Dan Demystifies the Colonoscopy Experience   Part 4 of 4

Recap Parts 1 – 3 – After my Medicare Insurance was denied by my preferred colonoscopy provider, I did eventually find another gastroenterologist.  The day before the colonoscopy, I began fasting.  Click here for Part 1.   Click here for Part 2.  Click here for part 3.

colon GoLytely jog

At 2P the day before my colonoscopy, I stare at the gallon bottle of liquid and find it hard to imagine that all this brew is going down my throat, find its way to my large intestine, and come spewing out into the wild blue yonder (tidy bowl blue).  Doubling my resolve, I man up and repeatedly suck on a plastic McDonald’s straw to finish the eight ounces of GoLYTELY; the brew turns out to be not as detestable as I remember.  With seven plus hours to go, I’ve got a helluva an afternoon and evening ahead.  Boo hoo!  Still my first glass of the vile concoction isn’t terrible.

At 230P, forsaking the straw, I just slug down the cocktail.  Glass two again isn’t horrible!  I expected horrible.  Maybe taking it over eight hours minimizes the nasty taste.

At 4P, I have drunk five of the roughly 16 eight ounce glasses of GoLYTELY that I will down this afternoon and evening.  After two hours of this witch’s brew, you’d think I’d be sprinting to the bathroom, but nothing is stirring down under.  Fact is, if I am going to drink this disgusting concoction, I want to see some results, some action!

Here’s my routine as I approach my eight ounces of GoLYTELY.  Once my iPhone alarm goes off after 30 minutes, I go to the fridge and take out the GoLYTELY jug.  Filling my glass with eight ounces of potion, I place my straw in the glass and suck up as quickly as I possibly can to just get it over with.  I never time it, but I must have polished off the eight ounces in less than 15 seconds; I shake my head back and forth vigorously yelling Woooooo, then sigh in appreciation that I don’t have to do it again for 30 minutes.

At 545P, after nearly four hours of drinking, I get all the action I could ever want as tsunami waves of liquid come again and again.

And when the process comes, it comes with the power of Vin Diesel in Fast and Furious 8!  It’s not accurate that I dash to the bathroom, but I do walk purposefully without delay.  In the next hour, I relieve myself ten times or more.  As the evening wears on and I still have two liters to consume, I go back to the straw as the drinking process becomes tedious but not vomit inducing.  Helluva recommendation!

colon golytely bottle empty

At 830P, I drink my final glass of GoLytely.  Water logged but pleased that the ordeal is over, I can now watch The Good Wife with Julianna Margulies for a whole thirty minutes without dashing to the downstairs bathroom.

About 10P, I am ready for bed, for a night of up and down and up again making the toilet my new friend.  Reading Sue Grafton’s Y is for Yesterday, I settle in for regularly forays to the bathroom, but after three trips in the first half hour, I sleep through the night.

Colonoscopy Day itself – After midnight, I can have no liquids, not even water or black coffee.  Waking at 430A, I have four hours to kill til Hannah drives me to Southern Maine Health Care Gastroenterology in Kennebunk for the procedure.  I stretch, then meditate with Hannah.  I am not hungry, probably since I know that I can’t have anything nor do I want to screw up my 36 hours of fasting.  But in my mind I see visions of a heaping bowl of oatmeal with all the seeds, fruit, and nuts.  Sports Center fills the remaining time til we leave.

colon smhc sign

Arriving in Kennebunk, I fill out paperwork and then am brought into a hospital-type prep room where I am giving a johnnie and asked to remove everything but my socks.  The nurse Barbara sets me up with a drip IV of saline.  Eventually the sedation will come through a plastic tube to knock me out as the scope will wind its way through my rectum, along the sigmoid to the descending and ascending colon of my intestines.

At the start, air is blown in to widen the opening of my rectum for the scope, a process that might cause some cramping.  If so, the nurse tells me to let her know and she’ll give me more painkiller.  I never do feel any cramping.

Wheeled into the operating room by Julie the tech, I am hooked up again to a blood pressure cuff and patches with electrodes are applied to my chest to monitor my heart rate and oxygen level.  I learn that ten colonoscopies can be done on any given day, which pleases me no end that they are so experienced.

colon doc john thompson

The good doctor

Once the good doctor Thompson comes, the dirty work begins.  Dr. T looks me in the eye comfortingly and says, I’ve done 2000 of these in the past year (at least I think that is the time frame).  That is just what I want to hear.  Thank you, doc.  He says the whole procedure will take about 20 minutes as the drugs start mellowing me out.

colon d in bed apres with english muffins

And that’s it done.  I am awake and not awake.  The doc and nurses are smiling.  It feels like a triumph.  Served an English muffin and orange juice, I have completed a 36 hour marathon as I cross the finish line.

The paper work from Doc Thompson that I leave with says, 2 small polyps removed.  Both appear benign.  Both will be sent to pathology.  Depending on pathology results suspension of further screening or repeat in five years. 

colon d and h in bed apres

Once Hannah drives me home, I have a king’s lunch of oatmeal with all the fixins’.

One week later.  Electronically through my Maine Health My Chart page, I get the surgical pathology tissue specimen details; they were not in English.

FINAL DIAGNOSIS:
(A) Colon polyp, cecum base: Tubular adenoma.

(B) Colon polyp, hepatic flexure: Small fragments of benign mucosa,  clinically polypoid.

Calling Southern Maine Health Care Gastroeneterology, I learn that (B) one polyp was benign and not an issue and (A) the tubular adeoma may be pre-cancerous but because Dr. Thomspson removed the polyp, I am good to go for five years.

Despite the preparation process, I will be all over my next colonoscopy in 2023!   By the way, in June 2018 the American Cancer Society recommended patients get screened for colorectal cancer starting at age 45!  Previously the recommendation had been to start the screening at 50.

I received an email with two colonoscopy songs.  Who knew there are such songs!

One is from Peter Yarrow of Peter, Paul & Mary who sings how getting a regular colonoscopy saves lives.  Click here for Peter Yarrow’s Colonoscopy song.

The Colorectal Surgeon Song by George Bowser and Rick Blue (Bowser and Blue) praises the colorectal surgeon.    Click here for their playful tune.

 

From the online SilverSneakers Newsletter, May 9, 2018

3. Colonoscopies

From age 50 to 75, most people should get a colonoscopy every 10 years. After 75, the USPSTF recommends stopping the regular testing because the risks of this test begin to outweigh the benefits.

“As you get older, your skin starts to get thinner. The same thing happens on the inside,” Dr. Green says. “That means you’re more likely to have your bowels punctured during a colonoscopy, which can be life-threatening,” she says. “The prep for a frail, older adult can also be very taxing, as it can lead to dehydration which may increase the risk of a fall.”

Another concern is that many older adults wouldn’t be able to handle treatment for colon cancer, should the test turn up anything suspicious. But again, this isn’t a one-size-fits-all rule. “If someone is in their late 70s and still out playing tennis 3 days per week, that’s a person who might still benefit from this test,” Dr. Green says. As always, the best way to make a plan is to have a conversation with your doctor.

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Dan Demystifies the Colonoscopy Experience   Part 3 of 4

Recap from parts I and II – At the last minute before my scheduled colonoscopy, I was informed that my preferred gastroenterologist did not accept my Aetna Medicare Advantage plan.  I found an alternative doctor but wondered if he is as good.  I also wondered if my current Medicare Advantage health insurance would serve me in a health crises of major proportions.  Click here for Part 1 and click here for Part 2.

colon SMHCG

Four days before my colonoscopy (a Monday) – The colon prep instructions from Southern Maine Health Care Gastroenterology have not arrived.  It’s not a big deal since I have the previous instructions from Atlantic Digestive Specialists.  Basically, until my colonoscopy exam this Friday, I am to avoid corn, popcorn, foods with seeds, nuts, and raw vegetables

My usual air popcorn will be put on hold (Hannah never thinks eating that “cardboard” popcorn is palatable anyway.) and I’ll be breakfasting on the blandest of oatmeals since I must forego my blueberries, raisins, almonds, walnuts, and a trio of seeds – flax, sunflower, and chia.  Somehow, I’ll survive quite nicely.  You might be thinking, Dan you are my hero!  Or not.

colon picture of intestines

As Friday approaches, I think that my excellent previous exams of my colon do not preclude the possibility of less encouraging results this time.  People do get colon cancer and are in for the fight of their lives.  That said, it must count for something that I have had three clean results from previous colonoscopies when I was 50, 55, and 60.  Five years ago, I had a few polyps removed but such that it didn’t concern my gastroenterologist enough, so I was cleared to wait five years for my next exam.

Typically, colonoscopies are done every ten years, as Hannah has hers, if there is no family history (which I have since my dad, brother, and sister have had polyps) or previous polyps (which I have had).

I’m not worried, overly concerned, nor supremely confident either.  I look forward to finding out the state of my colon and then dealing with whatever happens.  Worrying about tomorrow steals the joy from today – Barbara Camerson

Three days before (Tuesday) – Not having food with seeds or nuts is really cramping my style.  My daily oatmeal is just mush without my fruit, nuts, and seeds.  I can’t lunch on my usual everything bagel either.  Then, there’s no afternoon popcorn.  Wa-wa-wa.  I just thought someone might care.  I am now aware no one does, and obviously life is pretty good if these are my issues.

colon doc john thompson

Dr. John Thompson

Two days before (Wednesday) – As my gastroenterologist Dr. John Thompson is new to me, I check him out online.  I learn he is 64 and has been in practice for 37 years.  I like experience when someone is probing with a scope through my large intestines.  He has board certifications in gastroenterology and internal medicine.  That checks two more boxes.  He completed a fellowship at Yale University School of Medicine, Gastroenterology.  I am always over-impressed with Ivy League schooling.  So that is a plus.

Day of Fasting the day before (Thursday) – I sleep poorly but am looking forward to the day of fasting to move this process forward.  (You see what I did!)  Let me remind you my colonoscopy prep begins in earnest at 2P today when I begin my first eight ounces of the GoLytely concoction.

colon golytely instructions

While in California, I had heard that the nasty taste of the GoLytely mix can be mitigated if I drink the liquid through a straw.  I’ll give it a shot, but I may just resort to chugging the eight ounces to get it over with.

Today’s diet includes black coffee and lime jello.  But the real action begins at 2P.  Literally!  (more colonoscopy humor).  The brew has been in the fridge overnight because that makes the drink more palatable cold.

Surprisingly, I’m not hungry after an early morning workout at Coastal Fitness gym.  Usually, breakfast is my favorite meal.  I love my bowl of fruit, often cantaloupe, sliced pears, tangerines, and pineapple.  That’s followed by two/thirds of a cup of oatmeal with nuts, seeds, and fruit.  Followed by a Hannah’s biscuit or two with decafe.  It’s true amore!

colon GoLytely jog

Ouch

But I know downing four liters of GoLytely this afternoon and evening is not going to be a piece of cake, perhaps more like a sonic boom.

In Part 4, my colonoscopy drama concludes with a play by play of the magic GoLytely and then the surgical operation itself.  Polyps?

 

 

Dan Demystifies the Colonoscopy Experience  Part 1 of 4

Two men walk into a bar.  One says to the other, I am having a colonoscopy Friday.  The other says, the colonoscopy isn’t bad, it’s the nasty drink beforehand that makes me want to puke.  The first man says, Be a man.  Suck it up.  Use a straw to get around the nasty tasting concoction.  And so, I will use a straw and suck it up!

One week til my colonoscopy (a Tuesday) – Urban legend is correct; the worst part of the colonoscopy is the foul liquid drink that makes my intestines as clean as a whistle.  It’s so nasty that in the past I have wanted to barf.  Five years ago, I took the contemptible brew with lemon Gatorade and now I hate Gatorade.

colon picture of intestines

As a veteran of the colonoscopy, in seven days I will be having my fifth one.  Usually colonoscopies are every ten years, but since my dad, my brother, sister and I have all had polyps, I am on the five year plan.  Despite the invasiveness of the doc’s scope up my rectum, I don’t miss a date with my gastroenterologist.  It’s hard to argue since colonoscopies make colon cancer one of the most preventable cancers known to man and woman.

First, to minimize the noxious taste of the liquid laxative, I have learned from our recent month in California that a straw can bypass some of the taste buds in my tongue.  Certainly, sounds promising.  I’ll report back in seven days.

The colonoscopy itself has never been an issue as I am sedated and wake with no recollection of the sinuous scope with a camera and snippers that has snaked its way through my large intestine.

 

Five days before (Thursday) –Arriving home after indoor pickleball, I have a call from Atlantic Digestive Specialists (ADS), whose Dr. Hyett is going to do my colonoscopy next Tuesday.  It seems that Houston, I have a problem.

colon ADS

Though seven weeks after I set up an appointment for my colonoscopy, ADS informs me that they do not accept my Aetna Medicare Advantage health insurance.  What!  You are telling me this with five days before my procedure!

Calling my Aetna customer service rep, I find that they disagree with ADS and say all nine gastroenterologists of ADS accept my insurance.  ADS begs to differ, and they say, in so many words, you are shit out of luck (a little colonoscopy humor).  I’ll set the scene more visually for you.  ADS is the creek.  I am up it.  As you might have guessed, I have no paddle.

There is no arbitration, no appeal, unless I want to pay the $896 doctor’s fee that may increase if there are polyps or other complications.  I have no choice but to go to Plan B – I get on the horn and call Aetna to find what local gastroenterologists will accept my Medicare insurance.  Fortunately, there is a Dr. Thompson in Kennebunk (24 miles away from York) of the Southern Maine Health Care Gastroenterology (SMHCG) practice who is in-network and accepts my insurance.

colon SMHCG

SMHCG does have appointments, but they need one little thing – my colonoscopy files from ADS.  Assuming the files will arrive within the month, Donna at SMHCG tentatively schedules me for June 6 at 9A, four bleeping weeks away.  Are you shitting me?  (I couldn’t resist.)  Supportively she adds, we do have earlier appointments, even one next week, but we need the files of your previous colon exams faxed to us.

Calling ADS with urgency in my voice, I learn it’s not all that simple.  I first have to sign a release.  Kelly at ADS says, I can mail you the release.  But in my mind, I know that could take the better part of a week for me to receive it and mail it back.  I have no choice but…

…to jump into my Prius and drive to Somersworth, NH (25 miles from home) where the ADS files are kept.  Without thinking twice, I tell Kelly I am on my way to sign the release.  See you within the hour.  With Hannah shaking her head in disbelief that I want to drive to Somersworth for the files, I am out the door in five minutes for the 30-minute drive.

Once there, I approach the receptionist who explains that any request for files can take up to 30 days.  I explain my sad story and she says you can make an urgent request that may help it be faxed in five days.   I do, and she promises to walk my request to Kelly’s office immediately.  True to her word, she does, as I head out the front door of ADS knowing that I’ve done all I can.

Never thought I’d be so looking forward to the colonoscopy prep with its foul tasting laxative and the procedure itself now that I no longer have a Tuesday appointment.

Sometimes you win, and sometimes you learn.

colon aetna medicare

Let’s summarize.  I have learned with a Medicare Advantage health insurance that it is my responsibility to see if an elective procedure is covered and the provider is in-network.  Though the ER visits that Hannah and I have had are routinely covered, planned surgery needs to be in-network.  That’s on me.  I need to know my plan much better.  One of the pitfalls of being so damn healthy is that I rarely use my health insurance.  (Is that what is called a false brag?)

Part 2, follows this story from Somersworth, NH to Kennebunk, ME as I deal with Big Medicine and Big Insurance sparring as they use me as the punching bag.