There are certain medical procedures and immunizations that come along with age.
Just before I turned 50 this past April, I began to compile a list of health care to-dos such as getting pneumococcal and shingles vaccines, scheduling a skin cancer screening, setting up a bone density test and other procedures.
As I ticked off the appointments on my list, it was the appointment for my first colonoscopy that had me dragging my feet in calling my doctor.
A colonoscopy is a procedure that allows a doctor to view the inside of a patient’s large intestine to look for any abnormalities such as polyps, cancer, bleeding, ulcerative colitis, Crohn’s disease and other issues that can occur in the intestines.
The large intestine is comprised of four main areas: the sigmoid colon, descending colon, transverse colon and ascending colon. The large intestine, or colon, measures about 5 feet long and has a smooth inner wall.
The large intestine is connected to the small intestine, which measures a whopping 22-25 feet. The job of the large intestine is to absorb water and electrolytes from digested food that comes from the small intestine as well as store stool until it is ready to be expelled.
And if you haven’t figured it out already, there’s only one way in and one way out of the colon: through the anus.
During a colonoscopy, a doctor inserts a long, flexible tube, called a colonoscope, into the anus and gently threads it up into the four areas of the colon. The colonoscope has a light, a camera and other tools that allow the doctor to see, record and photograph the procedure as well as remove any tissue or polyps for biopsies.
During the procedure, patients are given a light sedative and pain reliever that helps relax the patient and often causes them to fall asleep. Most patients opt for the sedative, but the procedure can also be done while the patient is awake and alert.
“I definitely have a number of patients for a variety of reasons don’t want to have sedation,” said Dr. Mark Rosenblatt, a gastroenterologist with UCHealth. “It’s not critical that they have to have sedation and in some instances, it makes sense that they don’t. As long as you don’t have any abnormal anatomy, it’s absolutely fine if you don’t want sedation.”
The procedure takes about 30 minutes to complete and could take a bit longer if there are any polyps or tissues that need to be removed.
The actual procedure itself is a breeze. While I did feel some very slight cramping and gas, I was fine.
The worst part was the bowel prep.
‘AGHHH’ — also known as the bowel prep
In order for the doctor to clearly see the folds and walls of the colon, things have to be clean — squeaky clean.
To achieve this, the patient is prescribed a bowel prep kit. Bowel prep kits come in a variety of formulas, sizes and methods including liquid and pill forms.
The day before a colonoscopy, the patient either drinks the liquid or takes the pills. The bowel prep solution or pills causes the patient to have watery diarrhea, which cleans out the colon.
The most popular prep kit, and the one that I was prescribed, is what my nurse referred to as “the jug of joy.” It was definitely a jug, but I can tell you there was absolutely no joy in any of it.
The jug of joy is a polymer-based laxative known as polyethylene glycol 3350, or PEG. Names for some of the PEG formulas include GoLYTELY, NuLYTELY, TriLyte, GaviLyte and MoviPrep. The formula I was prescribed was CoLyte.
I was a little taken aback when the pharmacist handed me a gallon jug with some powder at the bottom. As I stood there staring at the thing, he explained that I needed to fill the jug up to the specified line with water, shake it and then drink 8 ounces every 15-20 minutes.
He also suggested that I refrigerate it and mix Crystal Light or any other flavored powder into the liquid to “make it taste better.” He did give me a little lemon flavor packet but advised that I would want to add more.
Despite my jug being concealed in a paper bag, pretty much everyone in line for the pharmacy knew what I was in for and offered me sympathetic looks and nods as I walked by.
When I spoke with Dr. Doug Kemme, an oncologist for UCHealth, a couple years ago about a story I was doing on colon cancer and colonoscopies, one thing he stressed was to eat very light three to four days prior to the bowel cleanout.
The less food going in means the less stuff that has to come out, Kemme reasoned.
Also, sticking to a low-fiber diet a few days prior to the cleanout process makes the cleanout process easier.
Heeding the expert’s advice, I cut my food intake way down and stuck to mainly protein and spinach three days prior to my procedure.
Patients undergoing a colonoscopy need someone to drive them home after the procedure due to the sedative they are given. Rather than take the logical route and ask one of my friends who actually live in Colorado to drive me, I opted to fly my mom out from California for this fun adventure.
Walking into my little house, my mom saw the jug sitting on my counter and cringed.
“Oh, boy. Your dad and I know what that’s like,” she said. “It’s terrible.”
In my infinite wisdom, I decided to schedule my colonoscopy the day after my birthday. Obviously, I didn’t think this through because if I did, I would have realized that I wouldn’t be able to eat anything and would instead spend the evening of my 50th birthday in the bathroom doing a bowel cleanout.
Oh well — live and learn, I guess.
Per the pharmacist’s instructions, I got ready for the cleanout the day before my procedure by refrigerating the liquid. At the recommended 4 p.m. time slot, I added the little lemon flavor packet and one large Crystal Light packet, shook it and poured my first 8 ounces.
After praising myself for taking care of my body and making sure I am healthy, I took a giant gulp of the liquid … and wanted to cry.
“Terrible” is not a word I would use to describe GoLyte. Honestly, I don’t think there is a word in any vocabulary to describe just how awful it tastes, only facial expressions and retching can correctly convey just how horrible this stuff is.
All I could choke out was, “Oh, God. Ugh. Ohhh, God.”
I tell you, it was going to take an act of God to get me through this gallon of liquid horror.
Aside from it being kind of salty, bitter and just plain gross, it was slightly on the thick side.
I decided drinking a larger quantity was better and ditched the 8-ounce glass for a 32-ounce one. I again filled it to the top, took a couple of deep breaths and drank it as fast as I could.
I could feel my stomach churning and it felt full like I had just finished a three-day bender at Hometown Buffet. Yet, I poured another glass.
“If me and your dad can do it, so can you,” my mother said.
Being that I have a much lower standard for myself than my parents, I doubted the words of encouragement. I mean, they survived World War II, Vietnam, Korea and raising two girls.
I had a major meltdown and just about jumped off a bridge when my dog, Don Luigi, pooped in my car.
We definitely don’t share the same “you-can-do-it” genes.
After my second 32-ounce glass, I started to get worried because nothing was really happening other than my stomach feeling super full and my tastebuds dying.
“Just wait, it’ll happen,” my mom cautioned. “Believe me. It went in, and it’s going to come out.”
Now, I know how my life rolls. Luck has never been on my side. If something is going to go wrong, it’s going to happen to me.
As I started to question whether the pharmacist could have given me an expired jug of joy, the liquid kicked in, and it was a race to the bathroom.
The trips to the bathroom continued and became more frequent as I continued to down the formula. So much so that I had my mom just turn the TV toward the bathroom so that I could watch “The Eyes of Tammy Faye” from the toilet. By the end of that movie, Tammy Faye wasn’t the only one with mascara running down her face.
Luckily since I had not eaten heavily for a few days, the entire process was just a little over 1 hour and 45 minutes. Praise. God.
“Every office has their recommendations, but the goal is that the fluid coming out of you has got to be clear,” Rosenblatt said. “Everyone’s body is a little different, but when it comes out clear, then you know you are ready for your procedure.”
My doctor wanted me to do a split cleanout for my procedure, so I had to save about 1/4 of the solution to drink the next day three hours prior to my appointment.
The split cleanout process is the recommended standard of care and helps remove any waste or secretions that may have traveled into the colon overnight, Rosenblatt explained.
“The beginning of the colon and the right side of the colon, this is the area where we’ve really been able to improve upon since we’ve introduced the split dose,” he said.
And if you are worried that you might have an accident in the car on the way to your appointment, believe me, you are all cleaned out and ready for the camera by the time you finish that last 1/4 of the solution.
I stressed this concern to the nurse several times during my appointment confirmation call, and she wholeheartedly assured me that “everything was going to be fine.”
I told her I hoped so because if there were to be any poop-related accidents on the way to the clinic, I was going to be late because I’d have to stop in a field, light my car on fire and then wait for an Uber.
Seriously.
Lights, camera — wait, that’s going where?
The next morning, I finished the last bit of the solution and made my last trips to the bathroom before my mom and me, along with my super-clean colon, headed over to the Skyline Endoscopy Center in Loveland for the procedure.
Once checked in, I was given a hospital gown and told to remove everything but my socks. The nurse set an IV, took my vitals and explained what was going to happen.
From there, I was taken into the procedure room where the nurse anesthetist gave me the sedation medication and pain reliever. I don’t remember anything else until I woke up, back in the original room.
With my dad having several polyps removed during his past two colonoscopies, and myself being BRCA 2 positive, I wasn’t surprised when Dr. Daniel Langer told me he had found and removed a 10-millimeter single sessile polyp from my transverse colon. While 10 millimeters doesn’t sound that large, in the polyp world, it’s pretty sizable.
However, Langer said from his experience in doing colonoscopies and seeing all kinds of cancerous and non-cancerous polyps, mine did not raise any concerns. But he was still going to send it in to be tested.
Since the polyp was large, I will have to return for my next colonoscopy in three years, which I have already set as a reminder in my calendar on my phone.
After the procedure, things were pretty much back to normal. Despite being ravenous, I took it easy for my first post-procedure meal and just had some eggs and toast. I was sure to drink a lot of water and just took it easy the rest of the day.
By that evening, I felt fine and back to my normal diet without any issues.
Colon polyps and cancer
Next to breast and lung cancer, colon cancer is one of the most common forms of cancer in the U.S., with about 1 in 20 people getting the disease, reports the American Cancer Society. Ninety percent of new colon cancer cases occur in people ages 50 and older.
Colon cancer almost always begins as a polyp. Polyps are fleshy tumors that grow in the lining of the colon and can be shaped like a mushroom on a stalk, called pedunculated, or are very flat, which is referred to as sessile. Sessile polyps are more likely to turn into cancer than pedunculated polyps.
“In terms of polyps, they come in lots of different appearances, lots of different morphology,” Rosenblatt said. “We like to describe them because it can suggest what the underlying disease is. Their appearance also influences how we remove them.”
The location of the growth inside the colon can also give physicians an insight as to what kind of polyp they are.
“For instance, very frequently we have what we call ‘diminutive polyps,’ which are 1 millimeter in size and are typically found at the beginning in the rectum. Those are actually benign and don’t need to be removed. They have no precancerous material,” Rosenblatt said. “In the right colon, there are these flatter … polyps that can be hard to recognize. Those are called serrated adenomas because under a microscope, they look like a serrated knife. Those behave more aggressively.”
Alternatives to the jug of joy
As I wrote earlier, there are a few different options that aid in the bowel cleanout process.
“For the most part, the split dose is generally the favorite approach,” Rosenblatt said. “All of the preps work basically as a stimulant, drawing in fluid and causing diarrhea.”
Patients can add flavor packets, like Crystal Light or Kool-Aid, to the liquid to help make it more palatable.
I did find out that there is a smaller version of the liquid option that is super concentrated, so a patient only has to drink one small bottle the day before the procedure and then another small bottle three to four hours prior to the procedure. This version still has the terrible taste and texture, just a lot less of it.
And while the pill option seems the easiest and least horrifying on your taste buds, it may not work for everybody.
Insurance can also dictate what method can be prescribed, however, patients can opt to pay for the smaller split-dose or pill versions.
For people who want to skip the procedure, they may opt for a home-test version like Cologuard or FIT.
Home-test kits are noninvasive and can be done at home at any time. A patient collects a small sample of stool and sends it into the lab, where they test it for any signs of cancer.
“They definitely play a role, but they are not for everybody. If somebody wants to have the discussion, that’s absolutely fair,” Rosenblatt said. “It’s not 100%. It’s about an 87% accuracy, so there are some errors with that.”
However, these tests only detect if there is blood in the stool or other DNA factors of cancer, not if the patient has any polyps. That’s where the importance of a colonoscopy comes into play. A health care provider can actually see inside your colon and identify any polyps or abnormalities that home tests can’t screen for.
Also, home-test kits are for people with an average risk level of colon cancer rather than for someone with a family history. It’s recommended that home tests be done every year with colonoscopies starting at age 45, reported Testing.com.
If eligible, patients can have a virtual colonoscopy, which is a CT scan, Rosenblatt said.
“It uses software to visualize colon polyps and it does use radiation,” he said. “There are inaccuracies with it, and it does miss smaller lesions and pick up incidental abnormalities.”
When to get your insides checked out
For years, the designated age for colonoscopies was 50, however, as health care providers have seen an uptick in colon cancer cases in younger people, the U.S. Preventative Services Task Force and the American College of Gastroenterology updated their guidelines in 2021 for colon cancer screenings to begin at age 45 for adults with average risk factors.
For people who have a family history of colon cancer or polyps, screenings should begin 10 years prior to the age your family member was diagnosed, Rosenblatt said.
So if a mother or father was diagnosed with polyps or colon cancer at 50, for example, the children should begin screenings at age 40.
People with the BRCA 1 or 2 genes, which cause an increase risk of colon cancer, should consult with a health care provider as to when they should start their screenings.
“Certain ethnicities are at increased risk — African-Americans and Native Americans are at increased risk,” Rosenblatt said. “So in these sub-categories, we will screen them earlier.”
People who are not high risk or have any polyps generally have colonoscopies every 10 years, while people with higher risks or instances of polyps may have to have a colonoscopy every year, three years or five years.
Colon cancer screenings should be done through the age of 75. After that, the patient and their doctor can decide on further screenings.
“We are definitely seeing a trend in seeing more polyps and more disease in younger people,” Rosenblatt said. “And I think the health care, primary care providers, are aware of these recommendations because we are getting these patients in and referred to us appropriately.”
Just like prostate exams, mammograms, pap smears and other somewhat invasive screenings, colonoscopies aren’t fun but are necessary for our best health.
And compared to a delayed diagnosis of colon cancer — which could delay treatment — it really is worth the hassle.
For more information on colonoscopies, polyps, colon cancer facts and figures, go to https://bit.ly/3Jt653z.