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%.
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:
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.