NaP time
Monday, November 17 2008
Colonoscopies are the standard for Crohn’s diagnosis, so of course I’ve had a few. In fact, if you go by the ACS guidelines for colon cancer screening, I’m nearly 200 years old.
When I was first diagnosed, my dad clipped an article about emerging colon-imaging technologies. The article was about tiny robots crawling around in your gut. Like most articles about “an exciting breakthrough”, this one obviously hasn’t happened yet. The article was really only memorable for one patient’s complaint about current colonoscopy technology: “When Amtrak says take the Metroliner, they don’t mean ‘by suppository’.”
It’s funny, but it’s not exactly true. The worst part of colonscopy is not the camera, but – by far – the bowel prep. Words cannot convey how much I detest bowel prep. The easiest way I have found to do it is to chug undiluted phosphosoda (NaP), and then immediately drink several glasses of ice-cold water. Even then, the phosphosoda tastes like demon seed must – burning my tongue, boiling my guts. I could vomit just thinking about it.
So I pay attention to anything that gives me hope for a future without bowel prep – like this post from Gooznews, on the AHRQ report on the cost-effectivness of CT colonography (CTC) compared to colonoscopy, in which Goozner mentions:
The report was also skeptical about claims that people would be more willing to undergo scans because they don’t entail the pre-colonoscopy bowel cleansing ritual (as someone who has already gotten two colonoscopies, I can assure you that it isn’t fun).
Though I knew the report was about colon cancer, I couldn’t help but be curious. So I tried to click through; Goozner’s link doesn’t work. I found the report here; it ultimately concludes that CTC is too expensive and not sensitive enough compared to the Metroliner. I understand their rationale, but the truth is that I would still be willing to pay a lot to avoid bowel prep. So maybe it could work?
But while looking for that report, I found this earlier one from the AHRQ. And what’s this? On the bottom of page 40 of the AHRQ report:
Common bowel preparation agents for colonoscopy or CTC include polyethylene glycol (PEG) solution, oral sodium phosphate (NaP) solution, sodium picosulphate (SPS), with or without additional oral laxatives.
Argh! So CTC does involve bowel prep – at least sometimes – in which case there’s a whole different set of factors to consider. Let me preface this by saying that I’m not a drug abuser. I’ve taken my share of pain-killers – but when the pain stopped, so did the pills. Nonetheless, the only thing that makes bowel prep worth it – doable – is the anaesthesia I get for the colonscopy. The only way I can get that awful phosphosoda into me is by remembering how much better I’ll feel when the Fentanyl or whatever hits my vein. I only have the foggiest memory of that sensation, since they also give me Versed. Still, I remember enough to know I feel better. Once I’m under, I don’t really care what you do with me, or even whether I wake up – but if I’m going through bowel prep, I’ve got to get doped. It’s as simple as that, and since CTC doesn’t include anaesthesia, I’ll keep taking the train.
