I am generally a pretty healthy guy and so I generally don’t spend much time in Doctor’s offices for myself. I get a physical every 10 years whether I need it or not and the results are (thankfully) the same.
A few weeks back, it was time for my first physical (WHERE AGE > 50) (sorry for slipping into SQL there). My doctor went through all the normal things and everything was fine and nothing had changed since my last physical in 2001. That was all great news.
But then we had “the conversation” about how people over 50 need a Coloscopy. Given that I am in pretty good health and have no family history of cancer of any kind let alone colon cancer, I might have had a decent excuse to say “no thanks” and walk away.
I knew this conversation was going to happen and so in the days before, I thought about my good friend and dear colleague Bob Frost.
As much as I wanted to run away and say “no”, I knew the right answer was “yes”.
So yesterday was my date for the Colonoscopy procedure at the University of Michigan Hospital. I had known other folks who had the procedure at UM Hospital so that made me extra comfortable.
The preparation started Thursday morning. Most folks say the prep is the worst part. This is the prep that we chose:
I followed the prep almost perfectly. Wednesday night, I had a substantial meal with steak, soup, salad and a baked potato at Buddies in Holt at about 10PM. I wanted my body to have lots of pre-digested protein, fat and carbohydrates in the bloodstream to endure the 1.5 day fast. My last solid food was a Egg McMuffin at 8AM on Thursday.
I had an IMS LTI teleconference at noon to talk about RDF and XML bindings when the prep was supposed to start. I foolishly waited to the last minute to buy my pills and MiraLax and Gatorade. Then meeting started to go long. So I switched to my cell phone and drove to the pharmacy to pick up my materials. There was some detailed discussions going on as I picked up my supplies. I must have sounded pretty weird to folks in the other aisles at CVS when I started addressing the availability of RDF libraries for PHP. To be courteous, I dropped off the call to check out and then rushed back home to rejoin the call. I took the pills at 1PM (one hour late) in my car on the way home to get the procedure started. I got home in time to rejoin and finish the meeting from my home office. It was a great meeting and a lot was accomplished – I was glad I did not miss it.
At about 3PM I started drinking the MiraLax/Gatorade mix. The procedure said to wait until “something happened” or 6PM – but nothing “happened” and I did not want to fall behind schedule so I started chugging the 9X daily dose of MiraLax between 3PM and 5PM. By 6PM, still nothing was “happening”. I was starting to feel like a failure. But by 6:30PM, I was relieved that things started to “happen”. After that, they happened about every 30 minutes pretty much like clockwork.
For me, there was never any bloating, cramping, or discomfort. About every 30 minutes I would begin to “feel the need” and – would take care of business, and then go lay down and watch TV. I was not tired or uncomfortable at any point. But I was distracted enough to screw up and miss an IEEE Computer Editorial board teleconference at 4PM (Sorry Ron and Judith). I could have made the meeting – I just forgot because I was too focused at 4PM and worried that nothing was happening and I was falling behind schedule – and I hate to fall behind schedule.
By 9PM things had been progressing very comfortably and regularly every 30 minutes. I had to make a run to pick up some football tickets for a Friday night game from my friend John Liskey. He was at a bar about 20 minutes away from my house. So I waited until “something happened” and then rushed to the bar. There was construction on the route I took so it took longer than I had anticipated (uh-oh). At 9PM on a Thursday they were resurfacing Cedar Street and in a pipelined fashion, they were grinding off a lane, cleaning it, and laying down new asphalt and then finishing the asphalt – all in a amazing dance that took about 500 yards of machinery. It was beautiful engineering – but my mind was elsewhere as the traffic crawled along. I got through traffic and made it to the bar before I was completely uncomfortable – I rushed in, waved at John, and then ran to the restroom. I stayed at the bar for 30 minutes, and when it happened again, I knew I had 30 minutes to get home so I quickly said my good-byes and took a much quicker route back home.
By 10:30 things were slowing down to be more like once per hour. So I decided to try to get some sleep. I slept for a while and then needed to get up and then went back to sleep. It was OK – kind of like a west-coast redeye flight. I got enough sleep to trick my body into not being tired the next day. At 4AM, I started the next 9 doses of MiraLax plus Gatorade and pretty quickly we were back on the every 30 minutes schedule. By 5AM I desired to stop trying to go back to sleep and started to catch up on E-Mail in between sittings.
I was a little concerned with the “output”. Throughout the night, there were less and less solids and at about 6AM there were no solids at all. But the color was brownish and still not fully clear as specified in the procedure. Again I started to feel like I was behind schedule and might end up failing.
My “last allowed liquid” time was 9AM so I savored a cup of good black coffee (Loving my Bunn Velocity Brew Coffee maker) with a bit of sugar – but no cream. I did not want to end up with a caffeine headache during the day. By 9AM, the mean time between sittings was creeping back up to 45 minutes and the “output” was increasingly light, but it was not “clear and yellow” per the prep specifications. I was quite worried. At 9AM I felt confident enough to do some lifting and hauling and did an errand that took me about 45 minutes – no problem at all – by then the pace was slowing.
At 10 AM it was time to take the 1 hour drive to Ann Arbor and Michigan Hospital. So off we went. About 45 minutes into the drive, I started to get “the feeling” and would have been most happy if we stopped. But since we were running late, stopping was not in the cards. It was not really uncomfortable but I was really happy when we arrived at the hospital. And doubly happy that the hospital has restrooms as soon as you walk out of the parking ramp and into the hospital.
And the awesome news was that the “output” was perfect! It met all the prep specifications and then some. I was so happy – it was so pretty. I should have taken a picture and tweeted it! All the stuff I had read suggested a lemonade-color. But this was more of a pretty deep yellow color – more like egg-drop soup without the eggs. To me, it was so pretty because the last thing I wanted to do was disappoint my doctors and I certainly did not want to have to come back and try again another week. School starts Tuesday and it is hard to take two days off while teaching.
So we rushed to the Medical Procedures Unit five minutes late and checked in. I have been vague-tweeting because I did not want folks to get concerned. When they called my name, I made my last tweet and then gave my phone to Teresa and in I go to get my gown and lay down on my side.
Inside the unit, I changed into my gown and went to the bathroom one more time – and yes it was that awesome clear yellow color. I had achieved the specifications of the prep only 60 minutes before my appointment – but hey – it was on time and on budget – so I was very pleased.
There was a really nice clinician who wanted to ask me some survey questions for a study they were doing. When she got to the privacy part, she said, “The worst case that might happen is that if one of our servers were hacked, someone might figure out that you had a Colonoscopy.” I told her I was not too worried about privacy since I had tweeted that I was having one about 15 minutes earlier. It was a cool survey and I told her I wished I had the “as-built” data to inform my prep. She laughed. I told her that during the prep, I really wanted to do it right and I spent a lot of time on Google trying to find anything that might give me some kind of summary of what should happen when as you do the colonoscopy preparation. They were great telling me what to do – but not so good telling me what to expect and how the prep would progress. I also said that their timing was perfect – although I might have wished it finished 2 hours earlier. If I do this next time, I might start the process at 11AM. But of course, because of the IMS LTI meeting I did not start until 1PM – so I *was* an hour late starting – so the schedule slip was my fault (Mark, Greg, Lance, and Colin contributed to the schedule slip unknowingly).
Once I finished the survey, it was time for the IV – this was the scariest part for me. I have a weird relationship with needles. I can handle the pain but somehow I am scared of them (except of course when I am getting a tattoo). One time many years ago, I fainted after I stood up having blood drawn. So since then I tell anyone about to put a needle into me that I am a wuss. I think that by me telling them that I am a little scared makes it OK for me because since I started telling them I was scared I have had no problems. But my veins are too small and it took her four tries to get me locked and loaded. Gaak. It was not painful but more nerve wracking than anything else. But the clinician kept asking me questions about the prep and it distracted me nicely. Now that I think about it – maybe she was not doing a survey at all – she was just they’re to distract me – Hmmm. Whatever. It worked. And we had the IV.
The nurse asked me all the stock questions and that went fine. Then we were went over all the risks and that was fine. Then we got to the part where I was going to sign it all and I had a little concern. I felt uncomfortable signing a document that said we were going to look in and remove whatever polyps they would find so they could do a biopsy. The one other person I knew that had this done – they found one polyp and removed it.
What concerned me was that I was signing a “blank slate”. For me, taking a quick look and removing 1-2 polyps for diagnostic purposes was OK and understandable. But what if they found more? How many would they take out? It seemed to me that at some point when you go from 1-2 removals to 10+ removals (would be very rare) we are switching from a low-risk diagnostic procedure to a small major surgery. And frankly, I wanted to understand what is going on if there was to be a major surgery – I might want a second opinion or something and I wanted to be emotionally prepared if there was something major. What made me most uncomfortable was the sense that they would put me out and then I woke up they would tell me if I had a routine diagnostic procedure or a (what seemed to me to be) small major surgery. I was not ready to let that decision be made while I was under anesthesia. That was my decision to make and I wanted to be awake and presented with the evidence so I could participate in that choice.
This was the first time they joked and mentioned the phrase “Doctor’s make the worst patients.” I went through the story of my concerns four times. First I explained it to the clinician doing the survey and she told me horror stories of colon cancer. I then told her the story of Bob Frost and told her I was properly respectful of colon cancer but wanted to be part of any major surgery decisions. The clinician was nice about it. Then the receiving nurse came in and we had the same conversation. She just said, lets sign the consent form as is and put a sticky note on it. I agreed.
Then the nurse supervisor came in and we did the story again. She was somewhat stern but understood. I am sure that the problem is that if they need to bring the doctor out to talk to me, it messes up their timing a lot. I understand efficiency concerns but I was not gong to agree to something I did not understand. So I laid there for what must have been 45 minutes all prepped and ready to go telling this story to folks over and over again. I watched others being wheeled in ahead of me whilst I waited (all the while with no laptop or iPhone to pass the time).
Since I was insisting on discussing the procedure – I spent more time waiting. Laying in the hospital bed looking out the window with nothing to do, I spent a lot of time thinking about Brent, his surgeries, and the fact that he is working through some tough issues.
Finally the doctor came in. She was awesome. I explained my concerns about being comfortable with removing a polyp or two for a biopsy and not comfortable with declaring “open season” if there were a small army of polyps when they got in there. She assured me that if there were more than 1-2 polyps that she would stop at 2 – so I agreed and we tore up the sticky note and were good to go.
In a few more minutes they wheeled me into the room with the nurses and the doctor and I rolled over on my left side. Everyone was joking, light-hearted and laughing. They were amazed that I scheduled a colonoscopy on my birthday. I told them it was my birthday present to myself. I told them that if it was my fiftieth birthday it would show how much I wanted the colonoscopy. But instead I told them that it took four years before my physician “caught up with me”. I also told them that I needed to get this done before classes started at University of Michigan on Tuesday September 6.
The put the drugs in my IV and in about 15 seconds, I said – “Things are a little out of focus” and then 5 seconds later I gently went to sleep. The next thing I know I am back awake with no discomfort at all – I mean zero – no discomfort. I am looking at a computer monitor showing video from the camera. I don’t know it it was video being replayed or it was live – but I was seeing them pulling the camera slowly back out of my intestine. It was so awesome – I wish I could have had the whole video – you could see the folds and chambers of the inside of my colon – it was the coolest thing.
It turned out that I had one polyp (completely normal) and they took it out to examine (completely normal). They wheeled me into recovery where Teresa came in. They gave me some pictures of the polyp and the test results. I got my iPhone back and tweeted post-procedure with a picture of my scary IV that was still in. In about 20 minutes I was ready to get dressed and leave. There was no lingering pain no bloating – absolutely no abnormal feeling at all. It was literally as if nothing had happened.
So we left (I of course was not driving) and went to have lunch at the Caribbean Jerk Pit for lunch. Since I had just had a Colonoscopy I backed off and only had medium spiciness. I figured to take it easy. Because of the timing of the steak meal and Egg McMuffin, iI never experienced any hunger. I am a bit weird because I skip meals all the time and don’t feel hungry – so your mileage may vary on the hunger thing.
One the way back to Lansing we stopped at the Secretary of State office to renew my plates (it is my birthday remember) since I had waited to the last minute for that as well. Then we went to Culvers for some custard.
Then we went home and changed and went to the football game at 7:30PM. I would point out that after I went to the bathroom about 11:30 AM right before I went into the procedure, I had no more urges to go to the bathroom at all. The timing and dosage of the MiraLax cocktail was perfect.
I next went to the bathroom normally on Saturday morning (20 hours after the colonoscopy) and everything was normal – no pain, no bloating, no urge, no nothing.
All in all, it was an amazing experience and I am nothing but impressed with the medical professionals at the UM Hospital who do this procedure. And it is an awesomely good feeling to know that my colon is as healthy as the rest of me. And I certainly have Bob Frost to thank to make sure I had the backbone to actually do this and not delay it.
Obviously if you are looking at this considering your own procedure, all situations are different. Other than being a bit chubby and sitting in front of a laptop computer too much, I am in excellent health and this was a *diagnostic* procedure as part of a physical exam. If you have health issues or are on medication you may have a quite different experience. I guess what I would suggest is not to be worried about a Colonoscopy procedure at all if you are in good health.
I hope that if you have read this far, (a) you are not too grossed out, and (b) you have found this helpful.
Comments and suggestions welcome.