Let’s start with the things that we know about colon cancer:
It is the second most common form of cancer.
All colon cancers start out as polyps.
Polyps do not cause pain or change the quality of stool until they are big.
Removing polyps reduces the risk of colon cancer by up to 90%.
Screenings start routinely at the age of 50. If there is a family history of colon cancer, all first degree relatives (patients, children, siblings) should begin screening ten years before the age of diagnosis. Diagnostic colonoscopies are done when symptoms are present (pain, bleeding, anemia, etc.) Diagnostic colonoscopies can be recommended by your primary care physician or your gastroenterologist at any age. Even if your primary care physician doesn’t remind you to have a colonoscopy, you should request one if you have reached the age of 50 and haven’t had one yet.
There are a few different preparations available for a colonoscopy. Your gastroenterologist chooses your preparation with you in mind. He/she took several things into consideration when he/she picked your prep (age, medical history, how your body responds to laxatives, and what has worked well for other patients in the past). You need to limit your intake to fluids or thick liquids. Stay away from seeds and nuts for the week before your colonoscopy. You may be asked to stay away from things with red dye in them. This is because when the laxatives start to work, red dye in your system can look like blood.
Different laxatives take different amounts of time before they work. Your doctor has performed many of these tests, he/she knows what works and how much needs to be taken in order to get the colon thoroughly cleaned out. Take all of the prep ordered for you. Do not discontinue prepping because you think you are cleaned out enough without speaking to your doctor.
Whatever is coming out of the colon near the time of your test needs to be liquid and we need to be able to see through it. That means, if you were to drop a penny in the toilet, you would be able to see it. Little flecks of sediment are okay. A yellow or orange color is expected. Your gastroenterologist can do some washing and suctioning of liquid from the colon, but if the colon is not cleaned out enough, polyps can be missed. If a preparation is not good, it takes longer to do the test. This can increase your time here, cause delays, and increase the amount of sedation you will require. You can help us keep you on time by following your preparation instructions. If you are still having solid or dark stool or are unable to tolerate your preparation, call your gastroenterologist as soon as you can. He/she may ask you to change laxative or take an additional laxative.
The laxatives you will take use the fluids you drink to help move stool through the colon. If you don’t drink enough fluid, your colon uses the fluid from within your body. This can cause dehydration. It is very important to drink at least as much fluid as your preparation instructions tell you to. If you start feeling nauseous, jittery, or faint during your preparation, it is most likely because you aren’t drinking enough fluid. Staying hydrated helps you to tolerate the prep better.
You will not be able to have sedation if you come to the facility without transportation home by a responsible adult. This is for your safety. After your test you will be under the influence of sedatives and narcotics, and this is very similar to being drunk. Even if you feel fine, you will not be allowed to drive yourself home. Your judgment and reflexes will be compromised by the drugs. If you want to have your test without sedation, you can drive yourself home. You will not be allowed to take public transportation unless a responsible adult is with you. The bus or cab driver isn’t responsible for your safety, we are.
When you arrive at the facility, you will sign in at the front desk on the first floor. The receptionist will make copies of your insurance card and check your photo identification. The receptionist will also collect any co-pays, co-insurance or outstanding deductibles that may be due. She will review the initial paperwork with you. We do all of our documentation electronically. If you want hard copies of any of the paperwork, we will gladly give you copies. Your escort/driver should check in with you. We will ask for a phone number of your driver if your escort is not staying at the facility during the procedure. You will be in the facility for approximately two hours from the time you arrive. We will call your ride approximately 30 minutes before you will be ready to leave the facility.
You will have the opportunity to use the bathroom immediately before going into your procedure. The admitting nurse will review your medical history, your current medications, and your allergies with you. This allows us to have the most current information and offers you the opportunity to make any last minute updates in your healthcare information. We are a separate business from the physicians' medical offices, and although you may have given your information to the physician when you saw him/her, we don’t have access to that information because of patient confidentiality regulations. The corroboration and recollection of data helps us to make sure your records are accurate. It helps us to eliminate errors and provide you with the safest care possible. If you take a number of medications, bring a list of them with you, including the dosages.
You will change into a procedure gown and your personal belongings will stay with you during your entire visit here. We encourage you to leave your valuables at home or with your escort. Once you have changed, we will start an intravenous. Through this intravenous, you will receive fluids and the sedation required for your test(s). This enables us to keep you comfortable and safe during your test. The goal with the medications that we use is to keep you comfortable. Most people fall asleep. Sleep is not a necessary part of the sedation. Many things influence whether you will fall asleep for your test. The most significant is the medications you take. If you take pain medicine, anxiety medicine or muscle relaxers, you may not fall asleep. We will give you as much medication as we can to keep you comfortable during your test. The only limitation to the amount of medication we can use is your safety. We will take an initial set of vitals, so that we have a baseline for comparison throughout your test.
Once you are taken into the procedure room, you will be hooked up to a blood pressure monitor, heart monitor, pulse oximetry, and oxygen. We assess this information continuously during your test to maintain your safety. All of our nurses and physicians are trained and licensed in advanced cardiac life support so that we are prepared for all emergencies. After you are hooked up to the monitors, you will have the opportunity to speak with your physician and ask questions, if you have any. Once we make sure all your questions are answered, we will have you position yourself on your left side. When you are settled and comfortable we will start to sedate you. The medications work very quickly. We adjust the doses based upon many factors, your safety being the most important factor. If you are uncomfortable, we will give you whatever we can safely give you. Most people go to sleep and become more awake towards the end of the test. If you start to wake up and you are uncomfortable, we will give you more medicine to make you more comfortable. As you can imagine, the less medicine you receive, the shorter the recovery time and the less groggy you will feel after your procedure.
Many things affect how long the procedure takes. The most significant factor is the quality of the preparation. If the preparation isn’t good, we have to spend time to make it better. If we find polyps, we stop and remove them. If you have 10 polyps we take them all out. Every effort is made to adhere to our schedule, but we will not cut a procedure short because the allotted time is finished. Because of this, there may be delays. There are things you can do to help us stay on time. 1) Be on time and 2) Follow your preparation instructions exactly. A colonoscopy takes about 20 minutes if there are no polyps and the preparation is good. An upper endoscopy takes about 10 minutes.
If you are having a colonoscopy, the end result of the preparation needs to be that we can see through whatever is left in the colon. Small bits or flakes of sediment are normal. A yellow color, is normal. Your body continually produces stool, this is it’s job. Even if you think the first dose of laxative cleaned you out completely, take the second dose. The colon is long — the first dose cleans out the bottom portion of the colon and the second dose cleans the top portion of the colon. The last thing you want is to have to repeat the test and preparation because the colon isn’t cleaned out well enough. If you notice that the stool still coming out is dark and not yellow or clear liquid, call the physician. He/she may advise an extra laxative. Drink plenty of fluids during your preparation; this does two things. It prevents you from becoming dehydrated and it helps move the stool through the colon. If you are having trouble tolerating the prep, call the physician. There are a number of different preparations. Your prep was chosen for you by your physician for many reasons — your age, your health history, the time of your test, and the potential side effects of the specific laxatives. Don’t change your prep without consulting your physician. The times of the doses are also given for reasons — how long the prep takes to work, the time of your test, and potential side effects of the laxatives. A half hour deviation from the times may not make a difference, but prolonged delays or taking doses too close together can increase the risks of side effects or alter the quality of the prep. A good prep minimizes the amount of sedation required, because the test is shorter. We have built in 10 minutes extra on every single case to allow for things we cannot control. This means that sometimes we even run ahead of schedule! That is part of the reason you need to be here 45 minutes before your scheduled procedure time.
After your test is finished, you will be taken to the recovery room. We will monitor your vital signs, give you a drink and a snack, discontinue your intravenous, review your test results with you and escort you to your waiting driver. Recovery time is usually about 30 minutes. It is not uncommon for you to forget much, if not all, of this process. The drugs we use can cause short term amnesia. You may not remember the physician speaking to you after your test. This is not unusual. We will provide you with written discharge instructions that you can refer to later when you are more awake and we will call you the day after your procedure to make sure you don’t have any questions or concerns. If you are not home to receive this phone call we will leave a message. The discharge instructions not only tell you what to do after your test, but also what your test results are. If you have any questions, we encourage you to call us back. If you have an urgent concern, contact the physician’s office directly at 401-274-4800.
The doctor performing your test produces a report immediately after finishing your test. A copy of this report is faxed to your primary care physician within 24 hours of your test. If we have taken biopsies or removed polyps, copies of these reports are forwarded to your primary care physician as soon as they have been reviewed by the gastroenterologist. These results are available to you from us over the phone a week after your procedure. Your primary care physician will get this report usually within two weeks of your procedure. If there is something of concern or something that needs additional treatment the physician’s office will contact you directly.