Think twice about getting a colonoscopy in Salem (Oregon)

First off, note that I said think twice. Your first thought -- "I should get a colonoscopy"-- is absolutely correct.

The procedure saves lots of lives through early detection and prevention of colon cancer, though recent research shows it isn't as effective as previously thought. Now it looks like colonoscopies prevent 60-70% of cancers rather than 90%.

Still darn good. Which is why I had a virtual (CT) colonoscopy in 2006. Naturally I blogged about it.

Last fall an occult (hidden) blood test done as part of my annual physical exam was positive. I asked for a re-test, since I had reasons to think that this was an anomaly. The second test turned out negative.

Regardless, my family doctor and I agreed it made sense for me to get a regular tube-up-the-butt colonoscopy. The procedure is no fun, especially the preparation for it, but colon cancer is a lot worse.

Thus I dutifully made an appointment at the only place in Salem, Oregon that does colonoscopies, so far as I know: Salem Gastroenterology Associates (SGA).

It didn't take long before I was doing my second thinking, because SGA turned out to be a frustrating place for an informed patient to deal with. Since I'd had a previous colonoscopy, albeit a virtual one, I was familiar with the typical preparation procedure.

This involves various dietary restrictions starting a week before the procedure. Then, on the day before the colonoscopy a clear liquid diet is proscribed. No solid food.

Yet when I had my pre-colonoscopy appointment with a SGA physician's assistant, and was given the preparation packet, I saw that the clear liquid diet was to begin at noon two days before the colonoscopy.

Whoa! That was about 14 hours additional waking-time fasting.

Vegetarians like me are used to eating frequently, and I wasn't looking forward to even a 19 hour clear liquid diet (if my colonoscopy was scheduled for 10 am, that's about how many waking hours the usual "day before" prep would last).

I fired up Google and did some research.

The Mayo Clinic said that typically the colon prep is done during the 24 hours prior to the exam. Mass General Hospital, another leading medical center, was more liberal, allowing a light lunch on the day before the colonoscopy.

I couldn't find any prep procedures that started two days before the colonoscopy, though I understood that in special circumstances (constipation, for example) this could be necessary.

My family doctor thought it was entirely appropriate to contact the physician at Salem Gastroenterology Associates who would be doing the procedure and ask about adapting the preparation schedule.

After all, I was a vegetarian who didn't consume nasty colon-clogging animal flesh, and I'd done just fine with a "day before" prep when I had the virtual colonoscopy.

So I wrote Patricia Kao, M.D. a thoughtful, respectful, well-documented two page letter, complete with attachments showing how Mass General and some other gastroenterology clinics handle colonoscopy preps.

I ended the letter this way:

As a final comment, a day or two after I had scheduled this exam I was listening to Dr. Dean Edell on the radio. A woman phoned in with almost exactly the same concerns I had about the colonoscopy prep schedule.

Edell told her that old habits die hard with physicians, that there are alternatives to the “old style” prep, and that doctors learn one way of doing things. He mentioned that his own colonoscopy prep “was horrible” and repeated that there are newer ways of accomplishing this. His ending advice to the woman was to be insistent with her physician.

I don’t particularly like the word “insistent.” I guess I prefer “questioning.” It seems to me that there are good reasons to modify my prep schedule, and I’m confident that we’ll come to a mutually satisfactory agreement on this.

Well, I was wrong. Because I never got to talk with Dr. Kao. Just a front office sort of person, who phoned to tell me that there wouldn't be any changes made to the two-day prep schedule.

I asked, "Why?" The response: "Dr. Kao and Mr. Butler [the physician's assistant] keep up on the latest research and regularly attend conferences."

I told the staffer, "That's nice. But the fact remains that the Mayo Clinic, Mass General, and every other colonoscopy place that I could find on the Internet typically uses a one-day prep, and I'd like to know why Salem Gastroenterology Associates thinks it knows better than the medical consensus."

In reply I got a robotic repeat of "Dr. Kao and Mr. Butler keep up... ."

I hung up the phone. Contacted my family doctor. Asked for a referral to Gastroenterology Specialists of Oregon (GSO) -- who have several offices in the Portland area and were one of the "day before" prep examples I'd mentioned in my Dr. Kao letter.

Everything went smoothly once I made the change to GSO. I was treated like a human being there, rather than a patient who shouldn't ask questions and do whatever I was told.

I didn't agree with everything in the GSO colonoscopy prep guidelines. But at least I could discuss things with staff and get reasons for doing this or that a certain way.

I told them about a "Gourmet Colon Prep" article, written by a nutritionist and physician, which cited research showing that nutritional supplements like Ensure could be taken in addition to clear liquids without messing up the quality of the colonoscopy.
Download Gourmet Colon Prep 

When I had the virtual colonoscopy, Ensure was allowed. It made a big difference to my uncomfortably empty stomach, providing some substance in addition to the clear liquids.

But I survived without it the second time around. When it came time for the colonoscopy itself, that was the easiest part. I went to sleep about two seconds after the intravenous sedative started flowing and didn't wake up until I was back in the recovery area.

The doctor told me that he found a polyp. It was removed. Turned out to be non-cancerous. I'm supposed to have another colonoscopy in a couple of years.

This shows that it's possible to have a "clean" virtual colonoscopy, and within two years get a regular colonoscopy that turns up a polyp. Of course, the same could happen with regular colonoscopies two years apart.

My experience also taught me that if a physican isn't listening to you and is playing the "Just do it, because I'm the doctor" game, head for another medical provider.

I might have gotten an equally excellent colonoscopy at Salem Gastroenterology Associates. But I lost confidence in that clinic after I was treated like a patient rather than a person.

Interestingly, I began my post-graduate school working career as a Research Associate in Family Practice at the Oregon Health Sciences University Family Practice Department.

One of my jobs was designing patient satisfaction questionnaires for the Family Practice Clinic, so doctors-in-training could get feedback on how they were coming across to patients.

I wish Salem Gastroenterology Associates would have sent me such a questionnaire. (The clinic I ended up going to, Gastroenterology Associates of Oregon, does use a patient satisfaction questionnaire -- and got excellent results.)

But I guess this blog post will serve equally well as a way of saying to them, "Respond respectfully to people when they have questions; doctors aren't gods, and shouldn't be preachy either."

If you live in the Salem area, get a colonoscopy when it is called for. But realize that you have options about where to get it. And what sort of preparation you have to go through.

Comments

[Larry Nunn]

Next time you might try Silverton. Dr. Waters did a good job with my colonoscopy. And the Silverton Hospital is closer and easier to get to than Portland.

[Sam]

Congratualtions on your clean bill of health. Based on your blog, I always assumed you were full of shit. I guess I was wrong.

[Cyndi]

Good Sam in Corvallis would be a good choice, too. Very nice facility with *wonderful* staff, and a pretty drive from Salem, taboot. I'm glad it went well for you.

[rednikki]

I stumbled upon this because I'm about to have my second colonoscopy. When I had my first, five years ago, I was a meat-eater, and the prep process was AWFUL. This time, I'm a vegetarian, and it's...well, not exactly delightful, but one heck of a lot easier. That article you linked to gave some great explanation as to why.

Interestingly, about half the places you'll stumble upon say one must avoid cranberry juice during prep; the other half specifically *recommend* cranberry juice. Upon research, it seems that cranberry juice is fine; the problem is that a lot of cranberry juice has red dye in it, which is a problem.

[Best Supplements]

Oh heck yes, Nikki. You should try being a raw foods vegan prior to a colonoscopy sometime. ;) You wouldn't even believe how much of a difference it is, lol.

[Michael]

I am pretty sure Gastroenterology Specialists of Oregon has offices in Tualatin, Oregon City and Newberg.

[Blogger Brian]

Michael, they do. I went to the Tualatin clinic, being closest to Salem.

[Pooper Scooper]

I happen to know that the clinic in Salem you are referring is a great place to have your procedure. The staff is great and the physicians are great. What a shame you feel the need to slander them with half truths. Its people like you that put a bad taste in my mouth. Next time get the facts right before giving wrong information on the internet

[Blogger Brian]

Pooper Scooper, what half truths? I simply told about my experience with Salem Gastroenterology Associates. Apparently you've had a different experience.

I didn't put out any false facts. What I said was the truth. Point to any wrong information that I gave before you engage in blanket criticism of my post.

People should shop around for the best colonoscopy provider. If you don't feel comfortable with how a clinic or doctor is treating you, as a patient and a person, this is a sign that you should look elsewhere for treatment.

We're all individuals. A clinic/doctor who appeals to one person might be distasteful to someone else. It's nice that you found the clinic to be a great place. I had a different experience. That's the way life is: full of differences.

[Lisa]

Dr. Kao handled mine a couple years ago and I don't remember any problems with the prep. Sunday was somewhat uncomfortable with just the liquid diet and the meds to help "flush", but otherwise, no problems. The best part was on Monday, after waking up, my husband drove me home and I took a nice long nap in the afternoon and then slept all night. For someone who hadn't had a good nights sleep for over two years. I was in heaven.

[KOURTNEY]

OH HI BRIAN, WHY DONT YOU TELL EVERYONE THE TRUTH , WE BOTH KNOW YOU WORK FOR THE CLINIC.

[Blogger Brian]

Kourtney, YOU DON"T NEED TO USE ALL CAPS, because the truth isn't affected by "yelling." No, I don't work for any clinic. I don't work at all, in fact, being pleasantly retired. But thanks for the conspiracy theory.

[polyprone]

When you have concerns about anything that has to do with your colonoscopy, including the prep, the GI physician has a duty to answer your concerns BEFORE the exam. If you don't get satisfaction from the office staff, ask the physician to call you personally and if they don't, cancel and go elsewhere. I don't do sedation and scheduling my exam wasn't easy without any but the best GI doc in town personally answered all of my questions and agreed to do an unsedated exam (hard for her but not painful). She even called me at home on the day before the exam to reassure me that it wouldn't be too painful and that I coud get fentanyl (painkiller) if I wanted it...This doc treated me like a king, not a piece of meat. When I thanked her for her kindness, she told me: "that's my job and we need to do whatever it takes to get you screened and to make it as tolerable as possible because we want you to be willing to undergo repeat exams as needed". The exam was easy and I'm having another (unsedated) next year (precancerous polyps).

[Shiela]

I stumbled upon this blog looking for another GI office besides Salem. I dealt with them today and found everyone I talked to in that office to be rude, holier than thou people. I wouldn't send a stray dog to them for anything.

[Arlene Hauben]

This is a really good blog about preparing for a colonoscopy and selecting the right doctor. It is a dreaded experience -- fear of fasting and fear of aesthesia all in one. I am scheduled for one here in South Florida and was hoping to be able to drink Ensure, but looks like not. I for one appreciate your information. Doctors are not the almighty. I want to be able to ask as many questions as I want to and get answers that are not condescending.

[Karen L. Freeman]

My finance is going to go through the prep this weekend. I came upon your article and read it to try and provide him with a non negative prep experience. My question for the day before the prep or 2 days before the procedure is about allowing chicken noodle soup but without vegetables. His instructions from the Harbin Clinic allow well cooked tender vegetables including carrots, celery and green beans, so why the chicken noodle soup minus the veggies?
My e-mail is kiatapps@yahoo.com. If you could respond on this by Saturday, 12-17-2011, I would be grateful. Thank you. Sincerely, Karen L. Freeman.

[MARYANN HUDGINS]

Hello. I'm glad I fell upon this information.The reason is I have nothing but
trouble with Salem Gsatro. I told them I had a cloting factor. Well, as soon I the Cholo. was off and then the nures called and they where going to the Endo scope Instead, I'm a vegetarian and in Dec. Of last year, I stared getting week and and very tired. I got this Dr., who stated she would take me. I was in there for a vistit. I have Thyroid problem. I was natural Thyroid hormone and The Dr stronghly that armour was not good to because had pocine in that it would cause all kind for me. She did ask any guestions about how I was feeling. well I decided I would go to a specialist and that did not well. I was labeled.March comes and my Physical,cont.

[MARYANN HUDGINS]

Hello continue from the other post. The Dr. me point blank, I did not have any Iron in my blood, know, If I did not have Iron in my body, I would be dead or in the hospital. she is I believe is a good Dr. so refered me to Salem Gastro. and thats where more started. I would accept the Endoscope. you see have been bledding inside some where. So they sent me to a blood Dr. and cancer Dr. she ran test. and still haven"t any thing done. so Friday I nee to find another Dr. Because, I do not want to die.

[cc]

all i can say is "they suck" although the doctor seemed ok ....his staff is really a buch of bitchy nasty people. there is no professionlism. my insurance requires i go here . I have barretts syndrome ...pre cancerous. when i called insurance i got very good news . When i called back to ask how much ...they required a deposit and she stated we will set you up with payments ...how about a bill first ...also there using demerol...not good ...this has beem black boxed by fda and salem hospital cont

[cc]

continues ....so there using demerol which salem hospital black boxed themselves 2 years ago .and here they are using it ..black box ...its not ok to use ...when i asked for other things ..i was told to go to portland ...they refuse to learn new ways ...they are a monoply in salem ..i have decided that i am going to take my chances without endoscopy that risk it with these unethical ,ignorant ,out of touch people ...ps they fought my insurance company company contrac 3 months and took 4 months to get referral done by THEM

[Elaine L]

Very helpful information and a good point about finding physicians who treat you like a person. I had the same experience this evening when I asked my health care providers if I could take 1 liter, instead of 2, of the saline laxative because I'm a small vegetarian female. Of course they said "no... Just because its protocol".

[Cara]

Thanks for sharing your experience. We need to get better at advocating for our best and personalized care and not be treated by general guidelines :)