehydration. Oh, as to the weighing scale — I weighed myself several times during the afternoon and evening of the prep, as to get some idea of how much liquid there was in me. Actually, I had managed to get my weight up about 6 or 7 pounds above my normal weight — water weighs a lot. Now, with morning, it had come down, but it was still in a good place. Overall, my “water management” went pretty well.

It was early morning, September 11. Only after I made the appointment did I realize the irony of the date. The morning actually was a lot like it was on that Tuesday of 16 years ago, sunny and pleasant. But somehow, despite all of the tragedy, American life is still going on. Including plebeian things like colonoscopies — which we should really be thankful for, but we aren’t.

So my brother pulled up in front of my place at 7:30 am and I was on my feet with a paper cup of coffee in hand for him (I couldn’t drink anything until after the colonoscopy was done). The sun was in my face and it started to become apparent that I was going to get it done after all.

And get it done I did. We arrived at the center a few minutes early, and they processed my papers and insurance info in good order. Before long, a nurse was at the door calling me in, and I looked back at my brother and said “wish me luck”. Everyone was professional and courteous and even friendly, and so I didn’t feel any indignity in changing into the gown. My blood pressure was 158/90 during the preparation interview, and I told the nurse that I felt pretty tense. She told me not to worry about it, because most everyone has high blood pressure at this point. So, before you know it, I was lying on the cot with an IV in my hand, zonking out. But before I went under, I did observe that the place had changed since the last time I was there, eleven years ago. Now there were lots of display screens on the walls, and I was wired up to a heart and lung monitor, as if I was going in for major surgery. I didn’t remember any of that last time.

But as with last time, it seemed to be over in a blink. The boss nurse came over and woke me up, and I was feeling pretty good. After giving me a cup of cranberry juice, she led me over to the locker area to get dressed, and in a few minutes I was sitting at a table, awaiting the verdict from the doctor. OK, despite all of the drama over the past 24 hours, this was the real crescendo, this was really the thing that would affect my life. I wasn’t pushing my luck by hoping for a clean report, but at least I hoped that any polyps were small and not likely to be an immediate cancer threat. And maybe I’d get a 3 year reprieve until I had to come back for this again.

The doctor finally broke from another colonoscopy and came over by me in a rush. Bad sign, good sign? It didn’t take long to find out. He didn’t even sit down at the desk with me. He immediately said “didn’t find anything, no polyps, no diverticulitis”. I was almost dumbfounded — “yea, really????” “Yea, and great job on the prep, you get a gold star for that”. He then gave me a serious moment — “ok, you’re done, but keep an eye on things for the next day, call me if anything at all seems wrong”. And off he went to the next patient.

I had to wait for my brother to get back to the center to pick me up, but in the mean time, they gave me a folder with some paperwork, including a report on the procedure. It actually has some printed digital pictures on it, presumably of my own colon !!! Well, this was certainly going to be a keepsake. Under “findings”, I saw a line of words, all “Normal”. In the procedure write-up, “The patient was prepped with Suprep. Preparation was excellent. No problems or issues”. Hey, if you say so.

So, happy ending !!! My brother got me home and I puttered around the house for the rest of the day. I got down some oatmeal and then had some lunch and a regular dinner in the evening. But there was one after-effect: it was an hour after my colonoscopy was done, and the Suprep was still working !!!! I had to “hit the head” another three times before things got back to normal. There were still a few drops left to go over the “Suprep waterfalls”.

In sum, Suprep really hit hard on the second round, after a deceptively placid first take. Given that, I’m left to wonder, were my “transgressions” (the agar jello and the Ensure Clear drink) in fact OK, given that the doc said that my preparation was “excellent”? Or was Suprep so powerful that I could have eaten a cheeseburger for dinner that night (not that I would, being a vegetarian), and it still would have been shot thru the cannon before dawn?

What did become apparent was that my body was a little tougher than I had thought in this situation. So, if a skinny, underweight old vegetarian like me can get thru a “Suprep” and a colonoscopy, then most anyone can, with a bit of planning and care. And despite how rough the colonoscopy prep can be, colonoscopies really are wonderful things. They really can stop colon cancer from happening (or catch it well before it becomes deadly). I hope that your next one goes well too!!

◊   posted by Jim G @ 10:43 pm      

  1. Jim, There is no doubt you have been very thorough in your study, explanation, and consideration of the preparation for a colonoscopy; and you have done a good job of studying the whole thing and preparing well for it.

    I do have some very minor comments to make and one more major one; this last more major one does not concern anything about you but more about a “why” question.

    First of all, it may be just a typo, but I do not think a colonoscopy counts as a “‘major’ medical procedure”. If you needed surgery for cancer found, THAT would be a major medical procedure. I tend to think a colonoscopy comes in the area of what might be considered a “minor” medical procedure. But perhaps that was simply a typo and I should apologize for even noting it. If so, be assured you are “apologized to”.

    Second, I would like to point out to you that you are NOT “old”; you are beginning to start to get “old”; but you are far from “old”. Just a point of clarification. But I also understand how you feel as when I was in my 60s I also tho’t I was “old” until I realized I might have another 20 or 25 years ahead of me, which is a good portion of life. Why consider oneself old then? Wait until one adds the 20 or 25 years and then deal with being “old”. I say this from solid, personal experience.

    You gave much more attention and care to the whole procedure than I ever would; and I’m sure that because of that attention and care your own procedure went as well as it did.

    I do find myself with a question that should likely be presented to a gastroenterologist. First, the reason why I ask this question: A few months ago I myself had to have both upper and lower endoscopies (one immediately following the other) on what turned out to be an “emergency” basis. I had had some bleeding and the doc sent me immediately to the “gut doctor” (that’s so much easier than writing gastroenterologist every time). When I got there, they were “ready” for me, and all “new doctor” info was taken, scripts for the prep were sent immediately to the pharmacy; I was to pick it up ASAP and take it that very night; procedure the next monring. The thing I note here is that there was NO! 3 day fast period, NO only broth for a day (or whatever it was for you), no separation of take this amt. of prep one day and the rest the next morning, etc.

    I left the doc’s, went to the pharmacy, picked up the prep. When I got home, I had been told to take it immediately: drink 8 oz. of prep every 15 minutes for two hours; and that was that. (Turned out by the time I had chug-a-luged the 8 ounces, it had started it’s work; only end in 15 minutes when the next 8 oz. was due to be taken. Thus 2 hours of downing prep, it working, and repeat. There was NO long 3 day fast (of sorts), no separation of when to take some and when to take others, etc. I was not told to fast; however, I might say that the prep did not make for any situation in which I cared to eat anything whatsoever.

    I WAS told that I must have someone with me for the entire thing. Then it was “my turn” and the lovely anesthesia kicked in, and I didn’t care what happened. (When the anesthesia has dissipated, then one doesn’t feel so peachy keen.) I also had a growth that had to be removed, but all is well after that. (No further date was given me for another such endoscopy; I figure due to my age, they probably think I may not be around that long for another.)

    To get back to my point my question is: If a person can have TWO endoscopies at one time with a prep that is given late in the evening the night before with notably NO previous 3 day fast or even a fast up to the point of taking the prep (I had eatern earlier in the day), what is the purpose of the 3 days “fast” if in the end there is no difference in the results of the preparation and the colon being clear?

    It would seem to me to be much easier on a person to simply take the entire prep late the evening before, go to the hospital for the procedure the next a.m., and be done with it all; why all the fuss about the whole 3 day prep?

    I wonder about this disparity in how the prep is given, emergency basis involved or not. If the prep works well for the emergency on an overnight basis, it should work well for a colonoscopy that is given on a non-emergency basis as well.

    What do the docs hope to achieve with the long preparation that cannot be achieved in an overnight preparation? I know you are not the one to answer this question, but the question kept recurring to me as I read your post. Or maybe it’s a matter of preference for the doctor? One of these days I’ll have to get around to asking a doctor about this question.

    I do say that I’m very glad all went well with your procedure and that you have a good report for the next several years. I’d say you are a healthy man and have a good life ahead of you yet. Perhaps there is something to being a vegetarian, I admit. But then again, I got to be well into my 80s; so I guess my diet which is far from being what might be termed “healthy” in today’s world has gotten me this far; so I’m satisfied. Glad all is well with you, Jim, Mary

    Comment by Mary S. — September 17, 2017 @ 1:46 pm

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