Colonoscopy tips plus should you even have one?

PART ONE

On my Facebook page, I said I had some tips for colonoscopy prep. So I will start with the tips in Part One. But, in Part Two, I want to give you info on an easy, inexpensive and effective alternative - the FIT fecal-test.

For context, the last time I did a colonoscopy, I used Moviprep and had to drink it all in one day. I became very bloated and got worried that it would NEVER work. It did, finally, but it was a pain, physically and mentally.

I changed to Kaiser this time, and their prep is longer, but way easier - WITH ALTERATIONS. (Their instructions are here if you want to read the full thing.) The idea is that you switch to low-fiber - aka low-residue - foods three days before the procedure. You have a liquid diet the day before and drink half a gallon - Gavilyte-g was the stuff I used - starting at 6 pm. Then, the next morning, you drink the rest of the half-gallon.

I think preparing over three days really made it much easier, but I wasn't looking forward to the all-liquid diet for a full day (though I did know that as soon as I drank the stuff, my appetite would be gone...)

Tip One: Screw the all-liquid diet on the day before. You can eat low-residue food in small amounts. There are a whole lot of scientific studies about this that have come out in the last few years, and they all agree: the all-liquid diet is not necessary, and absolutely not better. Here is an article about one of those studies. Therefore, I ignored Kaiser, and ate two eggs and some toast in the morning the day before the procedure. That was enough for me to feel good until I drank the stuff. Basically, medical organizations haven't caught up to the science on this one. Here is an article on low-residue diets - though there are abundant articles about them on the internet.

Tip Two: Do your own timing of when to drink the stuff. I used their timing on the day before - that is to drink it at 6 pm - but that is a stupid time for me. It took until about midnight to get rid of the first wave. I would have liked to gone to bed earlier. Clearly, I should have started at 4pm - and would have been ready for bed by 10PM.

Similarly, the next day they wanted me to start 5 hours before, have the second gallon done by 3 hours before - and take no more liquids after. I totally ignored that and started about 7 hours before, and drank about half the remaining stuff. Within three hours, I was "piss-pooping" clear (and slightly yellow, which is what they expect) and threw the remaining prep down the drain. Yes! If it hadn't been clear, I still had another hour to drink more.  I then drank clear liquids until the three hour mark.

If you have an early morning colonoscopy, they expect you to wake up in the middle of the night to do this. If you are a rule follower and want sleep - truly you should get a mid-afternoon appointment with this regime (as I had). Or, decide to make changes based on the time...

Tip Three. Drink it down fast and make sure it is chilled! This is one that most people know - and manufacturers of the stuff advise.  I didn't flavor it - but lots of people swear by that. But whatever you do, have a chaser. The taste (which isn't all that bad) only lasts as long as it takes to drink your chaser. I used tea sometimes and chicken broth other times. But anything you like will work that is in the ok-liquid column.

Others can feel free to put other tips below in the comments. You can do so anonymously if you like.

PART TWO

In the United States - unlike any other place in the world - colonoscopies are the go-to for colon cancer screening beginning at the age of 50. The rest of the world uses much less expensive but, perhaps, just as effective screening techniques such as the fecal-test FIT. This test must be done every year to be effective.

The fact is that colonoscopies - as yet - haven't been proven to be more effective (or as effective, for that matter) than this test in detecting cancer or reducing mortality. Now, the logic is that colonoscopies should be the most effective - after all, you get rid of the polyps before they have time to become cancerous. But, the fact is there has never been a randomized controlled trial - the most rigorous type of study - of colonoscopies to see if they, in fact, reduce colon cancer mortality more than other methods. (Though there are three studies in process, and in about seven years we might know for sure!) That does not mean there haven't been other types of studies that are very encouraging about them, such as Baxter et al.  and Nishihara et al 2013, which certainly indicate a colonoscopy is pretty darn good, though it has risks such as perforation of the colon, infection, and bleeding.

But, there is no proof, as yet, that it is better - or as good as - a simple, inexpensive fecal test.

So, if they haven't been proven to be better, scientifically, than the alternatives, why are we so colonoscopy-crazy in the United States? Could it be $$$$? Check out this NY Times article on this.

Bottomline: you don't have to get a routine colonoscopy for cancer screening - unless the fecal test shows a problem. For most people, it's probably the best way to go. Kaiser, for instance, emphasizes FIT tests as the basic screening test, and colonoscopies are only recommended for people in a higher-risk group, such as people who always get polyps - like me!  

Anyway, as they say - ask your doctor if the FIT test is right for you instead of doing this rigmarole. Colon cancer is the second leading cause of cancer death in the United States. So whichever screening method you use - don't skip it!