Colonoscopy

Colonoscopies – a procedure that does not discriminate. Every man or woman – at some point in their life will most likely schedule, prep, and proceed with this diagnostic test.

Tips to decrease your risk of colorectal cancer

If you have been watching the news lately you have most likely seen the increase in colorectal cancers, especially among a younger population (20’s-3o’s). While researchers cannot specifically identify why this is happening, there are many contributing factors that increase the risk of colon cancer. To spin this into a positive affirmation, if you want to decrease your risk of colorectal cancer:

• Maintain a healthy weight
• Do not smoke (this includes vaping)
• Increase your fiber intake
• Be physically active
• Avoid alcohol
• Limit processed and red meat

Studies have shown that 1/2 of cancer prevention can occur via lifestyle modifications like the ones above.

Scheduling

The Centers for Disease Control (CDC) and American Cancer Society (ACS) recommend that average risk patients get their first, screening colonoscopy by age 45. That is the minimum.

If you have a family risk – i.e. known family member (1st or 2nd degree) with colorectal cancer or a family member with a history of polyps please discuss this history with your primary care provider, as you may need to be screened sooner.

I always wear a dress before surgery – comfortable and an instant pick-me-up

For example, if your cousin had colon cancer that would be a 2nd degree relative, which increases your risk and would allow you (via insurance) to have a colonoscopy before age 45. Further risks, as designed by the ACS, can be found here.

Understanding normals

I am a firm believer that you should know your body’s “normals” so that you can identify if, or when, something becomes abnormal.

I am about to get real here…

You should know your daily voiding and bowel habits. Look in the toilet every time you goto the bathroom. Yes, I said it. Know your normals!

Your body is a beautiful, intricate, complex system – but, you do not need a book to crack the code. You just need to learn the normals for you. The basics of interpretation.

For example, when you void (that is a fancy medical term for urinate), look at the color of your urine. Is it dark and concentrated? If so, drink a glass of filtered water, ASAP!

Is it clear or light yellow – then awesome, you are well hydrated and on track.

A quick chart to reference your urine colors can be found here.

Normal Bowel Habits

Ok, let’s now take this experiment to the other excrement from your body – stool. Again, I encourage you to observe not only your bowel habits (i.e. how frequently you may goto the bathroom), but your actual stool consistency, color, etc. It is an amazing diagnostic tool giving you insight into your health, your diet, etc. My favorite tool to learn how to understand your bowel habits is to review this Stool Analyzer.

Warning signs of colorectal cancer

I would be remiss to not mention the warning sigs of colon cancer. If you have any of the following (and granted this is not an exhaustive list, nor meant to supersede your provider’s recommendations), then please follow up with your primary care:

• A change in bowel habits, such as more frequent diarrhea or constipation.
• Rectal bleeding or blood in the stool.
• Ongoing discomfort in the belly area.
• A feeling that the bowel doesn’t empty all the way during a bowel movement.
• Weakness or tiredness.
• Losing weight without trying.

Booking a colonoscopy

So, now we are down to the actual procedure. I usually provide anesthesia for the Endoscopy suite a few days every month. At my institution most colonoscopies are done with sedation provided by an anesthesia professional.

Obviously, I am biased in this area, but I highly recommend going to a center that uses anesthesia coverage. It provides not only a deeper sedation level (i.e. keeps you still while the proceduralist performs the colonoscopy), but it also adds an additional layer of safety.

Also, I personally would not have a procedure done in a facility that did not have a code cart, and the ability for anesthesia to function to their full scope of practice. Specific questions I would ask before having a colonoscopy:

• Who will be providing my sedation?
• Are those providers able to function to their full scope of practice? (i.e. do they have necessary equipment to resuscitate me, if needed).

Colonoscopy prep

Colonoscopy prep can vary from institution to institution. At my center they asked me to refrain from all fiber for 2 days, then have a full day of fasting (liquids only + the actual prep), and then my procedure. Not eating fibrous foods was way more difficult for me vs. not eating for a full day.

Fasting is a part of my lifestyle. Eschewing food for 24h does not, and did not, phase me. If this concept seems daunting, I highly encourage you to read more about fasting. If your blood glucose is well controlled you should be able to fast – and get energy from fasting – with relative ease. It takes time, but you can get there!

I digress … the hardest part of this prep was the two days of no-fiber foods! Think white – white rice, white bread, etc. As someone who lives off of fruits, nuts, seeds, vegetables – this task was challenging. I had to consciously seek out foods that I thought would be appropriate.

Be sure to press your tofu

Sautéed tofu and jasmine rice

Some examples of food that I ate:

• Breakfast:
  • Plain bagel with eggs for breakfast
  • Impossible breakfast sandwich from Starbucks (minus the cheese)
  • Waffles
• Lunch/Dinner:
  • Pasta with cooked mushrooms (well cooked mushrooms)
  • Vanilla smoothie with just protein powder, almond milk and scoop of plain peanut butter (no veggies or fruit)
  • Sautéed tofu, jasmine rice, and a bite of avocado (easy to digest).
  • Grass-fed burger, no bun with sweet potato fries

I felt large blood sugar spikes and shifts eating the above diet. It reminded me of the importance of a balanced diet and stable blood sugars. Also, it showed me how the Standard American Diet feels if you do regularly eat FIBER.

My saving grace during this period were my LMNT packs. I love them and cannot go a day without them!

Post- Colonoscopy

Resting with my daughter

It is important to also be mindful of what you eat now that your gut has been reset. Surprisingly, I found that post-procedure I did not have much of an appetite. We went to our favorite Greek restaurant, ordered a variety of dishes (to support my microbiome), and I enjoyed a small bite of each: hummus, tabouli, grilled chicken, green salad with quality olive oil. That evening, after a long nap, I found I did not have a large appetite so I skipped dinner and got back on track with my normal diet the following day.

I also recommend to my patients to listen to your body after a procedure, or surgery. If you are hungry – eat  (non-greasy food), and if you are not, then that is a cue to rest.

Your body is brilliant and will tell you exactly what it wants, and needs to heal, if you just take the time to listen.