OVERCOMING MENTAL CONSTIPATION THROUGH INTESTINAL FORTITUDE

As a regular follower of my blog, you will notice this maybe is, if not one of my longest posts. It covers the three months following my last appointment with my primary physician making his stern unwavering plea to get this particular procedure scheduled and ultimately completed before another year begins. I began documenting my story of this ordeal before the time I turned 50 in December 2019 but those bits started out but slowly faded away. Now that I am done, I have been able to weave all the loose parts together and post some of the highlights and my fail starts and many of the stressful milestone steps in between. However, much of it takes place from the first week of September 2021 to completing it the last week of December 2021. Let it be known and be forewarned, the section gets a bit personal, perhaps a little unpleasant and surely embarrassing. I feel my story has to be shared. as it may help another get through the experience a little easier, knowing someone before them dealt with it with some dignity, a dose of definitive reality check and an ounce of humor for good measure. I digress…let me get back to my story.
 
Just about two years ago, on my first medical check-up of the new year 2020, at the end of the routine checks my physician a shows me a picture of an Atari 2600, one of the first home video gaming units. He asked me, with an all-seriousness tone, “Do you know what that is?” as he pointed at the gaming unit in the picture. Both my birthday and Christmas were still recent and fresh in my mind as I answered, “It was what every 12 year-old boy wanted for his birthday or Christmas.” He quickly without skipping a heartbeat (pun intended) responded, “WaaaWawWaaaaa.” I think that’s how you spell that annoying sound of game shows of the same era when a contestant lost the round being played. He then proceeded to tell me, why I am wrong. The correct answer was I reached the certain age and the dreaded colonoscopy procedure is now due and on his radar. My doctor proceeded gave me the family history lecture and as I was walking out he handed me an informational handout about the importance of having a preventative colonoscopy and a referral to a gastroenterologist.

When Katie Couric’s husband Jay Monahan lost his life to colon cancer in 1998, it resulted in a surge in the number of colonoscopies, ultimately resulting in what professionals called the Couric Effect. NBC televised live her own prep and own colonoscopy to emphasize the case for the much dreaded but ever more important procedure. Often by the time colon cancer shows signs its often too late to treat. Couric has been and continues to remain a strong advocate for preventative colonoscopies. Since her leading the charge for change, many other celebrities began publicizing their own appointments; to name a few Tom Hanks, Steve Martin, Martin Short, Will Smith and Jimmy Kimmel to name a few. Even a short-lived television series, “Men of a Certain Age” which the was a storyline is based on three childhood best friends and their lives as middle age men dedicated an episode to it. On the episode, "Let the Sunshine In" one of the friends was scheduled to have his colonoscopy and the other two followed to do the same as a sign of brotherhood and lifetime friendship. They ended up making a whole bromantic get-away in Palm Springs. W-A-I-T, or as Bugs Bunny would say, “wait a cotton pickin’ minute” why did I just rattle off the name of only men? Although its more prevalent amongst men, especially combined with certain other factors, women should be cognizant of this, as they too are at risk, albeit just slightly less.

Fast forward many years later when my Dad was diagnosed and treated for colon cancer.  My Dad managed to go with the flow (pun intended) and always maintained his sense of humor through the countless preps and colonoscopies and all the other countless other medical procedures and emergency room visits he had done over the next few years. I remember sharing with him how my legs and my quads hurt from doing modified squats with my personal trainer. He laughed and explained how he mastered that skill along with the mad dash to the bathroom after taking the bowel prep. I don’t remember him ever complaining of having to go through this as many times as he did, he just did what he needed to do and found the humor in it. He always told me the drinking the jug of the prep was the worst part of the whole experience and he joked about being rewarded by getting his best sleep under the anesthesia.

My Mom began harassing me to get a baseline preventative colonoscopy soon after my Dad’s first diagnosis of colon cancer. I tried without much success dodging and avoiding the conversation. I compromised by promising to ask my then primary physician’s (before I switched to my Dad’s physician) guidance. He remained steadfast at the textbook philosophy of getting a baseline done five years before the age of my closest relative’s age when they were diagnosed with colon cancer or to have it done at 50 years of age. My Dad had his first diagnosis after the age of 50, therefore it bought me time in delaying this conversation with my Mom. Just as I thought I was saved from the conversation, out of nowhere, my Dad’s best right hook was thrown and blindsided me when he too got into the conversation. He strongly advocated me having it done as his siblings in Hungary have history of health-related issues of the gastrointestinal area. For many families this would be an extremely sensitive area to bring up let alone to talk about and then add cancer to conversation and I bet most families would only hear crickets chirping. I know am how blessed I am to have parents who have been able to have open dialogue on just about anything; without shame, fear of repercussion or concerns of getting in trouble. I always knew I could expect to hear the truth from their mouths and not a hesitatingly, sugar coated parable, but a direct, never to be misunderstood conversation.

As I aged, I also began understanding how this is just another gene in my closet of health issues my parents handed down to me and have learned to deal with. Sometime during Grade 8, I had a surgical repair of a lower gastro-intestinal fistula and fissure. The trauma of the entire experience of having anything done in the general area outside of a normal bowel movement, especially the thoughts of a dreaded colonoscopy put me in a paralyzing mental block. Even the frequency of my bowel movements stirred (again, pun intended) conversation with my parents on what is considered healthy and normal. Let’s leave it at the conclusion, we agreed to disagree and I am considered not healthy nor normal. Since then, I’ve learned to change up or avoid the conversation of having a colonoscopy not because of my own Dad’s battle with colon cancer but because of my previous history.

For what seemed like eternity, but was more like a few months after my surgery, I remember never being able to find a comfortable seated position. From the hard seats attached to my desk at school or to the seats on the school bus which I felt every bump on the road as if the bus lacked any suspension and shock absorbers. Simply, taking a seat, not here or there, but anywhere was an ordeal. I was unable to participate in gym class, karate class, go in a pool or swim in the ocean or ride my bicycle for the same perpetuity. As any teenager, I was very self-conscious, what teenager isn’t? of how I would fit in around my peers. I remained anxious as the surgical site healed and repeatedly questioned what would I do if the surgical site drained or bled and caused spotting in my pants? The memories of this happening and horror of being teased and bullied should anyone have found out my secret only fueled my fears of this being spread amongst the many middle school gossip channels.

All this history had to be confronted at my first medical check up in 2021 when I had to have the conversation with my primary physician why I hadn’t gone for the big “C” in 2020. With the Covid-19 pandemic, my physician gave me a board game's “get out of jail card” for the remaining 2020 check-ups by not pressing me why I had not gone. Starting in 2021, with each consecutive check-up, a more in-depth stern lecture of the importance of getting my colonoscopy not just scheduled but actually completed while extending his arm with an additional referral to the gastroenterologist. I may have failed to mention but I changed, my primary physician to what was my Dad’s for many years when it became increasingly difficult ordeal to for my Mom to help Dad in and out of the car, lifting the wheelchair in and out of the back of her vehicle for his many check-ups. With me changing to the same primary doctor, it allowed me to get my check-ups within the same appointment time and be able to help out my Mom. He took care of my own Dad as if it were his own parent he was treating.

At my last check-up for 2021, I had my first of several meltdowns as I explained my paralyzing mental block and fear of this routine procedure. Apparently, I convinced him with my voice shaking and getting just a tad a bit emotional. I explained, I realize there is no constant pain, no prolonged healing and no fear of spotting my pants with a colonoscopy when compared to the surgical procedure I had what seems like lifetime ago, but it was almost 40 years ago, but this has my brain frozen like nothing I ever faced. I was not choosing to be defiant, but my history prevailed a small victory when he wrote me up a minimal prescription for diazepam (valium) to help calm me down. He prescribed just enough to help me get through the anxiety of making the appointment for the consult, going to the doctor for the consultation and any pre-procedure anxiety. I guess we could agree to say it was a win-win for us both.

Considering I am personally am friends with one of the nurses at the gastrology group I was referred to, you would think this would make it easier. I thought I would be able to just pick up the phone and talk with her to make the appointment and have her schedule me with a doctor with good bedside manner, gentle and is able to be a patient communicator with my questions before and after the colonoscopy. Unluckily for me, this made making the appointment all the more difficult. It took more than a few attempts over the next few weeks to get the cojones (google it – if you don’t know what this means) and one small pill to call and make the appointment for the initial conversation. October 27 2021 was still a few weeks away, it gave me still a lot of room to get my nerves all worked up and possibly cancel or reschedule the appointment.

Before I even had a chance to cancel or reschedule, the day to go for the consult appointment arrived. I had made arrangements for my Mom to drive me as I was going to take a valium just before my appointment. After meeting the doctor, my nerves calmed down ever so slightly (perhaps because of the valium) as he was an active listener as I told him my history. He was compassionate and understood my mental block and calmly assured me he would answer any questions now, before the procedure and would be there after I awoke to report back the findings and answer any additional questions I may have. Upon completion of my appointment with the doctor, he accompanied me to my friend, the nurse and her office to schedule my procedure and complete any paperwork, process my insurance etc. She scheduled for December 22 2021 at the local hospital as opposed to an outpatient medical endoscopy medical center due to a couple of my own underlying health conditions. As we finished up our chat and wished each other Christmas blessings, she handed me a gift of the bowel prep with a handout of directions to supersede those provided by the manufacturer and I was on my way.

Due to my own procrastinating and pity party, this self-imposed belated birthday and an early Christmas gift presented itself. I hope you sensed my excitement and joy of having this done at this time. Again, the time between the two appointments allowed enough time for me to contemplate canceling the procedure, never mind just rescheduling it, but again the powers above conquered my own mind as I got distracted with pre-operative check-in and in-take, a Covid-19 test and a couple of related phone calls prior to the day of the procedure. Somewhere after the consultation with the gastroenterologist and before my procedure, I contacted my primary physician per the gastroenterologist’s orders to follow-up regarding which medications I should not take beginning one week prior to my procedure. After reviewing my medications, he informed to monitor my blood glucose levels the day before the procedure and give my bolus insulin as necessary but to not take my evening bolus or basal insulin. He wished me a smooth and not too crappy of an experience for my upcoming procedure. My Dad always enjoyed his subtle yet odd sense of humor.

The date of December 21 2021 has come, it was time to begin prepping for the procedure. I re-read the direction handout several times over to make sure I understood them. I even began to watch what I ate three days out prior to ensure there was no unnecessary obstructions or complications on the big day which could jeopardize and cause a re-do. I already planned my meals out for the day: breakfast; apple juice and hot tea, lunch; chicken broth and sherbet and dinner; was a combination of all the leftovers remaining. The fasting portion was not as difficult as I thought it would be as I spent much of the day binge watching shows on Netflix. My blood glucose levels were higher than where I would normally like them to be, but I was in a quandary where I didn’t want my blood glucose levels to drop too low before going in for my procedure nor did I want the numbers to escalate higher than they were already. I just eased up on the items having added sugars and I was able to maintain blood glucose levels.

My dessert after dinner was the bowel prep which consisted of two small bottles which I had to drink at two specifically designated times followed with several cups of any clear liquid of my choosing over a set period of time. If I recall properly, my Dad had this huge jug which he had to pour in a powder mix in and fill with water and take additional laxatives to produce the same results. The latter seemed to be more than my two bottles which I chugged down rather than carry around intimidating the massive jug. I probably drank the same amount of clear liquids but my actual prep was more concentrated. The smell of it was like rotten lemons and didn’t taste much better. I started my prepping at 6:00pm and began to get concerned when nothing happened but at 9:00pm on the half hour, The mad dashes to the bathroom began as did the squats that would make both my Dad and personal trainer proud. I .  I was well stocked in both bathrooms as there was no toilet paper shortage going on like at the onset of the Covid pandemic. This went on nonstop until about 4:00am which coupled with my nerves and visits to the bathroom, I got very little sleep and just like that, it was time to get ready and go to the hospital for the procedure.  

My Mom taught me early on, its better to be an hour early anywhere before a minute late – even for this, as she pulled up in my parking lot on December 22 2021 to take me for my 8:00am appointment. My Mom throughout this whole ordeal was my compassionate ear, listening to my concerns, hearing my worries and just being the wonderful Mother she has always been. Although she has the calm exterior, I know underneath she was anxious for me, although she didn’t share with me her flashbacks and experiences to further my own anxiety. I am sure she tried hard to suppress her emotions of the countless times my Dad went through all this and with the doctor not always returning with the favorable news we prayed to hear. Dad managed to still live his remaining days cancer free even after a late stage colon cancer diagnosis. As we pulled up to the outpatient center driveway, I broke out in a nervous sweat as I exited the car. Due to the recent variant of Covid, only the patients scheduled for a procedure within the hour were allowed entry into the hospital. I managed to stumble my words to Mom, “I love you to” and gave her a hug and kiss as I left the car.

I entered the hospital and proceeded through the magnetron and was bombarded by a hospital employee checking my name against a list of patients and their appointment times. She drilled me if I had any of the Covid symptoms while pointing to a life-size poster of symptoms, with my negative response, I was escorted to the check-in desk. The check-in desk verified my identification and asked me to take a seat until a registrar calls my name. I was unsure if I was going to need to race to the restroom one last time so I took a seat closest to the restrooms and waited impatiently until a registrar called my name. The registrar called my name almost immediately, after confirming my identification and insurance information she placed an identification bracelet on my wrist and asked me a series of medical questions and then released me back to the waiting area for to be called by nurse who would escort me up to the procedure waiting area.

The sit and wait game slightly tested my patience, finally my name was called and after a couple more in-take questions, I was asked to change into their high fashion medical gown, you know the one where you flash your whole rear side to the world and then asked to make myself comfortable on the procedure gurney. While on the gurney, the nurse asked a few more questions until the anesthesiologist came by introduced themselves and asked even more questions and proceeded to check the inside of my mouth. On the other side of me a nurse was struggling to find a strong vein and eventually had to use my knuckle. Had she only asked, I would have directed her immediately to the area as I knew she wouldn’t get any veins in my upper arm. Once I was prepped and ready to be served, the doctor came by greeted me and tried to offer relaxing words and said he will be ready for me into the procedure room shortly.

As I lay on the gurney, my hearing and sense of smell became highly sensitized to my environment and reminded me of the many times I was here with my Dad, at this same hospital. The distinct sounds of beeps and bells of equipment, emergency codes over the intercom and medical staff’s indistinct chatter of patients they are treating to the strong smells of disinfectant and odor neutralizers. Next thing, I know, I am being told by a transporter that I am being taken for my procedure. As we navigated out of my curtained bay through the narrow pathway, congested with my medical entourage following to the procedure room. The room was quite small and seemed quite cramped to have my doctor, a few nurses, anesthesiologist and staff and me in the room. I was greeted by the doctor and don’t quite remember who asked me to confirm my name and what procedure I am having done. After this formality was done, the anesthesiologist placed an oxygen mask on me and told me before I know it, I will be finished with my procedure and will wake up and go home to being able to enjoy a hearty breakfast or lunch. All I remember telling her all I want is some uninterrupted sleep. As she explained what was about to happen, I felt my eye lids get rather heavy despite trying to keep them open to hear what she was telling me and trying to understand what all the medical staff were talking about.

What seemed only moments later, (actually just about an hour) I was back in recovery bay, sitting up and drinking a cup of ice chilled water and being told the procedure was completed and was told by one of the nurses I did well. Oddly, all I remembered for the first few moments in recovery was everyone wanted to know my full name and my birthdate and then checked it against my identification bracelet, as if they were expecting it to change from the last person who asked. A different one of the nurses I recognized, explained I’ll remain in this area so they can monitor my vitals, which where being checked automatically at intermittent set times. After several readings, another nurse came in and removed the IV as well as the heart monitor and provided me some privacy to change and called my Mom to come pick me up.  Once I opened the curtains to signify, I was dressed, another nurse came by reviewed my discharge notes.  The doctor came by explained how the procedure went without complication and two small polyps were found and removed.  Based on his experience, he can say with almost 100% certainity these types of polyps are benign, but will be sent to pathology to confirm his diagnosis.  He also noted seeing significant scar tissue from my procedure many years ago. He told me unless I have other questions or needs, I won’t need a post-procedure office visit. Unless my primary physician tells me otherwise, I’ll have a recall date with him in five years, to hopefully once again to overcome my mental constipation and build up some intestinal fortitude to go through this ordeal again.

Once the transporter arrived with the wheelchair, she asked me to take a seat and began to wheel me out of the area, I was able to say farewell to all the nurses who were with me from the moment I arrived. Within a few moments of arriving downstairs, my Mom pulled up to the very same outpatient center driveway where she dropped off earlier the same morning. I thanked my transport, and cautiously stepped out of the wheelchair and got into my Mom’s car for the whole not even five minute ride to her house, where I would remain for most of the day to rest and recover, then she would drop me back of at my home, as we just completed the full circle of another experience we shared together.