Still Here!

My but time does fly.  The months have whizzed past.  I've been busy.  Kinda.

Since I last posted, I've had a couple surgeries and a bunch of procedures.  I'm healing nicely for the most part.

I've memorized the 5 signs of infection, in English and in Latin.  Because my principle surgeon has a sense of humor, that's why.  Also because prevention is so much nicer than treating. For everybody.

I've been fortunate to once again have a nice team of medical professionals looking after me.  They are lovely people.  Dedicated.  Kind.  Funny.  Great taste in music.  I don't want to see them anymore.

But I have to, because I'm not done yet.  Another 3 things to go (assuming this last one heals well), and I should be all done.  Except for regularly scheduled checkups.


And for anyone who cares, the 5 signs of infection are:

heat
swelling
redness
pain
discharge

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. 

I couldn't resist

This is Friday's lunch.  We were running behind schedule, so there was some dashing about in the kitchen.  I did have a much fancier looking lunch in mind, but when everyone overslept, that just wasn't going to happen.

The girls took the same lunch contents, but they were arranged differently.  Peanut's was more plain, as she is too old now for cutsey lunches.  Below is Pumpkin's lunch.  She's fine with the cutesy.

It started with just ham on tortillas, with grapes and blueberries in the silicone cups.  Then I thought, hey, the broccoli kinda looks like hair!  

So I added grapes for eyes and a blueberry nose.  I could not find the toothpicks anywhere, so they are held in place with short bits of whole-wheat spaghetti.  The face was taking shape, and screamed out for a mouth.   Pumpkin also got a yellow pepper ring cut in half for a smile. 

Braaaaaaains

Today the girls took something a little.....different.

Saturday is World Zombie Day.  Many cities are having celebrations, lots of them involving food drives to support local food banks.

The girls' school is having a food drive, but it is the annual Thanksgiving drive.  It has nothing to do with Zombies, but will have some links to Oktoberfest, which kicks off Friday.

What is the favourite food of zombies?  

Brains!

Of course I couldn't send real brains to school!  These are maccaroni elbows with a little garlic and grana padana, shaped roughly into a brain (see the cleft?), with tomato paste dabbed on for blood.
The brains are held in place with cucumber slices. A silicone muffin cup holds the grapes.  Broccoli, red pepper slices and carrot slices  fill in gaps.

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.

Summer Camp Lunch

It's still summer camp season!

Today's lunch has cold BBQ Chicken Thighs (boneless, left over from last night), green and yellow beans (fresh from the garden bed), local cherries, pita and grapes.
The pita was toasted, cooled and torn to bits.  Peanut reported that it did stay not soggy the last time we did this, so here's hoping it works again.  You can see the condensation that started forming on the grapes in the brief time they were out of the fridge.  Frozen juice boxes will hopefully help keep the lunch nice and cool.

Sunscreen

Exactly how much sun screen do I need to use?

This is a question I ask myself a lot.  One year I slathered SPF 30 on, had lunch outside (45 min, tops) and came in with a lovely burn.

So, if sunscreen extends the time you can safely be in the sun before burning, I've got what, a little over a minute I can be in the sun at any one time?
Great. 
My Darling Hubby bought me the "Keep out of direct sunlight" shirt from ThinkGeek for my birthday.

OK, but really.  How much?
According to this article, at least 2 Tablespoons for you body, and half a teaspoon for your face.  This other article says essentially the same thing.  Both of those talk about relative SPFs and have other tips.  I like the shadow rule myself:  If your shadow is shorter than you, head for cover.

But staying inside and/or out of the sun totally isn't going to cut it.  I want to be outside. (Maybe not so much this week.)  The other day I popped into a Dollar Store, and picked up a set of plastic measuring spoons:

Now I can squirt sunscreen into them, hand it to Peanut, and get her used to the volume that needs to be slathered on, and repeat as necessary. Pumpkin will still require some parental assistance, but still has a handy visual aid.  These things are going to live with the sunscreen bottles, and will be traveling to the beach with us this year, too.

Some Good News in the Fight Against Cancer

Pumpkin asked why I was slathering her face in sunscreen.  I've done it many, many times, but this was the first time she asked why.

"Because I want to help you not get cancer of the skin."  I answered.
"Oh.  How can you tell if someone has skin cancer?  Is it wrinkles?"

Clearly I need to explain this to her a little better, and a rushed discussion while she was putting her shoes on wasn't going to cut it.  Earlier in the week I read a CBC article about sunscreen.  Today I went to the Canadian Cancer Society's page for additional info, and came across something awesome. Sunscreen stuff will be a future post.

Beacuse there have been three (3!) breakthroughs in the fight against cancer announced THIS WEEK!

Are they in the news?  Well, not up here.  Today I've heard the 'hard news' about the storm in Eastern Ontario, the fires in the American South West, the Postal Worker's Strike, and the arrest of a singer.  And of course, the feel-good story of ducks in the road.  This time in Washington.  Oh, and Hugh Jackman coming to Toronto in July.

So, what's the exciting, science-y good news?
- Improvements in Preventing Breast Cancer (!) in women having an increased risk
- Revised Treatment of Breast Cancer, reducing risk of recurrance
- Revised Treatment of Prostate Cancer, with fewer side effects

Read all about it at cancer .ca

What you don’t know can kill you

Normally the Friday post is health related.  It usually has a cancer focus.  Not this week. 

I was reading the paper the other day, and I came across an article about strokes.   It’s available on-line here.    The full report is available on the website for the Heart and Stroke Foundation, here.

I was shocked to read how little women know about heart attacks and strokes. 

Especially Chinese and South Asian women.   

Which is really upsetting, considering they have the highest death rate. 

Apparently there are lots of emails circulating that share “tips” on what to do before, during and after a stroke.  The Heart and Stroke Foundation recommends you do not follow or forward these things (Snopes.com has examples of the emails, if you are curious), but instead become familiar with the actual warning signs of stroke by visiting their website.

Stroke Warning signs

Heart Attack Warning signs

Food Doesn’t Taste Right While On Chemotherapy

A while ago, I bumped into an old friend from University.  Not that she is old.  Or that I am old.  Well, maybe a little bit older than, say, new grads, but we aren’t up for CPP or anything yet. 

Anyway....

We were chatting about all kinds of stuff, and Cancer came up.  She was looking for advice for her Mom, who had started Chemotherapy, and was having food issues.  Specifically, it was hard to eat as much as she was supposed to because the food just didn’t taste right. 

Being a Cancer Sherpa, I promised I would ask around, and tell her what I found.  I sent her an email long ago, but still had the info on my desktop.  So why not share it?  That’s what this blog thing is for, right?

A summary of what I learned:

1. I know an awful lot of people who either have cancer right now or have battled it at least once in their lives. 
2. There is no one answer.  Unless you count “It depends.”  Everyone I spoke to had a different way of dealing with the food issues. 

The tips themselves:

• Eat tiny portions.  One friend will eat only 2-3 tablespoons at any one time, to combat nausea.  It means he's pretty much constantly "snacking" on foods that are pretty much pureed, alternating with soda crackers.
• Eat with plastic fork, knife and spoon.  One friend-of-a-friend can really taste the metal in foods, and stainless steel utensils make it worse.
• Eat the food only when it is really hot.  One friend says the food doesn't taste right because the taste buds are formed by fast growing cells, so the chemo gets them, too.  She finds the food has a more natural taste if it is hotter.
• Add more spice to the food.  This is another friend who follows the 'taste buds are dying' approach.  She uses a lot of spices (no salt!) in her food to make it more palatable.  Unfortunately, her family can't stand the extra, so she seasons her food separately.
• Eat the food really cold.  Yet another friend (I told you I know a lot of people on chemo) prefers his food to be so cold it has no taste.  He lets his supper portion cool while the family eats, then puts it in the fridge for a bit (30 mins. or so) and eats it as cold as possible.

Other tips I received:

• Eat the comfort food from your childhood; it will make you feel better.
• Don't eat the comfort food from your childhood; it will ruin it forever. Clearly no winner on that one.
• If you feel like eating something, eat it.
• Eat when you feel like it, even if people look at you funny.
• Suck on a mint or chew gum to get rid of dry mouth.
• Never suck on a mint or chew gum to get rid of dry mouth. Again, this seems to be a contested, personal choice thing.
• Magic Mouthwash will eliminate cottonmouth!  This was unanimous among those who'd tried it.  It's a prescription item, and you will have to ask your Oncologist or Oncological Pharmacist person about it.  I tried to get the actual name of the thing, but all anyone would say is "Magic Mouthwash".

And here’s a tip from me:

Contact your local chapter of the Cancer Society, or check it out on line.  There may be a survivor’s or living-with-cancer group in your area.  They may have some good resources available.    

If you have something to add to the list, let me know.

National Cancer Survivor's Day is June 5th

Hey!  Did you hear?  There is a National Cancer Survivor's Day!  And it's coming up!  Mark your calendars!

Why do I care?

When I went in for my most recent checkup, I met a lovely woman who had never met a cancer survivor.  Every one she knew who had cancer died.

And she was scared.

Because she had cancer.

And it's scary.

Now here's the thing; she is not the only person in this boat.

A little while ago, I attended a survivor's group with a friend.  She signed me up, actually.  She didn't want to go to the thing alone.  And, since I was her Sherpa, I went.

My friend (who shall henceforth be known as Madame President) introduces herself to people as the President of the Survivors' Club, and Chair of the Welcoming Committee For Cancer Survivors. She is a 30 year survivor.  Unfortunately, she put herself up for renewed membership 2 years ago.   That darn paperwork ;-)

But guess what?  She is still here!  And she's fine!

We hear the crappy news all the time.  It's easy to find, easy to print.  We need to hear the good sometimes, too.  Recognize that cancer doesn't always win.

So, let's get the word out, shall we?    If one in 4 people will have cancer in their lifetimes, odds are exceptionally good that you already know one person who has, will have, or has had the big CA.

Dates:
Canada's Survivor Day is June 5th.

It looks like this was started in the US, and a few other countries have joined in.  See here for more info. 

I totally understand people not wanting to "Out" themselves as having had cancer.  You face an awful lot of negative attention.  You get blamed for having been sick.  You get accused of lying, because you aren't dead.  You will never be able to get insurance again.  You may not be able to get a job.  You may loose a job.  People treat you like you are contagious.

But honestly?  If we don't stand up, and stand together, then cancer wins.

Again.

And NOBODY wants that.

Where did my mind go? Chemo Brain and the "Ooh-shiny's"

Chemo Brain.

Have you heard of it?  That awful loss of your mind that happens when you've had chemo.  Did you know that even cancer patients who've had surgery, but not chemo, get it?  Yep.

Sucks, doesn't it?

Some things aren't mentioned to patients (or the general public) about chemotherapy.  Or any cancer treatments, for that matter.

"Your short term memory will be affected."  This they tell you.
It kind of makes sense, because the chemo is killing the little grey cells.  But it happens to people who've had their cancer treated via just surgery as well.  That part doesn't get shared so much.

"You get distracted more easily."  Some patients are told this, some not.  Some researchers I worked with called it the "Ooooh shiny! Effect" or, the "Ooh-shiny's" for short.

What is it like?  Well, bloody annoying for the person who has it.  I'm sure some folks who work or live with the person don't enjoy it either.  Some of the survivors I've spoken to were afraid to even mention this to their care givers.  They were (almost unanimously) terrified it was a symptom of something else.  Like metastases to the brain.  Or some form of dementia. 

You are trying to have a conversation with someone about something, like a book you've been reading, and all of a sudden, something grabs your attention.  Something you only partially saw, maybe.  Out of the corner of your eye.

And WHAM!

Your train of thought has been completely derailed.
Poof!  Right in the middle of your sentence.

And it happens again and again.  You keep going off on a tangent.  Or you completely forgot what you were saying.  Or what the person you were talking to was saying.

Now, everyone has this at one time in their life.  But with someone who has been (or is being) treated for cancer, it happens a lot more.

Does it go away?
Yes.

When?
It depends.  (Do you hate that answer as much as I do?)

Most people see the effects gradually diminish following the end of chemo.  If you've never had chemo, but still got the Ooh-shiny's, things will (probably) be totally back to normal after 36 months.  If you had many rounds of chemo, it could take as long as 10 years.


Want to know more?
Check out the links below.

Memory Loss In Cancer Survivors Not Always Due To Chemotherapy 

Chemobrain Is Real but May Need New Name

Canadian Cancer Society - Changes in memory and concentration 

Central Neurotoxicity, Memory Loss, and Their Relationship to Chemotherapy

What Does The Sherpa Pack For a Trip to The Chemo Ward?

The short answer is: it depends.  The long answer...is longer.  And starts with 'it depends'.

It depends on who is going, and for what.  It depends how long it is going to take, and the length of your journey.

It starts with the bag:
Something light, yet strong.  Something that will allow you to have at least one hand free at all times.  Something you will be able to carry or drag or pull when you are very, very tired.  Something that won't fall off your shoulder at the worst possible time.  Something that is the right size to hold your stuff, plus the chemo patient's stuff.

Backpacks and across the body bags are good.  I'm sure a wheeled bag of some kind would also work, but you have to consider terrain.  How are you getting to the hospital?  Cars? Buses? Trains? Subways? What about stairs?

What stuff do you take to Chemo?  

Below is a list, based on stuff I've packed while being a cancer sherpa, and what others have packed when they were sherpa-ing:

1.  Directions and maps.
To the hospital.  Or, in some cases, to the part of the hospital your patient is going.  Sometimes Hospitals are HUGE complexes of buildings.  Know where you are supposed to be going.

2.  Change.
Change for parking (although folding money will probably work, too), change for vending machines.  Change to toss into a wishing well, maybe.  Carry coins.

3.  Kleenex.
Hospitals tend to have those tiny KimWipes thingies.  I have disliked those since the early nineties.  Sadly thin, half-width approximations of facial tissue.  Bah!

4.  A Notebook.

5.  Something to write with.
Two pens, one mechanical pencil and a black fine point sharpie.  You never know when you will have to fill in a form, do math or label something.  They don't take up much space.

6.  A Swiss Army knife. 
You can use one to trim the dangling end of a hospital id bracelet, or open a packaged 'sandwich' from the cafeteria, or put the tiny screw back into your glasses. Just don't try to get on an airplane with one.

7.  Reading material.
Yes, hospitals have magazines.  Hospitals also have drug resistant bacteria outbreaks.  No one sanitizes the magazines.  Bring your own.  Your patient is on Chemo, and as such, has a weakened immune system.

8.  Something else to occupy your time.
A deck of cards or a portable DVD player (or smart phone) with a headset.  Or two. Cross words.  Sudoku.  You and your patient are going to be in the Chemo Ward for a while.  I don't recommend bringing knitting, crochet or cross-stitch.  Again, germs.  Yes, the chemo ward will be nice and clean, for the most part.  It's the people who wander through the hospital who are the problem. 

9. NOTHING OF VALUE.
OK, yes, I just said DVD player up there.  Here's the thing;  at some point, you will need to go to the bathroom.  Part of your job as Sherpa is to watch the patient's stuff.  If it's not something that you are comfortable leaving unattended, don't bring it.

10.  A beverage or two.
Water, juice, ginger ale, what ever.  Your patient may have special stuff that you will need to carry, or perhaps the hospital will provide water or juice for them.  You will need to carry your own provisions.  Be aware that you might not be allowed to consume food or drink in the chemo ward.  If this is the case, be nice and take your snack outside without fuss. 

11.  Breath mints or gum.
Some people are very sensitive to scents when on chemo.  If your patient is one of these people, you the Sherpa should be aware of how you smell.  Ask.  Encourage a blunt reply.

12.  Travel Eye mask and ear plugs.
This one really depends on your patient.  Perhaps they will want to nap.  Perhaps not. 

13.  Lip balm and hand cream.
Hospitals are dry.  You will wash your hands a lot. 

14. Hand sanitizer.
Yes, Hospitals have the stuff everywhere.  But what if you stop at a coffee shop on the way?

15. Large plastic zip-top bags, like Ziploc.
I always pack at least one.  You never know. 

This list is not complete.  Or maybe it is.  Or  maybe there is too much stuff on it.
It is a starting point.  Pack what you think you will use.  If you don't need it, don't take it next time.    Revise as you go. 

I do recommend keeping the support pack, or chemo-bag ready with the stuff you'll need for the next trip to the ward.  Top off whatever's depleted when you get back.  Get in the routine of having the bag always ready and you won't have to rush around at the last minute.

March is Colorectal Cancer Awareness Month

Why should you care?

It’s a form of cancer that can be detected early.  And stopped.

It is, in fact, the second highest cause of death from Cancer in Canada. (Source: Canadian Cancer Society)

Think it doesn’t affect you?

One in 15 women will likely get colorectal cancer during her lifetime.

One in 31 will die from it. (Source: Canadian Cancer Society)

For men, the odds are pretty much the same:  One in 14 will get it, one in 27 will die from colorectal cancer.

But, I eat the right foods/am vegetarian, so I’m safe, right?

Short answer: No

Want the longer answer?  Read this page.

Yikes!

Are there things that make me more likely to get it?

Well, the Colorectal Cancer Association of Canada has excellent information on that.  The full page is here, but to summarize:

-You are more likely to develop it as you get older, but young people get colon cancer too.

-Having had polyps before

-Having inflammatory bowel disease

-A family history of colon cancer

-A genetic disorder

-Growth hormone disorder

-Race and Ethnicity

-Having had certain other cancers before

-Having had radiation therapy for certain cancers before

-Type II Diabetes

-Obesity

-Sedentary Lifestyle

-Poor diet

-Smoking

-Heavy Drinking

-Working the night shift

OK, so what are the symptoms?

-Constipation or Diarrhea.  Occasionally, everybody gets them.  But if it persists despite changing your diet or drinking more water, see your doctor!  It may not be the big CA, but definitely indicates something is wrong!

-Narrow stools.  Consistently passing ‘pencil poo’ or ‘ribbons’.  Again, not a normal thing.

-Abdominal cramping.

-A feeling that you ‘still have to go’ even after you’ve finished on the toilet.

-Bloody stools.  Passing blood is never a good sign.  Again, whether or not it’s CA, see your doctor!

- Unexplained weight loss or loss of appetite.

-Nausea and vomiting.

-Gas and bloating. (Yes, this means burping as well)

-Unexplained fatigue and lethargy.  Again, not always a sign of CA; can indicate other things are wrong, too.

Great, so, what should I do?

You should, at your next regularly scheduled appointment, talk to your doctor about colon cancer, and the screening method that is best for you, and when to start it.

UNLESS you have reason to believe something is seriously wrong, in which case you shouldn’t wait, you should phone your doctor.

Don’t die of embarrassment.

Want to know more?

The Canadian Cancer Society:

The Colorectal Cancer Association of Canada.

Beige is Not Slimming

It can be very hard to look svelte in beige.   How many stunning beige bathing suits are there?  How many women can pull off a beige ensemble on a red carpet?  How many men can wear a full-on beige suit and wear it well?

 And the foods that are beige? 

Have you ever noticed when someone is on a reality show, having their diet examined, the unhealthy ones are…beige?

You Are What You Eat – beige

Supper Size vs Super Skinny – beige, usually for both, oddly enough.  Just different quantities.

And the fad diets?  The ones that have some success, even if only initially?  What do they tell you not to eat?  Brace yourself-

Beige.

Do you have a pantry?  What’s in it?

Beige?  Really?  Why is that?

The shelf-stable, long life things are beige.  Prepared foods?  How much of that stuff is beige?  I like to stay away from prepared foods mostly because I don’t like the taste.  But there’s a ton of salt and other yuckies in them, too. 

Still, my pantry does have beige.  I’ve got whole wheat pasta (beige), and several kinds of rice (brown, which is beige; Arborio, which is white; wild, which is white and black).  Rice noodles.  Three different widths, all clear/white, so they will get lumped into beige.

Oats.  Beige.  Flour.  Beige.  Massa.  Yellowish, but still beige.  Taco shells.  Yellow, but may as well be beige.  Crackers.  Also beige.  Potatoes?  Assorted starchy beige.

Breads tend to be beige.  Or worse, an unnatural looking, gleaming white.  And yes, eating lots of it is definitely not good for you.  But neither is eating too much of any one food.

But are all beige foods bad?

I don’t think so.

Lentils?  Chickpeas?  What colour are they? Barley?  Quinoa?  Parsnips?  Ruddibegga? Turnips? Oats?  Rice?  Whole Wheat flour?  If you eat a varied diet, you should be fine.

Look at Canada’s food guide.  Or the food pyramid.  Or the eat a rainbow plan. It’s not news.  Its not rocket science.  Its not something you have to run out and buy the latest diet book for.  

It is common sense, or it should be.  It’s actually listening to scientists and trained medical professionals, who’ve been saying this for years.   Eat a variety of foods, including the colorful ones.  You don’t have to banish beige entirely, just eat responsibly.

And buy well fitting khakis.

Avoiding a beige bathing suit is probably still a good idea, though.

(Note:  While I do believe eating responsibly can help someone be healthy-ish, I don’t subscribe to the ‘perfect diet will keep you free from all illness’ philosophy. )

A simple, useful tool.

One of the most useful tools in your cancer-fighting arsenal can be obtained for as little as a dollar.

A notebook.

When someone has been diagnosed, they encounter a few things fairly often:  questions, information, worrying and waiting.  Yes, there are more than just those four.  But they do keep coming up.

A notebook can really help.

It gives you a place to record all the appointments you will have.

All the doctors and office numbers.  Who to call when in case of whatever. When you fill in forms, you will probably be asked for the name, phone number and address of your doctor.  And the fax number.  Possibly the email address.  When you are a cancer patient, you collect a lot of doctors and other medical professionals.  I recommend writing the contact info on one or two pages, right at the front of the notebook.  Along with what each one does.

You can write notes from meetings in the notebook.  You can write questions in it, so you have a better chance of remembering to ask them.  You have a place to put forms, pamphlets and business cards.  You may need to staple or glue them in, but still.  It saves rummaging for the things later, when you are trying to go someplace and really can’t spare the time.

One of the things that happen to the patient is an increase in stress levels.  This happens for their principal support person/care giver, too.  There is a hormone, called cortisol, that is IMHO, really annoying.  When you are stressed, you produce more of it.  It really isn’t your friend.  It packs weight on you, screws with your sleep patterns, and can make you forget stuff, and may even make you more likely to develop breast cancer. There are good descriptors at this link.  And of course here’s another paper that says stress makes cancer grow.

Lovely.  Does this help the patient?  Well, I suppose it does, but it also makes me think of the IT Crowd episode, in which the boss of the company declares war on stress.  And decrees that anyone who is stressed will be fired.  Because that’s going to help.

But forewarned is forearmed.  If there is something you can do to reduce your worry, why not try it? 

So, back to the notebook.

Write stuff down!  It may help!

If there is a change in your treatment, write it down.  If someone recommends you do something, but you want to check with your care team first, write it down. 

Your doctors will want to know your history.  Write it down.  When did you first notice symptoms?  When you’ve figured that out, write it down.  You can refer to it later. 

When did you have a test?  When will you get the result?  Do you call them or do they call you?  Write it down.

It doesn’t have to be fancy, or plain, or depressing.  I like a notebook with a flexible cover, but something with a cheerful or calming cover may be more your style.  Stick photos in it.  Drawings.  Things that make you feel happy. 

Or at least, less stressed. 

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.)