If you’re like me you don’t spend a lot of time thinking about your colon. You should, however, get screened for colorectal cancer. About 3 years ago, at 56 years of age, I was at the doctor’s getting my annual checkup and he said: “By the way, I’m putting your name in for a colonoscopy if you say OK”. I asked why and he said that while I had no symptoms of colon cancer it generally has none until it is advanced, at which point you generally die. If caught early, however, you had a pretty good chance of surviving the number 2 cause of cancer death. He also said “Don’t hold your breath, the waiting list is over 2 years long if you have no symptoms or family history”. In the meantime I did a Fecal Occult Blood test, fondly known as the “Poop Smear”. This is the one in Darryl Sittler’s radio spots. It’s easy to do, no more disgusting than taking care of the average baby, and statistically will detect 40% of colon cancers (unfortunately not really early ones) and has a 2-3% false positive rate. Nothing showed up
Well, three years passed and I got a letter last December telling me I had a consultation appointment January 2 at the Forzani and MacPhail Colon Cancer Screening Centre. Along with a reminder to stay off the Ex-Lax (or equivalents such as Mexican food and beer) since this was just a consultation, there was a fact sheet about how colon cancer develops (from “polyps” or mushroom like growths on the inside of your colon) and the various screening tests. In addition to the “Poop Smear” they are:
Sigmoidoscopy: You get an enema, then they stick a videoscope up your butt and look at the left side of your colon.
Barium Enema and X-ray: You can probably guess what’s involved.
Virtual Colonoscopy: Like a CAT scan of your colon. You get a pretty high radiation dose. You also get to pay for it yourself ($800 or so I think).
Full colonoscopy like they perform at the screening centre.
The other screening tests ALL result in a full colonoscopy if anything shows up so to my mind you might as well cut out the middleman as it were.
On January 2 I went to my appointment. A bunch of us were gathered in a room and a nurse went over the procedure, the alternatives above, and the risks associated with a colonoscopy (1 in 1000 of annoying complications, 1 in 10,000 of dying from them). She also told us we had the option of being sedated or not during the procedure. She showed us some nifty pictures of a couple of colons: a nice clean one (they’ll see pretty well all cancers or polyps) and a not so clean one. Imagine the Pirates of the Caribbean ride in a sewage treatment plant. Not so clean is not so good since a): they might give you an enema, b): they might miss something, or c): you might get to come back again for a redo. They took questions if you had any. After this we were called in one by one to see one of the nurses, female in my case. She went over my medical history, medications, and allergies. She took my blood pressure and felt my abdomen. At this point she said there was no medical reason to not get a colonoscopy and asked if I wanted to do it. I said sure, beats dying of colon cancer. Since my family doctor is retiring I figured this was step one in my plan to never get sick again. I signed the waiver saying I understood the risks and was booked for 10:30 AM January 15, arriving at the screening centre at 10AM. I was sent home with a list of stuff to do before the procedure.
Five days before the big day I went on a low fibre diet. No raw vegetables, popcorn, nuts, anything with seeds, whole wheat bread, Metamucil, etc. No aspirin. I also stopped eating anything red. I went the local Safeway, being a supporter of local business, and asked about their selection of super duper “PEG” laxatives. The screening centre gave us 3 choices: “Colyte”, “Peglyte”, and “Golytely” (named by somebody with an evil sense of humour). They all have the same active ingredients- electrolytes and polyethylene glycol (not to be confused with ethylene glycol which is toxic– don’t try to save money by drinking Prestone) and are designed to go right through you without adding of taking away any water from your system (the term is “iso-osmotic”). Colyte (about $29) has pineapple flavouring added and its taste has been reliably described to me as gross, gag-inducing, etc. Golytely is cheaper at about $20 and has no flavouring added. It’s sort of the “President’s Choice” of PEG laxatives. You mix it up to 4 litres with water. The day before the procedure I had 2 pieces of toast for breakfast and that was it for food. After that you can drink water or other clear non-red liquids (so as not to mistake them for blood). At 8 PM that day I started drinking the first 2 litres of Golytely at 250 ml (8 oz) every 10 minutes. It’s best to just chug it down. Tasted like slightly salty water. Come 9:20 and the fun began. My advice is to pick a good book because you’ll be spending a lot of time sitting on the toilet. I got up at 5 AM the next day (not to mention once or twice during the night) and chugged the remaining 2 litres according to instructions. By the time you’re done its coming out pretty well as it looked like going in and you hopefully have a nice clean colon. People pay a lot of money for so-called “cleanses” but I doubt very much if they work as good as this stuff. You get to drink clear fluids until 2 hours before your arrival time.
10 AM and I arrive at the screening centre as instructed. The whole operation is a model of efficiency. Within 5 minutes of arrival a nurse takes me back and I get undressed and put on one of those bum-freezer gowns. Meanwhile the nurse asks me how my little toilet session went, whether I’d eaten etc. Then they stuck an IV tap into my arm (everybody gets one) and asked if I wanted sedation. This is so-called conscious sedation. You’re awake but you just don’t give a damn. I went for it because as they said the more relaxed you are the less it hurts. After getting my blood pressure checked and a few more questions I was wheeled in to one of the six endoscopy rooms by 10:30 and got to meet Dr. Kumar, the endoscopist and a very nice lady, and the surgical nurse. The first thing she said to me was “They tell you this won’t hurt much but in your case it will. You’ve had a burst appendix and a hernia operation so you have lots of scar tissue which will make it more difficult to shove the scope through and inject the air.” At this point I was quite happy to be sedated. The colonoscope is a high tech piece of equipment. The business end can be rotated to look in various directions including straight back. It carries lights, cameras, suction and irrigation tubes as well as instruments for cutting out polyps and taking tissue samples. All this is carried through a tube about the diameter of my middle (driving) finger. You lie on your left side, knees up to your chest, and they put a blood pressure cuff and a pulse monitor on you. Right in front of you is a high resolution monitor so you can watch the whole thing. Following every guys’ favourite, the digital rectal exam (I think the girls get one too), they stuck the scope in through you know where and proceeded to shove it through to the end of my colon, a distance of about 4 feet believe it or not. Once they hit the end they pull it back out and look at everything, all the while injecting air to expand it (it’s corrugated usually). If there had been any polyps they could have removed them and carried them back for examination or if something looked like cancer they can take a biopsy. It did hurt a bit but nothing unbearable. After 20 minutes or so they’re done, they detach the scope and send it off to get sterilised, and they wheel you out to where you started to eat a cookie or two, drink some juice, clean yourself up a bit in the can, and read the report which comes complete with a few colour pictures (show your friends!) while you enjoy major flatulence as all the air they pumped in comes out (no smell though!). I’ve got a great shot of where my appendix used to be at the far end of my colon. You get to ask questions and your doctor gets a copy. I was out of there by 11:20. Due to the sedation you’re legally impaired so somebody has to drive you.
My results? I had no polyps and no sign of colon cancer. I probably won’t need to be screened again for 10 years. What I do have is what’s called “pan-colonic diverticulosis” which means I have small pockets or dimples formed in the lining of my colon. They can become inflamed in which case you get an attack of diverticulitis which is no fun or can in some cases erode through a blood vessel and cause bleeding. I had no idea I had this problem but I’m not all that surprised since both my mother and my brother have been hospitalised with diverticulitis. They told me what to eat (high fibre and lots of fluids) to minimise my risk of an attack. I haven’t had one yet so I’m fairly optimistic I won’t have one.
Am I glad I went through this? You bet. While not fun it wasn’t that bad. It was actually pretty interesting. The staff is great and they treat you with efficiency and courtesy. They’ve also probably heard every butt joke known to mankind. It’s a relief to know I don’t have colon cancer or the polyps that develop into cancer. I also know I have diverticulosis and can watch my diet and hopefully stay out of the hospital. Don’t let fear, the laxatives, or the embarrassing location where they go in to have a look keep you from getting screened. It could save your life. You can get more information at www.colonscreeningcentre.com or ask your doctor. If you run into me I promise I won’t pull out the pictures!
