Blogonoscopy: A doctor's tale of getting a colonoscopy

I just had The Test. It seems like it was only yesterday. Maybe it was yesterday. The details are fuzzy already. The truth is I can barely remember a thing.

Having just turned 50, I was supposed to have a colonoscopy. Everyone who turns 50 is supposed to have one. There are only a few exceptions to this recommendation, including people who already had a colonoscopy in recent years (and are not yet due for another) or those with medical conditions that reduce the expected benefit of the procedure or increase its risk. For example, doctors caring for an elderly person with severe heart disease might not recommend a routine screening colonoscopy.

The Test is looking for early, curable colon cancer but, just as important (perhaps more important), it is also looking for polyps. One type, called an adenoma (or adenomatous polyp), can become cancerous over many years. Detecting adenomas and removing them through the colonoscope can prevent colon cancer before it occurs.

Even knowing all the reasons I should have it, I dreaded The Test. In fact, I began fretting about it just about the time I turned 49. For a full year, I was whining to myself (and, sometimes, out loud) about how little I was looking forward to it. I even thought about trying to have it early, to get it out of the way. I also thought about skipping it. But how could I turn down a test I knew made medical sense? High quality studies provide powerful evidence that people who have routine screening colonoscopies live longer colon-cancer-free than those who skip The Test. In addition, I wanted to avoid the “do-as-I-say-not-as-I-do” hypocrisy I’d be guilty of if I didn’t have a test I’d recommended to so many of my own patients.

So, why was I dreading it so much? Here’s why: I had heard The Stories.

The Stories did not come from medical textbooks or scientific journals. No, the official, authoritative medical sources make it perfectly clear: I should stop whining and just have The Test.

The Stories that gave me pause came from friends and family who had gone down this road before me. There was the aunt who vomited for hours the night before. She was trying to keep down “The Prep” (more on this in a moment). Between the vomiting and the prohibition from eating solid food, she became weak and dizzy, and had to receive intravenous fluids at a local emergency room. There was the friend who had so much pain during the procedure it had to be stopped. He had to have The Test again a few weeks later. And, I’d heard stories here in the hospital that made me worry: though significant complications of colonoscopy are rare - on the order of 1 in 1000 or less - they do occur. I knew of at least one patient in recent months who had a routine colonoscopy and reported to our emergency room 24 hours later with a perforated bowel requiring emergency surgery.

It seemed to me I had plenty to squirm about: a significant investment of time, inconvenience, the unpleasant preparation, hunger, discomfort and danger. Was all of this really necessary?

As it turned out, I needn’t have worried so much. Here’s what actually happened:

• The day before The Test, I could only drink liquids. This included broth, clear juices, and popsicles. I ate a lot of popsicles.

• That afternoon (still the day before The Test), The Prep began. I took four laxative pills all at once and a few hours later, I began drinking “GoLYTELY,” (a prescription drink designed to clean out the colon). I was supposed to drink one 8-ounce glass every 10 to 15 minutes until I’d ingested a gallon of the stuff. It did not taste great and had an odd, slightly oily consistency. For me, the worst part was trying to force down that much liquid when I wasn’t thirsty.

• The next few hours were spent “indisposed.” Let’s just say I was well-served by the advice of others who suggested I not wander far from a restroom. The good news was that this colon cleansing process was complete in just a few hours. I went back to being hungry—and was still only allowed clear liquid.

• The next morning, I had my black coffee (thank goodness that was allowed!) but nothing more for several hours prior to the time of The Test.  I arrived at the outpatient procedure center where I was one of several people each hour having The Test. I put on a gown, answered some basic medical questions, signed a waiver, and had an intravenous catheter placed in my arm. Thankfully, the nurse used a novocaine-type medicine to numb the skin first.

• I chatted with the nurses about how Katie Couric’s televised colonoscopy had done more to make The Test more mainstream and more popular than any doctor could. At that point I first met the physician who would actually perform The Test. Soon after that, the “conscious sedation” was injected into the catheter, and it all goes blank. I literally cannot recall being touched by the colonoscopy or any other instrument. If I had pain, I recall nothing about it. (This raises an interesting question, a bit like a tree falling in the woods: If I had pain but have no memory of it, was it really pain? Does it “count”?)

• I remember dozing in the recovery area, awakening about an hour later as if it were a new day. I got dressed and my wife drove me home. I vaguely recall someone saying “everything looked fine in there.” I was handed the doctor’s card and told to email him in five days to find out the results of the biopsy. The biopsy?  What biopsy?

Five days later, I emailed my gastroenterologist, who called me back and said everything was normal. He also said I should do this again in ten years. Immediately I started to worry, but then I caught myself and realized I should be relieved that the biopsy was normal, not worried about getting another painless test in a decade. My experience is much more typical than the horror stories I’d heard during the months before my assigned test date. And I’d forgotten stories about uneventful tests others had.

On one hand, The Test is not “nothing,” as many doctors might suggest (especially those who have never had The Test themselves!). But it’s also not an enormous or tortuous undertaking, as it may seem when you first hear about it. My advice is this: when your time comes, schedule The Test, follow the instructions to the letter and ask questions. But then have The Test.  When I turn 60, I’ll do it again - with much less dread.

What have you heard about colonoscopy? Have you had one before? Was it better or worse than you expected? Let me know!

Robert H. Shmerling, M.D. is an Associate Physician at Beth Israel Deaconess Medical Center. He is also a Senior Medical Editor for Harvard Health Publications.

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