Cancer Scares

There's this thing that happens once you've had cancer.  You become more aware of the little things.  Not just things like the chirping of birds, or the way rain smells.  Things like how different parts of your body feel.  What things generally look like.  You become very aware of things that are out of the ordinary, for you. 

In my case, when something seems a little not-quite-right, I hear Jeff Goldblum saying "Are...are we worrying?  I...I mean....is....is this....OK?

Every cancer survivor I've spoken to has had a scare.  At least one. 
The sinking "something's a little off" feeling is one thing.   It is easy enough to deal with - you talk to a medical professional and you get it sorted out, right?  Done and done. 

But it's not that easy for everyone.  You may think you are imaging things.  Or that you are perhaps over reacting.  Or that you have become a hypochondriac.  Or that you can't run to the doctor for every little thing; you really need to man-up.  Or that your family can't take the stress of having to deal with cancer again.  Or that you can't take the stress of having to deal with cancer again.

So you wait.  For a sign that it's definitely something.  Or definitely nothing.

And you feel like an idiot for waiting.  You feel bad about being scared.  You are supposed to be tough, right?  You beat this thing once, right?  So maybe you go see that medical professional. Or, maybe you wait some more.  It's the cat in the box again.  You are both fine and very much not fine until the test results are in.

So, why am I telling you all this?

Because I had a scare. 

I've had more than one so far, but this one was bad.  Waiting for the biopsy results was rough. 

And you know what?  It's not cancer.  It's serious, and there will be surgeries ahead (I've already had one), but I will deal with it.  Because it's not cancer. 

Now, I have a very, very dear friend who waited.  And it was cancer.  And her journey was not an easy one.  She's still here.  She's doing great.  The thought of what she went through got me to see a medical professional when I noticed something wrong.  That, plus I'd eventually have to tell her, either way, and she can (and will) kick my sorry butt. 

So, how do you know if cancer has come back?  How do you know if it's going to be OK? 

You don't. 
You have to pick up the phone.  You have to call your doctor.  You have to check. 

Only a test

Remember a while back I mentioned testing season?  It's over for this year.

I'm fine.

Except for the pinky toe on my left foot.  It didn't quite clear a door frame the other day.  At least it's not sandal weather.

Speaking of weather.....

Yes, we did have snow the other day.  Just like Cinnamon said.  No, I am not happy about it.

5 Reasons Mammograms Are Not Really Scary

Really.  They aren't.  Honest.

Getting a mammogram is not my favourite way to spend an afternoon, but it is way less invasive and/or uncomfortable than many other medical tests.

So why do so many people put them off?  Is it because mammography is scary?

Then in the name of naming and exposing the monster under the bed (Geoff, and really just made of balled-up unwashed socks) to make it less frightening, here is a short list to de-scare-ify mammograms. 

1. There is no prep for a mammogram.
None.  At all.  OK, so you don’t wear deodorant/antiperspirant before the test.  It gets the plates all gunky and can be hard to clean off.  But still, this isn’t a prep kind of thing.  You don’t have to drink anything gross.  You don’t have to fast.  You just show up.

2. It is not invasive.

Let’s face it, the majority of people getting mammograms are women.  Ladies, this is nowhere near as invasive as the way, way more common cancer screen – the PAP smear. 
Yep, you have to have your top off.  However, you will probably have a gown to cover you, or some little jacket thing, depending on the place doing your test.  This is nothing like trying to arrange 2-3 pieces of paper to cover yourself.

For the gentlemen out there who will require this test (yes, men get breast cancer too) while you will probably get looks from the women (well, some of them), I've been told it's it’s not as bad as a prostate exam or hernia check.  Not that I’ve ever had either.  This is what I’ve heard from a friend-of-a-friend who is a male breast cancer survivor.  He’s also a veteran, and a grandfather.

3. It doesn’t hurt.

Seriously.  Your breasts are pretty malleable.  The mammography machine (let’s call it….Betty) has two plates.  You kind of lean into Betty, and the plates compress your breast tissue.  Yes, Betty does  squish your breasts fairly flattish. I would say it is more discomfort than actual pain.

Now, if you are having a mammogram and find yourself thinking “Jade lied!  This hurts!  Betty is evil!”, tell your technician.  You will probably need to describe the pain (Stabbing/throbbing/burning etc.)  It might be that you can be repositioned. Or maybe not, but it only takes a second for the “picture”, so it won't last long.

4.  A mammogram doesn’t take a long time.

When I had my first one, I figured it would take the whole afternoon.  It took less time than I expected.  It would fit into a lunch hour.  Now, there are exceptions to this, of course.  The center I go to has two mammogram suites, and other rooms just for ultrasound, biopsy, and consultation.  If you have to have extra images taken for what ever reason (like having dense breasts), it can take a little bit longer.  

5. It’s not really the test that worries you, is it?

It’s the possibility of the bad result. 

There have been lots of theories floated about why people don’t get checked.  I subscribe to the "If I don’t know, then I’m fine" theory of denial.  It’s a little like a small child covering his eyes and thinking you can't see him.  It also doesn’t work. 

Getting a bad result (or a diagnosis of cancer) doesn’t mean that in the second a Doctor says the Big C Word you’ve received a zott of deadliness. 

Nope.

It has been there, lurking, undetected, for some time.  Kinda like The Silence. (For Dr. Who fans.  For everyone else, I’ll wait while you click this link.)  Every bit as creepy.  Every bit as malicious.

And the sooner you know, the more time you have to do something about it. 

But ignoring your own health? 

That's really scary.

Testing....testing....

So, you may have noticed I've not done any health related or cancer focused posts lately.  That's because it's testing season, again.  Eventually I'll get all my assorted appointments coordinated so I can get them done inside the same month or two, but right now there are tests run in the spring, and more in late summer/early fall.

No, we are not going to worry.  I get to do these every year.   It's part of the life of a survivor.  That doesn't make it fun.  I have tests and exams, and then I wait.

The waiting is the worst.  It makes me feel like cat in a physicist's thought experiment.  You know the one.*  Inside the box, I'm both fine and not fine, until someone checks and reports the result.


Meow?
 



*Schrödinger's cat,  this interpretation

Colonoscopy time Part 3 – The Main Event

 At last, you are at the hospital.  Or clinic.  Hooray!  Now you get to check in!

I have an uncanny ability to find the imaging department in a hospital.  I think it’s because I’ve spent so much time in them.  Each place is a little different, but most hospitals have signs and volunteers.  And pumps of hand sanitizer.  I strongly suggest you use all three, especially if this is your first visit.

“No!” you shout.  “I shall not ask directions!  I can read!” 

“Ah, yes,” say I. “But the volunteers know which elevator to take.  And which is out of order.  And which hallway is closed because of construction.”  Twice volunteers have led me ‘the back way’ through the hospital to get to something I never would have found without them. 

Checking in

You will need to check in, letting the department people know you are there.  This step varies from place to place, but you will be asked for id, a health card, possibly a specific card for that hospital (one reason to allow extra time) and your order papers.  You will be asked if you have any allergies.  Tell them if you have allergies.  Or sensitivities.  Like, if you break out in a rash from contact with something, like Band-Aids.  That one can be important.

Some clinics are self-contained, with everything in one place, on one floor.  Others are more spread out.  You may have to check in with, say, outpatient procedures, and then go on to the endoscopy suite.  If someone is coming with you, they can generally just tag-along until you get to the IV part.  There may be a special waiting area for them, or perhaps they will be told when and where to show up to collect you.  One thing is certain; when your companion is someplace that’s not allowed, someone will speak up.

During check in, someone will ask if you know why you are there.  This is NOT the time to be sarcastic/funny.  It is part of the informed consent process.  They have to make sure you know why you are there.  Your procedure will be explained to you.  Don’t say “Oh I read all about it on the Internet”.  They hate that.  There’s lots of weird stuff on the Internet.  For all they know, you read an article that says the process will be carried out under the full moon by a specially qualified cat, who also plays piano.

At some point the following things will likely happen:

-You will be given a hospital bracelet or two.  One will have information identifying you.  You may also get a second one, possibly red, if you have an allergy that they really need to know about for the procedure.  Like the adhesive one I mentioned earlier.  If your only allergy is to cat hair, you probably won’t get a red bracelet.

- You will be asked to change.  You will probably be given a basket or bag and a bundle of hospital gowns and booties, and shown to a change area.  A really posh big-city type hospital may even have a special locker room!

Note: 

There are many different kinds of hospital gowns.  Do not be surprised if there is a diagram in the change room, explaining what to take off and how to put the gowns on.  Follow the instructions.  Yes, sometimes they really do need the diagrams. 

(Ladies: if you feel more comfortable keeping your undies on, that’s probably ok.  You can always ask the person handing you the gown, or your nurse before you get onto the bed in the procedure room, or slip them off and tuck them discretely into…uh….you know what?  Tell the nurse.  Trust me.  They are used to that, especially with ladies of a certain age, who tend to be more modest.)

-You will have someone ask you your name and age and address, again, while holding a paper that already says this in one hand, and your hospital bracelet, which is attached to your wrist, in the other hand.  Again, not the time for funny.  This is the hospital’s way of confirming that the Mrs. Jane Doe in front of them is the Mrs. Jane Doe who is supposed to be having a colonoscopy with Dr.WhatsHisName today.  It prevents mix-ups.  Don’t knock it.

-You will probably be asked if you have any symptoms of a cold or the flu, or a cough.  You will probably have your temperature taken.  This is so they can do a basic assessment of general health before beginning.  There may be some conditions under which it’s not a good idea to proceed with the scope.  Since I’m not a doctor, I have no idea what they are. 

-You will have your blood pressure taken.  It will almost certainly be higher than normal.  The nurse may be asking you questions while this is going on, you may have had to sprint to get there on time, your gown may not be cooperating, you may be nervous.  This is all normal.  The nurse may want to take your pressure again, or try the other arm.  If this happens, try to relax and follow her instructions.

(I said her! Sorry Sam from GI Oncology!  There are some great male nurses out there, but mostly the profession is female dominated.)

-You will be given an IV.  Now, I am a good patient for my nurses, except when it comes to the IV.  I’m what they call a hard-stick.  I’m sure they have other names for it, too.    I could go on and on about IVs, but that’s probably best left for a separate post.

- You will get to wait a bit, possibly even between steps above.  For whatever reason, the department will be running behind.  Why?  Are they understaffed?  Are the doctors late?  Who knows.  Odds are good someone’s procedure is taking a little longer than planned.  Or perhaps a nurse has been diverted to deal with something.  Either way, you will wait.  Hospital time is another phenomenon that deserves its own post.

This is the really, really boring part.  You probably don’t have your stuff, so no reading material.  There may be magazines lying about, but they are hospital magazines.  There might be a TV somewhere, likely tuned to either the weather channel or a news station of some kind.

Oh! And yes, the instructions do say to keep drinking, but this does not mean you need to keep sipping your bottle of water right up to the procedure time.  The nurses will take it away from you.  Please do not cause a scene (yes, I’ve seen it happen).

The main event!

Yay!  Your name has been called!  You walk down to the colonoscopy procedure room.  And…

It is probably smaller than you were expecting. 

For such a scary sounding thing with so many steps, shouldn’t there be a giant room?  Perhaps with medical students looking on?

Nope.

 It’s you, your GG and two, maybe 3 other people.  It depends on what we are doing today, and how big the room is.  Because I’m a regular, I tend to have students and new hires watch my procedure.  But that will be another post.

-You will get on the bed, and do what they say.  You may have to start on your back and have them raise the table, or you may start off on your left side, knees bent, everything covered up.  To start.

- Your IV  drip will be started with saline/glucose, if it wasn’t already. 

- A clip will be put on your finger.  I can’t tell which one, it depends on how the room is set up. 

- Oxygen may be made available to you.  Don’t panic.  It’s just easier to do it now.  You may not ever need it. 

-You will be introduced to the people in the room.   They are often called ‘The Team”. They will not expect you to remember their names.  They may make a joke about it. 

While they are getting everything ready, The Team may chat amongst themselves.  This will sound nothing like the medical shows on TV, and everything like what  people talk about where you work.   

Why is that?  Are they being unprofessional? Shouldn’t they be shouting “Stat!”, carrying clipboards?  Wearing stethoscopes?  Running?  And shouldn’t someone be biting her lip and looking dreamily while some older guy fumes about something?

Nope.  This is reality. 

This is the team’s day job.  Pretty boring?  Good. You, as a patient, want boring.  As my GastroGuy once said, “The thing you never want to be as a patient is ‘interesting’.  And never, ever, ‘exciting’.”

- Your Gastroenterologist (GastroGuy, or GastroGal, or GG) will probably confirm with you that you are who you say you are, and that he is who he says he is, and that you are going to have the procedure you expected.  Again, double-checking is a good thing. 

- You may be palpated.  That’s a fancy doctor word for poked with the flat part of the fingers.  If your doctor’s hands are warm, please mention this in the comments.  I’ve yet to meet a warm handed doctor.

- You will be told to reposition, and the team will artfully arrange the covers so that only the part they need to see is visible.  Also, they almost always point the camera at the floor, or a blanket or something right up until the last possible moment. 

Which is nice, because you really don’t want to see your backside on a 21 inch screen.

- You may be facing a monitor on top of a bunch of computer-related looking things.  You may see a jumble of wires and tubes.  Don’t panic.  They are all supposed to be there.  They have a purpose.  It’s OK if they look messy from where you are.

- You will have a digital rectal exam.  This does not mean they are going to use a digital camera and then look at the photo of your bottom. 

The medical term for a finger is ‘digit’.  Your GG is going to stick his (or her) finger in your rectum.  I don’t know which finger, but you can feel free to ask at the time.   It will probably be very cold and uncomfortable.   

- Your GG will explain the sedative to you.  Most people have something called ‘conscious sedation’.  It means you won’t feel pain, but will be able to feel pressure.  You see, they need to shove this tube with a camera and stuff in it into your rectum, then snake it all the way to the end, and slowly remove it, looking around the whole time, while also removing stuff that looks suspicious.

 And as we all know, you can’t push on a rope, unless it’s frozen.  And even then, it may not be that easy.

Your colon has 3 parts, from the rectum to the small intestine, they are: descending, transverse, ascending.  Here, take a look.  

See that bend?  The one between descending and transverse?  That is the most difficult one to negotiate, apparently.  People are different, and everyone’s bend is a little different.  Your GG needs you to be aware when the scope goes through this part, so that you can tell him if it hurts, etc.  He/she will probably explain this to you better than I can.

Sedation

My GG was lovely at explaining this to me:  When it enters the vein, it will feel a little cool, as it is lower than your body temperature.  In about two heartbeats, you will feel like you’ve consumed several beers way too fast. 

Now, I don’t drink, so I was worried. 

He was right about the cold.  And in two beats, I felt very relaxed.  Limp even.  My eyes didn’t blink at the same time, and I felt like the room was spinning ever so slightly.  What I said was “Issh a gud thing immm laying down becahush I feel likesh I rally need to laa downsh.”  And then I don’t remember much.  Except:

My GG saying “And that’s our cue to start”, followed by, “I’m going to insert the scope now, you may feel a little pressure”.  I remember feeling the scope go in a little bit, and then things went black. 

Colonoscopy, itself

You may be facing the monitor during the procedure.  If you handle sedation like I do, you will “float to the surface” every so often.  If/when you do, you may talk.  I’m told this is normal.  And that they don’t laugh at you.  But they will ask you to please stop singing.  And they will tell you that they cannot “change the channel”, no matter how boring the nature program is.

Will it hurt?

I wouldn’t say that it hurts.  Not really, no.  It doesn’t feel good, that’s for sure. 

To move the scope along, your intestines will be inflated a bit.  Generally this doesn’t hurt, it just feels like, well, lots of gas in your intestines. 

The negotiation of the bend may involve a bit more movement, and your GG will want to know if you are uncomfortable or in pain.  Answer honestly.  And if you ever do feel pain, or like throwing up or something speak up immediately!  Don’t try to ‘tough it out’.  You aren’t helping anyone. 

Polyp removal doesn’t hurt.  It does feel weird, because you can feel pulling inside your intestines.   The best way I can describe it is like this:

Gently pinch the little flap of skin between your thumb and index finger.  Got it?  OK, now, tug a little bit.  Feel that?  You can feel the pinch, and you can feel the tug, but it doesn’t hurt, right?  That is pretty much it.

Removal of larger growths (should you be unlucky enough to have them) also doesn’t hurt.  In both cases, because there are blood vessels in your intestines, you may bleed a little bit.  Your GG and team will take care of that.

Another thing you may feel is the irrigation.  Blasting water at the sides of your intestines doesn’t hurt.  It feels cold, and you can feel the pressure, which is very strange.  Suctioning of air, water and residue from your purge doesn’t hurt, either.

About half an hour or so later, the whole thing will be over, and you will be wheeled into the recovery room.  Hopefully nothing of any interest whatsoever will have happened.

Really?  All that buildup?  And we’re DONE? 

Yep.  Really.

You will be left to recover in the recovery room, with the curtains pulled around your bed.  It is during this time you "deflate", and the sedation wears off.

The recovery room

As your doctor will have explained to you, your colon will be expanded via compressed air or gas during the procedure.  They are able to let most of it out before you leave the procedure room, but not all of it.  While you are in the recovery room, you should expel the gas.  You may feel very self conscious.  It seems really rude.  But it’s ok.  The recovery room is for this.  Everyone in there is in the same state. 

Nurses will check on you every so often.  Even if you can’t see them, there is someone pretty close by, keeping an eye on everything.  There is no need for you to rush off.  Take your time.  You do not have to hurry up and wake up all-the-way-fast-fast-fast.

When they are satisfied that you are ok, they will remove your IV, let you get dressed, ask you a bunch of questions, give you any papers your GG left for you, and ask you who is there to take you home.  They may even give you a small amount of gingerale or juice or something.  But not always.  It depends on the hospital, etc.. 

In the (very unlikely, I hope) event that something suspicious or even bad was seen by your GG, he may have a chat with you before you leave.  Or, if you have been anxious, he still may pop in for a quick chat, even if nothing is wrong.  Basically, if something isn’t right, someone will tell you.

By the time you are discharged, you should be fairly alert, and not feeling too bad.  A little bloated maybe.  You will be told what you can and can’t do after the procedure, and when you can eat.   You will be told what to expect following the procedure, especially if your doctor found and removed polyps.

You should under no circumstances drive home.  While you feel fine, and can see and everything, your reaction time will have been severely affected.  I know a gentleman who knocked over a bottle of water, then watched in shock as it fell and emptied completely before he could move his hand over and pick it up.  And that’s someone who has cat-like reflexes, usually.    Within a few more hours he was basically back to normal, however. 

If you have any concerns, talk to either your doctor or one of the recovery room nurses before you go home.  Since they are trained medical professionals who do this every day, they are far more qualified than I am to give advice on this bit.

You will probably still feel a little bloated the next day, and continue to deflate for a bit.

And that’s it.  For such a scary sounding thing, it’s mostly preparation.  And a half-hour or so procedure.  Kind of a let-down, isn’t it? 

I hope you find this information helpful.  Colonoscopy is a very important diagnostic procedure.  It really isn't as scary as some people make it out to be. 

But, what if?
-You need a pedicure? They don’t care.  And you should wear socks anyway.  Hospitals are cold.  Especially when you aren’t wearing pants.

-You forgot to shave? They don’t care.

- It’s almost time for the scope or IV and you need to visit the bathroom again?  There tend to be bathrooms available near the procedure rooms.  You are not the first person to require them.  If you have to leave a waiting area to use one, tell someone.  This way they won’t page you when you are indisposed.  But they may knock on the door.  Or try the handle.

- It is your ‘time of the month’?  Tell the nurse who takes your vital info.  The one who is taking your blood pressure, or going to give you an IV.  You may not wear a tampon during the procedure.  You might not be able to insert one afterwards.  Remember the sedation?  Wear a pad, and bring a spare or two.

-       Something else happens that I’ve not covered here?  Ask a nurse in the department.

Colonoscopy Time (Part 2)

Purgatives and Extras

Purgatives:

 You may be given, or told to get, a really strong laxative.  Once upon a time, it was called ‘Intestinal Lav’, and it came in 1L boxes, like juice.  I’m sure this is still out there.  When I had my first scope, I had to take PhosphoSoda.  I used the pharmacist-recommended store brand, rather than name brand.  If this is what you have been prescribed, store brand is fine.  The taste is equally bad.   In fact the advice from the Pharmacist was “Try not to taste it.”  Now there is a fabulous thing called Pico-Salax.  It doesn’t taste bad at all! More about this later.

You may have been told to purchase an enema for administration at home, before your scope.  Here it is definitely worth it to spend the extra dollar or so and go for Fleet.  Again, more later.

Extras:

I recommend splurging on a package of flushable wet wipes.  You may wish to add a tube of barrier cream of some kind.  If you have changed babies’ tushies, you know that when they have lots of outputs, their little bottom gets red and sore.  You would of course use something soft and damp to clean the sore little bottom, and a barrier cream to make it easier next time, and to make future eliminations less painful.  Prepare to do this for yourself.  Vaseline is fine, (zinc oxide not necessary) and can often be found in a convenient squeeze tube in the baby needs aisle. 

You will be spending rather a lot of time in the bathroom. A word search, crossword puzzle, Sudoku, or some magazines may make this a little more bearable.

You may wish to pick up a small package of disposable ‘adult hygiene products’ - the discrete ones, that look like underwear.  Since you (probably) have to ask the Pharmacist for the purgative, you can ask about these at the same time.  Don’t be embarrassed.  The pharmacist is your friend.  You probably won’t have an accident, but some people feel more comfortable sleeping in them.

Oh, and don’t worry that the cashier is going to judge you based on the above items being in your shopping cart.  I’ve been a drugstore cashier.  People buy this stuff all the time.   It’s really not a big deal.

Supplies assembled, diet followed, time to cleanse!

Assemble your stuff:

You will need your instructions, and whatever purgative you have to take.  Of course, you should always follow your doctor’s orders.  It just so happens my GG’s orders didn’t exactly match what it said on my box of purgative.  He told me this would be the case, and to follow his instructions.  Which I did.

Re-read your instructions. 

You may have seen an episode of MASH, in which the surgeons have to diffuse a bomb, but have a problem because the instructions are written out of order.   Sometimes instructions are written that way in recipes, too.  As a result, re-reading before starting is always recommended.

Drink your purgative.

Follow your doctor’s orders for this one.  You will need to consume liquid throughout the cleansing to keep yourself hydrated.  Make sure you choose your beverages carefully.   For example, I will never drink grapefruit juice again.  EVER.   You should avoid drinking anything with bubbles.

Will it really taste that bad?

Lav? Ughblechshudder sums it up quite nicely.

Phosphosoda? By far the most disgusting thing I’ve ever had to consume.  Like thick, salty, dish soap.  It coats your tongue and stays there.  Try not to taste it.   Don’t pay more for ‘Lemon-ginger’ flavor.  (What is it with manufactures of horrible tasting things and citrus?  Did an orange or lemon tree attack them as children?)

PicoSalax ? Not bad at all. The taste - to me, anyway- is a little like Neo-Citron that is just slightly off.  Slightly lemony, possibly a little soapy.  (Again?  Citrus?  Why not mint? Or better yet - tasteless?)   Sorry.  Moving on.

How bad will the effects be?

They will vary.  You will probably notice something happening within 20 minutes to an hour.  The advice I was given for PhosphoSoda was: before you down the last shot (3 in a bottle), have the bathroom door open, the lid up, and a crossword puzzle or Sudoku ready beside the toilet.

No matter what purgative/laxative you’ve taken, if you feel like you may have gas, go to the bathroom.

The cleansing will take a while.  Again, results vary.  Each person is unique.  Some people find they go to the toilet once an hour, for 10 minutes at a time, for a few hours.  Some go less frequently, but for longer.  Either way, you will be spending a fair amount of time in that room.

This is why I suggested puzzle books and magazines.  It gets really, really boring.  You get to really look at your walls and fixtures.  I wonder how many people decide to remodel their bathroom following a colonoscopy?

Can I eat anything?

No.  No you can’t.  You can drink clear fluids.  Popsicles and Jell-O are allowed, but not all colours.   Check with your doctor.  I know one person who isn’t allowed to have Gatorade, for example.

Please, please use common sense!  I met one lady who decided to consume beer for breakfast before her scope, reasoning that it was clear, liquid, and contained calories.  DO NOT DO THAT!  She was drunk.  Really, really drunk.  Possibly this is a lifestyle choice of hers, but it was definitely not appropriate. 

Also, her GastroGuy was not able to perform her scope that day.  She delayed the patients behind her.  She annoyed the patients in the waiting area.  She made some of them very uncomfortable.  She was a big problem for the nursing staff on more than one floor, taking their focus away from actual patients who were ill and really needed help. Don’t be like her, please.

Enema?

You may be asked to prepare at home by giving yourself (or having someone give you) an enema.  I’d say this is the hardest part, especially if you have limited flexibility and/or no one to assist you.  If that’s the case, talk to your doctor. 

If you are up to it, I say splurge on the Fleet.  They know their stuff.  It is an awkward business to be sure, but theirs is easier to administer. 

Awkward?

The instructions tell you to do it yourself by lying on your side, drawing your knee up towards your chest, and inserting the lubricated tip (TAKE THE CAP OFF FIRST!) into your rectum, angled toward your belly button. 

Let’s just think about that for a bit.

Are you able to get into that position on your own?  Can you then reach your backside, and accurately aim something about 6 – 8 inches long?  Toward your belly button?  While inside a bathtub, or lying on towels on the floor?  This is why I strongly recommend discussing with your GG.  Your doctor will know which preparation method will yield the best results for your scope.

Finally it’s time to go to the hospital or clinic!  Hooray!

-       Do not wear perfume or aftershave.  You may be going to a scent-sensitive area.

-       Do not wear jewelry.  No, it’s not the staff losing track of your earrings that you have to worry about; it’s the people who wander through the hospital, willing to take them off you.  There was a case in Toronto of a dying woman being robbed in her bed.  

-       Do not take anything of value.  See above.

-       Wear comfortable clothes.

-       Wear socks.  Cute socks, warm socks, doesn’t really matter.  You will be in a waiting area without trousers.  You may get to keep your shoes, or you may have paper slippers.

o   Which reminds me:  Ladies, you will be in a waiting area sans trousers.  If you forgot to shave, that’s ok.  It is considered rude to inspect the other patients.  Also, you don’t need to wax your bikini zone.  Your doctor really doesn’t care.

-       Do not wear makeup.  During your scope, someone will be monitoring you at all times.  Makeup can make it harder for them to tell if you are having an adverse reaction to a sedative. 

-       Do not wear nail polish.  You will have an oxygen monitor clipped to your finger.  It doesn’t hurt.  It is really neat, that they can do this now.  Don’t make the nurses take off the polish for you.  And don’t yell at them if they do have to take it off.  They aren’t doing it to be mean.  They are doing it because it is important to make sure you are still getting enough oxygen, especially while you are sedated.

-       Do not take any foods; there will be time to eat later.  Everyone in the clinic is in the same boat.  

Fine. So, what can I take with me?

-       Your ID

-       Your Health Card

-       Your Procedure Request, or whatever other papers your doctor gave you. The hospital may need them.  They will probably write something on them, and either give them to you to take to the next room, or forward them themselves.  It’s a little different everywhere.

-       A list of medications, herbal supplements, vitamins etc.  Heck, maybe even bring the bottles in a baggie if you like. You will be under partial sedation.  The folks working to keep you out of pain want to make sure nothing they give you will interact with something you’ve already taken with an unfortunate result.

-       Anything your doctor has specified you bring with you. 

-       Someone who can drive you home.  This is so very important.  You will not be allowed to drive home.  You will feel fine.  You will be in no condition to drive.  I have seen someone (who was trying to sneak out), walk into a closing door because he misjudged the distance and/or could not put his arm out in time.  He was promptly ushered to ER for a suspected broken nose.  This is why some hospitals/clinics will not let you out until your driver shows up to collect you.  If you don’t have someone, ask about taxi services in advance.

-       You can take water but be prepared to leave it with your driver/companion.

-       Directions to the hospital or clinic, including parking information

-       Change and small bills for parking.  If you’ve never been to the hospital or clinic before, call before you go.  Or visit their web page.  Lots of hospitals have pay parking lots.  (Come to think of it, I’ve only been to one hospital that had free parking.)

-       Many hospitals have some sort of construction going on.  Make sure you have enough time to

a) Get to the hospital or clinic.

b) Find a place to park.

c) Find the proper department.

d) Check in.

Phew!  That’s a lot! What’s next?

Part 3: The Hospital/Endoscopy Clinic.

(By the way, at no time has anyone given me any product or promotional materials from any manufacturer or vendor of any of the products mentioned above.)

It’s Colonoscopy Time!

EveningGoose (not her real name, obviously) asked me to write about colonoscopy.  Her Mother, Mrs. EveningGoose’s Mother - to borrow the format used by children - gets to have her very first full colonoscopy soon.  [singsong voice]  “I get to be helpful.”

Ahem.  Yes.  To business.

First of all, colonoscopy isn’t that bad.   I know it worries people.  It is a strange medical thing.  You don’t hear much about it in the media.  It deals with [whispering] your bottom.  It sounds uncomfortable, scary and embarrassing.  And, among other things, it checks for Cancer.  

Did you go to that link?  Whole Lea Cow, talk about depressing.  Not exactly welcoming, warm and friendly, is it? 

But the procedure itself is really not that bad.  Let’s start with the name.  Colonoscopy.  A doctor is going to be looking at your colon (the large intestine) through something called an endoscope, which is essentially a long, flexible tube with a camera on the end.  It looks a little like thick coaxial cable – like the stuff that goes from the wall to the TV.   A ‘scope’ of some kind.  A scope for your colon.  Colon-o-scope.  But it’s not really pronounced like that.  If you do say it that way, your doctor will look at you a little funny.  But you can call it a scope.  That isn’t as scary, is it?  Scope is the term we’ll be using.

By the way, the preparation (or prep.) is the worst part.  Also the longest part.  And it’s not as bad as it used to be. 

Your doctor may have sent you to a specialist, called a Gastroenterologist.  This lovely person will perform the procedure, probably in a hospital or other clinical setting.  My Gastroenterologist is a very nice man.  I refer to him as GastroGuy.  Not to his face, of course.  I don’t know how he’d take it.  I don’t think he would be offended, but he may feel compelled to start wearing a cape, or a mask and tights, and that wouldn’t look dignified.  It probably wouldn’t inspire confidence in his patients, either.

Anyway, Your GastroGuy (or GastroGal, or GG) will have given you a list of instructions around the time you booked your scope, or they will be sent to you probably 2 weeks before your scope.  Read These Instructions!

Like the ones for CT, they didn’t write them for the laughs.  They are to help you with the preparations before hand.  If you follow them, the prep shouldn’t be too bad.  The instructions will help make the overall procedure easier for all concerned.

You may have a list of foods you should not eat before the scope.  It’s a good idea to make a menu plan on your calendar, and ensure you stop eating things like, say, poppy seeds or cucumbers or tomatoes when the instructions tell you to.  

You need to stop taking the things in so that they will have enough time to come out before the scope.  Cucumber and sesame seeds can (and will) stick to the sides of your colon.  Your GG will have to remove them to get a good look at your colon walls.  This will be accomplished during the scope with a jet of really, really cold water.  It doesn’t hurt, but it is:

    a) an incredibly bizarre feeling that you probably will not enjoy at all,
    b) a little embarrassing, because it says "I didn’t read the instructions."  

Unless of course you did read and follow all the instructions, in which case your GG will talk to you about it.  Don’t Panic! 

You will not be allowed to eat solids for some number of hours before you take your purgative.  You will not be allowed to consume dairy for some number of hours before you take your purgative.  Trust me when I say this is really, really important.

At the beginning of this post, I said that the prep is really long.  It is.  So, for the sake of readability, I will be breaking this into a few posts.  I want to give a good description/explanation of what to expect, in smallish increments.

Stay tuned!

Things they don’t tell you before your CT

 

Before you report to the Hospital or Imaging Centre ¹ for your CT, you will be given a list of instructions.  Things to bring to the hospital, like a Health Card, ID, Copy of the Procedure Orders (if you’ve been given them), list of medications or the medications themselves, vitamins or natural supplements you take, that sort of stuff.  Bring them.  You will be told how to prepare for your study.  When to eat or to stop eating.  If you have to take a purgative.  What to take as a purgative.  When and how to take it.  Do what they say.  The folks who told you to do this stuff didn’t write the instructions for laughs.  You do it this way to make it easier for you, not easier for them. 

OK, some of the stuff makes it easier for them.  Bringing your vitamins and supplements and telling the nurses and techs about any allergies you have ahead of time means the these lovely people probably won’t have to deal with you having a reaction and screwing up the whole day.   Not just your whole day.  The tech’s day.  The nurses’ day.  The doctor’s day.  And the days of all the patients scheduled to have the test after you.   Don’t be ‘That Guy'.

In addition to all the very important stuff they do tell you, which includes why you are having the test, and what the side effects are, and what the risks may be, there are things they don’t tell you.  Well, sometimes they do tell you, but not always.  Why?  Well, because it’s not really that important in the grand scheme of things. 

Anyway, I’ve had some of these tests lots of times.  If I can help you not panic, I’m all for it.  I’m often the youngest person in the waiting area.  I try to calm the other patients down.  After all, if you are here to see exactly how bad off you are, isn’t it nice to see someone who has done it before?  

  

• Barium tastes bad. Orange flavor is a lie.  Whoever decided that abomination was ‘orange’ has clearly never eaten any form of citrus in his (or her) life.  And who decided ‘Orange’ was a palatable flavor for a thick liquid-metal-chalk thing anyway?
• The drink itself looks (initially) like milk.  Kinda.  If you squint.  It is thicker, almost thick milkshake consistency.  It does not taste good.  I have seen 2 men (or perhaps it was the same man twice) chug it.  They just some how opened up their throats and down it went.  One 500ml glass at a time.  Clearly this is an important skill. 
• Have tissues handy, and try not to lick your lips.  Ever notice that you do that when you drink?  Lick your lips after a sip?  Try it.  I’ll wait.  Did you get yourself a nice beverage.  Take a sip.  Then another.  Do you feel any fluid on your lips?  Did you lick it?  C’mon, you know you did. It must be a reflexive action.  Well, when you drink barium (or intestinal lav., for that matter) don’t  lick.  If you are at all like me, and odds are you may be, the taste is so unbelievably repulsive that the barium may come back up just a little bit.  And that’s bad.  Not because it will hurt you in some way.  No, it’s bad because you will have to drink another glass.  And the nurse/tech supervising will make that face.  You know the one. 
• Iodine may be used as a contrast agent, too.  It’s better than barium, in that you don’t taste it.  Right away.  It is a vascular contrast agent.  This means it will be injected. To see the vascular structures.  You know, the lovely little tubes that carry your blood around your body.  They are everywhere.  They are even in your tongue.  Yep.  But the part they don’t tell you about until you are strapped to the table with the stupid needle in your arm, is that the iodine will cause you to feel warm as it courses through you.  This is really neat, in that you can actually feel it moving through your body.  Those of you with medical experience, or practical patient experience, know what is coming.  You have lots of vascular structures in your lower abdomen and groin.  When the iodine hits, it will feel as if you are going to pee yourself.  And it will feel like you may have peed yourself.  You (probably) didn’t, it’s just a side effect of the contrast agent.  Just to be safe, always go to the bathroom before a CT.   
• As a courtesy, don’t look too closely at the patients coming out of the exam room.  They may be feeling a little self-conscious as they exit.
• According to one patient, the Iodine induced warming feels very much like a menopausal hot flash.  This may reassure you.  Or it may make you dread menopause.  Or it may give you empathy for menopausal women.
• Be nice.   I always try to be nice for my techs.  I wouldn’t want their job.  Yes, you are having a test, and yes, this is not a very good time for you.  They are here to help you, and they have some not particularly pleasant things they have to do.  However, in chatting with many techs,  I’ve found that we know the same people.  Although I now live in a good-sized city, I grew up in a small town.  
• Ask the techs if you should eat or avoid eating anything in particular after your test.  You will have been fasting, and may have also taken a purgative before hand.  Sometimes the contrast agents will have a residual after taste.  If they say to not eat something in particular, DO NOT EAT IT!    They are helping you here. 
• The barium follow through will be eliminated from your body.  It will not be painful, nor will it look like the sort of thing that is normally eliminated from your person.  Spackle?  Bird poop? Parging, possibly?  Don’t panic.

Well, ok, you can panic a little.    

1  I live in Canada.