Committing to a Covid colonoscopy.

Blog Post Number  :  Committing to a Covid colonoscopy.
Living in the time of a pandemic has its challenges.  But I don’t know – maybe it is the Type A in me, but I apparently did not think it was challenging enough.  I decided to enhance the degree of difficulty by going through with a colonoscopy scheduled for the middle of June.  

This procedure was scheduled four to five months ago.  Then the pandemic happened, and the state shutdown initially included the cessation of outpatient procedures.  When the state of Virginia allowed for the resumption of outpatient medical procedures, I wondered if I should go through with the colonoscopy.
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The coverage of my previous colonoscopy was going to expire at the end of January 2021.  So even if I cancelled the June procedure, I would still have six months left.  But it appears that while the virus is slowing down in some places, it is resurging in other places.  There seems to be a lot that we still do not know about the virus, including whether there will be a resurgence in the fall, and whether we will have a vaccination in place by January.  Given that right now the statistics seem to be improving in Virginia and outpatient procedures are allowed, it seemed worth considering.  But I thought perhaps I should check in with the heart doctors since I have this atrial flutter that has also emerged since I scheduled the procedure.

Both my heart failure doctor and my cardiologist supported moving forward with the colonoscopy.  In fact, the heart failure doctor said he would issue a letter of cardiac clearance.  My gastroenterologist indicated that she would like a cardiac clearance letter, and that she would put it in the file for the anesthesiologist to see.  The letter was sent, and I confirmed that I was going forward with the procedure, even though since that time I have wondered if I needed to have my head examined.     

I have had a colonoscopy two times in my life, and a similar procedure known as a sigmoidoscopy once in my life.  It isn’t a fun event because of the preparation you need to do ahead of time to make sure that the colon area is clean.  But the first two procedures just required you to be on a liquid diet (with no red liquid in it) the day before  the procedure; that you drink some really awful concoction the night before; and that you spend a lot of time in the bathroom.  Then you had the procedure the next day and it was all over.

Now you start out 7 days before the procedure with a special diet.  The instructions are:  Avoid eating raw vegetables, corn, popcorn, nuts and seeds (including seeds in fruits and vegetables).  This really must be challenging for vegetarians and vegans. The instructions should probably just say “don’t eat for 7 days” because what choices are left for them?   

There are also a number of drugs that you have to discontinue taking 5 to 7 days ahead of the procedure such as weight loss drugs, non-steroidal anti-inflammatory drugs and blood thinners.  Also, there are special instructions for diabetics to consult with their doctors for advice on taking insulin and blood sugar medications.

When Covid made its way into Arlington, Virginia I tried to limit my trips to the grocery store to once a week.  Unfortunately, the week before my procedure I looked carefully at some of my diet staples after I returned from my weekly shopping trip and realized that nuts and seeds appeared to be ingredients in more things than I knew.  I had to make about 3 trips to the grocery store to make sure I had acceptable diet items.  I also had to stock up on juice and Gatorade because these were recommended for the liquid diet.  I do not drink any of these things so this was another reason for the extra grocery trips.

Both the hospital and the doctor’s office sent me several e-mails in advance to know that I would need to be at the hospital earlier than initially planned.  This was because I would be required to be swabbed for a Rapid Covid test prior to the procedure.  Oh swell – what if we found out I had Covid?  Did this mean that all the grody prep work would be for naught?  But I understand this is the way of the world during a pandemic, so I just crossed my fingers and hoped for the best.  On the upside, if they are testing all their patients, then they are screening out the people with the germs from the hospital environment , so that benefits the other patients.  I decided If I happen to find out I have it, well then I would know to self-quarantine and  I would let the heart docs know so that they could keep an eye on me and how my heart is impacted by the disease.

I did do  a bit of a doubletake when I read the instructions to the prep kit two days before my fast.  The patient insert said: 

• Cardiac Arrhythmias.  There have been rare reports of serious arrhythmias associate with the use of ionic osmotic laxative products for bowl preparation.  Use caution when prescribing Suprep for patients at increased risk of arrhythmias (e.g., patients with a history of prolonged QT, uncontrolled arrhythmias, recent myocardial infarction, unstable angina, congestive heart failure, or cardiomyopathy).  Pre-dose and post colonoscopy ECGs should be considered in patients at increased risk of serious cardiac arrhythmias.

 
It seemed to me that the writers of the insert were not saying that heart patients shouldn’t’ take it, because they used terms like "rare reports" and "use caution".  But since I do not have a medical degree, I did what I do best. I e-mailed one of my heart doctors who I am grateful reads my e-mails on a Sunday.  I asked him if it were safe to use this prep kit, or did I have to ask for a different product?  He let me know that the prep kit was fine for me.  Of course, the people who write the patient inserts have to include all the risks, even remote ones.  But I always reach out to the people who know because while I thought it was a very remote risk, always good to ask and not just assume it’s okay.   
 
The day before the procedure, I had a pre-screening interview with a nurse, who went over my medical history, my medications and other vital information to make it easier for the doctor and anesthesiologist to perform the colonoscopy.  She gave me instructions on which drugs I should take in the morning before the procedure.  There are some drugs that would not be wise for me to take like the diuretic I am on (not Lasix but Aldactone) and one of the ingredients in my Entresto.  I was also told that I could shower and wash my hair but not to wear makeup or body lotions or deodorant.  The deodorant instruction struck me as odd, but apparently it can interfere with the monitor that will be checking my cardiac signs.

The nurse was very familiar with my heart device and my heart ailments.  Her husband also was diagnosed with heart failure out of the blue.  The doctors initially thought he had pneumonia and then found out Holy Smokes – it’s heart failure!  As a result, the questions she asked about my health so that she could compile a good record for the colonoscopy team were especially relevant.  She also thought it was really neat that I am in a study for a new heart failure drug!  Like everyone I meet in the medical field, she thanked me for participating in something that can make a difference for so many patients.  I think she could really relate to the importance of this study in light of her husband’s condition.

I spent the rest of the day fasting and then taking the prep solution.   For those of you who have done the colonoscopy, you know that the prep is the worst part.   And it lived up to it’s reputation this time around.  The best thing I can say is that it did its job and I was in good shape to have the procedure done even though I got almost no sleep.

My wonderful friend got me to the hospital a few minutes before 7 and I bopped (well straggled) to the GI unit.  After I was checked in, they took me back to do the rapid Covid test.  Let me tell you what a rapid Covid test is like.  The nurse asked me which nostril do you breathe better from? and I said the right.  I soon learned the error of my answer.  Even though I think I breathe better from the right, there was something blocking her from getting the swab where it needed to be.  It was as uncomfortable as heck to find that out.  Then, she put it in the left nostril with a better result - well better for her anyway.  Once she got it all the way up to what felt like my brain, she swabbed it around for about 10 seconds.  After removing the swab, she instructed me go ahead and change into a hospital gown and wait while they got the results.  It took probably about 30 - 45 minutes till another nurse came in and tell me I was negative for Covid .  Yay - I guess wearing a mask and social distancing and being careful is a good thing.
 
Another set of nurses came in to check my vital signs and to start an IV.  The nurse on the IV apologized for sticking me.  Actually, I told her I didn’t feel a thing and am used to needle sticks because of all the blood work I have at my heart appointments.  The other nurse said that now the patients have to have rapid Covid tests, they don’t complain about IVs at all.  I guess it’s all relative.
 
The last time I had a colonoscopy, I was in a "twilight sleep" . But this time the nurse anesthetist said he was going to try to slowly put me all the way to sleep.  As you can imagine, my heart, my low blood pressure and my cardiac device causes some challenges.  This is why he used the word “slowly” to make sure he didn’t cause any heart disruptions.  And I learned something new.  They had to get a magnet for the procedure room.  There must be a black market for magnets because they were disappearing from all the rooms and a nurse had to track one down.  I had always heard that I shouldn't go through a magnetometer because it could cause havoc with my defibrillator.  But apparently they use the magnet to disable the defibrillator while they are doing the procedure.  You see if your heart rhythms start to go a bit off because you are under some type of anesthesia, it might cause the defibrillator to fire.  Not a good thing.
 
The gastroenterologist came in, and we greeted each other.  Then the nurse anesthetist said   he was going to give me something to make me go to sleep.  The next thing I remember is coming to as they wheeled me back into my room and it took me a while to remember where I was.  But the good news is that there were no polyps this time.  But she does want me to do the next colonoscopy in five years.  I suspect this is because I have some other conditions that they probably want to monitor.  That is fine.  And as always, they gave me pictures of my colon and it was indeed extremely clean.  The pictures always remind me of an interior of a cave.  I would say that the prep was worth it to have a clean colon.  But I would be lying.  The most that I can say is that the prep was a necessary evil to get me the result I needed. 
 
I was in the recovery room for about 30 minutes while they gave me a snack and went over the discharge precautions.  I was not allowed to drive and operate dangerous equipment like the stove.  For anyone who knows me, my cooking skills are limited, so the stove is often a dangerous piece of equipment for me.  The nurse had already called my friend to come and pick me up.  The nurse escorted me to the pickup lane of the hospital and my friend was eagerly awaiting.  I suspect that she couldn’t tell because of the mask on my face, but I had a huge smile to see her.  And even though I still felt a little worse for wear from the prep, I believe there was a spring in my step.
 
I returned home and spent the day trying to rehydrate and eat!  Even though I was apprehensive about this procedure, I was happy that I committed to go through with it.  Plus, I thanked God for having good doctors, good health in at least some aspects of my life, and the blessing of friends who are always there for me.