Colonoscopy Prep: Salt Water Blues

colonoscopy prep goes wrong
It's a routine procedure- what could go wrong?
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As my 56th birthday loomed I acquiesced to my primary care physician’s desire for her reluctant patient to undergo a colonoscopy examination for the first time; a reasonable request considering the preponderance of cancer on both sides of my family tree.  What is usually a routine, pro-active approach to health care for most folks proved calamitous for me and is the basis for this story.


Whenever the subject of colon cancer emerged in conversations I welcomed the opportunity to hear what those who’d been screened for the disease had to say about their experiences; chiefly, was the procedure awkward or painful?  Hands down, all swore the worst part of a colonoscopy is actually the prelude to it:  drinking the libation that flushes out your lower digestive tract.  Compared to camping in the lavatory for hours, all claimed they’d breezed through the probe portion thanks to a generous dose of anesthesia.  All assured me they’d suffered no discomfort or embarrassment whatsoever.


Based on those cursory reviews I trusted my turn at bat would be equally unremarkable.  Thus mollified, I phoned the gastrointestinal clinic at the hospital expecting to be told I’d need to see the gastroenterologist prior to scheduling the procedure.  To my pleasant surprise, however, the receptionist indicated otherwise.  If the truth be told, I’d sooner hang glide over the Grand Canyon with both hands tied behind my back than go to a medical  appointment.  The woman went on to say she’d mail me a prescription for the polyethylene glycol powder (the infamous “preparation”) along with detailed instructions, everything the patient needed to get himself or herself ready.


The hospital employed only one gastro specialist and she didn’t perform the complex exams on a weekly basis, so the limited spots were sometimes booked months in advance.  I anticipated a nice long leisurely wait, but as luck would have it, a cancellation had opened a slot three weeks hence.  At my job I arranged to take off Thursday in order to fast at home (hunger makes me grouchy and hinders my ability to concentrate) and Friday, of course, for the test itself.  My chum Emery agreed to provide taxi service the day of the test.


Getting the ball rolling eased my guilty conscience, until I stopped at the drug store and the pharmacy clerk handed me an empty plastic gallon jug with a paper sachet attached.  While it’s true I hadn’t queried my colleagues regarding the quantity of swamp water a person must ingest (and none had extrapolated on this aspect), I never imagined the amount would rival how much milk I consume during a typical week!  If, for the average person, quaffing four quarts of a favorite beverage in a single sitting constituted a challenge, then contemplating the same with a gallon of a colonic cocktail must be the equivalent of the Ironman Triathlon!


The three weeks sped by and the days of reckoning arrived.  Thursday morning I drank half a pot of black coffee for breakfast with a tap-water chaser the rest of the day.  Per the directions, at noon I emptied the packet of polyethylene glycol powder into the jug, filled the container with water, shook it to blend the contents and placed the receptacle in the refrigerator to chill.  At 6:00 p.m. I sipped the brackish fluid cautiously and involuntarily shuddered.  The brininess reminded me of sea water or a gargling remedy for a sore throat.


The guidelines recommended downing eight ounces every fifteen minutes, a pace far easier said than accomplished when imbibing saline solution.  Overcoming a natural aversion with every hoist of the tumbler to my mouth involved Herculean effort, especially on a stomach void of food for twenty-four hours.  Swallowing swiftly to prevent the nasty liquid from lingering on my tongue, I had to coax myself into not dallying between swigs.

Early in the trial a twinge of nausea flickered in the pit of my stomach, sparking mild anxiety.  The information sheet suggested stopping for half an hour if you got too full or queasy.  Hoping for a miracle, I took a thirty-minute break and tried diverting my attention watching television.  It didn’t do the trick, though, much to my consternation.  The seasickness persisted as the sitcom credits rolled across the screen.


This unexpected new wrinkle threw me into a terrible quandary.  Now I’d have to decide if the benefits of persevering outweighed the risks, a daunting dilemma.  Starting all over meant losing two more vacation days and, worse, fasting again; yet an already-upset stomach didn’t bode well either.


Caught between the proverbial rock and a hard place, several anguished minutes of indecision ensued.  In the end, call it foolhardiness or blind obstinacy, I decided to throw caution to the wind and “Git ‘er done” as Larry the cable guy says, rationalizing that crossing any bridge to avoid repeating the miserable modus operandi would be worth the gamble.  With renewed resolve I tilted the jug and gulped a few sizable mouthfuls in rapid succession.


At approximately the half-gallon mark my bloated belly roiled with the ferocity of ocean swells in a hurricane.  I surrendered to the potency of the preparation in literally gut-wrenching defeat.  Too ill to stand, I tottered to my bedroom and lay on the bed in a fetal position.  Moments later bilious surges sent me careening towards the bathroom where I vomited in the sink.  I’d barely caught my breath before being overwhelmed with another spasm of violent retching.  The powerful waves of nausea forced me to my hands and knees.  Eventually the emetic got purged in the tub, only to be replaced with bile.


To the best of my knowledge, I didn’t exit the bathroom until dawn on Friday when, frightened by the alarming deterioration of my body, I struggled to my feet and called 911.  The operator culled enough pertinent information from the sentence fragments I gasped to dispatch two firemen to the correct address.


Dehydration symptoms can mirror alcohol intoxication.  Heaven knows the paramedics’ thoughts as they watched me stagger about my apartment slurring my words.  At their behest I sat on the couch, balancing dizzily on the edge of the seat cushion as one of the rescuers crouched at an arm’s length distance observing me with an inquiring expression on his face.  Normally a reasonably articulate person, scrambled speech centers thwarted my efforts to explain the events leading up to my ghastly condition.


Too sick and agitated to sit still, I rose and stumbled to the bathroom seeking asylum on the cool linoleum for a couple minutes.  Heedful of the firefighters still waiting, I scraped my carcass off the floor and wobbled back to the living room where the guys asked me if I wanted to go to the hospital.


In the emergency room, fading in and out of consciousness, I was aware of my jeans being yanked off and a gown dropped on my chest.  A clipboard hovered over my face as I feebly signed a consent-to-treatment form.  My next recollection is looking at a stranger wearing a white lab coat as he dropped a bomb in my lap:  “You just had a seizure.”  I was thunderstruck but too depleted to counter.  Neither I nor any member of my family had ever suffered a seizure.  As far as I was concerned, the doctor was mistaken.


Unfortunately, the message had been delivered to the right patient.  In an electrifying moment of clarity I realized my independence and freedom hung in the balance because I knew the “attack” put me at risk for losing my driver’s license.  State motor vehicle laws mandate medical personnel report seizures, blackouts, comas and etc. to the department of licensing.  A cloud of unreality settled over the scene.


The physician who’d dispensed the numbing news checked me into the hospital although I’ve no recollection of moving.  Coming to in the cardiac unit I had temporary amnesia and was disoriented by the unfamiliar surroundings, but elated to be free of the debilitating nausea.  Seated to my left a familiar face caught my eye:  Emery.  Suddenly the events of the previous evening flooded my memory.  My relieved buddy relayed her dogged pursuit of me all morning and how she’d finally tracked me down here.  I felt guilty for subjecting her to such a nerve-wracking ordeal, albeit unintentionally.


Shortly thereafter another visitor, a baffled gastroenterologist, stood scratching her head in bewilderment at the foot of the bed.  She’d performed hundreds of these exams in the course of her twelve-year career and I held the dubious honor of being her first patient to react negatively to the prep.  We were both stumped.  The middle-aged practitioner vowed not to take any chances the next time.  At a future date she’d play it safe by putting me in the hospital the day before so every step could be monitored in a controlled environment.


My third visitor, a neurologist, offered no more insight than I’d need to see him the following week.  In the meantime, he’d review and evaluate the diagnostic data and render a verdict on the case at our follow-up appointment (his five-minute bedside consultation cost me five hundred forty-three dollars).  The tight-lipped nervous-system expert didn’t mention the license issue, though I surmised the ultimate fate of my driving privileges rested in his hands.


After my company departed I underwent a CAT scan, an MRI, a brain scan and an EKG to determine the source, if any, of the seizure.  The CAT scan, brain scan and EKG detected no underlying diseases or anomalies, shoring up my confidence in the aberration theory.  I’d get the MRI results at the appointment with the neurologist.


The hospital discharged me Saturday about 2:00 p.m. lacking an official diagnosis.  Aftercare instructions dictated staying home the following week and refraining from driving, the latter a moot point for the time being.  Drained of energy upon returning home, I slept virtually around the clock unperturbed about the driving ban.


The following Thursday I received the positive news I’d wished for:  the MRI disclosed no irregularities.  The seizure had been the result of dehydration due to excessive vomiting.  I could have kissed the doctor with glee when he gave me the go-ahead to resume driving.


Basically, dehydration occurs when the body loses more fluid than it takes in.  Without getting too technical suffice it to say water, salt and minerals (electrolytes) are lost in a host of ways including urination, perspiration, fevers, diarrhea, vomiting, or simply not drinking enough fluids.  Electrolytes are crucial substances responsible for conducting electricity across cells enabling organs to function properly (metabolism).


The type of dehydration I experienced, called hypotonic, (meaning fluid loss exceeded salt loss) was at a potentially life-threatening stage as evidenced by the seizure.  Any loss of fluids sufficient to cause an imbalance or abnormality of electrolytes is dangerous, however, and requires immediate medical attention.


In retrospect, I’ve speculated about how much I may have unwittingly contributed to the catastrophe (as I refer to that harrowing night) if, indeed, I short-changed myself on water before starting the prep.  What seems to add credence to that notion is the fact that a year after the foregoing transpired I survived a colonoscopy unscathed in a hospital setting where, among other safeguards, there was a stint in my arm continuously dripping fluids.

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